Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; therapy ; Treatment Outcome

Objective This study aimed to establish an anatomic basis for the microscopic surgical anatomy of the cavemous sinus via the extended transsphenoidal approach.Methods Simulated surgery via extended transsphenoidal ap-proach was performed on seven adult cadaver heads with red--colored latex injected arteries.The cavernous segment of the ICA and its branch vessels and its relationship with cranial nerve were exposed and its anatomic parameters were measured under microscope.Results The tuberculum sellae,clivus,sellar base,ICA prominence,and optic nerve prominence are the important bone landmarks to define the surgical area.The average of the extent of bone removal of extended transsphe-noidal approach is 37.6 mm(range:28.7 mm～44.0 mm).Conclusions The bone removal from sellar base to the media edge of the foramen rotundum and over the ICA prominence can effectively expose the entire unilateral cavernous sinus.The microscopic cavernous sinus surgery via the extended transsphenoidal approach is an optimal surgical approach for the le-sions that invade the cavernous sinus from sella.

Objective To investigate the clinicopathological features of thymic neuroendocrine carcinoma and its differential diagnosis. Methods Clinicopathologic analysis and immunohistochemical staining were performed in 5 cases of TNC. Results For 5 cases TNC, 3 cases occurred in men, 2 cases occurred in women. The average age was 46.8 years. They were with chest symptoms before operation. 3 cases were Ⅱ and 2 cases were Ⅲ by clinic stages. Grossly , the tumors were gray in color with areas of hemorrhage and necrosis. Histopathology of well differentiated 2 cases and poorly differentiated 3 cases. Immunohistochemically, the tumor cells were positive for CK, NSE, SyN and CgA. 3 cases were positive for PCNA, Ki67, p53. Conclusions TNC has a pleomorphic appearance of histological features with well, moderate and poorly-differentiated areas. Immunohistochemical staining is helpful in the differential diagnosis of TNC from other tumors derived from the thymus. Neither grading as neuroendocrine carcinomas nor any individual histologic parameter showed a significant association with prognosis. Initial aggressive treatment, including complete surgical excision and adjuvant radiotherapy, appears to offer the best hope for prolonged survival. Adjuvant chemotherapy also should be considered, because the incidence of distant relapse is high.

AIM: to assess the effectiveness of a combined procedure ( pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty). in the complicated cases and the risk factors for the surgical failure.METHODS: Restrospectively reviewed charts of patients who underwent penetrating keratoplasty in combination with vitreoretinal surgery between 1990 and 2005, with a follow-up of 3mo to 9a. Analysis was focused on ocular history, indications for surgery, visual acuity (VA), anatomic results, and complications.RESULTS: 18 eyes had light perception or VA of hand motions only. The best-corrected VA improved during the first 3mo, increased in 72.2% of all eyes, remained unchanged in 27.78%, and no decreased. In 3 of 18 eyes (16.67%), VA was better than finger counting and hand motions, and nine eyes(50%) showed useful vision (0.05) postoperatively. 10 eyes showed a clear corneal graft (55.56%). 2 eyes needs the second keratoplasty, Bullous corneal edema was evident in 3 eyes, band keratopathy was evident in a 3 eyes. 10 patients were observed for more than 2a;6 had a clear graft (60%). Two eyes (11.11%) had silicone oil-corneal endothelium contact and all of these grafts failed.CONCLUSION: Although the functional outcome of a combined procedure is limited by primary and secondary tissue destruction, preserving ambulatory vision is possible and thus improves the quality of life, at least in patients with single remaining eyes.

The article has studied the application and the student-centered teaching mode in clinic medicine teaching and discussed how to cultivate students' self-learning ability and life-time learning skills by means of internet teaching,problem-base learning,case-studying and question-discussion.It has also pointed out that compared with the traditional teaching mode this teaching mode has advantages in cultivating innovative,pioneering and practical medical talents.

Objective To explore the correlation between serum brain natriuretlc peptide(BNP) and cardiac function in children with pneumonia.Methods Fifty-two children with pneumonia were seleated.Among them 20 were complicated with congestive heart failure(CHF),including 9 boys and 11 girls,their ages ranging from 4 months to 4 years old;and 32 cases non-complicated with CHF,including 17 boys and 15 girls,their ages ranging from 5 months to 6 years old.Besides,there were 30 healthy children as control group,including 16 boys and 14 girls,their ages ranging from 6 months to 5 years old.For all the children,their serum BNP was measured by using ELISA met-hod,and CK-MB was measured by automatic biochemistry analyzer.In the sametime,their cardial function was measured by echocardiography.Results In the children with pneumonina complicated with CHF,the levels of serum BNP[(182.45?57.32) ng/L] and CK-MB [(48.19?16.08) IU/L] were higher than those of healthy control group[(35.12?13.84) ng/L,(11.48?4.29) IU/L Pa0.05).The levels of left ventricular ejection fraction(LVEF),left ventricle shortening fraction(FS),peak flow velocity of arteriae arota(PFVA),peak flow velocity of pulmonary artery(PFVP) in the children with pneumonia complicated with CHF were lower than those of healthy control group(Pa0.05).There was a positive correlation between the levels of serum BNP and CK-MB(r=0.28 P0.05).Conclusion The levels of serum BNP may be an important index in diagnosis of infant pneumonia complicated with CHF.

Objective To investigate the synergistic effects of 9-cis-retinoic acid(9-cis-RA) and 8-cl-cAMP on growth inhibition and apoptosis induction in H460 and H292 cell lines of non-small-cell lung cancer(NSCLC). Methods Experimental groups included 9-cis-RA groups(1,5,10 and 20 ?mol/L),8-cl-cAMP groups(5,10,20 and 50 ?mol/L),9-cis-RA(5 and 10 ?mol/L) combined with 8-cl-cAMP(10 ?mol/L) groups and blank control group.The cell growth inhibition rates were detected by trypan blue staining,and the apoptosis of H460 and H292 cells were observed by Hoechst33258 fluorescence microscope,DNA gel electrophoresis and flow cytometer(FCM). Results 9-cis-RA inhibited the growth of H460 cells in a time-and dose-dependent manner,and induced the apoptosis of H460 cells(P

Objective To explore the clinical value of imaging examinations of medullary sponge kidney with the literature reviewed.Methods The features of X-ray plain film (1 case),IVP (2 cases),B-mode US(3 cases) and CT images (9 cases) of medullary sponge kidney (MSK) in 11 cases were analysed retrospectively.Results X-ray plain film showed a cluster of round and oval high density images in renal papillae and renal medulla in one case one kidney.Collecting tubes were showed as like line,brush and sac like dilatation on IVP in 2 cases 3 kidneys.B-mode US revealed a cluster of high echo spots scattered in renal medulla in 3 cases 5 kidneys and sac like dilatation of collecting tubes in 2 cases 3 kidneys.CT images showed the stones of spongiform kidney scattered alone renal medulla in 9 cases 16 kidneys,while the stones covered by contrast media on enhanced CT images in 3 cases 5 kidneys,and enhanced stripes of high density projected from renal papillae to renal medulla.Conclusion X-ray plain film,IVP,B-made US and CT all can be used in diagnosing spongiform kidney.Plain film and IVP are yet the first selected methods and IVP is specific and direct in showing collecting tubes dilatation.B-mode US especially CT have a high showing rate of stone in spongiform kidney and can be helpful to evaluate the collecting tube dilatation.

Objective To discuss the mode of onset,clinical characteristics,treatment and prognosis of children with granulocyte sarcoma (GS),in order to provide guidance for early diagnosis and effective treatment of GS.Methods Six cases of children with GS diagnosed at the Department of Hematology,Children's Hospital Affiliated to Soochow University between June 2009 and June 2014 were analyzed,the data including the mode of onset,clinical manifestation,diagnosis,treatment and outcome.Results There were 2 cases with a painless mass onset (1 case was 2 years old,characterized by right waist mass,about 10 cm × 5 cm;the other case was 6 years old,characterized by axillary lump,about 2 cm × 3 cm),and both of them received surgical removal of the tumor,then the postoperative tumor was examined by pathologic and immunohistochemical method,and at last the primary granulocyte sarcoma was diagnosed.The third case was a 7 years old girl,she was onset characterized by scalp lump,about 2 cm × 3 cm,and was diagnosed by the pathologic and immunohistochemical method,and changes in hematological system appeared a month later and acute myeloid leukemia(AML) was confirmed by bone marrow examination.The onset ages of other 3 cases were in 10 months,1 year and 7 months,13 years and 3 months old respectively,characterized by scalp lump (about 2 cm × 3 cm),spinal canal tumor (about 1.0 cm × 1.5 cm),intracranial tumors (6.0 cm × 4.9 cm),with AML occurring at the same time,which was confirmed by surgical pathology,immunohistochemistry and bone marrow cell morphology,immune classification,chromosome,and fusion gene diagnosis.Four cases were hematopoietic malignancies by pathology,2 cases of then belonging to small round cell tumor.The immune pathology showed 5 cases of myeloperoxidase positive,CD68-positive,3 cases of CD43-positive,CD123-positive.All children CD3,CD20 levels in all children were negative.Four cases underwent surgery combined with chemotherapy,other 2 cases received surgery and then gave up treatment,1 case discontinued follow-up 3 months later,and the other case died of intracranial hemorrhage after 3 months,which induced by thrombocytopenia.The treated 4 cases were followed up 3 to 58 months,and all had disease-free survival.Conclusions Children with GS have low incidence and non-specific diagnostic criteria,its diagnosis depends on immune pathology,and the treatment is mainly in accordance with AML program for high-dose chemotherapy.The systematic chemotherapy helps to prolong overall survival;at the same time,the hematopoietic stem cell transplantation with bone marrow may help to improve the prognosis.

Objective This study was to investigate the association of certain single nucleotide polymorphisms (SNPs) of the ER with genetic susceptibility to ISS .Methods Genomic DNA was extracted from peripheral blood of children with ISS (n=355) and of normal growth and development individuals as controls from Jiangxi province (n=345) .The association between the ER gene polymorphisms with the height-related clinical traits was analysed .Results The allele T of rs6557177 is significantly lower in the ISS group than in the control group(P=0 .021 ,OR=0 .624) .The clinical indexes of two kinds of different genotypes were analyzed and compared ,there was no statistical difference(P>0 .05) .Conclusion The allele T of rs6557177 of ER gene is a protection factor of ISS .C gene and T gene grouping clinical parameters (hight ,weight ,IGF-1 ,IGFBP3 ,E2 and BMI) were analyzed and found no statistically significant difference .