Objective To discuss the effects of remifentanfl for delthemte hypotension in intracranial aneurysm clamp operation,evaluating the feasibility and safety.Methods Twenty intracranial aneurysm patients undergoing occlusion surgery were prospectively randomized in to two groups:Group Ⅰ and Group Ⅱ.Group Ⅰ adopted remifentanil for deliberate hypotension and Group Ⅱ adopted sodium nitroprusside.The data were analyzed with SPSS 11.5 for Windows.Results Deliberate hypotension was achieved at the target mean arterial pressure(MAP)for remifentanil and nitroprusside respectively.During deliberate hypotension,HR in Group Ⅰ were lower than that in Group Ⅱ(P<0.01).RPP in Group Ⅰwere lower than that in Group Ⅱ(P<0.01).Blood loss in Group Ⅰ were lower than that in Group Ⅱ(P<0.05).Conclusion For general anesthesia in intracranial aneurysm clamp operation,using remifentanil for deliberate hypotemion is a good choice.

Objective Due to the anatomy of the scapula itself is exceptional,fracture is often associated with other damage.So it is particularly important to evaluate the patients,physical examination,as well as the choice of surgical approach during perioperative period.By studing of the relevant literatures,this article reviewed the anatomy and classification of the shoulder blades,patient assessment,surgical indications and approaches,as well as the functional exercise.

Object To define the molecular characters of differentiating Bupleurum chinense DC., B. scorzonerifolium Willd. from their allied species B. marginatum Wall. ex DC., B. smithii Wolff var. parvifolium Shan et Y.Li. and B. longiradiatum Turoz. Methods General DNA was isolated from fresh leaves of Bupleurum L. species by CTAB. The random amplified polymorphic DNA (RAPD) was used to identify them. Results Five Bupleurum L. species can be identified by primer OPA-1(5'-CAGGCCCTTC-3'), OPD-8 (5'-GTGTGCCCCA-3'), OPD-11 (5'-AGCGCCATTG-3'). Conclusion The method of RAPD can be used to identify the Bupleurum L. species and its allied species.

Objective To observe the effect of RNA interference binding immunoglobulin protein (BiP) on expression of bone markers and keytranscription factors in osteoblast exposed to fluoride.Methods MC3T3-E1 cells were used as osteoblast model in vitro.The cell viability was test with cell counting Kit-8 after cells were administrated with varying concentrations of fluoride [0.0 (control),0.1,1.0,2.0,4.0,8.0,16.0,20.0,32.0 and 64.0 mg/L] for different duration.Cells transfected with small interfering RNA (siRNA) BiP were exposed to fluoride (2.0,8.0 and 20.0 mg/L) for 2 days.Real-time PCR and Western blotting technique were used to determine the gene and protein levels of BiP.Meantime,the mRNA expression of bone markers and key transcription factors was investigated by real-time PCR.Results The difference of all viability in fluoride-dose groups was statistically significant exposed for 1,3,7 and 14 days (F =46.7,118.6,214.6,325.6,all P ＜ 0.05).Expression of BiP significantly increased in cells exposed to 20.0 mg/L compared to that of control (11.22 ± 3.25 vs.7.94 ± 1.31,P ＜ 0.05).The expression of alkaline phosphatase (ALP) elevated in cells exposed to 2.0 mg/L of fluoride (12.81 ± 3.62 vs.6.86 ± 2.13,P ＜ 0.01);conversely,it significantly reduced in cells exposed to 20.0 mg/L of fluoride (0.89 ± 0.17 vs.6.87 ± 2.14,P ＜ 0.01).Cells transfected with siRNA BiP significantly decreased the ALP expression in cells exposed to fluoride compared to that of cells only exposed to the same concentration of fluorine (12.81 ± 3.62 vs.7.43 ± 2.06;5.92 ± 2.38 vs.3.96 ± 0.21,all P ＜ 0.05).Cells transfected with siRNA BiP and administrated with 2.0 mg/L significantly reduced the osteocalcin expression (4.29 ± 0.99 vs.1.29 ± 0.86,P ＜ 0.01).Similarly,expression of runt-related transcription factor 2 (Runx2) significantly increased in cells exposed to 2.0 mg/L.However,expression of Runx2 significantly decreased in cells transfected with siRNA BiP and administrated with fluoride.Cells transfected with siRNA BiP significantly decreased the Runx2 expression in cells exposed to 2.0 mg/L and 20.0 mg/L compared to that of cells only exposed to the same concentration of fluorine (1.13 ± 0.22 vs.6.61 ± 0.48;0.02 ± 0.02 vs.1.50 ± 0.38,all P ＜ 0.01).As the downstream of Runx2,the expression of osterix in cells treated with different concentrations of fluoride was similar to that of Runx2.Conclusion BiP is not directly involved in the process of osteoblast differentiation induced by fluoride;instead,it affects the expression of bone markers and key transcription factors in osteoblast exposed to fluoride.

Objective To explore the neutrophil to lymphocyte ratio (NLR) and its relationship with the effect of chemotherapy and prognosis in patients with diffuse large B-cell lymphoma (DLBCL).Methods The clinicopathological characteristics and outcome of 51 patients with DLBCL diagnosed by pathological biopsy and immunohistochemistry who received CHOP or R-CHOP regimen were collected and reviewed.According to the median of NLR,the patients were divided into low NLR group (NLR≤2.32) and high NLR group (NLR＞2.32).The prognostic influence of the NLR on overall survival (OS) was studied by Kaplan-Meier method and Log-rank test.To evaluate the independent prognostic relevance of NLR,univariate and multivariate Cox regression models were applied.Results The complete response (CR) rates of the low and high NLR groups were 71.4 ％ (20/28) and 39.1％ (9/23),respectively (P =0.02).The OS in the low NLR group was significantly better than that in the high NLR group (1,2 and 3-year OSs were 96.4 ％,90.4 ％ and 72.3 ％ vs 63.9 ％,52.7 ％ and 42.2 ％,respectively,P =0.009).Univariate and multivariate Cox regression models analysis showed that NLR ＞ 2.32 was an independent prognostic factor (P =0.016).Conclusion An elevated NLR before treatment indicates the poor effect of chemotherapy and prognosis of patients.NLR is an independent prognostic factor for DLBCL.

Pancreatic cancer is a rapidly progressive and highly malignancy of the digestive system. In recent years, the diagnosis and treatment of pancreatic cancer has been in a slow stage of development, and the 5-year survival rate of patients remains very low. The main objective of translational medicine is to remove the barriers between basic medical research and clinical medical applications, to achieve practical integration between laboratory and clinic, and to accelerate the translation of the results obtained from basic research into clinical diagnosis, evaluation and treatment of diseases, thus promoting the development of life sciences. With the rapid development of the concept and technology of translational medicine, its application in the early diagnosis of pancreatic cancer can bring new hope for effectively improving the overall prognosis of patients. The authors comprehensively analyzed the latest research progress of translational medicine in the early diagnosis of pancreatic cancer in order to improve the early diagnosis and long-term survival of pancreatic cancer patient.

Sonic hedgehog (Shh) signaling has recently been shown to be involved in the pathological angiogenesis in response to tissue hypoxia and ischemic injury. Hypoxia/ischemia is considered to play an important role in the development of choroidal neovascularization (CNV). This study was aimed to examine the effect of blockade of the Shh signaling pathway on CNV and the underlying mechanism. A total of 64 male Brown-Norway (BN) rats were used in this study. One eye of each rat underwent laser photocoagulation. The other eye served as normal control. After the laser treatment, the 64 rats were divided into four groups (n=16 in each group): Blank control group, in which no intravitreal administration was given; cyclopamine group, recombinant Shh N-terminals protein (rShh) group and phosphate-buffered saline (PBS) group, in which cyclopamine (a Shh inhibitor), rShh (a Shh activator) and PBS were intravitreally injected into the laser-treated eyes respectively every other day for a total of four intravitreal injections immediately after the laser treatment. Fourteen days after the intravitreal administration, the changes of CNV-related variables, including positive CNV lesion percentage, CNV membrane area and CNV membrane thickness, were evaluated by fluorescein angiography, indocyanine green angiography and pathological examinations. The mRNA and protein expression of PTCH1, Gli1, HIF-1(α), VEGF and DLL4 in each group on 14 days of CNV model was detected by real-time quantitative PCR and western blot analysis, and the relationship between the Shh cascade and the HIF-1(α)-VEGF-DLL4 cascade in CNV was analyzed. The results showed that the CNV membrane area and the CNV membrane thickness were decreased by 62.5% and 41.9% in the cyclopamine group and increased by 85.7% and 64.3% in the rShh group in comparison to those in the blank control group (P<0.01 for each). There was no significant difference in the CNV membrane area and thickness between the blank control group and PBS group (P=0.102 and P=0.063, respectively). Real-time quantitative PCR revealed a 5.23-, 4.14-, 2.97-, 2.78- and 2.39-fold up-regulation of the mRNA expression of PTCH1, Gli1, HIF-1(α), VEGF and DLL4 genes in the laser-treated eyes compared with the normal control eyes in the control group. In the cyclopamine group, the mRNA and protein expression of Gli1, HIF-1(α), VEGF and DLL4 was significantly down-regulated (P<0.05 for each) while the expression of PTCH1 showed no significant changes at the mRNA (P=0.293) and protein level (P=0.304). The mRNA expression and protein expression (P=0.001 and P=0.021, respectively) of PTCH1, Gli1, HIF-1(α), VEGF and DLL4 was significantly increased in the rShh group when compared with the control group. The expression level of these genes was related to the severity of the CNV. It was concluded that intravitreal administration of cyclopamine can effectively inhibit the formation of laser-induced experimental CNV by down-regulating the expression of the HIF-1(α)-VEGF-DLL4 cascade in CNV. The Shh signaling pathway as an upstream signaling pathway of HIF-1(α)-VEGF-DLL4 cascade is implicated in the development of experimental CNV.

Objective To compare the operative results of removing large olfactory groove meningiomas(diameter≥3 cm)using either a unilat?eral or bilateral subfrontal approach ,and to determine whether there is an advantage in the unilateral approach. Methods Sixty?nine cases of large olfactory groove meningioma,treated in our department,by either a unilateral or bilateral subfrontal approach microsurgery were retrospec?tively reviewed. Removal grading,post?operative complications,and other clinical indices were evaluated. Results Total resection(Simpson Ⅰ or Ⅱ)was achieved in all the cases. There were lesser complications with use of the unilateral subfrontal approach. Conclusion Patients with ol?factory groove meningioma have a good prognosis when a unilateral subfrontal approach is used for surgery.

Objective To evaluate the CT and MR features of renal oncocytoma in order to improve the ability for recognition and ima-gingdiagnosis.Methods The CT and MR findings of renal oncocytoma in 12 patients proved by pathology were retrospectively analyzed.Results CT scans were performed in 12 patients,one of which was accompanied with the contralateral renal angiomyoliptoma.In all lesions, seven were in the right kidney and five in the left.The lesions were round or oval in shape with the diameter 1.5 cm-12.3 cm.On pre-contrast scan,the homogeneous density was found in 3,calcification in 2,and central scar tissue in 5.On post-contrast images,the parenchyma of tumor was obviously enhanced in the cortical phase.However,the enhancement was attenuated in the parenchymal phase.Seven patients underwent MRI at the same time,exhibiting iso-or hypointensity on T1 WI in 4 and heterogenous hyperintensity on T2 WI in 5.Dynamic contrast enhanced MRI demonstrated homogenous enhancement in 1 and heterogenous enhancement in others with delayed enhancement of the central scar.Conclusion Most renal oncocytomas show certain characteristics on CT or MRI, which are helpful for preoperative diagnosis and surgical therapy.

Objective To discuss the characteristics of clinical features,diagnosis and therapy procedure of Anti-gamma-aminobutyric acid B (anti-GABAB)receptor encephalitis.Methods Procedure of clinical diagnosis and treatment in two patients with anti-GABAB receptor encephalitis were retrospected in Neurological Department of Tianjin Huanhu Hospital and the characteristics of anti-GABAB receptor encephalitis were analyzed with literature review.Results In both patients,the clinical manifestations were epileptic seizure,which was a focal seizure at first,seconded by generalized tonic clonic seizure,with frequent attacks or epilepticus state.Significant cognitive and memory impairments and psychological and behavioral abnormalities were observed during the course of the disease.Abnormal MRI signals were found in mesial temporal lobe,with normal electroencephalography.Antibody against anti-GABABreceptor was positive in both cerebrospinal fluid and blood,and immune regulation therapy was effective.Conclusions The patients present with epileptic seizures,seconded by cognitive and memory impairment,often accompanied by MR imagingrevealed mesial temporal lobe lesion.And positive anti-GABAB receptor antibody is major characteristics of anti-GABAB receptor encephalitis.The patients often combine small cell lung cancer,and Immune regulation therapy is effective.