Objective To investigate closure of different Fisher grade patients with subarachnoid product volume and the degree of cerebral vasospasm aneurysm clipping.Methods Patients with subarachnoid hemorrhage (SAH) were selected from January 2014 to January 2015,including 20 patients with grade Ⅰ,25 patients with grade Ⅱ,and 15 patients with grade Ⅲ.They were divided into 20 patients with aneurysmal SAH(A group),18 patients without aneurysmal SAH (B group) and C group(22 cases).The operation effect was compared.Results C group as the standard,CT preoperative diagnosis had no statistically significant difference among A,B,C group (x2 =0.12,P ＞0.05).After treatment,the cerebral spasticity scores of A,B group were significantly decreased,and the level-Ⅰ and Ⅱ patients decreased more significantly compared with stage Ⅲ patients,the difference between the two groups was statistically significant(x2 =7.05,P ＜ 0.05).In group C,the blood flow velocity at the 7th and 13rd day significantly increased (x2 =7.05,P ＜ 0.05),and velocity of blood flow in group A and B Ⅰ and Ⅱ patients was significantly higher than that of grade Ⅲ patients (t =8.75,P ＜ 0.05).Conclusion For the patients with Fisher grade Ⅰ and Ⅱ,the increase in the volume of subarachnoid hemorrhage,cerebral vasospasm,and the effect of the patients with Ⅲ were more obvious.

The position,length,size,and the site and pattern of ramification of the innominate arteries and common carotid arteries were studied in 76 specimens(♂44,♀32)of one- year-old to three-year-old Chinese infants. 1.The position relation between the innominate artery and trachea may be divided into three patterns:type Ⅰ:2 infants(2.63?1.8%),type Ⅱ:33 infants(43.42? 5.72%),type Ⅲ:41 infants(53.95?5.71%). 2.In 76 specimens the ramification region of innominate arteries of the Chinese infants were studied,among which in 57 specimens(75.0?4.96%)the site of ramifi- cation of innominate arteries is situated above the upper border of the sternoclavicular joint,and in 19 specimens(25.0?4.96%)behind the sternoclavicular joint.The region of ramification is higher in position in the infant than in the adult. 3.The average length of innominate arteries of all 76 specimens of 3 age groups: one,two,and three years old,is 20.7?0.42mm,19.2?0.56mm and 21.8?0.94mm respectively.The average circumference is 19.8?0.64mm,20.3?0.21mm and 21.0? 0.51mm respectively. 4.In 63 cases(82.9?4.32%)the innominate artery arises from the aortic arch by itself,in the other 13(17.1?4.32%)it arises from a common trunk,which is formed by the union of the innominate artery with the left common carotid artery.Among the 76 specimens,71 cases did not give off branches on its way,but in 4 specimens(5.26? 2.56%)the thyroidea ima is branched off directly from the innominate artery on its way,while in 1 specimen(1.32?1.31%)it arises from the common trunk. 5.The average site of ramification of the common carotid artery of the 76 Chinese infants is situated at the level of npper border of the intervertebral disc between the third and the fourth cervical vertebrae,but it is different on both sides:37 cases(48.7? 5.73%)with a higher level on the left,14 cases(18.4?4.44%)with.a higher level on the right side,25 cases(32.9?5.38%)with both sides on the same level. 6.The ramification angle of the common carotid arteries of the 76 infants fall into three patterns:60 sides(39.5?3.96%)belong to the acute angle pattern,40 sides(26.3? 3.57%)belong to the arcform pattern and 52 sides(34.2?84%)belong to the in- termediate pattern.The acute angle pattern is more common than the arcform pattern in the infants. 7.The average length of common carotid arteries of all 76 specimens of the three age-groups in one-、two-、three-year-old Chinese infants was 42.9?1.55mm,45.7?0.57 mm and 47.8?1.50mm on the right side and 59.0?1.10 mm,56.7?2.99mm and 64.9?1.62mm on the left side respectively,but the average circumference was 14.8 ?0.77mm,16.3?0.14mm and 16.6?0.19mm on the right side and 15.6?0.61 mm, 16.6?0.13mm and 17.3?0.40mm on the left side respectively.

The aortic arch and its ramifications were studied in 76 chinese infant specimens (♂44,♀52)We examined its position,length and circumference and the types of its ramifications. 1.In average,the superior border of infant's aortic arch is situated at the level of the intervertebral disc between the second and third thoracic vertebrae,and the inferior border is situated at the level of the upper one-third of the fourth thoracic vertebra. 2.The medial point between the superior and inferior borders of the aortic arch,in average,is situated at the level of lower one third of the third thoracic vertebra.In the 3 age-groups,1,2 and 3-year old infants,in 76 specimens,we found that the levels of the medial point of aortic arches,corresponding to 6.05,6.10and 6.19 in the 7 th region of the vertebral column respectively,Comparison of this figures with those of the adult revealed that its height in the infant is higher than in the adult. 3.The average lengths of aortic arch of the 3 age-groups of the Chinese infants were 20.6?1.31mm,19.3?0.59mm and 20.8?0.43mm respectively. 4.The circumferences of the aortic arch of the 3 age-groups of the Chinese infants before the aortic arch divided int?the innominate artery,in average,were 35.8?0.86 mm,36.4?1.04 mm and 38.6?0.83 mm respectively,and after dividing into the left subclavian artery,in average,they were 26.1?1.01mm,26.9?1.25 mm and 29.7?0.79 mm respectively. 5.Seven types can be distinguished in the patterns of the ramifications of the aortic arch.One type was not included in the twenty types of the ramification that have been suggested by Chang Wei-lung according to McDdonald and Anson's classification.This new type increases the number of the types of the human aortic arch to twenty one.The seven types viz: Type A:52.infants,68.42?5.33%.Type B:11 infants,14.47?4.03%.Type G: 4 infants,5.26?2.56%.Type D:1 infant,1.32?1.31%.Type F:4 infants,5.26? 2.56%.(One of the four cases is named thyro-thymus trunk).Type BF:1 infant,1.32 ?1.31%.(This type was composed of a common trunk,which consisted of the inno- minate and left common carotid,the left subclavian and the thyroidea ima arising from the common trunk.According to De Garis's classification,we combine type B with type F into type BF).Type J:3 infants,3.95?2.23%.(This type was more common in infants than in adults). 6.By comparing the types of ramification of aortic arch in 76 specimens with those of the adult,it reveals that the types of the ramifications of aortic arches vary with age.

Objective To explore the clinical application of mirabilite abdominal hot compression bag designed by ourselves for the moderately severe acute pancreatitis ( MSAP ) or severe acute pancreatitis ( SAP) .Methods Seventy MSAP and SAP patients were randomly divided into the observed and control groups according to the admission date.Each group included 35 patients.All the patients received the routine treatment.The patients in observed group received the treatment of compression action on abdomen by mirabilite abdominal continual hot compression bag designed by ourselves, while the traditional mirabilite hot compression action was used in the control group.The APACHEⅡscore and the levels of plasma CRP, IL-1, IL-6 and TNF-αof all patients on the 1st, 3rd, 6th, and 9th day after being admitted, the rate of complications including the intra-abdominal hypertension (IAH), pancreatic pseudocysts (PPC) and pulmonary infection, the recovery time of intestinal function and mean hospitalization time were all recorded and the therapeutic efficacy was compared between the two groups.Furthermore, the therapeutic effects of MSAP and SAP were compared between two groups.Results The APACHEⅡscore and the levels of plasma CRP, IL-1, IL-6 and TNF-αwere not statistically different between the two groups on the 1st day after hospitalization.The APACHEⅡscore and the levels of plasma CRP, IL-1 and TNF-αon the 3rd day in the observed group were significantly lower than those in the control group(P<0.05 or <0.01).The APACHEⅡ score and the levels of plasma CRP, IL-1 , IL-6 and TNF-αon the 6th day in the observed group were significantly lower, comparing to those in the control group.The levels of serum IL-1 and TNF-αin the observed groups were significantly lower than those in control group on the 9th day.All the differences above were statistically significant ( P<0.05 or <0.01).In the observed group, 4 cases (11.4%) had IAH and 7 cases (20.0%) developed other complications.The time of intestinal recovery and mean hospitalization was (4.9 ±0.8)d and (13.1 ±2.1)d, respectively, in the observed group.In the control group, 11 cases (31.4%) had IAH and 10 cases (28.6%) had other complications, and the time of intestinal recovery and mean hospitalization was (5.5 ±0.8) d and (15.4 ±3.9)d,respectively,.The rate of IAH, intestinal function recovery time and hospitalization time in the observed group were significantly less than those in control group (P<0.05 or <0.01).There was no statistical difference on other complications between the two groups.The intestinal function recovery time and hospitalization time of MSAPs in the observed group were significantly less than those in control group [(5.0 ± 0.8)d vs (5.5 ±0.8)d, P=0.03; (12.7 ±1.7)d vs (15.2 ±3.6)d, P=0.02].The APACHEⅡ score and the levels of plasma CRP, IL-1, IL-6 and TNF-αof SAPs were not statistically different between the two groups.Conclusions The application of the mirabilite abdominal continual hot compression bag could alleviate inflammatory response of MSAP and SAP, decrease the rate of IAH, improve the intestinal function recovery time,and shorten the hospitalization time.

Objective To investigate the anti-erythropoietin antibody level and its clinical significance in maintenance dialysis patients. Methods Eighty maintenance hemodialysis (HD) and 30 peritoneal dialysis (PD) patients were enrolled in the study. Serum anti-erythropoietin antibody levels of above 110 dialysis patients were measured by ELISA. Immunoreactive parathyroid hormone (iPTH), Scr, BUN, Hb, and CRP were determined by conventional methods at the same time. Correlations among these indexes were examined. Results The anti-erythropoietin antibody levels of the dialysis patients were significantly higher than those of healthy people (P＜0.05), but no significant difference was found between HD patients and PD patients. There were no significant differences of anti-erythropoietin antibody, Hb, BUN, Scr, iPTH and CRP among different primary diseases. Hb was negatively correlated with anti-erythropoietin antibody and CRP (r=-0.56, -0.20,P ＜0.05), but was not correlated with BUN, Scr, iPTH. There was no correlation of antierythropoietin antibody with BUN, Scr, CRP and iPTH. One patient receiving recombinant human erythropoietin (rHuEPO) treatment with anti-erythropoietin antibody 43.63 U/L developed pure red cell aplasia diagnosed by marrow biopsy. Conclusions The anti-erythropoietin antibody levels of the dialysis patients are significantly higher as compared to healthy people, but are not significantly different between HD and PD patients. Anti-erythropoietin antibody is not correlated with BUN, Scr,iPTH and CRP. Hb is negatively correlated with anti-erythropoietin antibody and CRP. The rHuEPO can induce the anti-erythropoietin antibody leading to pure red cell aplasia in dialysis patients.

Osteoclastic bone resorption and osteoblastic bone formation are coordinated as a coupled mechanism to effect the development of bone and to maintain bone homeostasis. Recently reported Eph/ephrin bidirectional signaling between osteoclasts and osteoblasts plays a pivol role in bone homeostasis and casts new light on coupling of bone resorption and bone formation, which is gaining more and more attention in researches of bone biology and bone diseases. The present article aims to address the researches on the Eph/ephrin bidirectional signaling between osteoblasts and osteoclasts with molecular constitution, mechanism of the signal transduction, biological significance and so on.

Objective To detect the expression and effect of human tumor necrosis factor related apoptosis-inducing ligand (hTRAIL) in vivo,by using a novel double expressing adenoviral vector encoding hTRAIL and firefly luciferase ( luc ) gene ( ad -luc-hTRAIL),in which luc was used as reporter gene.Methods Lung cancer A549 cell xenografts in 16 nude mice models were established in subcutaneous inoculation way,the adenovirus vectors ( ad-luc-hTRAIL,ad-hTRAIL,ad-luc) and phosphate buffer saline (PBS) (n =4) as control were injected into tumor respectively.The size of the tumor was measured at different time points (4,7,10,14,21,28 d)after injection.The activity of luciferase in surface of the tumor was detected in vivo by using high-sensitivity cooled-charged coupled device(CCD) camera.The expression of hTRAIL was demonstrated by immunohistochemistry staining after sacrificing the animals at different time points,and immunohistochemical scores (IHS) were measured. The apoptosis rate of tumor cells was detected by using TUNEL and calculated. Analysis of variance,the paired t test and linear correlation analysis was used for the statistics. Results The growing speed of tumour xenografts was more slowly in ad-luc-hTRAIL and ad-hTRAIL groups than PBS group (t =2.71,2.72,P ＜ 0.05 ).The tumor volumes of ad-luc-hTRAIL,ad-hTRAIL,ad-luc and PBS groups 28 days after injection were (208.4 ± 42.3 ),( 181.5 ±23.9),( 403.1 ± 54.0 ) and ( 427.0 ± 59.3 ) mm3, respectively. There was no significant difference between ad-luc group and PBS group(t =2.07,P ＞ 0.05).The expression of luciferase in ad-luc-hTRAILgroup reached its peak at 7th day ( 1.37 ± 1.04),and then decreased quickly.The IHS and apoptosis rate in ad-luc-hTRAIL and ad-hTRAIL groups reached their peaks at 7th day,the peak values of IHS were 6.25 ±2.06 and 6.5 ± 2.89,the peak values of apoptosis rate were (60.75 ± 8.06 ) ％ and ( 61.50 ± 8.47 ) ％,respectively.The amount of luciferase expression ( absolute number of photons detected by CCD camera)was linear positive correlated with IHS and apoptosis rate ( rphotons/IHs =0.942,rph /rate =0.842,rIHs/rate =0.887,P ＜ 0.05 ).Conclusion The target gene hTRAIL can be transfected into lung cancer A549 cell xenografts nude mice models efficiently with a high level expression,and the therapeutic effect of hTRAIL can be monitored by detecting the expression of luc.

Objective To investigate the effects of preconditioning with different concentrations of sevoflurane on the expression of Toll-like receptor 4 (TLR4) in rats with acute lung injury (ALI) induced by lipopolysaccharide (LPS).Methods Thirty adult male Sprague-Dawlcy rats,wcighing 200-250 g,were randomly divided into 5 groups (n =6 each):normal saline group (group NS),group ALI,and preconditioning with different concentrations of sevoflurane groups (groups S1-3).ALI was induced by intratracheal instillation of LPS 5 mg/kg.Groups S1-3 inhaled 1.2％,2.4 ％ and 4.8 ％ sevoflurane for 30 min respectively,and ALI was induced 30 min later.The rats were sacrificed at 12 h after administration of LPS or normal saline and lungs were removed for microscopic examination and for determination of TLR4 mRNA and protein expression in lung tissues and concentrations of TNF-α and IL-1β in broncho-alveolar lavage fluid (BALF).W/D lung weight ratio was calculated.Results Compared with group NS,W/D lung weight ratio and concentrations of TNF-a and IL-1β in BALF were significantly increased and the expression of TLR4 mRNA and protein was up-regulated in groups ALI and S1-3 (P ＜ 0.01).Compared with group ALI,the parameters mentioned above were significantly decreased in groups S2 and S3,and the concentrations of TNF-α and IL-1 β in BALF were significantly decreased and the expression of TLR4 mRNA was down-regulated in group S1 (P ＜ 0.05 or 0.01).The parameters mentioned above were significantly lower in groups S2 and S3 than in group S1 (P ＜ 0.05).The pathologic changes were significantly attenuated in groups S1-3 compared with group ALI.Conclusion Preconditioning with sevoflurane can concentration-dependently reduce LPS-induced ALI in rats through inhibiting the up-regulation of TLR4 expression in lung tissues and reducing the inflammatory response.

Objective To investigate the diagnosis and treatment of the blunt pancreatic injury.Methods The clinical data of 21 blunt pancreatic trauma patients admitted to our hospital in the past 5 years were analyzed retrospectively.Results 3 of 21 patients were simple blunt pancreatic injury, while the other 18 patients were complicated with other abdominal organs injuries.According to the grading criteria, the number of Ⅰ , Ⅱ, Ⅲ, Ⅳ, Ⅴ grade injury were 4, 7, 5, 3 and 2 cases, respectively, and only 9 patients were diagnosed by CT before operation, and the diagnosis was confirmed during the operation in 11 patients, and 1 was miediagnosed in the first operation.Single drainage or debridement and drainage were performed in 8 cases and distal pancreatectomy with and without spleen were performed in 5 and 3 cases, respectively, and 3patients received pancreaticojejunostomy, 1 received Whipple operation, the other 1 case underwent duodenorrhahy and diverticulation.The mortality rate was 9.5% (2/21), and the complications of pancreatic pseudocyst and fistula developed in 2 (9.5%, 2/21 ) and 5 (23.8%, 5/21 ) cases respectively, and they were cured by drainage, while the other 12 were cured completely.Conclusions The preoperative misdiagnosis rate of pancreatic trauma is high;CT scan should be used to confirm the diagnosis.Careful pancreatic exploration is mandatory and simple and effective surgical procedures with effective drainage is important for treatment success.

Objective To investigate the pharmacodynamics of remifentanil required to prevent laryngeal mask airway (LMA) insertion response in patients anesthetized with propofol by TCI. Methods Thirty-six ASA Ⅰor Ⅱ patients aged 18-59 yr with body mass index ＜ 30 kg/m2 undergoing elective breast operation were enrolled in the study. Propofol was administered by TCI at an effect-site concentration of 4.0 μg/ml. When the patients lost conciousness, TCI of remifentanil was started. The initial target plasma concentration of remifentanil was set at 2.9 ng/ml, and the ratio of two consecutive effect-site concentrations was 1.2. LMA was inserted at 3 min after the target effect-site concentration and the plasma concentration achieved the balance. Criteria of successful insertion were defined as Muzi score≤2 and the increase in MAP and HR≤ 15% of the baseline values within 3 min after insertion. EC50 was determined by modified Dixon's up-and-down sequential trial and the 95 % confidence interval was calculated. Results The EC50 of remifentanil was 2.75 ng/ml. The 95% confidence interval was 2.51-3.01 ng/ml. Conclusion The EC50 of remifentanil for suppression of cardiovascular response to LMA insertion is 2.75 ng/ml in patients anesthetized with propofol by TCI.