Volume 88  ·   Issue 13  ·  2008

The prognosis of surgical patients is related to a variety of factors, such as the patient's condition, complicated diseases, intraoperative drugs, postoperative nursing level, etc. Anesthesia mode is only one of many influencing factors, but anesthesiologists have always paid attention to the relationship between anesthesia mode and prognosis of patients.

Objective To present the experience in a technique used to treat intractable postherpetic neuralgia(PHN)-percutaneous dorsal root ganglion(DGR)radiofrequency thermocoagulation guided by CT scanning.Methods Sixteen PHN patients underwent puncture of radiohealing needie into the superior 1/3 of the corresponding intervertebral foramen guided by CT.Electric stimulation test and impedance test were conducted to confirm the right spot.Radiofrequency heat coagulation therapy under the condition of 90℃ 90 s was performed for 3 cycles.Then mixture of betamethasone and lidocain was injected and the needle was pulled out.CT was conducted to observe if pneumothorax occurred.The patients were followed up for 2-16 months.Results Radiofrequency thermoeoagulation was performed on 45 target dorsal root ganglia in 16 PHN patients with the effect of immediate disappearance of hyperalgesia.Remaining spontaneous pain was seen in 5 cases,however,with decreases of attack frequency and severity.The visual analogue Dain seale score was decreased from 7-9 before the procedure to 2-3 after the procedure.No relapse was found during the follow-up.Conclusion Selective percutaneous DRG radiofrequeney thermocoagulation guided by CT scanning is effective in treatment of PHN.

Objective To investigate the possibility of establishing rat model of bone cancer pain using cancer cells cultured in vitro or by ascites passaging and verify the reliability of this method.Methods Syngeneic SD rat carcinoma cells of the line Walker 256 were cultured in vitro and inoculated into the peritoneal cavity of SD rats respectively.Two kinds of Walker 256 cell suspension were made.Thirty-two SD rats were randomly divided into 4 equal groups:Group N(undergoing injection of Hank's solution into cavitas medullaris of left tibia),Group K(undergoing injection of heat-killed Walker 256 cells),Group V (injected with Walker 256 cells cultured in vitro),and Group A(injected with Walker 256 cells passaged in ascites). After 6,12,and 18 days,the rats underwent roentgenography. Radio nuclide emission computed tomography(ECT)was conducted 12 days later.And MRI was conducted 15 days later.Thermal withdrawal latency(TWL)and pressure withdrawal threshold(PWT)were measured.Von Frey threshold and weight bearing of left hind limb were examined. On the 18th day after the establishment of model the rats were killed with their left tibia taken out to undergo microscopy.Results The rats of Groups A and V began to display decrease of left hint limb activity and roentgenography showed minute defect of bone trabecula in the proximal epiphysis by day 6.By day 12 roentgenography showed multiple defect of bone trabecula,ECT showed reactive bone formation.The rats of Groups A and V displayed signs of weight loss by day 14,and by day 18 roentgenography showed full thickness bicortieal bone loss and formation of soft tissue tumor.Histological examination 18 days later revealed that the bones inoculated with live cells showed infiltration of bone marrow spaces by malignant tumor.The PWT values gradually decreased since day 6 to day 18,and the PWT values in this period of Groups A and V were all significantly lower than those of Groups K and N ( a11 P＜0.01).The von Frey values gradually decreased since day 6 to day 18,and the yon Frey valties in this period of Groups A and V were all significantly lower than those of Groups K and N(all P＜0.01).The weight bearing value of left hind limb gradually decreased and the weight bearing difference between the 2 hind limbs gradually increased since day 6 to day 18,and the values of weight bearing difference between the 2 hind limbs of Groups A and V were significantly higher than those of Groups K and N(all P＜0.01).Sixteen rats underwent subcutaneous injection of morphine,and the PWT values increased 20,30,and 40 min later in a dose-dependent manner(P＜0.01).Naloxone injected 1 h later antagonized the analgesic effect of morphine.Condusion A SD rat model of bone cancer pain has been successfully established by using syngeneic rat bone carcinoma cells cultured in vitro or in vivo,and the latter being more convenient.

Objective To investigate whether erythropoietin(EPO)protects neuron against ketamine induced injuries.Methods Neurons were obtained from SD rat brain,cultured.and treated with ketamine of the concentrations of 0.1,1,10,and 30 μmol/L respectively.Neurons not treated by any agent were used as control group.Another neurons were divided into 3 groups undergoing the treatment of ketamine of the terminal concentration of 10 μmol/L,EPO+ketamine group undergoing the treatment of 10 μmol/L ketamine and EPO of the terminal concentrations of 0.3,1,3,and 10 U/ml,and ketamine+EPO+LY294002 group undergoing the treatment of 10 μmol/L ketamine, 1 U/ml EPO, and 10 μmol/L LY294002,a P13k inhibitor.Twenty-four hours after the co-inoculation the survival rates of the neurons were detected by MTT method.The apoptotic rate was detected by TUNEL assay.The neuron vitality was measured by MTT assay. Apoptotic neurons were measured by TUNEL assay.The activity of caspase-3 was detected with the caspase-3 fluorometric assay kit.The level of pAkt protein was analyzed by Westem blotting.Results The survival rates of the neurons exposed to ketamine of the concentrations of 1.10,and 30 μmol/L were(91±5)%,(42±6)%,and(23±7)%respectively,significantly lower than that of the control group(P＜0.05 or P＜0.01).The survival rates of the neurons treated by 10 μmol/L ketamine and EPO of the concentrations of 0.3,1,3,and 10 U/ml were(73±6)%,(86±9)%,(78±8)%,and (71±10)% respectively,all significantly high than that of the 10 μmol/L ketamine group(P＜0.05 or P＜0.01).The number of apoptotic neurons of the 10 μmol/L ketamine group was significantly higher than that pf the control group,the number of apoptotic neurons of the 10 μmol/L ketamine+10 U/ml EPO group was significantly lower than that of the 10 μmol/L ketamine,and the number of apoptotic neurons of the ketamine+EPO+LY294002 group was(130±30)%,remarkably lower than that of the ketamine group.(P＜0.01),and the relative activity of caspase-3 of the 10 μmol/L ketamine group was(280±60)%,significantly higher than that of the control group, (P＜0.01).The relative activity of caspase-3 of the ketamine+EPO+LY294002 group was(220±34)%,significantly higher than that of the ketamine+EPO (P＜0.01).The pAkt protein level of the 10 μmol/L ketamine group was significantly lower than that of the control group(P＜0.05),the pAkt protein level of the 10 μmol/L ketamine+10 U/ml EPO group was significantly higher than that of the 10 μmol/L ketamine group(P＜0.01),and the pAkt protein Ievel of the ketamine+EPO+LY294002 group was significantly lower than that of the ketamine+10 U/ml EPO group(P＜0.01).Conclusion EPO affords significant neuroprotection against ketamine induced injury in neurons via PI3K/Akt-mediated signaling pathway.

Objective To investigate the effects of different nuclear factor(NF)-κB dimers on the survival of immortalized neural progenitor cells(INPCs).Methods The control vector RC/CMV,containing the promoter of cytomegalovirus(CMV),and the expression vectors,RcCMV-p50 and RcCMV-p65,containing the coding regions of NF-κB subunits p50 and p65 genes,were transfected into the INPCs bv liposome respectively.Stably transfected clones were screened out following G418 selection.Subsequently,the plasmid RcCMV-p50 was transiently transfected into the INPCs which had been stably transfected with the plasmid RcCMV-p65.The expression of p50 or p65 gene was detected in each cell strain by Western blotting.And the NF-κB DNA binding activity in the cell nuclear extracts was measured by electrophoresis mobility shift assay(EMSA).The expression of IκBα in the cytoplasm was detected by Western blotting.After oxygen and glucose deprivation for 13 h,the cell survival rate was measured by MTT assay.Results After gene transfection,five different cell strains were obtained:INPC,INPC/CMV,INPC/p50.INPC/p65,and INPC/p50p65.p50 or p65 gene was translated correctly and efficiently in the cell strains which had been transfected with the corresponding plasmids.EMSA showed that the INPC/p50,INPC/p65,and INPC/p50p65 ceils all gave rise to NF-κB specific bands,which were composed of p50 homodimer,p65 homodimer,and p50 p65 heterodimer and p50 homodimer respectively.The expression of IκBα was increased significantly in the cytoplasm of the INPC/p65 and INPC/p50p65 cells.Games-Howell test showed that after oxygen and glucose deprivation for 13 h,the survival rates of the NPC/p65 and INPC/p50p65 cells were(6.0±1.0)% and(4.6±0.6)% respectively,both significantly lower than those of the INPC,INPC/CMV,and INPC/p50 cells[(72.5±6.2)%,(70.1±4.3)%,and(70.4±7.3)% respectively,all P＜0.05]. Conclusions Overexpression of p50 gene and p65 gene directly enhance the DNA binding activities of different NF-kB dimers in the nuclei. In neural progenitor cells,NF-κB dimers with transcriptiVe activity decreases the cellular survival after oxygen and glucose deprivation,but NF-κB dimers without transcriptive activity don't prevent the cells from death.

Objective To investigate the impact of transplantation of immortalized neural progenitor cells (INPCs)into the brain with focal cerebral ischemia and the survival and differentiation thereof.Methods Twenty-four male SD rats underwent middle cerebral artery occlusion(MCAO)and were randomly divided into 2 equal groups:INPC group undergoing transplantation of BrdU-labeled INPCs into the penumbra zone in striatum using stereotaxie apparatus 3 days after brain ischemia,and control group undergoing transplantation of PBS.Neurological severity score(NSS)system was used 6 hours,1 day,and 3 days after MCAO,and 1,2,3,and 4 weeks respectively after transplantation.One week after transplantation,6 animals of each group were randomly chosen and killed with their brains taken out,the rest of the animals were killed four weeks after transplantation.The survivaI of INPCs in the brain was determined by double immunofluorescent labeling technique with BrdU+NSE or BrdU+GFAP antibody.Results The NSS values at different time points after transplantation of both groups were all higher than those before MCAO;however,no significant difference in NSS was detected between the two groups.BrdU+GFAP and BrdU+NSE positive astroeytes and neurons were detected in the INPC group by double immunofluorescent labeling technique 1 week and 4 weeks after transplantation.Conclusion INPC can survive in penumbra zone in rats with focal cerebral ischemia and develop into neurons and astrocytes.

Objective To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy(LM).Methods Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups,Group A undergoing fibroid pedicle ligation,Group B injected with 12 IU diluted vasopressin around the myoma,Group C injected with 20 IU oxytocin combined with pedicle ligation,and Group D injected with vasopressin combined with pedicle ligation.The operation time,amount of blood loss,operative complications,bowel deflation,post-operative hemoglobin dropping,and length of hospital stay were compared.Results The amounts of blood loss of Groups A and C were (171±146)ml and(184±140)ml,both significantly higher than those of Groups B and D[(115±70)ml and(106±73)ml,both P＜0.01].The length of hospital stay of Group D was(2.9±0.5)d,significantly shorter than those of Groups A,B,and C[(3.1±0.7)d,(3.6±0.8)d,and(3.3±0.7)d,all P＜0.05 ].The bowel deflation time of Group D was(20±6)h,significantly shorter than those of the Groups A,B,and C[(26±)h,(25±7)h,and(25±8)h respectively,all P＜0.05].The post-operative hemoglobin dropping of group D was(1.1±0.9)g/L,significantly less than those of Groups A,B,and C[(1.5±1.0),(1.4±0.8),and(1.2±0.7)g/L respectively,all P＜0.05].Conclusions Vasopressin(12 IU)injection around the myoma is a simple,effective,and safe homeostatic procedure during LM.Pedicle ligation can reduce advanced post-operative bleeding post-operation.

Objective To study the clinical characteristics and diagnosis of rheumatoid arthritis (RA)in the upper cervical spine.Methods The clinical data of 71 patients with RA in the upper cervical spine,18 males and 53 females,aged 46.2(23-76),with a mean duration of RA of 18.2 years (2 months-47 years)were retrospectively reviewed.Fifty-three patients received glucocortieoid for more than 3 months.In addition to routine examinations,all patients underwent plain X-ray film taking,CT and MRI scanning.and erythrocyte sedimentation rate,rheumatoid factor(RF)and antistreptolysin O testing.Results The symptoms of upper cervical spine appeared at 8.3 years(2 months-46 years)after the diagnosis of RA was confirmed.The clinical manifestations of RA in the upper cervical spine were intractable pain in craniocervical iunction or radiating pain.Abnormal postures in the neck and Sherp-Purser's sign were positive in some patients.Progressive neurological dysfunction with the involvement of spinal cord,medulla,or some cranial nerves might gradually appear.Irregular destruction of bone with osteoporosis around the lateral and median atlantoaxial ioint was a common finding in the X-ray films and CT scans.Instability of the atlantoaxial joint,including anterior atlantoaxial subluxation,posterior atlantoaxial subluxation and anterior-posterior atlantoaxial subluxation were found in 68 cases,while rotation subluxation was presented in 37 cases.Vertical migration of the odentoid was seen in 11 cases.RF was positive in 18 cases.MRI revealed that the cause of spinal cord compression was the bone tissue and soft tissue pannus. Conclusions RA in the upper cervical spine is a common situation in the clinical settings.The key point in the diagnosis of this disease is the identification of instability in the atlantoaxial ioint and assessment of the spinal neurological deficit.And a careful analysis of the natural history will further help to achieve a better treatment effect.

Objective To report the clinical experience in trans-sacroiliac joint with plate via the anterior approach in management of posterior pelvic injuries.Methods The clinical data of 29 cases ( 30 sides)with pelvic injury,16 being of type B,and 13 of type C according to the Tile classification;with the average displacement of the posterior ring injuries of 18 mm;undergoing trans-sacroiliac joint with plate via the anterior approach from January 2002 to June 2007 were analyzed retrospectively,among which 20 sides were fixed by two plates across the sacroiliac joint and 10 sides by single plate.The anterior pelvic injuries of 22 cases were fixed by plates too.Twenty-one cases were followed up for 35 months on average.Results The average operation time was 3 hours,and the average blood transfusion was 1200 ml.Reduction was excellent in 23 sides(77%),good in 6 sides(20%),and fair in 1 side(3%).Operative injury of lumbosacral trunk occurred in 3 sides(10%)and operative injury of lateral femoral cutaneous nerve occurred in 7 sides(23%).Intra-operative major hemorrhage occurred in 2 cases.The average outcome score according to the Majeed grading system was 93,and the function results all were excellent or good.Conclusion Plating the sacroiliac joint through the anterior approach is an effective method for the management of sacroiliac dislocation or trans-iliac fracture dislocation,while the blood loss of the operation is obvious,and the risk of iatrogenic nerve injury is high.

Objective To investigate the risk factors,pathogenesis,cause of death,and outcome of different stroke subtypes.Methods The relevant data,including demographics,baseline risk factors,cause of death,and 1-year case fatality,were analyzed among 1913 consecutive hospitalized patients with ischemic and hemorrhagic stroke,599(31.3%)with intracerebral hemorrhage(ICH)and 1314 with ischemic stroke(68.7%),including 209 cases(15.9%)of total anterior circulation infarction(TACI),417 cases(31.7%)of partial anterior circulation infarction(PACI),and 186 cases(14.2%)of posterior circulation infarctions(POCI),and 502 cases(38.2%)of lacunar infarctions(LACI),1098 males and 815 females,aged 64±13(14-98).Results Multivariate analysis showed that when age and sex were adjusted,atrial fibrillation was the independent predictive factor of TACI[odds ratio(OR)=1.42,95% CI=1.25-2.31),hypertension and alcohol intake were the independent predictive factor LACI(OR=1.24,95%CI=1.02-2.18;OR=1.12,95%CI=1.03-3.04)and ICH(OR=1.84,95%CI:1.31-3.02;OR=1.04,95%CI=1.01-4.13). A negative association was observed between hypertension and TACI(OR=0.62,95%CI=0.34-0.72),atrial fibrillation and LACI(OR=0.46,95%CI=0.26-0.82),and ICH and diabetes(OR=0.56,95%CI=0.42-0.76).As compared to LACI,TACI and ICH significantly increased the risk of 1-year mortality(OR=6.21,95%CI=2.86-8.42:OR=5.86:95%CI=2.46-8.52). Conclusions Stroke subtypes have different risk factor profile, causes and outcome.1nformation on determinants of the clinical syndromes may impact on the prevention and acute phase interventions.

Objective To explore the most effective daily dose and use method of mannitol in reducing intracranial pressure in patients with cerebral hemorrhage in acute stage.Methods One hunred and eighteen cerebral hemorrhage patients with elevated intracranial pressure,74 males and 44 females,aged(58±11)(33-80),that had undergone cranial CT scanning to calculate the volume of hemorrhage,were divided into 4 groups treated with 20%mannitol 125 ml:32 cases treated q 4 h,35 cases treated q 6 h,25 cases treated q 8 h,and 26 cases treated q 12 h.The everyday doses of mannitol were recorded.Intracranial pressure was monitored daily by NIP-200 noninvasive intracranial pressure aDparatus.The difference between the very day and that of the last day(effect of decreasing intracranial pressure per day)was calculated.Multivariate regression analysis was conducted.Results The average saturation dosage of mannitol was 750-6000(3504±1085)ml,the time from the hospitalization till the saturation dosage was 1-8(4.5±1.5)d.The average intracranial pressure at admission was 330-698(486±93)mm H2O,the average intracranial pressure when mannitol reached the saturation dosage was 160-378(253±52)mm H2O.The effect of reduction of intracranial pressure was not associated with age(P＞0.05).The effects of reducing intracranial pressure in the 1st,2nd,3rd,and 4th day were associated with the volume of hematoma and mannitol doses(all P＜0.01).Best effects of reducing the intracranial pressure in the 1st,2nd,3rd,and 4th day could be reached when 20% mannitol 125 ml was used every 4 hours.Conclusions Mannitol use every 4 hours per day has evident effect of reducing the intracranial pressure in the 1st,2nd,3rd,and 4th day,then mannitol should be used temporarily according to the intracranial pressure after the 5th day,Mannitol should not be used for more than 8 days.

Objective To investigate the relationship between the left ventricular function and the expression of P-selectin in the serum and cardiac muscle in hemorrhagic shock resuscitation,and to evaluate the effects of L-arginine(L-Arg)against the harmful effect of P-selectin.Methods Thirty SD rats were randomly divided into 3 equal groups:hemorrhagic shock resuscitation(HS)group(undergoing bloodletting until the mean arterial pressure of 40 mm Hg and then re-infusion of the lost blood),L-Arg treatment group (undergoing bloodletting and then re-infusion with L-Arg simultaneously),and normal control(NC)group (undergoing infusion of normal saline).Cannulation was conducted via left carotid artery into the left ventricular to record left ventricular systolic pressure(LVSP),left ventricular end diastolic pressure (LVEDP),and left ventricular±dp/dtmax.Serum creatine kinase(CK)was detected by colorimetry.Three hours after the HS the rats were killed with samples of blood and apex of heart collected to detect the P-selectin expression by ELISA and immunohistochemistry.Microscopy was used to observe the expression of P-selectin in the vascular endothelial cells and cardiac muscle cells.Results The LVSP,maximal rate of LV pressure elevation(+dp/dtmax),and maximal rate of LV pressure depression(-dp/dtmax)of the HS and L-Arg groups were all significantly lower than those of the NC group(all P＜0.01).The LVEDP of the HS and L-Arg groups were all higher than that of the NC group(both P＜0.01).Three hours after resuscitation,the CK levels of the HS and L-Arg groups were significantly higher than that of the NC group (both P＜0.01),and that of the L-Arg groups was significantly lower than that of the HS group(P＜0.05),the P-selectin levels of the serum and cardiac muscle cells of the HS and L-Arg groups were all significantly higher than those of the NC group(both P＜0.01),and those of the L-Arg group were significantly lowcr than those of the HS group ( both P＜0.05).Conclusion After hemorrhagic shock and resuscitation P-selectin may play an important role in cardiac injury,L-Arg can inhibit the expression of Pseleetin,thus protecting the cardiac function against the harmful effect of P-selectin.

Objective To examine the feasibility of using human dermal fibroblasts(DFbs)and polyglycolic acids(PGA)to engineer tendon in vitro.Methods Human dermal fibroblasts(DFbs)were isolated from the foreskin tissues of children obtained during operation with collagenase and cultured in vitro.Human tendon was obtained from a patient undergoing amputation during operation to isolate tenocytes.The DFbs of second passage were seeded on PGA fibers to form cell-scaffold constructs in shape of tendons.Those constructs were divided into 4 groups:experimental group(n=15)with the DFbs inoculated on PGA scaffbld under constant tension generated by a U-shaped spring,control group 1(n=15)with the DFbs inoculated on PGA scaffold without tension,control group 2(n=3),i.e.,cell-free pare PGA scaffolds under tension,and control group 3(n=5),i.e.,tenocyte-scaffold constructs under tension that was harvested only at the ninth week.Samples were harvested 2,5,9,14,and 18 weeks later to undergo histological examination and biomechanical test. Results Two weeks later histological examination showed that the constructs were mainly composed of PGA fibers in both the experimental group and the group without tension.Transmission electron microscopy showed fine cell attachment and stretching on the scaffold.By the 5th week,a neo-tendon was formed in all groups except for the cell-free group,and histology revealed the formation of collagen fibers.At the 9th week,the PGA fibers of the cell-free group were broken and Dartially degraded,the neo-tendon's diameter of the experimental group was(1.18±0.25)mm, significantly thinner than that of the group without tension[(2.43±0.49)mm,P=0.017].The gross morphology of tendons of the experimental group and tenocyte group were similar to each other except for more cells in the experimental group.In experimental group,immunohistochemistry revealed the production of fibers of collagen type Ⅰ & Ⅲ that were aligned longitudinally along the force axis like the normal tendon pattern.An irregular collagen pattern was observed in the group without tension.The maximum tensile stress of the experimental group was(2.75±0.59)MPa,similar to that of the tenocyte group[(3.08±0.30)MPa,P=0.439],and significantly greater than that of the group without tension[(0.82±0.21)MPa,P=0.006].At the 14th week the PGA fibers of the cell-free group were mostly degraded.In addition,more dead cells and tissue atrophy were observed in the experimental group,and the tensile stress was higher than that of the salne group by the 9th week.In the 18th week the number of hollow fiber of the experimental group was more obvious,the number of dead cells increased,and the tensile stress was lower,however,there was no significant difference in other characteristics compared with those in the 14th week.Conclusions DFbs can be used for in vitro tendon engineering as tennocytes.Mechanical stimulation by statistic strain is beneficial for tissue formation,but the effect may not be optimal if the tension is applied for too long.

Objective To investigate the effects of RNA interference(RNAi)targeting human epidermal growth factor receptor 2(HER-2)gene on the change of chemosensitivity to cisplatin of ovarian carcinoma cells.Methods Three kinds of HER-2 gene targeting siRNA,HER-2 siRNA Ⅰ-Ⅲ,were synthesized and the best one ( HER-2 siRNA Ⅲ)was screened.Human ovarian carcinoma cells of the line SKOV3 were cultured randomly divided into 3 groups:HER-2 siRNA Ⅲ group,transfected with HER-2 siRNA Ⅲ.non-specific siRNA group,transfected with non-specific siRNA Ⅲ,and control group,without transfection.Cisplatin of the concentrations of 0,0.05,0.2.0.4,0.8,1.0,2.0,10,and 20 μg/ml was added into the culture fluid for 24 h.MTT method was used to detect the proliferation rate of the SKOV3 cells.Other SKOV3 cells were divided into 3 groups:siRNA group,transfected with HER-2 siRNA Ⅲ,cisplatin group,exposed to cisplatin,and HER-2 siRNA Ⅲ and exposed to cisplatin.Annexin V method arid flow cytometry,were used to detect the apnptosis of the SKOV3 cells.The HER-2 gene expression was assessed by Western blotting.The chemosensitivity of transfected cells to cisplatin was measured by MTT.Western blotting was used to detect the protein expression of apoptosis related proteins:Bcl-2,surviving,XIAP,and Smac. Results After exposed to cisplatin,the cell survival rate decreased as the dose of cisplatin increased.The proliferation rate of the SKOV3 cells transfected with HER-2 siRNA Ⅲ and exposed to 1 μg/ml cisplatin was(58±5)%,significantly lower than those of the nonspecific siRNA Ⅲ transfection group [(65±6)%] and the control group[(68±3)%,both P＜0.01].No significant difference in the cell survival rate was found between the control and nonspecific groups(P＞0.05).The apoptosis rates at different time point of the HER-2 siRNA Ⅲ+cisplatin group were all higher than those of the other 2 groups (all P＜0.01).The protein expression levels of the antiapoptotic proteins Bcl-2,survivin,and XIAP were of the HER-2 siRNA Ⅲ+cisplatin group were significantly lower than those of the cisplatin group, and the protem expression level of the apoptotic protein Smac of the HER-2 siRNA Ⅲ+cisplatin group significantly higher than that of the cisplatin group(all P＜0.05).Conclusions HER-2 siRNA Ⅲ induces cell apoptosis significantly and increases the sensitivity of the human ovarian carcinoma cells to cisplatin.The mechanism of induction of cell apoptosis by HER-2 siRNA Ⅲ+cisplatin may be related to the downregulation of Bcl-2,survivin and XIAP protein and the up-regulation of Smac protein.

A 19-year-old female was admitted to hospital on October 19, 2006 due to joint swelling and pain for 2 months, butterfly erythema for 7 days and fever for 1 day. In August 2006, the patient developed multiple joint swelling and pain with morning stiffness without obvious trigger, palpitations and symmetrical concave edema of both lower limbs.

The incidence of osteoporosis is increasing year by year with the increase of human average life expectancy and the increase of elderly population. The most common complication of osteoporosis is fracture, which occurs in vertebral body, hip and distal radius [1-2].

Rheumatoid arthritis (RA) has been recognized since the 17th century, but its etiology and pathogenesis are not fully understood at present. It may be the result of genetics, sex, infection, immune disorder and other factors. Smoking, diet, occupational exposure and other factors are also related to the disease.

Thoracogastric respiratory fistula is a complication with high mortality rate after esophageal cancer surgery [1]. Because of insufficient understanding of this complication in clinic, it often causes delay in diagnosis, and even if the diagnosis is established, it is extremely difficult to treat it.

The patient, male, 5 years old, Han nationality, was seen for "right shoulder deformity, right upper limb shortened for several years". Past history: no dystocia at birth, due to hypoxia asphyxia, current intelligence is lower than that of the same age; There was only minor trauma of right elbow 3 years ago, and it was cured after treatment. There was no history of this kind of genetic disease in the family.

A 17-year-old female was admitted to the emergency department on January 29, 2005 due to heat feeling, palpitations, polyuria, polydipsia, weight loss for more than 10 months, and coma for 4 h. Five months ago, free triiodothyronine (FT3) and free thyroxine (FT4) were significantly increased, and thyroid stimulating hormone (TSH) was significantly decreased. She was diagnosed as "hyperthyroidism" and was treated with radioactive 131I. Treatment with methimazole and propranolol 3 months ago, irregular medication, no obvious improvement of symptoms.