Volume 96  ·  Issue 27  ·  2016

Takayasu artertis (TA) is a systemic granulomatous macrovasculitis of unknown etiology that mainly involves the aorta and its branches. It occurs in Asian women under 40 years old. Blood vessels such as aorta, aortic arch and unnamed artery above arch, left common carotid artery, left subclavian artery, ascending aorta, thoracic and abdominal aorta, renal artery and pulmonary artery are often involved. Stenosis, occlusion or dilation of blood vessels leads to ischemia, infarction or bleeding of the affected organs, which ultimately leads to organ failure, blindness, syncope, hemiplegia, coma, renal failure and other manifestations, which threaten patients' lives in severe cases. The difficulty of diagnosis and treatment of Takayasu arteritis lies in the fact that most patients have a hidden onset and progress quietly. Once symptomatic, vascular disease is not early and often irreversible. Therefore, this leads to poor prognosis and low quality of life of Takayasu arteritis patients. On the other hand, there is not enough attention to Takayasu arteritis worldwide. From the 1950s to now, the number of literatures per year is less than 100, and most of them are reviews or surgical case reports of vascular lesions. So far, the pathogenesis of this disease is unknown, and there is a lack of clinical diagnosis and therapeutic research in a large sample size. Therefore, this also leads to the lack of diagnosis and evaluation methods of Takayasu arteritis, and the treatment is mostly based on clinical experience. In recent years, the development of diagnostic technology, the emphasis on clinical research and the promotion of precision medicine have brought opportunities for the progress of diagnosis and treatment of Takayasu arteritis.

Most of the various disciplines of clinical medicine are divided according to systems or organs, and there are many correspondences between internal medicine and surgery, such as thoracic surgery and respiratory surgery, cardiac surgery and cardiology, gastrointestinal surgery, hepatobiliary surgery, pancreatic surgery, anorectal surgery, etc. also echo with gastroenterology. Those with indications for surgery were returned to surgery, and those without indications for surgery were returned to internal medicine. In many cases, the disease requires medical and surgical cooperation, especially those who have elective surgery. It is often necessary to control the disease activity first to create conditions for surgery, and long-term medical treatment is needed after surgery to prevent recurrence. The cooperation of internal medicine and surgery can often obtain better results. Some specialties of a surgical nature were once confused because there was no corresponding internal medicine, and orthopedics is an example. In the 1980s, orthopedic experts from Xiangya Hospital affiliated to Central South University once called for the establishment of "orthopedic medicine", but it was unrealistic for surgeons to switch to internal medicine. Later, with the establishment of the Department of Rheumatology and Immunology, orthopedic surgeons found "Orthopedics" here. In recent ten years, biomedical engineering has promoted the development of artificial blood vessels, vascular stent intervention and other technologies, and vascular surgery has grown rapidly. Does vascular surgery need to have a corresponding "vascular medicine"?

neurodegeneration with brain iron accumulation (NBIA) is a group of rare neurogenetic degenerative diseases caused by gene mutation with extrapyramidal symptoms and other complex clinical symptoms. Abnormal iron deposition can be seen in specific parts of brain tissue. The incidence is (1~3) /1 000 000. Despite the high clinical and genetic heterogeneity of the NBIA disease spectrum, such diseases have characteristic abnormal signs on imaging, especially magnetic resonance (MRI), due to abnormal deposition of iron ions. Molecular genetics testing of the disease-causing gene can confirm the diagnosis. In order to help clinicians more accurately diagnose and standardize the treatment of NBIA disease spectrum, an expert consensus on the diagnosis and treatment of neurodegenerative diseases with iron deposition in brain tissue has been specially formulated.

This study aimed to analyze and evaluate the diagnostic efficacy of Ishikawa's, the modified Ishikawa's criteria, 1990 American College of Rheumatology (ACR ) classification criteria and the diagnostic model based on Chinese population in Chinese TA patients.

One hundred and forty-nine patients with Takayasu arteritis and 126 patients with other vascular disorders which involved aorta or its branches were recruited in this study.All the patients were admitted to the Department of rheumatism and Immunology clinic or inpatient department of Zhongshan Hospital affiliated to Fudan University from January 1^st, 2008 to June 31^st, 2015.General characteristics, clinical manifestations, laboratory results and imaging data of all the patients were collected.Sensitivity, specificity, accuracy and area under receiver operating characteristics (ROC) curve of different criteria were analyzed.

Sensitivity, specificity, accuracy and area under ROC curve of Chinese diagnostic model were 90.60%, 80.95%, 86.18%, and 85.80%, respectively, while those of Ishikawa criteria were 34.23%, 99.21%, 64.00%, and 66.70%, respectively.These four indicators of the modified Ishikawa criteria were 84.13%, 79.87%, 81.82%, and 82.00%, respectively and that of ACR criteria were 83.89%, 83.33%, 83.64%, and 83.60%, respectively.No significant difference was found between any two of Chinese diagnostic model, the modified Ishikawa criteria and ACR criteria in all the indicators.Sensitivity of Chinese diagnostic model was highest, while specificity of Ishikawa criteria was the highest.Among these four criteria, the diagnostic efficacy of Chinese model was the best and that of Ishikawa criteria was the worst.

Chinese diagnostic model, which is based on Chinese population and adopts advanced imaging modality, has better diagnostic efficacy.

To investigate the clinical features of valvular lesions in Takayasu's arteritis.

We analyzed 22 medical records of patients with Takayasu's arteritis and valvular lesions in Anzhen Hospital, Capital Medical University from January 2012 to January 2015.

The spectrums of valvular involvements were aortic valve regurgitation (11, 50%), aortic valve stenosis (1, 4.5%), mitral valve regurgitation (1, 4.5%), mitral valve stenosis (1, 4.5%) and multiple valvular diseases (7, 36.5%).64.7% of patients with aortic valve regurgitation had aortic root dilation.Heart failure was the most common manifestation (63.6%). Glucocorticoid and/or immunosuppressant were administrated on 11 (50%) patients.One (4.5%) patient received Tocilizumab injection.Surgeries were performed on 12 (54.5%) patients with cardiac architecture.Reversible changes in cardiac structure were found by echocardiography within one week after surgery (P<0.05). Three patients died during 10-46 month follow-up, with none of whom taking any anti-inflammatory treatments.

Aortic regurgitation is the prominent valvular lesion in Takayasu's arteritis, mostly secondary to aortic root dilation.Operation could block myocardium reconstruction promptly.The early surgical complication is rare, while perivalvular leakage may occur during longstanding follow-up.Poor inflammatory control might lead to poor long-term outcome.

To evaluate the clinical features, treatment and prognosis of Eosinophilic Granulomatous Vasculitis.

We analyzed retrospectively the clinical and laboratory features, treatment and prognosis of 43 patients with Eosinophilic Granulomatous Vasculitis who admitted to the Department of Rheumatology of the First Affiliated University Hospital of Sun Yat-sen University between 2005 and 2014.

Of the 43 patients, 31 patients (72.1%) had allergic symptoms in the disease course and 16 patients (37.2%) had asthma and lung wheezing sound when performing the physical examination.Organs involvements included skin, acra, lung, kidney, central and peripheral nervous system, digestive system and heart.Positive antineutrophilic cytoplasmic antibody (ANCA) which mainly with MPO-ANCA was found in 18 patients (41.9%). Thirty-nine patients (90.7%)had high blood eosinophil level while all patients (100%) had elevated IgE.Two patients died of multiple organ failure in their acute phase, and the others had favorable prognosis after receiving the treatment of glucocorticoid combine with cyclophosphamide or methotrexate.

Eosinophilic Granulomatous Vasculitiscould make damage to organs and tissues.Only 72.1% patients had allergic symptoms and 37.2% patients had asthma and lung wheezing sound.More than half patients have the negative ANCA.Glucocorticoidcombine with cyclophosphamide or methotrexate can achieve satisfactory therapeutic effects.

To investigate the clinical features of patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV), and to explore the disease activity of AAV patients and the relationship with prognosis.

The clinical data of 46 cases of AAV patients in the First Affiliated Hospital of PLA General Hospital were analyzed retrospectively.The clinical and laboratory features of each clinical subtype were compared.The disease activity of AAV and the relationship between disease activity and prognosis were evaluated.

Among the 46 patients with AAV, 24 were male, and 22 were female, with the average age of 56±18.Among the subtypes of AAV, the number of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA) were 22, 17 and 4 respectively, while the positive rate of ANCA are 72.7%, 88.2% and 50.0% respectively.For GPA, the results of ANCA were mainly C-ANCA or ANCA directed toward proteinase-3 (PR3), and for MPA, the results of ANCA were mainly P-ANCA or ANCA directed toward myeloperoxidase (MPO). Upper and lower respiratory disease, renal involvement and non-deformity arthropathy were the common clinical manifestations of all primary AAV subtypes.Epistaxis, nasal blood scab, saddle nose, pulmonary nodule and intrapulmonary cavities were the characteristic manifestations of GPA, while rapid progress of renal failure was prominent in MPA.Whatever their ANCA results, there were no significant differences between each other as to system-organ involvements and laboratory indexes.Seven patients (15.2%) died during hospitalization or in follow-up visits.Serious involvements of heart, lung, kidney, and complicated with infections were the main risk factors of death in AAV patients.

Upper and lower respiratory involvements and kidney diseases are the primary manifestations of AAV patients.ANCA results are irrelevant with disease activity and system-organ involvements.Serious involvements of heart, lung, kidney, and complicated with infections are the main risk factors of death in AAV patients.

To compare the sensitivity and specificity between the 24 hour urine free cortisol (24 h UFC) and serum cortisol in dexamethasone suppression test (DST) in the diagnosis of Cushing syndrome (CS).

Combined low dose DST (LDDST) and high dose DST (HDDST) were carried out in 67 cases of CS with surgically confirmed cases in recent 3 years(from January 2011 to November 2015). The serum cortisol and 24 h UFC were collected simultaneously for each subject and the sensitivity and specificity of serum cortisol and 24 h UFC were compared.

There were Cushing disease (CD) group (n=53), ectopic adrenocorticotropic hormone (ACTH) syndrome group (n=7) and ACTH-independent Cushing syndrome group (n=7) according to the etiology of hypercorticordism.There were no significant differences among 3 groups in gender and age.The sensitivity of serum cortisol of different cut off points(50, 110, 140 nmol/L and 50% of control)after LDDST was 97.01%, 86.57%, 83.58% and 70.15% respectively.Meanwhile, the sensitivity of cutoff point of 24 h UFC <32 nmol in combined LDDST was 92.54% in the diagnosis of Cushing syndrome.There was no significant differences in two groups between serum cortisol <110 nmol/L and 24 h UFC <32 nmol.However, the sensitivity of serum cortisol <50 nmol/L was significantly higher than 24 h UFC<32 nmol ( P<0.05). Furthermore, in combined HDDST, if the suppression rate was ≥50%, the sensitivity of serum cortisol and 24 h UFC in differentiating the etiology of Cushing disease was 60.38% and 90.57%, and the specificity was 91.43% and 96.00% respectively.There were significant differences between serum cortisol and 24 h UFC in both of sensitivity and specificity (bothP<0.05). In addition, if the suppression rate of 24 h UFC in HDDST was adjusted to 60.85% according to receiver operating characteristic (ROC) curve, it could have the best levels of sensitivity (92.6%) with the specificity of 85.7%. If the suppression rate of serum cortisol was adjusted to 61.53% in HDDST according to ROC curve, it could have the best sensitivity (64.8%) with the specificity of 78.6% accordingly.

In combined LDDST, the serum cortisol <50 nmol/L had a higher sensitivity than the 24 h UFC<32 nmol when they were used as the criteria in determining the diagnosis of CS.In HDDST, the sensitivity and specificity of suppression rate of 24 h UFC ≥50% were better than serum cortisol to differentiate the etiology of CS.

To explore hormone such as follicle-stimulating hormone (FSH), luteinizing (LH), prolactin (PRL), estradiol (E2), progesterone (PROG) and testosterone (TESTO) levels in first-episode drug-free schizophrenics, and the relationship between clinical symptoms and sex hormones, in order to further study the pathogenesis of schizophrenia.

Eighty-one first-episode drug-free schizophrenics including thirty-nine male and forty-two female from First Affiliated Hospital of Zhengzhou University and seventy healthy subjects (thirty male and forty female) were enrolled.Serum levels of hormone were measured using electrical chemiluminescence immunoassay, and Positive and Negative Syndrome Scale (PANSS) was used to evaluate the mental symptoms and Matrics Consensus Cognitive Battery (MCCB) was used to evaluate cognitive function.

(1) The serum levels of PRL in male patients group ((24±9) ng/ml) was higher than that of control group ((10±3) ng/ml) (P<0.05), the serum levels of E2, TESTO of male patients group ((29±10) ng/ml), ((3.2±1.7) ng/ml) was lower than that of control group ((35±11) ng/ml), ((4.4±1.6) ng/ml) (P<0.05); The serum levels of PRL, TESTO of female patients group ((29±16) ng/ml), ((0.5±0.4) ng/ml) were dramatically higher than that of control group ((13±5) ng/ml), ((0.3±0.1) ng/ml) (P<0.05), the serum levels of E2 of female patients group ((51±40) ng/ml) was lower than that of control group ((63±66) ng/ml) (P=0.05). (2) The serum levels of PRL, E2, TESTO in male patients group were negatively associated with negative symptoms (r=-0.478,-0.443,-0.576, P<0.05), PRL were negatively related to positive symptoms (r=-0.542, P<0.05); In female patients group, the serum levels of PRL were negatively associated with negative symptoms (r=-0.343, P<0.05), the serum levels of E2 was negatively related to positive symptoms, general psychopathology grade, total PANSS grade (r=-0.351,-0.487,-0.405, P<0.05), TESTO had a positive correlation with positive symptoms (r=0.445, P<0.05). (3) In male patients group, PRL had an negative correlation with working memory P point, reasoning and problem solving P points (r=-0.384,-0.374, P<0.05), the serum levels of E2 was positively related to Information processing rate P points, Visual memory P points, Reasoning and problem solving P points (r=0.379, 0.336, 0.407, P<0.05), TESTO had a positive correlation with Information processing rate P points, Visual memory P points, Reasoning and problem solving P points (r=0.564, 0.513, 0.552, P<0.05). In female patients group, PRL had an negative correlation with working memory P point, Reasoning and problem solving P points and social cognition P points (r=-0.303,-0.358,-0.368, P<0.05), the serum levels of E2 was positively related to working memory, Reasoning and problem solving P points, social cognition P points (r=0.376, 0.453, 0.355, P<0.05).

Our study shows that first-episode drug-free schizophrenics have hormone secretion abnormal, which suggests that hypothalamus-hypophysis-gonad axis may probably involve in physiopathologic mechanism of first-episode medicine-free schizophrenics.Slightly elevated serum PRL level may be the reaction of stress response in first-episode medicine-free schizophrenics.Endogenous testosterone and estradiol may protect cognitive function against recession, and declining of testosterone and estradiol in blood is the hazards of cognitive dysfunction in first-episode drug-free male schizophrenics. PRL, E2, TESTO may be one of the measurements of the severity of clinical symptoms.

To investigate the factors associated with positive results of blood culture and the impact of positive results on the prognosis of patients in ICU of Peking University People's Hospital.

We retrospectively analyzed 1 008 blood culture results of 379 critical ill adult patients in ICU from July 1st, 2013 to June 30th, 2014. According to blood culture results, the patients were divided into positive and negative groups. The patients' maximal body temperature, sample collection times, number of bottles within 24 hours, routine hematological variables [(white blood cell count (WBC), percentage of neutrophils (NEU%), lymphocyte count (LYM), platelet count (PLT)], serum C-reactive protein (CRP), usage of antibiotics were compared between the two groups, as well as the patients' gender, age, duration of mechanical ventilation, length of ICU stay and hospital mortality rate.

The total positiverate of blood culture of our study was 15.38%, and the positive rate of patients was 24.27%.When compared between positive group and negative group, the medians of sample collection times were 3 and 1(P<0.000 1); the medians of sample bottles were 4 and 4(P=0.001 2); the medians of WBC were 8.61×10⁹/L and 9.95×10⁹/L(P=0.001 7); and the medians of mechanical ventilation time were 179.5 hours and 47 hours(P<0.000 1); the medians of length of ICU stay were 17 days and 7 days(P<0.000 1), respectively. Hospital mortality rates in positive patients and negative patients were 35.87% and 20.21%(P=0.002 2), respectively. There was no significant difference(P>0.05) between the two groups in body temperature, NEU%, LYM, PLT, CRP or usage of antibiotics.

Increasing the frequency of sampling and the bottles of blood culture will improve the positive rate of blood culture. The body temperature, WBC, NEU%, LYM, PLT, CRP, us age of antibiotics, gender and age have no effect on the positive rate of blood culture. The patients with positive blood culture results have longer duration of mechanical ventilation, longer ICU stayand higher hospital mortality rate.

To demonstrate the ultrasonographic features of papillary thyroid carcinoma (PTC) in predicting associated cervical lymph nodes metastasis (LNM).

A total of 136 patients diagnosed with PTC in Beijing Tongren Hospital between January 2014 and September 2014 were enrolled.Of 136 cases, forty patients were confirmed with cervical lymph node metastasis.Seven were males, 33 were females, aged from 18 to 65 years old, mean age was (39.6±10.3) years .The remaining 96 were reported without lymph node metastasis.Twenty-one were males, 75 were females, aged from 23 to 86 years old, mean age was (47.7±12.8) years.Medical record was reviewed for demographic characteristics and pathological findings.The ultrasonographic features of each case were evaluated retrospectively.The difference of ultrasonographic features between the patients with and without LNM was examined.

There were 178 PTCs confirmed with pathology, 159 lesions (89.3%) were detected by ultrasonography, the remaining 19 lesions (10.7%) were under-detected.Of 136 patients with PTC, 40 cases (40/136, 29.4%) were confirmed with cervical LNM, while the remaining 96 cases (96/136, 70.6%) were determined without cervical LNM.PTC with cervical LNM was more frequently seen in the patients who were younger (P=0.000 5) and presenting with multifocal tumors (P=0.014 6). Ultrasonographic features of PTC which significantly associated with LNM were ill-defined margins (P=0.018), solid appearance (P=0.003), and presence of calcification (P=0.000). Of 40 cases with LNM, central cervical LNM was seen in 32 cases (80%), 72.5% of whom appeared as unilateral distribution.

Patients diagnosed with PTC with younger age and identified with multiple foci of tumors at the time of diagnosis are in an increased risk of associated cervical LNM.Ultrasonographic features of ill-defined margins, solid appearance and calcification in PTC are significant predictors of LNM.

To explore the clinical, pathological and imaging features of Ewing's sarcoma in pelvis and to improve knowledge and diagnosis of the disease.

A retrospective analysis of the clinical, pathological and imaging data of pathologically confirmed 13 cases of Ewing's sarcoma in pelvis was carried out between May 2008 and March 2016 in the Affiliated Hospital of Hangzhou Normal University, the Third Hospital of Hebei Medical University and the Second Hospital of Hebei Medical University.

The median age 13 cases of pelvic primary Ewing's sarcoma was 17 years old.The X-ray and CT imagings showed osteolytic and mixed bone destruction, CT showed mixed type in 10 cases, 8 cases of bone tumors as a flocculent, 10 cases of bone expansion failure, 10 cases of periosteal reaction, the layered 5 cases, radial in 5 cases.Thirteen cases showed soft tissue mass, soft tissue mass was equal or slightly lower density.Four cases showed heterogeneous contrast enhancement.The lesions showed low signal in T₁WI and mixed high signal in T₂WI of magnetic resonance imaging(MRI). The boundary of the lesions were obscure, and 5 cases had patchy necrosis area, and 9 cases had incomplete false capsule, surrounding soft tissue was violated.Four cases showed heterogeneous contrast enhancement after MRI enhancement scan.

The age of onset of Ewing's sarcoma of the pelvis is more concentrated in about 15 years.The imaging feaures are mixed bone destruction and more bone is swelling and permeability damage, soft tissue mass is larger, bone tumor is cloudy or acicular, periosteal reaction in a layered and radial, most cases show that the false envelope is not complete.Combined with clinical and imaging examination, the diagnosis of the disease can be made.

To investigate the application effect of oncolytic herpes simplex virus Once Vex^GM-CSF and adriamycin in malignant tumor.

A total of 102 cases of malignant tumor were analyzed retrospectively from April 2013 to April 2015 of Cancer Treatment Center of Affiliated Hospital of Beihua University, and these cases were randomly divided into trial group (n=51) and control group (n=51). The control group was treated with adriamycin and the trial group patients received conditionally replicating adenoviruses on the basis of the control group.The adenovirus proliferation was analyzed via quantitative PCR to investigate the malignant tumor cell inhibitory action in two groups.

Treatment group total effective rate (96.1%, 49/51) was significantly higher than the control group (78.4%, 40/51) (χ²=7.845, P=0.014). There were statistically significant difference of the killing capability between trial group (86.3%, 44/51) and control group (23.5%, 12/51) (χ²=7.859, P=0.013). Tumor shrinkage rate of trial group(76.5%, 39/51) was superior to that of the control group(19.6%, 10/51), the difference was statistically significant (χ²=7.654, P=0.019). There was statistically significant difference of the decrease of tumor marker CA125 between trial group (74.5%, 38/51) and control group (23.5%, 12/51) (χ²=7.342, P=0.023).

Once Vex^GM-CSF can effectively kill the tumor cells in the treatment of malignant tumor, and shrink the tumor significantly.

To investigate the incidence, occurrence time and types of aphakic glaucoma following infantile congenital cataract surgery.

The records of children who underwent surgery for congenital cataract within the first 24 months of life between January 2010 and January 2014 at the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed.Children with preoperative conditions associated with glaucoma were excluded.The following parameters were ascertained: age received cataract surgery, operation method, the incidence, occurrence time and types of glaucoma.

A total of 205 patients (324 eyes) with an average surgery age of 13.9 months were included, and the mean follow-up time was 47.6 months.The operation method was cataract extraction combined with posterior continuous circular capsulorhexis and anterior vitrectomy.Twenty-nine patients (37 eyes, 11.42%) had subsequent development of aphakic glaucoma, 9 eyes of which (2.78%) developed early onset angle closed glaucoma, and the occurrence time was (4.2±2.6) months after cataract surgery; 28 eyes (8.64%) developed late onset open angle glaucoma, 26 of which was angle open glaucoma, and the rest two was angle closed glaucoma.The occurrence time was (37.5±11.0) months after cataract surgery. Twenty-nine patients (37 eyes) developed aphakic glaucoma had cataract surgery within 2 to 12 months (6.8 months on average). The rest 176 patients (287 eyes) who did not develop glaucoma had cataract surgery at 10 to 24 months (14.1 months on average).

The incidence of aphakic glaucoma following infantile congenital cataract surgery is 11.42%.Aphakic glaucoma is divided into two types of early onset angle closed glaucoma and late onset open angle glaucoma.The occurence time of glaucoma was 2 months to 64 months after cataract surgery.Late onset open angle glaucoma is the most common type.

To evaluate the value of T-cell interferon releases detection of tuberculosis infection(T-SPOT.TB)assay in quick diagnosis of spinal tuberculosis.

From January 2012 to June 2015, a group of 122 diagnosed patients with spinal tuberculosis in the Qingdao Municipal Chest Hospital and a group of 86 patients suspected with spinal tuberculosis in Department of Orthopaedic, the Qingdao Third People's Hospital were accepted to undergone TB-DOT, T-SPOT.TB and TB-DNA PCR tests Department of Clinical Laboratory.

The sensitivity of TB-DOT, T-SPOT.TB and TB-DNA PCR tests were 69.7%, 86.1% and 56.6%, respectively.The sensitivity of T-SPOT.TB was significantly higher than TB-DOT and TB-DNA PCR tests (χ²=9.51, P<0.05; χ²=25.96, P<0.05). The specificity of TB-DOT, T-SPOT.TB and TB-DNA PCR tests were 62.8%, 88.3% and 91.9%, respectively.The specificity of T-SPOT.TB was significantly higher than TB-DOT test (χ²=15.25, P<0.05).

T-SPOT.TB assay possesses high sensitivity and specificity in quick diagnosis of patients with spinal tuberculosis, which is valuable in diagnosis of spinal tuberculosis.

To explore the relationship between nuclear factor (NF)-κB and vitro nature degeneration model of endplate chondrocyte in rats.

Rats endplate chondrocytes were isolated and cultured in vitro.Rebulated vitro natural degeneration model and cells were divided into control group (P2 cells group), naturally passaged group (P5 cells group) and NF-κB signaling pathway inhibition group (added Bay11-7082 when the passaged to P5 cells). The changes of cellular morphology were observed by inverted phase contrast microscope, the phenotype of endplate chondrocyte were identified by toluidine blue staining, electromagnetic compatibility (EMC) were observed by alcian blue staining.Type Ⅱ collagen, sry related HMG box (SOX)-9, matrix metalloproteinase(MMP)13 and aggrecan genes were detected by real time-polymerase chain reaction (RT-PCR) to verify the degeneration mode.NF-κB transcriptional activity was assessed by examining cytosolic phosphorylated IκBα and nuclear phosphorylated p65 levels by Western blot.

With chondrocytes passing, the cells lost the original morphology gradually.Alcian blue stains observed EMC decreased in naturally passaged group.The leave of Type Ⅱ collagen (P5/P2=0.182, P<0.01), aggrecan (P5/P2=0.287,P<0.01) and SOX-9 (P5/P2=0.488,P<0.01) were significantly reduced, MMP13 (P5/P2=1.324,P<0.05) significantly increased.Western blot analysis showed that in P5 cells nuclear phosphorylation p65 and cytosolic levels of phosphorylated IκBα increased and Bay11-7082 treatment attenuated increase in nuclear phosphorylation p65 and blocked acidinduced increase in cytosolic levels of phosphorylated IκBα.Moreover, the leave of Type Ⅱ collagen (Bay11-7082/P5=4.173,P<0.01), aggrecan (Bay11-7082/P5=2.732,P<0.05) and SOX-9 (Bay11-7082/P5=1.567,P<0.05) significantlyincreased, MMP13 (Bay11-7082/P5=0.611,P<0.05) significantly reduced in treatment group.

Inhibitor NF-κB signaling pathway plays an important role in the vitro degeneration of endplate cartilage.Reasonable regulation of NF-κB signaling pathway may be a new way to prevent Intervertebral disc degeneration.

To investigate the effects of a dual phosphoinosmde-3-kinase (PI3K)/ mammalian target of rapamycin (mTOR) inhibitor, PI-103, cooperating with tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on the laryngeal squamous carcinoma Hep-2 cells.

Hep-2 cells were divided into 7 groups: LY294002 group, Rapamycin group, PI-103 group, LY294002+ TRAIL group, Rapamycin+ TRAIL group, PI-103+ TRAIL group and control group.The cell cycle and apoptosis of Hep-2 cells were assessed by flow cytometry.For PI-103 group, PI-103+ TRAIL group and control group, migration and invasion ability were measured by transwell migration and invasion assay respectively.The expression of relative proteins in apoptosis and PI3K/AKT/mTOR signal pathway was examined by Western blotting.

Combination of PI-103 and TRAIL could make cell cycle arrest at S phase (G1: 1.80%±0.30%; G2: 0.00), inhibit cell proliferation, and enhance apoptosis (66.78%±2.93%) (P<0.05). Combination of PI-103 and TRAIL could statistically decrease the migration and invasion number of Hep-2 cells (17.0±3.4, 18.4±5.4) than that of PI-103 group (41.2±3.8, 41.6±4.7). PI-103 could inhibit PI3K/AKT/mTOR signal pathway by decreasing the protein expression of p-AKT and p-4E-BP1.Comparing with the control group, the expression of cysteinyl aspartate specific proteinase (Caspase) 9, 8, 3 were increased while the expression of Cyclin D1, Cyclin E1, p-AKT, p-4E-BP1 were decreased in PI-103 and PI-103+ TRAIL group (P<0.05).

Enhanced anti-tumor effects was observed by combination of PI-103 and TRAIL on laryngeal cancer cells in vitro and this combined administration might be a promising strategy for clinical treatment of laryngeal cancer.

This study was designed to observe the antioxidant effects of hyperbaric oxygen (HBO) on brains of rats after acute carbon monoxide (CO) poisoning.

Sixty-six Sprague-Dawley (SD) male rats were divided into three groups including control group, CO group and HBO group.Morris water maze experiments were used for monitoring cognitive function.Antioxidant capacities were evaluated by detecting T-AOC, GSH-PX, GR and CAT activities in the brain.

Compared with the control group (45±17, 43±14, 35±12, 34±11, 29±13) s and the HBO group (40±10, 39±6, 35±9, 31±11, 21±10) s, the CO group (57±5, 54±8, 52±8, 52±10, 46±8) s had the longer escape latency (P<0.05). Compared with the control group (51±6) s and the HBO group(40±10) s, the CO group (8±5) s had the shorter swimming time in I quadrant (P<0.05). Compared with the control group (1.25±0.40) U/mg and the HBO group(0.97±0.31, 0.97±0.39, 1.45±0.15, 1.40±0.25, 1.20±0.20) U/mg, the CO group (0.68±0.09, 0.45±0.17, 0.71±0.18, 0.69±0.29, 0.48±0.29) U/mg had the lower T-AOC activity of brain tissue.The GSH-PX activity (42±13, 106±46, 197±49, 173±42, 429±58) U/mg in the CO group decreased compared with the control group (182±53) U/mg and the HBO group (203±63, 325±86, 389±29, 385±100, 453±32) U/mg.GR activity (4.3±0.7, 2.6±0.5, 3.0±1.2, 1.8±0.8, 3.2±1.9) U/mg in the CO group decreased compared with the control group(14.5±3.0) U/mg and the HBO group (13.9±3.3, 4.3±1.0, 3.9±0.7, 4.8±0.9, 4.6±0.9) U/mg.CAT activity (1.6±0.8, 4.3±1.6, 3.9±1.0, 8.5±2.6, 5.4±1.7) U/mg in the CO group decreased compared with the control group(5.2±1.3) U/mg and the HBO group (5.2±2.2, 8.8±2.8, 5.3±1.0, 9.2±2.1, 14.1±3.8) U/mg.

HBO can improve the behavior of rats after acute CO poisoning.The antioxidant capacity in rat brain tissue after acute CO poisoning decreases, while after the HBO therapy, the antioxidant capacity in rat brain tissue can increase.

A 37-year-old female was admitted to Taizhou People's Hospital of Jiangsu Province with abdominal pain for 1 d. The patient had abdominal pain without obvious trigger, progressive aggravation, vomiting twice, abdominal distension, previous history of cesarean section and ectopic pregnancy, slight tension in the abdominal wall during physical examination, tenderness in the whole abdomen, mainly in the lower abdomen, positive mobile voicing, and normal intestinal sounds. Laboratory tests: blood amylase 31 U/L, hemoglobin 95 g/L. Transabdominal B-ultrasound of uterine adnexes showed mixed echoes of 8.2 cm ×3.1 cm in the posterior pelvic cavity of the uterus, and the internal echoes were messy (Figure 1)。 Emergency total abdominal CT plain scan + enhancement showed a large amount of blood and fluid accumulation in the abdominal and pelvic cavities, full uterine shape, multiple tortuous enhanced vascular shadows around the uterine body, 3 cm ×2 cm mass-shaped annular enhancement shadows in the right uterine corner, no obvious contrast medium exudation shadows, and annular enhancement shadows in the right adnexal area (Figure 2)。 Emergency urinary pregnancy test was positive with chorionic gonadotropin>10 000 IU/L. Emergency laparoscopic abdominopelvic exploration: 1 000 ml of abdominopelvic hemorrhage and clotting, full uterus, absence of right fallopian tube, a 3 cm ×2 cm ×2 cm protrusion formed in the right uterine horn and the stump of the right fallopian tube interstitium, with a purple-black surface, a rupture and active bleeding were seen, the interstitial part of the fallopian tube was incised to the horn of the uterus, about 3 cm long, and villus was extruded. Intraoperative diagnosis: rupture of pregnancy of the fallopian tube stump. Pathological results: A small amount of basal decidua, villi and trophoblast cells were found in the right uterine horn clot, and local trophoblast cell proliferation stage.

perioperative visual loss (POLV) can occur during or after non-eye surgery. This phenomenon is very rare, but once it occurs, it will bring disastrous consequences for both doctors and patients. Non-eye surgery POLV is a ghost that quietly arrives with the development of surgery and anesthesiology. It was first developed by Slocum et al.^[1]It was reported in 1948 and later reported in various surgical fields. Based on some physicians' sense of self-protection or fear of causing disputes, the number of reported cases of non-eye surgery POLV should be much smaller than the true number of cases. In recent years, with the gradual increase of the number of cases, this phenomenon has gradually attracted people's attention. The American Society of Anesthesiologists (ASA) established a POLV registry in 1999, developed a POLV patient manual, recommended that patients be fully informed about POLV before surgery, and conducted relevant research^[2]。

Takayasu arteritis is an immune-related chronic non-specific, granulomatous macrovascular vasculitis that mostly occurs in young women and is common in Southeast Asian countries such as China, Japan and India, and Turkey in the Middle East. Takayasu arteritis progresses latently, mainly involving the aorta and subclavian artery, common carotid artery, renal artery and other branch arteries. Chronic vascular fibrosis leads to wall thickening, lumen stenosis, ischemia and functional impairment of corresponding organs. Patients can show systemic symptoms such as fever, fatigue, and weight loss, as well as symptoms or signs of vascular involvement such as hypertension, pulselessness, vascular murmur, and dizziness. Since Japanese scholars reported the disease in 1908, Takayasu arteritis has been reported all over the world. At present, with the improvement of imaging technology, the diagnosis rate of Takayasu arteritis has also increased. However, the research of Takayasu arteritis is obviously lagging behind in the field of rheumatism, and most of them are case reports, case analysis and cross-sectional studies. In recent years, foreign basic and clinical research on Takayasu arteritis has made progress, including serological markers of the disease, disease assessment system and treatment plan, etc. However, there is no systematic basic and clinical research on Takayasu arteritis in China, and due to regional and ethnic differences, the diagnosis, assessment system and treatment plan of Takayasu arteritis proposed abroad need to be verified in the Chinese population before they can be applied and popularized in clinical practice. The progress in the diagnosis, disease assessment and treatment of Takayasu arteritis is summarized as follows.

computer tomography perfusion imaging (CTPI) is a technique developed based on the principle of calculating organ blood flow in nuclear medicine. It can reflect the hemodynamic state of tissues and organs, and belongs to the category of functional imaging. The quantitative study of perfusion parameters of liver is helpful to detect the hemodynamic changes of liver lesions before the morphology changes, and has a wide clinical application prospect. This article reviews the characteristics of liver CTPI and its value in evaluating the biological characteristics and therapeutic efficacy of hepatocellular carcinoma.