Abstract:Transsphenoidal microsurgery has become a major approach for removal of pituitary adenomas. Due to the anatomic differences of skull base between Chinese and foreigners and the different experience of surgeons, the pre- and post-operation managements of the operation are different. From 1982 to 2002, a total of 1 047 patients received transsphenoidal removal of pituitary adenomas in our hospital and gained satisfactory outcomes. This article summarizes our experience on 1 047 patients and discusses some relevant problems, including the diagnostic standards of adenoma size, surgery indications, the apoplexy operation, the re-operation for recurrent cases, management of complications, post-operation radiotherapy, and the anatomy of sphenoidal sinus and sellar area, hoping to improve the successful rate of the operation.

Abstract:Objective：To detect and analyze the mycoplasma infection in human laryngeal carcinoma and to explore the relationship between the infection with the development, progression and prognosis of laryngeal cancer. Methods： Immunohistochemical methods were employed to detect the mycoplasma infection in 214 specimens of different laryngeal lesions and cervical lymphatic tumors metastasized from laryngeal cancer, including 121 laryngeal cancer specimens, 21 laryngeal precancerous specimens, 17 vocal cord polypus specimens, 14 normal laryngeal tissues adjacent to cancer tissues, 9 normal laryngeal tissues opposite to the cancer, and 32 cervical lymphatic tumor specimens metastasized from laryngeal cancer. The infection results were subjected to statistical analysis. Results： The positive rates of mycoplasma 2G10 antibody in laryngeal carcinoma specimens, cervical lymphatic tumor specimens metastasized from laryngeal cancer, laryngeal precancerous specimens, vocal cord polypus specimens, normal laryngeal tissues adjacent to cancer tissues, and normal laryngeal tissues opposite to the cancer were 44.63% （54/121） ,34.38%（11/32） ,23.81%（5/21） ,17.65%（3/17） ,7.14%（1/14） ,and 0%（0/9）, respectively, with those of laryngeal carcinoma specimens and cervical lymphatic tumor specimens metastasized from laryngeal cancer significantly higher than those of other specimens（P〈0.05）. The positive rate of early stage laryngeal carcinoma （Ⅰ-Ⅱ stage, 16.36 % [9/55]） was significantly lower than that of advanced stage laryngeal carcinoma（ Ⅲ-Ⅳ, 68.18 % [45/66]）, （P〈0.01）. The positive rate of laryngeal carcinoma with cervical metastasis was higher （62.50%[20/32]） than that without cervical metastasis（35.96%[32/89]） ,（P〈0.01）. The 3- and 5-year survival rates of Ⅲ-Ⅳ stage patients positive of 2G10 antigen （60.0%[27/45], 58.14%[25/43]） were lower than those of patients negative of 2G10 antigen （85.71 % [18/21] ,84.21% （[16/19]）, （P〈0.05）. Conclusion： Laryngeal carcinoma has a high infection rate of mycoplasma, which may be related with the development, progression and prognosis of laryngeal carcinoma.

Abstract:Objective：To provide anatomic data for management of pterygopalatine fossa lesions via endoscopic transnasal approach. Methods： Fifteen （30 sides） formalin-preserved human skulls were subjected to microsurgical dissection to evaluate the exposure scopes of 3 different endoscopic surgery approaches： endonasal middle meatal transpalatine approach, endonasal middle meatal transantral approach, and endonasal inferior turbinectomy transantral approach. Meanwhile, 20 （40 sides） dry skulls were dissected and the related measurements were obtained. Results： The 3 approaches allowed for different exposure of the pterygopalatine fossa structure. The mean distances from foramen rotundum to anterior nasal spur, superior orbital fissure, and optic canal were （61.86±3.67）mm,（3. 56±0. 75） mm,and （11.23±1.24） mm, respectively. Conclusion： The 3 endoscopic approaches are safe and effective for resection of different pterygopalatine fossa lesions and foramen rotundum serves as a landmark for safe management of the pterygopalatine fossa.

Abstract:Objective：To search for a safe approach for transsphenoidal endoscopic pituitary surgery, so as to avoid injury of intercavernous sinuses during the operation. Methods： The anterior intercavernous sinus, posterior intercavernous sinus, inferior intercavernous sinus, basilar sinus, and dorsum sella sinus of 20 Chinese adult cadavers were surgically observed; and the relevant data were obtained and analyzed. Results： The existence rates of anterior intercavernous sinuses, posterior intercavernous sinuses, inferiorintercavernous sinuses, basilar sinuses, dorsum sella sinuses were 95%（19）, 75%（15）, 10%（2）, 100% （20） and 30%（6）,respectively; their anteroposterior diameters were （2.08±0. 90） mm,（5. 14±2. 54） mm,（1.30±0.40） mm,（2.26±1.02） mm, and （2. 01 ± 0. 80） mm, respectively; and their supra-inferior diameters were （2. 74 ± 0. 96） mm, （1.10±0.74） mm, （1.48±0.29） mm, （15.67±4.54） mm, and （3.35±1.93） mm, respectively. The distance between inferior edge of anterior intercavernous sinus and the anterior edge of posterior intercavernous sinus was （5. 78 ± 1. 89） mm. Conclusion：The intercavernous sinus should be avoided to expose the pituitary after opening the antapex of sella trucica during transsphenoidal endoscopic pituitary surgery. When the intercavernous sinus can not be avoided, reasonable incision and hemostatic method should be selected before operation to prevent severe bleeding.

Abstract:Objective：To search for sensitive indicators for the voice assessment of patients with larynx leukoplakia and to analyze the clinical relevance of voice assessment in diagnosis of larynx leukoplakia. Methods： Sixty-three patients with larynx leukoplakia （including 47 males and 16 females） were subjected to voice assessment by Dr. Speech software and the values of Jitter, Shimmer, normalized noise energy （NNE）, harmonics-to-noise ratios （HNR）, and fundamental frequency （Fo） were calculated. The results of the 47 male leukoplakia patients and 16 females were compared with those of normal controls （male 30, female 30） and of patients with vocal cord polyp （male 30, female 30） . Results： The Jitter and Shimmer values of male leukoplakia patients were obviously higher than those of normal controls and patients with vocal cord polyp; their HNR value was lower than those of normal controls and higher than those of patients with vocal cord polyp; their NNE value was lower than those of normal controls and patients with vocal cord polyp （all P〈0.05）; and their Fo value was similar to those of normal controls and patients with vocal cord polyp. Female leukoplakia patients had a similar result to the male ones. Conclusion： The Jitter, Shimmer, NNE, and HNR values can be used as sensitive indicators for voice assessment of patients with larynx leukoplakia; among them the Jitter and Shimmer values have the strongest sensitivity and can be used as indicators for diagnosis and prognosis of larynx leukoplakia.

Abstract:Objective：To express the granulysin protein in E. coli and to detect its bioactivity after purification. Methods： Using cultured human peripheral blood mononuclear cells as the template, we selectively amplified the fragment coding granulysin by RT-PCR. The fragment was then inserted into the prokaryotic expression vector pET28a （＋） for transforming E. coli BL21（DE3） plysS. Fusion protein expression was induced by isopropyl-Beta-D-thiogalactopyranoside （IPTG）. After renaturation, the protein was purified by affinity chromatography and its bioactivity was examined by colony-forming unit. Results： We successfully inserted granulysin cDNA fragment into vector pET28a （＋） and constructed the expression plasmid pET28a （＋）GNLY. The fusion protein, with a molecular weight of 9 000, was obtained through IPTG induction. After renaturation and purification, the recombinant protein was proven to be bioactive by CFU and its cytotoxicity was in a dose-dependent manner. Conclusion： The fusion protein obtained in the present study is bioactive and can be used for further study on its function,mechanism of action and clinical application.

Abstract:Objective： To construct a recombinant retroviral vector expressing pancreatic duodenal homeobox-1 （PDX-1） gene and express the PDX-1 expression cassette in liver progenitor cells （LEPCs）, so as to study the conversion of hepatic cells to pancreatic-like cells, Methods： The full length of PDX-1 gene was amplified by PCR and subcloned into pMSCVpuro vector. The pMSCV PDX-1 puro was then introduced into Phoenix package cells and the cell culture supernatant was used for Ping- Pong infection of another packaging cell line PT67 to obtain stable virus-producing cell line. Results： The pMSCV PDX-1 puro vector was successfully constructed and transfected into PT67 cells. The viral supernatants of PT67 cells efficiently infected LEPCs in vitro and the infected LEPCs stably expressed PDX-1 gene, Conclusion： The pMSCV PDX-1 puro vector and PDX-1 expressing LEPCs have been successfully constructed, laying a basis for studying the transdifferentiation of liver progenitor cells to pancreas lineage cells.

Abstract:Objective： To construct DNA vaccines expressing prostate-specific membrane antigen （PSMA） and/or granulocytemacrophage colony-stimulating factor （GM-CSF） and to determine their immunoactivity. Methods： Recombinant plasmids pIRES-PSMA-mGM-CSF , pIRES-PSMA, and pIRES-mGM-CSF were constructed with DNA vaccine vector plRES. Alter identified by endonuclease digestion, the above 3 plasmids and blank pIRES vector were used to immunize C56BL/6 mice （n= 15）. LDH release assay was used to exam the cytotoxicity of cytolytic T lyrnphocytes in each group. Results： We successfully constructed the above mentioned recombinant plasmids. Mice in pIRES-PSMA-mGM-CSF immunized group had the highest specific cytotoxicity, followed by pIRES-PSMA and pIRES-mGM-CSF immunized groups. The blank pIRES group had the lowest cytotoxicity （P〈0.05）. The cytotoxicity was the highest in all 4 groups at an effector/target ratio of 10/1. Condusion： The bicistronic DNA vaccine expressing PSMA and mGM-CSF may have a promising therapeutic value in gene therapy of prostate cancer.

Abstract:Objective：To develop a real time fluorescent quantitative reverse transcriptase polymerase chain reaction （RTPCR） system for determining the expression of Dicer mRNA in human hepatoma cell lines and 20 samples of primary hepatocellular carcinoma（PHC）tissues. Methods： The specific primers, designed according to the complete sequence of Dicer mRNA, and the fluorescence dye SYBR Green I were used for RT-PCR amplification. The fluorescence was monitored in a real time manner. The expression levels of Dicer mRNA in samples were calculated according to the standard curve and the nonspecific amplifications were excluded by melting curve analysis. The mRNA levels of Dicer were presented as the ratios of Dicer mRNA to 18S rRNA. Results： The linear detection range of this system was from 5 × 10^2to 5 × 10^9 copies/btl and the coefficient of variation values for intra-experimental and inter-experimental reproducibility ranged from 4. 13% to 19. 72% and from 6.25% to 18.76%, respectively. The expression levels of Dicer mRNA in HBV positive hepatoma cell line HepG2.2.15 or in HBV negative hepatoma cell line HepG2 were significantly lower （P~0.05） compared to those of the normal liver cell line WRL-68; and those in PHC tissues were lower compared to those in the corresponding adjacent tissues of PHC （P〈0. 05）. Conclusion： Real time fluorescent quantitative RT-PCR has good sensitivity, specificity and reproducibility in determining Dicer mRNA levels. Determination of Dicer mRNA levels in hepatoma cell lines and PHC tissues lays a good theoretical foundation for further studying the mechanism of PHC

Abstract:Objective：To evaluate the influence of rhCD40L on mononuclear macrophage, U937 cells, secreting matrix metalloproteinases （MMPs） and its possible mechanism. Methods： U937 cells were treated with different concentrations of rhCD40L and NS-398 （specific antagonist of COX-2） for 24 h and the supernatants were harvested. Cells treated with 0.4 μg/ml rhCD40L were further treated with 10^-4 mol/L NS-398 or aspirin separately for 24 h and the supernatants were harvested. Zymography was used to determine the activities of MMPs in the above supernatants. Results： rhCD40L increase the activity of MMP-2 and MMP-9 in a dose-dependent manner （P〈0.01） ; the increased peaked when rhCD40L was at 0.4 μg/ml. NS-398 inhibited the activity of MMP-2 and MMP-9 in a dose-dependent manner （P〈0.05）. NS-398 and aspirin both significantly inhibited the activity of MMP-2 and MMP-9 induced by rhCD40L （P〈0.05）. Conclusion： rhCD40L can induce U937 cells to secrete MMPs in a dose dependent manner, which might be related to COX, more possibly through COX-2 than COX-1 pathway

Abstract:Objective：To investigate the effect of carboxymethylchitosan on autocrine growth factor and morphology of fibroblasts cultured in vitro, so as to discuss the possible mechanism by which carboxymethylchitosan alleviates overhealing and prevents adhesion in wound healing. Methods： Fibroblasts were cultured in vitro. Fibroblasts of passage 4-6 were treated with different concentrations of carboxymethylchitosan （0.01,0.1,1.0 and 10 mg/ml） for 4 days or with 0. 1 mg/ml carboxymethylchitosan for 1, 2, 3, 4, 5, and 6 days. The levels of autocrine transforming growth factor-β1 （TGF-β1） and epidermal growth factor （EGF） of fibroblasts were determined by ELISA and radioimmunoassay. The fibroblastic morphology was detected by transmission electron microscopy （TEM） and microscope after fibroblasts were treated with different strategies. Results.. Carboxymethylchitosan（≥0.1 mg/ml）inhibited autocrine TGF-β1 of fibroblast in a time- and concentration dependent manner （P〈0.05）. However, Carboxymethylchitosan had no obvious influence on the secretion of EGF（P〉0.05）. Carboxymethylchitosan （≥0.1 mg/ml）also inhibited the proliferation of fibroblasts and caused their ultrastructural changes. Conclusion： Carboxymethylchitosan （≥0.1 mg/ml）can inhibit fibroblasts proliferation and reduce tissue adhesion, possibly through altering fibroblast ultrastructure and selectively inhibiting secretion of TGF-β1

Abstract:鼻咽癌常以回缩涕中带血、鼻塞、耳鸣、耳闷、听力下降以及颈部淋巴结肿大为首发症状，而以外展神经麻痹为首发症状的较为罕见，现报告2例。[第一段]

Abstract:Objective：To study the biological characteristics and the differentiation ability of multipotent adult progenitor cells （MAPCs） in vitro and to observe the clinical outcome of MAPC differentiated cells in treatment of ischemic heart disease （IHD） in rabbits, so as to assess the feasibility of transplanting MAPCs in treatment of cardiac infarction. Methods： The bone marrow mononuclear cells were separated from volunteer bone marrow by gradient density centrifugation. The mononuclear cells were separated in CD45 and GlyA fractions by magnetic cell sorting （MACS）. The viability of MAPCs was assessed by trypan-blue assay and their purity were detected by flow cytometry. After cultured with 5-azacytidine （10 μmol/L） for 24 h, MAPCs were subjected to transmission electron microscopic observation. The myogenic cells differentiated from MAPCs were transplanted into the myocardial infarction sites in rabbits and the improvement of their cardiac function was evaluated. Results： The viability of unpurified MAPCs were （96.7±1.7）%, which was not significantly different from that of the purified MAPCs （96.0±2.4） %. The purity of MACS-sorted CD45^- and GlyA^- cells was 〉98%. Thick myofibers were observed by transmission electron microscopy after induction with 5-aza. Four weeks after transplantation, the left ventricle ejection fraction, the movement extent of left ventricle, left ventricle systolic wall thickening and dp/dt of rabbits were all higher than those of the control group and cardiac infarction model group （P〈0.05 or 0.01）, but lower than those of the sham operation group （P〈0.05）. Conclusion： The human MAPCs can differentiate into myogenic cells in the presence of 5-aza. The cardiac function of cardiac infarcted rabbits can be improved by MAPCs transplantation

Abstract:Objective：To investigate the feasibility of inducing canine bone marrow mesenchymal stem cells （BMSCs） to differentiate into epithelium-like cells in vitro and the basic inducing conditions. Methods： BMSCs were obtained from healthy adult canine bone marrow aspirates and were purified by density gradient centrifugation and anchoring culture. BMSCs of second passage were cultured with 4 different media.. K-SFM＋ EGF＋ BPE, DMEM4- EGF, K-SFM＋ BPE, and DMEM＋ FBS. The changes in cell morphology were observed daily under phase-contrast microscopy and cell growth curves of every group were drawn by the continual cell counting. The cells were identified by immunocytochemistry staining and flow cytometer through detecting cytokeratin （CK） and epithelial membrane antigen （EMA） on the 7^th and 14^th day of induction. Results.. A few BMSCs in K-SFM＋EGF＋BPE group became round or oval with processes on the 7^th day of induction; more BMSCs became round or oval and their phenotypic markers were CK＋ and EMA＋ on the 14^th day. FACS analysis showed that CK or EMA positive cells were rare in K-SFM＋EGF＋BPE group on the 7^th day after induction （〈1%）, and the number of positive cells were increased （〉 7 %） on the 14^th day. Cell morphology had no obvious change in DMEM＋EGF, K-SFM＋BPE, and DMEM＋FBS groups during the whole culture process. Moreover, cells in DMEM＋ EGF, K-SFM＋ BPE, and DMEM＋ FBS group were negative for CK and EMA. Conclusion： Our experiment indicates that the combination of K-SFM, EGF and BPE can induce canine BMSCs to differentiate into epithelium-like cells in vitro.

Abstract:1 临床资料 患者，男，56岁，2004年11月因声嘶、说话含水音及吞咽异物感3个月入院，查体：心肺肝肾无异常。专科检查：喉体无明显扩大，颈部未触及明显肿大淋巴结。电子喉镜下见喉腔左侧声门区及声门下区有一隆起新生物，左喉室下方、左声带、左声门下区3．5cm范围受肿瘤侵及，左声带固定，肿瘤表面欠光滑。喉增强CT扫描示左侧喉腔见一3．8cm×2．7cm×3．5cm大小肿块，内有多发点状、斑片状高密度钙化影，左甲状软骨板受到破坏，颈部未见肿大淋巴结。于2004年11月26日在全麻下行扩大全喉切除术，[第一段]

Abstract:Objective：To establish a white noise-induced stress ulcer model in rats and to assess the changes of gastric parietal cell configuration and acid secretion under noise stress. Methods： Rats were randomly divided into 3 groups： NS 4 h,8 h and control groups. The rat NS model was induced by white noise. The pH values of gastric juice were measured by the pH/mV pH meter and the gastric ulcer index （UI） was evaluated. The stomach tissue was processed for immunofluorescence detection and the 13 subunit of H^＋ , K^＋-ATPase was immunostained. The gastric parietal cell configuration was observed with conventional microscopy and confocal laser scanning microscope. Results.. （1） The pH value of NS 4 h group （2.22 ± 0.05） was significantly lower than that of control group （2.59±0.21, P〈0.05） , but higher than that of NS 8 h group （1.31±0.06,P〈0.01）. （2） The UI of NS 4 h group （10.5±1.29） was significantly higher than that of the control group （P〈0.05）, but significantly lower than that of NS 8 h group （34. 36±2. 22, P〈0. 01）. （3） The reticular pattern parietal cells in NS 4 h group （55.5±3.42）/100 was significantly higher than that in control group （42.5±3.70/100, P〈0.01）, but lower than that in NS 8 h groups （62.0±3.46 /100,P〈0.05）. （4） The pH was negatively related with both UI （r=-0.85, P〈0.05） and the number of reticular parietal cells （r= -0.89, P〈0.05）. Conclusion： A white noise-induced stress ulcer model has been successfully established in rats. NS rats develop gastric mucosal lesions with increased acid secretion, which is closely related with the oxyntic function of parietal cells.

Abstract:Objective：To study the distributions of velocity, wall pressure and wall shear stress of blood flow in the human thoracic aorta under normal physiological pulsatile flow conditions, so as to provide a theoretical foundation for elucidating the pathogenesis of aortic dissection. Methods： By virtue of the Computational Fluid Dynamics and the fundamentals of hemodynamics, the authors obtained the numerical simulations and flow visualizations of pulsating blood flow in the human thoracic aorta. Results： The distributions of velocity, wall pressure, wall shear stress and path line of the blood flow in the thoracic aorta were calculated with a function of time in the cardiac circle. The systoltic wall pressure and its dp/dt were higher than diastolic wall pressure and its dp/dt. The pressure of lateral wall was higher than the pressure of medial wall during systole. A distinct depressed pressure was found located at the intersection between aortic arch and descending aorta. Shear stress of wall of lateral aortic arch was less than that of medial wall of aortic arch and the shear stress change in medial wall of aortic arch was greater than that in the lateral aortic wall. The shear stress was in a cyclic and alternative manner. Conclusion.. The findings suggest that the wall pressure may be related to the development of aortic dissection.

Abstract:Objective：To evaluate the clinical value of MR cholangiopancreatography （MRCP） as the only imaging procedure in diagnosing biliary complications after orthotopic liver transplantation （OLT）. Methods： The MRCP results were analyzed in 54 consecutive patients presented with clinical or biochemical signs of biliary complications after receiving OLT, and were compared with the findings eventually confirmed by surgery, direct cholangiography, and clinical follow-up. Two different MRCP snapshot techniques were applied： thick-slab T2-weighted sequences and multi-section thin-slab T2-weighted sequences. Results： Surgery, direct cholangiography, and clinical follow-up confirmed that 36 patients had biliary complications. MRCP had a sensitivity of 100% （36/36） in diagnosing biliary complications after OLT, with a positive predictive value of 91.7% （33/ 36）, a false-positive rate of 5.56% （2/36）, and an overall diagnostic accuracy of 94.4%（51/54）. MRCP as the only imaging procedure achieved a specific diagnosis in 96.3% （52/54） of the patients in the present study. Only 2 patients required additional endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholecystostomy. Direct cholangiography was required only as a therapeutic procedure in 25.9% （14/54） of the patients. Conclusion： MRCP is an effective imaging procedure in the assessment of biliary complications after OLT. Direct cholangiography is not needed for diagnosis but should be reserved as a therapeutic procedure.

Abstract:Objective： To study the MR spectroscopic characteristics of orbital tumors and normal tissues in vitro by the super high field MR, so as to provide theoretical basis for clinical application of MR spectroscopy （MRS）. Methods： Ten tumor specimens （including 7 benign ones and 3 malignant ones） and 2 normal tissue samples received MR spectroscopic examination by BRUKER AVANCE 400（SB）super high field MR, and their MR spectroscopic characteristics were compared. Results： ^1H- MRS with super high field MR showed that the Cho and Cr peaks of malignant orbital tumors were higher than those of benign tumors. Three consecutive single peaks were noticed around 2 × 10^-6 in the MRS of benign and malignant tumors, but not in that of normal tissues. Conclusion： ^1H-MRS can differentiate benign, malignant orbital tumors and normal tissues, making it worth of further study for clinical application.

Abstract:Objective：To investigate the regulatory effect of dexamethasone on NF-κB and its target gene cyclinD1 in human prostate cancer cell line PC-3, so as to explore the anti-proliferation mechanism of dexamethasone. Methods.. The inhibitory effects of dexamethasone on growth of PC-3 cells were determined by MTT. The basic transcriptional activity of NF-κB in many kinds of tumor cells and the effects of dexamethasone on the activation of PC-3 cell NF-κB were determined by reporter gene assay. The expression of cyclinD1 protein was determined by Western blots. Results： Dexamethasone inhibited the growth of PC- 3 cells and NF-κB was constitutively activated in the PC-3 cells. Dexamethasone also inhibited the activation of NF-κB and down-regulated the expression of cyclinD1 protein in PC-3 cells. Conclusion： Dexamethasone can inhibit cell growth of prostate cancer cell line PC-3 ,which might be related to the inhibitory effect of dexamethasone on the transcriptional activation of NF-κB and cyclinD1 protein.

Abstract:Objective：To investigate the bioactive chemical constituents in Bidens bipinnata L. for treatment of diabetes. Methods： Extraction was done with 80% EtOH; isolation and purification were carried out on silica gel,C18 silica gel column, and Sephadex-LH20 column; and the chemical structures of the products were identified by physicochemical properties and spectral analysis. Results： Nine compounds were obtained from Bidens bipinnata L. and their chemical structures were identified as： quercitin（ Ⅰ ）, hyperoside （ Ⅱ ） ,quercitin-7-O-rhamnopyranoside（ Ⅲ ） ,6,7,3 ＇4 ＇-tetrahydroxy aurone（ Ⅳ ） ,4,5-di-O- caffeoyl quinic acid（ Ⅴ ） ,stigmasterol 3-O-glucopyranoside （ Ⅵ ）, ethyl 3,4-dihydroxybenzoate（ Ⅶ ）, okanin（ Ⅷ ）, and luteolin（ Ⅸ ）. Conelusion： Except for okanin and hyperoside,the rest 7 compounds are isolated from the plant for the first time.

Abstract:Objective：To extract and identify the chemical constituents in the roots and stems of Tabernaernontana divaricata. Methods： The solvent extraction approach and silica column chromatography were used for separation of the chemical constituents, and their structures were identified by physicochemical properties and spectra analysis. Results： Seven compounds were isolated and their structures were identified as α-amyrin （1）, α-amyrin acetate （2）, α-amyryl octadecanoate（3）, taraxasterol acetate （4）, calycosin （5）, formononetin （6） ,and farnisin （7）. Conclusion： Compound 1, 3, 4, 5, 6 and 7 are isolated from this plant for the first time, and Compound 3, 4, 5, 6 and 7 are isolated from Tabernaemontan genus for the first time

Abstract:Chest wall resection and reconstruction remains a severe challenge for reconstructive surgeons, which often leads to conservative treatment regimens in clinical practice, consequently resulting in poor outcomes （high morbidity and mortality）. In recent 20 years, advances in muscle flap surgery and availability of chest reconstructive prosthesis have encouraged the surgeons to take an active attitude toward chest wall resection; many ＂unresectable＂ lesions now have a chance to be resected and cured. This article reviews the problems concerning the principles for chest wall resection, reconstruction, prosthesis selection, etc. in chest wall reconstruction

Abstract:Objective： To establish a high performance liquid chromatography/tandem mass spectrometry （HPLC-MS） method for determination of cyclosporin A level in the whole blood. Methods： A Hypersil C8 column （65 ℃, 4.6 mm × 150 mm, 5 μm） was used with a mobile phase of acetonitrile-acetic acid （pH 4.50） 70 ： 30 at a flow rate of 1.0 ml · min^-1. Atomospheric pressure electronic spray ionization was used to quantify cyclosporin A, with the capillary voltage being 4 000 V, the flow of drying gas being 8.0 L · min^-1 , nebulizer pressure being 30 psi, and fragment voltage being 140 V. Results： The calibration curve of cyclosporin A was linear in a range of 26.68 -1 067 μg · L^-1 ： y=0. 001 1x-0. 004 6（r=0. 999 3）. The lowest limit of detection was 4. 35 μg · L^-1. The method recoveries of low, medium and high concentrations cyclosporin A were （89.81±4.91）%, （104.5±3.73）%, and （95. 17±2.33）%, respectively; the extraction recoveries of 3 concentrations were （77.64 ± 4.38）%, （78.01 ±3.79）%, and （83.02±1.59）%, respectively. The intra-day and inter-day RSD was less than 6%, and the RSD was less than 5% in 150 days. Conclusion： The present method is fast, sensitive and selective. It is suitable for clinical monitoring of cycolsporin A.

Abstract:Objective：To establish a mouse model of human orbital rhabdomyosarcoma（RD）. Methods： RD cells were cultured and implanted subcutaneously into the costal regions of nude mice and severe combined immunodeficiency （SCID） mice （4 weeks old）. The nude mice were radiated by ^60Co 1 day before the injection. The rhbdomyosarcoma tissue masses were harvested from nude mice and were subcutaneously implanted into the costal regions of another group of BALB/c mice （tumor tissue mass implantation）. The tumor growth was observed in all groups and the growth curves were ploted. H-E staining was used to examine pathology of the tumor tissues. Results： Solid tumors were palpable 6-8 weeks after implantation in ^60Co radiated nude mice and about 3-4 weeks after implantation in SCID mice. The solid tumors were obviously seen in the nude mice 2 weeks after tumor tissue mass transplantation. The tumor forming rates were 100% in all groups. The tumor growing curves were successfully ploted and the tumors had a progressive growth. Pathological findings of the tumor tissue were similar to those of human orbital rhabdomyosarcoma. Conclusion： The human orbital rhabdomyosarcoma models have been successfully established in nude mice and SCID mice. Tumor tissue mass implantation can shorten the tumor forming time in BALB/c nude mice. This research lays a foundation for further study or human orbital rhabdomyosarcoma.

Abstract:From 2003 to 2004, 83 patients （166 sides） with nasal septum deviation were treated in our hospital, including 38 receiving submucous resection of nasal septum （SRNS） and 45 receiving submucous resection of nasal septum plus unilateral or bilateral partial inferior turbinectomy （SRNS＋U/B PIT）. All patients were tested by Eccovision acoustic rhinometry before and 6 months after operation to assess the treatment effect. It was found that total nasal cavity was bigger in the patients receiving SRNS＋U/B PIT than in those receiving SRNS alone （P〈0.05）. It was also found that patients receiving SRNS had unsatisfactory and unstable outcomes. Therefore, it is suggested that patients suffering from deviation of nasal septum （caused by chronic hypertrophic rhinitis） should receive SRNS＋U/B PIT. In order to standardize this surgical procedure, we named this operation as ＂nasal modification＂; the operation indications and principles of it should be established and completed.

Abstract:目的:评价椎体成形术和后凸成形术治疗骨质疏松性脊柱压缩性骨折的临床疗效.方法:18例23个椎体骨质疏松性压缩性骨折,男7例,女11例;年龄58～85岁,平均71.5岁.应用椎体成形术治疗12例16个椎体,后凸成形术治疗6例7个椎体.术后对患者的疼痛、镇痛药使用、活动能力及影像学结果进行分析.结果:所有患者均获随访,随访时间平均9个月(3～14个月).椎体成形术组视觉类比评分(VAS)平均由术前7.9到术后2.7和最终随访2.4;镇痛药使用评分由术前2.3到术后0.6和最终随访0.7;活动能力评分由术前2.4到术后1.5和最终随访1.3.后凸成形术组VAS平均评分由术前8.1到术后2.8到最终随访2.4 (P＜0.01) ;镇痛药使用评分由术前2.4到术后0.7和最终随访0.7(P＜0.01);活动能力评分由术前2.5到术后1.5和最终随访1.4(P＜0.05).椎体成形术组和后凸成形术组均能恢复伤椎前中柱高度,后凸成形术组效果更明显,均无严重并发症发生.结论:椎体成形术和后凸成形术均能迅速缓解骨质疏松性脊柱压缩骨折患者疼痛,减少镇痛药依赖以及改善生活质量;后凸成形术能更好恢复伤椎高度,降低骨水泥渗漏发生率.

Abstract:目的:分析外伤性视神经管骨折所致视力障碍的诊断要点,应用视神经管减压术术后疗效及其影响因素.方法:对49例外伤性视神经管骨折继发视力障碍的患者,经眶尖部CT检查后,在药物治疗的同时,采用鼻外筛蝶窦进路及鼻内窥镜下筛蝶窦进路视神经管减压术治疗.结果:眶尖部CT检查视神经管骨折的阳性率为71.4﹪,无假阳性结果.伤后立即出现视力障碍者,术后有效率为46.2﹪;伤后24 h内出现视力障碍者有效率为66.7﹪;伤后48 h以后出现视力障碍者有效率为87.5﹪.术中明确发现有视神经管骨折者有效率为42.9﹪;无骨折仅见或无视神经水肿者有效率为100﹪.手术时机愈晚,疗效愈差.结论:眶尖部CT检查对视神经管骨折具有重要诊断价值,但CT检查阴性不能除外该病;术后疗效与患者视神经损伤程度及手术时机等因素有关.

Abstract:目的:总结喉全切除术后安放Blom-Singer发音管进行发声重建的临床经验,以提高发声重建的成功率.方法:回顾性分析1993～2005年48例喉全切除术后行气管食管穿刺安放Blom-Singer发音管发声重建患者的临床资料.结果:48例中6例行咽下缩肌食管括约肌切开术,7例行咽丛神经切断术,24例行气管造瘘口扩大成形术,均取得良好的效果.随访1～12年,48例中44例发音效果清晰流畅,成功率91.67﹪;瘘口肉芽增生、早期感染,气管食管瘘口过大出现漏液发生率较低,分别为2/48、1/48、1/48.结论:喉全切除术后Blom-Singer发声重建操作简单、成功率高、并发症较少,咽缩肌切开术或咽丛神经切断术能提高其成功率.

Abstract:目的:总结伴有腺体样肥大分泌性中耳炎(OME)的序列治疗经验.方法:回顾性分析1998年9月～2005年2月 91例(161耳)实施了包括腺样体切除术、鼓膜激光造孔、鼓室穿刺冲洗、鼓膜按摩和围手术期处理等在内序列治疗患儿的临床资料,总结临床经验.结果: 91例患儿(161耳)治愈率、好转率及无效率分别60.9﹪(98耳)、27.9﹪(45耳)和11.2﹪(18耳),效果较好,并发症较少.结论:采用以腺样体切除术为主的序列治疗可改善咽鼓管功能,降低中耳腔压力,能有效地治疗伴有腺体样肥大的分泌性中耳炎.

Abstract:目的:探讨后腹腔镜加下腹部斜行小切口行肾盂癌根治性切除术的手术方法,并对此术式的临床效果进行评价.方法:回顾性分析12例行后腹腔镜加下腹部斜行小切口肾盂癌根治性切除术患者的临床资料及手术方法.结果:手术均成功,无一例中转开放;平均手术时间为(155±61.5) min,术中平均出血量(102±53) ml;术后肠功能恢复时间平均为(26±13)h,术后平均住院时间为(6±2.3) d.术中术后未发生明显并发症.随访1～11个月均未见肿瘤复发及转移.结论:后腹腔镜加下腹部斜行小切口行肾盂癌根治术是一种安全有效的微创方法,与传统开放手术和其他术式相比,具有手术时间短、出血少、恢复快、术后并发症少等优点.

Abstract:目的:探讨后腹腔镜下保留肾单位的肾肿瘤切除术的临床疗效.方法:经病理确诊为透明细胞癌的肾癌患者7例,瘤体直径1～3 cm,平均(2.5±0.5) cm,均采用后腹腔镜下肾肿瘤剜除术.手术过程:分离暴露肾动脉和瘤体,自制血管阻断器阻断肾动脉, 距离瘤体1 cm用超声刀剜除完整瘤体,以止血纱布压迫创面,1-0可吸收线双8字缝扎创面, 解除血管阻断,观察出血情况,必要时再次加压处理,取出肿瘤,完成手术.术后随访3～7个月.结果:手术均成功,无一例转开放.手术时间130～200 min,平均(158±28) min;术中出血100～500 ml,平均(225±50) ml.肠道功能12～36 h恢复,绝对卧床10 d后下床活动,术后住院10～14 d.术后肾图显示患侧肾脏血流良好,功能无明显异常;随访3～7个月,未见复发和转移病例.结论:后腹腔镜下保护肾单位的肾肿瘤切除术除具有创伤小,康复快等优点外,还可以有效保留肾单位,适合于处理直径小于3 cm的肿瘤.

Abstract:目的:探讨眼附属器包括眼睑、结膜、眼眶和泪腺等部位MALT淋巴瘤的临床诊断要点,影像学检查特征与治疗和预后.方法:回顾性分析1994年至2005年45例病理确诊的眼附属器MALT淋巴瘤患者的临床表现、影像学和免疫学检查结果、治疗经过、疗效分析及预后情况.结果:眼附属器MALT淋巴瘤 23例发生于眼眶,10例发生于眼睑,8例发生于泪腺,4例发生于结膜.B超能较好的显示病变内部结构和形态;CT对眶骨结构和肿瘤侵犯范围与周围组织的关系显示良好,具有定性诊断价值;MRI对软组织的分辨力强,可区别病变内部不同组织.30例患者CD20表达阳性.45例均行手术治疗,其中22例辅以放疗,10例结合化疗.42例随访4～ 135个月,1例死亡,3例复发,总生存率为97.7﹪,复发率为6.6﹪.结论:眼附属器MALT淋巴瘤好发于眼眶上方及眼睑,B超、CT、MRI检查能提供较好的定性、定位诊断;手术切除肿瘤,结合放疗、化疗能取得较好的疗效;病变可长期局限,预后一般较好.

Abstract:目的:观察心力衰竭患者经卡维地络治疗后B型钠尿肽前体N末端(NT-proBNP)的变化,探讨血NT-proBNP水平监测心衰药物治疗效果的可行性.方法:30例NYHA心功能Ⅱ～Ⅳ级收缩性心衰患者,随机给予标准治疗(标准治疗组, n=15)或"标准+卡维地络"治疗 (卡维地络组, n=15),观察治疗前后心功能和血NT-proBNP水平的变化,并与健康人(n=22)血NT-proBNP进行比较.结果:心力衰竭患者血NT-proBNP为(1 919.0±1 565.7) pg/ml,显著高于健康人群[(37.1±19.7)pg/ml,P＜0.00].卡维地络组和标准治疗组治疗前的一般情况具有可比性;治疗后卡维地络组血NT-proBNP(pg/ml)明显下降(1 732±1 404 vs 1 134±708, P＜0.01),而标准治疗组治疗前后无显著差异(2 105±1 727 vs 1 905±1 509,P>0.05).结论:收缩性心衰患者经卡维地络治疗后血NT-proBNP水平下降明显,血NT-proBNP水平可能有助于监测心衰药物治疗效果.

Abstract:上肢手术后疼痛原因复杂，除手术切口本身的疼痛刺激外，手术后患肢肿胀、肌筋膜紧张、骨间摩擦和骨膜的刺激等皆为术后疼痛的重要因素，加之术后对患肢常行包扎或石膏固定，更加重了患肢缺血胀痛不适。上肢手术术式的改进如交锁髓内钉、DHS内固定、肱骨头置换等，其创伤程度和疼痛也增大。因此，寻找较好的镇痛方法是术后镇痛研究的重要内容。本研究拟评价在臂丛神经麻醉下行上肢手术患者术后采用左旋布比卡因、芬太尼及氟哌啶混合液用于上肢手术后臂丛神经自控镇痛的可行性。[第一段]

Abstract:甲硝唑对厌氧菌有较强的杀灭作用，对厌氧菌引起的口腔急性感染、口腔溃疡有较好的治疗作用Ⅲ。地塞米松磷酸钠具抗炎、抗毒、抗过敏作用，抗菌素、激素联合使用具有消肿、抗炎、抗菌、抗过敏的协同作用，并可提高疗效。盐酸丁卡因表面穿透力强，涂于黏膜表面，能使黏膜下感觉神经末梢产生麻醉，消除痛觉。本研究以甲硝唑为主药，地塞米松磷酸钠、盐酸丁卡因为辅药，羧甲基纤维素钠为赋形剂，研制复方甲硝唑涂剂，应用于洽疗口腔溃疡、牙龈红肿，使用方便，疗效确切。临床观察40例，其中口腔溃疡31例，牙龈炎6例，牙周炎3例，疗程最长15d，最短6d，1～3d局部疼痛减轻，7d左右口腔溃疡患者痊愈，与其他抗生素配伍，13d左右牙周组织基本恢复正常，有效率为82．3％。[第一段]

Abstract:外耳道胆脂瘤所致面瘫临床上较为少见，在临床上常与中耳胆脂瘤性面瘫相混淆，导致误诊误治。本科自1989～2002年间共诊治了12例（12耳）外耳道胆脂瘤所致面瘫，现报告如下。[第一段]

Abstract:1 临床资料 患者，女，29岁，发现“右侧颈动脉三角处无痛性肿块1个月余”。超声检查所见：右侧颈总动脉分支部探及一大小为50mm×10mm×30mm的中等偏低回声团块，位于颈内，外动脉的后方，并将之向前方挤压，但未包绕该二血管（图1A）；肿块边界清晰，有包膜，内部回声中等偏低，欠均匀（图1B）；[第一段]