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Objective:To observe the effect of botulinum toxin A (BTX-A) on pain, the activation of microglia and the expression of tumor necrosis factor-α (TNF-α) in the spinal cord in arthritis, and to explore how BTX-A treatment relieves pain.Methods:Sixty clean, male Sprague-Dawley rats were randomly divided into a sham operated group, a Freund′s adjuvant group and a BTX-A group. The ankle cavities of the left hind limbs of all of the rats except those in the sham group were injected with 50μl of Freund′s adjuvant to establish an arthritis pain model. The sham operated group received 50μl of saline solution as controls. Afterward the sham operation group and the Freund′s adjuvant group were given another 20μl of normal saline, while the BTX-A group was injected with 20μl of botulinum toxin A, again into the ankle joint cavity of the left hind limb. The mechanical and thermal pain thresholds of the rats in each group were measured 1 day before the modeling and 1, 3, 7, 14 and 21 days afterward. Western blotting and immunofluorescence staining were used to detect the expression of IBA-1 and IBA-1-IR. In addition, the expression of TNF-α protein and TNF-α mRNA in the spinal cord was detected using ELISA and RT-PCR.Results:Compared with the Freund′s adjuvant group, the latency of the mechanical and thermal pain thresholds had increased significantly in the BTX-A group after 3 days. The differences remained significant until the 14th day after the injection. The expression of IBA-1 protein and the number of immunopositive cells in the spinal cord decreased significantly, as did the expression of TNF-α protein and mRNA.Conclusions:Botulinum toxin A can alleviate the pain induced by Freund′s adjuvant. The analgesic mechanism may be related to inhibiting the activation of spinal microglia and the release of TNF-α.
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Objective: To investigate the clinicopathological features and molecular phenotypes of gastric cancer with enteroblastic dif-ferentiation (GCED). Methods: A retrospective analysis of 337 patients with gastric adenocarcinoma diagnosed by the pathology de-partment of the First Affiliated Hospital of Zhejiang University in March 2013-2017 was conducted. Of them, 8 patients were diag-nosed with gastric carcinoma with intestinal blastocyte differentiation. All the patients were elderly, including 6 men and 2 women. The onset age was 68-83 years (mean 76.6 years). Two cases had serum AFP≥200 μg/L before treatment. According to the histopatho-logical morphology, the immunophenotype was analyzed by immunohistochemistry, the SALL4 gene was detected using reverse tran-scription-polymerase chain reaction (RT-PCR), and the relevant literature was reviewed. Results: Microscopically, all cases had primi-tive enteroid structures, consisting of cubic or columnar cells with clear cytoplasm, and immunohistochemical staining showed positivi-ty for either AFP and GPC3 or SALL4. The expression of SALL4 mRNA was significantly increased by RT-PCR. Follow-up from 1 to 5 years showed that 5 patients had liver and other organ metastases, 2 patients died, and 1 patient survived without a tumor. Conclusions:GCED is a rare invasive gastric adenocarcinoma with a worse prognosis than that of normal intestinal adenocarcinoma. The treatment of general intestinal adenocarcinoma has little effect. There are some characteristic changes in histology. It would be helpful for diag-nosis and differential diagnosis if clinicians are familiar with the tumor spectrum and genetic characteristics. Target therapy for an origi-nal marker, such as SALL4, has a bright future.
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Objective To investigate the influence of preoperative arterial chemoembolization on the expression of Survivin,and study the clinical significance in bladder cancer.Methods The tissue before and after chemoembolization of 50 patients with bladder cancer were selected,the Survivin expression was examined by immunohistochemical method.The Survivin expression was compared between before and after chemoembolization in bladder cancer tissue,and the relation of its expression to the pathological grade and clinical stage was evaluated clinically.Results The positive rate of Survivin expression before chemoembolization raised with the rising of the pathological grade and clinical stage,there was statistical difference (P ＜ 0.05).The positive rate of Survivin expression before and after chemoembolization was 72％ (36/50) and 22％ (11/50),there was statistical difference (P ＜0.01).The positive rate of Survivin expression in high grade pathological grade and T2-T4 clinical stage after chemoembolization was significantly lower than that before chemoembolization,there was statistical difference (P ＜0.01).The survival rate 3 years after chemoembolization in Survivin negative expression patients was higher than that in Survivin positive expression patients [94.87％(37/39) vs.7/11],but there was no statistical difference (P ＞ 0.05).The Survivin positive expression in recurrence patients was significantly higher than that in non-recurrence patients [5/8 vs.5.56％ (2/36)],there was statistical difference (P ＜ 0.01).Conclusions Preoperative arterial chemoembolization can reduce the expression of Survivin,adjust malignancy of bladder cancer,could downgrade and downstage the tumor,reduce recurrence rate.The expression of Survivin can serve as predictive factor for prognosis of bladder cancer.
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Objective To investigate the relationship of urinary vascular endothelial growth factor (VEGF) and occurrence and invasiveness of bladder cancer. Method The expression of urinary VEGF in 48 patients with bladder cancer (bladder cancer group) and 45 normal cases (control group) were examined by ELISA immunohistochemical staining. Results VEGF levels in urine in bladder cancer group [(174.77±83.41) μg/L] were higher statistically than those in control group [(63.53 ±22.62) μg/L] (P < 0.01), and related to the staging and grading of tumors. VEGF levels were significant higher in invasive lesions [(223.00 ± 83.13) μg/L] than those in superficial ones [(130.40 ± 54.86) μg/L] (P < 0.01). VEGF levels of G3 [(259.23 ± 75.82) μg/L] were significant higher compared with G1 [(138.00± 85.60) μ g/L] and G2 [(146.22 ±47.53) μ g/L] (P < 0.01). Conclusion The concentration of urinary VEGF relates to the clinical staging and pathological grading, and it is a labeling index of the biological behavior of bladder cancer.
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Objective To investigate the influence of preoperative arterial chemoembolization on expression of Ki-67,and clinical significance in bladder cancer. Methods Before and after chemoembolizafion of therapy,the expression of Ki-67 in 30 patients of bladder cancer tissue were examined by immunohistochemical staining.The rehtion of its expression to the pathological grade and clinical stage was evaluated clinically.Results Positive rate of Ki-67 expression in the bladder cancer tissue was 70.00% and 26.67% respectively.There was significant difference between the before and after therapy (P＜0.01). Follow-up for mean 24.6 months recurrence rate in 30 cases was 16.67%.The expression of Ki-67 correhted to the pathological grade, clinical stage and patient recurrence rates of bladder cancer.Conclusions Preoperative arterial chemeembelization can reduce the expression of Ki-67,adjust malignancy of bladder cancer,could downgrade and downstage the tumors,and cut down the postoperative metastasis,improve survival rate and reduce recurrence rate.Both of the Ki-67 labeling index are predictive factor for recurrence of superficial bladder cancer.
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Objective To investigate the effect of transcatheter bladder arterial chemoembolization on microvessel density(MVD)change in bladder cancer. Methods The MVD count of bladder cancer tissue of 30 patients before and after chemoembolization were examined by SP immunohistochemical staining.Cancer tissues were examined pathology after chemoembolization.All the cases were followed up for 12 to 36 months(mean 24.6 months),the 3 years survival rate was evaluated clinically. Results MVD counts were 69.8±3.4 and 56.4±3.3 before and after therapy respectively(P<0.05).Cancer tissues were severely damaged ultramicroscopically after interventional chemotherapy.The recurrent rate was 16.67%in 30 cases. Conclusions The chemoembolization could decrease MVD,improve survival rate and reduce the recurrence rate.
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Objective To study the influence of transeatheter bladder arterial chemoembolization on neovascularization and vascular endothelial growth factor (VEGF) expression in bladder cancer treatment. Methods Thirty bladder cancer patients (Tis =1, Ta =2, T1 =6, T2 =11, T3 =9, T4 = 1; G1 = 9, G2=13, G3 = 8) were treated with transcatheter arterial chemotherapy with Mitomycin (20 mg) or Hydroxycamptothecin (10 nag) adding cisplatin (60 rag) and embolization with gelatine sponge particle gelform 1 week before surgery. Before and after the chemoembolization, the expression of VEGF and microvessel density (MVD) count in cancer tissue were examined by SP immunohistochemical staining. Tumor samples after chemoembolization were taken and sent for pathological examination. The over all survival rates were recorded and analyzed as well. Results Before and after the chemoembolization, positive rates of VEGF expression in bladder cancer tissue were 73. 3% and 43.3%, respectively and MVD were 69.8±3.4 and 56. 4±3.3, respectively. There were significant differences between the parameters before and after the treatment (P<0.05). After the intervention, tumor diameter decreased from 2.2±0.9 cm to 1.6±0. 9 cm (P<0.05) and tumor tissues were in severe necrosis and degeneration. During the follow-up of 24. 6 months (ranging from 12 to 36 months),there were 5 recurrent cases (G1 T1 =1, G2 T1=1, G2T3=1, G3T3 = 1, G3 T4 =1, primary transitional cell carcinoma= 4, admixture carcinoma= 1). In the recurrent group, VEGF expression were positive in 5 cases (100% strong positive) and 4 cases (80%, 3 positive, 1 strong positive) (P>0. 05) before and after the chemoembolization. However, it had significant difference in strong positive expression (P<0.05); MVD were 87.4±3.0 and 72.4±4.1 (P<0.05) before and after the treatment. The MVD in no recurrent group was 53.2±3. 5 after chemoembolization, and it had statistical significance comparing with the recurrent group (P<0. 05). Conclusions The chemoembolization can decrease the expression of tumor VEGF and MVD. Thus, it can adjust bladder cancer malignancy, downgrade and downstage the tumors and decrease the risk of postoperative metastasis. For the long-term, this treatment will improve the survival rate and reduce recurrence rate.
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Objective To report the treatment of 7 cases of carpal tunnel syndrome(CTS)with algesia.Methods One hundred and twenty eight cases of carpal tunnel syndrome within the period of March 2002 and March 2005 were retrospectively analyzed.There were 7 cases(4 female and 3 male)had algesia,4 cases were treated with endoscopic management of carpal tunnel release (ECTR) and 3 cases were treated with open management of carpal tunnel release(OCTR).These 7 cases were followed-up 1-4years(average 1.5 years)postoperatively.Results Two ECTR cases and 2 OCTR cases had bad therapeutic effect and the others had good effect.Both 2 bad-effect ECTR cases feel special pain when insert the catheter.Only inject Triamcinolone Acetonide-A within epineurium after completely release in the goodeffect OCTR ease.Conclusion CTS with algesia is a special type of CTS,the key to treat it is to protect epineurium.
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Objective To study the indications of endoscopic treatment for carpal tunnel syndrome(CTS).Methods From July 2004 to September 2007,21 patients(24 wrists) with CTS received endoscopic treatment in our hospital.Under local anesthesia,an 1-cm incision was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.A special cannula was inserted into the carpal tunnel,and then the transverse carpal ligment was cut and the median nerve was decompressed.All the patients were re-examined in 1,2,3,and 5 months postoperation.Results According to the criteria of Kelly,11 cases achieved excellent outcomes in 5 months,meanwhile 6 were good,2(3 wrists) were fair,and 2 were poor.One of the 2 poor cases received a second operation by traditional procedures(nerve release) 7 months after the first surgery,another case were treated by conservative therapy because of sympathetic symptoms.Conclusions ① Endoscopy is the first choice for idiopathic cases,while open surgery should be performed on secondary cases(rheumatic synovitis,fracture deformity,tumar,inflammation,gout,neurodegenerative desease etc.).② The carpal tunnel release should be used for patients with abnormal opponens function of the thumb,as well as advanced cases.③ Routine operation are the first choice for eldly patients but not for the younger ones.
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Objective To investigate the necessity of releasing the distal holdfast fibers of the flexor retinaculum(DHFFR) during endoscopic carpal tunnel release(ECTR).Methods The Experiment Group included 16 cases.The operation was conducted under brachial plexus anesthesia without the use of tourniquet.A 1 cm skin incision was made.The USE system(Universal Subcutaneous Endoscope System) was employed.Both flexor retinaculum(FR) and distal holdfast fibers of the flexor retinaculum were cut off.Postoperative outcomes were compared with another 16 cases of flexor retinaculum release only(Control Group).Results Follow-up evaluation was carried out at 6 postoperative months.According to the Kelly's criteria,there were 13 cases of excellent results and 3 cases of good results in the Experiment Group,and 8 cases of excellent,5 cases of good,and 3 cases of fair results in the Control Group.Significant difference was obser red in flameda Ⅱ or Ⅲ grade patients between the two groups in carative effects(?~2=6.278,P=0.043).No serious complications or postoperative recurrence occurred.Conclusions Flexor retinaculum is not the only structure existing in the carpal canal to be released.More attention should be paid to complete decompression of both flexor retinaculum and distal holdfast fibers of the flexor retinaculum,especially in those who have serious symptoms.
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Objective To investigate the feasibility of endoscopy in diagnosis and treatment of compressed peripheral nerves. Methods An 1.5 cm transverse incision posterior to the margin of pectoralis major along the second rib was made in 2 old and 9 fresh cadaver specimens. The distance from the incision to the insertions of anterior and middle scalene muscle on the first rib was measured at various angles. The structures surrounding the approach was observed and measured to find a safer approach for endoscopic treatment of brachial plexus compression syndrome. Results With the upper limb hyperabducted at 120 degrees, anteriorly tilting at 30 degrees, through an 1.5 cm transverse incision made posteriorly to the margin of pectoralis major and along the second rib, the apparatus was inserted toward the point 6.5 cm laterally apart from the sternoclavicular articulation and 7.8 cm in depth, reaching the insertions of the anterior and middle scalene muscle on the first rib without injury to the nerves and vessels. Conclusion The approach is safe for endoscopic apparatus reaching the insertions of the anterior and middle scalene muscles on the first rib. It also provides a basis for further investigation of cutting anterior and middle scalene muscles through endoscope.
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Objective To introduce our surgical experience and techniques of endoscopic carpal tunnel release (ECTR) by Chow technique (two-portal technique). Methods A total of 30 endoscopic procedures in 25 patients with carpal tunnel syndrome (CTR) were performed. Results Follow-up evaluations for 1～12 months were made in all the patients. The sensibility of radial 3 fingers and a half returned to normal at postoperative 4～6 weeks in 20 sides of 18 patients. The greater thenar atrophy and opposition dysfunction in 10 sides of 7 patients disappeared at 8～12 postoperative weeks. No serious complications occurred in this series. Conclusions ECTR by Chow method has advantages of short incision, minimal invasion and rapid recovery, being an easy, safe and reliable minimally invasive procedure.
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Objective To evaluate the endoscopic tendon sheath release for stenosing tenovaginitis (trigger finger). Methods Five patients with stenosing tenovaginitis (2 in thumbs, 1 in middle finger, and 2 in ring fingers) underwent operations by Smith & Nephew Endoscopic Trigger Finger Release system. After two 3.0mm transverse incisions were made, the window cannula assembly was inserted subcutaneously along the sheath from the proximal portal and advanced until it passed through the distal portal. Then a 2.7 mm endoscope was passed into from the proximal portal and a retrograde knife was introduced into the operative site from the distal portal. Finally the entire length of sheath was sectioned under direct endoscopic vision. Results All operations were successfully completed. Finger's flexion and extension function recovered immediately after the operations. All the patients restarted their employment one week postoperatively. There were no complications such as distinct pain or delayed wound healing in these patients. Conclusions This method has the advantages of minimal invasion, safety, effectiveness and quick recovery, especially suited to diabetic patients or multiple trigger fingers.
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Objective To introduce a new technique--Carpal tunnel release by Okutsu's technique Methods A 1cm skin incision was made under local anaesthesia without tourniquet. The procedure was performed by system (Universal Subcutaneous Endoscope System). Postoperative functional assessment was done by Kelly's standards. Follow-up was conducted in the first, third and twelve month after the operation. Results One hundred and forty-nine sides of 126 cases of CTS were treated with this method. And seventy eight sides of 69 cases of CTS were followed up. 54 cases were excellent; 19 cases good; 3 cases fair; 2 cases poor. The average time of the operation was ten minutes. There was less blood lost in the procedure. Complication occurred in one case. Conclusions As compared with open procedure, the method has advantage of minimal incision,less tissue damage, shorter operation time, less skin scar and no postoperatioven plastic splint. The therapeutic results was as efficient as routine procedure.
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Objective To study the ulnar nerve and its adjacent structures in the forearm and understand the anatomic basis for endoscopic harvesting of the ulnar nerve for the treatment of brachial plexus avulsion injury. Methods Ulnar nerves and their adjacent structures in 6 formaldehyde solution fixed upper limb specimen and 26 fresh upper limb specimens were carefully dissected and observed and measured. The entry path and implementation were designed according to the observations. Simulated operation was performed in 6 fresh autopsy specimens Results In the forearm, ulnar nerve passes through the flexor carpi ulnaris under the medial epicondyle of the humerus and the dorsal branch of the hand passes between the ulnar bone and flexor carpi ulnaris. Also the ulnar nerve descends through intermuscular space, accompaning the ulnar artery in the distant part of the forearm and the artery lies laterally along the nerve. The simulated operations were successfully done in all the 6 specimens. Conclusions The anatomy of the ulnar nerve in the forearm is fairly fixed with no crossing with important structures in its path, incisions of 1～2cm are made above the pisiform bone and under the medial epicondyle of the humerus 3～5cm respecitvely, After isolation of the ulnar nerve's two crosses from the muscle, the remaining part of the ulnar nerve and its adjacent structures are easily dissected. It is concluded that it is safe and reliable to harvest the ulnar nerve in the forearm with endoscopy.
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Objective To investigate the correlation of the expression of p27 and Ki-67 with the clinicopathologic features in breast invasive ductal carcinoma. Methods S-P immunohistochemical staining was performed to examine the expression of p27 and Ki-67 in 60 specimens of breast invasive ductal carcinoma. Results The low p27 expression rate was 45.0 %(27/60), low expression in breast cancer was associated with larger tumor, nerve/vessel invasion, lymph node metastasis and histological grade(P
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Objective To report carpal tunnel release using Universal Subcutaneous Endoscope System from anatomical and clinical point of view for the purpose of avoiding operative complication and improving clinical efficacy. Methods Operation approach and adjacent structures were observed and measured on 18 fresh upper limb specimens and 26 formaldehyde solution fixed upper limb specimens. Nineteen patients with 21 carpal tunnel syndrome (CTS) were treated with this method under local anaesthesia without tourniquet. The incision is made in the wrist just 2-3 cm superior to palmar crease of the wrist at the medial border of the palmaris longus. The operation plane is just under the deeper layer of deep fascia. The instrument points to the third web. The median nerve and its branches, flexor retinaculum and superficial palmar arch were carefully observed. Results The results were satisfactory in all patients. Conclusion Single wrist portal arthroscopic procedure is a safe, simple and efficient approach if the anatomic structures of the wrist are perfectly clear to the opeator.