Transforaminal percutaneous endoscopic lumbar discectomy combined with anchorage technique of pedicle for the treatment of high prolapse free lumbar disc herniation / 中国骨伤

OBJECTIVE@#To investigate the clinical effects of percutaneous spinal endoscopy (percutaneous endoscopy) in the treatment of high prolapse free lumbar disc herniation.@*METHODS@#From May 2016 to June 2018, 24 patients with highly prolapse free lumbar disc herniation were enrolled in this study, including 11 males and 13 females, ranging in age from 48 to 72 years old, with an average of (59.5±7.2) years old. There were 1 case of L, 5 cases of L, 18 cases of L. The course of disease ranged from 8 to 26 months, with an average of (16.2±6.3) months. All the patients were subjected to local infiltration anesthesia. The clinical outcomes were evaluated by visual analog scale (VAS) for leg pain, low backpain and Oswestry Disability Index (ODI) at preoperative, first day after operation and 6 month after surgery. All data were statisticed by SPSS 22.0.@*RESULTS@#All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (17.5±5.3) months. The average operation time was(69.8±14.2) minutes. One patient had cerebrospinal fluid leakage, which improved after supine rest. VAS scores of lower back pain were 6.36±1.27, 3.94±1.03, 1.62±0.87, 0.44±0.27, 0.37±0.29. VAS scores of leg pain were 8.28±1.74, 3.16±1.24, 2.83±1.13, 0.83±0.31, 0.46±0.31, and the differences were statistically significant (<0.05). The ODI were (48.79±9.83)%, (36.51±11.24)%, (21.05±6.35)%, (9.83±4.62)% and (7.24±4.72)% 1 day before and 1 weeks, 3 months, 6 months and 1 year after the operation, respectively. One year after the operation, the modified Macnab evaluation system was used to evaluate the clinical efficacy of the patients, 19 patients got an excellent result, 3 good, 2 fair and 0 poor.@*CONCLUSION@#Percutaneous endoscopic pedicle anchoring technique for the treatment of high prolapse free lumbar disc herniation can effectively improve the clinical symptoms of patients, and has the advantages of less trauma, less bleeding, rapid recovery, complete removal of the nucleus pulposus, and less pain of patients, etc., its clinical efficacy is accurate, operability is strong, it is worth promoting in the clinical use.

Forecasting incidence of extended spectrum β-lactamases-producing Escherichia coli by multiple seasonal ARIMA model / 预防医学

Objective To predict monthly incidents of extended spectrum β-Lactamases (ESBLs)-producing Escherichia coli in Zhejiang Hospital by establishing multiple seasonal autoregressive integrated moving average (ARIMA) model, so as to provide scientific evidence for reducing the incidents of nosocomial infection of ESBLs producing Escherichia coli. Methods Multiple seasonal ARIMA model was established by monthly records of ESBLs producing Escherichia coli from 2010 to 2016 in Zhejiang hospital. Monthly incidents of ESBLs producing Escherichia coli from 2017 to February 2018 were used to verify the predicted result. The predictions were evaluated by models of mean absolute percent error (MAPE) and bayesian information criterion (BIC) . Results The optional model for the monthly incidence from 2010 to 2016 was ARIMA (0, 1, 1) (0, 1, 1)12. The MAPE was 14.76, BIC was 2.01, and the Ljung-Box statistics value Q was 16.79 (P=0.40) . These parameters suggested a good model fitting. The average relative error between the predictive value and the actual value of the monthly incidents ESBLs producing Escherichia coli from 2017 to February 2018 was 14.08%.The actual values were within the 95% confidence interval. Conclusion The multiple seasonal ARIMA model of ARIMA (0, 1, 1) (0, 1, 1 )12 fits and can be used for short-term prediction and dynamic analysis of the incidents of ESBLs producing Escherichia coli in Zhejiang Hospital.

MRI outstands mammogram in sensitivity of breast ductal carcinoma in situ:an analysis of 122 cases / 中华外科杂志

<p><b>OBJECTIVES</b>To compare the sensitivity of mammogram and breast dedicated MRI in detecting ductal carcinoma in situ with microinvaion (DCIS-MI) and ductal carcinoma in situ (DCIS) lesions, and to further investigate the independent predictive factors of mammogram and MRI sensitivity.</p><p><b>METHODS</b>From August 2009 to November 2011, 122 consecutive confirmed breast cancer patients who had received operations were recruited for this clinical research. These patients were divided into two groups including DCIS (72 cases) and DCIS-MI (50 cases) based on pathologic reports. All the patients were female, with mean ages of 52.6 years and 54.4 years. Preoperative bilateral breast mammogram, breast dedicated MRI depictions and reports as well as histopathological reports were collected.</p><p><b>RESULTS</b>Sensitivity of MRI outstood mammogram in each subgroups: 84.7% vs. 42.4% in DCIS (χ(2) = 27.028, P = 0.000), 94.0% vs. 80.0% in DCIS-MI group (χ(2) = 4.540, P = 0.040). And further analysis showed that MRI was more sensitive to high nuclear grade DCIS and DCIS-MI lesions than low nuclear grade ones (OR = 3.471, P = 0.031).</p><p><b>RESULTS</b>of logistic regression analysis proved microcalcification was an independent predictive factor of mammogram sensitivity (OR = 11.287, P = 0.001).</p><p><b>CONCLUSIONS</b>Sensitivity of breast dedicated MRI is superior to mammogram in detecting DCIS and DCIS-MI groups. Lesions with microcalcifiation is an independent predictive marker which meant that mammogram would achieve high detection rate in cancers presented calcification on mammogram image when compared with non-calcification. Diagnostic performance of breast MRI is less affected by clinical and pathological characteristics of the early stage breast cancer patients but further increased detection rate is observed in DCIS and DCIS-MI with high nuclear grade lesions which indicated that MRI could detect more early stage cancers with relative more aggression biological behaviour and provide these patients with early surgical interventions before possible progression to invasive breast cancers.</p>

Correlation of bilateral testicular volume discrepancy with semen parameters in men with varicocele / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the influence of varicocele on the volume discrepancy of bilateral testes, and the relationship between testicular volume discrepancy and semen parameters.</p><p><b>METHODS</b>This study included 181 varicocele patients and 102 normal fertile men without varicocele. We retrospectively analyzed their clinical data, including the grades and locations of varicocele, testis volume and semen parameters.</p><p><b>RESULTS</b>Bilateral testicular volume discrepancy was found in 132 (72.9%) of the varicocele patients (including 117 cases of left testicular hypotrophy [88.6%]), and 35 (34.3%) of the non-varicocele fertile men. The rates of bilateral testicular volume discrepancy were 61.3%, 3.5%, 20.9% and 14.3% in the grade-III, grade-II, grade-I and non-varicocele groups, respectively (P < 0.05), with statistically significant differences among different age groups (P < 0.05). The percentage of morphologically normal sperm and sperm motility were reduced differently with different degrees of testicular volume discrepancy (P <0.05).</p><p><b>CONCLUSION</b>Testicular volume discrepancy is more common in men with left varicocele, and its prevalence and degree are correlated with the grade of varicocele. Semen quality decreases with the increase of testicular volume discrepancy.</p>

Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.</p><p><b>METHODS</b>The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4 - 1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy (ESWL). Two patients had stones sized < 0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt. One patient had a pelvic stone (1.2 cm), which was removed surgically.</p><p><b>RESULTS</b>The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.</p><p><b>CONCLUSIONS</b>The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.</p>

Imaging diagnosis of pelvic eosinophilic granuloma and analyses of the misdiagnoses / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the imaging diagnosis of pelvic eosinophilic granuloma and improve diagnosis accuracy.</p><p><b>METHODS</b>A retrospective analysis of the plain film, CT and MRI was conducted in 24 cases of pathologically confirmed eosinophilic granuloma. All the patients received radiography, CT scan was performed in 17 cases and MRI was done 9 cases.</p><p><b>RESULTS</b>In the 24 cases of eosinophilic granuloma, 6 lesions were located in the pubis, 5 in the ischium and 13 in the iliac region. The lesion showed bony destruction or irregular bony destruction, with periosteal reaction and soft tissue mass.</p><p><b>CONCLUSION</b>Pelvic eosinophilic granuloma has characteristic imaging features, and combination of the imaging findings can improve the diagnosing accuracy.</p>

Laparoscopic excision of seminal vesicle cyst / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the method and clinical efficacy of laparoscopic excision of seminal vesicle cyst.</p><p><b>METHODS</b>Laparoscopic excision of seminal vesicle cyst was performed under general anaesthesia in two patients with symptomatic seminal vesicle cyst confirmed by ultrasonography and CT scanning preoperatively. The sizes of the seminal vesicle cysts were 3.3 cm x 3.7 cm x 2.5 cm and 4.1 cm x 4.3 cm x 5.3 cm, respectively.</p><p><b>RESULTS</b>The operations were performed successfully in both the patients, with the operation time of 140 min and 100 min, blood loss of 50 ml and 20 ml, and postoperative stay of 6 days. The patients were followed up for 6 and 7 months, respectively. All the preoperative symptoms disappeared, and no complications and recurrence were found.</p><p><b>CONCLUSION</b>Laparoscopic excision of seminal vesicle cyst, with a good visual field, refined procedure, minimal invasiveness and rapid recovery, is a safe and effective surgical option for patients with seminal vesicle cyst.</p>

Imaging features of primary pulmonary lymphoepithelioma-like carcinoma: report of 10 cases and literature review / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the imaging features of primary pulmonary lymphoepitheliom-like carcinoma (LELC).</p><p><b>METHODS</b>Ten cases of primary pulmonary LELC were confirmed by surgery and pathology. The findings in clinical pathology, X-ray and CT were retrospectively analyzed and the related references were reviewed.</p><p><b>RESULTS</b>The clinical manifestations included coughing (5 cases), hemoptysis (2 cases), chest distress (4 cases), thoracodynia (3 cases), and fever (2 cases), with 3 cases being asymptomatic. Radiographically, primary pulmonary LELC appeared mainly as peripheral nodules or masses. The maximum diameter of the lesion was 2.3 to 12.4 cm. The lesions were slightly lobulated in 7 cases and spiky on the edge in 3 cases. Pleura retraction was shown in 3 cases. CT contrast scanning revealed light or significant enhancement in 5 cases.</p><p><b>CONCLUSION</b>Primary pulmonary LELC has some characteristic imaging features, but X-ray and CT only are not sufficient for a definite diagnosis, which still relies on bronchoscopic biopsy and percutaneous pulmonary puncture biopsy.</p>

All-trans retinoic acid enhances bystander effect of suicide-gene therapy against androgen-unresponsive prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the enhancing effect of all-trans retinoic acid (ATRA) on the bystander effect of the herpes simplex virus thymidine kinase(HSV-TK)/ganciclovir (GCV) against androgen unresponsive prostate cancer.</p><p><b>METHODS</b>The bystander effect of the HSV-TK/GCV system was measured by methyl thiazolyl tetrazolium (MTT) assay on PC-3 cells before and after ATRA treatment. The growth and the histopathology of transplant tumors were observed in 4 groups of nude mice with prostate cancer.</p><p><b>RESULTS</b>ATRA augmented significantly the bystander effect of the HSV-TK/GCV system by reducing TK positive PC-3 cells from 50% to 30% (P < 0.05). HSV-TK showed an inhibiting effect, while ATRA with the HSV-TK/GCV system produced significant effect on prostate cancer 1 week earlier than the former (P < 0.05).</p><p><b>CONCLUSION</b>ATRA can argument the in vivo and in vitro bystander effect of the HSV-TK/GCV system in the treatment of androgen unresponsive prostate cancer.</p>

Expressions of eNOS and connexin 43 in the penile tissue of rats with diabetic erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the expressions of endothelial nitric oxide synthase (eNOS) and connexin 43 (Cx43) in the penile tissue of rats with diabetes mellitus induced erectile dysfunction (DMED) and their correlation with DMED.</p><p><b>METHODS</b>SD rat models of DM were established by intraperitoneal injection of alloxan, and 8 weeks later, apomorphine was administered to induce ED in the DM models. The expressions of eNOS and Cx43 were measured by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry, respectively.</p><p><b>RESULTS</b>Alloxan did not influence the expressions of eNOS mRNA and Cx43 mRNA in the penile tissue. Compared with the DM models, the expression of eNOS mRNA significantly decreased in the DMED group (0.155 +/- 0.157 vs 0.508 +/- 0.242, P < 0.01), while that of Cx43 mRNA markedly increased (0.993 +/- 0.157 vs 0.545 +/- 0.138, P < 0.01), with a negative correlation between the two expressions (r = -0.987). The same results were shown by immunohistochemistry in the penile smooth muscle cells of the DMED rats.</p><p><b>CONCLUSION</b>The decrease of eNOS expression in the penile tissue might play a key role in the development of ED in diabetic patients, while the accompanying compensative elevation of the Cx43 level has yet to be further studied.</p>

HER2 and topoisomerase IIalpha: possible predictors of response to neoadjuvant chemotherapy for breast cancer patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surrogate markers may be used to assess the response to neoadjuvant treatment. The association between HER2 overexpression and favorable response to specific therapy in breast cancer is controversial, and the mechanism unclear. The purpose of the study was to evaluate HER2 and topoisomerase IIalpha (Topo IIalpha) as candidates for predicting the response to neoadjuvant chemotherapy in breast cancer patients.</p><p><b>METHODS</b>Between 1999 and 2006, seventy-six breast cancer patients who had received neoadjuvant chemotherapy were studied. Regimens including either CEF (cyclophosphamide, epirubicin, 5-fluorouracil) or CMF (cyclophosphamide, methotrexate, 5-fluorouracil) were given in more than three cycles to this group of patients. Protein expression of HER2 and Topo IIalpha were determined by immunohistochemistry. The primary endpoint was pathological and clinical response.</p><p><b>RESULTS</b>Of 76 primary breast cancer samples, 27 (35.5%) showed overexpression of either HER2 (25%) or Topo IIalpha protein (10.5%), whereas in 7 tumors (9.2%) both proteins were found to be overexpressed. Ten patients (13.2%) had a clinical complete response and 21 (27.6%) had a clinical partial response. Five women (6.6%) had a pathological complete response, 5 (6.6%) had microscopic residual disease, and 46 (60.5%) had macroscopic residual disease. HER2 and Topo IIalpha overexpression was significantly associated with a favorable response (P < 0.001 and P = 0.005 respectively).</p><p><b>CONCLUSION</b>Our study suggests that HER2 and Topo IIalpha overexpression could be predictors of the response to neoadjuvant chemotherapy in both the CEF and CMF arms.</p>

Understanding the planes of total mesorectal excision through surgical anatomy of pelvic fascia / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.</p><p><b>METHODS</b>Twenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.</p><p><b>RESULTS</b>There were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.</p><p><b>CONCLUSIONS</b>The posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.</p>

A case report of huge fungal granuloma in deep maxillofacial region and review of the literature / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report one case of huge fungal granuloma in the deep maxillofacial region with its clinical findings,diagnosis and treatment process to improve our understanding of fungal granuloma and lessen misdiagnosis.METHODS: The literature was reviewed with combination of case report.RESULTS: The clinical and imaging findings of fungal granuloma had no specificity and were very subject to misdiagnosis. Confirmed diagnosis needed histopathological examination and bacterial culture.CONCLUSION: Deepened understanding of this disease can decrease misdiagnosis and benefit prompt and proper treatment.