Establishment of finite element model of anterior cervical transpedicular system for reconstruction of cervical stability after subtotal resection of two segments of lower cervical spine / 中国骨伤

OBJECTIVE@#To establish the fixation model of anterior cervical transpedicular system (ACTPS) after subtotal resection of two segments of lower cervical spine(C3-C7) in order to provide a finite element modeling method for anterior cervical reconstruction.@*METHODS@#The CT data of the cervical segment (C1-T1) of a 30-year-old adult healthy male volunteer was collected. Used Mimics 10.0, Rapidform XOR3, HyperMesh 10.0, CATIA5V19 and ANSYS 14.0 to establish the three-dimensional nonlinear complete model of lower cervical spine(C3-C7) as the intact group. The number of units and nodes of the complete model were recorded. After the effectiveness of the complete model was verified, the C5 and C6 vertebral subtotal resection was performed, and the ACTPS model was established as the ACTPS group. The axial force of 75 N and moment couple of 1N·m was loaded on the upper surface of C3 in intact group and ACTPS group, the range of motion(ROM)and stress distribution in states of flexion extension, lateral flexion, rotation was compared between two groups.@*RESULTS@#There were 85 832 elements and 23 612 nodes in the complete model of lower cervical spine(C3-C7) which was established in this experiment. The stress distribution of ACTPS internal fixation model was relatively uniform. Comparing with the intact group, the overall range of motion in ACTPS group was decreased in flexion extension, lateral flexion and rotation directions, and the corresponding compensation of adjacent C3,4 segment was increased slightly.@*CONCLUSION@#The stress distribution of ACTPS fixation system is uniform, there is no stress concentration area at the joint of screw and titanium plate, and the fracture risk of internal fixation is low. It is suitable for stability reconstruction after anterior decompression of two or more cervical segments.

Imaging study of soft tissue swelling after anterior cervical corpectomy / 中国骨伤

OBJECTIVE@#To study the changes of anterior soft tissue swelling after anterior cervical subtotal corpectomy, titanium mesh fusion and internal fixation.@*METHODS@#From November 2015 to July 2018, 151 patients with cervical spondylotic myelopathy were treated with anterior single corpectomy, titanium mesh fusion and internal fixation, including 109 males and 42 females, aged 44 to 81 (59.77±8.34) years. Through postoperative follow up observation, the C@*RESULTS@#All patients were followed up for 15 to 40(28.00±3.52) months. One week after the operation, the swelling of anterior soft tissue reached the peak, and then decreased. At 8 months after the operation, the swelling of anterior soft tissue on C@*CONCLUSION@#Anterior subtotal cervical corpectomy, titanium mesh bone graft fusion and internal fixation can cause swelling of the anterior soft tissue. One week after operation, we should pay more attention to the aggravation of the swelling of the anterior soft tissue to avoid the occurrence of dysphagia, respiratory obstruction, asphyxia and other complications.

Application of posterior arch of the atlasrch resection for high-level cervical dumbbell schwannoma surgery / 中国骨伤

OBJECTIVE@#To investigate the feasibility and clinical effect of hemi-resection of posterior arch of atlas in the upper cervical spinal dumbbell-shaped schwannomas.@*METHODS@#A retrospective analysis was performed on 13 patients with high level cervical dumbbell schwannomas from January 2005 to December 2018, including 10 males and 3 females, aged 19 to 67 years old. The occipital foramen to the C@*RESULTS@#The operation was successfully completed in 13 cases of this group. No vertebral artery injury or spinal cord injury occurred during the operation. All 13 patients were followed up for more than 12 months. No local recurrence was found. Both the VAS and the JOA score were significantly improved compared with those before surgery. The ASIA classification before operation was:1 case of grade C, 6 cases of grade D, 6 cases of grade E;the latest follow up was 3 cases of ASIA grade D and 10 cases of E.@*CONCLUSION@#The posterior arch of the atlas hemisection can remove the upper cervical dumbbell schwannoma in one stage. The short-term clinical effect is good, and there are no complications such as cervical instability.

Diagnosis, treatment and etiology analysis of nerve compression by bone fragment after lumbar spine surgery / 中国骨伤

OBJECTIVE@#To explore the diagnosis, treatment, cause and prevention of nerve compression by bone fragment after lumbar spine surgery.@*METHODS@#The clinical data of 23 patients with nerve compression by bone fragment after lumbar spine surgery from February 2012 to March 2019 were collected retrospectively, including 9 males and 14 females, aged 42 to 81 years with an average of (62.60±5.70) years. The surgical methods included lumbar interbody fusion in 20 cases and spinal endoscopy in 3 cases. All 23 patients experienced radiating pain on the decompression side or the contralateral limb after operation. The time of occurrence was from immediately after operation to 2 weeks after operation, with an average of (3.2±1.7) days. All patients underwent postoperative examination of lumbar spine CT or MRI to confirm residual ectopic bone fragments, and at the same time, bilateral lower extremity color Doppler ultrasound excluded thrombosis. Sources of ectopic bone fragments:14 cases of residual bone fragments caused by intervertebral fusion bone graft loss or fenestration fusion, 6 cases of fractured upper articular process head, and 3 cases of upper articular process bone remaining during spinal endoscopic surgery.@*RESULTS@#The patient's hospital stay was 10 to 37 (23.4±6.2) days. All patients were followed up for 6 to 25 (13.6±3.4) months. Three patients underwent posterior open nerve root exploration for removing bone fragments on the same day or the second day after surgery, and the symptoms were relieved. Twenty patients underwent conservative treatment firstly, and 13 patients were discharged after pain relieved by conservative treatment, 7 patients failed conservative treatment, the 2 cases of failed 7 cases had undergone nerve root block surgery during conservative treatment. Two patients underwent spinal endoscopy nerve root exploration and bone mass removal, and five patients underwent posterior open nerve root exploration and bone fragmentation removal. All postoperative pain symptoms were relieved. Preoperative CT, MRI and intraoperative bone fragment removal confirmed the shape and location of the bone fragments. The most likely source of bone fragments was the loss of intervertebral fusion bone grafts or residual bone fragments resulting from fenestration fusion (14 cases), fractured upper articular process head (6 cases), and upper articular process bones remaining in endoscopic surgery (3 cases). According to the Macnab criteria in evaluating clinical outcome, 20 cases got excellent results and 3 good.@*CONCLUSION@#After the lumbar spine surgery, the nerve compression by bone fragments is treated with appropriate treatments, and good clinical results can be obtained. Timely removal of residual bone fragments during operation and careful exploration of nerve roots before closing incision can avoid such complications.

Arthroscopic denervation of patella combined with microfracture for patellofemoral arthritis / 中国骨伤

OBJECTIVE@#To explore the clinical effect of knee denervation combined with micro-fracture under arthroscope in the treatment of patellofemoral arthritis.@*METHODS@#From May 2015 to May 2018, 60 patients with knee joint degenerative patellofemoral arthritis were treated, including 28 males and 32 females, aged from 24 to 56(40.5±3.35) years old. Among them, 30 cases underwent arthroscopic debridement alone(control group), 30 cases underwent arthroscopic debridement, peripatellar denervation combined with cartilage cone and patellofemoral articular surface microfracture treatment (treatment group). VAS, Lysholm and Kujala scores were used to evaluate the therapeutic effect.@*RESULTS@#No complications such as wound infection, vascular nerve injury and deep venous thrombosis occurred in all patients. The patients were followed up for 7 to 36 months with an average of 12.5 months. The VAS scores of the two groups were improved 4 weeks after operation, and the improvement of the treatment group was significantly better than that of the control group, the difference was statistically significant (<0.05). Lysholm and Kujala scores were compared at the last follow-up of the two groups, the improvement of the treatment group was significantly better than that of the control group.@*CONCLUSIONS@#The treatment of patellofemoral arthritis with patellar denervation combined with microfracture can better relieve pain and improve knee function.

Treatment of migrated lumbar disc herniation with percutaneous endoscopic lumbar discectomy and target foraminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of percutaneous endoscopic lumbar discectomy with target foraminoplasty in treating migrated lumbar disc herniation.</p><p><b>METHODS</b>From June 2015 to January 2016, 25 patients with migrated lumbar disc herniation were treated with percutaneous endoscopic lumbar discectomy with target foraminoplasty. A total of 14 males and 11 females, aging from 23 to 52 years old (average: 37.6) were enrolled in this study. Discectomy occurred in L₂,₃ of 1 case, L₃,₄ of 3 cases, L₄,₅ of 12 cases, L₅S₁ of 9 cases. Preoperative, 1-week and 1-year postoperative visual analogue scale (VAS) scores were collected to evaluate lower back and leg pain; Oswestry Disability Index(ODI) was used to assess the lumbar function.</p><p><b>RESULTS</b>All the patients were followed up for 12 to 19 months with an average of 15.2 months. The mean operation time was 108.6 min. No injury of dura, nerve root, or wound infection were found. Preoperative, 1-week and 1-year postoperative visual analogue scale(VAS) scores of lower back pain were 5.8±0.5, 2.5±0.4, 0.9±0.2, respectively, with significant differences among each other(<0.05);VAS scores of leg pain were 7.1±0.6, 1.5±0.4, 0.7±0.6, respectively, with significant differences among each other(<0.05). Lumbar ODI scores were 69.2±1.8, 22.5±4.7, 10.2±2.4 at the above time points and showed significant differences among each other(<0.05).</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic lumbar discectomy with target foraminoplasty for migrated lumbar disc herniation showed advantages of less injuries, bleeding and complication. It also promotes rapid recovery, being curative safely and effectively.</p>

Finite element analysis for self-made femoral head brace device in the treatment of early femoral head necrosis / 中国组织工程研究

BACKGROUND: Core decompression for early adult ischemic necrosis of femoral head gets the identity of most scholars, but the postoperative femoral head easily experiences collapse. How to prevent collapse is still a problem to be solved currently. OBJECTIVE: To perform biomechanical analysis of femoral head ischemic necrosis by using the finite element method and to provide biomechanical basis for the treatment of early adult femoral head necrosis. METHODS: One fresh femur specimen died of accidental death in youth and young adults was obtained, and no deformity or fracture was found. X-ray confirmed that it did not have tumor or osteoporosis. Spiral CT was used to scan normal femoral head and neck, pulp core decompression of femoral head and neck, brace device placement and bone-graft of femoral head and neck for acquiring image data from the proximal to distal vertical longitudinal axis. Scanning data were input in the Mimics software. Finite element method was utilized for biomechanical analysis of femoral head and neck of three models. RESULTS AND CONCLUSION: (1) The stress dispersal and downward conduction of normal femoral head was concentrated in the shaft of the femur and the tensile stress was concentrated in the rotor socket. (2) After pulp core decompression, the stress concentration, displacement and strain increased in the weight-bearing area of femoral head. (3) The stress of the internal bracing was similar to that of normal femoral head. (4) The stress of weight bearing area of femoral head is concentrated, and the strain is increased, so that weight bearing area is easy to collapse after pulp core decompression. The more stress distribution, more bearing load and less strain of implant and bone graft model, are conformed to the normal mechanical properties of the normal femoral head and neck.

Efficacy analysis of phacoemulsification combined with intraocular lens implantation in the treatment of retinitis pigmentosa complicated with cataract / 眼科新进展

Objective To investigate the efficacy of phacoemulsification combined with intraocular lens implantation in the treatment of retinitis pigmentosa complicated with cataract.Methods A retrospective study was conducted in 52 patients (101 eyes) who admitted in Leshan People's Hospital from January 2012 to December 2016 after diagnosed with primary retinitis pigmentosa combined with cataract and underwent phacoemulsification combined with intraocular lens implantation,and then the clinical data were retrospectively analyzed.All patients were examined for the best corrected visual acuity (BCVA),intraocular pressure,slit lamp anterior segment examination,fundus examination under cycloplegia and optical coherence tomography before and after treatment.The preoperative and postoperative variables were compared by paired t-test,and the correlation between visual acuity and the macular thickness was analyzed by Pearson correlation test.Results Cataract surgery was completed successfully,and all patients were followed-up for (3-12) months,with an average (5.09 ± 2.20) months.The average BCVA of 101 eyes was increased from (0.12 ± 0.09)before surgery to (0.21 ± 0.16) after surgery,and the difference was statistically significant (t =-8.016,P =0.000).Postoperative visual acuity was significantly correlated with macular thickness.Furthermore,there was a negative correlation of macular thickness with macular cystoid edema,macular epiretinal membrane and visual acuity (r =-0.866,P =0.001),but a positive correlation with macular atrophy (r =0.928,P =0.000).Unfortunately,anterior capsule contraction occurred in 2 eyes after cataract surgery,and secondary intraocular hypertension appeared in 2 eyes.Visual acuity was improved and stable for a long time after radial incision of anterior capsule and medication control of intraocular pressure.Conclusion Phacoemuisification combined with intraocular lens implantation can improve the vision of patients,and is a safe and effective method for the treatment of retinitis pigmentosa complicated cataract.

Efficacy of photocoagulation alone or combined with intravitreal Bevacizumab for radiation retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM:To evaluate the efficacy of photocoagulation alone or combined with intravitreal Bevacizumab for radiation retinopathy ( RR) .?METHODS: There were 43 patients ( 43 eyes ) with RR were collected at the Fifth Affiliated Hospital Sun Yet-Sen University between Jan.2009 and Jan.2014.Twenty-one patients received the photocoagulation treatment combined with intravitreal bevacizumab and 22 patients received the treatment of photocoagulation alone.All the patients would complete ophthalmologic examinations, including best -corrected visual acuity ( BCVA ) , intraocular pressure, optical coherence tomography, fundus fluorescein angiography before and after the treatment.?RESULTS:BCVA:In monotherapy group, there were no statistically difference about BCVA before and after treatment ( P>0.05).In combined therapy group, the BCVA had been increasing gradually in 2wk, 1, 3, 6mo after treatment ( P 0.05).In the comparison of BCVA in these two groups in 2wk, 1, 3, 6mo after treatment, the combined therapy group were better than monotherapy group in each time point (P0.05).Central macular thickness (CMT):in monotherapy group, the CMT had been decreasing gradually in 2wk, 1, 3, 6mo after treatment ( P 0.05).In combined therapy group, the CMT had been decreasing gradually in 2wk, 1, 3, 6mo after treatment ( P0.05).In the comparison of CMT between these two groups in the 2wk, 1, 3, 6mo after treatment, those of combined therapy group were thinner and difference were statistically significant ( P 0.05).? CONCLUSION: Photocoagulation combined with intravitreal bevacizumab for the treatment of radiation retinopathy both have an effect on reducing the macular edema in a short time (6mo).But the long-term efficacy is poor.

Anterior revision surgery for the treatment of cervical spondylosis after anterior decompression and titanium mesh fusion / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the reasons why anterior decompression and titanium mesh fusion for cervical spondylosis always show poor therapeutic effects, and to investigate the clinical effects of anterior revision surgery in these patients.</p><p><b>METHODS</b>From January 2004 to December 2011, 16 patients underwent anterior decompression and titanium mesh fusion for cervical myelopathy were treated with anterior revision surgery. There were 7 males and 9 females with an average age of 61 years old (ranged from 46 to 75 years), including 11 cases with cervical spondylotic myelopathy, 2 cases with nerve root cervical spondylosis and 3 cases with mixed type cervical spondylosis. Average duration from the first operation to reoperation was 7 years(ranged from 4 to 12 years). In the first operation, titanium mesh segment located in C3-C5 (2 cases), C4-C6 (8 cases), C4-C7 (2 cases), C5-C7 (4 cases), and one of them, titanium mesh implantation in C4 and C5,6 intervertebral disk removal and cage fusion. After the first operation, symptom of 13 patients recurred after improvement or disappearance, 2 patients did not show obvious improvement, and 1 patient aggravated. Cervical spine radiography, CT scan and MRI were performed in all patients before re-operation. There were 12 patients with compression of the spinal cord or nerve root caused by degenerative changes in adjacent segments of fusion segments, 4 cases in upper segments, and 8 cases in lower segments; 3 patients with compression of the spinal cord or nerve root caused by vertebral posterior osteophyte of decompressed segments; 1 patient with compression of the spinal cord caused by incomplete anterior decompression. JOA, NDI and Odom classification were used to assess the clinical effects.</p><p><b>RESULTS</b>All anterior revision surgery were successful with a mean time of 110 min (80 to 150 min) and mean bleeding of 160 ml (30 to 200 ml). There was 30 ml clear drainage fluid in 1 patient suspected of cerebrospinal fluid leakage. But the 2nd day after operation, the tube was removed and the drainage opening was sutured, and the suture incision healed in grade A after 10 days. Other patients had no complications such as dysdipsia, hoarseness, and laryngeal edema, etc. All patients were followed up for 12 to 28 months with an average of 16 months. Two months after operation and at last follow-up, JOA scores and ODI index had obviously improved than preoperation (P < 0.01), and there was significant difference between postoperative 2 months and last follow-up (P < 0.01). At the final follow-up, improvement rate of JOA was (72.9 +/- 0.2)%. According to the standard of Odom, 12 cases got excellent results, 3 good, 1 fair.</p><p><b>CONCLUSION</b>After surgery of cervical decompression and bone graft fusion with titanium mesh, the patients need re-operation because of incomplete decompression, degenerative changes in adjacent segments or newly formed compression factors, and complications caused by implants. Anterior revision surgery can obtain good clinical effects.</p>

Roles of PIK3R1 gene in development of hepatocellular carcinoma / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the roles of phosphatidylinositol 3 kinase regulatory subunit alpha (PIK3R1）gene in the development of hepatocellular carcinoma （HCC）.</p><p><b>METHODS</b>Surgical specimens of liver cancer and corresponding pericancerous liver tissue were collected from 20 patients with hepatocellular carcinoma. Expression of p85α, encoded by PIK3R1, in HCC tissue specimens was detected by Western blotting and immunohistochemistry. HCC HepG2 cells were transfected with PIK3R1 siRNA or PIK3R1-cDNA. The expression of PIK3R1 in transfected HepG2 cells or control cells were detected by real-time PCR. Cell proliferation was evaluated by MTT, colony formation assays and flow cytometry respectively. The expression of PI3K/AKT pathway-related proteins were detected by Western blotting.</p><p><b>RESULTS</b>The expression of p85α in liver tissue was higher than that in pericancerous tissues (1.27±0.58 vs 0.99±0.47，t=-3.25，P<0.05）. The expression of PIK3R1 was decreased by 0.19±0.03 fold in PIK3R1siRNA-transfected HepG2 cells(t=46.77，P<0.05)，and increased by 32.36±3.33 fold in PIK3R1 cDNA -transfected cells（t=-16.31， P<0.05）. MTT result showed that PIK3R1 siRNA inhibited growth of HepG2 cells （0.611±0.072 vs 0.807±0.059，t=3.65，P<0.05），while PIK3R1 cDNA increased the cell growth（0.937±0.060 vs 0.693±0.065，t=-4.78，P<0.05）. PIK3R1 siRNA transfected cells presented lower colony-forming efficiency than control group（3.8%±0.84% vs 15.0%±2.3%，t=7.92，P<0.05），while PIK3R1 cDNA transfected cells had higher colony-forming efficiency than control group (23.6%±3.4% vs 12.0%±1.5%，t=-5.40，P<0.05）. PIK3R1 siRNA reduced the ratio of S phase cells（13.9%±0.015% vs 32.9%±0.07%，t=45.97，P<0.01, while PIK3R1 cDNA increased S phase cells（56.33%±0.024% vs 31.94%±0.042%，t=-8.73，P<0.01）. PIK3R1 increased the level of p-AKT and decreased p53 level. CONCLUSION：p85α is highly expressed in HCC，and PIK3R1 gene may promote proliferation of HepG2 cells by activating PI3K/AKT pathway.</p>

Radiological study on the n-HA/PA66 cage used in the transforaminal lumbar interbody fusion / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effects of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage on recovering and maintaining lumbar curvature, lumbar heights and fusion rate when used in the transforaminal lumbar interbody fusion.</p><p><b>METHODS</b>From February to July 2012, 50 patients with degenerative lumbar disease(lumbar disc herniation in 32 cases and lumbar spondylolisthesis in 18 cases) were treated with transforaminal lumbar interbody fusion using the n-HA/PA66 cage, and their preoperative and postoperative clinical outcomes were analyzed. The patients were followed up for 2, 4, 6 and 8 months after operation, during which the CR and CT film of lumbar vertebra were checked to get relative height of vertebral space, Taillard index,index of lumbar spinal curvature,angle of segmental and full lumbar lordosis. The data were analyzed respectively with pair t-test, analysis of variance or LSD-t-test.</p><p><b>RESULTS</b>All the patients were followed up, and the duraion ranged from 8 to 13 months, with a mean of 11.32 months. There were significant differences in relative height of vertebral space, Taillard index, index of lumbar spinal curvature, angle of segmental and full lumbar lordosis after surgery, but there were no significant differences in different periods after operation. The fusion time of lumbar ranged from 4 to 8 months.</p><p><b>CONCLUSION</b>The n-HA/PA66 cage can recover and maintain lumbar normal stability with higher rate of fusion and less complications.</p>

One stage anterior debridement, bone fusion and internal fixation for the treatment of lumbosacral tuberculosis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of the anterior debridement,bone fusion, single screw-rod fixation for the treatment of lumbosacral tuberculosis.</p><p><b>METHODS</b>From March 2005 to February 2011,18 patients with lumbosacral (L3-S1) tuberculosis (including 13 males and 5 females with an average age of 38.5 years old ranging from 24 to 61 years) were treated with removing focus completely, large piece of iliac bone strut grafting, single screw-rod vertebral lateral anterior internal fixation through anterior extraperitoneal approach. The process segment was L3,4 in 2 cases, L4,5 in 5, L4 in 2, L5S1 in 6, L4-S1 in 3. All patients were routinely treated with antituberculous druy for 12-18 months after operation, erythrocyte sedimentation rate and liver function, X-ray films, CT examination, were statedly rechecked, and condition of antituberculosis treatment and bone grafting fusion were detected.</p><p><b>RESULTS</b>Intraoperative focus were exposed clearly, debrided thoroughly. There were no large blood vessels, nerves, ureteral injury and other serious complications during operation. All patients were followed up form 6 to 42 months with an average of 13 months. Internal fixations were not loosening,breaking; bone of grafting was not displacement and obtained good healing; erythrocyte sedimentation rate and C-reactive protein were normal; tuberculosis lesions were not recurrence.</p><p><b>CONCLUSION</b>Through anterior extraperitoneal approach to remove focus, bone fusion, single screw-rod fixation in treating lumbosacral tuberculosis can complete cut lesion and rebuild the stability of lumbosacral vertebrae,in this area with a single screw and rod fixation is a feasible method.</p>

Treatment of atlantoaxial hemangioma with vertebroplasty through anterior approach / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the diagnostic and therapeutic experience for the atlantoaxial hemangioma with vertebral plasty through anterior approach.</p><p><b>METHODS</b>From January 2005 to April 2012,6 cases were initially diagnosed as atlantoaxial hemangioma under MRI,and treated with vertebroplasty through anterior approach. There were 2 males and 4 females ranging in age from 35 to 67 years old with an average of 49 years old. Six patients were followed up by out-patient clinic or telephone after operation for 6 months,and WHO standard clinical effects were used to assesse pain degree.</p><p><b>RESULTS</b>All the hemangioma were confirmed by puncture. The mean operative time and injection amount of bone cement were 58 min and 2.6 ml,repectively. Postoperative X-ray or CT scan showed that the bone cement filled focus satisfactorily. All patients were followed up from 6 to 48 months with average of 28 months. According to the pain degree of WHO standard, 2 cases got partly relief and 4 got completely relief and up to final follow-up,the results were still stable.</p><p><b>CONCLUSION</b>Treatment of atlantoaxial hemangioma with vertebroplasty through anterior approach is a safe and effective method. And correct puncture, adequate injection time and volume of bone cement are keys to successful.</p>

Lateral neck lymph node metastasis in cN0 papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the pattern of lymph node spread in papillary thyroid carcinoma (PTC) with clinically negative node (cN0).</p><p><b>METHODS</b>A total of 106 patients with cN0 PTC who underwent total or subtotal thyroidectomy plus unilateral or bilateral lateral neck dissection (LND, level II-V or level I-V) at West China Hospital of Sichuan University between April 2004 and August 2010 were analyzed retrospectively.</p><p><b>RESULTS</b>The lateral neck lymph node metastasis in cN0 PTC was significantly associated with sex (male, P = 0.007), tumor stage (T3/T4, P = 0.006), tumor size (> 1 cm, P = 0.014) and the number of positive central lymph nodes (≥ 2, P < 0.001), but not with age and multifocal tumor. Level III (47/116, 40.5%) was the most prevalent metastatic site, followed by level IV (41/116, 35.3%), level II (18/116, 15.5%) and level V (2/29, 6.9%). Of the cases with lymph node metastases in level III and IV, 89.8% (79/88) of primary thyroid tumors existed in the lower and middle sites of the thyroid lobes, while in the cases with lymph node metastases in level II, 77.8% (14/18) of primary thyroid tumors in the upper sites of the thyroid lobes, and 83.3% of cases with level II metastases were accompanied with level III metastases. Two cases with level V metastases were accompanied with metastases in levels II, III and IV.</p><p><b>CONCLUSIONS</b>LND should be considered for cN0 PTC in male, with T3/T4 lesions and positive central lymph nodes ≥ 2, and the range of dissection should include level III and IV. Dissection of level II should be considered in cN0 PTC with primary tumor localized in the upper site of the thyroid lobe or with level III metastasis. Dissection of level V should be considered at present of metastases in level II, III, and IV. For cN0 PTC with tumor size < 1 cm, confined to the thyroid and without lymph node metastasis in the central compartment, LND is not recommended.</p>

The changes of organelle ultrastructure and Ca2+ homeostasis in maize mesophyll cells during the process of drought-induced leaf senescence

The changes of cell ultra structure as well as Ca2+ homeostasis involved in the drought-induced maize leaf senescence was investigated. Meanwhile, many indicatives of leaf senescence including thiobarbituric acid reactive substance (MDA), electrolyte leakage (EL), and chlorophyll along with soluble proteins were also detected during the process. The Polyethylene glycol6000(PEG6000)-incubated detached leaves showed a slight increase in the MDA content and electrolyte leakage during the first 30 min of our detection, which was corresponded to an unobvious alteration of the cell ultrastructure. Other typical senescence parameters measured in whole leaf exhibited a moderate elevation as well. Thereafter, however, the EL and MDA rose to a large extent, which was correlated with a dramatic damage to the cell ultrastructure with concomitant sharp decrease in the chlorophyll and soluble proteins content. The deposits of calcium antimonite, being an indicator for Ca2+ localization, were observed in the vacuoles as well as intercellular spaces in the leaves grown under normal condition. Nevertheless, after PEG treatment, it was revealed a distinct increment of Ca2+ in the cytoplasm as well as chloroplasts and nuclei. Moreover, with long-lasting treatment of PEG to the detached leaves, the concentration of Ca2+ as described above showed a continuous increment which was consist with the remarked alteration of physiological parameters and severe damage to the ultrastructure of cells, all of which indicated the leaf senescence. Such drought-induced leaf senescence might result from a loss of the cell's capability to extrude Ca2+. All above findings give us a good insight into the important role of Ca2+ homeostasis in the process of leaf senescence accelerated by the drought stress.

Multiple soft tissue defects of hand repaired by muliplefoliated tissue flap only pedicled by descending branch of lateral circumflex femoral artery / 中华显微外科杂志

ObjectiveTo introduction of perforator flaps,muscle flaps pedicled by descending branch of lateral circumflex femoral artery,method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.MethodsFifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled bydescending branch lateral circumflex femoral artery.At first,the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap,fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects.The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time.ResultsNo vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months(the average was 8.7 months).Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent.ConclusionMultiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.

Biphasic modulation of cocaine-induced conditioned place preference through inhibition of histone acetyltransferase and histone deacetylase

To examine the causative relationship between aberrant histone acetylation changes and cocaine-induced reward. Male Sprague-Dawley rats [n=160] were tested by conditioned place preference [CPP] - procedure, to evaluate the effects of inhibitors of histone deacetylase [HDAC] and histone acetyltransferase [HAT] on the conditioned effects of cocaine. Conditioning sessions were conducted twice daily for 2-4 days. For each conditioning session, rats were injected with either HDAC [or HAT] inhibitors or saline in home cages, followed by cocaine [intraperitoneally [ip]] or saline [ip] 30 minutes later, and then immediately confined for 50 minutes in the cue-specific chamber. On the day following the last conditioning session, the rats were tested for place preference for 15 minutes. The present study was carried out at the Department of Pharmacology of Jiaxing University, Jiaxing, Zhejiang, and Pharmacology Research Center of Fudan University, Shanghai, China between October 2007 and January 2009. Our results showed that pretreatment with HDAC inhibitor [sodium butyrate], potentiated cocaine-induced CPP, but did not itself lead to conditioned preferences, or aversions. On the contrary, rats pretreated with curcumin [HAT inhibitor] markedly inhibited cocaine-induced CPP, but did not itself lead to conditioned preferences or aversions. Histone modifications may be an important mechanism that underlies conditioned effects of cocaine. Moreover, HAT may bye a potential therapeutic target for cocaine addiction

Effect of sulfated polymannuroguluronate on Tat induced proinflammatory cytokines release in THP-1 cells and its mechanism of action / 药学学报

<p><b>AIM</b>To investigate the effects of sulfated polymannuroguluronate (SPMG), a novel candidate anti-AIDS drug in Phase II clinical trial, on Tat-induced release of proinflammatory cytokines (i.e., TNFalpha, IL-1beta and IL-6) and its related mechanism.</p><p><b>METHODS</b>The effects of SPMG on Tat induced TNFalpha (4 h), IL-1beta and IL-6 (6 h) secretion in THP-1 cells were measured by ELISA. Western blotting analysis was used to study the effects of SPMG on Tat induced PKCzeta, PKCtheta and PKCsigma phosphorylation.</p><p><b>RESULTS</b>SPMG (50 to 100 microg x mL(-1)) markedly suppressed TNFalpha, IL-1beta and IL-6 secretion in Tat activated THP-1 cells. In THP-1 cells the phosphorylation levels of PKCzeta, PKCtheta and PKCsigma significantly increased following Tat stimulation, and only PKCsigma phosphorylation levels was inhibited by SPMG (50 to 100 microg x mL(-1)).</p><p><b>CONCLUSION</b>SPMG suppresses the secretion of proinflammatory cytokines in THP-1 cells may be by inhibiting PKCsigma activation.</p>

A field trial for evaluating the safety of recombinant human interferon alpha-2b for nasal spray / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To evaluate the safety of recombinant human interferon alpha-2b for nasal spray for the prevention of SARS and other upper respiratory viral infections.</p><p><b>METHODS</b>Field epidemiologic evaluation was conducted, the design was randomized and had a synchronously parallel control group. In the study, the drugs were given for five days and all subjects were followed up for ten days.</p><p><b>RESULTS</b>During the period of using interferon, body temperature of the experimental group was normal compared to the control group. Experimental group had more influenza-like symptoms than the control group (P < 0.05), such as headache (4.83%-7.09%), dizziness (7.17%-11.63%), lassitude (8.55%-15.06%), muscular soreness (4.43%-7.09%), pharynx dryness (12.10%-17.85%), angina (6.25%-8.72%), abdominal pain (2.30%-5.50%) and diarrhea (2.45%-5.66%). Most of side effects reached their peak with in the first 3 days. Except for pharynx dryness, the incidences of all other side effects declined after completion of the use of the trial drug, and incidences of some symptoms in experimental group were lower than those of the control group. There were no significant differences in the symptoms of cough and expectoration between the experimental group and the control group. The incidence of exanthem in the control group was significantly higher than that in the experimental group. The side effect of bloody nasal mucus was not observed in experimental group, which had been reported by other authors in several volunteer studies.</p><p><b>CONCLUSION</b>Using recombinant human interferon alpha-2b for nasal spray could lead to some influenza-like symptoms, however, all those symptoms were mild , reversible, and relieved after completion of the use of the trial drug. No serious side effects were found during the period of following up. The authors conclude that the drug is safe.</p>