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【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.
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Objective To observe the effects of melatonin (MT) on the expression of heme oxygenase-1 (HO-1),phosphorylated adenine dinucleotide quinone oxidoreductase-1 (NQO-1) and nuclear factor erythroid-2-related factor 2 (Nrf2),so as to explore the mechanism of MT's action in the Nrf2-ARE signaling pathway.Methods A total of 72 Sprague-Dawley rats were randomly divided into a control group,an injury group and a melatonin group,each of 24.T11-T12 acute SCI was induced in the injury and melatonin groups using the modified Allen's method.Ten minutes after the injury,equal amounts of absolute ethyl alcohol and melatonin were intraperitoneally injected into the rats in the injury and melatonin groups.For the control group,the vertebral plate was cut to expose the T11-T12 spinal cord without any injury of the nerves.Six rats from each group were randomly selected for sacrifice at 6,12 and 24 hours after the operation,and T11-T12 spinal cord specimens were collected.The spinal cord injury and inflammatory response were observed using haematoxylin eosin staining.The expression of HO-1,NQO-1 and Nrf2 was examined using immunofluorescence,while the expression of HO-1,NQO-1 and Nrf2 protein and mRNA were detected using RT-PCRs.Results The neuronal cells in the spinal cords of the control rats were of normal shape,without edema,necrosis or obvious hemorrhagic foci.Hemorrhagic foci,significantly more inflammatory cells and some spinal cord neurons with edema and necrosis were observed in the injury group.However,significantly fewer hemorrhagic spots and cells with edema were found in the melatonin group compared with the injury group.The average expression of HO-1,NQO-1 and Nrf2 protein and mRNA was significantly higher in the melatonin group than in the other two groups.The levels in the injury group were also significantly higher than in the control group 12 and 24 hours after the experiments.Immunofluorescence showed that the greatest number of cells with HO-1,NQO-1 and Nrf2 was found in the melatonin group,followed by the injury group and then the control group,with significant differences among all 3 groups.Conclusion Melatonin can promote the expression of HO-1,NQO-1 and Nrf2 in rats with acute spinal cord injury,which might be related with its activating the Nrf2-ARE signaling pathway.
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Objective To explore the effects of melatonin (MT) on the expression of interleukin (IL)-10,interleukin-6 and interleukin-8 as well as the inflammatory reaction and nerve repair after acute spinal cord injury (SCI).Methods One hundred and eight Sprague-Dawley rats were randomly divided into a spinal cord injury group (group A),an MT treatment group (group B) and a sham operation group (group C),each with 36 rats.SCI models were established in the rats of groups A and B using a version of Allen's weight drop method (50gcf at the T12 level).Group C had removal of the lamina only.Ten minutes later,group A was injected with 5％ ethanol in saline (the MT solvent) and group B with 100 mg/kg of melatonin preparation.At 6,12,18 and 24 hours,IL-6,IL-8 and IL-10 levels in serum were detected in 6 rats of each group.At 18 hours post-surgery,spinal cord specimens were taken from 6 rats of each group for hematoxylin eosin staining,morphological examination and immunohistochemical SP detection of IL-10 expression.Results The specimens of group A showed inflammatory reaction and ulceration at 48 h; groups B and C had no ulcers.Group B showed the highest levels of IL-10 in serum and IL-10 mRNA in the spinal cord,while group C showed the lowest level.The differences were statistically significant.Group A had the highest levels of IL-6 and IL-8 and group C had the lowest.The difference between group B and groups A and C was significant.The morpho-logical observation showed that after melatonin treatment the IL-10 levels in the spinal cord's central canal and around the gray matter improved.Conclusions Melatonin can improve nerve lipid peroxidation and inflammatory reaction in the treatment of spinal cord injury by increasing IL-10 expression and inhibiting IL-6 and IL-8 expression.
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Objective To investigate changes in the expression of prepro-orexin and orexin receptor-1 ( OX1R) following permanent middle cerebral artery occlusion ( MCAO ) with or without preconditioning through electrical stimulation of the cerebellar fastigial nucleus (FNS). Methods Wistar rats were subjected to permanent MCAO and randomly divided into 5 groups: a sham-operated control group (PO), an FNS preconditioning + shamoperated control group (FNS-PO) , an ischemia group, an FNS preconditioning + ischemia group (FNS-PI) and a cerebellar fastigial nucleus injury + FNS preconditioning + ischemia group (FNL-FNS-PI). Each group was divided into 5 subgroups according to the time at which the animals were sacrificed after the MCAO ( 1, 3, 6, 12 and 24 h).RT-PCR was used to detect expression of OX1R mRNA, and ELISA to measure the levels of orexin-A in the hypothalamus and plasma. Results The immunoreactivity of prepro-orexin decreased significantly in the PI groups, with further decreases over time. At the 12th h after MCAO, the immunoreactivity of prepro-orexin reached a minimum.There were significant differences between the rats in the PO and FNS-PO groups. On the contrary, the immunoreactivity of OX1R increased significantly in the PI groups, with further increases continuing over time, peaking at 12 h after the MCAO. There were significant differences between the PO and FNS-PO groups. In the rats with FNS preconditioning (PI-FNS) , the decrease in prepro-orexin and the increase in OX1R were significantly inhibited compared to the PI subgroups at the 6th and 12th hour. There was no significant difference between the FNL-PIFNS group and the PI group. The expression of OX1R mRNA increased significantly in the PI group, with further increases continuing over time, peaking at 24 hours. The plasma levels of orexin-A were not significantly different among the groups, but the levels of orexin-A in the hypothalamus decreased significantly in the PI and FNL-PI-FNS groups, with further decreases continuing over time. At the 12th h after the MCAO the levels were significantly different compared with the PO and PO-FNS groups. While in the rats with FNS preconditioning (PI-FNS) , the decrease in orexin-A level was reversed and there was no significant difference compared with PO and PO-FNS groups. Conclusions The orexinergic system is altered following cerebral ischaemia. FNS preconditioning may be able to regulate these changes.
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Objective To assess metabolic state in patients with Roux-y sigmoid neobladder.Methods The study comprised 33 patients(21 men and 12 women) with Roux-y sigmoid neobladder after oneological sur-gery.All enrolled patients were treated by the same protocol.Before and after withdrawing the catheter , serum e-lectrolytes, ereatinine and urea were analysed and used to assess the effect.Results All 33 patients were evalu-able.Before and after withdrawing the catheter , serum electrolytes, creatinine and urea were normal values and there was no signifcant difference(P >0.05).Three patients developed mild metabolic acidosis.Conclusions The Roux-y sigmoid neobladder is a feasible , safe and effective method for continent urinary diversion.This surgi-cal technique had no signifcant effect on metabolic state.
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BACKGROUND:Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion.But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal.OBJECTIVE:To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobladder.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Urinary Surgery,the 184 Hospital of Chinese PLA between June 2000 and November 2008.PARTICIPANTS:The experimental group comprised 33 bladder carcinoma patients,21 males and 12 females,averaging 64 years of age.The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy.METHODS:Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter.Prior to and after neobladder drainage tube removal,serum levels of electrolyte,creatinine,and urea nitrogen were detected.Before and 36 months after surgery,reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined.For the control group,the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined.MAIN OUTCOME MEASURES:Electrolyte,renal function,acid-base balance,mucosal layer thickness,numbers of intestinal glands prior to and after surgery,as well as prior to and after drainage tube extraction.RESULTS:After surgery,electrolyte,creatinine,and urea nitrogen were all normal in 30 patients.There was no significant difference in serum electrolyte,creatinine,and urea nitrogen between prior to and after surgery.Mild acid poisoning was found in 3 patients.Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery,and it basically kept the normal tissue structure;in the experimental group,sigmoid colon mucosa that was(577.6±169.4)μm prior to surgery was thinned(412.5±114.7)μm(P＜0.05),intestinal glands were loosely arranged,interstitial substance became less,and the number of intestinal glands per high-fold visual field that was(26.4±3.5)/high-fold visual field prior to surgery was decreased(15.2±2.7)/high-fold visual field(P＜0.05),after surgery.In addition,intestinal villus in the neobladder was gradually atrophied,and no enterocyte proliferation and malignant changes were found after surgery.CONCLUSION:After Roux-y sigmoid neobladder application,colon mucosa was gradually thinned,intestinal glands were loosely arranged,interstitial substance became less,the number of glands per high-fold visual field was decreased,and body metabolism produced no changes.
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AIM: To investigate the synergistic induction of apoptosis in rhabdomyosarcoma cells by the combination of TRAIL or TRAIL gene with cisplatin. METHODS: Rhabdomyosarcoma cells were treated with TRAIL, (Ad/GT)-TRAIL, cisplatin, respectively or the combination for 3 days. The cytotoxicity was observed by MTT assay. The apoptotic rates and the expression rates of Fas protein were measured by flow cytometry (FCM). The expression of cFLIP mRNA was determined by RT-PCR. RESULTS: Rhabdomyosarcoma cells were treated with Ad/ GT-TRAIL and TRAIL (100.0 ?g/L), the cytotoxicity index were 52.5% and 43.5%, the percentage of apoptotic cells were 12.95% and 10.26%, respectively. Combined with cisplatin, the cytotoxicity index and the percentage of apoptotic cells were increased significantly (P