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BACKGROUND:The main treatment of lumbar isthmic spondylolisthesis is the surgery, in a broader attempt to decompression, reduction, fixation and fusion of the lesioned segments. The golden standard of the treatment is biological fusion, while internal fixation is a reliable assistance for fusion therapy. ＜br> OBJECTIVE:To discuss the clinical value and curative effect of intervertebral fusion cage combined with pedicle screw systems for the treatment of lumbar isthmic spondylolisthesis. ＜br> METHODS:From March 2010 to March 2013, 21 cases of isthmic spondylolisthesis were treated with intervertebral fusion cage combined with pedicle screw systems, including 18 cases of spondylolisthesis of degree II and 3 cases of spondylolisthesis of degree III. Al patients were fol owed up regularly, taking JOA lumbago score and visual analog scale score as the objective evaluation criteria of pain in postoperative fol ow-ups. The curative effect was assessed by Macrab standard, and the functional recovery was evaluated based on indicators such as Prolo, and the spinal fusion rate was assessed according to Lenke criteria. Changes of slippage rate, slippage angle, sacral inclination angle and intervertebral space post height in preoperative and postoperative periods were evaluated by iconography data. ＜br> RESULTS AND CONCLUSION:Al the 21 patients with isthmic spondylolisthesis were fol owed up for 12-16 months. JOA lumbago score and vasual analog scale score of al patients were improved after treatment, and the difference was statistical y significant compared with before treatment (P=0.000). According to Macrab evaluation criteria, there were 17 excellent cases and 4 good cases. Each indicator evaluated by preoperative Prolo activities and symptom grading showed significant differences in preoperative and postoperative periods (P=0.003). Postoperative lumbar spondylolisthesis was basical y reset, the slippage angle was significantly reduced, the sacral inclination angle was increased, and the height of the intervertebral space was recovered basical y. Intervertebral fusion cage combined with pedicle screw systems was one of the effective strategies to treat lumbar isthmic spondylolisthesis.
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BACKGROUND:Bryan cervical disc replacement and anterior cervical discectomy and fusion have a dispute in the treatment of cervical spondylosis. OBJECTIVE:To evaluate the clinical effects of Bryan cervical disc replacement and anterior cervical discectomy and fusion by meta-analysis, thereby providing clinical evidence for treatment strategy of cervical spondylosis. METHODS:The authors searched Medline, PubMed, EMBASE, OVID, CBM, CNKI and also searched manual y seven relevant Chinese orthopedic journals for articles pertinent to clinical research of Bryan cervical disc replacement and anterior cervical discectomy and fusion. Extracted data included the range of motion of the cervical spine, visual analog scale score, neck disability index, the Japanese Orthopaedic Association score. Meta-analysis and forest plots were conducted with RevMan4.2.2 Software. RESULTS AND CONCLUSION:There are eight articles in the meta-analysis, including 883 patients (430 patients receiving Bryan cervical disc replacement, and 453 patients receiving anterior cervical discectomy and fusion). Meta-analysis did detect statistical y significant differences in the range of motion of the cervical spine at 3 months and 24 months postoperatively between the two groups, but did not detect statistical y significant differences in visual analog scale score, neck disability index, the Japanese Orthopaedic Association score between the two groups. These findings indicate that Bryan cervical disc replacement is superior to anterior cervical discectomy and fusion in the range of motion of the cervical spine. However, the current literature offers no evidence to support superiority of the Bryan cervical disc replacement over the anterior cervical discectomy and fusion.
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Objective To investigate the relationship between telomerase reverse transcriptase (TERT) gene expression and astrocyte activation.Methods Twenty neonatal 3-day-old male SD rats were used for culture of the astrocytes.The astrocytes were divided into Group A (activated,non-transfected astrocytes),Group B (activated,transfected astrocytes),Group C (unactivated astrocytes) and Group D (activated,empty plasmid transfected astrocytes) according to the random number table,with 5 rats per group.The cell proliferation rate in each group was detected by cell counting kit-8 (CCK-8) ;TERT expression by immunocytochemical method; expressions of TERT and glial fibrillary acidic protein (GFAP) genes by RT-PCR assay.Results Astrocytic proliferation ability in Group B lowered significantly as compared with that in Groups A,D and C (F =43.418,P ＜ 0.01).Expressions of TERT and GFAP mRNAs in Groups A and D were significantly higher than those in Group B and C,and no significant difference was found between Groups A and D.Besides,there was a linear correlation between mRNAs expressions of both genes in Groups A and D (r =0.701,0.704,P ＜ 0.01),while no significant linear correlation was observed in Groups B and C (r =0.260,P ＞ 0.05).Expressions of TERT and GFAP proteins in Groups A and D were markedly higher than those in Groups B and C and no significant difference was found between Groups A and D.Conclusion TERT genes are involved in the activation of astrocytes and exert effect on promoting the activation of astrocytes.
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ObjectiveTo explore the diagnosis and surgical treatment techniques for the patients with primary presacral tumor.Methods Data from 31 patients with primary presacral tumor admitted into our Department for Surgery from Jan. 1999 to Jar. 2009 were retrospectively analyzed.All patients underwent surgical treatment,among them,10 received per-sacroiliac or per-perineum approaches to remove the tumors,18 receivedper-abdomentumorectomy, and3receivedcombinedper-peritoneumandper-perineum tumorectomy.Results Patients visited the doctor while exhibiting the compression symptoms by the the tumors.Final diagnosis could be reached with the help of rectal touch,B-mode ultrasound,computerized tomography,or magnetic resonance imaging.Complete resection was performed in 28 patients.Partial resection was performed in 3 patients.Fractionated resection was successfully performed in 2 patients with chronic infection or sinus tract.ConclusionThe primary presacral tumor should be surgically resected once final diagnosised and without surgical contraindications.Pelvic plexus should be preserved and presacral hemorrhage should be prevented.The tumor should be resected as complete as possible.
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Objective To study the reasons and prevention of the hoarse voice after continuity-intact recurrent laryngeal nerve (RLN)operation without damage of RLN under naked eyes.Methods Data of 1871 patients undergoing thyroid surgery from Jan.2001 to Jan.2011 were retrospectly analyzed.919 patients had their RLN exposed,among whom 757 patients had bilateral RLN exposed.952 patients didn't have their RLN exposed in the surgery.Results A total of 1676 RLNs were exposed by the routine method and minimally invasive method.All the nerves were confirmed no damage and continuity intact under naked eyes.Hoarse voice occurred to 19patients after surgery,with the percentage of 2.12％ (19/897).The rate of hoarse voice in the non-exposed group was 5.46％ (52/952).The difference of horse voice between the RLN exposed group and non-exposed group had statistical significance(P ＜ 0.05).Conclusions RLN without damage under naked eyes and continuity intact doesn't mean no damage of electroneurophysiology.The rate of RLN damage in the exposed group was less than that in the non-exposed group.The major causes of hoarse voice may include misoperation,heat conduction and postoperative scar adhesion.The key to avoid RLN damage is prevention.
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Objective To explore the effect of endocrine therapy in breast cancer patients whose estrogen receptor (ER) and progesterone receptor(PR) was preoperatively negative and turned positive after neoadjuvant chemotherapy. Methods The clinical experimental study was carried out in 97 cases of breast cancer which were divided into endocrine treatment group and control group. The follow-up time ranged from 15 to 60 months. Results In endocrine treatment group, 3 and 5-year disease-free survival were respectively 74.5% (38/51), 60.7% (31/51), and 3 and 5-year overall survival were respectively 80%(41/51), 74. 5% (38/51). In control group, 3 and 5-year disease-free survival were respectively 54.2% (26/46), 41.7%(20/46), and 3 and 5-year overall survival were 60.9%(28/46),50%(23/46),respectively. The corresponding values were significantly higher in endocrine treatment group than in control group(P＜0.05).Conclusions Remedy endocrine therapy improves the disease-free and overall survival rate in breast cancer patients with the expression of ER and PR turning positive after initial neoadjuvant chemotherapy.
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Objective To explore the effects of preoperative neoadjuvant endocrine therapy on expression and significance of ER, PR, C-erbB-2 in pestmenopause breast cancer patients over 60 years old. Methods 36 patients were treated with endrocrine therapy by oral tamoxifen for 60 ～ 90 days, and the expression of ER, PR and C-erbB-2 was examined before and after the endrocrine therapy. Results In 36 patients the negative expres-sion rate of ER, PR was 16.78% and 11.11% respectively before the endrocrine therapy, compared to 50% and 33.33% after the endrocrine therapy. There was significant difference(P<0.05). The expression of C-erbB-2 was 13.8% and 16.67% before and after the endrocrine therapy, and there was no significant difference between the two figures. Conclusions The neoadjuvant endocrine therapy by tamoxifen alone can down-regulate the ex-pression of ER, PR, and can inhibit tumor growth. Some patients may get partially relieved.
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Objective To study the relationship ofiliac vein, portal vein(PV) and superior mesenteric vein (SMV), explore the feasibility on application of iliac vein in extended pancreatoduodenoctomy, and observe the clinical results. Methods Portal system and iliac venous system were dissected in 20 adult corpses. The caliber, thickness and branches of iliac vein, PV and SMV were observed and compared. The application of iliac vein in extended pancreateduodenoctomy were studied in 2 patients. Results There were no branch in 30 mm near lilac vein, 1 branch in 30--50 nun and 2-3 branches in 51-70 ram. The thickness and caliber of iliac vein matched with PV's and SMV's, there was no significant difference. Only proper pro-longed operative incisions were needed and the operation time was 5-7 hours. Postoperative vascular throm-bosis, necrosis of intestine, liver failure and so on were not occurred. No evidence of vascular embolism and recurrence happened within 6-16 months' follow-up. Conclusion Uiac vein, as a choice, can be used for vasotransplantation in the pancreatoduodenectomy.