OBJECTIVETo observe the effects on the lower limbs function after lumbar or sacral nerve root transferring to reconstruct urination function.

METHODSNine patients with bladder dysfunction and normal lower limb function after spinal cord injury were treated with anastomosis the S2 or S3 nerve root with the normal lumbar or sacral nerve root to reconstruct a new bladder artificial reflex arc. Then the alterations on the sensation and motor function of the lower limb after the surgery were observed.

RESULTSMyodynamia of the legs decreased slightly, and the decreasing about half grade of the myodynamia in the plantar flexion of the ankles were detected in 4 of 9 patients with S1 transferring. And the myodynamia recovered 3 months postoperatively. No obvious decreasing of the myodynamia appeared in the other cases.

CONCLUSIONNo obvious effects on the motor function can be found after the single lumbar or sacral nerve root transferring to reconstruct urination function.

Adult ; Exercise ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; innervation ; physiopathology ; Lumbosacral Region ; Male ; Middle Aged ; Reflex ; Rhizotomy ; Spinal Cord Injuries ; complications ; physiopathology ; Spinal Nerve Roots ; surgery ; Treatment Outcome ; Urinary Bladder ; innervation ; physiopathology ; Urinary Bladder, Neurogenic ; etiology ; physiopathology ; surgery

OBJECTIVETo investigate the influence of high mobility group box-1 protein (HMGB1) on the immunosuppression function of splenic regulatory T cells (Tregs) and its potential regulatory mechanism underlying the effect on CD4+ CD25- T cells in mice.

METHODSCD4+ CD25+ Tregs isolated from the spleens of male BALB/c mice by magnetic beads were seeded on 96-well (1 x 10(5) cells/well) cell culture plates coated with 1 microg/ml anti-CD3 and soluble CD28. After being stimulated with HMGB1 for different time and concentrations, the secretions of IL-2 and IL-10 were analyzed by ELISA. Tregs stimulated for 72 hours were cultured with CD4+ CD25- T cells together. The suppressive activity of CD4+ CD25+ Treg to CD4+ CD25- T cells was analyzed by MTT test. IL-2, IL-10, IL-4, and interferon (IFN)-gamma in the cell suspensions were determined by ELISA.

RESULTSAfter stimulation with HMGB1, the suppressive activity of splenic Tregs in mice were significantly down-regulated at 72 hours, when the proportion of Tregs to CD4+ CD25- T cells was 1 : 1. The secretion of IL-2 of Tregs stimulated by HMGB1 was not markedly changed (P > 0.05), while a dose-dependent decrease between IL-10 induction and HMGB1 concentration was obviously (P < 0.05). When CD4+ CD25- T cells were cultured with stimulated Tregs, comparing with unstimulated-Treg group, levels of IL-2 and IFN-gamma were elevated following the increased concentration of HMGB1 (P < 0.05 or P < 0.01). Meanwhile the secretion of IL-4 and IL-10 significantly decreased when cultured with stimulated Tregs (P < 0.05).

CONCLUSIONSThese data suggested that HMGB1 stimulation can result in significant down-regulation of immunosuppression of splenic Tregs in mice. HMGB1 might be a potential immunoregulatory signal that influences the proliferation of effector T cells, secretion of IL-2 and cells-polarization by inhibiting CD4+ CD25+ Tregs activity.

Animals ; Cell Communication ; drug effects ; Cells, Cultured ; HMGB1 Protein ; pharmacology ; Interleukin-10 ; metabolism ; Interleukin-2 ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Receptors, Interleukin-2 ; Spleen ; cytology ; T-Lymphocytes, Regulatory ; drug effects ; immunology ; metabolism

OBJECTIVETo build sub-endplate microcirculation disturbance animal model and to investigate the potential pathogenesis of intervertebral disc degeneration (IVDD).

METHODSTwenty four New Zealand white rabbits were divided into treatment group (Group A) and control group (Group B). In Group A, animals received endotoxin and corticosteroid application to build sub-endplate microcirculation disturbance animal model, validated by microthrombus staining. In Group B, animals were given no drug, but standard feeding. After 3 month, the extent of IVDD was evaluated by the water content, biochemistry analysis, and morphology.

RESULTSSub-endplate microthrombus staining confirmed the exist of microcirculation disturbance. The water content and biochemistry components content of disc in Group A were lower than those of disc in Group B, and IVDD was observed in morphology.

CONCLUSIONSub-endplate microcirculation disturbance can directly contribute to IVDD, the nutrients diffusion barrier is the potential pathogenesis of IVDD.

Animals ; Disease Models, Animal ; Female ; Intervertebral Disc ; blood supply ; metabolism ; pathology ; Male ; Microcirculation ; Rabbits ; Random Allocation ; Thrombosis ; complications ; metabolism ; pathology

OBJECTIVETo explore the strategy of pediatric intractable epilepsy surgery.

METHODSThe clinical data of 96 pediatric cases with intractable epilepsy and epilepsy syndromes underwent surgical treatment from April 2004 to April 2006 were retrospectively analyzed.

RESULTSThe surgical treatments were performed based on the results of comprehensive data from neurological, neurosurgical and pediatric departments. Among of them, 78 cases were performed with curative procedure, 17 cases with palliative procedure and 1 case with stereotactic damage procedure. The surgical effect was judged with Engel's standard, 58 cases had no seizure during 14 to 26 months follow-up, 26 cases had significantly improved in seizure control and the total efficiency was 87.5%. 81 cases had improvements in neuropsychological tests. 22 cases had postoperative complications such as neuro-dysfunctions and 15 cases were gradually recovered after the period of follow-up ended, 1 case died of CSF over drainage after operation 3 months.

CONCLUSIONSPediatric patients with symptomatic epilepsy and epilepsy syndromes are suitable to surgical treatment, the results are satisfactory in seizure control and neuropsychological function tests.

Adolescent ; Child ; Child, Preschool ; Epilepsy ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo summarize and analyze the diagnosis and arthroscopic treatment of osteochondral lesion of talus (OLT).

METHODSFrom 2000 to 2005 the data of 34 patients of OLT of the talus were retrospectively studied, including the symptom, physical examination, image, arthroscopic treatment All patients took X-ray and MRI examination before the arthroscopic surgery. Arthroscopic debridement was performed for all patients, in addition to drilling in 5 cases, and microfracture in 18 cases. Before operation, ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 71 +/- 8, and the score of pain (visual analogue scale, VAS) was 7.5 +/- 1.3.

RESULTSWeight-bearing pain of the ankle joint aggravated after exercise was the predominant complaint of OLT. X-ray examination was negative in 13 cases, and all lesions were detected by MRI, which was significantly better than X-ray (chi2 = 16.07, P < 0. 001). Thirty-one patients were followed up for an average of 28 months. The average post-operative AOFAS was 91 +/- 9 (t = 9.147, P < 0.001); And VAS was 2.4 +/- 2. 3, which was significantly lower than that in pre-operation (t = 10.853, P < 0.001). Of the 31 patients, 27 (87.1%) had good or excellent results.

CONCLUSIONSMRI could improve the accuracy of diagnosis. The results of arthroscopic treatment for OLT are satisfactory.

Adolescent ; Adult ; Ankle Injuries ; diagnosis ; surgery ; Arthroscopy ; methods ; Cartilage, Articular ; injuries ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Talus ; injuries ; Treatment Outcome

OBJECTIVETo investigate the advantages of using the preoperative computer-aided design system (CAD) in total hip replacement (THR).

METHODSFrom March 2002 to September 2005, 182 patients who underwent primary THR were screened and divided into 2 groups randomly. CAD and traditional preoperative templating were used in preoperative planning respectively.

RESULTSIn group using CAD, the migration of the center of acetabulum was smaller, and the discrepancy of the limb length and the abductor force lever arm were fewer. All the differences above were significantly different.

CONCLUSIONSCAD helps remove much of the guesswork during surgery, and the implant can be more precise fitting to the patient. And equal limb lengths and balanced abductor force can be restored more accurately.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Surgery, Computer-Assisted

OBJECTIVETo evaluate the occurrence and management of complications following minimally invasive percutaneous nephrolithotomy (MPCNL).

METHODSThe data of 4326 cases of MPCNL from January 2001 to February 2006 were reviewed, including 2451 male cases and 1875 female cases. Their age ranged from 4 to 82 years with a mean of 42 years. Of 4326 cases, 1221 cases had simple nephrolithiasis, 1735 staghorn nephrolithiasis, 386 upper ureterolithiasis, 90 serious stone street after extracorporeal shock wave lithotripsy, and 894 residual calculi after open surgery.

RESULTSAmong the 4326 cases of MPCNL, complications occurred in 445 cases (10.3%). Of the 445 cases, 20 had massive hemorrhage, 13 pleural injuries, 1 colonic perforation, 343 fever attacks (T > 38 degrees C), 13 septic shocks, 16 perinephric urinoma, 9 perinephric abscess, 26 renal perforating injuries, 1 guide wire misled into inferior vena cava, 3 died.

CONCLUSIONSMPCNL is a minimally invasive operation. However, serious complications would occur if the procedure were ignored. The improvement in the prevention and management of complications can promote the application of this procedure.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Kidney Calculi ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; adverse effects ; methods ; Postoperative Complications ; prevention & control ; therapy ; Ureteral Calculi ; surgery

OBJECTIVETo evaluate and analyze a therapeutic principle and strategy to treat the traumatic instability of sub-axial cervical spine as well as the prognosis assessment.

METHODSAccording to the Allen-Fergurson's classification, 83 patients who suffered from the traumatic instability of sub-axial cervical spine were performed operations depending on the patients's general health, the local pathological anatomy and neurological function, including both the decompression and reconstruction maneuvers through anterior, posterior or combined approach.

RESULTSThe average follow-up was 3 years and 9 months. The distraction-flexion and compression-flexion were the most frequent injury subtypes. There were 46, 28 and 9 operations through anterior, posterior or combined approach respectively. No operation through anterior-posterior-anterior approach occurred. The average scores of JOA, VAS and ASIA motor index improved from 11.2, 7.8 and 53.5 before operation, to 15.3, 2.6 and 67.8 at the final follow-up, respectively. After operation, there were different extent improvements of average radiologic parameter. Fusion was achieved in all patients and 12 complications occurred.

CONCLUSIONSAccording to both the patients's general health and the local pathological anatomy, individual therapeutic designing should be determined to treat the traumatic instability of sub-axial cervical spine.

Adolescent ; Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; etiology ; surgery ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Spinal Fusion ; methods ; Spinal Injuries ; complications

OBJECTIVETo explore the methods of the treatment and the principles of the prevention of bronchus-pleural fistula (BPF) after pneumonectomy.

METHODSThe clinical data of 15 cases of BPF after pneumonectomy in 815 lung cancer cases treated from July 1999 to June 2006 were analyzed retrospectively.

RESULTSThe occurrence rate of BPF after right pneumonectomy was 3.9% (12/310), higher than 0.6% (3/505) of left pneumonectomy (P < 0.01). The occurrence rate of BPF in cases with positive cancer residues in stump of bronchus was 22.7% (5/22), higher than 1.3% (10/793) of the cases with negative stump of bronchus (P < 0.01). The occurrence rate of BPF in the cases received preoperative radio- or chemotherapy was 5.0% (6/119), higher than 1.3% (9/696) of the cases received operation only (P < 0.05). There were no BPF occurred in the 76 cases whose bronchial stump were covered with autogenous tissues. All of the cases diagnosed as BPF were undertaken either closed or open chest drainage. Two cases were cured by thoracentesis aspiration and infusion antibiotics repeatedly. Two cases were cured by blocking the fistula with fibrin glue after sufficient anti-inflammatory treatment and hypertonic saline flushing. Six cases were discharged with a stable condition after closed drainage only. One case was discharged with open drainage for long time and 1 case was cured by hypertonic saline flushing after failure to cover the BPF using muscle flaps. Three cases died of multi-organs functional failure.

CONCLUSIONSBPF are related to the bronchial stump management and positive or negative residue of tumor at the bronchial stump. Autogenous tissues covering of the bronchial stump is a effective method for decrease the rate of BPF and especially for those patients received preoperative radio- or chemotherapy and right pneumonectomy. It should be performed for early mild cases with repeated thoracentesis aspirations or blocking the fistula with fibrin glue together with antibiotics. Chest closed drainage immediately and flushing with hypertonic saline repeatedly are effective methods for BPF.

Adult ; Aged ; Aged, 80 and over ; Bronchial Fistula ; epidemiology ; prevention & control ; therapy ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pleural Diseases ; epidemiology ; prevention & control ; therapy ; Pneumonectomy ; adverse effects ; methods ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the risk factors of lateral lymph node metastasis in advanced lower rectal cancer and its correlation with local recurrence and prognosis.

METHODSData from 96 consecutive patients with advanced lower rectal cancer underwent curative surgery with lateral dissection were retrospectively analyzed. The correlations of lateral lymph node metastasis with clinicopathologic characteristics, local recurrence and prognosis were investigated.

RESULTSLateral lymph node metastasis was observed in 14.6 (14/96) of the cases. In 40 patients with tumor diameter > or = 5 cm, 10 (25.0%) patients were found with lateral lymph node metastasis; while in the other 56 patients, only 4 (7.1%) cases were found with lateral lymph node metastasis (P < 0.05). Lateral lymph node metastasis was more frequent in patients whose tumor infiltrated full range of the intestinal wall (70%) than patients with 3/4, 2/4 and 1/4 intestinal wall was infiltrated (12.0%, 6.7% and 6.3%, respectively) (P < 0.05). Lateral lymph node metastasis rate of poorly differentiated carcinomas was significantly higher than those of moderate and well-differentiated ones (30% vs. 9.1% and 4.5%, P < 0.05). Local recurrence occurred in 18.8% (18 of 96 cases) of patients. Local recurrence in patients with positive lateral lymph node metastasis was 64.3%, while 11.0% in those without lateral lymph node metastasis (P < 0.05). Kaplan-Meier survival analysis showed significant improvements in median survival for patients with negative lateral lymph node metastasis over patients with lateral lymph node metastasis (80.9 +/- 2.1 vs. 38 +/- 6.7 months, log-rank P < 0.05).

CONCLUSIONSTumor diameter, degree of tumor infiltration and histological differentiation are significant risk factors of lateral lymph node metastasis in advanced lower rectal cancer. Lateral lymph node metastasis is an important predictor of local recurrence and prognosis of patients.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Prognosis ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies