Objective To investigate the clinical efficacy of vertebral pedicle screw fixation for lumbar fractures without nerve injury. Methods A total of 100 patients with vertebral fractures from February 2012 to December 2012 in our hospital were researched.According to the order of the patient admitted to the hospital,50 patients from February 2012 to June 2012 were divided into observation group,50 pa-tients from 2012 July to December 2012 were divided into control group.The observation group were treated with vertebral pedicle screw fixa-tion,the control group were treated with a four nail fixation.The therapy and complications between two groups were compared after treatment, and the satisfaction of two groups were investigated.Results There was no significant difference in vertebral anterior height compression rate and Cobb angle between two groups before treatment(t =0.356 9,t =0.633 6,P =0.721 9,P =0.527 8),but after a week of treatment,ver-tebral anterior height compression rate and Cobb angle in observation group was better than those of the control group,the difference was sta-tistically significant(t =2.705 7,t =2.840 2,P =0.008 0,P =0.005 5).After one-year follow-up,there was no significant difference in effi-cacy between two groups(t =0.914 7,t =0.464 6,P =0.362 6,P =0.643 2).The postoperative complication rate of observation group was 4%,compared with 16% of control group,the difference was statistically significant (χ2 =4.000 0,P =0.045 5).The satisfaction rate of patient in observation group was 96%,compared with 84%of the control group,the difference was statistically significant (u =2.477 9,P =0.013 2). The fracturesof patients in two groups after 12 months were cured,without aggravating circumstances in nerve damage .Conclusion The ver-tebral pedicle screw fixation can effectively correct angular deformity,restore vertebral body height,strengthen the stability of the spine for treatment of patients with lumbar vertebrae without nerve injury.

Objective To investigate the safety of transrectal ultrasound guided prostate biopsy (TUPB)and its role in early diagnosis of prostate cancer(PCa) by analyzing the large sample data of a single center. Methods Between June 2005 and August 2014, 3256 consecutive patients with an age range from 50 to 80 years (average 69 years),underwent TUPB at Changhai hospital. Prostate specific antigen (PSA) and prostate volume was evaluated; and 12 cores biopsy was undertaken with separate Gleason score evaluation for each core.Student’s t test was used for statistically analysis. Results The positive predictive value (PPV) of cancer was 34.2%, and the median PSA and Gleason score of PCa patients were 22.8 ng/ml and 7. When the PSA value ranged less than 4.0, 4.1-10.0, 10.1-20.0, 20.1-50.0 ng/ml and 50.0ng/ml or more, PPV was 10.1%, 17.3%, 23.8%, 54.6%, and 90.7%, respectively. Of all the patients with PCa, 43.5% had PSA less than 20ng/ml.A total of 6 patients had infection and of them 2 patient had severe sepsis; 45 patients had rectal bleeding but only 2 patients needed treatment; the other minor complications were acute urine retention,haematouria and vasovagal syncope. All the patients convalesced without sequela. Conclusions TUPB is safe and effective and combination with PSA screen is still the standard for early diagnosis of PCa in China so far, regardless of continuous challenging from upto-date biopsy technique.

Objective To investigate the feasibility and safety of Sandwich Balloon Dilation for totally ultrasound guided percutaneous nephrolithotomy (PCNL) . Methods An 18G needle with length marker was used to puncture the target calyx under the guidance of ultrasound and the depth of percutaneous tract was defined. Then the length of balloon similar to tract depth was marked by marker pen. Sandwich Balloon Dilation: Balloon was indwelled along the zebra guidewire until the marker, and inflated with 20atm for 5 minutes; 20.8F renoscope combined with EMS lithotripsy were used for fragmentation; finally before the end of surgery balloon was used again to tamponade the percutaneous tract. Results Between June 2014 and October 2014, a total of 56 patients (32 males and 21 females) with the average age of 53y underwent PCNL. The average stone size was 2.4±0.4cm; BMI23.1±2.8 and hospitalization 7 days. The average hemoglobin and hematocrit before and after operation was 14.1±2.1 vs 13.3±2.1g/dl and 40.7±5.3% vs 38.1±5.1%, respectively. No patient needed transfusion or embolization. No other severe complications happened. Conclusion Balloon dilation makes totally ultrasound PCNL easy and safe; while Sandwich Balloon Dilation further decreases haemorrhage complication.

Objective To indentify the high risk factors of bone metastasis in Chinese patients at the initial stage of prostate cancer (PCa) diagnosis, so as to elucidate the characteristics of patients with very low risk of bone metastasis at the initial stage of prostate cancer. Methods A consecutive series of 496 patients with newly diagnosed PCa between 2010 and 2015 were enrolled in the present study. All the patients were subjected to ECT scan for presence of bone metastasis (BM) using total-body 99mTc MDP scintigraphy regardless of baseline PCa characteristics. Factors including the age of diagnosis, prostate specific antigen (PSA) level at diagnosis, Gleason score, clinical T stage, bone scan and CT/MRI results were analyzed. Univariate and multivariate logistic regression analyses were performed to identify the predictors of bone metastases. Results Of the 496 patients, 81 patients (16.3%) had bone metastases. The PSA levels of patients with BM were significantly higher than those without BM (P<0.001). The mean age of the patients with BM was not significantly older than that of the patients without BM. Patients with higher PSA level, clinical T stage or Gleason score showed a significantly higher risk of BM (P<0.001). Univariate logistic regression analysis showed that PSA>20 ng/mL at diagnosis, clinical stage at T3-T4 and Gleason score≥8 were the risk factors of bone metastasis in PCa patients. The multivariate analysis showed that the PSA level>50 ng/mL and the Gleason score≥8 were the independent predictors of bone metastases. No bone metastasis was found in 79 patients with PSA≤20 ng/mL and at the same time with Gleason score≤6. Conclusion The bone metastases rate is very low in Chinese patients with a PSA level ≤20 ng/mL and at the same time with Gleason score≤6, so a bone scan is not necessary as a routine for these patients with newly diagnosed prostate cancer.

Objective To evaluate the prevalence of advanced colorectal neoplasm (ACN) in asymptomatic average-risk Chinese Han population, so as to provide a scientific basis for determining the optimal age for colorectal cancer screening. Methods A prospective cross-sectional design was used in this study. We used a self-made questionnaire to survey the average-risk adults receiving colonoscopy; the subjects were from 19 nationwide representative hospitals. The survey items included the demographic characteristics, life style, dietary habits, colonoscopy examination results, etc. The risk of ACN was evaluated using previou sly established average-risk evaluation system, which was composed of eight variables: age, sex, smoking, diabetes mellitus, green vegetables, pickled food, fried food and white meat, with a total score of 0 to 14 points. We calculated the ACN prevalence of each risk level. The χ2-test was used to compare the prevalence rates of ACN between different risk levels, age groups and genders. Results A total of 7, 541 subjects received complete colonoscopies. The ACN prevalence rose greatly with the increase of risk score. In the population with a risk score of 0-2, the ACN prevalence was 1. 3%-4. 0% in those younger than 70 years and 8. 9%-15. 3% in those elder than 70 years(P<0. 01). In the population with a risk score of 3-4, the ACN prevalence was 3. 6% in those younger than 45 years old and 5. 4%-14. 8% in those elder than 45 years (P<0. 01). In the population with a risk score higher than 4, the ACN prevalence was at a high level (9. 8%-22. 7%), with the prevalence being 9. 8% in the 40-44 years group, which was higher than those in subjects of 70-74 years old with a risk score of 0-2(8. 9%). The overall ACN prevalence was 2. 9%-4. 6% in subjects younger than 55 years old and 6. 8%-17. 6% in those elder than 55 years (P<0. 01). The high-risk age of ACN was elder than 45 in male and elder than 60 in female. Conclusion The optimal starting ages for colorectal cancer screening are different for subjects with different risks and genders. The starting ages for those with risks scores of 0-2, 3-4, and >4 were 70 years, 45 years and 40 years, respectively. The optimal starting age for screening in women can be 15 years later than in men.

Objective To compare the clinical effect of manual aspiration thrombectomy versus systemic thrombolysis for acute lower extremity deep venous thrombosis of mixed type.Methods The clinical data of 380 patients with acute lower extremity deep venous thrombosis of nixed type was analyzed retrospectively,who were classified into two groups according to treatment methods.Group A (229 cases):the ipsilateral femoral vein was accessed under local anesthesia,a 12-14 F sheath was introduced via a guide wire to aspirate iliofenoral thrombus.As for the femoropopliteal thrombus,a Fogarty balloon catheter was introduced to pull thrombus to iliac vein,then mechanical aspiration thrombectomy was performed.One hundred and thirteen patients with stenosis or occlusion of comnon iliac vein were treated with adjunctive PTA and stenting.As for the residual thrombus bclow popliteal vein,a small dose urokinase vas given to thrombolysis and heparin anticoagulation after procedure.Group B(151 cases) were treated by systemic thrombolysis and anticoagulation with heparin.Results The swelling and pain of affected limbs of group A began to relief after operation immediately,but these times of group B was 3-7 days after operation.The thrombus was eliminated completely(Grade Ⅰ):goup A was better than group B (63.32％ vs 37.09％) (x2 =20.53,P =0.002).Conclusions The manual aspiration thrombectomy was superior to simple systemic thrombolysis in treating acute lower extremity deep venous thrombosis of mixed type,especially in protecting the normal valve function that was better than thrombolysis,aspiration thrombectomy with adjunctive iliac vein angioplasty was a more reasonable method to treat acute LEDVT.

AIM: To study effects of urokinase-type plasminogen activator (uPA) signal transduction on expression of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of matrix metalloproteinase-3 (TIMP-3) in giant cell tumor of bone (GCT). METHODS: Expression of uPAR, MMP-2 and TIMP-3 in GCT tissue was detected by immunohistochemistry. Phosphorylation level of mitogen-activated protein kinase (p44) in uPA/uPAR signal pathway in cultured GCT cells was detected by immunoprecipitation. The expression of MMP-2 and TIMP-3 in cultured cells after treatment with uPA-ATF or anti-uPAR antibody was also detected by Western blotting. RESULTS: 1) Urokinase-type plasminogen activator receptor (uPAR) was positive on the cell membrane and in cytoplasm of some mononuclear stromal cells (MSCs) and multinucleated giant cells (MGCs); 2) MMP-2 was positive in the cytoplasm and on the cell membrane of almost all of MSCs and some of MGCs. The polar distribution of MMP-2 in the cytoplasm of MGCs was especially obvious; 3) The expression of TIMP-3 of some MSCs and MGCs in GCT was much lower than MMP-2. The positive signal also showed a prominent polarity; 4) After treatment with uPA-ATF, the phosphorylation level of p44 in GCT cultured cells was much higher than the control. Addition of anti-uPAR antibody in the cells remarkably down-regulated the phosphorylation level of p44 as compared with the control group, suggesting that uPA-ATF participates cell signal transduction and this reaction can be inhibited by anti-uPAR antibody; 5) uPA-ATF cell signal pathway up-regulated expression of MMP-2 and TIMP-3, while anti-uPAR antibody down-regulated the expression of MMP-2 and TIMP-3. CONCLUSION: These results demonstrate for the first time that uPA-ATF directly regulates the expression of MMP-2 and TIMP-3 by signal transduction pathway, and the over-expression of MMP-2 and TIMP-3 may play an important role in local osteolysis of GCT. [

Objective To investigate the correlation between the quantitative results,the semi-quantitative scores from ultrasound elastography and the distribution of myofibroblasts (MFS)in breast tumor,and to analyze the value of quantitative results and the semi-quantitative score from ultrasound elastography in the diagnosis of breast tumor.Methods Thirty eight patients with breast lesions underwent ultrasound elasticity examinations,tissue dispersion quantitative analysis technique was used to assess the 11 characteristic quantities and the corresponding strain ratios in all lesions,and the score of ultrasonic elastography was evaluated.38 cases were divided into benign and malignant group according to pathological diagnosis results.The expression levels of CD34 andα-SMA protein in breast tissue were examined by immunohistochemistry.The distribution patterns of MFS in breast tumor were analyzed. The correlation between the quantitative results, the semi-quantitative scores from ultrasound elastography and the distribution of MFS in breast tumor was studied.Results The expression level of CD34 in malignant group was significantly higher than that in benign group, while the expression level of α-SMA was significantly higher than that in benign group;the differences in the expression levels of CD34 andα-SMA between benign and malignant breast tumor patients were statistically significant (P < 0.01 ).The masses observed in malignant group by elastography were shown in blue,while most of the masses in benign group were shown in green.There were statistically significant differences between two groups in elastography scores (P < 0.05 ). There was a anegative correlation between the CD34 expression in tumor tissue and the score of ultrasound elastography (r=-0.423 7,P =0.027 3).There was a negative correlation between the CD34 expression and the score of ultrasound elastography (r=-0.423 7,P =0.027 3),while the positive correlation was found between theα-SMA expression and the score of ultrasound elastography (r=0.397 0,P =0.014 2).The CD34 expression was significantly correlated with the average relative strain value,entropy,area ratio of low-strain region,kurtosis, skewness and inverse difference moment (P <0.05).Among the 11 characteristics,CD34 was positively correlated with the average relative strain value (r=0.385 6,P =0.016 8)and entropy (r=0.380 5,P =0.018 5);CD34 was negatively correlated with area ratio of low-strain region (r = - 0.351 7,P = 0.030 4),kurtosis (r =-0.427 7,P =0.007 4),skewness (r=-0.394 6,P =0.014 2),inverse difference moment (r = -0.344 3, P =0.034 3),angular second moment (r = - 0.484 9,P = 0.002 0)and strain ration (r = - 0.379 0,P =0.047 5);CD34 was not correlated with standard deviation,complexity and contrast (P > 0.05).The α-SMA espression was positively correlated with kurtosis (r = 0.356 9,P = 0.027 8),skewness (r = 0.323 0,P =0.047 9),area ratio of low-strain region (r=0.382 0,P =0.021 6)and strain ratio (r=0.403 3,P =0.012 0). Conclusion The features and its scores of ultrasound elastography are correlated with the distribution of MFS in breast tumor,suggesting that the ultrasound elastography is very informative and helpful in the diagnosis of breast tumor.

Hypertension disorder complicating pregnancy (HDCP) can be associated with multiple organ dysfunction or failure, even convulsions, coma and death in severe cases. HDCP poses a serious threat to maternal and fetal health, and is one of the important reasons for maternal and perinatal infant mortality. However, the etiology of HDCP remains largely unknown. Recently many studies have found HDCP is accompanied by changes of some hormones, including progesterone, humanchorionic gonadotropin, thyroid hormone and corticotropin-releasing hormone. In this review we delineated the fluctuations of the above four common hormones in HDCP patients and their relation with HDCP, hoping to cast new sights for its etiology and prediction.

To explore therapeutic value of radiotherapy combined retrograde ureteral catheterization on Cervical cancer complicated with ureteral obstruction. Methods 63 cases of cervical cancer patients complicated with ureteral obstruction were retrospectively analyzed With ureteral stent guided by cystoscope,retrograde double J stent was performed before Concurrent chemoradiotherapy. Ureteral stents success rate and renal function were compared before and after cannulation. The effect of ureteral stent placement on radiotherapy in Cervical cancer complicated with ureteral obstruction was observed. Results 50 of 63 patients were Successful in retrograde ureteral catheterization. Renal function significantly improved compared with the pre-operation. The overall response rate was 94% (47/50),including CR,35 cases; PR,l 2 cases; NC,3 cases.Double J tube had no significant effect on radiation therapy. Conclusions Radiotherapy combined retrograde ureteral catheterization is an effective method to treat cervical cancer complicated with ureteral obstruction. The technique is easy and safe without complications.