Objective To evaluate the efficacy of fusion with and without instrumentation in the treatment of chronic low back pain.Methods To search Medline(from 1966 to Deeember.2006).Embase (1984 to December,2006),Cochrane Central Register of Controlled Trial f4th Quarter 2006),Current Controlled Trials.The China Biological Medicine Database(1984 to December,2006).and hand searched several related journals.The quality of included trials was evaluated.Data were extracted by two reviewers independently with a designed extraction form RevMan 4.2.8 software was used for data analysis.Results Eight studies involving 656 patients were included.The results of meta-analysis indicated that statistically significant difierences were observed between the two operative procedures in the fusion rate(OR=2.26,95% CI 1.51-3.38,P=0.0001),clinical outcome(OR=1.54,95%CI 1.09-2.19,P=0.01),incidence of re-operation (OR=2.16.95% CI 1.08-4.33,P=0.002).There were no statistically significant difierences in back pain scores (WMD=-0.22,95% CI-0.81-0.36),leg pain scores(WMD=0.22,95%CI-0.50-0.93),complications(OR=1.68,95%CI 0.78-3.63),satisfaction of surgery by patients(OR=1.54,95%CI 0.93-2.55).Three studies described the mean surgical time,perioperative blood loss,days in hospital after surgery,which revealed that single fusion was superior to fusion with instrumentation.Three studies described the work status of patients post-operatively.Two studies indicated smoking could decrease the fusion rate.Conclusion To compare with single fusion,fusion with instrumentation can increase the fusion rate and improve clinical outcome slightly,but it also increases the incidence of re-operation.More high quality large-scale randomized controlled trims are required.

Objective To evaluate the efficacy and safety of ultrasound elastography in the diagnosis of pros-tate cancer.Methods 83 patients with prostate cancer were selected and diagnosed by transrectal ultrasound elastog-raphy (TRTE)and transrectal ultrasound(TRUS).The surgical pathology of the patients was used as diagnosis basis, and the efficacy of the two methods was evaluated.Results There were 102 nodules of all the 83 patients,44 patients'surgical pathology were benign,a total of 49 nodules,39 cases were vicious,a total of 53 nodules.47 nodules were gland nodules,accounting for 46.08% and 55 nodules were outer gland nodules,accounting for 53.92% of all the 102 nodules.There were 54 focis,the TRTE detected 36 focis,the detection rate was 66.67%,and TRUS detected 24 focis,the detection rate was 44.44%.The sensitivity,specificity and accuracy rates of TRTE were 66.67%, 68.65% and 67.64%,which were higher than 44.44%,64.58% and 53.92% of TRUS,and the differences were statistically significant (χ2 =10.710,P <0.05;χ2 =3.879,P <0.05;χ2 =4.084,P <0.05).The differences of pathological findings and TRTE,TRUS findings of the benign and malignant prostate nodules were not statistically significant (P >0.05 ).Conclusion It has higher diagnostic sensitivity,specificity and diagnostic accuracy for ultrasound elastography in the diagnosis of prostate cancer,which can improve the clinical diagnostic performance and worthy of clinical application.

Objective:To explore the vailation of serum sP-selectin,sE-selectin,levels in the patients of pre-diabetic,simple type 2 diabetes mellitus (T2DM) and T2DM with coronary heartdisease(CAD).To investigate the possible mechanism that sP-selectin, sE-selectin accelerate type 2 diabetes mellitus.Methods: Level of serum sP-selectin, sE-selectin was assayed by ELISA in type 2 diabetes with or without coronary heart disease (32 and 34 cases respectively),pre-diabetic (32 cases) and control group(32 cases). Meanwhile BMI,BP,FBS,FINS,TG,CHO,HDL-C,LDL-C,HbA1C were determined in all cases as well as in control group.Results:The serum levels of sP-selectin and sE-selectin in pre-diabetic,type 2 diabetes mellitus with or without coronary heart disease groups were significantly higher than the control group ( P<0.01 ).There was significant positive correlation between serum levels of sP-selectin,sE-selectin and these items including FBG ,FINS,TG,HbA1C,HOMA-IR(P<0.01);but sE-selectin was negatively correlated with HDL-C (P<0.05).Conclusion:sP-selectin,sE-selectin,are risk factors in the initiation and progression of pre-diabetic,type 2 diabetes with or without coronary heart disease;sP-selectin and sE-selectin possibly accelerate type 2 diabetes by inducing insulin resist-ance.

Objective To reproduce an SD rat model of prostatic calculus by using nanobacteria (NB), and explore the role of NB in contributing to prostatitis and prostatic calculus. Methods Twenty adult male SD rats were randomized to the control group and 20 to the model group. Rat prostate infection models were reproduced by infusing 0. 2 ml (Concentration, 1 Mai unit) NB suspension transurethrally. 0.2 ml physiological saline was infused transurethrally in the rat control group. The rats were sacrificed 4 and 8 weeks later and prostatic pathology were viewed by hematoxylin and eosin (HE) staining. Lithogenesis was observed by scanning electron microscope (SEM) or Transmission electron microscopy (TEM). Re-isolation, culture and identification of nanobacteria were also done in rat prostatic tissues. Results Chronic inflammatory changes of prostates were shown in the model group at both 4 weeks and 8 weeks after infusing NB suspension. Prostatic calculi were detected by SEM and TEM at 8 weeks in the prostates of the rat model group (7/10). Neither chronic inflammatory changes nor prostatic calculus was found in the control group. NB was positive in the model group, but negative in the control group. Conclusions NB infection could cause chronic prostatitis and prostatic calculus in rats.

Objective To investigate the clinicopathologic characteristics and prognosis of medullary breast carcinoma.Methods We conducted a retrospective analysis on clinical and pathologic data of 166 patients with medullary breast cancer.Results All the patients were female with a median age of 52 years old.The proportion of patients with stage Ⅰ,Ⅱ and Ⅲ disease was 16.9％,68.1％,15.0％,respectively.The Luminal,HER-2 overexpressing and triple-negative subtypes constituted 31.3％,8.4％,and 60.3％,respectively.There was significant difference in regional lymph node status of medullary breast cancer patients with different molecular types (x2 =18.248,P =0.003),but not in tumor size,TNM stage,histological grade,and expression of Ki67 (all P ＞ 0.05).Multivariate survival analysis indicated that TNM stage was an independent predictor in the prognosis of medullary breast cancer (HR =5.664,P =0.001).All the patients were followed up from 15 months to 145 months with a median follow-up time of 108 months.The 5-year survival rate was 91.5％ and the 10-year survival rate was 87.2％.Conclusions The prognosis of medullary breast cancer is favorable.Personalized treatment according to the TNM stage and histopathologic characteristics achieve a favorable prognosis.

Objective:To investigate the correlation between myocardial infarction and carotid atherosclerosis in older adult patients.Methods:A total of 98 older adult patients with myocardial infarction who received treatment in Lishui People's Hospital from June 2020 to June 2021 were included in this study. They were divided into three subgroups: mild ( n = 25), moderate ( n = 43) and severe ( n = 30) groups according to the severity of myocardial infarction. An additional 50 healthy subjects who concurrently received physical examination in the same hospital were included as controls. All participants underwent color Doppler ultrasound to evaluate the degree of carotid stenosis and its correlation with the severity of myocardial infarction. Results:In the myocardial infarction group, 327 carotid plaques were detected in 88 out of 98 patients, with the detection rate of 89.8%. In the control group, 85 carotid plaques were detected in 17 out of 50 healthy subjects, with the detection rate of 34.0%. In the myocardial infarction group, most plaques were mixed and soft, accounting for 34.8% (114/327) and 51.4% (168/327), respectively. In the control group, most plaques were calcified, accounting for 62.3% (53/85). There was significant difference in plaque property between the two groups ( χ2 = 102.23, P < 0.05). There was significant difference in the degree of carotid lumen stenosis between control and myocardial infarction groups ( χ2 = 60.07, P < 0.05). The degree of carotid lumen stenosis increased with the aggravation of myocardial infarction ( χ2 = 15.17, P < 0.05). Carotid intima-media thickness in the severe group was (1.49 ± 0.26) mm, which was significantly greater than (1.28 ± 0.24) mm in the moderate group, (1.15 ± 0.21) mm in the mild group and (0.82 ± 0.16) mm in the control group ( t = 5.21, 7.42, 14.29, all P < 0.05). Plaque score in the severe group was (2.56 ± 0.51) points, which was significantly higher than (2.33 ± 0.45) points in the moderate group, (1.58 ± 0.39) points in the mild group, and (1.12 ± 0.36) points in the control group ( t = 3.00, 11.23, 14.77, all P < 0.05). Correlation analysis showed that the severity of myocardial infarction was positively correlated with the degree of carotid artery lumen stenosis, intima-media thickness and plaque score ( r = 0.41, 0.33, 0.28, all P < 0.01). Conclusion:The severity of myocardial infarction in the older adults is correlated with carotid atherosclerosis, and carotid lumen stenosis can be used as a predictor of myocardial infarction.

[ABSTRACT]OBJECTIVETo study the expressions of 34βE12, Galectin-3 and HBME-1 in thyroid nodules, and to explore its diagnostic value for papillary thyroid carcinoma (PTC).METHODSEn VisionTM immunohistochemical technique was used to detect the expression of 34βE12, Galectin-3 and HBME-1 in 352 thyroid lesions. The correlation between the expressions of the 3 protein markers and clinicopathological characteristics was evaluated. The receiver operating characteristic area under the curve (ROC-AUC) and their index for diagnosis evaluation were also calculated.RESULTSThe positive rates of 34βE12, Galectin-3 and HBME-1 in 246 PTC lesions were significantly higher than those in benign nodules (P<0.001). There was no relationship between the expression of the 3 protein markers and clinicopathological characteristics (eg. gender, age, numbers of lesions, tumor size, capsular invasion, lymph node metastasis, TNM staging). The ROC-AUC of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 0.936, 0.915 and 0.898 respectively. The sensitivity of 34βE12, Galectin-3 and HBME-1 for diagnosis of PTC was 94.3%, 95.5% and 91.1% respectively, while the specificity was 81.1%, 71.7% and 83.0% respectively, and the diagnostic accuracy rate was 90.3%, 88.4% and 88.6% respectively.CONCLUSION The expressions of 34βE12, Galectin-3 and HBME-1 are statistically different between PTC and benign lesions, but no associations are found with clinicopathological characteristics, indicating the three protein markers have important diagnostic value for PTC.

AIM:To explore the therapeutic effect of a novel Rho kinase inhibitor WAR 5 on the experimental autoimmune encephalomyelitis (EAE) and its possible mechanism.METHODS: Female C57BL/6 mice were randomly divided into EAE group and WAR5 group.EAE model was induced by the application of MOG 35-55 peptide.WAR5 was in-jected intraperitoneally every other day from post-immunization (PI) day 3 to PI day 27.The clinical score and body weight were recorded every other day .On PI day 28, the animals were sacrificed and spinal cords were obtained for HE and mye-lin staining .The splenocytes were isolated and the expression of CD 16/32 and CD206 were analyzed by flow cytometry . The protein extracts from the brains and spinal cords were collected for the measurement of inducible nitric oxide synthase ( iNOS) by Western blotting .RESULTS:The administration of WAR 5 delayed the onset of EAE and attenuated the clini-cal symptoms .The results of the pathological examination revealed that WAR 5 inhibited the infiltration of inflammatory cells and improved myelination in spinal cords , accompanied with the poralization of M 1 macrophages to M2 phenotype in the spleen.WAR5 inhibited the expression of iNOS in the central nervous system , especially in the spinal cords .CON-CLUSION:The therapeutic effect of WAR5 on EAE may be related to the shift of M1 macrophages to M2 phenotype and inhibition of inflammation in the central nerve system .

Acute ischemic stroke has ischemic penumbra and actual infarct core, and when there is a bigger difference in the volume of the two, it is called " mismatch". It is not only manifested as a mismatch between the clinical manifestations and the infarct core, but also as a mismatch between the infarct core and the perfusion area. The advancement of neuroimaging technology enables this " mismatch" phenomenon to be manifested through different imaging methods or different sequences of the same imaging method, thereby providing more guidance for the further diagnosis and treatment process.

Objective:To investigate the clinic diagnostic value of multi-slice CT (MSCT) imaging features in various subtypes of nodular lung adenocarcinoma.Methods:The imaging information and general clinical data of 160 patients with nodular lung adenocarcinoma who were admitted to Yantai Affiliated Hospital of Binzhou Medical University and received surgical treatment from January 2017 to May 2019 were retrospectively analyzed. Univariate analysis was used to screen statistically significant imaging features of each pathological subtype, and binary logistic regression analysis was performed. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was calculated, and the diagnostic efficacy was compared.Results:The age of patients with atypical adenomatous hyperplasia and adenocarcinoma in situ (AAH+ AIS), minimally invasive ademocarcinoma (MIA), invasive adenocarcinoma cancer (IAC) and variant of invasive adenocarcinoma cancer (VIAC) were (57.07±7.92), (59.37±6.96), (60.68±8.83), (63.33±6.89) years old, with no statistically significant difference ( F=1.221, P=0.304). The age of patients with VIAC, IAC, MIA and AAH+ AIS decreased in turn. The imaging features of AAH+ AIS, MIA, IAC and VIAC that exhibited statistically significant differences were as following in turn: the maximum diameter of lesion [6.85 (3.73) mm vs. 8.00 (5.00) mm vs. 16.00 (11.90) mm vs. 17.20 (9.08) mm, H=55.107, P<0.001], CT value [-563.50 (176.63) HU vs. -536.00 (293.50) HU vs. -235.50 (346.50) HU vs. -23.00 (30.50) HU, H=47.499, P<0.001], solid ratio [0 (0) vs. 0 (0) vs. 49.00% (100.00%) vs. 100.00% (0), H=44.242, P<0.001], vacuolar sign [14 (87.50%) vs. 35 (100.00%) vs. 84 (81.55%) vs. 3 (50.00%), χ2=13.925, P=0.002], inflatable bronchus sign [1 (6.25%) vs. 2 (5.71%) vs. 36 (34.95%) vs. 2 (33.33%), χ2=16.578, P=0.001], intratumoral vascular sign [13 (81.25%) vs. 28 (80.00%) vs. 64 (62.14%) vs. 1 (16.67%), χ2=11.168, P=0.009], vessel convergence sign [1 (6.25%) vs. 3 (8.57%) vs. 66 (64.08%) vs. 6 (100.00%), χ2=54.232, P<0.001], short burr sign [3 (18.75%) vs. 11 (31.43%) vs. 77 (74.76%) vs. 6 (100.00%), χ2=36.218, P<0.001], lobulation sign [4 (25.00%) vs. 18 (51.43%) vs. 93 (90.29%) vs. 6 (100.00%), χ2=43.302, P<0.001], pleural traction sign [0 (0) vs. 6 (17.14%) vs. 70 (67.96%) vs. 5 (83.33%), χ2=50.794, P<0.001]. The maximum diameter of lesion ( OR=0.858, 95% CI: 0.754-0.977, P=0.021) and pleural traction sign ( OR=0.288, 95% CI: 0.084-0.993, P=0.049) were independent influencing factors of MIA. The maximum diameter of lesion ( OR=1.131, 95% CI: 1.030-1.241, P=0.010) and pleural traction sign ( OR=3.441, 95% CI: 1.279-9.254, P=0.014) were independent influencing factors of IAC. The optimum threshold of the maximum diameter of lesion in diagnosis of MIA was 11.05 mm, AUC was 0.798 (95% CI: 0.724-0.872) sensitivity was 68.00%, and specificity was 85.70%. The AUC of pleural traction sign in diagnosis of MIA was 0.714 (95% CI: 0.623-0.806). The diagnostic efficacy exhibited no statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of MIA ( Z=1.838, P=0.066). The optimum threshold of the maximum diameter of lesion in diagnosis of IAC was 11.05 mm, AUC was 0.827 (95% CI: 0.759-0.895), sensitivity was 75.70%, and specificity was 78.90%. The AUC of pleural traction sign in diagnosis of IAC was 0.743 (95% CI: 0.663-0.823). The diagnostic efficacy exhibited statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of IAC ( Z=2.114, P=0.035), and the maximum diameter of lesion > 11.05 mm was better for the diagnosis of IAC. Conclusion:The maximum diameter of lesion and pleural traction sign are independent influence factors in diagnosis of MIA and IAC, and the maximum diameter of lesion > 11.05 mm is better for the diagnosis of IAC.