BACKGROUND:Lumbar disc herniation is a clinical syndrome of lumbar pain and radiated pain of the lower limb induced by biochemical changes after intervertebral disc degeneration. Transforaminal endoscopic spine system (TESSYS) and Yeung endoscopic spine system (YESS) are commonly used in the clinic, but their effects are different.
OBJECTIVE:To compare the curative effect of TESSYS and YESS in treatment of lumbar disc herniation. METHODS:Fol ow-up data of 134 cases of lumbar disc herniation were retrospectively analyzed. They were assigned to TESSYS group (n=76) and YESS group (n=58). Intraoperative condition, pain at various time points after repair, and lumbar function changes were compared between the two groups.
RESULTS AND CONCLUSION:(1) No significant difference in Visual Analogue Scale and Oswestry Disability Index scores was detected between the two groups before repair (P>0.05). At 1, 3, and 6 months after repair and during final fol ow-up, above scores were significantly decreased in both groups (P<0.05). Above scores were significantly lower in the TESSYS group than in the YESS group at various time points after repair (P<0.05). (2) No significant difference in Japanese Orthopedic Association score was found between the two groups before repair (P>0.05). Japanese Orthopedic Association score was greater in the TESSYS group than in the YESS group at 1, 3 and 6 months fol owing repair and during final fol ow-up (P<0.05). (3) The excel ent and good rate was significantly greater in the TESSYS group than in the YESS group during final fol ow-up (P<0.05). (4) Operation time and incision length were significantly shorter in the TESSYS group than in the YESS group. No significant difference in the amount of bleeding was detectable between the two groups (P>0.05). Results suggest that TESSYS for lumbar disc herniation was characterized by smal trauma, mild pain and good recovery of function.

Pancreaticoduodenectomy (PD) is the procedure for treating adenocarcinoma in periampullary region.This involves resection of multiple organs and complex reconstructions.The modern surgery has witnessed the dramatic improvement in outcomes after PD.Mortality has dropped to less than 4％,however,the complication rate remains high,making this procedure still a big challenge for most surgeons. PD is so complicated that even small mistakes could jeopardize the whole procedure and outcomes.With experiences of over 1000 PDs,we discuss the challenges of this procedure and strategies to deal with them.

The da Vinci robotic surgical system assisted colorectal radical resection has been widely applied in many countries and regions.The advantages of the da Vinci robotic surgical system include stable and distinct stereoscopic vision,short learning curve,convenient operation and feasibility of remote manipulation,while its disadvantages are expensive cost,lack of tremor and prolonged operation time.The advantage of da Vinci robotic surgical system is not distinct when compared with traditional laparoscope in radical resection of colorectal cancer.With the accumulation of clinical data and the update of the system,the prospect of da Vinci robotic surgical system assisted colorectal radical resection is promising.

Objective To investigate the prevalence of gastroeaophageat reflux disease(GERD)in the end stage renal disease patients(ESRD)with maintenance hemodialysis and the pathogenetic factors of GERD.Methods 60 cases who had heart burn and acid regurgitation symptoms were enrolled,31 cases of them were ESRD patients with maintenance hemodialysis,29 patients who were renal diseases free as control group.GERD was diagnosed by three methods:endoscopy,24h esophageal pH monitoring,endoscopic esophageal biopsy.GERD was established if any of these tests was positive.HP infection and serum gastrin were assessed too.Results (1)The prevalences of GERD in two groups were 83.9%,79.3% respectively and had no significant difference(P＞0.05).(2)The prevalence of HP infection in the ESRD group was significantly lower than control group(19 4% vs 51.7%,P＜0.05).(3)The concentration of serum gastrin in the ESRD group and control group was(102.61±30.80)ng/ml and (83.41±20.61)ng/ml,two group had significant difference(P＜0.05).Conclusion The prevalence of GERD inthe ESRD patients was higher than expected,and was correlated with absence of HP infection and hypergastinemia.

Objective To comparatively investigate the characteristics of bone metabolism in forelimb malformation WHBE rabbits based on the OPG/RANK/RANKL system.Methods Healthy male 2-2.5-month old WHBE rabbit ( HWR) , Healthy Japanese rabbit ( HJR) and forelimb malformation WHBE rabbit ( FMWR) were used in this study and divided into 3 groups, HWR, HJR and FMWR groups, with 10 rabbits in each group.The shape of forelimb and mean gray value observed from X-ray film were examined, and the bone tissue micro-morphology was analyzed using HE staining.Re-al-time fluorescence quantitative PCR was used to determine the expression of osteoprotegerin ( OPG) and receptor activator of NF-KB ligand ( RANKL) mRNA.The expressions of OPG, receptor activator of NF-KB ( RANK) and RANKL protein in serum and bone tissue were assayed by enzyme-linked immunoassay ( ELISA) and immunohistochemistry, respectively. Results Compared with the HWR and HJR groups, rabbits in the FMWR group appeared abnormal in toutuous forelimb and thinner bone cortex.The mean gray values of X-ray in the FMWR group were lower than that in the HWR group ( P<0.05).There were significant differences between the FMWR and healthy rabbits (HWR and HJR) in the following pa-rameters:RANKL mRNA expression and RANKL/OPG mRNA ratio in the liver(P<0.05, P<0.01), serum protein expression of RANK and RANKL and RANKL/OPG ratio (P<0.05, P<0.01), and positive index of expression of RANKL protein and RANKL/OPG ratio in the bone tissue(P<0.05, P<0.01).Furthermore, the gene expression lev-els of OPG and RANKL of HWR were significantly higher than that of HJR(P<0.05, P<0.01).Conclusions The FMWR show some abnormal symptoms in bone metabolism as well as decrease of bone quality and histological changes of bone micro-structure, due to the significant increase of RANKL/OPG ratio of FMWR.The breed differences between WHBE and Japanese rabbits in RANKL mRNA expression level may be one of factors inducing limb malformation in the WHBE rabbits.

Objective To explore the immunoregulatory and lethal effects of natural killer T lymphocytes(NKTs) in vitro .Meth‐ods The mixed lymphocyte cultured(MLC) system was established ,in which the B16F10‐luc‐G5 cells were set as target cells ,the total lymphocyte cells were set as effector cells .(1)In the experiment on immunoregulatory effects ,NKT lymphocytes or CD4+CD25+ T lymphocytes were set as regulating cells ,there was three groups ,including the NKT group ,CD4+CD25+ T group and pure target cell control group .Otherewise ,the 1640 blank control group was set by only adding RPMI1640 solution .(2)In the ex‐periment on antitumor effects ,the NKT or natural killer(NK) lymphocytes were set as killer cells ,there was three groups ,inclu‐ding the NKT group ,NK group and pure target cell control group .Mixed culturing 24 ,48 and 72 hours ,the bioluminescence of target cells in MCL system was detected by using the in vivo imaging system .Results (1)In the experiment on immunoregulatory effects ,there were statistically significant differences in measured average photon numbers between NKT group ,CD4+ CD25+ T group and the two control groups(P<0 .05) .The statistically significant differences were also found in the NKT group between 24 hours and 72 hours (P<0 .05) .(2)In the experiment on antitumor effects ,there were statistically significant differences in meas‐ured average photon numbers ,when the NKT group and NK group were compared to the pure target cell control group(P<0 .05) . After culturing 24 and 72 hours ,statistically significant differences were found between NKT group and NK group(P<0 .05) .Con‐clusion The NKT cells could inhibit the lethal effects of lymphocyte cells on target cells ,and the inhibitory effects are changed by the length of culturing .Compared with the CD4+CD25+ T lymphocytes ,NKT lymphocytes have strongger regulatory effects .Addi‐tionally ,the NKT cells have lethal effects on target cells ,which might be weaker than that of NK cells .

BACKGROUND: Calcium sulfate (CS) is a good bone conduction material due to its good biocompatibility and degradability. However, simple CS lacks of osteoinductive capability, so it can not satisfy clinical requirements.OBJECTIVE: To verify the potential ofCS/bone matrix gelatin (BMG) composite biomaterial in the repair of segmental bone defects.DESIGN, TIME AND SETTING: An in vivo multi-dimensional observation was performed in the Laboratory Animal Center, Nanfang Hospital, Southern Medical University between December 2004 and April 2006.MATERIALS: Twenty-one healthy adult New Zealand rabbits, weighing 2.5-3.5 kg, were included. The segmental ulnar defects of 15 mm were created bilaterally. CS and BMG were self-prepared.METHODS: CS and BMG were composited at 2:1 and then implanted into 15-mm rabbit ulnar bone defect. The present study consisted of 3 groups: CS/BMG group, defects were filled with CS/BMG; CS group, defects were filled with CS; and blank control group, untreated control defects.MAIN OUTCOME MEASURES: At weeks 4, 8, and 12 post-surgery, repair of bone defect was observed by gross observation, radiographic, histomorphological and tetracycline tracing analysis.RESULTS: Surgical incisions all primarily healed. No inflammatory or foreign reaction was found around all the defects. Both CS/BMG and CS were almost completely absorbed at week 8 post-surgery. In the CS/BMG group, newly formed bone was found throughout the defects after 4 weeks; all defects were repaired with a well-organized trabecular pattern and a thit neocortex after 12 weeks. In the CS group, mass of new bone tissue formed at the periphery of the defect at week 4 post-surgery, but the development of new bone in the center of defect was latter compared with the CS/BMG group: at 12 weeks, all defects were bridged by newly formed bone tissue with little adjacent medullary bone. In the blank control group, slight new bone was found at the periphery of the defect region, and the defects were filled with fibrous tissue.CONCLUSION: CS/BMG composite is totally bioresorbable and biocompatible. The composite can repair bone defects effectively as a bone graft substitute.

Objective To approach work pressure and its influencing factors in general surgical nurses. Methods 105 general surgical nurses were selected from 8 hospitals with stratification clus-tering randomization methods. The job stressor inventory,- personality scale, coping styles questionnaire and general state of health questionnaire were used to carry out investigation and the results underwent analysis. Results The main stressors came from the factor of workload and time allocation, then from nursing specialty and job. Working time more than 10 years, undergraduate degree or above, work shift, neuroticism, wrapping, avoidance, letting off were risk factors of work pressure in general surgical nurses. Age more than 40 years old, nurse and associate director, exotrophy, planning to solve the ques-tions, seeking social support, rational coping were protective factors of work pressure for nurses. Con-clusions The overall pressure level of general surgical nurses was moderate. We should cultivate favourable personality of nurses and positive coping styles in combination with their demography char-acters to prevent work pressure.

[Objective] To investigate the results and to evaluate the validity of the supracondylar femoral osteotomy and internal fixation for treatment of flexion deformity of the knee joint in adult polio patients.[Methods]From April 2002 to August 2008,141 knees in 127 cases with flexion deformity of knee from poliomyelitis were treated with supracondylar femoral extension osteotomy and internal fixation.They were 14~45 years old with an average of 18.3.Of them,62 knees in 56 cases were male,79 knees in 71 cases were female.Eighty-three cases needed pressing knee on walking.Thirty-five cases walked with a crutch and 9 cases walked with two crutches.It should be treated with soft tissue release and skeletal traction before osteotomy in severe flexion deformity(over 40 degrees).All cases took weight-bearing X-ray films of lower extremities before and after operation.Angle of knee flexion,operative complications,bone healing and final function were recorded.Patients can undertake continuous passive flexion and extension motion from the 2nd day postoperatively.The knee operated was put in 10~20? flexion after operation and extended to full extension gradually in 2 weeks.[Results]All patients felt comfortable after operation and no neurovscular complications and infection happened.Follow-up time was 12-72 months with an average of 18 months.Solid bone union showed in all femoral cutting ends.No mal-union,non-union and implant failure happened.All flexion deformities of knees were corrected.The angle of flexion contracture of knee was from 36.4?(18?～61?)preoperatively to 2.8?(-5?～8?)postoperatively.The amount of correction was 18?to 56?with an average of 32.9?.One hundred and eight patients can walk stably by hinself or with brace,19 cases still need some help for walking(pressing knee in 6 case,one crutch in 10 cases and two crutches in 3 cases)at last follow-up.No ankylosis of knee joint or peroneal nerve paralysis occurred.All cases were satisfying with their range of motion of knee.[Conclusion]Supracondylar femoral osteotomy and rigid internal fixation and early rehabilitation exercise is a safe and effective strategy for the adult flexion deformity of knee joint.

[Objective] To investigate the osteogenetic effect of calcium sulfate(CS)combined with bone matrix gelatin(CS)as bone substitute material in a rabbit ulnar defect model.[Method]Twenty one adult New Zealand White rabbits were used.The segmental ulnar defects of 15 mm were created b/laterally and were divided into tbree groups:Group 1,defects were filled with CS/BMG;Group 2,defects were filled with CS;Group 3,untreated control defects.The samples were harvested at 4,8,12 weeks and were examined by radiographic,histomorphological and tetracycline tracing analysis.[Result]No inflammatory or foreign body reaction was observed around all the defects.Both CS/BMG and CS were almost completely resorbed 8 weeks postoperation.At the group 1,nem bone was found throngbout the defects after 4 weeks.All defects were repaired with a well-organized traheeular pattern and a thin neocortex after 12 weeks.At the group 2,mass of new bone tissue formed at the periphery of the defect 4 weeks postoperatlon,but the development of new bone at the central of the defect was latter than that at the group 1.At 12 weeks,all defects were bridged by new bone tissue with little adjacent medullary bone.At the group 3,slight new bone was observed at the periphery of the defect region,and the defects were filled with fibrous tissue.[Conclusion]Calcium sulfate containing bone matrix gelatin is totally bioresorbable and biocompatible.The compound material can enhance the repair bone defects effectively as a bone graft substitute.