Objective To summarize countermeasures on common problems of microendoscopic discectomy(MED). Methods Microendoscopic discectomy was performed in 104 cases of lumbar disc herniation by using the MED system(Sofamor Danek Group,USA).Frequently encountered problems during the operation were reviewed and summarized. Results Conversions to open surgery were required in 4 out of 104 cases due to bleeding or adherence.Among the rest of 100 cases,dural injury occurred in 3 cases,with 1 case accompanying leakage of cerebrospinal fluid.Of the 100 cases(115 intervertebral spaces),the average operation time was 50 min(range,30~90 min) and the average hemorrhage amount was 80 ml(range,20~400 ml) for each intervertebral space.The 100 cases were followed for 3~32 months(average,18 months).According to the Macnab criteria,the curative effects were classified as excellent in 65 cases,good in 29 cases,and fair in 6,the rate of excellent or good effects being 94.0%(94/100). Conclusions The most frequent problems during MED are bleeding and prolonged excision of the ligamenta flava.Strict adherence to technique,acquaintance with the weakness of the ligamenta flava,and familiarity with anatomic structures of the vertebral vein system and its relationship with abdominal pressure,are very important in the prevention and treatments of surgical complications.

The application of network and multimedia technology in combination with bilingual teaching in orthopedics is explored which not only promotes the use of multimedia technology in teaching,but also enhances students' understanding ability for professional knowledge.Moreover,it can enhance students' learning interest in medical English and medical knowledge,thus promoting education effectively.

Objective To investigate the expression and significance of MMP-3 in knee joint synovium of different stage in osteoarthritis (OA) patients. Methods MMP-3 protein were detected by immunohistochemical method in knee synovial tissues from 90 OA patients (the OA group) and OA group was divided into 3 subgroups according to Kellgren and LawrenceX-ray diagnosing standards: the gradeⅠ(n = 30), gradeⅡ (n = 30) and grade Ⅲ subgroups (n = 30). 30 patients were enrolled as control group. Immunohistochemistry was used to detect the expression of MMP-3 protein in the tissue. Results The expression level of MMP-3 protein in OA group was significantly higher that in the normal synovium (P < 0.05). There existed significant difference in the expression of MMP-3 protein between the grade Ⅲ subgroup and the gradeⅠ, or Ⅱsubgroups (P < 0.05). The expression of MMP-3 protein related positively to the severity of OA (r = 0.912, P < 0.05). Conclusion The expression of MMP-3 protein related closely to the pathogenic mechanism of OA. It may serve as an important indicator of early diagnosis and the activity of OA.

ObjectiveTo explore the effect of the swimming training on the microcirculations in cochlea in guinea pigs after chronic hypoxia.Methods28 guinea pigs were divided into normal control group (group A) which were outside of cabin and chronic hypoxia model group (group B) randomly. 4 weeks after, the model group were divided into the model control group (group B1), medical treatment group (group B2) and swimming training with medical treatment group (group B3). The blood flow of the cochlea (CBF) were measured using laser Doppler flow. The spiral ligament spreaded-slice optical lens was used to observe the vascular veins, capillary appearance and red blood cells (RBC) counts.Resultsthe CBF of group A was(98.075±5.08)% ,while that of group B1 was(86.80±2.12)%(P<0.01 vs group A), that of group B2 was (89.14±4.12)%(P<0.05 vs group B1), that of group B3 was (91.18±5.02)%(P>0.05 vs group B2, but P<0.01 vs group B1).ConclusionSwimming training can facilitate the improvement of the swelling on the thin blood vessel and the microcirculation in cochlea under chronic hypoxia environment with ligustrazine in guinea pigs.

To investigate whether chemotherapy could prolong the postoperative survival time in patients with early stages pancreatic ductal adenocarcinoma (PDAC). A total of 5280 stage ⅠA -ⅡB PDAC patients diagnosed from 2010 to 2015 were selected from surveillance，epidemiology，and end results (SEER) database. Propensity score matching (PSM) analysis was adopted to reduce the baseline differences between the groups. Univariate survival analysis was conducted with the Kaplan-Meier method. Multivariate survival analysis was performed with the Cox proportional hazards model. Univariate and multivariate survival analyses showed that age, differentiation, stage, chemotherapy were independent risk factors for the survival of PDAC patients. After PSM, it is found that adjuvant chemotherapy could prolong the median overall survival time (mOS) for stage ⅠB, ⅡA and ⅡB patients. However, for stage ⅠA patients, there were no significant differences in 3-year survival rate and mOS between patients with chemotherapy (=283) and without chemotherapy (=229) (57.4% vs 55.6%, vs all >0.05). Further analyses show that among 101 patients with well differentiated PDAC and 294 patients with moderately differentiated PDAC, there were no significant differences in survival rate and mOS between patients with and without chemotherapy (all >0.05). Among 117 patients with low-differentiated + undifferentiated PDAC, 3-year survival rate and mOS in patients with chemotherapy were significantly better than those without chemotherapy (48.5% vs 34.1%, vs all <0.05). Chemotherapy regimen used currently is not beneficial for patients with moderately and well differentiated stage ⅠA PDAC, but it is an independent prognostic factor for low-differentiated + undifferentiated PDAC patients.
Adenocarcinoma/pathology* ; Carcinoma, Pancreatic Ductal/surgery* ; Chemotherapy, Adjuvant ; Humans ; Neoplasm Staging ; Pancreatic Neoplasms/drug therapy* ; Prognosis ; Propensity Score

ObjectiveTo establish a method for content determination of total iridoid compounds and baldrinal and 11-ethoxyviburtinal from Valerianae Jatamansi Rhizoma et Radix; To determine the contents of total iridoid compounds and baldrinal and 11-ethoxyviburtinal in Valerianae Jatamansi Rhizoma et Radix from three medicinal origins.Methods UV spectrophotometry was applied, 11-ethoxyviburtinal (cyclopentane-pyran-7-formaldehyde, 4-ethoxy methyl) was set as the reference substance, and the content of total iridoid compounds was determined at 288 nm. HPLC method was used to simultaneously determine the contents of baldrinal and 11-ethoxyviburtinal. The HPLC analysis was performed on a Phenomenex Luna C18 column (250 mm×4.6 mm, 5μm). The mobile phase was composed of acetonitrile-water in gradient elution at a flow rate of 0.95 mL/min. The detection wavelength was 288 nm and the column temperature was 30℃.Results The total iridoid compounds, baldrinal and 11-ethoxyviburtinal were in good linearity within the ranges of 2.088–14.616μg/μL, 74.88–224.64μg, and 41.6–249.6μg, respectively. This method was precise, and with good repeatability, stability and recovery rate.Conclusion The method is accurate, simple, rapid, which can be used for the quality control of Valerianae Jatamansi Rhizoma et Radix.

Objective To observe the changes in transfer rates of epigoitrin, forsythoside A and forsythin in Ganmao Tuire Granules prescription medicinal materials by water decoction extraction, vacuum concentration and atmospheric concentration.Methods Prescription medicinal materials fromGanmao Tuire Granules were decocted in water and the decoction was condensed by vacuum and atmospheric concentration process. The contents of epigoitrin, forsythoside A and forsythin at different states were measured by HPLC for transfer rates.Results The transfer rates of epigoitrin, forsythoside A and forsythin were 72.97%, 29.27%, 72.84%, respectively after decocted in water. The RSD of epigoitrin, forsythoside A and forsythin were less than 2% in the process of vacuum concentration. The transfer rates of epigoitrin, forsythoside A and forsythin by atmospheric concentration decreased by 13.51%, 7.38% and 4.24% respectively compared with vacuum concentration when concentrated to the same state.Conclusion The method for simultaneous determination of epigoitrin, forsythoside A and forsythin by HPLC has been established. A more suitable extraction and concentration process should be chosen for the preparation ofGanmao Tuire Granules.

Objective To evaluate the clinical efficacy of small endoscopic sphincterotomy combined large-bal-loon dilation in treatment of common bile duct stones 1.0~2.5 cm in diameter. Methods 426 patients with large common bile duct (CBD) stones 1.0~2.5 cm in size were reviewed in our hospital between June 2010 and June 2014. They were randomized underwent small endoscopic sphincterotomy combined large-balloon dilation (SESPLBD) (n=218) or endoscopic sphincterotomy (EST) ( n= 208) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results SESPLBD had higher complete duct clearance in one session (95.41 % vs. 93.75%), but there was no statistical significant difference. Bleeding was much less occurred in SESPLBD than in EST (2.29 % vs. 7.69 %, P= 0.025), especially when the stones were bigger than 1.5 cm in diameter. Mechanical lithotripsy was performed less in SESPLBD (13.76%vs 25.96 %, P=0.002), especially when the stones were 1.5 ~2.0 cm in diameter. There was no statistical significant difference in the incidence rate of post-ERCP pancreatitis (9.17 % vs. 6.73 %,P = 0.452), hyperamylasemia (19.72 % vs. 18.27 %,P = 0.796), perforation and death. Conclusions SESPLBD could be a safe method for large bile duct stones 1.0~2.5 cm in size. Compared with routine EST, it had less bleeding rate and mechanical lithotripsy requirement without increasing the incidence rate of post-ERCP pancreatitis or hyperamylasemia.

Objective From the perspective of traditional Chinese medicine (TCM) syndrome differentiation to investigate the blood glucose control strategies of patients with different etiological factors and treated by mechanical ventilation.Methods One hundred and twenty-six mechanical ventilation patients admitted to the Department of Intensive Care Unit (ICU) of Hangzhou Third People's Hospital from February 2016 to February 2017 were enrolled, they were divided into a heart failure group (64 cases) and a pneumonia group (62 cases) according to the cause of disease. Altogether 4 cases due to death, giving up the treatment or being transferred to other hospital were excluded in each group, thus, 60 cases in heart failure group and 58 cases in pneumonia group were finally enrolled. Both groups received at least 4 days of formal blood glucose monitoring and control program. The differences in TCM syndromes, the number of patients necessary to use insulin to control the blood glucose, the daily use of insulin dosage, the incidence of hypoglycemia and prognosis of patients were compared between the two groups.Results According to TCM syndrome differentiation, deficiency was the primary syndrome in the heart failure group, while in the pneumonia group, excess was the primary syndrome, the proportion of deficiency syndrome in heart failure group was significantly higher than that in the pneumonia group [63.33% (38/60) vs. 31.03% (18/58),P < 0.05]. Within 4 days, the incidence of hyperglycemia [50.0% (29/58) vs. 13.3% (8/60)], daily insulin dose (U/d: 85.35±6.35 vs. 20.13±8.20) in pneumonia group were higher than those in the heart failure group (bothP < 0.05). The incidence of hypoglycemia in heart failure group was higher than that in pneumonia group [16.67% (10/60) vs. 3.45% (2/58),P < 0.01].Conclusions It is necessary to use different blood glucose control strategies in patients with heart failure and pneumonia to undergo mechanical ventilation, and the TCM syndrome differentiation can provide theoretical references.

AIM: In this paper, we studied the efficiencies and the mechanisms of a new Chinese herb Qcimum basilicum polysaccharide (BP) on PG cell metastasis in vitro. METHODS: The number of tumor cells going through matrigel was assayed and used to represent the ability of the invasion and migration of PG cells. Using Scrape-loading and dye transfer (SLDT) technique, the efficiencies of BP on recovering PG cell gap junction -mediated intercellular communication (GJIC) was measured. The expressions of c-myc, nm23-H1 and Tiam-1 genes mRNA in PG cells treated with BP were determined by RT-PCR. RESULTS: Compared with the control, the action of invasion and migration of PG cells were decreased after treated with BP (P