ObjectiveTo explore the diagnosis and surgical treatment techniques for the patients with primary presacral tumor.Methods Data from 31 patients with primary presacral tumor admitted into our Department for Surgery from Jan. 1999 to Jar. 2009 were retrospectively analyzed.All patients underwent surgical treatment,among them,10 received per-sacroiliac or per-perineum approaches to remove the tumors,18 receivedper-abdomentumorectomy, and3receivedcombinedper-peritoneumandper-perineum tumorectomy.Results Patients visited the doctor while exhibiting the compression symptoms by the the tumors.Final diagnosis could be reached with the help of rectal touch,B-mode ultrasound,computerized tomography,or magnetic resonance imaging.Complete resection was performed in 28 patients.Partial resection was performed in 3 patients.Fractionated resection was successfully performed in 2 patients with chronic infection or sinus tract.ConclusionThe primary presacral tumor should be surgically resected once final diagnosised and without surgical contraindications.Pelvic plexus should be preserved and presacral hemorrhage should be prevented.The tumor should be resected as complete as possible.

Objective To investigate the changes and mechanism of learning and memory in rats by different doses of benzo (a) pyrene (B(a)P). Methods Forty weaned rats (28 days) were randomly divided into control group (NS), solvent group ( vegetable oil) and three B (a) P dosage groups (the doses were 5,10 and 20 mg / kg body weight respectively ). And all rats were administrated intraperitoneally every other day to one month. The capability of learning and memory in rats were measured by Morris water maze test, and the brain-derived neurotrophic factor ( BDNF) and NMDAR2B content in hippocampus were tested by immunohistochemistry. Results In training of Morris water maze,the average escape latency was extended gradually with increasing dose, and there was a statistically significant difference between high-dose group((62. 78 ±47. 25 )s) and the control group((40.60±38.79)s)(P＜ 0.01). Compared with the control group(11.25 ±2.63), the number of crossplatform of high-dose group(4.33 ±2.08) was statistically reduced (P＜0.05). B(a)P at 10 and 20 mg/kg decreased NMDAR2B and BDNF expression in hippocampus of rats in immunohistochemistry. The level of NMDAR2B was (162.23 ±6.56) in the high-dose group and (150.38 ± 15.34) in the control group(P＜0.05);the expression level of BDNF was (163. 13 ± 8.09) in the high-dose group and (141.83 ± 13.37) in the control group(P＜ 0.05). Conclusion Subacute B(a)P exposure can reduce spatial learning and memory in weaning rats, it may be related to decreased levels of NMDAR2B and BDNF in hippocampus.

BACKGROUND:Bryan cervical disc replacement and anterior cervical discectomy and fusion have a dispute in the treatment of cervical spondylosis.
OBJECTIVE:To evaluate the clinical effects of Bryan cervical disc replacement and anterior cervical discectomy and fusion by meta-analysis, thereby providing clinical evidence for treatment strategy of cervical spondylosis.
METHODS:The authors searched Medline, PubMed, EMBASE, OVID, CBM, CNKI and also searched manual y seven relevant Chinese orthopedic journals for articles pertinent to clinical research of Bryan cervical disc replacement and anterior cervical discectomy and fusion. Extracted data included the range of motion of the cervical spine, visual analog scale score, neck disability index, the Japanese Orthopaedic Association score. Meta-analysis and forest plots were conducted with RevMan4.2.2 Software.
RESULTS AND CONCLUSION:There are eight articles in the meta-analysis, including 883 patients (430 patients receiving Bryan cervical disc replacement, and 453 patients receiving anterior cervical discectomy and fusion). Meta-analysis did detect statistical y significant differences in the range of motion of the cervical spine at 3 months and 24 months postoperatively between the two groups, but did not detect statistical y significant differences in visual analog scale score, neck disability index, the Japanese Orthopaedic Association score between the two groups. These findings indicate that Bryan cervical disc replacement is superior to anterior cervical discectomy and fusion in the range of motion of the cervical spine. However, the current literature offers no evidence to support superiority of the Bryan cervical disc replacement over the anterior cervical discectomy and fusion.

Objective To enhance the clinical diagnosis efficiency and accuracy of diabetic retinopathy (DR) to facilitate its early finding and diagnosis.Methods Image segmentation method was used to process and analyze DR vessel.Clinical images by fundus fluorescein angiography (FFA) were used as the objects for the research on DR vessel segmentation and extraction.Results Image processing and analysis gained higher definition and accuracy in segmenting the normal retinal image and DR vessel when they were compared with the fundus image and FFA image.Conclusion The method proposed enhances the early diagnosis of DR by processing and analyzing the retinal vessel,and thus contributes to the increased living quality of the patient.

Objective To explore the effects of preoperative neoadjuvant endocrine therapy on expression and significance of ER, PR, C-erbB-2 in pestmenopause breast cancer patients over 60 years old. Methods 36 patients were treated with endrocrine therapy by oral tamoxifen for 60 ～ 90 days, and the expression of ER, PR and C-erbB-2 was examined before and after the endrocrine therapy. Results In 36 patients the negative expres-sion rate of ER, PR was 16.78% and 11.11% respectively before the endrocrine therapy, compared to 50% and 33.33% after the endrocrine therapy. There was significant difference(P<0.05). The expression of C-erbB-2 was 13.8% and 16.67% before and after the endrocrine therapy, and there was no significant difference between the two figures. Conclusions The neoadjuvant endocrine therapy by tamoxifen alone can down-regulate the ex-pression of ER, PR, and can inhibit tumor growth. Some patients may get partially relieved.

Objective To study the relationship ofiliac vein, portal vein(PV) and superior mesenteric vein (SMV), explore the feasibility on application of iliac vein in extended pancreatoduodenoctomy, and observe the clinical results. Methods Portal system and iliac venous system were dissected in 20 adult corpses. The caliber, thickness and branches of iliac vein, PV and SMV were observed and compared. The application of iliac vein in extended pancreateduodenoctomy were studied in 2 patients. Results There were no branch in 30 mm near lilac vein, 1 branch in 30--50 nun and 2-3 branches in 51-70 ram. The thickness and caliber of iliac vein matched with PV's and SMV's, there was no significant difference. Only proper pro-longed operative incisions were needed and the operation time was 5-7 hours. Postoperative vascular throm-bosis, necrosis of intestine, liver failure and so on were not occurred. No evidence of vascular embolism and recurrence happened within 6-16 months' follow-up. Conclusion Uiac vein, as a choice, can be used for vasotransplantation in the pancreatoduodenectomy.

Objective To evaluate perioperative portal hemodynamic alterations in cirrhotic patients undergoing subtotal splenectomy,podicled spleen remnant retroperitoneal transplantation plus lower esophagus transection in the treatment of portal hypertension.Method Forty patients with cirrhotic portal hypertension were randomly allocated into 2 groups:splenic transplantation group (n = 20),in which patients underwent subtotal splenectomy with pedicled remnant spleen retroperitoneal transplantation and cardia-esophageal devascularization and transection,and control group (n = 20),in which splenectomy and cardia-esophageal devascularization and transection were performed.The cross section area,blood velocity and flow and collateral circulation of portal parameters were comparatively evaluated by 3D DEC MRA,and the size of remnant spleen,blood flow and collateral circulation of retroperitoneal transplanted spleen were comparatively assessed.Results At 6-month after operation,the disappearance of esophageal-gastric varices in two groups was similar,and the cross section areas of main portal vein (MPV) in two groups all decreased postoperatively,in study group it was (1.81±0.73) cm~2 vs.(1.20±0.52) cm~2,P ＜ 0.01;in control group it was (1.78±0.52) cm~2 vs.(1.30±0.12) cm~2,p ＜0.01.The mean blood velocity of MPV decreased postoperatively,in study group it was (9.86±0.10) cm/s vs.(7.06±1.92) cm/s,P ＜0.01;In control group it was (10.0 ±0.6)cm/s vs.(8.2±2.4) cm/s,P ＜0.01.The mean blood flow velocity of MPV in study group was lower postoperatively than that in control group(P＜0.01).The mean blood flow volume of MPV decreased postoperatively from (15.0±1.9) ml/s to (10.5 ±2.7)ml/s,P ＜0.01 in study group;and from (14.9±2.1) ml/s to (11.6±2.1) ml/s,P ＜ 0.01 in control group.The mean blood flow volume of MPV in study group was lower postoperatively than that in control group(P＜0.05).A significant collateral formation was observed around the retroperitoneally translocated pedicled remnant spleen.Conclusions Compared with splenectomy,subtotal splenectomy,retroperitoneal translocation of the pedicled remnant speen helps to preserve splenic function as well as to increase retroperitoneal collateral formation which is conducive to further decreasing the portal veinous pressure.

Objective To explore the application of CT value in calculating the proton incident energy in proton treatment planning system. Methods Bethe-Block formula and the formula for calculating the proton range were analyzed to study the correlation of the range of proton beam ( 70-250 MeV ) between a variety of radiation equivalent material and water. Procedure of Monte Carlo SRIM2008 was used to verify the possibility of a constant proportional coefficient of range ( Ci ). The proportional coefficient ( Ci ) of range in radiation-equivalent material and the CT value were fitted by using Origin 8.0 software to study the functional relation of CT value and Ci. The actual range of proton was equivalent to a range of water and incident proton energy could be calculated. Results There was a constant range of Ci of proton beam (70-250 MeV) between a variety of radiation equivalent material and water. There was a functional relation between CT value and Ci ( r = 0.999). The actual range of proton in radiation equivalent material can be equivalent to a range of the water. Conclusions CT values and a range of proportional coefficient ( Ci ),and the actual required range of the tumor could be used to accurately calculate the water equivalent range,and the incident proton energy to the position of Bragg peak. A new exploration for using CT technology in proton treatment planning system could be obtained.

Objective To investigate the mechanism of recurrent laryngeal nerve injury during total thyroidectomy.Methods The clinical data of 36 patients suffering from recurrent laryngeal nerve injury in total thyroidectomy from 2003 to 2014 was analyzed retrospectively.Results 21 cases had temporary recurrent laryngeal nerve injury while 16 cases had permanent injury.The cases of injury included giant thyroid goitre,with variation of recurrent laryngeal nerve,undergoing secondary surgery,with tumor invasion and complicating thyroiditis.During the first surgery,the incidence of temporary recurrent laryngeal nerve injury was 0.43％,and the incidence of permanent damage was 0.27％.The temporary and permanent injury incidence of secondary surgery after initial subtotal thyroidectomy was 4.59％ and 4.59％,respectively.For patients with grade 3 thyroid gland,that was 1.81％ and 0.30％,respectively and 0.51％,0.72％ respectively in malignant cases.In cases complicating thyroiditis temporary recurrent laryngeal nerve injury occurred in 1.01％.Conclusions There is increased risk of recurrent laryngeal nerve injury in giant goiter cases undergoing secondary operations.Hence it is suggested that initial surgical procedure be hemithyroidectomy or total thyroidectomy

BACKGROUND:The main treatment of lumbar isthmic spondylolisthesis is the surgery, in a broader attempt to decompression, reduction, fixation and fusion of the lesioned segments. The golden standard of the treatment is biological fusion, while internal fixation is a reliable assistance for fusion therapy. ＜br> OBJECTIVE:To discuss the clinical value and curative effect of intervertebral fusion cage combined with pedicle screw systems for the treatment of lumbar isthmic spondylolisthesis. ＜br> METHODS:From March 2010 to March 2013, 21 cases of isthmic spondylolisthesis were treated with intervertebral fusion cage combined with pedicle screw systems, including 18 cases of spondylolisthesis of degree II and 3 cases of spondylolisthesis of degree III. Al patients were fol owed up regularly, taking JOA lumbago score and visual analog scale score as the objective evaluation criteria of pain in postoperative fol ow-ups. The curative effect was assessed by Macrab standard, and the functional recovery was evaluated based on indicators such as Prolo, and the spinal fusion rate was assessed according to Lenke criteria. Changes of slippage rate, slippage angle, sacral inclination angle and intervertebral space post height in preoperative and postoperative periods were evaluated by iconography data. ＜br> RESULTS AND CONCLUSION:Al the 21 patients with isthmic spondylolisthesis were fol owed up for 12-16 months. JOA lumbago score and vasual analog scale score of al patients were improved after treatment, and the difference was statistical y significant compared with before treatment (P=0.000). According to Macrab evaluation criteria, there were 17 excellent cases and 4 good cases. Each indicator evaluated by preoperative Prolo activities and symptom grading showed significant differences in preoperative and postoperative periods (P=0.003). Postoperative lumbar spondylolisthesis was basical y reset, the slippage angle was significantly reduced, the sacral inclination angle was increased, and the height of the intervertebral space was recovered basical y. Intervertebral fusion cage combined with pedicle screw systems was one of the effective strategies to treat lumbar isthmic spondylolisthesis.