Objective To discuss the surgical indications,relative merits and clinical outcomes of anterior reconstruction plate fixation for treating unstable posterior pelvic ring injuries.MethodsA retrospective study was done on clinical data of 36 patients with unstable posterior pelvic ring injuries treated with anterior reconstruction plate fixation from August 2004 to July 2010 and followed up for minimum one year.There were 25 males and 11 females,at mean age of 35.8 years ( range,13-62 years).There were two patients with anterior dislocation of the sacroiliac joint and 34 with posterior dislocation.According to Tile classification,there were four patients with type B fractures ( B1:3,B2:1 ) and 32 with type C fractures (C1-1:17,C1-2:12,C2:2,C3:1 ).Results All patients were followed up for average 2.3 years ( range,1-6 years).Fat liquefaction and superficial infection were founded in two patients who were cured by dressing change and frequent but low-dose blood transfusion.Eight patients were subjected to iatrogenic lateral femoral cutaneous nerve injury.Meanwhile,five of them was recovered after treatment with neurotrophic drugs,but there were still three patients leaving lateral thigh numbness.One patient had L5 nerve root injury due to pull force,and was recovered after three months of neurotrophic drug therapy.According to Matta and Tometta criteria,the reduction results were excellent in 23 patients,good in 11 and fair in four,with excellence rate of 94％.No reduction loss or implant failure occurred.According to Majeed scoring system,the clinical outcomes were excellent in 17 patients,good in 14,fair in four and poor in one,with excellence rate of 86％.Of the seven patients pre-operatively associated with sacral plexusinjury,three obtained full recovery,two got partial recovery and two were free from recovery.Conclusion The anterior reconstruction plate fixation takes advantages of wide surgical indications,simple exposure,low infection rate,satisfactory reduction and solid fixation and may be a main treatment method for unstable posterior pelvic ring injuries.

OBJECTIVETo compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis.

METHODSThe clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them, 28 patients were treated with ACDR (ACDR group), including 18 males and 10 females, aged from 32 to 62 years old with an average of (45.2±6.2) years; and 48 patients were treated with ACDF (ACDF group), including 28 males and 20 females, aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale (VAS), Japanese Orthopedics Association (JOA) score, Short Form-36 (SF-36), imaging data were used to assess the clinical effects after operation.

RESULTSA total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (P<0.05), there was no significant difference between two group (P>0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased (P<0.05), ACDR group was better than that of ACDF group (P<0.05). In ACDR group, there was no significant difference in the range of motion of surgical segments and adjacent segments between preoperative and postoperative (P>0.05); heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation, no fusion was found on the 1st year after operation. In ACDF group, the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation.

CONCLUSIONActiv C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory, but the long-term effects still need study.

Adult ; Cervical Vertebrae ; surgery ; Diskectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Total Disc Replacement ; methods

Objective To evaluate the effects of femoral offset (FO) on the stress level of bone cement total hip arthroplasty (THA) in the elder patients by the three-dimensional finite element analysis. Methods The normal bilateral hip joints in two cases was determined with CT imaging,with parameters including FO,neck shaft angle and neck length.The three-dimensional finite element model of THA was built so as to make Von Mises stress analysis of the changes of different neck lengths,neck shaft angles and FO. Results Stress levels in the prosthesis and bone cement reduced monotonically with the increase of neck shaft angles.In the meantime,the stress levels were lowered when neck length was in a range of 35-44 mm,but beyond the range they showed monotonous increase. Conclusions The reduction of stress levels of prosthesis and bone cement,promotion of femur stress and extension of range of motion of hip joints are closely related to FO.FO reconstruction benefits the restoration of abductor force arm and biomechanical function of normal hip joints.

ObjectiveTo evaluate the clinical safety and efficacy of SilverHawk directional atherectomy for femoropopliteal occlusive lesions. MethodsEighteen ischemia occlusive lesions in 11 patients of the lower extremity were treated with SilverHawk directional atherectomy.The mean lesion number was 1.6 ± 1. 1 per patient. The mean lesion length was ( 3.4 ± 2. 2 ) cm. The average degree of diameter stenosis was 96％ ± 14％. 9 lesions were totally occlusive. Clinical symptoms included claudication in 4 cases ( Rutherford classes: 3) and critical limb ischemia ( Rutherford classes: 4) in 7 cases. Lesions characteristics were divided by TASC classification: TASC B in 7 cases; TASC C in 1 case (in-stent occlusion); TASC D in 3 cases.Mean ABI was 0. 5± 0.4. Patency was evaluated with color duplex sonography or CTA besides clinical examination during follow-up.ResultsNine totally occlusive lesions were recanalizated successfully via intraluminal approach. 18 lesions achieved technical success (residual stenosis ＜50％ ) leaving 15％ ±7％ mean residual stenosis in mean (8 ±3)min, predilation was needed in one lesion ( in-stent occlusion) prior to atherectomy. Clinical symptoms improved or disappeared with mean ABI 1.07 ±0. 12 and Rutherford grades: 0 (n =9) and 1 (n =2). Patency rate was 100％ with mean 0. 93 ± 0. 14 ABI and Rutherford grades remain unchanged after follow-up of mean ( 9 ± 4 ) monthes.ConclusionsSilverHawk directional atherectomy is safe and effective for the treatment of lower extremity ischemia.

Objective To discuss the technical points and clinical effectiveness of the guidewire looping technique for re-canalizing chronic and total long-segment occlusions of femoropopliteal arteries.Methods The guidewire tip was formed into a U-shaped loop and then the guidewire loop was advanced to the occluded artery and was manipulated to re-open the occluded vessel. The catheter followed the guidewire gradually until the tip of the guidewire came into the true lumen of the outflow tract. Results The chronic long-segment occlusions of femoropopliteal arteries were successfully re-canalized in all 48 patients with a technical successful rate of 92.31% (48/51). The re-canalization procedure was failed in three cases.Conclusion Guidewire looping technique is an effective, safe and simple practical skill for re-canalizing chronic long-segment occlusions of femoropopliteal arteries.

Objective To evaluate the influence of laparoscopic uterine artery ligation on ovarian function. Methods In this retrospective study ,46 patients with laparoscopic myomectomy were selected and randomly divided into Ligation group and Non-Ligation group. The serum concentrations of follicular stimulating hormone (FSH), luteinizing hormone ( LH), estrogen ( E_2) were measured be-fore treatment and 1 ,3 ,6,12 months after treatment. Ovulating functions of ovary were monitored. All results were compared between two groups. Results All patients ovulated after 6 months. There were no significant differences between two groups in the levels of FSH, LH and E_2,.before and after treatment(P>0.05). Conclusions Laparoscopic uterine artery ligation do not affect ovarian function of pa-tients with uterine leiomyoma.

[ ABSTRACT] AIM:To investigate the mechanism of L-type calcium channel ( L-Ca2+)/calpain signal transduc-tion pathway in verapamil inversing resistance of papillary thyroid carcinoma to doxorubicin .METHODS:Human papillary thyroid carcinoma TPC-1 cells were cultured for 2 d.For determining the appropriate concentrations and treatment time of verapamil and doxorubicin , a compatibility test was conducted to detect the cell viability by CCK-8 assay.The cells were divided into control group , doxorubicin group , verapamil group and doxorubicin +verapamil group .The techniques of whole-cell patch-clamp was used to record L-Ca2+currents.The protein expression levels of calpain 1 and LC3 were detec-ted by Western blot .RESULTS: Compared with control group , the density of L-Ca2+current decreased in doxorubicin group and verapamil group (P<0.05).Compared with verapamil group , the density of L-Ca2+current decreased in doxo-rubicin+verapamil group (P<0.01).Compared with control group, the expression of calpain 1 decreased in doxorubicin group and verapamil group (P<0.05).Compared with doxorubicin group , the expression of calpain 1 decreased in doxo-rubicin+verapamil group (P<0.05).Compared with control group , the expression of LC3 increased in doxorubicin group and verapamil group (P<0.05).Compared with doxorubicin group , the expression of LC3 increased in doxorubicin +ver-apamil group ( P<0.01) .CONCLUSION:The drug resistance of TPC-1 cells to doxorubicin may be related to the in-crease in autophagic activity .Verapamil further increases autophagic activity of TPC-1 cells, resulting in autophagic death and inversing the resistance of TPC-1 cells to doxorubicin .The mechanism may be involved in L-Ca2+/calpain 1 signal transduction pathway of autophagy .

Objective To explore the neural damage induced by acute exposure to methamphetamine (METH).Methods The mice were administrated with METH,then the stereotyped behavior of mice was evaluated,and spatial recognition memory was analyzed by Y-maze test.In addition,nitric oxide synthase (NOS) activity was detected by kit,and the apoptotic proteins including Bax,Bcl-2,Caspase-3 were assayed by using Western blot.The DNA injury induced by METH was observed by using the comet assay.Moreover,mitochondrial membrane potential was detected to assess the toxic effects of METH on mitochondria by JC-1.With the Western blot assay,the phosphorylation of MAPK signaling pathways were also investigated.Results Acute METH exposure significantly increased the stereotyped behavior in mice,and spatial recognition ability of mice was obviously decreased.On the molecular level,total nitric oxide synthase (TNOS) and induced nitric oxide synthase (iNOS) were increased,and the apoptotic proteins,such as Bax and cleaved caspase-3 were markedly enhanced.With the comet assay,it showed that METH exposure resulted in DNA damage.In parallel,mitochondrial membrane was damaged which manifested as mitochondrial membrane potential decreased.With the western blot,It was further found that METH enhanced the activation of MAPKs.However,p38 MAPK signahng pathway was demonstrated to be the only one factor involved in METH-induced neural damage.Conclusion METH induced neural damage,and MAPK signaling pathways might be involved in this process,since inhibition of p38 MAPK signaling pathway significantly ameliorated METH-induced neural damage.

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma.Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively analyzed.There were 11 males(55%) and 9 females(45%) with a mean age of(45.9 ± 16.4) years(range, 13-71 years).The initial presentations were obstructive symptoms in 12 patients(60%).CT imaging were performed in 9 patients(45%), of which 4 cases were enhanced CT(20%).Results The misdiagnosed patients included 5 cases of extraesophageal lesions(4 cases of paraesophageal lymph node tuberculosis and 1 case of lymph node hyperplasia), 8 cases of begin interstitial diseases(3 cases of neurinoma, 3 cases of inclusion cyst, 2 cases of angioma), 5 cases of malignant interstitial diseases(4 cases of GIST, 1 case of PNET), and 2 cases of esophageal cancer.The 4 cases of esophageal tuberculosis were misdiagnosed due to the absence of CT examination.The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor.This might be associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope.The characteristic mucosal ulcer in patients with highly malignant GIST was overlooked.The disease relapsed postoperatively because only tumor enucleation was performed.Conclusion Preoperative diagnosis of esophageal leiomyoma is not uncommon.This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or esophageal GIST.CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis.The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.

Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascia1 laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND).Methods From January 2004 to June 2016,a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study.The mean age of the patients was 67 (range 44-88) years,and median PSA level was 21.2 (range 0.6-454.0) ng/ml.The patients were divided into earlier group (from January 2004 to December 2011,160 cases) and later group (from January 2012 to June 2016,95 cases) according to different treatment periods.The baseline demographics between the two groups were similar.All patients routinely received adjuvant hormone therapy (AHT) postoperatively.The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively.Those with a CRMP4 methylation level ＞ 15％ or rectum/bladder neck invasion,were treated by neoadjuvant hormone therapy (NHT) for 3-6 months.Positive surgical margin (PSM),progression-free survival (PFS),cancer-specific survival (CSS),overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared.Results The mean operative time of the earlier and later group were (239 ±65) min and (203±51) min,mean blood loss were (109-±65) ml and (96-±44) ml,mean dissected nodes were (19 ± 5) and (21 ± 7),respectively (all P ＞ 0.05).The total PSM rate was 19.2％,and PSM rates of the two groups were 23.1％ and 12.6％ (P =0.04).All the 255 cases received AHT and 25 cases in the later group underwent NHT.The median follow-up time was 73 months (range 10-152 months).The total 5-year PFS,CSS and OS rates were 77.7％,94.3％ and 87.1％,respectively,and the rates between groups were 73.8％ vs.86.1％ (P=0.03),93.1％ vs.98.6％ (P=0.07),and 85.0％ vs.92.8％ (P =0.11),respectively.The 1-year postoperative continence rates were 91.9％ vs.97.9％ (P =0.09).Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa,and improved PFS might be acquired by preoperative tumor staging.