Objective To analyze the factors related with intraoperative neurophysiological monitoring (IONM) in spine and spinal cord surgery under general anesthesia, in order to increase the effectiveness of IONM. Methods A retrospective study was performed on patients who received somatosensory-evoked potential (SEP) and motor-evoked potentials (MEP) in spine surgery under general anesthesia from Ju-ly, 2011 to January, 2016. Results Data from 104 patients were collected in which 18 cases had abnormal SEP and 17 cases had abnormal MEP. A single factor analysis indicated that abnormal SEP was related to concentration of inhalation anesthetic (CIA), hypothermia in peri-operative period (HTM), and type of anesthesia (χ2>6.219, P<0.05), whereas abnormal MEP was related to CIA, hypotension in periopera-tive period (HTN), and additional muscular relaxants (χ2>4.125, P<0.05). Logistic regression analysis indicated that abnormal SEP was relat-ed to CIA and HTM, whereas abnormal MEP was related to CIA and HTN (P<0.05). Conclusion CIA, HTM, and HTN were possible fac-tors related with IONM in spine surgery under general anesthesia.

Objective To evaluate the clinical value of eversion carotid endarterectomy in patients with carotid atherosclerosis stenosis. Method Summarized the clinical data of 20 patients who accepted eversiou carotid endarterectomy from March 2009 to August 2009, compared the outcomes with preoperative and postoperative image learnt materials and clinical symptoms. Results All cases finished successfully. All clinical symptoms were improved after operation. The stenosis were all improved completely on the image after operation. Conclusions Eversion carotid endarterectomy is safe, effective, and shortening operative time and hospitalization time. It has low restenosis rate, thicken endometrium and plaque can be stripped completely.

Objective To investigate the structural and functional changes of lower motor neuron distal to the site of spinal cord injury in rats. Methods Seventies Sprague-Dawley rats were divided randomly into 6 groups: sham-operation group (controls, n=10) and 3 day group (n=10), 1 week group (n=10), 2 week group (n=10), 4 week group (n=15) and 8 week group (n=15) after spinal cord transaction at T10. Neuronal apoptosis and acetylcholinesterase (AChE) activity of spinal cord at L4- 6 were observed by using the terminal deoxynucleotidal transferase- mediated DUTP-biotin nick end labeling (TUNEL) method and the semiquantitative enzyme cytochemistry, respectively. Results The assessment of apoptosis by TUNEL labeling showed that fluorescent markers were observed occasionally in anterior horn distal to the site of injury. The optical density (OD) value of AchE positive motor neurons (area > 300 μm2) initially decreased about 3 days after transaction and then overshot 1 week or so. However, after that, the OD value decreased again, the lowest about 4 weeks. Then the OD value increased again, though at 8 weeks was still lower than that of controls (P<0.05). Conclusion The findings on indistinctive apoptosis provided the proof of no significant changes of lower motor neuron distal to the site of transection. Semiquantitative histochemical results about AChE reflected marked metabolic changes of motoneurons caudal to the transaction, which represented as part of functional reorganization.

Objective To investigate the relationship between high-glucose-induced fibronectin(FN) expression and up-regulation of integrin-linked kinase(ILK) in human kidney tubular epithelial cells (HKC) and kidney of CD-1 mice. Methods Cultured human kidney tubular epithelial cells and streptozotocin (STZ)-indueed diabetic model of CD-1 mice were enrolled in this study.Western blot was used to detect the expression of FN and ILK.The kinase dead ILK plasmid (pCMV-kdlLK) were transferred to HKC. Results Four weeks after injection of STZ,CD-1 mice had higher blood glucose level as compared to the control [(20.3±2.7) mmol/L vs (6.1±1.4) mmol/L,P＜0.01].Meanwhile,expression of FN and ILK was significantly increased in diabetic mice as compared to the control (P＜0.01).There was positive correlation between the expression of FN and ILK (r=0.899,P＜0.01).High-glucose could up-regulate FN and ILK expression in cultured HKC in a time- and dose-dependent manner.Blockage of ILK activation by pCMV-kdILK abrogated high-glucose-incuced FN expression in HKC. Conclusions Highglucose can induce FN expression through up-regulating ILK expression.Blockage of ILK activation abrogates this effect.

Objective To summary the experience of surgical types selection of chronic suppurative otitis media tympano‐plasty and evaluate its clinical curative effect .Methods Chronic suppurative otitis media patient records were collected ,surgical types selection based on hearing ,otoscope and mastoid CT selection .Finally 161 chronic suppurative otitis media patients (164 ears) whoes medical records and follow‐up of contents were complete were collected ,in which type Ⅰ tympanoplasty group with 40 ears , intact bridge radical mastoidectomy+ type Ⅰ tympanoplasty group with 30 ears ,and open radical mastoidectomy+type Ⅱ tympan‐oplasty group with 94 ears .The therapeutic effects of the three surgical methods for the treatment of chronic suppurative otitis media were evaluated from hearing ,quality of life as well as satisfactory score after surgery .Results The mean values of the air conductive hearing thresholds after operation in the three tympanoplasty groups were decreased than those before operation (all P<0 .05) ,while the mean values of the bone conductive hearing thresholds after operation showed no obvious changes (all P>0 .05) .There were no statistically significant improvements in the air conductive hearing thresholds in the three tympanoplasty groups (P>0 .05) .The improvements in patient′s subjective hearing of the there surgical methods were 82 .5% ,70 .0% and 83 .0%respectively ,there was no statistically significant (P>0 .05) .The improvements in the overall quality of life of the three surgical methods were 80 .0% ,80 .0% and 79 .8% respectively ,showed no statistically significant differences (P>0 .05);the reduction rate of patient′s worry about illness were 90 .0% ,93 .3% and 95 .7% ,showed no statistically significant differences (P>0 .05);the bas‐ic satisfaction rates in the postoperative satisfaction ratings of the three surgical methods were 100 .0% ,100 .0% and 97 .9% ,and there were no statistically significant differences (P>0 .05) .Conclusion For tympanoplasty in chronic suppurative otitis media pa‐tients ,surgical types selection based on hearing ,otoscope ,mastoid CT selection and intraoperative findings .From the evaluation of postoperative patients with hearing and quality of life ,three surgical methods of chronic suppurative otitis media Tympanoplasty a‐chieve satisfactory results .

Objective To assess the dynamic changes of bacteria culture of patients with chronic suppurative otitis media (CSOM ) preoperative ,intraoperative ,and postoperative the mastoidectomy .Methods Secretions or tissues in 86 CSOM patients were collected for bacterial culture and drug sensitivity tests ,and analyzed the rusults between cholesteatoma group and nonchol-esteatoma group .Results Hospitalized CSOM patients with positive culture rates preoperatively ,intraoperatively and postopera-tively were 75 .6% ,41 .9% and 1 .2% respectively ;Before the mastoidectomy ,positive bacteria ,positive fungus and no pathogenic bacteria were found correspondingly 49 .1% ,25 .0% and 28 .6% of positive bacteria during the surgery .Culture positive rates be-tween the cholesteatoma group and noncholesteatoma group were significantly different intraoperatively (P<0 .05);while during in-traoperative samples ,no significant differences of positive rates were found between pyogenic fluids and tissues ,as well as tissues of mastoid tympanic antrum area and tympanic antrum entrance area (P>0 .05) .Different bacteria showed different drug sensitivity results .Conclusion Intraoperative bacteriological results shows the different bacteria and drug sensitivity from the preoperative bacteriological results ;CSOM patients with cholesteatoma are more likely to develop bacteria ;it is necessary to carry out dynamic detection on bacterial culture and drug sensitivity tests before ,during and after the surgery .

Objective The study aimed to study and translate the English edition of HHIE-S into Chinese, and verify the reliability and validity of the scale.Methods The Chinese scale was formed by translation,back-translation,revision and other steps.A total of 170 elder sujbects with normal hearing and presbycusis were sur-veyed.One to two weeks later,they were resurveyed.ResuIts The Chinese version of HHIE-S included 10 entries which were completely retained for their strong correlations.The scale had two subscales:emotional and situation-al,the Cronbach's αcoefficient of the scale were 0.889 and 0.924,respectively,the total coefficient was 0.935;the split-half reliability outcomes of the two subscales were 0.836 and 0.903.The total split -half reliability was 0.836 and the test-retest reliabilities of the two subscales and the ten items were between 0.749 and 0.921.The total scale was was 0.963.For the validity test:the correlation between the ten items and two subscales were 0.750 and 0.927,the correlation between the ten items and the total were 0.659 and 0.878,respectively.The varimax ro-tation factor analysis identified two principal factors:emotional subscale and situational subscale.The two factors would be used to explain 73.874% of the ten items.The factor loadings of 10 entries in the scale were all between 0.684 and 0.871 and the factor loadings of all entries on the corresponding factors were greater than 0.60,consist-ent with the source scale.The average hearing threshold was considered as the gold standard,the two subscales and the total scale were positively correlated to the pure-tone average.ConcIusion The Chinese version of HHIE-S conformed to the characteristics of Chinese culture,and easily accepted by elderly people.The scale had stable structure,satisfactory reliability and validity,provided the basis for a preliminary hearing screening of elder Chinese.

Objective To investigate the effect of high glucose on renal tubular epithelial-mesenchymal transition,and to analyze the relationship between high glucose and transforming growth factor β1(TGF-β1)and the mechanism of renal interstitial fibrosis. Methods HKC and Smad7-overexpression HKC cells were grown in DMEM/F12 medium containing 5%～10%newborn calf serum.They were cultured for 16 h in free serum medium after 80%cells were adhered onto the surface of the flask.Afterwards,they were stimulated by high glucose(glucose concentration:25 mmol/L and 50 mmol/L).The expression of α-SMA,E-cadherin and fibronectin was detected by Western blot while the supernatant level of TGF-β1 was detected by ELISA.Cell motility and migration was evaluated using Boyden chamber motogenicity assay. Results In HKC induced by high glucose,the expression of α-SMA and fibronectin protein was highly upregulated while the expression of E-cadhefin protein was down-regulated.The expression of TGF-β1was up-regulated in a dose-dependent manner.These above-mentioned effects could be obviously inhibited by anti-TGF-β1 antibody.The protein expression of α-SMA,fibronectin and E-cadherin had no obvious change in Smad7-overexpression HKC induced by high glucose.HKC exhibited enhanced motility and invasive capacity in high glucose groups,compared to that in control group.Migrated cell counting was(12.4±3.7)and(18.6±4.4)cell/HP in 25 and 50 mmol/L glucose groups respectively. Conclusion High glucose may induce renal tubular epithelialmesenchymal transition through TGF-β1 pathway,which can be inhibited by blocking the Smad signal pathway.

ObjectiveTo investigate the changes and relevance of H reflex and spasticity after cervical or thoracic spinal cord injury (SCI).MethodsH reflex of 13 healthy adults as controls and 30 SCI patients (subacute, n=18; chronic, n=12) was measured twice from soleus muscle once a month. In the same time, the evaluation of spasm was performed by the modified Ashworth scale.ResultsThere was no significant difference in the mean Hmax amplitude and Hmax/Mmax ratio between different SCI stages(P>0.05). However, the mean Hmax amplitude of the patients was smaller than that of controls(P<0.01). During subacute stage there was quadratic correlation between the mean Hmax amplitude and spasticity, Hmax/Mmax ratio and spasticity. But there was linear correlation between Hmax/Mmax ratio and spasticity during chronic stage.ConclusionThere was closer relation between spasticity and Hmax/Mmax ratio after spinal cord injury. However, the quantitative evaluation need to be proved by larger samples.

Objective To investigate the expression of neural-nitric oxide synthase (nNOS) in renal clear cell carcinoma and its clinical significance.Methods The expression of nNOS mRNA in 533 samples of TCGA database was analyzed with Student t test,and statistical analysis was performed to assess the relationship between nNOS expression and clinical prognosis with Kapla-Meier test.Western blot analysis of nNOS protein expression in 10 cases of clear cell renal cell carcinoma(ccRCC) from department of urology of Wuhan union hospital with student t test.Results The mRNA levels of nNOS in 72 cases of ccRCC in tumor tissues and adjacent tissues and were 2.99 ± 0.28 and-1.57 ± 0.17,it is significantly lower than those in adjacent tissues (P ＜ 0.01).The mRNA levels of nNOS in 533 cases of ccRCC,in tumor tissues and adjacent tissues and were 2.99 ± 0.28 and-1.76 ± 0.05,it is significantly lower than those in adjacent tissues (P ＜ 0.01).A total of 533 sample studies showed a low correlation between nNOS expression and clinical T stage,T1-1.59 ±0.08,T2-1.96 ±0.13,T3-1.90 ±0.09,T4-2.38 ±0.28 (P =0.0029) and -1.63 ±0.06 and-2.16 ± 0.13 between non-metastasis and no-metastasis (P =0.0009),and-1.57 ± 0.08 and-2.03 ± 0.11 between non-recurrence and recurrence (P =0.008).Survival analysis showed that the overall survival time were (40.3 ± 5.6) months and (48.3 ± 5.7) months in lower and higher nNOS expression,and disease free survival time were (37.1 ± 2.1) months and (40.3 ± 5.6) months in lower and higher nNOS expression,both with shorter time in low expression of nNOS (P ＜ 0.01).nNOS proteins were 1.02 ± 0.16 and 0.61 ± 0.1 1 in tumor tissues and adjacent tissues with significantly lower expression(P＜0.05).Conclusions The mRNA and protein of nNOS are lower in ccRCC with a poor prognosis of ccRCC.