Objective To evaluate the mid‐term efficacy of microendoscopic discectomy (MED) and microsurgical lumbar discectomy (MSLD) for treating lumbar disc herniation (LDH) .Methods 98 patients with single segment LDH in the Orthopedic department of the Second Hospital of Lanzhou University from March 2009 to April 2010 were divided into 2 groups ,including 44 cases undergoing MED and 54 cases undergoing MSLD .The operative efficacies were assessed by the visual analogue scale (VAS) , Japanese Orthopedic Association (JOA) scores and Oswestry Disability Index (ODI) .Results There were statistically significant differences in the skin incision length ,amount of intraoperative blood loss and time of returning to work between the two groups (P<0 .01) ,while the operation time ,average hospital stay time and incidence of complications showed no statistically significant differences (P>0 .05) .The mean follow‐up duration was 49 .13 months in the MED group and 47 .24 months in the MSLD group respectively .At the last follow‐up the postoperative back and leg pain VAS scores ,JOA scores and ODI in each group were signifi‐cantly improved compared with the preoperative data (P<0 .01) .However ,there were no statistically significant differences in the intergroup comparison .Conclusion MED and MSLD are the effective methods for treating single segment LDH .However ,MED has less trauma and early out‐of‐bed ambulation ,is an ideal minimally invasive surgery .

Objective To investigate the difference of standard tangential field and multiple fileld radiotherapy in axillary lymph node after conserving surgery,to provide a reference for clinical treatment.Methods 20 cases of left breast cancer patients were selected,all patients underwent breast -conserving surgery,postoperative radiothera-py.All patients used standard radiotherapy wild tangent based and reverse -intensity modulated radiation therapy optimization.Armpit I,Ⅱ lymph nodes were used to calculate the extent of coverage of the original plan,target dose uniformity HI,dose conformal CI,dosimetric parameters were calculated.Results Under standard tangential field irradiation,I stand mean dose was (33.95 ±8.24)Gy,which was significantly higher than Ⅱ station (22.13 ± 6.67)Gy,and V50,V45,V40 were (22.45 ±6.32)%,(39.83 ±7.54)%,(49.65 ±8.31)%,which were higher than Ⅱ stand,I stand irradiation was significantly more,the differences were statistically significant (t =5.632,P =0.009;t =7.214,P =0.000;t =8.954,P =0.000;t =6.121,P =0.002).The whole breast irradiation armpit IMRT plan,19 patients (95.00%)reached 95% by volume APTV≥50Gy,coverage was better;but HI,CI were (1.11 ± 0.03),(1.36 ±0.07)respectively,which were significantly worse than the standard wild tangent,the differences were statistically significant (t =6.584,P =0.001;t =9.144,P =0.000).Under Hatano IMRT irradiation ipsilateral lung,heart suffered an average dose of (1 694.58 ±102.31)cGy,(645.54 ±74.44)cGy,which were significantly more than the standard tangential field irradiation,the differences were statistically significant (t =7.654,P =0.000;t =6.654,P =0.001).Conclusion Standard tangential field irradiation has poor coverage in Ⅱ axillary lymph node station,irradiation intensity modulated radiation has better coverage,but significantly increased the dose to normal tissues.

Objective To investigate the clinical efficacy of microendoscopic discectomy(MED) and fanestration discectomy (FD) for treating single segement lumbar disc herniation(LDH).Methods A total of 168 patients with single segment LDH were included in this retrospective study from April 2009 to Janurary 2012.The patients were divided into MED group(81 cases) and FD group(87 cases) according to surgery mode.The operation and hospitalization indexes for each group were collected and compared respectively.The clinical outcomes were evaluated by the visual analogue scale(VAS),Japanese Orthopedic Association(JOA) scores and Oswestry Disability Index(ODD.Lumbar curves(Cobb's angle),intervertebral space height,horizontal displacement and angular displacement before and after surgery were applied to evaluate the lumbar spinal stability.Results The skin incision length,amount of intraoperative blood loss,operation time and hospitalization duration in the MED group were less than that in the FD group(P＜0.05).All cases completed follow up for more than 4 years.The each item score at last follow up in the two groups was significantly improved compared with before operation(P＜0.05),the inter-group comparison had no statistical difference(P＞0.05).The postoperative lumbar curve and intervertebral space height were decreased in both groups.The postoperative lumbar curve in the FD group was decreased compared with the MED.One case in the MED group and 3 cases in the FD group appeared lumbar vertebral instability.Conclusion Both MED and FD for treating single segment LDH can gain better clinical effect,MED has short operation time,small trauma and little influence on lumbar vertebral stability,and is an effective minimal invasive surgery.

Objective:To explore the effect of intelligent rehabilitation device on lower limb function rehabilitation in stroke patients with hemiplegia.Methods:Using convenience sampling, 186 stroke hemiplegic patients admitted to the Department of Neurology and Surgery of Brain Hospital, Cangzhou Central Hospital from July 2021 to July 2022 were selected as the study subject. The patients were divided into a control group, a strengthening group, and an intelligent rehabilitation group, with 62 patients in each group using the random number table. The control group received routine rehabilitation for 40 minutes per day, 5 days per week, for a total of 4 weeks. On the basis of the control group, the strengthening group received an additional 30 minutes of routine rehabilitation training every day. The intelligent rehabilitation group received an additional 30 minutes of intelligent rehabilitation device exercise per day on top of the control group. The Fugl-Meyer Assessment Lower Extremity (FMA-L), Berg Balance Scale (BBS) scores, and Functional Ambulation Category (FAC) grading of three groups of patients before and after intervention were compared.Results:Sixty patients in each group completed the study. The FMA-L and BBS scores of the three groups of patients after intervention were higher than those before intervention, and the FAC grading was better than that that before intervention, with statistical differences ( P<0.05). After intervention, the FAM-L and BBS scores of the intelligent rehabilitation group were higher than those of the control group and the strengthening group, and the FAC grading was better than that of the control group and the strengthening group, and the differences were statistically significant ( P<0.05) . Conclusions:The intelligent rehabilitation device can improve the lower limb function of stroke patients with hemiplegia, and is worthy of clinical promotion and practice.

Objective To investigate the effect and mechanism of kudinoside D(KD-D)on proliferation,apoptosis and autophagy of human HCC-1806 breast cancer cells.Methods Human HCC-1806 breast cancer cells were treated with different concentrations of KD-D,and the cell viability was detected by CCK-8 method.EdU method was used to detect cell proliferation ability;the ability of cell clone formation was detected by crystal violet staining.Apoptosis was detected by flow cytometry(Annexin V-FITC/PI).Mitochondrial membrane potential was detected by JC-1 staining.The protein expressions of Cleaved Caspase-3,LC3 and P62 were detected by immunofluorescence.The protein expressions of Cleaved Caspase-3,Pan-AKT,Phosp-AKT and LC3Ⅱ were detected by Western Blot.Autophagy double-labeled mRFP-EGFP-LC3 adenovirus infection assay was used to detect cell autophagy flow.Results Compared with the control group,HCC-1806 cells were treated with 12.5,25,50,100,200,400 μmol·L-1 KD-D for 24 and 48 hours.With the increase of drug concentration and treatment time,the cell activity was significantly decreased(P＜0.001),the intracellular absorbance value was significantly decreased(P＜0.001),and the cell proliferation was inhibited.The cell clone formation counts in 60 and 80 μmol·L-1 KD-D groups were significantly decreased(P＜0.001).The proportion of early and late apoptosis in 50,100,150 μmol·L-1 KD-D groups were significantly increased(P＜0.05,P＜0.001).The proportion of red fluorescence in 40,60 and 80 μmol·L-1 KD-D groups were significantly decreased(P＜0.001),the proportion of green fluorescence was significantly increased(P＜0.01,P＜0.001),and the mitochondrial membrane potential of HCC-1806 cells decreased.The protein expression of Cleaved Caspase-3 in 60,80,100 μmol·L-1 KD-D group were significantly up-regulated(P＜0.001),and the protein expressions of Pan-AKT and Phosp-AKT in 60 μmol·L-1 KD-D group were significantly up-regulated(P＜0.001).In the 60 μmol·L-1 KD-D group,the number of LC3 protein fluorescent dots was significantly increased(P＜0.001),the average fluorescence intensity of P62 protein was significantly decreased(P＜0.001),the expression of LC3Ⅱ protein was significantly up-regulated(P＜0.001),the number of autophagosomes and autolysosomes were significantly increased(P＜0.01,P＜0.001),and the autophagic flow was activated.Compared with 60 μmol·L-1 KD-D group,the expression of Cleaved Caspase-3 and Pan-AKT protein in KD-D+AKT inhibitor(Afuresertib)group was significantly down-regulated(P＜0.01,P＜0.001),and the expression of Phosp-AKT protein was significantly up-regulated(P＜0.001).Conclusion KD-D can inhibit the proliferation of human breast cancer HCC-1806 cells and induce apoptosis and autophagy.The apoptosis of HCC-1806 cells induced by KD-D may be related to the activation of AKT signal and the expression of Cleaved Caspase-3.