With the development of medical science, the level of minimally invasive spinal surgery is becoming higher and higher. Comparing to the traditional operation, the postoperative effect is equal to it or slightly better than it, with the higher patient satisfaction. The minimally invasive spine surgery is gradually accepted by the majority of patients. However, compared with the traditional operation, minimally invasive spinal surgery requires that spine surgeon must be familiar with principles and related concepts of minimally invasive surgery of the spine, due to its higher degree of fine operating, long learning curve. Only by following these principles and ideas, can the minimally invasive spine surgery be healthy sustainable and rapid developed.

Objective:To explore the relationship of Syk and VEGF-C expression in breast cancer with lymph node metastasis . Methods:The expression of Syk and VEGF-C in 40 cases of breast cancer were determined using immunohistochemistry assay .Then, the positive rates of Syk and VEGF-C were compared with lymph node metastasis .Results:The expression rate of VEGF-C and Syk in breast cancer was respectively 77.5%(31/40), 37.5%(15/40).VEGF-C protein expression was not significant related with the tumor diameter (P>0.05) and histological grade (P>0.05), but was significantly associated with lymph node metastasis (P<0.05).Syk protein expression was not significant related with tumor diameter (P>0.05) and the histological grade(P>0.05), and was associated with lymph node metastasis (P<0.05).The difference of Syk and VEGF-C had statistics significance(P<0.05).Con-clusion:Syk and VEGF-C involved in the lymphatic invasion and metastasis , may be an important indicator of prognosis .

To observe the clinical outcome of degenerative lumbar spondylolisthesis treated by TFC, transpedicle instrument and bone graft, transpedicle instrument and TFC, respectively, from May 1995 to Aug. 2000, 106 patients with degenerative lumbar spondylolisthesis were conservatively treated. According to Meyerding classification system of lumbar spondylolisthesis, 56 cases were classified as degree 1, 47 cases as degree 2, 3 cases as degree 3. The patients were followed up from 6 months to 10 years and 2 months, averaged 38 months. According to different operative methods, the patients were divided into 3 groups: TFC group, transpedicle instrument and bone graft group, transpedicle instrument and TFC group. Among the 31 cases in TFC group, 22 cases were followed up, the excellent rate was 95 5%. Among the 42 cases in transpedicle instrument and bone graft group, 35 cases were followed up, the anatomical reduction rate was 83%, the excellent rate was 94 8%. Among the 33 cases in transpedicle instrument and TFC group, 28 cases were followed up, the anatomical reduction rate was 81%, the excellent rate was 96 4%. According different indications, TFC and pedicle screw systems were all effective for spondylolisthesis. They had a lower complication rate. The use of spinal instrumentation is a valuable adjunct to achieve lumbosacral fusion in patients having undergone decompressive surgery for the spine.

Characteristics found in CT and MRI of osseous hydatidosis were analyzed. The incidence of osseous hydatidosis in China, and its diagnosis and treatment were discussed. The results showed that most of osseous hydatid disease was polycystic. On CT and MRI scanning, it was shown that there were many little cysts constituting a big lesion. Scolex and cyst wall were not clearly shown. Expansive growth was its main feature. The cystic wall was shown as a linear shadow. Recurrent signs of spinal cord compression called for reoperation. The patients led an acceptable life with the disease. Surgical eradication was the main treatment,but recurrence rate was high after the operation.

To evaluate the diagnosis and treatment of epidural neurilemmoma in the spinal canal, the diagnostic characteritics shown by X ray, MRI and CT were analyzed in 42 patients. Furthermore, peri operative conditions, operative time, blood loss and amount of blood transfusion during the operation, operative technique, changes in functions of the spinal cord before and after the operation were also analyzed. The results showed that there was marked recovery of nerve functions after the operation. MRI together with X ray and CT were in the diagnosis of the nature and site of the lesion. Excision of the tumor was done in all the patients. Among them, in 12 patients internal fixation was done at the same time. Follow up showed that the operation achieved good results. While radiologic examinations contributed greatly to the diagnosis, the final diagnosis depended on pathological examination. Internal fixation was optional depending on different situations.

head and neck region. Postoperative recurrence rate was 42 10%, five year survival rate was 8 33%. Not a single case was found to be malignant degeneration of neurolemmoma or neurofibromatosis, nor as a result of radiotherapy. It is suggested that MNST is a primary soft tissue malignant tumor, and early complete excision is the key treatment. The biological characteristics of this tumor as revealed in this study suggest that it is different from what was reported in the foreign literature.

Objective To study the effect of fibrin gel delivered with CT g ui ded trans-laminar injection on sacral nerve root sheath cysts. Methods From Apri l 1998 to February 2001, thirty-eight cases of sacral nerve root sheath cysts we re treated by fibrin gel injection. The location of cysts consisted of 12 L5 S1, 15 S1,2, 11 S2,3. All the fibrin gel was delivered by CT guided trans-laminar i njection. Results Thirty-eight cases were followed up for 3 to 37 months (averag e 9 months). Most of the patients obtained lower back and sacral pain and sacral nerve symptom alleviation. No infection, nerve injury, recurrence and cerebrosp inal fluid(CSF) leaking occurred. According to the critia of the clinic symptom releasing and the radiographic signs, there were 17 cases (44.7%) rated as excel lent, 18 (47.4%) good and 3 (7.9%) fair, the excellent and good rate was 92.1%. Conclusion CT-guided trans-laminar fibrin gel injection is an effective economic al and mini-invasive way to treat sacral nerve root sheath cysts.

OBJECTIVE:To investigate the effects of different doses of sufentanil citrate on hemodynamic indexes and stress response indexes of Crouzon syndrome children with craniofacial reconstruction. METHODS:60 cases of Crouzon syndrome under-going craniofacial reconstruction were selected from our hospital during Jan. 2010-Jan. 2016,and then randomly divided into group A,group B and group C,with 20 cases in each group. 3 groups were given pump injection of Propofol injection 4-8 mg/(kg·h)for anesthesia induction+Sufentanil citrate injection [group A 0.3 μg/(kg·h),pump injection;group B 0.6 μg/(kg·h),pump injection;group C 1.0 μg/kg,iv,0.5 h/time] for anesthesia maintenance, Cisatracurium besilate for injection 0.1 mg/kg,iv,every 40 min, drug withdrawal 5 min before the end of surgery. The hemodynamic indexes(MAP,HR)and stress response indexes(ACTH,cor-tisol)were observed in 3 groups at different time points as well as the occurrence of ADR. RESULTS:MAP levels of group C at 5 min after skin incision,1 h after operation and immediately at the end of surgery were significantly higher than before anesthesia, while those of group B were significantly higher than group C at same time points. HR of group A at 1 h after surgery and that of group B at 5 min after skin incision and 1 h after surgery were significantly higher than before anesthesias;HR of group B at 1 h after surgery was significantly lower than that of group A,and its HR at 5 min after skin incision and 1 h after surgery were signifi-cantly lower than those of group C. ACTH levels of 3 groups at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. ACTH levels of group B at 5 min after skin incision,1 h after surgery and immediately after the end of surgery were significantly lower than those of group A and C,and the group A was signifi-cantly lower than the group C at same time points. Cortisol levels of group A at 1 h after surgery,and those of group C at 5 min af-ter skin incision,1 h after surgery and immediately after the end of surgery were significantly higher than before anesthesia. Corti-sol levels of group B at 1 h after surgery were significantly lower than those of group A;cortisol levels of group A at 5 min after skin incision and immediately after the end of surgery and those of group B at 5 min after skin incision,1 h after surgery and imme-diately after the end of surgery were all significantly lower than those of group C. There were statistical significance all above(P<0.05). No obvious ADR was found in 3 groups. CONCLU-SIONS:Pump injection of sufentanil citrate 0.6 μg/(kg·h) can maintain analgesic effect of Crouzon syndrome children with craniofacial reconstruction,can keep hemodynamics sta-ble and effectively inhibit stress response during surgery with good safety.

Objective To investigate the effect of exercise preconditioning on the expression of nerve growth factor(NGF) and its receptor TrkA as well as learning-and-memory abilities in rats suffered from focal cerebral ischemia.Methods Thirty-six male SD rats were randomly divided into sham operation group (Sham-MCAO,n=12),focal cerebral ischemia-reperfusion group (MCAO,n=12) and exercise preconditioning + cerebral ischemia-reperfusion group (EX+MCAO,n=12).Rats in EX+MCAO group were placed in the treadmill device and accepted 4 weeks exercise training.Then method of middle cerebral artery occlusion was applied to prepare transient focal cerebral ischemia reperfusion model.Garcia's method was used to assess the neural function in rats.Western blotting was applied to test the expression of NGF and TrkA protein in the successfully established experimental MCAO rats.Morris water maze experiment was uti lized to test the learning-and-memory abilities of the rats.Results (1) Compared with Sham-MCAO group,the expression of NGF in rats' brain tissue was lower in MCAO group (cerebral ischemia 1h reperfusion 24h) (P＜0.05).The expression of NGF of EX+MCAO group was higher than that of MCAO group,but still lower than that of Sham-MCAO group (P＜0.05).(2)The expression of TrkA in rats' brain tissue was higher in MCAO group compared with Sham-MCAO group (P＜0.05).Compared with MCAO group,the expression of TrkA was even higher in EX+MCAO group (P＜0.05).(3)On the fifth day in the Morris water maze test,the latency of MCAO group was significantly longer than that of Sham-MCAO group((9.36± 1.18)s vs (4.86± 1.52) s,P＜0.05).However,compared with MCAO group,the latency in EX+MCAO group ((6.02± 1.04) s) was shorter,but still longer than Sham-MCAO group (P＜0.05).There was no significant difference among the three groups in the average swimming speed (P＞0.05).Conclusion Exercise preconditioning can up-regulate the expressions of NGF and TrkA protein,which can also improve the learning-and-memory abilities in rats suffered from focal cerebral ischemia reperfusion injury.

objective To assess the effect of aldosterone on the production of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9)and collagen Ⅳ in culture supematants of podocytes and the possible molecular mechanisms involved in the influence of aldosterone on the synthesis and degradation of extracellular matrix produced by podocytes. Methods Podecytes were treated with aldosterone at the concentration of 10-11, 10-9, 10-7 mol/L respectively. Cultured podocytes were examined at 24, 48 and 72 hours respectively. Spironolactone, a receptor antagonist of aldosterone, was added to observe the blocking effect on aldosterone. An inhibitor of TGF-β1 receptor was used to determine whether the effect of aldosterone on podocytes were mediated through TGF-β1 system. The enzymatic activities of MMP-2 and MMP-9 were assayed by gehtin zymography. Collagen Ⅳ 0.5 chain and TGF-β1 proteins released into culture supematants were assessed by Western blot and ELISA analysis. The adhesion rate of podocytes was monitored by flow cytometry. Results Aldosterone increased the activities of MMP-2 and MMP-9 in a dose- and time-dependent manner (P<0.05). Aldosterone decreased the level of collagen Ⅳ or5 chain protein in culture supernatants (P<0.05). Meanwhile, the expression of TGF-β1 was also increased (P<0.05). Spironolactone completely abolished the above-mentioned changes(P< 0.05). Blockage of TGF-β1 signaling with SB431542 prevented the aldosterone-induced upregulation of MMP-2 and MMP-9 as well as the downregulation of the collagen Ⅳ α5 chain protein and the adhesion rate of podocytes (P<0.05). Conclusions Aldosterone increases the activities of MMP-2 and MMP-9 but decreases the expression of collagen Ⅳ α5 chain and the adhension rate of podocytes possibly via TGF-β1 signaling pathway. Such alterations may contribute to glomerular podocyte injury associated with the GBM abnormality caused by the imbalance between matrix synthesis and degradation.