18 cases of atlanto-axial instability with symptoms of spinal cord compression were treated operati-vely. The reasons of instability were congenital deformity of great occipital foramen region with atlanto-axial subluxation in 7, atlantoaxial tuberculosis complicated with dislocation in 4, traumatic atlanto-axial dislocation in 5, and spontaneous dislocation of atlanto-axial joint in 2. Cranial traction was instituted preoperatively in most cases. The operations were done under local anesthesia. Open reduction of atlas, and fixation by wiring and fusion of atlanto-axial laminae with bone graft were performed in 8 cases, and occipto-cervical fusion by bone grafting with or without decompression of great occiptal foramen in 10 cases. Postoperative plaster bed or heas chest cast was stressed. All cases but one were successful, the dislocation was reduced, symptoms of spinal cord compression were relieved, the fusion was solid, and most of them returned to work.

Objective 1.To establish an improved method by inhaling hyperosmotic saline and mucosolvan ampoule and to observe the security and validity in elderly patients with chronic obstructive pulmonary disease(COPD).2.To observe the changes of cell component and soluble substance in the induced sputum of the elderly patients with COPD at their acute and stable stage,and explore the role of these substances in airway inflammation. Methods 1.40 elderly patients with COPD who were at their acute stage were stochastically divided into two groups,20 patients each,who inhaled hyperosmotic saline(3%)(group A)and hyperosmotie saline(3%)plus ambroxol hydrochloride(group B).We compared their electrocardiogram before and after inhalation,lung function,saturation of oxygen in artery,cell component,inflammatory factors in sputum and validity of inducing sputum.2.The cell component,inflammatory factors and the lung function of the patients in group B were determined at their acute and stable stage. Results 1.55.0% of the patients in group A felt uncomfortable.and 2 of them had excessive bronchial irritability so not undergoing sputum inducement.However,side effects were found in only 5 patients of the group B.Side effects in the group B were lower than those in hyperosmotic saline group(P＜0.05).Before and after the experiment,electrocardiogram of the patients in the two groups had no statistical difference(P＞0.05).It was the same as lung function and oxygenic saturation.Cell component and inflammatory faetors in the sputum of the two groups had no statistical difference(P＞0.05).2.In group B,the total cells,monoeyte,neutrophil,IL-8 and TNF-αof the patients at their acute stage were(3.4 5±0.52)×108/L,(38.8±4.3)%,(30.8±3.1)%,(316.75±43.14)ng/L,(39.4±4.58)ng/L.respectively.And those at their stable stage were(2.94±0.57)×108/L,(29.1±6.1)%,(28.2±4.2)%,(170.00±25.70)ng/L,(20.60±5.10)ng/L,respectively.The total cells,monocyte,neutrophils,IL-8 and TNF-α in acute and stable stage of the patients had statistical significance(P＜0.05).There was a negative correlation of the total cells,monocyte,neutrophil,IL-8,TNF-αwith the degree of the disease in group B at acute and stable stage. Conclusions The results suggest that inhaling ambroxol hydrodiloride is a practical,safe and effective method,for clarifying the mechanism of airway inflammation in elderly patients with COPD.

Background Myopia is one of the main blinding diseases worldwide.At present,a lot of studies on ocular structure focus on the changes of corneal curvature(CC),central corneal thickness (CCT),anterior chamber depth (ACD),ocular axial length (AL) and choroid and retina,but the research of anterior chamber angle section structure form and ciliary body shape is lack.Objective This study was to measure and analyze the changes of the anterior chamber angle and related tissue structure in myopic eyes.Methods One hundred and forty-nine eyes of 149 subjects were included from May 2008 to May 2010 in Eighth Hospital of Qingdao City with the ages of 18-40years old under the informed consent.The subjects were assigned to the emmetropia group (30 eyes) ([0.02±0.18] D),low myopia group(46 eyes) ([-1.64±0.69] D),moderate myopia group (35 eyes) ([-4.56±0.66] D) and high myopia group (38 eyes) ([-7.04 ± 1.02] D).Conventional indexes including intraocular pressure (IOP),CCT,CC,AL and ACD were measured,and the indexes including chamber angel open distance (AOD),iris thickness (IT1,IT2,IT3),the position of ciliary body such as A-angel,B-angel,trabecular ciliary process distance (TCPD),irisciliary process distance (ICPD) and ciliary body thickness (CBT1,CBT2,CBT3) were measured by ultrasound biomicroscope(UBM).Results The IOP,CC and CCT values showed slight change in different groups without remarkable difference among them (all at P＞0.05).As the increase of myopic degree,AL was extended and ACD was deepened,showing significant differences among the groups (both at P＜0.05).There were no significant differences in IT1,IT2 and IT3 among the four groups (all at P＞0.05).However,the measuring values of angle opening degree (TIA and AOD500),ciliary position (A-angle,B-angle,TCPD,ICPD) and CBT (CBT1,CBT2,CBT3) elevated with the increase of myopic degree (all at P＜0.05).Positive correlations were found between AOD500 and ACD,A-angle,CBT1,CBT2,AL,negative correlations was found between AOD500 and myopic degree (r =0.573,0.513,0.325,0.398,0.542,-0.435,all at P＜0.01);Positive correlations were found between TIA and ACD,A-angle,CBT1,CBT2,AL,negative correlations was found between AOD500 and myopic degree (r =0.573,0.464,0.276,0.410,0.539,-0.435,all at P ＜ 0.01).Conclusions Within certain limits,as the increase of myopic degree,ACD deepens,the anterior chamber angle widens,ciliary process thickens and ciliary body backward shifts.

Objective To evaluate the prognostic factors of brain metastasis from non-small cell lung cancer and suggest a individualized treatment method proposal with prognostic estimation. Methods From Dec. 2003 to Jan.2007, 183 patients received whole brain radiation therapy (WBRT) were retrospectively analyzed. Kaplan-Meier method was used to analyze the survival. Logrank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure. Results The overall l-, 2- and 3-year survival rate was 40.6%, 16.6% and 11.3%, respectively, but with a median survival time of 10.0 months (95% CI 8.6-11.4 months). In multivariate analysis, RAP grouping, weight loss, LDH in blood serum and treatment method were independent prognostic factors. The median survival time of WBRT alone, WBRT with chemotherapy, surgery with chemoradiotherapy and WBRT with Gefitinib was 9.0, 9.0, 22.0 and 13.0 months, respectively, but their difference were statistical significant (X2 = 10.37, P = 0.016). Conclusions The main prognostic factors of brain metastasis from non-small cell lung cancer are RAP grouping, weight loss, LDH in blood serum and treatment method. The survival time is prolonged by proper multidiseiplinary management than WBRT alone. The effect of combined treatment of surgery with chemoradiotherapy is favorable for the patients operated with single region of metastasis.

Objective To summarize the experience of applying choledochoscopy, duodenoscopy and laparoscopy, one-stage suturing of common bile duct, to treat cholecystolithiasis and choledocholithiasis that failed to respond to ordinary endoscopic sphincterotomy (EST). Methods Retrospectively analyzed the clinical data of twenty-five pa-tients with choledocholithiasis complicated with cholecystolithiasis. 25 cases of failure to endoscopic stone extraction underwent LC and laparoscopic common bile duct exploration with primary suture of (BD) from June 2013 to June 2015. Results One patient was converted to laparotomy with small incision. The other one had residual stones and therefore underwent a second EST. After the treatment, two patients developed hyperamylasemia, which was cured by conservative therapy; One patient had bile leakage, which was treated by percutaneous drainage with no serious complications and death. No long-term complication was found in a portion of patients followed up until now. Conclusion In properly selected patients of duodenoscopy management-failed, synchronous treatment of combined application of three endoscopies in laparoscopic surgery with primary suture of (BD) is feasible, effective and safe.

The aim of this study is to investigate the immune effects of BCG primary immunization and IL-12 combined with Mycobacterium tuberculosis Ag85A DNA vaccine booster immunization on mice .We randomly divided the mice into 7 groups ,namely PBS negative controls ,BCG controls ,pcAg85A controls ,BCG primary immunization combined with Ag85A booster immunization controls ,BCG primary immunization combined with Ag85A and IL-12 booster immunization controls , BCG primary immunization combined with IL-12 booster immunization controls ,and BCG primary immunization combined with pcDNA3 .1 booster immunization controls .Implementing the immune in procedure of BCG primary immunization and cytokine IL-12 booster immunization combined with mycobacterium tuberculosis Ag85A DNA ,we observed the immune effect on mice by detecting the mice serum total IgG , specific lymphocyte proliferation and cytokine levels in 4 ,6 ,8 weeks after the last immunization .Comparing the mice immunized in the strategy of BCG primary immunization and cytokine IL-12 combined with Mycobacterium tuberculosis Ag85A DNA vaccine strengthening immunization to the mice in other groups by other immune ways ,we found that ,in BCG/Ag85A+ IL-12 groups ,IgG in-creased significantly (P＜ 0 .05) ,specific lymphocyte prolifera-ted significantly ,and after strengthening immunization IFN-γlevels ,IL-2 levels and IL-4 levels in the three periods were 128 .2 ±20.4,190.2±16.51,244.2±39.14 ;146.2±17.29,271.6±16.36and16.36±28.12 ;68.6±6.62,96.6±5.5and5.5± 10 .71 ,respectively ,which were higher than those in other groups (P＜0 .05) .It’s suggested that the immunization way of BCG primary immunization and cytokine IL-12 combined with Mycobacterium tuberculosis Ag85A DNA vaccine booster immu-nization could significantly enhance the humoral and cellular immunity of the bodies ,and provide the basis for further study on protective effect test in animals .

[ ABSTRACT] AIM: To explore the effects of Mcl-1 signal pathway blockers on Mcl-1 expression, macrophage apoptosis and Mycobacterium tuberculosis in the model of mice infected with Mycobacterium tuberculosis H37Rv.METH-ODS:A mouse infection model was established by intraperitoneal injection of H37Rv suspension.The signaling pathway blockers AG490, PD98059 and LY294002 for JAK/STAT, MAPK and PI3K, respectively, were intraperitoneally injected into the mice infected with H37Rv.Cell acid-fast staining was used to observe whether the mouse peritoneal macrophages infected with H37Rv were successfully established.Immunocytochemical method was employed to detect Mcl-1 expression in the mouse peritoneal macrophages infected with H37Rv.The apoptotic rate in each group was measured by flow cytomer-ty.The scavenging capacity of apoptotic macrophages against H37Rv was determined by Mycobacterium tuberculosis colony counting.RESULTS:The result of cell acid-fast staining revealed the existence of dispersive arrangement of red short anti-acid Mycobacterium tuberculosis within infected macrophages.The result of cell immunocytochemistry showed strongly posi-tive expression of Mcl-1 protein in H37Rv infection group, AG490 treatment group and LY294002 treatment group, weakly positive expression of Mcl-1 protein in PD98059 treatment group, and negative expression of Mcl-1 protein in control group. The result of flow cytometry found that the macrophage apoptotic rate in H37Rv infection group was higher than that in con-trol group, while that in PD98059 treatment group was high than that in other groups with statistically significant differences (P<0.05).The result of Mycobacterium tuberculosis colony counting showed that PD98059 treatment had the most signifi-cant inhibitory effect on H37Rv strain.CONCLUSION: Mcl-1 signaling pathway blockers increase the apoptotic rate of macrophages infected with Mycobacterium tuberculosis H37Rv and inhibit the growth of Mycobacterium tuberculosis by inhibi-ting the signaling pathways of JAK/STAT, MAPK and PI3K, among which the MAPK has the most obvious interfering effect on Mcl-1, and leads to the highest apoptotic rate of infected macrophages and the strongest bacteriostasis.

OBJECTIVETo evaluate the value of en-bloc mesogastric excision (EME) in the treatment of advanced gastric cancer.

METHODSA retrospective analysis on clinical data of 98 gastric cancer patients who underwent total gastrectomy in China-Japan Union Hospital of Jilin University from January 2013 to December 2015 was carried out, including EME group of 48 cases (according to the mesangial space) and D2 radical group of 50 cases(D2 lymphadenectomy according to the vascular markers). Operations were performed by the same single surgeon team. Surgical indexes and recent efficacy indexes were compared between two groups.

RESULTSGeneral informations pertaining to two groups were comparable (P>0.05). All the operations were performed successfully. Compared with D2 radical group, EME group had a shorter operative time [(155.3±13.6) vs. (171.2±14.9) minutes, P=0.012] and less intraoperative blood loss [(95.1±19.5) vs.(122.6±28.0) milliliters, P=0.011]. There were no significant differences in the number of harvested lymph node (30.8±3.9 vs. 31.5±4.7, P=0.675), time to postoperative bowel function return [(3.2±1.2) vs.(3.9±1.4) days, P=0.179], postoperative hospital stay [(10.9±2.7) vs.(11.3±3.2) days, P=0.788], and the incidence of postoperative complication [8.3% vs. 10.0%, P=0.775]. During the follow-up of 1 year, all the patients had no long-term complications, no tumor recurrence or death.

CONCLUSIONSFor advanced gastric cancer, EME result in the same clinical efficacy compared with standard D2 resection. At the same time, EME can shorten the operative time and reduce the intraoperative blood loss, which is a new technology and worthy promoting.

Aged ; Blood Loss, Surgical ; Defecation ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

AIMTo investigate whether the measurement of serum zinc may improve the detection of prostate cancer (PCa) in men who had total prostate-specific antigen (PSA) levels higher than 4.1 ng/mL.

METHODSA mass screening for PCa of 3940 men over 50 years old was undertaken using total serum PSA. Of the 190 men (4.8%) with elevated PSA, 143 (3.6%) underwent a transrectal ultrasonography (TRUS)-guided biopsy of the prostate, and 42 men (1% of total and 29.3% of men undergoing biopsy) were found to have cancer. The areas under the receiver operating characteristic curves (ROC-AUC) were used to compare the diagnostic power of cancer detection by means of serum zinc, and free PSA/total PSA ratio (f/t).

RESULTSThe men with levels of serum zinc that ranged from 40 ng/mL-60 ng/mL, had an age-adjusted odds ratios(OR) of 5.0. A cutoff value of 100 microg/mL for serum zinc concentration provided a sensitivity of 90.5% and a specificity of 32.7% in elevated PSA range, and a sensitivity of 93.3% and specificity of 27.1% in gray zone, respectively. In the gray zone ranges of 4.1 ng/mL-10.0 ng/mL, the ROC-AUC for zinc was 73.0% higher than 62.7% of f/t PSA ratio and 56.7% of total PSA.

CONCLUSIONPCa displays a lower serum zinc concentration. The measurement of zinc levels improves PCa detection in the gray zone compared with the f/t PSA ratio and total PSA.

Area Under Curve ; Biopsy ; methods ; Humans ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; diagnostic imaging ; pathology ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography ; Zinc ; blood

Objective To determine vascular endothelial growth factor(VEGF)-460 gene polymorphism in Uyghurs and its relationship to urolithiasis in south Xinjiang. Methods Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP),gene sequencing and genetic analysis methods were used in 200 urolithiasis patients of Uyghurs, and 200 healthy Uyghurs. Results The distribution of genotype and allele had no significant difference between urolithiasis patients and normal controls (P＞0. 05). The frequencies for the CC,TT and CT genotypes in patients with urolithiasis and normal controls were 1.5 %, 29.0 %, 69.5 % and 0. 5 %, 27.5 %, 72.0 %, respectively. The frequencies for C and T allele were 36.2%,63.7% and 36.9% ,63.1%, respectively. Conclusions The results of VEGF-460 gene polymorphisms indicate no significant relationship between patients with turolithiasis and normal controls in Uyghurs in south Xinjiang,which may not be urolithiasis susceptibility genetic locus.