AIM: To clarify the role and mechanism of hippocampus in the formation of P3-like. METHODS: (1) The hippocampal and parietal P3-like were simultaneously recorded by chronically implanted electrodes in rats. (2) In forebrain ischemia/reperfusion model, the effects of the selective damage of hippocampal CA1 subfield on the hippocampal and parietal P3-like were examined. (3) The changes of hippocampal and parietal P3-like after the inhibition of acetylcholine activity in the septo-hippocampal pathway by intraperitoneal injection of atropine (30 mg/kg) were also detected. (4) The changes of conditional active avoidance response was tested by shuttle-box following forebrain ischemia/reperfusion. RESULTS: (1) The peak latencies of hippocampal and parietal P3-like were prolonged after forebrain ischemia/reperfusion. (2) The polarity of hippocampal P3-like were reversed after the inhibition of acetylcholine activity in the septo-hippocampal pathway by atropine. (3) The prolongation of P3-like peak latency was closely related to the lowering of the score of conditional active avoidance response after forebrain ischemia/reperfusion. CONCLUSION: (1) The formation of P3-like depends on the integrity of hippocampus formation. (2) Hippocampus is not the only generator of P3-like, P3-like could be produced in multiple way. (3) The activity of acetylcholine in the septo-hippocampal pathway has notable effects on the formation of P3-like. (4) P3-like could be used as the sensitive marker of cognitive function.

Objective To evaluate the clinical effect of thoracic discectomy via trans-facet-joint approach in the treatment of thoracic disc herniation.Methods Thirty-three cases were included in this group from October 1994 to August 2009.There were 27 males and 6 females.The age ranged from 18 to 72 years old,with an average of 41.8 years.The course of disease ranged from 12 days to 36 months and was lesser than one month in 13 cases.The weakness and numbness of lower limbs occurred after trauma in 9 cases.Fifteen cases were diagnosed as simple thoracic disc herniation.Six cases were associated with ossification of posterior longitudinal ligament and 12 cases were associated with ossification or hypertrophy of yellow ligament.A total of 45 discs were involved,including 32 in lower thoracic segments(71.11%),8 in upper thoracic segments(17.78%)and 5 in middle thoracic segments(11.11%).All the herniated discs and the ossified OPLL were excised via the trans-facet-joint approach.For the cases with ossification or hypertrophy of yellow ligament,the laminectomy and replantation were performed.The screw-rod system was used on both sides in 14 cases,on one side in 19 cases.Results Follow-up was acquired in 27 patients,ranged from 12 to 63 months(mean,37 months).According to Epstein and Schwall grade,there were excellent in 15 cases,good in 10 cases,improved in 2 cases and poor in 2 cases.The excellent and good rate was 86.21% and total effective rate was 93.10%.Postoperative complications occurred in 3 cases,including exacerbation of preexisting deficits in 2 cases and implant failure in 1 case.The former 2 cases were treated with methylprednisolone,dehydrant,neural nutrition and hyperbaric oxygen.One patient had recovered to preoperative level,the other had not recovered to the preoperative level.The implant was removed 18 months after operation for the implant failure.The post-operative CT or MRI showed that all the replanted lamina obtained fusion,and the canal decompression was complete.Conclusion Thoracic discectomy via trans-facet-joint approach can improve the clinical result obviously.

ObjectiveTo assess the clinical value of minimally invasive transforaminal lumbar interbody fusion(TLIF) through the Wiltse approach for the treatment of lumbar spondylolisthesis. Methods Sixty-nine patients with lumbar spondylolisthesis were randomly divided into two groups. Group A underwent minimally invasive TLIF via the Wiltse approach, Group B via the traditional approach. There were 31 cases in group A, the affected level was L4.5 in 19 cases and L5S1 in 12. The degree of vertebrae slippage was Ⅰ degree in 17 cases,and Ⅱ degree in 14. There were 38 cases in group B, the affected level was L4,5 in 22 cases and L5S1 in 16. The degree of vertebrae slippage was Ⅰ in 21 cases, and Ⅱ in 17. The Japanese Orthopaedics Association (JOA) score, visual analogue scale (VAS) of low back pain and leg pain were evaluated at 3, 6, and 12 months follow-up. The post-operative dynamic X-rays, CT and/or MRI were used for image evaluation. ResultsThere was no statistically difference in operating time between the two groups. The incision length, blood loss and exposing time of group A were shorter than those of group B. The JOA scores, recovery rate, VAS of low back pain and leg pain, interbody fusion rate and atrophy rate of multifidus in group A were 24.7±3.5, 77.0％±3.1％, 1.0±0.7, 1.1±0.3, 71.0％±5.8％, 2.1±0.2, respectively, and in group B were 24.3±2.8, 73.6％±6.4％, 3.1±0.6, 1.8±0.5, 76.3％±6.1％, 0.5±0.1, respectively. The VAS of low back pain was lower in group A than in group B. The atrophy rate was better in group A than in group B. Conclusion Both TLIF approaches can acquire satisfactory clinical results. Minimally invasive TLIF through the Wiltse approach can significantly reduced damage of multifidus and incidence of chronic low back pain postoperative.

Background and purpose: The incidence of Hashimoto's disease (HD) coexistent with thyroid carcinoma is 0.5%-38%, and it is increased significantly in recent years. Therefore, we investigated the clinical characteristics and surgical experiences in patients with HD coexistent with thyroid neoplasm. Methods: The clinical data in 417 cases of HD coexistent with thyroid nodules including 93 cases of HD coexistent with thyroid carcinoma treated surgically and confirmed pathologically from Jun. 1985 to Dec. 2007 were analyzed. Results: The coexistent rate of HD with thyroid carcinoma (TC) was 22.3% respectively. The coexistent rate of HD with TC was 9.2% before 1995, and it went up to 24.7% after that year (P<0.05). Among those HD coexistent with TC patients, 66 cases were papillary carcinoma, 15 cases were follicular carcinoma, 9 cases were mixture and 3 cases were lymphoma. There were 43 cases of micro-foci thyroid carcinoma, which accounted for 46.2% of the malignancy. Unilateral or bilateral, total, subtotal or partial thyroidectomy and biopsy were the main operative procedures for the disease. Conclusion: There is a high incidence of thyroid carcinoma in patients with HD coexistent with thyroid nodules, and it is rising up recently. In the clinical treatment of HD, we should be aware of the coexistent thyroid tumors and micro-foci thyroid carcinoma.

Objective To explore if keratinocytes that stably maintain HPV11 genome can be obtained by transfection and selection methods. Methods Escherichia coil containing pBR322.HPV11 plasmid was cultured and amplified. Then the plasmid was extracted, purified and digested with BamH Ⅰ enzyme to release viral genome from the bacterial vector. After recovering from the low-melting point agarose gel by electrophoresis, the genome was self-circulated with T4 DNA ligase. The religated DNA was cotransfected with pTK-neo DNA into HaCaT keratinocytes using Lipofectamine reagent. After selection with G418 for 2 to 3 weeks, clonal and pooled cultures were expanded and analyzed. Fluorescent quantitative PCR (FQ-PCR) and nested reverse transcriptase PCR (nRT-PCR) were applied to detect HPV11 DNA and spliced HPV11 E1^E4 mRNA expression in the transfected cells. Results After the cotransfection of HPV11 genome into HaCaT keratinocytes and two-week selection,G418-resistant cell colonies were obtained with morphological features indistinguishable from normal HaCaT keratinocytes. As shown by FQ-PCR, HPV11 DNA was present in G418-selected HaCaT keratinocytes. The average viral DNA load capacity was 15.9±16.8 copies/cell in the primary culture of G418-selected HaCaT cells and 23.9±1.1 copies/cell in the third passage of the cells; there was no statistical difference between the two passages of cells (t=-0.822, P>0.05). nRT-PCR targeting HPV11 E1^E4 mRNA transcript produced a specific 628-bp fragment, which was shown by agarose gel electrophoresis. Conclusions Our data indicate that HPV11 genome can be successfully introduced into HaCaT keratinocytes by transfection and HPV11 DNA-positive cells can be obtained by G418 selection. Moreover, HPV11 DNA is still present in the third passage of transfected cells.

Background and purpose:The incidence of Hashimoto’s disease (HD) coexistent with thyroid carcinoma is 0.5%-38%, and it is increased significantly in recent years. Therefore, we investigated the clinical characteristics and surgical experiences in patients with HD coexistent with thyroid neoplasm. Methods:The clinical data in 417 cases of HD coexistent with thyroid nodules including 93 cases of HD coexistent with thyroid carcinoma treated surgically and confirmed pathologically from Jun. 1985 to Dec. 2007 were analyzed. Results:The coexistent rate of HD with thyroid carcinoma (TC) was 22.3% respectively. The coexistent rate of HD with TC was 9.2% before 1995, and it went up to 24.7% after that year (P

Objective To report the results using endoscopic techniques in ce rvical discectomy and intervertebral fusion. Methods From October 2002 to August 2003, 26 patients underwent cervical discectomy and intervertebral fusion using endoscopic techniques. 16 patients had been followed-up more than 3 months, inc luding 4 females and 12 males. The average age was 53.2 years (range, 23 to 65 y ears). The disorders lasted from 3 to 14 months before surgery. There were 3 cas es of cervical injury associated cervical disc herniation (CDH), 8 of cervical s pondylotic myelopathy (CSM), 2 of solitary ossification of the posterior longitu dinal ligament (OPLL), and 3 of radiculopathy. The mean preoperative ADL of Japa nese Orthopedic Association (JOA) score was 7.2. The working channel was inserte d through a 2 cm long incision, the protruded discs or ossified posterior longit udinal ligaments were excised for complete decompression, then an appropriate in tervertebral PEEK fusion cage was implanted. Results All patients obtained endos copic cervical discectomy and interbody fusion successfully. None of cases was c onverted to open procedures. The surgery lasted an average of 120 min (range, 50 to 150 min), mean blood loss was 110 ml (range, from 40 to 140 ml). There was n o complication during operation and no any stimulating symptoms on laryngopharyn x after surgery. However, postoperative hemorrhage of the incision occurred in 1 case, then an injury of a thyroid vessel was found during immediate exploration . The follow-up period extended from 3 to 8 months (mean, 6.5 months), the aver age preoperative ADL of JOA score was 13.1 while the improvement rate was 60.2%. Conclusion The cervical discectomy and intervertebral fusion through endoscopi c approach is able to reduce the soft tissue injury and the incidence of stimula ting symptoms on laryngopharynx, which makes the surgery more safe. The indicati ons for this procedure include cervical disc herniation, cervical myelopathy, ra diculopathy, and traumatic cervical disc injury on C3,4 to C5,6 segments.

Objective To summarize the imaging features of the thoracic canal stenosis caused by ossification of ligamentum flavum, and to evaluate its clinical results of a novel decompression of total laminotomy and autografting in-situ. Methods 31 patients underwent total laminotomy, autografting in-situ and decompression to treat the ossification of thoracic ligamentum flavum. In the study, there were 18 males and 13 females; the average age was 45.7 years (rang, 26 to 73). 3 patients were associated with cervical stenosis, 5 with lumbar stenosis, and 2 with both cervical and lumbar stenosis. 9 were associated with anterior compression by thoracic disc herniation or OPLL. The vertebrae affected were 1 level in 3 patients, 2 levels in 12, 3 levels in 11 and more than 4 levels in 5. 23 affected segments were located at the upper thoracic spine(T1-T4), 19 at the mid-thoracic spine(T5-T8) and 52 at lower-thoracic spine(T9-T12). All the patients underwent total laminotomy and autografting in-situ, 9 patients with thoracic disc herniation or OPLL received discectomy and internal fixation at one stage. The postoperative outcomes were evaluated according to Epstein criteria. Results The patients were followed up 6 to 63 months (mean, 15 months). The clinical outcomes were excellent in 14 cases, good in 7 cases, and fair in 3 cases, and the excellent and good rate was 87.5%. One case experienced neurological complication with Frankel C grade improved to Frankel D grade treated with neurotrophic drug and hyperbaric oxygen and to Frankel E grade at 5 months after operation. 2 presented with lower limb intravenous thrombosis, and CSF leakage happened in 1 case and cured with re-operation. The osteotomy of total laminotomy was bony healed at average of 5.5 months, and there was not new formed ossification anterior to re-implanted vertebral lamina and spinal cord compression. Conclusion MRI combined with CT scanning is a most useful imaging modality for the diagnosis of ossification of thoracic ligamentum flavum. The novel surgical procedure designed by the authors is safe and effective in treating ossification of thoracic ligamentum flavum.

Objective To investigate the effects of the compound T0 extracted from Tripterygium wilfordii, a traditional Chinese herb, in comparison with those of cyclosporin A(CyA), on down－ regulating the expression and activities of IL－ 1 and IL－ 2. Methods The cellular reactive systems of peritoneal macrophage (rat)－ thymocytes (rat), and spleen cells (rat)－ CTLL－ 2 (mouse) were set up. The technique of 3H－ TdR incorporation was applied. Results The production of IL－ 1 and IL－ 2 were significantly inhibited by T0 and CyA. The activities of IL－ 1 and IL－ 2 were down－ regulated by T0,rather than by CyA. Conclusion T0 and CyA are potent inhibitors of the production of IL－ 1 and IL－ 2. Effects of T0 on the activities of IL－ 1 and IL－ 2 are different from those of CyA.

Objective To observe the clinical advantage of treating the dens fracture with cannulated screws by microendoscopy system and navigation system through anterior approach. Methods From October 2002 to August 2004, 6 dens fracture (type Ⅱ) patients had undergone single cannulated screws fixation by the microendoscopy system and image guidance through the anterior approach, including 2 females and 4 males with an average of 53.2 years (range from 23 to 65 years). The preoperative Frankel grade was D in 1 case and E in 5 cases. 4 cases had fracture displacement. All patients accepted skull traction and external fixation before surgery. The patients accepted the MR examination and the images were reconstructed by the Vector Vision spinal navigation system in order to make the proper surgical plan, including the nails' direction and length in three-dimension. After affirming the reduction of the dens fractures according the C-arm fluoroscopy, the work channel was inserted through 2 cm long incision at the C5 level, then extended to the C2 level, to excise part of inferior C2 vertebral body. Under the navigation system guide, a guidance needle was inserted and the fracture was fixed by cannulated screw through the work channel. The patients did not need any C-arm fluoroscopy during the surgery. After the surgery the patients were with external fixation for 2 months. Results The surgery lasted 80 min (range from 50 to 150 min), blood loss was 75 ml (40 to 90 ml). There was no related complication during and after surgery including odynophagia or dysphagia. Follow-up period extended from 6 to 37 months (mean 13.5 months). All dens fractures were reduced and healed satisfactory during the follow up. All patients' postoperative Frankel grade was E in the most recent follow-up. Conclusion To fix the dens fracture through microendoscopy and navigation system guide can reduce the soft tissue injury and the incidence of odynophagia or dysphagia, make the surgery safer, avert the repeated C-arm check-up during the surgery compared with the traditional anterior fixation method. The procedure is very safe, simple and can reduce the surgical time effectively.