Objective To investigate the long-term effects of microendoscopic discectomy for lumbar intervertebral disc herniation. Methods A retrospective analysis was made on 218 cases of lumbar intervertebral disc protrusion treated by microendoscopic discectomy. The Japanese Orthopedic Association (JOA) scoring system for lumbar myelopathy was used to evaluate surgical outcomes for each patient. Results All the patients were followed for more than 3 years postoperatively. Excellent outcomes were achieved in 121 cases, good in 80 cases, fair in 16, and poor in 1, the rate of excellent or good outcomes being 92.2% (201/218) . Conclusions Microendoscopic discectomy for lumbar intervertebral disc herniation has definitive long-term effects. Skillful surgical performance and proper postoperative rehabilitation training are crucial to good surgical outcomes.

ObjectiveTo evaluate endovascular repair(EVAR) of penetrating atherosclerotic ulcer (PAU) of the thoracic aorta.MethodsThere were 12 cases of PAU treated at our department. All the cases had severe acute thoracic pain. Computer tomography angiography (CTA) showed well outlined ulcer in 12 cases, intramural hematoma in 8 cases. EVARs were done under general anaesthesia and 12 stent grafts were used. Two cases received by-pass procedure ahead of EVARs because of main branches involved.Patients were followed up with CTA from 12 months to 4 years( median 36 months).ResultsA total of 12 stent grafts were implanted to 12 patients.The average diameter of stent graft was ( 35.7 ± 2. 5 ) mm(32-40 mm) , length was ( 163 ± 19) mm ( 152-202 mm). There was a very small internal leakage in one case with large size ulcer after implantation of stent graft, other ulcers were excluded completely. Primary technical success rate was 100％. There were no perioperative death and severe complications. All cases were free from symptoms after operation and alive during follow-up. CTA showed satisfactory results without internal leakage.The small leakage in the case disappeared within 3 months.ConclusionsBeing miniinvasive and effective, EVAR is the choice of therapy for symptomatic PAU.

Background and purpose:The prognosis of high grade gliomas remains poor, and multidisciplinary treatment strategy has been much investigated recently. This study was to explore the efficacy of Temozolomide as first-line treatment combined with radiotherapy and followed by adjuvant chemotherapy for the treatment of newly diagnosed high grade gliomas. Methods:18 patients who had been pathologically proven to be high grade gliomas were enrolled into the study. The patients received 40 Gy/20fractions for the whole brain and followed by 20Gy/10fractions as a boost to tumor bed. All of the patients were given daily oral temozolomide 75mg/ m2 during radiotherapy. 4 weeks after radiotherapy, all of the patients received 6 cycles of Temozolomide, each cycle lasted 5 days with 28 days interval between each cycles. 150 mg/m2 of temozolomide was given for the first cycle for five days,followd by 200 mg/m2 of drug for the rest of the cycles if no significant drug related toxicities were observed. Results:Median follow-up was 12.5 months, 11 cases had either recurrence or progression, 5 of them died from the disease. The median time for disease progression-free survival was 9.8 months (95% CI, 6.1~9.8months), the median time for overall survival was 14 months (95% CI, 8.5 ~ 19.5months), 1-year overall survival rate was 55.6% ,6-month progression-free survival rate was 81.8%. there were no severe temozolomide related toxicities. Conclusion: Concurrent temozolomide with radiotherapy and followed by 6 cycles of temozolomide in the treatment of high grade gliomas had better clinical efficacy, the patients tolerated the strategy well and no severe toxicities were observed.

Background and purpose:At present,the treatment of metastatic breast cancer has remained diff icult for patients who have failed after the use of anthracycline and taxane,so the treatment options for those with advanced metastatic breast cancer are very limited.Therefore,pemetrexed combined with cisplatin in the treatment of anthracycline and taxane failed advanced metastatic breast cancer patients,its effi cacy and adverse reactions were studied.Methods:10 patients with advanced metastatic breast cancer patients received pemetrexed and cisplatin chemotherapy,pemetrexed 500mg/m2 intravenous infusion,cisplatin 75mg/m2 intravenous drip,repeated every 3 weeks.Evaluation of response and adverse reactions were practiced every 2 cycles.Results:10 patients were evaluable,CR 1 patient,PR 4 patients,SD 2 patients,PD 3 patients.With a median follow-up of 6 months(4-18 months),8 patients survived and 2 patients died.The median time to progression was 4 months(3-14 months),the median survival time was 8 months(4-18 months).The most common adverse reaction was fatigue,white blood cells decrease and the digestive tract reactions,followed by oral ulcers.Conclusion:Pemetrexed combined with cisplatin in the treatment of anthracycline and taxane treatment failed patients with advanced metastatic breast cancer could improve survival,adverse reactions could be tolerated.

Objective To evaluate carotid endarterectomy for patients with atherosclerotic occlusive diseases. Method Surgical experience of endarterectomy in 32 patients with atherosclerotic occlusive diseases was retrospectively analyzed. Internal carotid artery stem pressure was measured during operation. Shunting was used routinely. Patching was used electively. Anti-platelet agents and agents reducing plasma fibrinogen were given perioperatively. Result There was no perioperative mortality, nor ischemic cerebral stroke. Patients were followed-up from 5 months to 20 months with no occurrence of ischemic cerebral stroke during the follow-up. One case presented dysfunction of hypoglossal nerve. Two cases presented dilation of carotid artery on ultrasound scan. There were no restenosis (≥50%) and thrombosis. Conclusion Carotid endarterectomy for patients with atherosclerotic occlusive diseases of carotid artery is effective and safe. Careful performance, shunting, patching and the correct order of clamps removing are the keys of preventing complications.

Objective To explore the diagnosis and management of ruptured abdominal aortic aneurysm(RAAA).Methods Twelve patients with RAAA treated in past 7 years were revienled retrospectively.The main clinical manifestations were abdominal pain and / or back pain,low blood pressure or shock,and pulsating abdominal mass.All cases were accurately diagnosed with CT and 7 were treated by conventional operation,one by EVAR,and the other 4 did not receive surgical treatment.Results Perioperative death occurred in 5 cases(mortality rate was 62.5%) in 8 surgical treated patients,including circulatory failure in 2 cases,renal failure in 1 case,and multiple organ failure in 2 cases.All the 4 patients treated with nonoperative method were dead.Conclusions Surgical operation in RAAA cases still carried a high mortality.Early dignosis,appropriate resuscitation,urgent surgical repair,reduction of operative time,and infrarenal clamping are measures conducive to lowering the mortality rate of RAAA.EVAR has the potential to reduce the mortality rate from RAAA.

Objective To construct the recombinant adenovirus vector carrying rat vascular endothelial growth factor(VEGF) as preparation for later use for genetic transfection.Methods Rat VEGF was obtained by using RT-PCR amplification and then cloned into the shutter plasmid pDC316.Subsequently,this newly constructed plasmid pDC316-VEGF,after identification by nuclease digestion analysis and sequencing analysis,was transfected into human embryonic kidney cells HEK293 by lipofectamine 2000 mediation,together with adenovirus-packaging plasmid pBHGE3.Based on the homologous recombination of the two plasmids within HEK293 cells,the recombinant adenovirus vector carrying VEGF,VDC316-VEGF,was created.VDC316-VEGF was subsequently identified using PCR,purified using repeated plaque passages,proliferated using freezing and melting within HEK293 cells,and titrated using 50% Tissue Culture Infective Dose(TCID50) assay.Results The newly constructed recombinant adenovirus was confirmed carrying rat VEGF by PCR,and its titration value determined based on TCID50 assay was 3?109pfu/ml.Conclusions The recombinant adenovirus carrying rat VEGF was successfully constructed.The newly constructed adenovirus can produce a sufficiently high titration value within HEK293 cells,providing a reliable tool for genetic transfection in further gene therapy researches.

This study was aimed to observe the influence on angiogenesis factor and expression of its receptor protein on estrogen-induced uterine fibroids rat models with Y i-Qi Xiao-Zheng (YQXZ) method, in order to explore the mechanism of this method in the inhibition of angiogenesis in the treatment of uterine fibroids. Castration and estro-gen-induced method were used in the establishment of guinea pig uterine fibroids rat model. And then, different doses of Chinese medicine of YQXZ method were given. The immunohistochemical method was used in the detection of microvessel density (MVD) and vascular endothelial growth factor (VEGF) protein expression of the uterine tissues. The RT-PCR method was used to detect the expression of VEGFR1 mRNA and VEGFR2 mRNA. Then, statistical analysis was given on indexes mentioned above. The results showed that compared with the normal control group, ex-pression of MVD, VEGF and VEGFR of uterine muscle tissues in the model group was significantly higher (P <0.01). Compared with the model group, Chinese medicine group of different doses showed different reducing. Among them, the high-dose group was the most obvious one. It showed that the high-dose Chinese medicine of YQXZ group was able to significantly inhibit the expression of MVD, VEGF and theirs receptors. It was concluded that YQXZ method can antagonize proliferation of the leiomyoma cell by inhibiting angiogenesis. Therefore, it may be one of the mechanisms of this method in the treatment of uterine fibroids.

Background and purpose:In recent years, energy-based instruments have been widely used in today’s open surgeries. Harmonic Focus? (HF) and Ligasure Small Jaw? (LSJ) are both custom-made for thyroid open surgery. This study aimed to explore the effcacy and safety of HF and LSJ in open thyroidectomy.Methods:The data from patients who undertook total thyroidectomy with central neck dissection by the same surgeon during last year in this hospital were reviewed. HF was used in 100 patients, and LSJ was used in 104 patients. The effectiveness was appraised by comparing operation time and postoperative volume of drainage on the ifrst postoperative day. The safety was appraised by comparing the incidence of postoperative complications.Results:The results of the effectiveness:the average duration of operation was (95.8±18.0) min for HF group, and (97.8±19.1) min for LSJ group, there was no statistical signiifcance (P=0.363). Postoperative volume of drainage on the ifrst postoperative day was (35.2±20.3) mL for HF group, and (36.3±23.8) mL for LSJ group, there was no statistical signiifcance (P=0.977). One patient (1.0%) had temporary vocal cord paralysis in HF and one had postoperative hematoma (1.0%) in LSJ group. Temporary hypo-parathyroidism was detected in 18 patients (18.0%) of HF group, and 16 patients (15.4%) of LSJ group. The decline of parathyroid hormone during the ifrst postoperative day was (12.3±12.8) pg/mL in HF group, and (13.9±13.4) pg/mL in LSJ group. The decline of serum calcium was (0.20±0.13) mg/dL in HF group, and (0.20±0.16) mg/dL in LSJ group. There were all no statistical signiifcances (P>0.05).Conclusion:Both HF and LSJ are safe and effective in open thy-roidectomy without similar operative complications.

Background:Pyruvate kinase M2( PKM2 ),which is highly expressed in cancer cells,plays an important role in cancer cell growth and aerobic glycolysis and is a promising target for cancer therapy. Aims:To investigate the effect of silencing PKM2 by siRNA on proliferation,apoptosis,migration,invasion and glycolysis of gastric cancer cell line SGC-7901 cells. Methods:SGC-7901 cells were divided into three groups:non-transfectd SGC-7901 cells,SGC-7901 cells transfected with empty plasmid and SCG-7901 cellls transfected with PKM2 siRNA. Expression of PKM2 was detected by fluorescent quantitative PCR and Western blotting at mRNA and protein levels. Intracellular expression and distribution of PKM2 was determined by immunofluorescence. CCK-8 assay,flow cytometry,migration and invasion experiment were used to assess cell proliferation,apoptosis,migration and invasion,respectively. Western blotting was used to determine the expression of glucose transporter-1( Glut-1)and lactate dehydrogenase A( LDHA). Spectrophotometry was used to detect levels of extracellular glucose and lactic acid and intracellular lactate dehydrogenase( LDH). Results:Compared with non-transfected group and negative control( empty plasmid )group,PKM2 mRNA and protein expressions were significantly decreased in PKM2 siRNA plasmid transfected group(P<0. 05). Intracellular expression of PKM2 was markedly decreased in PKM2 siRNA cells. After transfected with PKM2 siRNA plasmid,cell proliferation,migration and invasion were significantly inhibited,and cell apoptosis was increased significantly( P<0. 05 ). Expressions of Glut-1 and LDHA were down-regulated in PKM2 silenced cells( P <0. 05 ). Glucose uptake,lactic acid production and LDH activities were significantly decreased in PKM2 silenced cells(P<0. 05). Conclusions:RNA interference targeting PKM2 gene inhibits PKM2 expression in human gastric adenocarcinoma cell line SGC-7901 cells,thereby inhibits cell proliferation and glycolysis.