[Objective] To discuss the clinical manifestations,treatment,and therapeutic efficacy of lumbar disc herniation complicated by lumbar spinal stenosis in elderly patients.[Method]Thirty-six elderly patients with lumbar disc herniation complicated by lumbar spinal stenosis were treated with surgical treatment,including multi-segment fenestration,laminectomy,resection of nucleus pulposus,and internal fixation of pedicle screws.The therapeutic efficacy was retrospectively assessed.[Result]All patients were followed up with an average time of 3 years and 6 months.The good to excellence results was 83%.[Conclusion]In elderly patients with lumbar spinal stenosis,there are patients have special clinical manifestations.Different operations should be adopted for different patients.There are several important factors that affect the efficacy of operation,including operation modes,sufficient decompression,restotation of spinal instability,and postoperative exercises of lumbodorsal muscles.

BACKGROUND: Nowadays, it is thought that transforming growth factorβ (TGFβ) is closely related with cicatrization. TGFβ that is a key active molecule can affect each phase of cicatrization. Theoretically, to inhibit the biological effect of TGF β can reduce cicatrization.OBJECTIVE: To explore the inhibitive effect of antisense TGF β1 deoxy-oligonucleotide on generation of cicatricle in intention of animal models with hyperplastic scars and observe the effective route of administration of using antisense TGF β1.DESIGN: Own control and animal study.SETTING: Department of Plastic Surgery, Anning Hospital of General Hospital, Lanzhou Military Area Command of Chinese PLAMATERIALS: The experiment was performed at the laboratory of anatomy,Lanzhou Medical College from September 2002 to July 2003. Totally 20flap-eared Japanese rabbits were selected.METHODS: Blood vessels could be seen in ventral surface of each rabbits' ear getting out of the way along long axis to establish two 1.0 cm×2.5 cm oblong full-thickness cutaneous deficiency raw surfaces that interval for 1.5 cm, to the surface of cartilage, totally 80, so asto establish ventral surface of rabbits' ear models with hyperplastic scars. After epithelizatio of raw surfaces of rabbits' ear (20 days, averagely), 5μL(1 g/L) antisense TGF β1 deoxy-oligonucleotide was closely injected into local endepidermis of each raw surface of left ear of each rabbit with microinjector, which was regarded as TGF β1 group. 5 μL saline was injected into each raw surface of right ears, which was regarded as saline control group. After injection for3, 7, 11, 20, 30 days, cicatricial tissues were cut, 4 rabbits in each time phase. Hematoxylin-esoin (HE) staining, Masson staining and TGFβ1 mRNA, type Ⅰ and Ⅲ collagen mRNA in situ hybridization histochemistry staining were applied.MAIN OUTCOME MEASURES: Results of HE staining, Masson staining and in situ hybridization histochemistry staining.RESUTLS: A total of 20 animals were included in the result analysis. ①HE staining showed that inflammatory cell infiltration and significant infiltrative zone of leukocytes occurred in hyperplastic scars of right ears in each group. There was inflammatory cell infiltration, but no infiltrative zone of leukocytes in hyperplastic scars of left ears after intervention with antisense TGF β1. ②Masson staining suggested that collagen fibers with deep blue-stain occurred in hyperplastic scars of right ears from the 3rd week after injury, till the 7th week there still was blue-stain collagen fibers,which was bulky (width of about 8-10 μm) and arranged in a great mess.The blue-stain collagenous fibers also appeared in hyperplastic scars of left ears at the 3rd week after injury by the intervention of antisense TGF β1,but till the 6th and 7th weeks the blue-stain became light and thin (width of about 3-5 μm), arranged in order. ③In situ hybridization revealed that expressive rates of TGF β1 mRNA, type Ⅰ collagen mRNA, type Ⅲ collagen mRNA positive cells decreased obviously.CONCLUSION: Antisense TGF β1 can inhibit the proliferation of hyperplastic scars of rabbits' ears and lighten markedly the fibrosis of cicatricial tissue. The local injection with naked DNA is feasible in the treatment of cicatricle.

Objective To compare the safety and efficacy of greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection for the treatment of superficial bladder tumor. Methods Under sacral anesthesia or epidural anesthesia,a total of 42 patients with superficial bladder tumor were treated with greenlight photos selective vaporization while the other 42 patients received the RevoLix 2 micron continuous wave laser Vaporesection. The clinical stage of the patients was T1-T2,and the pathology grade was G1-G2. Results The greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection were successfully completed in all of the patients. No patients required blood transfusion. No complications such as obturator nerve reflex,bladder perforation or overhydration occurred. No significant difference was noticed in the operation time [(15.3?10.5) min vs (14.3?6.5) min,t=0.525,P=0.601],catheterization time [(6.3?0.5) d vs (6.3?1.2) d,t=0.000,P=0.999],and postoperative hospital stay [(6.3?3.5) d vs (7.2?2.4) d,t=-1.374,P=0.173]. The patients were followed up for 6 months,during the period the recurrence rate was 11.9%(5/42) and 7.1%(3/42) respectively in the greenlight group and RevoLix group (?2=0.138,P=0.710). Conclusions Both greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection are effective and safe for superficial bladder tumor and lead to low rates of postoperative complications and recurrence. Further studies are necessary to evaluate its long-term effect. For T2 and higher grades of bladder tumors,open surgery should be performed.

[Objective]To evaluated the clinical results of the ulnar osteotomy and external fixation for the treatment of chronic anterior dislocation of head of the radius in children.[Method]From 2002 to 2004,thirteen cases of children with chronic anterior dislocation of the radial head were treated by ulnar osteotomy,external fixation and close or open reduction of elbow joint but without repair of the annular ligament. Their mean age was 5.5 years(2 to 11) and the mean interval between the injury and reconstruction was 19 months(2 months to 3 years).[Result]All radial heads remained reduced at a mean follow-up of 14 months(2 months to 3 years).Normal ranges of movement for flexion,extension,pronation and supination were improved or unchanged in 12 patients.One patient had further decreased in 10? for supination.There were one superficial pin-track infections but with no serious complication.[Conclusion]Angular ulnar osteotomy and external fixation of the ulna can lead to stable reduction of the radial head with minimal complications.Reconstruction of the annular ligament is not necessary if satisfactory re-orientation of the ulnar is achieved in all planes.

Objective To observe the ultrasonic features of cystic renal cell carcinoma. Methods Ultrasonic features of 18 patients of cystic renal cell carcinoma confirmed with operation and pathology were analyzed retrospectively.Results Among 18 patients, 7 were clear-cell carcinoma of cystis degeneration, 5 were cystic renal cell carcinoma (clear cell type), 3 were multilocular renal cell carcinoma, 1 was corpora mammillaria renal cell carcinoma, and one clear-cell carcinoma was on capsule wall of cyst and 1 was nephroblastoma. Ultrasound diagnosed 15 patients and misdiagnosed 3 with a diagnostic rate of 83.33%.Conclusion Cystic renal cell carcinoma has specific ultrasonic characteristics, and having an intimate knowledge of these characteristics may be helpful to diagnosis.

Objective To explore the ultrasonographic appearance of dermatofibrosarcoma protuberans. Methods Clinical data, sonographic features and color Doppler flow imaging characteristics of 12 patients surgically and pathologically confirmed dermatofibrosarcoma protuberans were retrospectively analyzed.Results Single mass was detected in 11 patients (11/12, 91.67%) with the diameter ranged 0.9-8.0 cm. The tumors distributed in the trunk (8/12, 66.67%), proximal limbs (2/12, 16.67%) or face and neck (2/12, 16.67%). Most of the tumors (10/12, 83.33%) developed from skin and subcutaneous fat layer of the trunk and limbs and were hypoechoic and heterogeneous (11/12, 91.67%), some (8/12,66.67%) with distinct boundary and regular shape without liquification, calcification nor regional lymph node metastasis. Affluent color Doppler flow signals of tumor were found in 11 patients (91.67%).Conclusion Ultrasonographic characteristics of dermatofibrosarcoma protuberans include distinct boundary, regular shape, heterogeneous hypoechogenicity and rich color Doppler flow signals without regional lymph node metastasis.

Objective To establish an UPLC method for determination of Triptolide in serum and explore its pharmacokinetics in patients with rheumatoid arthritis after oral administration of tripterygium glycosides tablet. Methods Three patients with rheumatoid arthritis were enrolled. Using Estazolam as internal standard, serum was extracted with acetic ether, and determination was performed on column of Waters Acquity C18 (2.1 mm×100 mm, 1.7 μm) with mobile phase consisted of acetonitrile-0.1% glacial acetic acid (30∶70) at the flow rate of 0.2 mL/min. The column temperature was 30 ℃, and the detection wavelength was set at 220 nm. The serum concentration of Triptolide was processed by DAS 2.1.1 computer program. Results Triptolide was well-separated from internal standard, and the retention time were about 4.9 min and 8.9 min, respectively. Linear range of Triptolide was 13.13-840.00 ng/mL. RSD of intra-day and inter-day were lower than 15%and the recoveries were 88.25%-99.33%. Pharmacokinetic parameters were as follows:Cmax was (159.97±42.43) ng/mL, Tmax was (1.33±0.58) h, T1/2βwas (7.51±2.26) h, and AUC0-12 h was (1131.12±89.20) mg?h/L, respectively. Conclusion Pharmacokinetics of Triptolide conformed to two compartment model. Triptolide can be quickly absorbed, and exists differences among individuals.

OBJECTIVE:To investigate the clinical characteristics and rules of allergic reaction caused by anti-copper treat-ment with Sodium dimercaptoproane sulfonate(DMPS)injection,and to provide reference for diagnosis,treatment and monitoring of drug-induced allergic reaction. METHODS:By using retrospective analysis,allergic reaction reports of DMPS injection were se-lected from our hospital during Jan. 2013-Dec. 2015 were analyzed statistically. RESULTS:A total of 131 cases of allergic reaction were reported. The average age of the patients was(23.26±9.63)years old,mainly concentrated on 10-39 years old(87.79%). Al-lergic reaction mainly occurred in the first and second courses of treatment,accounting for 71.76%. For systems-organs involved, skin and its appendages disorders had the highest proportion (85.90%),being mainly the lesion of limbs (27.45%) and body (22.22%) involved;followed by systemic damage (12.33%). Clinical manifestations of systemic impairment were mainly fever, with rash or itching at the same time frequently. 131 patients had good outcome after treatment. The symptoms of 115 patients (87.79%)disappeared in 7 d. Serious cases accounted for 25.19%. The proportion of drug allergy history,the rate of anti-copper treatment failure with allergy prevention or desensitization therapy,and symptom duration in patients with severe ADR were higher or longer than that in general ADR cases,the difference was statistically significant(P<0.05). CONCLUSIONS:The allergic reac-tion of DMPS injection increased the difficulty of anti-copper treatment. ADR monitoring should be strengthened in the process of using DMPS,specially for the history of allergies and the first,second treatment courses of patients.

Objective To study the treatment of severe dysfunction of knee joint after trauma and explore the operative indication and method for total knee replacement treating such kind of disease. Methods From June 1997 to June 2004, total knee replacement using total knee prosthesis system was carried out in 21 knees of 18 cases with severe dysfunction of knee joint at late stage after knee replacement treating knee trauma, of which 12 knees in 10 cases with severe traumatic arthritis underwent total knee surface replacement. Seven knees in six cases with traumatic arthritis combined with 20?-40?varus or valgus or 20?-90?fixity flexion deformity and two knees in two cases with completely bony ankylosis were treated with rotation hinged knee joint. All cases were followed up for mean 3.5 years, ranging from six months to seven years. The Hospital for Special Surgery (HSS) knee rating score system was used to evaluate the clinical results. Results Pain relief, function recovery, rectification of knee deformities, stability and muscle power were all poor before operation. But postoperative valuation of pain relief, function recovery, rectification of knee deformities, stability and muscle power showed excellent result in 12 cases, good in seven and fair in two, with excellence rate of 90% and rate of patient satisfaction of 100%. Conclusion The knee replacement is an effective method for treating severe dysfunction of knee joint at late stage after knee replacement treating knee trauma.

OBJECTIVE:To systematically review the efficacy and safety of Xiaoke pill versus glibenclamide in the treatment of type 2 diabetes mellitus,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from Medline, PubMed,EMBase,Cochrane Library,CBM,CJFD,Wanfang Database and VIP Database,randomized controlled trials (RCT) about the Xiaoke pill(test group)versus glibenclamide(control group)in the treatment of type 2 diabetes mellitus were enrolled. Meta-analysis was performed by using Rev Man 5.2 software after document selection,data extract and quality assessment by Co-chrane systematical evaluation. RESULTS:A total of 15 RCT were included,involving 3 319 patients. Results of Meta-analysis showed the hemoglobin A1c (HbA1c) level [MD=-0.39,95%CI(-0.75,-0.02),P=0.04],fasting plasma glucose (FPG) level [MD=-0.70,95%CI(-1.27,-0.12),P=0.02],2 h PG[MD=-0.87,95%CI(-1.55,-0.20),P=0.01],incidence of thirst with desire for drinks [RR=3.35,95%CI(1.92,5.85),P<0.001],incidence of tiredness and debilitation[RR=5.74,95%CI(3.52, 9.36),P<0.001] and incidence of hypoglycemia [RR=0.67,95%CI(0.49,0.91),P=0.01] in test group were significantly lower than control group,the differences were statistically significant. CONCLUSIONS:Xiaoke pill has better efficacy and safety than glibenclamide in the treatment of type 2 diabetes mellitus,can obviously improve the HbA1c,FPG,2 h PG tevel and TCM symp-toms.