Objective To investigate a therapeutic method which could provide sustained-release delivery and local longlasting anti-TB treatment after debridement of thoracic and lumbar spine tuberculosis.Methods Data of 18 patients (including 2 revised cases),who were diagnosed of thoracic and lumbar tuberculosis and required surgery treatment from October 2008 to January 2011 were retrospectively analyzed.There were 12 males and 6 females,with an average age of 48.7± 13.3 years (range,22 to 67 years).Affected spinal segments in these patients spanned from T8 to S1.fourteen patients were treated with posterior surgical procedure alone while the other 4 were treated with one-stage combined anterior-posterior surgery.Combined with autogenous bone,OSTEOSET RBK drug carrier-type artificial bone mixed with isoniazid and streptomycin was used after debridement.Chlinical parameters including clinical symptoms,laboratory results,and imaging data were evaluated during follow-up.Results Incisions of all patients achieved primary healing.The duration of patient follow-up ranged from 29 to 56 months (average,39.5months).No liver and kidney function abnormalities,ototoxicity,or local nerve irritations were found perioperatively.Improvements in clinical symptoms were observed in all patients.One patient with L2a tuberculosis recurred 18 months after the initial surgery.At 6-month follow-up,intervertebral body fusion was achieved without complications of internal fixation or significant angle loss of kyphosis correction.Conclusion OSTEOSET RBK dmg carrier-type artificial bone mixed with isoniazid,streptomycin for treatment of thoracic and lumbar spine tuberculosis is a safe and effective way to control local infection and recurrence.Combined with autologous bone could contribute to bone fusion.

Objective:To discuss the occurrence, treatment and prevention of benign anastomotic stenosis after radical resection for rectal cancer.Methods:The clinical data of 63 patients with benign anastomotic stenosis from Jan. 2016 to Dec.2020 at Department of Gastrointestinal Surgery, Renji Hospital Shanghai Jiaotong University School of Medicine, were retrospectively analyzed, including general conditions, intraoperative conditions, postoperative complications, anastomotic stenosis, treatment process and outcome. The relationship between stenosis type and treatment and outcome were analyzed.The measurement data obeying normal distribution was expressed by ( Mean± SD), and the t test was used comparison between groups. The chi-square test was used comparison between enumeration data. Results:Of all the 63 patients, 22 (34.9%) cases presented with membranous stenosis, 30 (47.6%) cases with tubular stenosis, and 11 (17.5%) cases with diffused stenosis. Three of the 9 patients with high stenosis underwent balloon dilatation through endoscopy, 3 were placed with self-expandable metal stent and the rest 3 patients underwent resection and reconstruction of the anastomosis. All the 54 patients with low stenosis underwent digital anal expansion, and finally the effective rate was 53.7% (29/54). Endoscopic balloon dilatation was successfully performed in 8 cases, including 4 cases were placed metal stent throngh endoscopy. Eight patients underwent trans-anal stricturotomy. In 5 patients with low diffused stenosis, either ileostomy was preserved or permanent colostomy was performed due to failure to treatment. There were more male patients, protective ileostomy, anastomotic leakage and low stenosis in patients failed to treatment than in the cured patients ( P>0.05). However, all the 5 patients who failed to treatment were suffered from diffused stenosis, and the difference was statistically significant compared with those who were cured ( P<0.05). Conclusions:Postoperative anastomotic stricture after anterior rectectomy requires different treatment strategies according to the location and types of stricture. Endoscopic balloon dilatation is preferred for high stenosis, and metal stents can be placed optionally. Digital anal expansion is preferred for low anastomotic stenosis, and endoscopic or minimally invasive transanal surgery is feasible if digital anal expansion fails.

Objective:To evaluate the mid- and long-term outcomes of Dynesys hybrid surgery (in some segments act as a non-fusion device, in other segments act as an alternative of rigid fixation in combination with interbody fusion) in the treatment of multi-segmental lumbar degenerative disease (LDD).Methods:The data of 27 patients who received Dynesys hybrid surgery (hybrid group) for the treatment of LDD from May 2011 to September 2016 and completed the follow-up were retrospectively analyzed. Among them, there were 8 males and 19 females; their average age was 59.1±11.9 years (23-78 years). Main diagnosis: 13 cases of lumbar spinal stenosis, 14 cases of lumbar disc herniation; 4 cases of combined lumbar dynamic position instability, 7 cases of combined lumbar spondylolisthesis. There were 15 cases of two-segment disease, 11 cases of three-segment disease, and 1 case of four-segment disease. Segments distribution: 9 cases of L 3-L 5, 6 cases of L 4-S 1, 7 cases of L 3-S 1, 4 cases of L 2-L 5, and 1 case of L 2-S 1. Midline incision was used to exposure, followed by bilateral pedicle screws implantation, and interbody fusion cage with bone grafting were performed at the fusion level. Twenty-seven patients who underwent TLIF+rigid internal fixation during the same period were included as the control group. Clinical outcomes were measured by visual analog scale (VAS) for low back pain and leg pain, and Oswestry disability index (ODI). Radiological outcomes included fusion rate, intervertebral disc height (DH) of surgical segments and the proximal adjacent segment, range of motion (ROM) of non-fusion segments and the proximal adjacent segment. At the same time, the occurrence of complications was observed. Results:Patients of Hybrid group and control group were followed up for an average of 83.8±20.9 months (48-112 months) and 87.3±16.2 months (53-114 months), respectively. Baseline data of the two groups (average follow-up time, age, gender, surgical level, diagnosis) showed no significant difference. The operation time (183.0±27.8 min) and intraoperative blood loss (301.9±178.9 ml) in the hybrid group were significantly lower than those in the control group (operation time t=2.337, P=0.023; blood loss t=2.706, P=0.01). At the final follow-up, the VAS scores of low back pain and leg pain (low back pain t=12.164, P<0.001; leg pain t=20.603, P<0.001), as well as ODI were significantly improved ( t=22.827, P<0.001). A total of 32 segments received TLIF+Dynesys stabilization and 35 segments received Dynesys non-fusion stabilization in the hybrid group, with 28 segments (87.5%) achieved solid fusion at 1-year follow-up. There were 67 fusion segments in the control group, and the fusion rate at 1-year follow-up was 85.1%. DH of non-fusion segments were lower than that before surgery with statistical significance at final follow-up ( t=2.647, P=0.012), while DH of the fusion segments in the hybrid group and the surgical segments in the control group increased compared with that before surgery at the final follow-up. A certain degree of ROM (2.4°±1.5°) was retained of the non-fusion segments at the final follow-up; the ROM of proximal adjacent segments of non-fused segments was significantly smaller than that of proximal adjacent segments of fused segments ( t=2.126, P=0.044). In the hybrid group, screw loosening occurred in 4 patients (8 screws) and adjacent segment degeneration (ASD) occurred in 5 patients. In the control group, screw loosening occurred in 3 patients (6 screws), while ASD occurred in 8 patients. No screw fracture was observed during the follow-up period and no patients received reoperation. Conclusion:Hybrid surgery of Dynesys stabilization combined with interbody fusion is a safe and effective method for the treatment of multi-segmental LDD. Compared with multi-segmental fusion, this lumbar hybrid surgery has the advantages of less trauma and retaining partial segmental ROM.

Objective To summarize the CT characteristics of tumor deposition adjacent to colorectal cancer (CRC),and provide the evidences for differential diagnosis.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 26 CRC patients who were admitted to the Wuxi Second People's Hospital of Nanjing Medical University from May 2015 to April 2017 were collected.Patients underwent preoperative multi-slice spiral CT scan and double-phase enhanced scan,and then received open surgery.Observation indicators:(1) characteristics of multi-slice spiral CT scan;(2) differential comparisons;(3) follow-up.Follow-up using telephone interview was performed to detect patients' prognosis once every 3 months up to May 2017.Measurement data with normal distribution were represented as (x)±s.Comparisons between groups and among groups were respectively analyzed using the t test and the one-way ANOVA.Pairwise comparison was done using the SNK method.Results (1) Characteristics of multi-slice spiral CT scan:of 26 patients,17 underwent double contrast enhanced scans of chest,abdomen and pelvic and 9 underwent double contrast scans of abdomen and pelvic.Primary tumors of 18 and 8 patients respectively located in the colon and rectum.Forty-one tumor deposits of 26 patients were collected,with number of tumor deposits of 1.6±0.9 per case,and number of tumor deposits ＜ 3 and ≥3 respectively were found in 20 and 6 patients.Tumor deposits were often isolated in the fat spaces around the rectum or colon and unconnected with the surrounding primary tumor or lymph node.Distance to the center of primary tumor was (2.6±l.0)cm (range,0.2-5.0 cm),the distance ＜2.6 cm and ≥2.6 cm were respectively detected in 22 and 19 patients.Thirty-three tumors showed signs of lobulation,22 showed signs of burr and 7 showed liquefaction necrosis,and there was a combination of multiple imaging characteristics in the same tumor deposit.The maximum width,minimum width,maximum diameter,plain scan value of CT,CT enhancement values in the arterial phase and venous phase in 41 tumor deposits were respectively (1.15 ± 0.60)cm,(1.11±0.44)cm,(1.13±0.49)cm,(27±13)HU,(28±14)HU and (49±19)HU.Of 41 tumor deposits,34 demonstrated homogeneous density in the plain scan,and obviously enhancement in early enhanced scan,with homogeneous enhancement;7 demonstrated heterogeneous density in the plain scan,with internal liquefaction necrosis,and enhanced scans showed no enhancement in the areas of necrosis and obviously early enhancement in the areas of non-necrosis.(2) Differential comparisons:26 patients underwent open surgery,including 8 with right hemectomy,2 with transverse colon resection,4 with left semicolon resection,2 with simple sigmoid resection,2 with abdominoperineal resection of rectal cancer and 8 with low anterior rectal resection,and all patients received postoperatively individualized treatment.Fifty-two lymph nodes with distance to center of primary tumor ＜ 5.0 cm that were confirmed by pathological examination were collected,including 19 metastatic lymph nodes.Of 41 tumor deposits,33 were irregular,and 8 were regular and round-like or oval-like shape.Of 19 metastatic lymph nodes,16 were regularly round-like shape,1 showed irregular shape and edge blur,and 2 were irregular with a mutual integration.The maximum width,minimum width and maximum diameter of 19 metastatic lymph nodes were respectively (1.09± 0.33) cm,(1.01 ± 0.23) cm and (1.05 ± 0.20) cm,with statistically significant differences in the above indicators between metastatic lymph nodes and tumor deposits (t =5.48,4.80,7.75,P＜0.05).The plain scan value of CT,CT enhancement values in the arterial phase and venous phase were respectively (12±7) HU,(18± 12) HU,(42± 15) HU in 19 metastatic lymph nodes and (33±6) HU,(31 ±15) HU,(53± 14)HU in 26 primary tumors,showing statistically significant differences in the plain scan value of CT and CT enhancement values in the arterial phase among tumor deposits,metastatic lymph nodes and primary tumors (F=24.43,4.46,P＜0.05),and no statistically significant difference in CT enhancement value in the venous phase (F=2.41,P＞0.05).There were statistically significant differences in the plain scan value of CT and CT enhancement values in the arterial phase between tumor deposits and metastatic lymph nodes (q =5.48,2.50,P＜0.05) and between metastatic lymph nodes and primary tumors (q =6.82,2.84,P＜0.05),and no statistically significant difference between tumor deposits and primary tumors (q =2.15,0.65,P＞0.05).Of 19 metastatic lymph nodes,11 demonstrated homogeneous density in plain scan,with a lower density compared with tumor deposits and primary tumors,and relatively homogeneous enhancement in the arterial phase of enhanced scan;8 demonstrated heterogeneous density with internal liquefaction necrosis,and ring-shaped enhancement in enhanced scan with no enhancement in the areas of necrosis.The density and enhancement range in the arterial phase and venous phase of tumor deposits were similar to primary tumors.(3) Follow-up:24 patients were followed up for 1-25 months,with a follow-up rate of 92.3％(24/26) and a median time of 17 months.Of 24 patients,2 were dead,and survival time were respectively 9 months and 21 months;22 had good survival.Conclusions Multislice spiral CT examination of tumor deposits demonstrates larger and irregular shape,with the signs of lobulation and burr,and the density in plain scan is similar to the primary tumor,with obviously enhancement in early enhanced scan.The metastatic lymph nodes are mostly round-like shape,diameter is smaller than that of tumor deposits,density in the plain scan and CT enhancement values in the arterial phase are lower than that of tumor deposits.

Objective Based on the gene expression omnibus(GEO)database,bioinformatics methods were employed to analyze the expression characteristics of hypoxia-related differentially expressed genes(HRDEGs)in ischemic stroke,and key genes were screened,to provide important support for a deeper understanding of ischemic stroke.Methods The GSE16561 and GSE58294 datasets were downloaded from the GEO database,and Python software was used for data integration.The Combat method was employed to eliminate batch effects while retaining disease grouping characteristics.Principal component analysis was conducted to reduce dimensionality of the data before and after batch effect removal,and intraclass correlation coefficient(ICC)testing was performed on the ischemic stroke and normal control groups.Gene set enrichment analysis(GSEA)and single-sample GSEA were conducted on the merged and batch effects eliminated dataset,with a nominal P-value(NOM P-val)＜0.05 and false discovery rate P-value(FDR P-val)＜0.25 used as criteria to select significantly different gene sets.Differential expression genes between the ischemic stroke samples and normal control samples after merging and eliminating batch effects of the GSE16561 and GSE58294 datasets were identified using R software,with an absolute value of log2 gene expression fold change(FC)≥0.58 and adjusted P-value(Padj)＜0.05 as selection criteria.Intersection with hypoxia-related genes obtained from the National Center for Biotechnology Information(NCBI)in the United States yielded the HRDEGs.Gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analyses were performed on the HRDEGs,and the STRING database was used to construct a protein-protein interaction network of differentially expressed genes.The top 10 key genes were filtered using Cytoscape 3.8 software.Results The ICC analysis results showed excellent consistency in the ischemic stroke and normal control samples after batch effect removal,with ICC values of 0.94 and 0.98 for the GSE16561 and GSE58294datasets,respectively.GSEA results demonstrated significant enrichment of 34 gene sets in the stroke samples in the newly merged and batch effects removed dataset from GSE16561 and GSE58294,leading to the identification of 404 differentially expressed genes(all with Padj＜0.05),including 354 upregulated genes and 50 downregulated genes.Intersection with hypoxia-related genes yielded 64 HRDEGs.GO enrichment analysis indicated significant enrichment of HRDEGs in vesicle lumen,cytoplasmic vesicle lumen,secretory granule lumen,with molecular functions such as amide binding,peptide binding,phospholipid binding,and enzyme inhibitor activity.These genes are primarily involved in the positive regulation of cytokine production,regulation of immune response,response to bacterium-derived molecules,and response to lipopolysaccharide,among other biological processes.KEGG enrichment analysis revealed enrichment of HRDEGs in pathways related to lipid and atherosclerosis,Salmonella infection,neutrophil extracellular trap formation,nucleotide-binding oligomerization domain-like receptor signaling pathway,protein glycosylation in cancer,tuberculosis,and necroptosis.Based on the protein-protein interaction network,10 key genes were identified,including arginase1(ARG1),caspase1(CASP1),interleukin1 receptor type 1(IL-1R1),integrin subunit alpha M(ITGAM),matrix metalloproteinase9(MMP9),prostaglandin-endoperoxide synthase 2(PTGS2),signal transducer and activator of transcription 3(STAT3),Toll-like receptor2(TLR2),TLR4,and TLR8.Conclusion This study has identified 10 key genes associated with ischemic stroke and hypoxia through bioinformatics mining,which maybe provid potential targets for subsequent research and diagnostic and therapeutic interventions.