BACKGROUND:Under hypoxic environment, hypoxia inducible factor-1 plays an important role in regulation of hypoxia-induced gene expression in the intervertebral disc. Hypoxia-inducible factor-1 consists of α and βsubunits, and which hypoxia inducible factor-1α determines the stability and activity of hypoxia-inducible factor-1. OBJECTIVE: To observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus of different herniated types and to judge their relationships. METHODS:A total of 60 nucleus pulposus samples were harvested from the lumbar vertebra, including 41 from L4-5 and 19 from L5-S1, and then divided into protruded group and sequestered group, with 30 cases in each group. Meanwhile, another 10 samples of lumbar nucleus pulposus served as controls. Hematoxylin-eosin staining and streptavidin-biotin peroxidase complex immunohistochemical technique were used to observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus in different groups. RESULTS AND CONCLUSION:The expression level of hypoxia inducible factor-1α was (58.2±7.5)% in the sequestered group, (27.3±2.3)% in the protruded group, and (10.5±4.7)% in the control group, which was significantly higher in the sequestered group than the other two groups (P < 0.01). These findings indicate that the expression of hypoxia inducible factor-1α in the lumbarnucleus pulposus is associated with the herniated types, which is the highest in the prolapse sequestered type.

BACKGROUND:Endogenous hydrogen sulfide can be used as a new gaseous signaling molecule, and has important signal transfer function and biological regulation effects. OBJECTIVE:To study the neuroprotective effects of hydrogen sulfide in rats with acute cauda equina syndrome. METHODS: The 72 Sprague-Dawley rats were randomly assigned to three groups. Experimental group, model group: laminectomy was performed at the lumbar 4 (L4) level of the vertebra, and a piece of silicone (10 mm long, 1 mm thick, and 1 mm wide) was placed under the laminae of the L5-6 vertebra to produce the animal model of cauda equina syndrome. Sham surgery group: a simple laminectomy was performed in L4, but silicone was not implanted. In the experimental group, 20 μmol/kg NaHS was injected intraperitonealy at 1 hour before model establishment. Model and sham surgery groups: an equal volume of saline was injected intraperitonealy. At 12, 24, 48 and 72 hours after model establishment, malonaldehyde and glutathione levels in cauda equina nerve tissue were detected. Simultaneously, hematoxylin-eosin staining and TUNEL staining were performed at 48 hours. RESULTS AND CONCLUSION:Hematoxylin-eosin staining demonstrated that cauda equina nerve tissue was dense and regular, with complete myelin sheath, no axon sweling in the sham surgery group. Cauda equina nerve tissue was sparse, with the presence of demyelination, and partial axons and myelin sheath sweling in the model group. Cauda equina nerve tissue was tight, with axonal sweling and demyelination in the experimental group. TUNEL staining demonstrated that the number of positive cels was less in the spinal cord and dorsal root ganglia in the sham surgery group. Abundant positive cels were detected in the spinal cord and dorsal root ganglia in the model group. The number of positive cels was significantly lower in the experimental group than that in the model group. Malonaldehyde levels were lower in the sham surgery and experimental groups than in the model group (P < 0.05, P < 0.01), but glutathione levels were higher than model group (P < 0.05,P < 0.01). These results indicated that hydrogen sulfide could decrease oxidative stress and protect cauda equina nerve in rats with acute cauda equina syndrome.

Objective To study the clinical value of 18F-FDG PET/CT in childhood neuroblastoma (NB). Methods 18F-FDG PET/CT was performed in 31 children diagnosed with NB. According to the treatment conditions, patients were divided into pre-therapy group, radiation and chemotherapy group, postoperative group, respectively. The positive rate, sites, and im-age characteristics of the primary lesion and metastasis lesion were analyzed through qualitative and quantitative analysis of the image. Results Twenty-one (67.7%) and fourteen (45.2%) patients were found positive in primary sites by CT and PET respectively. All cases (9/9, 100%) in pre-therapy group were found positive in primary lesions by PET, 3 positive cases (75.0%) in radiation and chemotherapy group and 2 positive cases (11.1%) in postoperative group. Twenty-one patients showed metas-tases (67.7%). Lymph nodes (16 cases) and bone (bone marrow) (13 cases) were the most common sites of metastasis followed by pleura, meninges, liver and retrobulbar inifltration, all of which showed increased FDG uptake. Two patients were found lesions in lungs by CT, but had no FDG uptake. SUVmax of primary lesions was signiifcantly different among pre-therapy, chemotherapy and postoperative group (H=13.89, P=0.001), and pre-therapy group had the highest value. Metastases (lymph nodes, bone and bone marrow, pleura, liver and meninges) in pre-therapy group had high SUVmax. Conclusions NB primary tumors are characterized by the increased FDG metabolism. PET can fully detect the distribution of NB metastases in whole body. Except the pulmonary metastasis, metastases in other positions show increased FDG uptake. PET has potential role in evaluating the efifcacy of radiation and chemotherapy, and identifying postoperative residual or recurrence.

BACKGROUND:Under hypoxic environment, hypoxia-inducible factor 1α plays a dualregulatory role in cel apoptosis. Severity of hypoxia is the key to determine whether cels appear to have apoptosis or adapt to survive. When the cels are exposed to chronic or extreme hypoxia, a lack of protection mechanisms from hypoxia-inducible factor-1α can induce cel apoptosis. OBJECTIVE: To research the expression of hypoxia-inducible factor 1α in human lumbar nucleus pulposus of different herniated types and its relationships with cel apoptosis. METHODS: The nucleus pulposus was harvested from 60 cases of herniation of lumbar intervertebral discs, L4-5 in 41 cases and L5-S1 in 19 cases. The nucleus pulposus tissues were equaly divided into protruded and sequestered groups. Meanwhile, the nucleus pulposus tissues from another 10 cases of lumbar spine fracture were taken as control group. Expression of hypoxia-inducible factor 1α and apoptosis of lumbar nucleus pulposus cels were observed and detected with immunohistochemical technique and TUNEL method. Correlation of hypoxia-inducible factor 1α and apoptosis in human lumbar nucleus pulposus of different herniated types was analyzed. RESULTS AND CONCLUSION: The expression of hypoxia-inducible factor 1α was visualized in each case, but it was significantly higher in the sequestered group than in the protruded group and control group (P < 0.01). Apoptosis of nucleus pulposus cels were found in al the three groups, but the apoptotic rate was also higher in the sequestered group than in the protruded group and control group (P < 0.01). Expression of hypoxia-inducible factor 1α was positively correlated with cel apoptosis in human lumbar nucleus pulposus (P < 0.01). Overal, the expression of hypoxia-inducible factor1α in degenerative human lumbar nucleus pulposus is associated with herniated types, which is the highest in the sequestered type. The relationship between hypoxia-inducible factor 1α and apoptosis is positive.

Objective To investigate the efficacy of the combination of bone marrow stromal cells (BMSCs) and bcl-2 gene in the treatment cerebral ischemia taxi its effect on the expression of basic fibroblast growth factor (bFGF) in rats.Methods Forty Wistar rats were used to establish middle cerebral artery occlusion model. They were randomly divided into 4 groups: saline control, bcl-2, BMSCs and BMSCs + bcl-2 groups (n = 10 in each group). Every group was redivided into 3- and 14-day after reperfusion subgroups (n = 5 in each subgroup). Neurological scores of the experimental rats were assessed. BMSCs were labeled with bromodeoxyuridine (BrdU). The distribution and numbers of BMSCs, the expressions of Bcl-2 and bFGF were detected by immunohistochemistry, and apoptotic cells were detected with TUNEL staining in rat brain. Results The neurological score at day 3 after reperfusion in the BMSCs + bcl-2 group was significantly lower than that in the saline control group (P < 0. 05), and at day 14, it was significantly lower than that in the other 3 groups (all P <0. 05). A large number of BrdU-positive BMSCs were observed in the infarcted hemisphere in the BMSCs + bcl-2 and BMSCs groups. The numbers of BrdU-positive BMSCs at day 3 and 14 after reperfusion in the BMSCs + bcl-2 group were significantly higher than those in the BMSCs group (all P <0. 05). The expressions of Bcl-2 in the infarcted hemisphere at day 3 and 14 after reperfusion in BMSCs +hel-2 group wre significantly higher than those in the other 3 groups (all P <0. 05). The expressions of Bcl-2 at all time points were increased more significantly than those in the other 3 groups (all P <0. 05). The numbers of apoptosis in brain at all time points in the BMSCs + bcl-2 group were decreased more significantly than those in the other 3 groups (all P <0. 05). Conclusions Both BMSCs and bcl-2 genes have the therapeutic effect on cerebral ischemia. The efficacy of combination of both ,of them is significantly superior to monotherapy. They may significantly improve the neurological function and increase the expression of bFGF in rats. Its mechanism may be that bcl-2 genes have inhibited BMSCs apoptosis at the same time of anti-apoptosis in brain.

BACKGROUND:The methylprednisolone pulse therapy in early period of spinal cord injury can attenuate the pathological degree of spinal cord injury, however no breakthrough was found within recent 20 years.
OBJECTIVE:To observe the protection effects of sodium aescinate on the nerve cellapoptosis and expression of glial fibrial ary acidic protein (GFAP) in the early spinal cord injured rats.
METHODS:Spinal cord injury models were established with the modified Al en’s method in 180 Sprague-Dawley rats, and were randomly divided into three groups, with 60 rats in each group. Immediately after injury, the rats in three groups were intraperitoneal y injected with sodium aescinate (5 mg/kg), methylprednisolone (100 mg/kg) and equal saline, respectively, once per day. At 8 hours, 24 hours, 96 hours and 7 days, 14 days after injury, rats were sacrificed and the injured segments were resected for hematoxylin-eosin staining and immunohistochemical staining, the nerve cellapoptosis and GFAP expression were detected.
RESULTS AND CONCLUSION:The apoptotic nerve cells were seen at 8 hours after injury and the number of apoptotic cells reached the peak at 7 days, the edema was attenuated at 14 days without less nerve cellapoptosis in al groups, significantly fewer apoptotic nerve cells can be seen in sodium aescinate and methylprednisolone groups compared with the control group (P<0.05) at each time. The expression of GFAP was increased in the time dependant manner in al groups, the increase was slow in methylprednisolone group but sharp in sodium aescinate group and control group within 96 hours. There was no difference between control group and sodium aescinate group within 24 hours (P>0.05), which was lower than methylprednisolone group (P<0.05);after 96 hours, methylprednisolone group and sodium aescinate group were both significantly lower than control group (P<0.05). Furthermore, the decreasing expression was observed in al groups after 7 days. Sodium ascinate has obvious protection effects on nerve cells in spinal cord injured rats and promotes neurological function through decreasing GFAP expression after injury. The efficacy of sodium ascinate is equal to that of methylprednisolone within 2 hours.

A 53-year-old man was admitted to the hospital for verrucous hyperplasia on the circular sulcus for 2 years as well as erythematous painful swelling, ulcer and rupture of inguinal lymph nodes for more than 2 months. Physical examination revealed erythematous, indurated and painful swelling of bilateral inguinal lymph nodes. Fluctuation could be felt at the centre of the right swollen inguinal lymph nodes, where several pores were seen with yellowish-white purulent fluid flowing out, giving the appearance of a watering can. Multiple swollen or ulcerative lymph nodes were separated by the inguinal ligament forming the groove sign.There were irregular, indurated, verrucous, proliferative and keratinized lesions sized 1 cm × 2 cm on both sides of the circular sulcus. The right scrotum was obviously swelling. Erythematous, fluctuating swelling, ulcer and rupture of the glans fraenum were also observed with yellowish-white purulent exudates. Neither the secretion from the skin lesions on the surface of bilateral inguinal lymph nodes nor the puncture sample from the right groin was positive for multiple fungal or bacterial culture, acid-fast stain or first culture of C. trachomatis.However, the endogenous plasmid of Chlamydia was successfully amplified by PCR from these samples, and restriction fragment length polymorphism (RFLP) analysis of the major outer membrane protein (MOMP) suggested that the genotype of the Chlamydia strain was L3. Western blot revealed the presence of anti-MOMP antibodies and anti-Pmp H antibodies (titer: ＞ 1: 800) in serum. Culture of C. trachomatis also gave positive results after multiple passage. Biopsy of the verrucous hyperplasia on the right groin is consistent with well-differentiated squamous cell carcinoma of the skin. A diagnosis of lymphogranuloma venereum complicated by cutaneous squamous cell carcinoma was made.

Objective To compare and analyze the advantages and disadvantages of the application of self-fixing and plain polypropylene mesh in open inguinal hernia repair.Methods A study of 83 patients who underwent open inguinal hernia repair patients from June 2014 to June 2016 in the Department of General Surgery,AnHui No.2 Provincial People's Hospital Patients were divided into two groups according to the use of different patches,42 cases were applicated self-fixating mesh (observation group) and 41 cases were applicated the ordinary polypropylene patch (control group).The operation time,average postoperative hospitalization time,postoperative complications and Visual Analogue Score of postoperative pain were compared.The measurement data were expressed by mean standard deviation (~ ± s),and using t test,Count data were represented by frequency and percentage,and chi-square test was used for comparison between groups.Results The operation time of the observation group and the control group was (49.9 ± 6.4) minutes and (67.9 ± 6.1) minutes,and there was significant difference(P ＜ 0.05).The postoperative hospitalization time of observation group and control group was (2.5 ± 1.4) days and (2.6 ± 1.8) days,there was no significant difference (P ＞ 0.05).In the complications of the two groups,there were 1 case of scrotal edema in the observation group,and 2 cases of scrotal edema in the control group,the difference was no statistically significance.The Visual Analogue Score in two groups was (4.0 ± 0.8) score and (4.1 ± 0.7) score,there was no significant difference between the two groups (P ＞ 0.05) within 12 hours after operation.The Visual Analogue Score was (2.6 ± 0.7) score,(1.4 ± 0.5) score within 24 hours and 48 hours after operation in the observation group,and was (3.1 ± 0.6) score,(2.7 ± 0.5) score in the control group.There was a significant difference between the two groups (P ＜ 0.05).There was no obvious local pain for the observation group and had a better sense of comfort in one month follow-up after the operation.Conclusions The application of self-fixing suture free patch can reduce the operation time of patients and relieve the discomfort of postoperative pain,and has a high clinical value.

Objective: To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP). Methods: From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage. Results: There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05). Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue.