Objective To investigate the value of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis. Methods In the light of preoperative localization by anterioposterior and lateral X-ray examinations of labeled lumbar vertebrae, the MED system was established under local anesthesia or epidural blockage. Part of lamina and hyperplastic and cohesive articular processes were removed by using a self-made osteotome to fully decompress the dura mater and nerve roots. Results The operation time ranged 25～180 min, with an intraoperative blood loss of 50～300 ml. A conversion to open surgery was required in 1 case because of widespread adhesions of the dura mater and nerve roots. All the 44 patients were followed for 3～40 months (mean, 15 months). According to Nakai criteria, 30 patients had an "excellent" result, 8 patients had a "good" result and 6 were classified as "poor", the rate of "good" or "excellent" results being 86.4% (38/44). Postoperative infection of intervertebral space and symptoms on healthy limbs were observed in 1 case and 2 cases, respectively. Conclusions MED has the advantages of minimal invasion, little blood loss and rapid recovery. It can offer both full decompression to nerves and the stability of spine to the greatest possible advantage, being an effective means in the treatment of lumbar spinal stenosis in elderly patients.

Objective To investigate the measures for the prevention of postoperative complications and dissatisfactory effects of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis in elderly patients. Methods A retrospective analysis was made on complications and causes of dissatisfactory effects following MED procedure in 62 cases. Results Follow-up observations in all the 62 cases for 3 ～ 40 months (mean,16 months) showed a "good" or "excellent" rate of 87 1% (54/62).Complications occurred in 4 cases (6 45%),including 1 case of interspace infection,1 case of injuries on cauda equine,and 2 cases of symptomatic healthy limbs; there was little symptomatic improvement in 4 cases. Conclusions Strictly-controlled indications for surgery,appropriate treatment of complications,and skillful surgical performance is the key to minimize the complications of MED.

Skp2 (S-phase kinase associated protein) is substrate recognition subunit of SCFSkp2 (Cul1-Rbx1-Skp1-F boxSkp2)complex,a kind of ubiquitin ligases (E3s). Skp2 involves in regulating many functions of cell,such as cell cycle progressing,cell proliferation and differentiation,as well as apoptosis.At present many studies indicated that Skp2 is closely related to tumorigenesis and prognosis.With deeper study of Skp2 in tumor, Skp2 has the potential to be a promising drug target and biomarker of prognosis in human cancer.

Invasion and migration are distinctive features of the malignant tumors.Studies showed that epithelial-mesenchymal transition ( EMT) , a conversion process with the loss of epithelial cell features and the gain of mesenchymal phenotype has been recog-nized as a key element of invasion and migration of malignancy.When EMT occurs, the downregulation of E-cadherins and the loss of adhesion in extracellular matrix play a critical role which are regarded as important indicators in the assessment of EMT.The latest re-searches indicated that integrin, one of the cell adhesion molecules family, was involved in EMT directly or indirectly through mediating either adhesion among cells, extracellular matrix or signal pathways by activating multiple kinases tyrosine phosphorylation cascade. The relationship between EMT and integrin is summarized in this article.

The theory of cancer stem cells proposed that recurrence and metastasis of liver cancer are closely related to liver cancer stem cells.The traditional surgical treatment of liver cancer simply kills those rapidly proliferating tunor cells instead of eliminating hepatic cancer stem cells which play decisive role in recurrence and metastasis.As far as people have concerned,there are many signaling pathways and regulatory factors modulating liver cancer stem cells,such as the Wnt/β-catenin pathway,TGF-β pathway,Notch pathway,Hedgehog pathway,hepatitis B virus,as well as epigenetics.Further studies on regulatory mechanisms of liver cancer stem cells are of great significance,in hope of providing new evidence for treatment and prevention of recurrence and metastasis of liver cancer.

Objective To explore the regulation role and expression level of thymosin for Th1/Th2 and T-bet , GATA-3 in asthma model rats respectively.Methods 60 SPF grade male rats (6-8w) were randomly divided into six groups:control group, asthma model group, dexamethasone (0.5 mg/kg) group, thymosin high dose group (5 mg/kg), thymosin middle dose group(2.5 mg/kg), thymosin low dose group (1.25 mg/kg).The asthma model was constructed with ovalbumin.The rat in the control group and asthma model group were injected with normal saline by intraperitoneal , while other rats were injected with corresponding drugs.Then the concentration of IL-4 and IFN-γin the serum of rats were tested by the method of enzyme linked immunosorbent assay(ELISA) and the protein expression level of GATA-3 and T-bet factor in the lung tissue were tested by immunohistochemistry in each group.Results The concentration of IL-4 in the serum was higher and IFN-γwas lower in the asthma model group than the other groups , while the protein expression level of GATA-3 was higher and T-bet was lower in the asthma model group than the other groups ( all P <0.05 ) . Conclusion Thymosin upregulation of IFN-γand inhibition of IL-4 may be achieved by upregulating T-bet and downregulating GATA-3, and thymosin has therapeutic effect on asthma rats.

Objective To discuss the efficacy of micro-diameter and multiple-drilling core decompression in treatment of early femur head necrosis. Methods Sixty-eight patients with early femur head necrosis were selected, and they were divided into 2 groups by random digits table method. The experiment group (35 cases) underwent the micro-diameter and multiple-drilling core decompression (3.0-4.0 mm Kirschner wire or drill), and the control group (33 cases) underwent traditional instruments surgery. Results The operative time, hospital stay and pain score of postoperative hip joint Harris score in experiment group were better than those in control group:(41.2±7.4) min vs. (74.3±10.2) min, (9.7±2.3) d vs. (14.3±4.2) d and (43.56±2.12) scores vs. (37.21±1.19) scores, and there were statistical differences (P<0.01 or<0.05). There were no statistical differences in blood loss and overall hospital costs between 2 groups (P>0.05). There were no statistical differences in the total score of hip joint Harris score at 3 and 6 months after surgery (P>0.05). The total scores of hip joint Harris score at 12 and 24 month after surgery in experiment group were significantly higher than those in control group:(93.11± 2.43) scores vs. (91.23±2.89) scores and (85.23±2.43) scores vs. (73.54±2.89) scores, and there were statistical differences (P<0.05). Conclusions The micro-diameter and multiple-drilling core decompression is applied to the early femur head necrosis with less trauma, shorter operative time, higher clearance rate of necrotic bone and slower disease progression compared with traditional instruments. The micro-diameter and multiple-drilling core decompression makes patients' hip function get a satisfactory recovery with certain clinical applications.

Fine-needle aspiration biopsy is the mainstay of preoperative diagnosis of thyroid cancer which is the most common type of endocrine malignancy.However,some aspirates yield indeterminate cytology and there is no clear recommendation for the management on these situations.The use of emerging molecular markers such as BRAF、RET、PAX8/PPARγ will likely improve the diagnosis of malignancy in thyroid nodules and facilitate more individualized therapeutic options and postoperative management.Some markers have been extensively characterized and introduced into clinical practice.

Objective:To explore the effects of allergic factors in chronic sinusitis . Method:Skin prick test and specific serum IgE of 194 patients with chronic sinusitis were performed in our department before endoscopic sinus surgery from October,2007 to October,2008, and correla- tion between test results and clinical classification was analyzed retrospectively. Result: ① Result of skin prick test was analyzed. Positive rate of house dust was 20.6% (40/194),of dust mites 16.0%(30/194),of house dust mites 14.9%(29/194). ② Positive rate of allergic specific serum IgE and skin prick test in experimental group was compared with that of control group. Positive rate of house dust mites,dust mites and house dust between groups were significantly different(P<0.05).③ Clinical classification of chronic sinusitis had a negative correlation with the specific serum IgE (house dust mites ,house dust and dust mites)about experimental group(P<0.05). Conclusion: Allergic factors was associated with etiopathoge-nisis and course of disease of chronic sinusitis.

[Summary] Thyroid nodules are a common clinical problem, the majority of which are regarded as benign nodules by initial fine-needle aspiration biopsy(FNAB) or ultrasound characteristics. Given the low false negative rate of ultrasound-guided FNAB cytology and the higher yield of missed malignancies based upon nodule sonographic pattern, a routine sonographic surveillance is recommended to the thyroid nodules with benign cytology. If there are any sonographic evidence of growth or development of new suspicious sonographic features, the FNAB could be repeated. Treatment for benign thyroid nodules includes medications, percutaneous ethanol injection, thermal ablation and surgery. In order to avoid over-treatment, the potential harm and benefits of any intervention should be assessed.