Objective To explore what cause the screw loosening after the internal fixation with thoracic and lumbar pedicle screws in the elderly and to develop the preventive measures.Methods Retrospective analysis were used to collect the clinical data from patients ager 60 years and over who had undergone surgeries of thoracolumbar pedicle screw internal fixation in our hospital during May 2011 and May 2013.Totally 187 cases were included in this study.According to whether there was a loosening of the screws, patients were divided into fixtion-loose and-well groups.The operation time and blood loss volume in the two groups were recorded.Visual analogue scale (VAS), Oswestry disability index (ODI), the rate of screw loosening were compared at 6 months after operation and the last follow-up.The causes of screw loosening were analyzed.Results The main causes for the thoracic and lumbar pedicle screw internal fixation were thoracolumbar kyphoscoliosis, fractures,spondylolisthesis, cancer and degenerative diseases, etc.Patients were followed up for an average of (35.2±8.7) months.13 patients (7.0％) were found screw loosening, 5 males and 8 females, with the mean age of (78.4 ± 3.5) years.The screw loosening occurred 3 months to 1 year after the surgery, (7.6±3.7) months on average.Among the 13 patients with screw loosening, 1 patient suffered screw loosening in single segment, 3 patients in two segments, and 9 patients in three segments or above.Osteoporosis combined with screw loosening.appeared in 10 patients VAS and ODI scores in all subjects had statistically differences at 6 months after operation and the last follow up versus preoperation (P＜0.05 for all), but no statistical difference versus the last follow-up(P＞ 0.05).There were significant differences in gender and preoperative osteoporosis rate between the two groups (P＜0.05 for both).Conclusions Osteoporosis is one of the reasons for the screw loosening in elderly patients after pedicle screw internal fixation.The increased probability of the screw loosening in long segment may be related with the change of the older spine mechanics.Further randomized controlled trials are still required to confirm whether elderly osteoporosis patients need to receive bone cement augmentation treatment.

Objective To study the expression of HER-3 in breast cancer patients and analyze its relationship with the clinical pathology and prognosis of breast cancer,ER,PR and HER-2.Methods Data of 139 female breast cancer patients undergoing operations at the Second Hospital of Dalian Medical University from Jan.2006 to Oct.2006 were collected.These 139 patients didn't have preoperative chemotherapy or radiation therapy,but had postoperative endocrine therapies.Immunohistochemisty was used to detect the expression of HER-3 in the 139 patients.Data like the expression of ER,PR and HER-2,histological grading,tumor size and lymph node metastasis were obtained from their medical records.The relationship between indicators and breast cancer was analyzed.Results ①The positive expression rate of HER-3,HER-2,ER,and PR was 30.2％ (42/139),42.5％ (59/139),66.9％ (93/139),and 59.7％ (83/139) respectively.(②)The statistical items had no relation with patients' age(P ＞0.05).③HER-3 expression was correlated with tumor sizes,lymph node metastasis,histological grading,5 year survival rate and HER-2 expression(P ＜ 0.05),and had no relation with ER or PR(P ＞0.05).④)The combined expression of HER-3 & HER-2 was correlated with tumor sizes,axillary lymph node metastasis,histological grading,ER and PR.(P ＜ 0.05).Conclusions HER-3 detection is of great significance for the diagnosis and prognosis of breast cancer.The combined examination of HER-3,HER-2,ER,and PR in breast cancer tissues is of clinical significance for early diagnosis/treatment,medication and prognosis of the tumor,as well as for new drug research and development.

Objective To investigate the efficacy and safety of ultrasound-guided polyglycol in patients with scar pregnancy. Methods Thirty-six patients with scarring treated in Third People's Hospital of Hangzhou from November 2014 to November 2016 were selected as subjects. All patients underwent ultrasound-guided polyglycol administration. The results were analyzed and analyzed. The results were analyzed. Gonadotropin (β-HCG) returned to normal time and the occurrence of adverse symptoms. Results The average recovery time, treatment cost, average recovery time and adverse reaction rate of blood β-HCG in the study group were lower than those in the control group, the difference was statistically significant (P<0.05). Conclusion The effect of ultrasound on the injection of polyphenols in patients with scar pregnancy is safe, feasible and easy to be accepted by patients and their families. It has clinical significance.

Objective To explore the anatomical basis,safty and manipuility of the puncture technique through anterolateral cervical approach.Methods Twenty two embalmed cadavers and 50 patients who underwent operation through anterolateral cervical approach were used to observe the cervical anatomical characteristics.During the cadaver dissection and operation,the following information was observed:the movement of the carotid sheath while the visceral sheath was pushed left,the features of interspace between the two sheaths at each cervical level,the movement of the esophagus and the interfascial space in which the esophagus moved while the trachea was pushed medially,and the movement of the carotid sheath while it was pushed medially and laterally.From January 2007 to December 2011,206 patients diagnosed as cervical discogenic pain or cervical vertigo were treated by radiofrequency using puncture technique through anterolateral cervical approach,including 93 males and 113 females,aged from 22 to 71 years (average,48years).A total of 434 discs were involved.Results Both in cadaver dissection and in operation,the following results were observed:there was no natural interspace between the carotid sheath and visceral sheath below the C4 level,as a result,manual separation was needed to create a interspace between the two sheaths for the puncture; the two layers of the prevertebral fascia could be separated easily; keeping the visceral sheath intact,the esophagus moved following the trachea when the latter was pushed medially,and the movement of the visceral sheath relative to the cervical vertebra occurred between the two layers of prevertebral fascia; the carotid sheath was primarily constituted by continuation of the prevertebral fascia,as a result,the movement of the carotid sheath was limited by its own tension and the prevertebral fascia.A total of 434 cases of puncture to cervical disc were performed smoothly with no complications related to the carotid artery,esophagus and cervical disc.Conclusion The puncture technique through anterolateral cervical approach requires a correct,thorough understanding of the anterior cervical anatomy,based on which this technique is safe and feasible.

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation (LDH).Methods A total of 124 LDH patients were recruited antd randomly divided into an experimental group and a control group,each of 62.The experimental group was given comprehensive rehabilitation consisting of medicine,physical therapy,and spinal stabilization exercises,while the control group received lumbar spine surgery.The patients' back and leg pain scores and their Oswestry Disability Index (ODI) scores were compared at admission and discharge,as well as 3 and 12 months after discharge.Anxiety and depression were also assessed at admission and 3 months after discharge.Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admisshin for both groups.There were no significant inter-group differences.In terms of anxiety and depression,however,these had decreased signifieantly in both groups,but the experimental group's average rating was significantly better at diseharge.Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH.Comprehensive rehabilitation should be considered as the first ehoiee for patients with rccurrent LDH,and only supplemented by surgical intervention if it is not effective.

ObjectiveTo find out the incidence of triple-negative breast cancer(TNBC) in all kinds of breast cancers.To compare and analyze the clinicopathological features,recurrence,metastasis,and prognosis of patients with TNBC and non-triple negative breast cancer (non-TNBC).MethodsThe clinicopathological features and follow-up data of 387 patients with primary breast cancer histopathologically conffirmed in our hospital from Sep.2004 to Sep.2006 were retrospectively analyzed.The 387 patients were divided into 2 groups:79 cases of TNBC and 308 cases of non-TNBC.The clinical features and prognosis of the 2 groups were compared.Results Compared with non-TNBC group,patients in TNBC group had their special features:1.higher ratio of patients ＜ 35 years( P =0.012 ) ; 2.higher ratio of patients with family history of breast cancer( P =0.031 ) ; 3.higher ratio of tumors with maximum diameter ≥ 5 cm ( P =0.044 ) ; 4. higher ratio of patients with positive lymph nodes(P =0.011 ) ; 5.higher ratio of tumors in clinical stage Ⅲ(P =0.007) ; 6.higher ratio of tumors in histological stage Ⅲ(P =0.028 ).The 5-year-disease-free survival (DFS) and overall survival (OS) rate for patients with TNBC were 72.15％ and 88.61％ respectively,lower than those of non-TNBC ( P =0.003 and 0.031 respectively).ConclusionsCompared with non-TNBC patients,patients with TNBC have the features of younger age,more advanced clinical stage upon diagnose,higher rate of lymph node metastasis,larger tumors,higher histological grade,faster and easier recurrence and metastasis,and lower rate of DFS and OS.The information of age,the maximum diameter of the tumor,lymph node status,clinical stage,histological grade and pathological types,especially the age and lymph node status,play an important role in predicting the prognosis of TNBC.

Objective To investigate status of the intravenous use of antibiotics in outpatients and emergency patients of a tertiary first-class hospital, and provide a reference for developing management measures in next step. Methods By a retrospective method,all the prescriptions using antibiotics by intravenous administration in outpatients and emergency department patients from a tertiary first-class hospital in 2013 were extracted from the hospital information system. The categories of antimicrobial agents,proportion of intravenous use of antimicrobial drugs,ranking of the antibiotic consumption sum and defined daily dose,and the top 10 clinical departments or wards intravenously using antimicrobial drugs were chosen to analyze. The data in 2014 were extracted as a comparison. Results Outpatients and emergency department patients respectively used 8 categories 31 kinds and 8 categories 30 kinds of intravenous antimicrobial drugs, with high consumption of cephalosporins and restricted antimicrobials such as sodium cefoxitin.Intravenous use of antimicrobial drug prescription proportion in emergency department is higher than that in outpatient department. Conclusion After intervention in 2014, antibiotic consumption is effectively controlled as compared that in 2013. But management should be strengthened and appropriate interventions should be taken to ensure the use of intravenous antibiotics in a safe,effective and economical manner.

Objective:To investigate the mechanism of long noncoding RNA (lncRNA) LBX2-AS1 regulating glioma cell proliferation, migration and apoptosis through epidermal growth factor receptor (EGFR) signaling pathway.Methods:From April 2018 to August 2021, glioma U251 cells (U251 cells for short) were divided into control group and observation group, with 4 strains in each group. The control group was routinely cultured, and the observation group was transfected with specific small interfering RNA (siRNA) targeting LBX2-AS1. The proliferation ability of U251 cells was detected by methyl thiazol tetrazolium method, the metastasis rate of U251 cells was detected by scratch test, the apoptosis rate of U251 cells was detected by flow cytometry, and the expression of total protein and vascular endothelial growth factor (VEGF), phosphorylated inositol 3 kinase (p-PI3K), phosphorylated protein kinase B (p-Akt), phosphorylated Ras (p-Ras) and phosphorylated Raf (p-Raf) protein were detected by Western blot.Results:The proliferation ability and metastasis rate of U251 cells in observation group were significantly lower than those in control group: (27.15 ± 1.38)% vs. (63.54 ± 2.47)% and (37.09 ± 3.74)% vs. (82.17 ± 9.24)%, the apoptosis rate of U251 cells was significantly higher than that in control group: (69.17 ± 5.83)% vs. (17.58 ± 1.22)%, and there were statistical differences ( P<0.01). The expression of total protein and VEGF, p-PI3K, p-Akt, p-Ras, p-Raf protein of U251 cells in observation group were significantly lower than those in control group (1.52 ± 0.23 vs. 2.39 ± 0.31, 0.73 ± 0.08 vs. 1.68 ± 0.45, 0.57 ± 0.11 vs. 1.89 ± 0.31, 0.68 ± 0.06 vs. 1.74 ± 0.51, 0.84 ± 0.12 vs. 1.99 ± 0.63 and 0.71 ± 0.08 vs. 1.52 ± 0.37), and there were statistical differences ( P<0.01). Conclusions:The lncRNA LBX2-AS1 is highly expressed in glioma cells. Silencing the expression of lncRNA LBX2-AS1 inhibits the proliferation and metastasis of glioma cells through EGFR pathway.

Since the concept of molecular imaging was put forward in 1999,optical molecular imaging techniques have been widely applied in the field of biomedical and clinical research.Its unique application value is especially shown in hepatobiliary surgery,such as in liver tumor imaging,anatomical liver resection,liver transplant angiography,cholangiography,and bile or pancreatic leakage prevention.Optical molecular imaging technique "lights up" targeted areas in surgical operations and provides convenience in carrying out precision operation.This paper reviewed the advantages of optical molecular imaging technology in clinical research and discussed its limitations in translational surgery,and put forward possible directions in improvement for the future.

OBJECTIVE: To explore the effect of telmisartan on the expression of metadherin in the kidney of mice with unilateral ureter obstruction. METHODS: Eighteen male C57 mice were randomized into sham-operated group, model group and telmisartan treatment group. In the latter two groups, renal interstitial fibrosis as the result of unilateral ureter obstruction (UUO) was induced by unilateral ureteral ligation with or without telmisartan intervention. Renal pathological changes of the mice were assessed using Masson staining, and immunohistochemistry and Western blotting were used to detect the expression of extracellular matrix proteins and metadherin in the kidney of the mice. In the experiment, cultured mouse renal tubular epithelial cells (mTECs) were stimulated with transforming growth factor-β1 (TGF-β1) and transfected with a siRNA targeting metadherin, and the changes in the expressions of extracellular matrix proteins and metadherin were detected using Western blotting. RESULTS: The expressions of extracellular matrix proteins and metadherin increased significantly in the kidney of mice with UUO ( < 0.05). Intervention with telmisartan significantly lowered the expressions of extracellular matrix proteins and metadherin and alleviated the pathology of renal fibrosis in mice with UUO ( < 0.05). In cultured mTECs, siRNA-mediated knockdown of metadherin obviously reversed TGF-β1-induced increase in the expressions of extracellular matrix proteins and metadherin. CONCLUSIONS Telmisartan can suppress the production of extracellular matrix proteins and the expression of metadhein to attenuate UUO-induced renal fibrosis in mice.
Angiotensin II Type 1 Receptor Blockers ; Animals ; Antihypertensive Agents ; Extracellular Matrix Proteins ; metabolism ; Fibrosis ; Kidney ; drug effects ; metabolism ; pathology ; Male ; Membrane Proteins ; genetics ; metabolism ; Mice ; Mice, Inbred C57BL ; RNA, Small Interfering ; Random Allocation ; Telmisartan ; pharmacology ; Transforming Growth Factor beta1 ; pharmacology ; Ureteral Obstruction ; complications ; metabolism