[Objective]To investigate the effect of treating degenerative spondylolisthesis by transforaminal lumbar interbody fusion with microendoscopic surgery.[Method]From January 2005 to December 2005,17 cases who underwent transforaminal lumbar interbody fusion with a pedicle screw system by microendoscopic surgery were analyzed retrospectively.The index diagnosis was degenerative lumbar spondylolisthesis with herniated nucleus pulposus in 11 cases,and with spinal canal stenosis in 5 cases.There were 10 male and 7 female,average age was 47.6(ranged,35～68)years.According to Meyerding grading system,roentgengram showed that there were 10 cases of grade Ⅰ?,7 cases of grade Ⅱ?,11 cases of L_4 and 6 L_5.[Result]Seventeen cases were reviewed after surgery.The postoperative follow-up ranged from 12 months to 24 months(averaged 16.2 months).Operative time averaged 160 minutes.Estimated blood loss averaged 120 ml.Mean length of hospital stay was 8 days.There were no nerve injury occurred during operation.No cases converted to open operation.In complications,one case suffered from intervertebral infection.Outcomes were quantified using Oswestry Disability Index.The average Oswestry score decreased from 48.3% preoperatively to 16.5% at 3 month and 14.0% at 6 month postoperatively.The rate of excellent and good was 97.5%.At last follow-up,all patients had solid fusions by radiographic criteria.[Conclusion]Transforaminal lumbar interbody fusion for lumbar vertebral degenerative spondylolisthesis by microendoscopic surgery has the advantages of shorter skin incision,less tissue damage,less blood loss and quicker postoperative recovery.

With the strengthening of nuclear weapon development and the expanding of neutron application in economic area,the injury accidents of neutron radiation are happening from time to time.Neutron exposure,with high linear energy transfer,has high casualty rate,severe symptom and poor prognosis.In comparison with low-LET radiation damage,neutron irradiation induced injuries are more difficult to rescue.This review focused on the recent research progresses of radiation effects,intrinsic mechanisms and clinical prevention measures of neutron radiation,and to provide a theoretical clue for establishing an effective prevention protocol of neutron radiation damage.

Objective To investigate the relationship between vessel cancer embolus with other clinicopathological features and tumor tissue KRAS gene mutation in the patients with colorectal cancer and its significance to colorectal cancer prognosis.Methods The postoperative clinicopathological data in 182 patients with colorectal cancer during 2011-2014 were retrospectively analyzed and the patients were followed up.Results Forty-five cases showed vessel cancer embolus positive of colorectal cancer,which had the rrelationship with the lymph node metastasis,pathological differentiation degree,liver metastasis,nerve infiltration and increase of CEA and CA199 levels,while had no relationship with the age,sex,tumor size,infiltration depth and pathological type.The 3-year survival rate was 51.1% in the vessel cancer embolus positive group,which was significantly lower than 61.3% in the negative group (P<0.05).However,the 3-year survival rate had no statistically significant difference between the vessel cancer embolus positive complicating KRAS gene mutation group and the vessel cancer embolus positive group(P>0.05).Conclusion Vessel cancer embolus decreases the 3-year survival rate and affects the prognosis in the patients with colorectal cancer.The survival rate in complicating KRAS gene mutation is similar.

Objective To investigate the accuracy of prognosis risk assessment and clinical applicability of Rockall (RS) and Blatchford scoring system (BRS) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB). Methods From January 2009 to December 2009, the clinical date 195 ANVUGIB patients who met the standards with complete information and treated in The First Affiliated Hospital of Anhui Medical University were recorded. Each patient's scores of RS and BRS were calculated for risk stratification. Patients were followed up for 30 days after discharged.Death or the prognosis of disease in 30 days after discharged was considered as clinical study endpoints.Checked prognostic capacity of these two scoring system. Results In the 195 patients, there were 150 years, mean age was 53.97±18.34 years. 90 patients' age was over sixty (elderly group), 105 less than sixty (non-elderly group). 182 patients survived (93.3%), while 13 dead (6.7%). In survival patients, 11were re-bleeding (5.6 %). Mortality ( 12.2 %, 11/90), the percentage of patients with comorbidities (43.3%, 39/90) and taking aspirin (24. 4%, 22/90) were higher in elderly patients than non-elderly patients (1.9%, 2/105; 16.2%, 17/105; 11.4%, 12/105 respectively)(P＜0.05).The AUC of RS in predicting risk of death was 0.742 (P=0.004) and re-bleeding was 0.469 (P=0.101). For BRS score system, the AUC of predicting risk of death was 0. 493 (P= 0. 067)and rebleeding was 0.341(P=0.092). The RS score was positively correlated with length of hospital stay,however there was no statistically significant between BRS score and length of hospital stay.Conclusion RS score system was good at predicting the risk of death, and the score was positively correlated with length of hospital stay. While it was poor in predicting the risk of re-bleeding. BRS performed poorly in predicting the risk of both death and re-bleeding, so it was not suitable for predicting the risk of hospitalized patients.

Objective Portal hypertension and ischemia/reperfusion (I/R) have been implicated in small-for-size liver graft dysfunction. Matrix metalloproteinases-2 (MMP-2) and MMP-9 are critically involved in hepatic I/R injury. The goal of this study was to investigate the role of MMP-2 and MMP-9 in acute small-for-size graft injury. Methods 108 rats were divided into three groups:100 % (full-size), 50 % (half-size) and 25 % (quarter-size) liver transplantation groups. Blood and liver samples were collected to assess liver function, hepatic malondialdehyde (MDA) content, tissue myeloperoxidase (MPO) activity and histological changes. ELISA, real-time PCR, gelatin zymography, and immunohistochemistry were used to determine the expression pattern of MMP-2 and MMP-9 in liver grafts. Results The expression levels of MMP-9 were significantly higher in quarter-size and half-size grafts than those in full-size liver grafts 6, 12, and 24 h after reperfusioa And theelevated levels of MMP-9 were related to graft size inversely. However, MMP-2 was expressed and remained in all groups invariably. MMP-9 overexpression was accompanied by extensive liver I/R injury, as evidenced by significant increases in hepatic microscopic damage scores, MDA content,MPO activity and liver function levels. Furthermore, MMP-9 was found mainly to locate around periportal area. The presence of the active form of MMP-9 was significantly higher in small-for-size grafts, which was correlated with sinusoidal dilatation, congestion and hemorrhage. Conclusion These results support critical function of MMP-9 in acute small-for-size liver graft injury. Moreover,portal hypertension may be a crucial trigger for expression and activation of MMP-9.

AIM:To establish a method for determing the entrapment efficiency(EE) of Nobiliside-A liposome. METHODS: Sephadex G-50 column filtration method and microcolumn centrifugation method were employed to separate the free drug and liposome. In order to select a better method to determine the entrapment efficiency of Nobiliside-A liposome. RESULTS: The two methods to determine the entrapment efficiency of the Nobiliside-A liposome got the similar results. CONCLUSION: In order to determine the entrapment efficiency of Nobiliside-A liposome conveniently and rapidly, we finally select microcolumn centrifugation method.

Objective Percheron artery is an uncommon anatomic variant. Percheron artery infarction with unilateral embryonic posterior cerebral artery ( PCA ) was rarely reported.The aim of this study was to characterize the clinical and imaging patterns of Percheron artery infarction with the unilateral embryonic PCA for early diagnosis and treatment.MethodsClinical and imaging data of 2 patients with Percheron artery infarction were reviewed retrospectively.ResultsTwo patients presented acute coma and one had paroxysmal blurred before coma.On neurological examinations,one patient had vertical gaze palsy besides two were unconsciousness. MRI showed symmetrical high signal intensity on diffusion weighed imaging (DWI)in bilateral paramedian thalami in two patients and a distinct pattern of V-shaped hyperintensity on DWI andFLAIR was present on the midbrain in one patient. Digital subtraction angiography and magnetic resonance angiography demonstrated unilateral embryonic PCA in two patients.ConclusionsThe classical clinical symptoms,symmetrical high signal in bilateral paramedian thalami and V-shaped sign in midbrain on DWI can improve recognition,evaluation and management of Percheron artery infarction.The unilateral embryonic PCA may be underlying risk factor of Percheron artery infarction.

Objective To assess the relationship of serum prealbumin level with the severity of acute ischemic stroke (AIS).Methods The clinical data of 2522 AIS patients who were admitted in Peking Union Medical College Hospital from 2000 to 2008 were retrospectively analyzed.The serum prealbumin and hypersensitive C-reactive protein (hs-CRP) levels were evaluated by immunoturbidimetric assay within 24 hours after admission.The AIS severity was evaluated at admission using modified Rankin Scale (mRS).Patients were divided into mild AIS group (mRS score ≤ 3 ) and severe AIS group (mRS score ＞ 3 ).The levels of serum prealbumin and hs-CRP were compared between these two groups,and the relationship between praalbumin and hs-CRP was also analyzed.Results There were 1697 patients in the mild group (average mRS score:1.67) and 825 patients in the severe group ( average mRS score:4.53 ).The severe group had significantly lower prealbumin level [ ( 191.20,82.00)versus (219.18,72.00) mg/L,P =0.000] and higher hs-CRP level [ (6.01,8.22) versus (4.15,6.93) mg/L,P =0.000 ] than the mild group,respectively.Partial regression analysis showed that the stroke severity was negatively correlated with serum prealbumin level (r =-0.115,P =0.000) and positively correlated with hs-CRP level (r =0.098,P =0.000).Serum prealbumin level was inversely correlated with hs-CRP level ( r =- 0.396,P =0.000).Conclusion The prealbumin level is relevant with the severity of AIS and inflammation.

Objective To examine the recurrent ischemic stroke(RIS)in hospitalized patients predicted by Essen Stroke Risk Score(ESRS)and investigate the effect of intensive antiplatelet therapy in patients with high risk of RIS. Methods Retrospective analysis of patients with acute noncardioembolic ischemic stroke consecutively admitted to Peking Union Medical College Hospital(PUMCH)during 2001-2008. All 1008 patients were included in this study, 377 hospitalized in 2001-2002, 315 in 2005 and 316 in 2008. High risk of RIS was defined as ESRS ≥3. The average ESRS score in three groups and percentage of patients with high risk of RIS in each group were calculated. Risk of RIS was evaluated by comparing the average ESRS score in these three groups. Patients with high risk and taking clopidogrel treatment were also evaluated. Results Average ESRS score was 2. 67 ± 1.47,3.55 ± 1.40 and 3.93 ± 1.48(F= 150. 85,P=0.000)in groups of patients hospitalized in 2001-2002, 2005 and 2008 respectively. A significant difference was shown in percentage of high risk patients with ESRS ≥3 in three groups: as 51.64% in 2001-2002,77. 19% in 2005 and 85. 45% in 2008(X2=98.30,P=0. 000),showing a trend of increasing risk of RIS. Except for patients age, rates of having the risk factors in patients increased significantly, including hypertension, diabetes, myocardial infarction, myocardial diseases, smoking,vascular disease and stroke history. Clopidogrel usage has been increasing to 25.63% in 2008, but was far behind high ratio of high risk RIS patients(85.45%). Conclusions This retrospective study showd an increasing trend in RIS risk during 2001-2008. Identifying high risk patients and applying intensified antiplatelet therapy might play an important role in reducing the risk of RIS.