[Objective]To discuss the diagnosis and surgical management of lumbar degenerative juxtafacet joint cysts. [Methods]From June 2004 to June 2007,seven patients were diagnosed as degenerative juxtafacet joint cysts and were treated by surgery. The authors made a retrospective analysis on the clinical data of these 7 patients. Among these 7 patients,there were one as ligamentum flavum cyst and six as facet joint cysts. Five lesions were located at the L4、5 level and two were located at the L5S1 level. According to the preoperative lateral films and CT scan,segment instability were found in two patients. Fenestration decompression,resection of cyst and 1/3 medial articular process were performed on five patient without preoperative segment instability,while additional posterior fixation and posterolateral fusion were done to two patients with preoperative segment instability.The mean length of follow up were 14 months (range: 9~24 months ). The VAS score and ODI score were used for clinical outcome assessment.[Results]The pathological results confirmed the preoperative radiological diagnosis in all patients. Improvement were found in all patients,including completely recovery in five patients and significant relief of pain in other two patients.[Conclusion]Lumbar degenerative juxtafacet joint cysts has been proved to be a cause of low back pain. Preoperative CT scan and MRI are helpful in the diagnosis and the clinical outcome of surgery is satisfactory.

AIM: To investigate the changes of first order kernel ( FOK ) and second order kernel ( SOK ) of multifocal electroretinogram( mf-ERG) in detecting the early retinal abnormalities in sub-clinical stage of diabetic retinopathy. ·METHODS: Totally 32 patients ( 58 eyes ) with type 2 diabetes mellitus ( DM ) without apparent diabetic retinopathy( DR) were detected by mf-ERG, from June 2014 to May 2015. Thirty cases ( 60 eyes ) of normal control group had also been taken to compare the difference of the amplitude and latency between the two groups. ·RESULTS: Compared with the control group: there was no statistical difference in the FOK b-wave latency of the diabetic group, and the FOK b-wave amplitude was significantly decreased (t=3. 099, P=0. 012). The SOK b-wave latency in diabetes group was statistically delayed (t=2. 643, P=0. 025), and the SOK b-wave amplitude statistically decreased (t=4. 833, P<0. 01). There was no statistically difference in the a-wave latency and amplitude of FOK and SOK. The b-wave amplitude of FOK and SOK was negatively correlated with the course of the disease. However, the b-wave amplitude was not statistically correlated with the duration of diabetes mellitus. ·CONCLUSION: The function of the post-polar outer and inner retina detected by FOK and SOK had been damage even before retinopathy. The anomaly is mainly reflected by the decreasing amplitude of b-wave.

ObjectiveTo investigate the event-based prospective memory (EBPM) and time-based prospective memory (TBPM) in patients with Alzheimer' s disease (AD). MethodsTwenty patients with AD, 20 adults with amnesia mild cognitive impairment (aMCI) and 30 healthy adults with matched age and education level were assessed with a battery of neuropsychological tests including EBPM and TBPM tasks.ResultsCompared with healthy elders and patients with aMCI on performance of PM (2. 23 + 0. 77,4.83 ±1.09;1.00±1.03,3. 10 ± 1.52) and episodic memory(0. 70 ±0. 12,0.66 +0. 16;0.45 ±0.07,0.54±0. 10), AD patients were all impaired in PM and episodic memory(0.20 +0.41,2.05 ± 1.43;0.33±0. 12,0.32±0. 10), and were impaired in EBPM more significantly (t=-2.792, P＜0.01;t =-10. 761 ,P ＜0. 01 ). ConclusionsThese results suggest that AD patients show deficits of PM, but their EBPM is impaired more significantly. EBPM impairment may be an early diagnostic of AD.

AIM:To analyze the accuracy and the influencing factors of LAMBDA100 retinometer in predicting the visual acuity of cataract patients with high axial myopia after phacoemulsification.METHODS: The retinal visual acuity was measured in 91 patients with 91 cataract eyes by LAMBDA100, and compared with the best corrected visual acuity 2wk after operations.If differences of predictive visual acuity and postoperative visual acuity between the two logarithmic visual acuity chart was within 2 lines, it was considered consistent.RESULTS: The total compliance rate was 62%, the false positive rate was 2%,the false negative rate was 36%.The predictive accuracy was affected by lens opacity, the deeper opacity, the lower accuracy.The predictive accuracy of eye with axial length ≥32mm was significantly lower than that of eye with axial length <32mm, the difference was statistically significant (P<0.05).The predictive accuracy rate of group that preoperative best corrected visual acuity was ≥4.0 was 75%;the predictive accuracy rate of group that preoperative best corrected visual acuity was <4.0 was 49%, the difference was statistically significant (P<0.05).CONCLUSION: LAMBDA100 can be used as an assistant tool for predicting postoperative visual acuity in immature stage cataract of patients with high myopia.The eye axial length, the degree of visual acuity and lens opacity can influence the predicting accuracy.

Objective To investigate the conception implicit memory (CIM) and perception implicit memory (PIM) impairment in patients with frontal and occipital lobe stroke patients.Method Patients with frontal lobe stroke (n =23) and occipital lobe stroke (n =21) and healthy controls (n =26) were administered with a neuropsychological battery of tests including conception and perception implicit memory (CIM and PIM) tasks,as well as explicit memory tasks including immediately recall,delay recall,delay recognition.Results Compared with healthy controls,patients with frontal lobe stroke performed poor CIM test (1.96 ± 1.00 and 3.52 ±0.52,t =6.987,P ＜0.01),as well as its performance in explicit memory tasks including immediate recall(3.91 ± 1.53 and 5.42 ± 1.06),delay recall (6.04 ± 3.05 and 8.19 ±1.60),delay recognition (22.61 ± 4.71 and 25.38 ± 3.24 ; t =2.428,3.990,3.138 ; all P ＜ 0.05).PIM was impaired in the patients with occipital lobe stroke (5.56 ± 8.19 and 22.12 ± 4.68,t =0.011,P ＜0.01),while there was no significant difference between occipital lobe stroke and healthy group in CIM task.Conclusion Frontal lobe stroke present CIM damage and PIM relative retention,while occipital lobe stroke patients perform PIM damage and CIM relative retention,confirm the dual separation in implicit memory neural mechanism.

Objective To study the expression of Survivin and COX-2 in ampullary carcinoma and their clinical significance.MethodsThe expression of Survivin and COX-2 proteins were tested by EnVision immunohistochemistry in 40 cases of ampullary carcinomas,and 8 cases of normal ampulla of vater as the controls.ResultsThe positive rate of Survivin in ampullary carcinonas was significantly higher than that of the controls(82.5％ vs 0,P ＜ 0.01 ). The expression of Survivin in ampullary carcinoma was correlated with duodenal invasion,pancreatic invasion and lymph node metastasis ( P ＜ 0.05 ).Significant difference was also observed in the expression rate of COX-2 between the patients with ampullary carcinoma and the normal controls (67.5％ vs 0,P ＜ 0.01 ).The expression of COX-2 in ampullary carcinoma was correlated with duodenal invasion,pancreatic invasion and lymph node metastasis (P ＜ 0.05). Significantly positive correlation was found between the expression of Survivin and COX-2 by using spearman correlation analysis ( r =0.383,P =0.015).ConclusionThe specific up-regulation of COX-2 gene and Survivin gene may play an important role in the genesis and development of ampullary carcinoma.COX-2 and Survivin may be used as early diagnosis markers and potential therapeutic targets in ampullary carcinoma.

Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).MethodsThe results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.ResultsThere was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P＜0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 ％ vs 2/99 2.02 ％,P＞0.05).ConclusionsDelayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.

ObjectiveTo evaluate treatment of type 2 diabetes mellitus (T2DM) by laparoscopic Roux-en-Y gastric bypass (LRYGB) using different amastomoses. MethodsTwenty one T2DM patients were divided into two groups:transoral EEA (OrVil) and Endo-GIA according to ways of gastrointestinal anatomosis andunderwentLRYGB. Clinicaldataincluding outcomeof operation, complications,preoperative and postoperative oral glucose tolerance test (OGTT),Homa-IR,Homa-β,blood lipid and nutrition status were analyzed.ResultsLRYGB procedures were successfully performed in all the 21 patients with no conversion to open surgery.The difference of intraoperative blood loss,postoperative recovery time between two groups was not significant.The mean operation time in OrVil group ( 126 ± 29 )mins was shorter than that in Endo-GIA group ( 156 ± 28 ) mins ( P ＜ 0.05 ),but at the same time,the mean expenditure was higher. Evaluated on three months after operation,the T2DM cure rate was 78％,and effective rate was 100％ in OrVil goup and those were 83％,100％ respectively in Endo-GIA group.No postoperative malnutrition, anemia or severe complication occurred.ConclusionsThe efficiency of laparoscopic Roux-en-Y gastric bypass using different amastomoses was same in the treatment of type 2 diabetes mellitus.The operation time was shorter in OrVil group but the expenditure was higher.

Objective To explore the safety of mobilization and collection as well as the feasibility of selection of autologous peripheral blood stem cells (auto-PBSC) from patients with juvenile severe autoimmune diseases (AID) for autologous hematopoietic stem cell transplantation (auto-HSCT). The clinical significance of these procedure is evaluated. Methods Eight patients with AID, including four patients with systemic lupus erythematosus(SLE),two patients with dermatomysoitis, one patient with juvenile rheumatoid arthritis (JRA), one patient with multiple sclerosis(MS),underwent auto-HSCT. Auto-PBSCs were mobilized in 8 patients using cyclophosphamide(CTX) and granulocyte colony-stimulating factor (G-CSF), and their PBSCs were collected by CS-3000 Blood Cell Separator, then the CD34+cells were selected and purified by CliniMACS CD34+cell selection device. The CD34+ cells were frozenand preserved under -80 ℃ ALL patients received non-myeloablative or lymphoablative conditioning regimens which consisted of CTX/Mel/ATG or CTX/ATG or BEAM/ATG. All patient received CD34+ cells transplantation. The safety of mobilization and collection process of auto-PBSC as well asthe feasibility of selection and purification of CD34+cells were recorded and hematopoietic reconstruction were evaluated. Results All patients tolerated the collection process well, and there was no mobilization-related mortality. The number of collected MNCs and CD34+ cells were 8.35×108/kg and 7.92×106/kg respectively. The number of CD34+ and CD3+ cells after purification was 6.28×106/kg and0.71 ×105/kg respectively. The mean granulocytes and platelet engraftment occurred on days 11 and 15 after G-CSF regimen, and they can be collected using CS-3000 instrument. PBSC mobilization and collection from patients with juvenile severe AID is safe. The CD34+ cell can be highly purified. The auto-PBSC CD34+cell transplantation is an alternative therapy for severe AIDs that do not respond to conventional treatments.

Objective To evaluate the clinical efficacy of transpedicular intracorporeal bone graft with allogenic bone in treatment of thoracolumbar osteoporotic compression fracture. Methods A total of 45 patients with thoracolumbar osteoporotic compression fractures were treated with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone. Anteroposte-rior and lateral X-ray photographs were taken before and after operation and at follow up period to determine the ratio of anterior and middle compressed body height to the normal height, the vertebral angle and the superior-inferior endplate angle. The extent of local pain was measured by VAS score. The implant failure was also recorded during follow-up. Results The operative reduction and interbody bone grafting exerted a satisfactory effect on the ratio of anterior and middle body height to the normal height, the vertebral angle and the superior-inferior endplate angle. Local back pain disappeared immediately after surgery in 34 patients out of 38 patients followed up for more than two years. No implant failure was found during follow-up. Conclusions Early treatment with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone can effectively correct local deformity, prevent late vertebral collapse and implant failure and is an ideal treatment method for thoracolumbar osteoporotic compression fracture.