Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment. Methods The clinical data from 182 patients with single-level lumbar disc herniation, who were treated from January 1983 to June 2008 and followed-up for more than 10 years, were analyzed retrospectively. These patients were divided into conservative treatment (CT) group (n=73) with a mean follow-up time of 17.61±3.87 years, and surgery group (n=109) with a mean follow up time of 17.17±3.47 years. In the CT group, 49 patients were male, 24 female; there were 44 patients with L4-L5 disc herniation, and 29 L5-S1 disc herniation. In 109 patients in the surgery group, 71 were male, 38 female; 68 had L4-L5 disc herniation, 41 had L5-S1 disc herniation, and all of them received lumbar discectomy. The long-term therapeutic effects were reviewed and compared retrospectively in the two groups, including clinical manifestations, image changes, neurofunctional evaluation, height of morbid intervertebral space, adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration. Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group, and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation. At final follow up, the height of morbid intervertebral space (0.62±0.15cm)in surgery group was significantly lower than that in CT group (0.69±0.13cm, P<0.05), the Oswestry score (23.9%±6.3% in surgery group, 23.3%±6.5% in CT group) and height of adjacent segment intervertebral space (0.83±0.11cm in surgery group, and 0.82±0.11cm in CT group) were statistically compared, and no significant difference was found between the two groups. Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging, however, none of them presented obvious clinical symptoms. According to UCLA criteria, cephalad adjacent segment degeneration occurred in 8 patients (12%) of CT group, and in 23 (22%) of surgery group, and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group (P<0.05). Conclusions The height of morbid intervertebral space is remarkably lower, and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy. Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.

Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment. Methods The clinical data from 182 patients with single-level lumbar disc herniation, who were treated from January 1983 to June 2008 and followed-up for more than 10 years, were analyzed retrospectively. These patients were divided into conservative treatment (CT) group (n=73) with a mean follow-up time of 17.61±3.87 years, and surgery group (n=109) with a mean follow up time of 17.17±3.47 years. In the CT group, 49 patients were male, 24 female; there were 44 patients with L4-L5 disc herniation, and 29 L5-S1 disc herniation. In 109 patients in the surgery group, 71 were male, 38 female; 68 had L4-L5 disc herniation, 41 had L5-S1 disc herniation, and all of them received lumbar discectomy. The long-term therapeutic effects were reviewed and compared retrospectively in the two groups, including clinical manifestations, image changes, neurofunctional evaluation, height of morbid intervertebral space, adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration. Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group, and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation. At final follow up, the height of morbid intervertebral space (0.62±0.15cm)in surgery group was significantly lower than that in CT group (0.69±0.13cm, P<0.05), the Oswestry score (23.9%±6.3% in surgery group, 23.3%±6.5% in CT group) and height of adjacent segment intervertebral space (0.83±0.11cm in surgery group, and 0.82±0.11cm in CT group) were statistically compared, and no significant difference was found between the two groups. Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging, however, none of them presented obvious clinical symptoms. According to UCLA criteria, cephalad adjacent segment degeneration occurred in 8 patients (12%) of CT group, and in 23 (22%) of surgery group, and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group (P<0.05). Conclusions The height of morbid intervertebral space is remarkably lower, and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy. Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.

Objective To observe the influence of ATP protection after brachial plexus injuries. Methods A total of 80 female Wistar rats,weighting 280～300 g,were randomly divided into ATP and con- trol groups.The right C_5～T_1 nerve roots were transected and then the intraperitoneal injection of 4m[ of ATP or normal saline was given immediately and once daily to the rats,respectively.The rats were sacrificed on postoperative days 14,28 and 42 respectively.The C_5-T_1 segments of the spinal cord were harvested.NT-3 activity was measured by enzymo-histochemistry method.Four weeks and 6 weeks postoperatively,ultrastruc- ture of the denervated skeletal muscles was observed.Results Compared to the control group,the expres- sions of NT-3 was increased in the treated groups with ATP injection (P

Objective:To summarize the diagnosis features of the prenatal genetic diagnosis of fetal renal cystic disease and to explore the clinical feasibility and significance of prenatal genetic diagnosis of congenital cystic nephrosis.Methods:A total of 25 fetuses with congenital renal cystic disease were examined via invasive prenatal diagnosis in Henan Provincial People's Hospital from June 2017 to September 2019. Amniotic fluid samples were extracted by amniocentesis. Chromosomal microarray analysis (CMA) were performed in 17 cases. In addition to CMA, the other 8 cases were analyzed by G-band karyotype. Whole exome sequencing (WES) was performed in 6 cases which got normal results by CMA and karyotype, and highly suspected as hereditary disease.Results:Of the 25 fetuses assessed, 4 cases (16.0%) pathogenic copy number variation (pCNV) were found, including 2 cases of 17q12 deletion, 1 case of 10p15.1p14 deletion and 1 case of 4q21.28q22.1 deletion(including PKD2 gene). There were 8 cases without chromosome abnormality by karyotype analysis. Six clinical WES analysis found NPHS1 gene c.1440+1 G>A and c.925G > T mutations were related to Finnish type congenital nephrotic syndrome in 1 case, PKD1 gene c.6878C>T mutation was related to autosomal dominant polycystic kidney disease (ADPKD) in 1 case, and there was no definitive mutation in 4 cases. Conclusions:CMA and next generation sequencing are powerful tools for accurate diagnosis, treatment and genetic counseling of fetal congenital renal cystic diseases. For congenital cystic nephropathy, genetic detection is helpful to clarify the etiology, and provide more exactly informations for prognosis evaluation, treatment and family genetic counseling.

OBJECTIVETo evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis.

METHODSFrom January 2002 to March 2013, 145 patients (84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them, 143 patients were followed up, aged from 2.5 to 81 years with an average of (42.60 +/- 17.14) years. Fourteen cases (6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse, 1 case with muscle strength decrease, this 2 cases were grade D of Frankle, other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy, 144 cases with CT-guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up.

RESULTSThe mean follow-up time was 67 months (ranged, 21 to 149 months) in 143 cases, and 73 cases more than 5 years. All patients obtained clinical healing. ESR was (44.96 +/- 12.41) mm/h before operation and (7.25 +/- 3.43) mm/h at final follow-up, there was significant difference between preoperative and postoperative (t=35.06, P=0.000). Lumbar lordosis angle was (36.32 +/- 8.55) degrees before operation and (33.35 +/- 8.16) at final follow-up, there was significant difference between preoperative and postoperative (t=13.90, P=0.000).

CONCLUSIONWhen conservative treatment fails for 3 months or more, the patients have good spinal stabilization, nerve function is more than grade D of Frankel, CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Debridement ; Female ; Humans ; Lumbosacral Region ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Sacrum ; surgery ; Tomography, X-Ray Computed ; Tuberculosis, Spinal ; diagnostic imaging ; surgery ; Young Adult

Background and purpose:Remarkable advances have been made in cancer chemotherapy by developing new anticancer drugs and therapy strategies.However,multidrug resistance in human cancers remains a major clinical challenge for cancer treatment.Attempts in several clinical studies to reverse multidrug resistance protein (MDR) by using MDR modulators have not yet generated promising results.Our aim was to explored the mechanism of reversal of multidrug resistance in human leukemia K562 cells by PI3-K inhibitor.Methods:Trypanblue dye exclusion method was used to observe the drug sensitivity and the effect of LY294002 on the drug resistance.Western blot to analyze P-gp and p-Akt phenotypes,and flow cytometer was used to measure the intracellular drug accumulation. Results:K562/D induced by DNR was cross resistant to DNR,ADR,VCR and VP16 (Resistance Index:65,52,134 and 50 respectively).DNR induced over-expressions of P-gp and p-Akt in K562/D cells;LY294002 increased the intracellular drug accumulation,and then reversed the drug resistance to DNR,ADR,VCR and VPI6 in K562/D cells(Resistance Index:23,21,63 and 29 respectively),but not in the sensitive cells (K562/S).Conclusion:The multidrug resistance of K562/D cells can be induced by DNR which is related to the P-gp and p-Akt over-expressions, and LY294002 can reverse multidrug resistance in human leukemia cells in vitro via inhibits PI3-K/Akt pathway.

Objective To investigate serum levels of soluble matrix lysin 2 (sST2) in patients with different stages of heart failure and its relationship with prognosis. Methods Data of 300 patients with heart failure of stages A, B, C and D were included in this study. Thirty-three cases of healthy elderly population for physical examination were used as control group. The general information, echocardiography and related biochemical tests containing sST2 and NT-proBNP were collected in the two groups. The survival periods of patients were evaluated according to the Seattle heart failure mode (SHFM). Patients were followed up for 1 year to record the occurrence of adverse events. Results The sST2 level was higher in heart failure group than that of control group. The sST2 level began to increase in stage B, and which increased with the development of cardiac function staging. The sST2 levels were significantly higher in stages B, C and D than those of stage A, and which were significantly higher in stage D than those of stages B and C (P<0.05). There were significantly higher incidence rates of adverse events, left ventricular end diastolic diameter (LVEDD) and left ventricular mass index (LVMI) in the patients with high sST2 level than those of patients with lower sST2 level (P<0.05). Values of sST2, NT-proBNP, LVEDD and LVMI were significantly higher, and values of LVEF and SHFM life expectancy were significantly lower, in patients with adverse events than those of patients without adverse events (P<0.05). There was a negative correlation between sST2 and LVEF, and positive correlation between sST2 with NT-proBNP, LVEDD and LVMI (P<0.05). The size under ROC curve, which was used to predict the cardiovascular endpoint events judged by sST2 was 0.665 (95％CI:0.574-0.757, P<0.01), and the one by NT-proBNP was 0.790 (95％ CI: 0.731-0.848, P<0.01). The best cut-off value of predicting the clinical adverse events was 139.27μg/L by sST2 and 855.35μg/L by NT-proBNP. Conclusion The serum level of sST2 is early indicator of heart failure, which not only reflects the severity of ventricular remodeling but also is one of indicators to estimate the prognosis of heart failure in one year.

OBJECTIVEThe precise mechanism of glucocorticoid-induced apoptosis has not yet been elucidated. Survivin, a member of the inhibitors of apoptosis protein family, correlates with inhibition of apoptosis, proliferation, angiogenesis and multiple drugs resistance. This study aimed to investigate the variation of the survivin gene expression in apoptosis induced by dexamethasone (Dex) in the human T-lineage acute lymphoblastic leukemia (ALL) cell line, CEM-WT cells.

METHODSThe logarithmically growing CEM cells cultured in vitro (cell density 2 x10(5)/mL) were exposed to 0.1, 0.5, 1, 5, and 10 microM Dex, then were collected 24, 48 and 72 hrs later. Untreated CEM cells were used as Controls. The cell viability was determined by trypan blue dye exclusion. Apoptosis was evaluated by morphology and flow cytometry. Survivin protein and gene were analyzed by Western Blot and RT-PCR.

RESULTSCEM cells growth was obviously inhibited by 0.1, 0.5, 1, 5, and 10 microM Dex from 48 hrs. The inhibition effect was dose- and time-dependent. CEM cells treated with Dex (> or = 5 microM) exhibited typical apoptotic features. The apoptosis increased after 5 microM Dex treatment in a time-dependent manner, with the apoptosis percentage increasing from 14.9% (12 hrs) to 46.2% (48 hrs). Compared with that of the Control group, the expression of survivin protein was down-regulated, with the expression rate of 54.6%, 45.5%, 15.8% and 9.7% respectively at 12, 24, 48 and 72 hrs after 5 microM Dex treatment. 5 microM Dex treatment also resulted in a decrease of survivin mRNA expression. The survivin mRNA expression was 76.4%, 67.3%, 55.0%, 49.9%, 38.3% and 18.3% of the Control respectively at 6, 12, 24, 48 and 72 hrs after Dex treatment.

CONCLUSIONSApoptosis induced by Dex in CEM cells is associated with downregulation of the survivin expression.

Apoptosis ; drug effects ; Cell Line, Tumor ; Dexamethasone ; pharmacology ; Humans ; Inhibitor of Apoptosis Proteins ; Leukemia-Lymphoma, Adult T-Cell ; metabolism ; pathology ; Microtubule-Associated Proteins ; analysis ; genetics ; Neoplasm Proteins ; analysis ; genetics

BACKGROUND AND OBJECTIVEc-Cbl and Cbl-b are two ubiquitous members of the Casitas B-lineage lymphoma (Cbl) family, which play important roles in the downregulation of epidermal growth factor receptor (EGFR) by acting as E3 ubiquitin ligases and multiadaptor proteins. This study investigated the expression of c-Cbl, Cbl-b, and EGFR in gastric carcinoma and its clinical significance.

METHODSThe expressions of c-Cbl, Cbl-b, and EGFR were detected by immunohistochemistry using tissue microarrays consisting of 124 specimens of gastric carcinoma and 16 specimens of normal gastric mucosa. The relationship between the expressions of c-Cbl, Cbl-b, and EGFR and clinicopathologic factors of gastric carcinoma were analyzed statistically.

RESULTSThe positive rates of c-Cbl, Cbl-b, and EGFR were higher in the gastric carcinoma group than in the normal group (71.0% vs. 18.0%, P<0.01; 82.3% vs. 25.0%, P<0.01; 56.5% vs. 12.5%, P<0.01, respectively). The expression of c-Cbl was positively correlated with depth of invasion (r=0.219, P=0.015), and TNM staging (r=0.266, P=0.003). The expression of Cbl-b was positively correlated with lymph node metastasis (r=0.190, P<0.034) and TNM staging (r=0.298, P<0.001). The expression of EGFR was positively correlated with depth of invasion (r=0.286, P<0.001) and TNM staging (r=0.362, P=0.000). The expression of both c-Cbl and Cbl-b was positively correlated with EGFR (r=0.241, P=0.007; r=0.183, P=0.042, respectively). Synchronous strong-positive expressions of c-Cbl, Cbl-b, and EGFR were observed in 27 specimens of gastric carcinoma, most of which were at advanced stage.

CONCLUSIONSOverexpressions of c-Cbl, Cbl-b, and EGFR are closely related to the invasion and progression of gastric carcinoma. c-Cbl and Cbl-b may serve as novel molecular markers for gastric carcinoma.

Adaptor Proteins, Signal Transducing ; metabolism ; Adenocarcinoma ; metabolism ; pathology ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; metabolism ; Disease Progression ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Proto-Oncogene Proteins c-cbl ; metabolism ; Receptor, Epidermal Growth Factor ; metabolism ; Stomach Neoplasms ; metabolism ; pathology ; Young Adult