OBJECTIVETo compare therapeutic effects between unilateral decompression technique only and open decompression technique with fusion and internal fixation for the treatment of lumbar spinal stenosis.

METHODSFrom March 2008 to February 2011, 82 patients with lumbar spinal stenosis were treated with operations, and divided into two groups. There were 13 males and 19 females in group A, with a mean age of (56.31±4.31) years old. The patients in group A were treated with unilateral decompression via fenestration technique only, including 23 patients obtaining single level decompression and 9 patients obtaining two levels decompression. In group B, there were 18 males and 32 females, with a mean age of (57.53±4.28) years old. The patients in group B were treated with open decompressive technique with fusion and internal fixation, including 38 patients obtaining single level decompression and 12 patients obtaining two levels decompression. The VAS of back pain and leg pain, ODI were recorded before and after surgery to evaluate low back pain,leg pain and walking tolerance.

RESULTSAll the patients were followed up, and the duration ranged from 10.9 to 43.4 months,with a mean of 32.8 months. There were no differences in age, stenosis level, VAS of back and leg pain and ODI before surgery between two groups. Compared with the corresponding ones in group B, the operation time, blood loss, hospitalization time,recovery time of routine daily life and finacial expenditure of patients were all shorter or less in group A. There was no statistically difference in complications between two groups.

CONCLUSION"Unilateral decompression via fenestration technique" is a less invasive and more effective decompressive technique for degenerative spinal stenosis without posterior elements damage. It has advantages in operation time, blood loss, hospitalization time, recovery to daily life and financial expenditure. When controlling the operative indications strictly, the technique could be an important procedure for surgical treatment of degenerative spinal stenosis, especially in the elderly population.

Adult ; Aged ; Case-Control Studies ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Spinal Fusion ; methods ; Spinal Stenosis ; surgery

BackgroundEndostatin (ES) is currently the strongest endogenous angiognesis inhibitor,and it can inhibit the occurrence of neovascularization.Various studies demonstrated that the poly RGD sequence can enhance the function of the ES gene.ObjectiveThis study was to evaluate the use of gene therapy of modified ES for alkaline burn-induced corneal neovascularization (CNV).MethodsOne hundred and two clean SD rats were randomly divided into the normal control group,the pCI empty vector group,the pCI-ES group,and the pCI-RGDRGDES group.Corneal neovascularization models were established by placing a piece of 3 mm filter paper with 1 mol/L NaOH at the central cornea for 40 seconds.3 μg of the pCI blank vector,ES-tranfected pCI blank vector,or RGDRGD-ES-transfected pCI vector was injected into the superior bulbar conjunctiva after the alkali burn twice at 1-week intervals.Area of CNV and edema of the cornea in the various groups of rats were examined daily under the slit lamp biomicroscope.1,4,7 and 14 days after operation,the rats were sacrificed by the excessive anesthesia method and corneal tissues were obtained to evaluate pathological changes.The expression of CD34 in vascular endothelial cells was detected by immunochemistry to calculate the corneal neovascular density.The expressions of VEGF mRNA and Flk-1 protein in the corneas were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot analysis.The use and maintenance of animals followed the Statement of ARVO.Results Seven to fourteen days after corneal alkali-burning,the corneal neovascular area was smaller in the pCI-ES group and pCI-RGDRGD-ES group compared with the normal control group and pCI blank vector group (P＜0.05,P＜0.01 ),and nevascular area in the pCI-RGDRGD-ES group was smaller than that in the pCI-ES group (P＜0.05).The expression level of CD34 was significantly lower in the pCI-ES group and pCI-RGDRGD-ES group than that in the normal control group and pCI blank vector group (P＜0.05,P＜0.01 ),and the expression level of CD34 was further declined in the pCI-RGDRGD-ES group compared with the pCI-ES group (P＜0.05 ).Compared with the normal control group and pCI vector group,the expressions of the Flk-1 protein and VEGF mRNA were decreased in the pCI-ES group and pCI-RGDRGD-ES group on the fourth day after corneal alkali-burning (P＜0.01,P＜0.05 ),and those in the pCI-RGDRGD-ES group were less than the pCI-ES group (P＜ 0.05,P＜ 0.05 ).Conclusions Subconjunctival injection of both ES and modified RGDRGD-ES genes result in significant suppression of CNV in vivo,and modified RGDRGD-ES appears to be more effective than native ES.The main mechanism of ES in inhibiting neovascularization is to downregulate the expression of VEGF and Flk-1.

A new steroid with a long cross-conjugation structure, 15a-hydroxy-(22E, 24R)-ergosta-3, 5, 8 (14), 22-tetraen-7-one (1), was isolated from the marine-derived fungus Aspergillus aculeatus. Its structure was established by the extensive spectroscopic analyses, and its cytotoxicities against P388, HL-60, and PC-3 cell lines were measured in vitro.
Animals ; Aspergillus ; chemistry ; Cell Line, Tumor ; drug effects ; Cholestenones ; chemistry ; isolation & purification ; pharmacology ; HL-60 Cells ; drug effects ; Humans ; Inhibitory Concentration 50 ; Molecular Structure ; Seawater ; microbiology

Objeetive To analyze the effect of treatment of rhegmatogenous retinal detachment(RRD) by scleral bucking as well as the relative risk factors affecting the anatomical reattachment and visual recovery.Methods One hundred and fortyeight patients (148 eyes) with RRD treated by sclera buckling surgery in our hospital during January 2012 to January 2016 were retrospectively analyzed.The rate of postoperative retinal anatomic reattachment,the best corrected visual acuity (BCVA) and complications were observed.Logistic regression analysis was performed to analyze the correlative factors affecting the anatomical reattachment and postoperative vision restoration.R~ults Retinal reattachment achieved in 91.9％ after initial surgery and the final success rate for anatomic reattachment was 97.3％ assessed with ophthalmoscope and fundus photography.But these two rates were assessed with the optical coherence tomography (OCT) were 60.1％ and 80.4％ respectively.Single factor Logistic regression analysis showed that retinal detachment was affected by multiple breaks and Grade C1 PVR(all P ＜0.05);Single factor Logistic regression analysis showed that preoperative BCVA,course of disease,retinal detachment range,macular involvement or not had an impact on the postoperative recovery of BCVA (all P ＜ 0.05),preoperative age,refractive status,releasing retinal fluid or not,intravitreal gas injection,combined scleral buckling,and postoperative subretinal fluid,all of these factors had no effect on BCVA recovery after surgery (all P ＞ 0.05).And through multiple factors Logistic regression analysis,preoperative BCVA was an independent risk factor for BCVA recovery after surgery (P ＜ 0.05).Conclusion Scleral bucking is an effective technique for managing RRD,but multiple breaks and Grade C1 PVR are significant risk factors for anatomic.Preoperative BCVA,course of disease,retinal detachment range,macular involvement or not have the impact on the BCVA recovery after scleral buckling,and the preoperative BCVA is the key factor.Early diagnosis and early treatment as well as protecting the preoperative visual acuity can improve prognosis.

0.05),the mean FA on the left was higher than the right(t=1.912,P

OBJECTIVETo investigate the clinical effects of laparoscopic tension-free repair of umbilical hernia using mesh.

METHODSForm August 2006 to April 2009, 26 patients with umbilical hernia were repaired with mesh under laparoscopy. After the tissues surrounding umbilical perforation were separated by using ultrasonic scalpel, the mesh was stapled to the hernia edge with under laparoscopy. The efficacy of this procedures was analyzed in this study.

RESULTSThe tension-free repairing operations were completed successfully in the 26 patients under laparoscopy. The patients felt slight pain and began eating normally on the second day after the operation. The mean operation time was 35 min (30 - 45 min) and the mean blood loss was 8 ml (5 - 15 ml). No operative death and infection occurred postoperatively. The mean postoperative hospital stay was 5 days (3 - 7 days). The patients were followed up for 3 - 25 months (mean 14 months), no recurrence of the hernia occurred in this group.Patients were satisfied with the operation.

CONCLUSIONSTension-free repairing of umbilical hernia with mesh under laparoscopy is a minimally invasive operation with fast recovery, few complications, it's in line with the principle of tension-free repair for hernia.

Adult ; Aged ; Female ; Hernia, Umbilical ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Surgical Mesh ; Treatment Outcome

Objective To describe the characteristics of sexual debut among college students in China to provide appropriate sex education in that population. Methods An anonymous questionnaire survey was conducted among 33 653 college students selected by multi-stage stratified cluster sampling method in 18 provinces and cities of China. Results The percentage of students who had initiated sexual intercourse before age 14 was 1.9%. Overall, male students (2.8%) were significantly more likely to have initiated sexual intercourse before age 14, than female students (1.1%). The percentage of students who had initiated sexual intercourse from age 15 to 18 was 6.4% in males versus 2.1% in females. while the rates of students who had initiated sexual intercourse after age 19 were 6.9% in males and 2.6% in females. The first sexual intercourse was significantly associated with parental educational attainment, geographic location and family structure. Students whose parents were relatively well educated, living in the western areas of the country China, or with nucleus/extensive families were more likely to have early sex in their puberties. Conclusion Sexual education should be strengthened especially in the western areas, and targeted on the students whose parents with relatively higher educational background or who were from extensive families.

OBJECTIVETo study and compare the accuracy and sensitivity of endoscopic ultrasonography (EUS) and CT scaning in determination of preoperative stage and vascular invasion by pancreatic and ampullary cancers.

METHODSFourty-two pancreatic cancer patients and 18 ampullary cancer patients were studied. With patients prepared according to conventional endoscopy, Olympus EUM-30 scope 1 set with a side view and 360 degrees rotate and switchable scanning probe [ultrasound frequency (7.5/12 MHz)], was introduced to the descending duodenum through the esophagus. Gas within the duodenum and stomach was aspirated. Then, in order to to facilitate ultrasound transmission, 200 ml deaerated water was injected into the duodenum and 500 ml into the stomach to distend it. The structures of each part of pancreatic head and ampullary together with surrounding vessels were scanned. Then, the scope was withdrawn to the gastric antrum, body and fundus gradually, while the pancreatic body and tail were scanned.

RESULTSBetween Apr. 1996 to May 2004, a total of 42 pancreatic cancer patients and 18 ampullary cancer patients were examined by EUS. Meanwhile, all these 58 patients received preoperative CT scaning. The results of stage and vascular invasion determined by EUS in this series were as following; pancreatic cancer group (n = 42): accuracy in T2-4 stage was 100.0% (5/5), 75.0% (9/12) and 48.0% (12/25), respectively; ampullary cancer group (n = 18): T1-4 stage was 75.0% (3/4), 66.7% (2/3), 75.0% (6/8) and 33.3% (1/3), respectively; the accuracy in N stage: P-group: 80.0% in N1 (4/5), 90.0% in N0 (9/10); A-group: 50.0% in N1 (3/6), 91.0% in N0 (10/11). The sensitivity, specificity of vascular invasion, resectability and unresectablilty determined by EUS and CT as compared with surgical findings during operation was 52.9% (9/17), 93.1% (27/29), 77.1% (27/35) and 81.8% (9/11) for EUS (n = 60), respectively; and 11.8% (2/17), 92.6% (25/27), 62.5% (25/40) and 50.0% (2/4) for CT (n = 58), respectively.

CONCLUSIONEndoscopic ultrosonography being one of the best image examinations to determine the stage and vascular invasion for pancreatic and ampullary cancer paitients is able to detect small pancreatic or ampullary cancer less than 2.0 cm in diameter due to its high resolution; but can not detect the secondary multiple distal metastases such as spread into the liver, peritonium or hepatoduodenal ligament, etc. due to its ultrasound depth limitation.

Ampulla of Vater ; diagnostic imaging ; pathology ; Common Bile Duct Neoplasms ; diagnostic imaging ; pathology ; surgery ; Endosonography ; Female ; Humans ; Lymphatic Metastasis ; Male ; Mesenteric Veins ; diagnostic imaging ; pathology ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreas ; diagnostic imaging ; pathology ; Pancreatectomy ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Portal Vein ; diagnostic imaging ; pathology ; Preoperative Care ; Tomography, X-Ray Computed ; Vascular Neoplasms ; diagnostic imaging ; pathology

Objective To assess the feasibility and efficacy of curved cutter stapler(Contour TM)in total mesorectal excixion with ultra low rectal cancer anal anus-preserving operation.Methods From January to October 2006，36 patients with ultra low rectal cancer fulfilled by anal preserving operation underwent total mesorectal excision with Contour TM. Results Fecal continences were preserved successfully in all patients.Postoperative biopsy of cutting margin was proved to be free of rectal malignant tumors. No anastomotic leakage or narrow and postoperative recurrences occurred in all patients. Conclusion Ultra low rectal cancer resection with Contour is a feasible， safe and convenient technique，which extends the indication range of anal sphincter preservation.

Objective To assess the feasibility and efficacy of curved cutter stapler(Contour TM)in total mesorectal excixion with ultra low rectal cancer anal anus-preserving operation.Methods From January to October 2006，36 patients with ultra low rectal cancer fulfilled by anal preserving operation underwent total mesorectal excision with Contour TM. Results Fecal continences were preserved successfully in all patients.Postoperative biopsy of cutting margin was proved to be free of rectal malignant tumors. No anastomotic leakage or narrow and postoperative recurrences occurred in all patients. Conclusion Ultra low rectal cancer resection with Contour is a feasible， safe and convenient technique，which extends the indication range of anal sphincter preservation.