Objective To investigate the interactions between melanoma-derived exosomes and the microenvironment.Methods The exosomes were isolated from the culture medium of mouse melanoma cells and then co-cuhured with mesenchymal stromal cells (MSC) after identification.Immunofluorescence assay was performed to observe the exosomes engulfed by MSC.CCK-8 and transwell assays were used to evaluate the proliferation and migration of MSC.Effects of the exosomes on the expression of α-smooth muscle actin (α-SMA) in MSC were analyzed by Western blot.Results Co-culture of MSC with melanoma cell-derived exosomes enhanced the proliferation and migration of MSC as well as the expression of α-SMA.All of the changes mediated by the exosomes could be blocked by using the inhibitor of TGF-β receptor.Conclusion Melanoma cell-derived exosomes enhanced the proliferation and migration of MSC as well as the expression of α-SMA through TGF-β signaling pathway,which provided an advantageous microenvironment for melanoma progression.

Humans ; Lymphohistiocytosis, Hemophagocytic ; Male ; Middle Aged

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

[Objective]To Probe the causes of significant operatiive complications of ossification of posterior longitudinal ligament as well as the treatment outcomes in order to reduce the surgical morbidities and to suggest preventive measures of complications.[Method]The surgical data of 85 cases with ossification of posterior longitudinal ligament were reviewed form March 2002 to May 2006.In continuous long segment OPLL which were treated by bilaminectomy with internal fixation system;short segment OPLL which were treated by corpectomy of anterior cervical approach with bone of autograft and anterior cervical spine locking plates.[Result]Totally 66 cases were followed-up from 3 to 25 months with an average of 13 months.Complication of posteior cervical approach:8 cases with the pain of neck-shoulder,which resulted from postoperative radiculopathy and nerve root irritation or injury.Most of 8 cases were recovered in 2 to 20 weeks by conservative treatment such as antalgica,dehydration and physiotherapy.Four cases with quadriparesis or symptom deteriorate,which resulted from reperfusion injury of spine cord.Two cases were recovered by hyperbaric oxygen and medication and 1 cases recovered not enough.Two cases with posterior cervical hemotoma were caused by bleeding of smaller blood vessels and obstruction of drainage.One case of CSF leakage were cured in 3 days with cervical spinal immobilization and moderate local compressiom.Two cases of local infection were cured during 20 days with antibiotics or combined with debridement and suturing.Complications of anterior cervical approach:a cases with quadriparesis or symptom deteriorate;1 case of CSF leakage.Complications related to instruments included 1 case of titanium net subsidence and 1 case of single lateral mass screw back-out.[Conclusion]Many kinds of operative complications could occur in either anterior or posterior approach of surgery of ossification of posterior longitudinal ligament.Preoperative good preparation,intraoperative carefull operation and postoperative strengthened management are the key points to decrease and prevent operative related complications.

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

[Objective]To review the clinical data on patients suffering from multi-level lumbar spine fracture treated with TSRH-3D pedicle screw system,and to investigate the post-operative efficacy.[Method]Eighteen patients with multi-level lumbar spine fracture were treated with TSRH-3D pedicle screw system.The operations were performed 4 hours to 2 days after injury,and the follow-up period was 15-32 months(average,23 months).The X-ray and CT scan were taken preoperatively and postoperatively.[Result](1)Twelve patients injured from height falling(67%),5 from traffic accident(28%) and 1 from crush injury(5%).(2)The improvement rates of the spine motion,back pain and the lower extremity pain were 67%,94% and 78%,respectively.(3) Compared with preoperation,the height of anterior border of vertebra improved by 59.2%,lost by 5.2% on average(P

OBJECTIVE: To study the effect of compound glycyrrhizin on hepatic function and hepatic fibrosis of patients with chronic hepatitis B. METHODS: 33 patients with chronic hepatitis B were injected i.v with 80ml compound glycyrrhizin q.d for 4 weeks. The hepatic function, hepatic fibrosis of patients and the clinic effects before and after treatment were observed. RESULTS: The total effective rates for patients with mild, moderate and severe degrees were 100%, 92.3% and 91.7%, respectively. There were significant differences in alanine aminotransferase, total bilirubin(P

[Objective]To evaluate the surgical results of spinal scoliosis in the elderly and to investigate the indications,surgical techniques and factors which may contribute to the outcome. [Methods]A retrospective study was held.Sixty-four patients≥65 years undergoing different kinds of operation for lumbar spinal scoliosis from Sep.2004 to Apr.2008 were recruited.The mean patient age at surgery was 69.2 years(61~75 years).[Results]There were a variety of treatment methods of degenerative scoliosis based on symptomatology and radiologic measurements of scoliosis and stenosis.Sixty-four patients were followed up for an average of 37 months.The average correction rate of scoliosis was 51.2% after operation.No case was found spinal cord injury.Clinical symptoms and functional tolerance for daily activities improved after surgery.Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument related failures or reoperations in this series.[Conclusion]The surgical results of lumbar scoliosis in the elderly are better than to those reported for the general population.Carefully perioperative preparation is very important in the treatment of elderly patients with lumbar spinal scoliosis.

Objectives To investigate the effects of nerve nutrient factors and inhibitory factors on neuronal regen? eration and axonal reconstruction at ischemic neocortical penumbra after focal cerebral ischemia in rats. Methods The rat model of middle cerebral artery ischemia was established using suture-occluded method. The pathological morpholo? gy of brain tissue was examined by using HE staining. The expression levels of GAP-43 SYN, nutrient factor (BDNF VEGF Ang1) and inhibitory factor (NogoA NogoR RhoA) were determined by using Western blotting technique. Results The number of neurons in ischemic penumbra was significantly decreased in model group (P<0.01) than in sham-operat? ed group. The expression levels of GAP-43 were significantly decreased (P<0.05) while the expression levels of NogoA NgR and RhoA in the thalamus were significantly increased (P<0.05) in model group than in sham-operated group. The expression levels of SYN and nutrient factors (BDNF VEGF Ang1) were not different between the model group and sham-operated group. Conclusion The increase in nerve inhibitory factors may contribute to the down-regulation of neu?rogenesis at ischemic neocortical penumbra after focal cerebral ischemia in rats.

Objective To investigate the chang and impaction of TM and D- Dimer on peripherally inserted central catheter (PICC) associated thrombosis in cancer patients. Methods The expression of TM and D-Dimer from 207 cancer patients with PICC was examined using nzyme-linked immunoassay. Paitents were divided into thrombosis group and control group according to Doppler Sonography. Results The thrombosis group had 33 cases and the control group had 174 cases in 207 malignant tumor patients with PICC. Compared with that in control group, the expression of TM (6.806 ± 1.805)μg/L and D-Dimer (0.786 ± 0.294) mg/L was significantly higher in thrombosis group and respectively statistically significant (P<0.05), The expression of TM and D-Dimer was positively correlated with thrombosis respectively (r=0.572 and 0.530, P<0.05). The multi-factor Logistics analysis showed the odd ratio of TM was 1.899 and the odd ratio of D-Dimer was 7.292, and the difference was statistically significant (P<0.05). Patients were dichotomized into elevated and noneelevated groups according to the 50th percentile of the levels of TM and D-Dimer of the total study population. In multivariable analysis, the odd ratio of both elevated TM and elevated D-Dimer was 2.04, which was higher than elevated TM (1.286) alone and elevated D-Dimer (1.044) alone, and there was difference in statistics (P<0.05). The results showed that the risk of PICC associated with thrombosis in both elevated TM and elevated D-Dimer TM increased 2.042 times. The expression of TM and D-Dimer was correlated with clinical stage respectively (r=0.477 and 0.492, P<0.05);but was not correlated with age, sex, site of tumor and concurrent radiochemotherapy (P>0.05). Conclusions The expression of TM, D-Dimer is elevated, which is expected to assess the early diagnosis and clinical value of PICC associated thrombosis in cancer.