ObjectiveTo explore the application of enlargement of plastic surgery for dural closure with radial neuro-patch in standardize large decompressive craniectomy (SLDC).MethodsTwenty-one patients (observation group) who needed a SLDC for various reasons were treated with radial incision in dura to release the high intracranial pressure and enlargement of plastic surgery for dural closure with radial neuropatch from March 2009 to June 2010.The neuro-patch were used as the dural substitutes.Twenty-one patients were treated with SLDC only for the similar reasons (control group).General healing effects were compared betweentwo groups.ResultsIn 6 hours and 72 hours after surgery,the rate of obvious effectiveness in observation group was significantly higher than that in control group [33.33％(7/21 ) vs.14.29％(3/21 ),33.33％(7/21 ) vs.19.05％(4/21 ) 、61.90％( 13/21 ) vs.28.57％(6/21 ),61.90％( 13/21 ) vs.38.10％(8/21 )](P ＜ 0.05).The rate of intracranial infection,cerebrospinal leak and epilepsy in observation group [0,0,4.76％ ( 1/21 )]was significantly lower than that in control group [14.29％ (3/21),14.29％ (3/21),19.05％ (4/21)](P ＜0.05).The rate of subcutaneous or subdural cerebrospinal fluid accumulation,cenencephalocele,cerebral ventricular malformation,brain hernia through the skull window had no significant difference between two groups [19.05％(4/21 ),0,4.76％( 1/21 ),0 in observation group;23.81％(5/21 ),9.52％(2/21 ),9.52％(2/21 ),4.76％( 1/21 ) in control group) (P ＞ 0.05 ).After followed up of 6-12 months,the rate of the well general outcome in observation group was significantly better than that in control group [85.71％ ( 18/21 ) vs.71.43％ ( 15/21 )](P ＜ 0.05 ).The rate of moderate-critical function handicapped in control group was significantly higher than that in observation group [23.81％(5/21 ) vs.9.52％(2/21 )](P＜0.05 ).ConclusionsThe SLDC is effective for decreasing the intracranial pressure,and the enlargement of plastic surgery for dural closure with radial neuro-patch can improve the efficiency and decrease the incidence of complicating diseases.This therapy can improve the patients' general quality of survival and is worth to be popularized in clinic.

Objective To evaluate the clinical significance of changes in peripheral lymphocyte count after surgery in early cervical cancer.Methods The 123 patients with stage Ⅰ bl and Ⅱ al treated by abdominal type Ⅲ radical hysterectomy from May 2008 to December 2012 were reviewed.The median age of patients was 43 years old (range:30 to 66 years).The median follow-up was 25 months with a range of 5-61 months.Peripheral blood samples were obtained on pre-operative,post-operation day 3 and 7.The log-rank test was used to compare the homogeneity of progression-free survival functions across strata defined by categories of prognostic variables.The Cox proportional hazard model was used to assess the significance of potential prognostic factors for progression-free survival.Results Univariate analyses preoperative lymphocyte count (P =0.012) and lymph nodes metastases status (P =0.001) and parametrial invasion (P =0.013) were significant risk factors for progression-free survival rate.On multivariate analyses,preoperative lymphocyte count [hazard ratio (HR) =6.087,95％ CI:1.743-21.251,P =0.005] and lymph nodes metastases status (HR =5.984,95％ CI:1.803-19.802,P =0.003) were independent risk factor of progression-free survival rate.Conclusion Peripheral lymphocyte counts after cervical cancer surgery may be a important prognostic factor.

Objective To study the effect of different draining way in the surgical treatment of chronic subdural haematoma (CSDH). Methods 126 patients with CSDH diagnosed by CT scanning or MRI were enrolled. The burr-hole was made at the site of the maximal hematoma thickness. A drainage tube was placed towards either the occipital (group A) or frontal ( group B) region as far as possible respectively, and for the latter, a lateral aperture was made about 2 cm far from the burr-hole on the side of the tube. The surgical complication (such as pneumocephalus, brain injury and recurrent hematoma et al.) and therapeutic efficacy of the two treatments were compared and analyzed to evaluate an optimal surgical technique. Results After treatment, complication rate in group A is 30%, the occurrence of complications in group B rate is 2% (P <0.05); operation time and hospitalization time in group B was significantly shorter than that in group A (P <0.05). Conclusion In the surgical treatment of CSDH, improved drainage pathway is safe and effective, which could improve the treatment efficacy and is worthy of clinical promotion.

Objective To study the influence of O-GlcNAcylation on on proliferation and invasion of gastric cancer cells and evaluate the role of Aktl on O-GlcNAcylation promotting cells proliferation and invasion in gastric cancer.Methods Build the cell model:O-GlcNAc glycosylation levels rise or fall.The cell viability was determine by MTT.To investigate whether O-GlcNAcylation affected colony formation ability of gastric cancer cells,soft agar colony assays were carried out.Cell migration or invasion was using transwell chambers.The expression of Akt1 was detected through Western blot.Thiamet-G was used to eualuate the role of Akt1 on O-Gcnac cylation regulating invasion in gastric Cancei.Results O-GlcNAcylation was increased the gastric cancer cells proliferation ability,colony formation ability,migration and invasion ability in vitro.Akt1 was activated by Ser473 phosphorylation upregulation though O-GlcNAcylation.Akt1 shRNA was inhibition the cell invasive which induced by Thiamet-G.Akt1 overexpression was promoted by Thiamet-G-induced cell invasion.Conclusion O-GlcNAcylation enhanced oncogenic phenotypes possibly partially involving Akt1.

Objective To investigate the correlation between the serum thyroid-stimulating hormone levels and the outcomes in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke were enrolled prospectively.The general clinical data,vascular risk factors,and biochemical indexes including thyroid hormones were collected.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline neurologic deficit.The modified Rankin Scale (mRS) was used to evaluate the neurological outcomes at day 90 after onset.The mRS 0-2 was defined as good outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of the poor outcomes in patients with acute ischemic stroke.Results A total of 140 patients with acute ischemic stroke were enrolled,including 95 men (67.86％) and 45 women (32.14％),aged 35-94 years old.Thirteen patients (9.29％)had subclinical hyperthyroidism and 17 (12.14％) had subclinical hypothyroidism.Ninety-eight patients (70.00％) had good outcome and 42 (30.00％) had poor outcome.The proportions of male (x2 =4.717,P =0.047) and small arterial occlusive stroke (x2 =5.564,P =0.018),as well as uric acid (t =2.602,P =0.010),FT3 (t =2.406,P=0.017),and TSH (t =2.302,P =0.023) in the good outcome group were significantly higher than those in the poor group (P =0.001);age (t =-3.489,P=0.001),fasting blood glucose (Z =-2.178,P =0.031),and baseline NIHSS score (t =-8.009,P ＜ 0.001) were significantly lower than those of poor outcome group.The proportion of patients with TSH in the first quartile (＜0.805 mU/L) in the good outcome group was significantly lower than that in the poor outcome group (17.35％ vs.42.86％;x2 =10.204,P =0.003,and that in the fourth quartile (＞ 2.476 mU/L) was significantly higher than the poor outcome group (30.61％ vs.11.90％;x2=5.488,P=0.002).Multivariate logistic regression analysis showed that after adjusting various confounding factors,the higher baseline NIHSS score was an independent risk factor for poor outcome at day 90 after onset (odds ratio,1.690,95％ confilence interval 1.317-2.168;P＜ 0.001),while the higher baseline TSH level was associated with good outcome (odds ratio,0.520,95％ confidence interval 0.408-0.867;P=0.007).Conclusions The higher serum TSH level was independently associated with good neurological outcome at day 90 after onset in patients with acute ischemic stroke.

Objective To clarify the clinical significance of p21 WAF1 and the relationship between it and p53. Methods Samples of human cholangiocarcinoma (HC) tissue and paired normal bile duct tissue adjacent to the tumor from 30 patients with HC were employed in this study. In situ hybridization (ISH) was used to detect the p53 and p21 mRNA expression. Immunohistochemistry (IHC) was applied to analyze p53 gene mutation and P21 protein expression. Results p21 WAF1 And p53 gene protein expression was detected in 36.7% (11/30) and 53.3% (16/30) of the carcinoma specimens, respectively, and none of the paired tissue by IHC. p53 Positivity was related to local lymph node metastasis. Comparing with non-lymph node metastatic group, p53 positivity in metastatic group was significantly higher. p53 Positivity of cholangiocarcinoma in clinical stage III was significantly higher than that in clinical stages I and II. The survival time was significantly shorter in patients with P53 protein expression than in those without. It was found that p53 expression was not associated with p21 WAF1 expression. Conclusions P53 Positivity may be correlated with tumor development but not tumor occurrence. The fact that p53 expression was not associated with p21 WAF1 expression indicates that p53-independent activation of p21 WAF1 may exist.

Objective To investigate the expressions of estrogen receptor (ER) and progesterone receptor (PR) in different tumor tissues of invasive ductal carcinoma(IDC) of the breast. Methods A total of 32 cases of IDC samples were collected. ER and PR expressions in 4 different sites of every sample were measured by immunohistochemical(IHC) assays. Results Overall, a high concordance in both estrogen receptor and progesterone receptor expressions are observed between different tumor tissue sites. The best Kappa values were 0.789 and 0.810 for ER and PR expression respectively. The worst Kappa values were 0. 563 and 0.672,respectively. Conclusion ER and PR expression is not significantly different in different tumor tissues of the same IDC sample. Repeated testing in different tumor tissue sites has little contributions in clinical settings.

Renal cell carcinoma(RCC)is currently one of treatment-resistant malignancies and is not sensitive to conventional radiotherapy or chemotherapy.The effective rate of high dose of recombinant human interleukin-2(IL-2)and recombinant human interferon-α(IFN-α)was only 10%-15%.Advances in the understanding of cancer at molecular level have led to more progress in the development of anti-cancer agents.Recently,mutation of Von Hippel-Lindau(VHL),Ras,PTEN genes have been observed in RCC and the mutation can result in different expression levels of RTK.Among the newly invented medications for targeted cancer therapy,protein kinase inhibitors target intracellular molecules crucial in sighaling pathways of cancer cell survival and proliferation.Compared with conventional chemotherapy and immune therapy,targeted therapy is effective,with fewer adverse effects.According to 2009 NCCN Clinical Practice Guidelines in oncology,this article reviewed the clinical application of sunitinib,sorafenib,temsirolimus,and bevacizumab in the targeted therapy for renal cell carcinoma.

Objective To investigate the use of antibacterial drugs in tension -free inguinal hernia repair before and after the 2012 National clinical use of antibiotics special management ,providing the basis for the rational use of antimicrobial drugs and standardized management .Methods Retrospectively investigate the antimicrobial ap-plication in patients undergoing tension-free inguinal hernia repair and discharged from July to September in 2011-2013,and analyzed the timing of administration ,usage,type and treatment time of antimicrobial drugs .Results There were respectively 93.24%,47.76%and 27.59%of patients in the three groups administrated prophylaxis antibacte-rial drugs,and respectively 9.19%,65.67%and 85.08%of patients with indications .The first wound healing rates were respectively 94.59%,98.51% and 96.55%.The rates of reasonable choice of medicines 70.60%,96.88%and 91.67%,respectively;the rates of reasonable timing for medication were 71.01%,81.25%and 70.83%,respec-tively;the rates of reasonable courses of prophylaxis therapy were 33.33%,56.25% and 58.33% respectively. Conclusion The principle of no preventive antibiotics use in tension-free inguinal hernia repair is operable .After en-actment of special management of antibacterial drugs ,the level of preventive medication for tension-free inguinal herni-a repair is improved greatly .However ,it still needs to strengthen the management of antimicrobial prophylaxis timing and overall prophylaxis treatment course .