BACKGROUND:When the intervertebral disc is under stress, the hydraulic pressure generated inside the nucleus pulposus makes the annulus fibrosus extend outward and expand, and the annulus colagen fibers are stretched so that the extracelular matrix of annulus fibrosus cels is also under the pressure. In the intervertebral disc, aggrecan is the main component of proteoglycans, matrix metaloproteinase-2 is a major enzyme for extracelular matrix degradation, and tissue inhibitor of metaloproteinase is a multifunctional specific inhibition factor for matrix metaloproteinase activity. There is a mutual regulation between the latter two to keep the homeostasis between them.
OBJECTIVE: To investigate the mechanism of cyclic tensile strain in the metabolism of intervertebral disc annulus matrix.
METHODS:Rat anulus fibrosus cels were subjected to 2% or 10% cyclic tensile strain at 1.0 Hz for 2 and 12 hours using Flexcel4000 tension system. Then cels were colected and cultured in conditioned medium for gene and protein detection. Real-time quantitative PCR was used to detect mRNA expression of aggrecan, matrix metaloproteinases-2 and tissue inhibitor of metaloproteinase-2. Gelatin zymography was used to detect matrix metaloproteinases-2 activity.
RESULTS AND CONCLUSION:The use of 2% cyclic tensile strain had no obvious effect on the stress fiber of actin cytoskeleton, whereas actin cytoskeleton was depolymerized in response to 10% cyclic tensile strain. The 2% cyclic tensile strain raised the expression of Aggrecan at 12 hours; whereas raised the matrix metaloproteinases-2 and tissue inhibitor of metaloproteinase-2 at 2 hours, both of which were in homeostasis; matrix metaloproteinases-2 activity had no significant changes. 10% cyclic tensile strain had no effect on the mRNA expression of Aggrecan. No matter stretching 2 or 12 hours, the matrix metaloproteinases-2 was up-regulated, and the tissue inhibitor of metaloproteinase-2 was down-regulated, both of which were not in balance. Moreover, the matrix metaloproteinases-2 activity was not significantly changed. These findings indicate that the mRNA expressions of Aggrecan, matrix metaloproteinases-2 and tissue inhibitor of metaloproteinase-2 alter in response to cyclic tensile strain in rat anulus fibrosus cels, and the tensile strain induces different mechano-responses in the actin cytoskeleton.

Objective To evaluate the long-term functional outcome after ileal pouch anal anastomosis with modified double-stapled technique.Methods From January 2002 to March 2011,forty-five patients underwent ileal pouch anal anastomosis with modified double-stapled technique.The clinical data of these patients were reviewed.The postoperative anal function was assessed by Kirwan classification and Oresland pouch-specific function score.Results During the median follow-up of 65 months,2 patients with malignant adenomatous polyps died,2 patients were diagnosed dysplasia by biopsy,4 patients developed mild to moderate anastomotic narrowing,1 patient developed persistent anastomotic stricture needing surgical intervention,16 patients developed at least 1 episode of pouchitis.There was no incontinence in these patients,and the median functional Oresland score was 6,3 and 2 after 1 year,2.5 years and 5 years respectively.Conclusion The functional results of ileal pouch anal anastomosis with modified double-stapled technique are promising,with no incontinence in our patients.

Objective: To investigate the protective effect of rhubarb (大黄) combined with scopolamine on gastric and gut mucosal barrier in patients with severe trauma. Methods: Forty patients with severe trauma, injury severity score (ISS)≥25, were randomly divided into two groups (each n=20), namely common therapy group (CM group) and rhubarb (infused into stomach) combined with scopolamine group (RS group). In RS group, rhubarb combined with scopolamine were given just after the first time measuring gastrointramucosal pH (pHi), the other treatment was the same as CM group.The mean arterial pressure (MAP) and heart rate (HR) were recorded, and pHi, lactic acid, interleukin-6 (IL-6) and tumor necrosis factor-? (TNF-?) were measured on admission and at 24, 48 and 72 hours after admission. Results: The MAP, HR and pHi were uptrend in both groups. There were significant increase in MAP and pHi of RS group at 72 hours compared with those of CM group (both P

Objective To prepare the lipid ultrasound microbubbles carrying gene and transactivating transc"ptional activator(Tat)peptide and to study the efficiency of carrying gene and Tat as well as to study their ability as an ultrasound contrast agent.Methods The lipid ultrasound microbubbles were prepared using mechanical vibration method.The appearance,distribution,concentration,diameter and zeta potential were measured.The efficiencies of carrying gene and Tat were studyed by a confocal laser scanning microscopy and a fluorospectrophotometer.For the in vivo experiment,contrast-enhanced ultrasonography was performed on six rabbits to observe the duration and intensity of enhancement in the heart chambers and myocardium after the injection of the microbubbles.Results The diameter of the self-made lipid microbubbles carrying gene and Tat was(2.27±0.38)μm,the concentration was(3.07±0.42)×109/ml and zeta potential was(1.95±0.13)mV.The gene encapsulation efficiency for the lipid ultrasound microbubbles was 32%,and the Tat encapsulation efficiency was 35%.The in vivo experiment showed that the lipid ultrasound microbubbles could significantly enhance the echo intensity of myocardium.Conclusions The efficiency of carrying gene and Tat for the prepared lipid microbubbles is high,which can be used as a new vehicle carrying genes or drugs for therapy as well as an ultrasound contrast agent.

Objective To evaluate the long-term therapeutic results of intersphincteric resection (ISR) in the treatment of ultra-low rectal cancer.Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection (ISR),and the clinical data were analyzed retrospectively.There were 39 males,21 females and their average age was 55 years old (range from 30 to 77 years old).The inferior border of the tumor were from 28 to 50 mm to the edge of anus,averaging 42 mm.Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively.After a median follow-up period of 49 months (range from 18 to 90 months),local and distant recurrence were observed in 6 and 4 patients respectively.Five-year overall survival rate and disease-free survival rate were 88.3％ and 83.3％ respectively.The mean stool frequency were (3.8 ± 1.3) times in each day based on data from 53 patients,and the stool control function of 73.6％ of all patients was preserved satisfactorily according to Kirwan classification.Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

Objective To compare the application,safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery(TEM) and the conventional transanal excision(TAE).Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed.Results Age,sex,tumour size,blood loss,postoperative hospital stay were similar in the two groups(P＞0.05).The median distance from the anal verge was significantly higher in the TEM group ( TEM/TAE =7.0/5.0 cm,P ＜ 0.01 ).The operation time was significantly longer in the TEM group (TEM/TAE =70.00/30.00 min,P ＜ 0.01 ).There was no operation-related mortality in both groups (P ＞ 0.05 ).Two patients in the TEM group developed postoperative haemorrhage,and one patient developed pulmonary infection and retention of urine respectively.There were two secondary haemorrhage cases in the TAE group.On median follow-up of 30 months,there was 7.8％ recurrence rate in the TEM group,compared with 23.2％ the in TAE group.Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm.It has broader indication,and better theraputic effect than the conventional transanal excision.

Objective To investigate the therapeutic effect of kansui root on patients with severe acute pancreatitis(SAP). Methods Clinical data of 54 cases of severe acute pancreatitis treated with kansui root(kansui root group) were analyzed and compared with 54 cases of severe acute pancreatitis treated without kansui root (control group).Results The releivng time of abdominal pain was significantly shorter than that in control group( P

Objective To assess the effect of hybrid debranching technique in treatment of patients with traumatic aortic arch rupture combined with pseudoaneurysm.Methods Clinical data of 3 patients with traumatic aortic arch rupture combined with pseudoaneurysm repaired using debranching technique from June 2011 to June 2013 were analyzed to determine their clinical features and treatment options.Hypersound or computed tomography angiography (CTA) was performed to confirm the therapeutic effects at postoperative 1 week,3,6,and 12 months as well as annually thereafter.Results All patients underwent operation uneventfully.Operation time was 6.8-10.5 hours (mean,7.6 hours) and intraoperative blood loss was 250-450 ml (mean,310 ml).Length of stay was 26-45 days (mean,32 days).There were no deaths at the 0.5-2 years of follow-up.Hypersound or CTA revealed no leakage of contrast medium after operation.Conclusion Hybrid debranching technique greatly reduces surgical trauma and provides satisfactory outcome and good function recovery.

Objective To study the pelvic fascia related to pelvic autonomic nerve and detect the anatomical localization of pelvic autonomic nerve by marker in adult male.Methods Twelve pelvises of adult male harvested from cadavers were studied by dissection.Results Hypogastric nerve was embedded in the posterior leaf of the visceral pelvic fascia.Pelvic plexus was situated between vesicohypogastric fascia and visceral fascia.Pelvic nerve branch of seminal vesicle and prostate was located at the anterolateral part of Denonvilliers fascia.Sacral promontory,ureter,junction of Denonvilliers fascia,visceral fascia and seminal vesicle could be regarded as anatomical markers for pelvic autonomic nerve.Conclusion The anatomical characteristics of pelvic autonomic nerve can be used for protecting and isolating pelvic autonomic nerve in total mesorectal excision of adult male.

Objective: To investigate the relationship between the melatonin and the development of testicle in rabbits. Methods: Thirty male rabbits (unreach puberty) were randomly divided into 2 groups:15 were actively immunized with melatonin and complete antigen, which was successfully synthesized through Mannich reaction by combining melatonin with BSA, the other 15 were taken as controls.The specific antibodies of rabbits were detected by ELISA and RIA.The serum testosterone(T) and luteinizing hormone(LH) were detected by RIA, the mass of testicle or epididymis and the number of sperm were measured. Results: The serum T and LH concentration in experiment group were significantly lower than that in the control group.The mass of testicle or epididymis and the number of sperm in experiment group were also significantly lower than that in the control group. Conclusion: The results suggest that the immunization of melatonin can block the development of testicle in male rabbits.