Objective To investigate the value of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis. Methods In the light of preoperative localization by anterioposterior and lateral X-ray examinations of labeled lumbar vertebrae, the MED system was established under local anesthesia or epidural blockage. Part of lamina and hyperplastic and cohesive articular processes were removed by using a self-made osteotome to fully decompress the dura mater and nerve roots. Results The operation time ranged 25～180 min, with an intraoperative blood loss of 50～300 ml. A conversion to open surgery was required in 1 case because of widespread adhesions of the dura mater and nerve roots. All the 44 patients were followed for 3～40 months (mean, 15 months). According to Nakai criteria, 30 patients had an "excellent" result, 8 patients had a "good" result and 6 were classified as "poor", the rate of "good" or "excellent" results being 86.4% (38/44). Postoperative infection of intervertebral space and symptoms on healthy limbs were observed in 1 case and 2 cases, respectively. Conclusions MED has the advantages of minimal invasion, little blood loss and rapid recovery. It can offer both full decompression to nerves and the stability of spine to the greatest possible advantage, being an effective means in the treatment of lumbar spinal stenosis in elderly patients.

Objective To investigate the measures for the prevention of postoperative complications and dissatisfactory effects of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis in elderly patients. Methods A retrospective analysis was made on complications and causes of dissatisfactory effects following MED procedure in 62 cases. Results Follow-up observations in all the 62 cases for 3 ～ 40 months (mean,16 months) showed a "good" or "excellent" rate of 87 1% (54/62).Complications occurred in 4 cases (6 45%),including 1 case of interspace infection,1 case of injuries on cauda equine,and 2 cases of symptomatic healthy limbs; there was little symptomatic improvement in 4 cases. Conclusions Strictly-controlled indications for surgery,appropriate treatment of complications,and skillful surgical performance is the key to minimize the complications of MED.

Fine-needle aspiration biopsy is the mainstay of preoperative diagnosis of thyroid cancer which is the most common type of endocrine malignancy.However,some aspirates yield indeterminate cytology and there is no clear recommendation for the management on these situations.The use of emerging molecular markers such as BRAF、RET、PAX8/PPARγ will likely improve the diagnosis of malignancy in thyroid nodules and facilitate more individualized therapeutic options and postoperative management.Some markers have been extensively characterized and introduced into clinical practice.

Nowadays,antiplatelet and anticoagulant drugs have been applied to a variety of cardiovascular diseases,such as atrial fibrillation and coronary artery disease.Several clinical studies show that there is a higher prevalence of gastrointestinal cancers in patients with cardiovascular disease.In addition,in patients taking antithrombotic drugs,positive fecal occult blood test (FOBT) improves the sensitivity for early detection of colorectal malignancies.This suggests that antithrombotic drugs may facilitate the detection of unrecognized cancers in patients with cardiovascular disease.However,there is no established evidence concerning whether more aggressive gastrointestinal tract screening will reduce the mortality of cancer in cardiology patients.But in an era of multiple antithrombotic drug usage,when patients appear unexplained anemia,gastrointestinal symptoms or positive FOBT,timely gastrointestinal tract screening is helpful to find concomitanted malignancies in these patients.

Skp2 (S-phase kinase associated protein) is substrate recognition subunit of SCFSkp2 (Cul1-Rbx1-Skp1-F boxSkp2)complex,a kind of ubiquitin ligases (E3s). Skp2 involves in regulating many functions of cell,such as cell cycle progressing,cell proliferation and differentiation,as well as apoptosis.At present many studies indicated that Skp2 is closely related to tumorigenesis and prognosis.With deeper study of Skp2 in tumor, Skp2 has the potential to be a promising drug target and biomarker of prognosis in human cancer.

Objective To discuss the efficacy of micro-diameter and multiple-drilling core decompression in treatment of early femur head necrosis. Methods Sixty-eight patients with early femur head necrosis were selected, and they were divided into 2 groups by random digits table method. The experiment group (35 cases) underwent the micro-diameter and multiple-drilling core decompression (3.0-4.0 mm Kirschner wire or drill), and the control group (33 cases) underwent traditional instruments surgery. Results The operative time, hospital stay and pain score of postoperative hip joint Harris score in experiment group were better than those in control group:(41.2±7.4) min vs. (74.3±10.2) min, (9.7±2.3) d vs. (14.3±4.2) d and (43.56±2.12) scores vs. (37.21±1.19) scores, and there were statistical differences (P<0.01 or<0.05). There were no statistical differences in blood loss and overall hospital costs between 2 groups (P>0.05). There were no statistical differences in the total score of hip joint Harris score at 3 and 6 months after surgery (P>0.05). The total scores of hip joint Harris score at 12 and 24 month after surgery in experiment group were significantly higher than those in control group:(93.11± 2.43) scores vs. (91.23±2.89) scores and (85.23±2.43) scores vs. (73.54±2.89) scores, and there were statistical differences (P<0.05). Conclusions The micro-diameter and multiple-drilling core decompression is applied to the early femur head necrosis with less trauma, shorter operative time, higher clearance rate of necrotic bone and slower disease progression compared with traditional instruments. The micro-diameter and multiple-drilling core decompression makes patients' hip function get a satisfactory recovery with certain clinical applications.

The theory of cancer stem cells proposed that recurrence and metastasis of liver cancer are closely related to liver cancer stem cells.The traditional surgical treatment of liver cancer simply kills those rapidly proliferating tunor cells instead of eliminating hepatic cancer stem cells which play decisive role in recurrence and metastasis.As far as people have concerned,there are many signaling pathways and regulatory factors modulating liver cancer stem cells,such as the Wnt/β-catenin pathway,TGF-β pathway,Notch pathway,Hedgehog pathway,hepatitis B virus,as well as epigenetics.Further studies on regulatory mechanisms of liver cancer stem cells are of great significance,in hope of providing new evidence for treatment and prevention of recurrence and metastasis of liver cancer.

[Summary] Thyroid nodules are a common clinical problem, the majority of which are regarded as benign nodules by initial fine-needle aspiration biopsy(FNAB) or ultrasound characteristics. Given the low false negative rate of ultrasound-guided FNAB cytology and the higher yield of missed malignancies based upon nodule sonographic pattern, a routine sonographic surveillance is recommended to the thyroid nodules with benign cytology. If there are any sonographic evidence of growth or development of new suspicious sonographic features, the FNAB could be repeated. Treatment for benign thyroid nodules includes medications, percutaneous ethanol injection, thermal ablation and surgery. In order to avoid over-treatment, the potential harm and benefits of any intervention should be assessed.

BACKGROUND: As an important part of tissue engineering, vascularization of compound materials is crucial to the survival of seed cells on scaffolds and the functional recovery of original tissues or organs. OBJECTIVE: To summarize the current development of vascularization in tissue engineering repair and reconstruction for urology. RETRIEVAL STRATEGY: An online search was conducted in PUBMED database and CNKI database to identify the articles related to vascularization in urology published from July 2002 to October 2007 using the of "tissue engineering, vascularization, angiogenesis, omentum, growth factor, endothelial progenitor cell, urethra, bladder, urology" in English or in Chinese. Inclusive criterion: The contents of articles were related to vascularization research in tissue engineering repair and reconstruction for urology. Those repeated studies were excluded. LITERATURE EVALUATION: Totally 214 related papers were collected, and 82 of them met the criteria, including 31 and 25 papers related to the use of omentum and growth factor in tissue engineering for urology respectively, and other 26 articles related to the use of seed cells for vascularization in urinary system. Thirty representative articles were selected as the references. DATA SYNTHESIS: At present, the great omentum has been used as a bioreactor. After being wrapped by the omentum, the tissue engineered ureter or bladder can be seen a well vascularized structure. Some researches have also found when acellular matrix is combined with some growth factors, such as vascular endothelial cell growth factor and basic fibroblast growth factor, the formation of blood capillary on scaffolds can be promoted. Moreover, various seed cells have been used to construct a substitute material by combining with capillary structure. Not only stem cells but also progenitor cells have been considered as a potential to construct microvascularized tissue engineered organs for urology. CONCLUSION: It is certain that vascularization research is one of the focal points of tissue engineering for urology. But the related research just can be used in laboratory. Few reports are used in clinical practice of urology. So many unsolved problems need an exploration.

Objective:To explore the effects of allergic factors in chronic sinusitis . Method:Skin prick test and specific serum IgE of 194 patients with chronic sinusitis were performed in our department before endoscopic sinus surgery from October,2007 to October,2008, and correla- tion between test results and clinical classification was analyzed retrospectively. Result: ① Result of skin prick test was analyzed. Positive rate of house dust was 20.6% (40/194),of dust mites 16.0%(30/194),of house dust mites 14.9%(29/194). ② Positive rate of allergic specific serum IgE and skin prick test in experimental group was compared with that of control group. Positive rate of house dust mites,dust mites and house dust between groups were significantly different(P<0.05).③ Clinical classification of chronic sinusitis had a negative correlation with the specific serum IgE (house dust mites ,house dust and dust mites)about experimental group(P<0.05). Conclusion: Allergic factors was associated with etiopathoge-nisis and course of disease of chronic sinusitis.