Objective To investigate the kinetics and the magnitude of intragraft gene expression of interleukin-2 (IL-2), interferon-gamma (IFN-y), perforin and granzyme B, and intragraft expression of interieukin-2 receptor (IL-2R) and intercellular adhesion molecule-1 ( ICAM-1 ) during acute rejection episodes, and to analyze the changes in apoptosis in small intestinal allograft rejection. Methods Heterotopic small intestine transplantation was performed with inbred rats F344/N (RT11) and Wistar/A (RT1-Ak, RT1-Ed). All recipients were divided into four groups: group 1 : Wistar, native control; group 2: Wistar→Wistar; group 3: F344→Wistar and group 4: F344→Wistar + cyclosporine A (6 mg·kg-1 ·d-1 I.M. ). The grafts were harvested on postoperative days (PODs) 3, 5 and 7. All samples were examined pathologically. Intragraft mRNA expression of IL-2, IFN-γ, perforin and granzyme B were detected with reverse transcriptase polymerase chain reaction (RT-PCR) and intragraft expression of IL-2R and ICAM-1 were stained using immunohistochemistry. We also analyzed the change in apoptosis rejection with terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL). Results Mild acute rejection occurred on POD 3 in the ailograft group, moderate acute rejection on POD 5, and severe acute rejection on POD 7, while none of the isografts had histological evidence of acute rejection. Cyclosporine A could effectively control rejection. Gene expression was virtually negative in the native control. Only on POD 5 was IL-2 mRNA expression of ailografts significantly higher than that of isografts ( P ＜ 0.05). IFN-γ mRNA expression was significantly higher than that of the control groups ( P ＜ 0.01 ) on PODs 3, 5 and 7, and the level of perforin and granzyme B mRNA expression reached significantly higher levels than in the other two control groups on POD 5 and POD 7. Intragraft IL-2R expression of the allograft was significantly higher than that of the other three control groups. Only on POD 3 was intragraft ICAM-1 expression of allografts significantly higher than isografts. The number of apoptotic cells per crypt of allografts was significantly higher than that of the other three control groups on POD 3 and POD 5 ( P ＜ 0.01 ). Conclusion Transcription of IL-2, IFN-γ, perforin and granzyme B, and expression of IL-2R and ICAM-1 as well as apoptosis of epithelial cells of the grafts play an important role in small intestine allograft rejection. Intragraft gene expression of IFN-γ and intragraft expression of IL-2R as well as apoptotic epithelial cells may become a specific and sensitive diagnostic method of clinical value. Furthermore, therapeutic strategies to alter these molecules in small intestine transplantation may improve the outcome of current antirejection therapy.

OBJECTIVETo investigate the clinical effects of spinal canal decompression and pedicle screw reduction and fixation, and intervertebral bone grafting fusion for the treatment of lumbar spondylolisthesis associated with nerve compression symptoms.

METHODSPostlaminectomy vertebral lamina reconstruction and pedicle screw reduction and fixation were performed in 32 patients with lumbar spondylolisthesis between August 2007 and August 2008. Of them, 26 patients were followed up for more than 1 year, including 16 males and 10 females who ranged in age from 55 to 76 years (mean 62.5 years). The course of disease was 2-10 years. All patients had low back pain, numbness and pain in one or both lower extremities and intermittent claudication symptoms. Radiograms showed L3, L4 or L5 anter-olisthesis of I to III degree. There were 18 cases of regressive olisthesis and 8 cases of spondylolysis. The clinical improvement, the vertebral reduction, the lamina fusion rate and canal stenosis state were observed and assessed.

RESULTSThe wounds healed well in all 26 cases without occurrence of significant complications. Clinical improvement was assessed according to the JOA lower back pain score scale. The mean preoperative score was 5.2 +/- 1.5, and 23.1 +/- 1.9 at 3 months after operation. The result was excellent in 20 cases, good in 5 cases, and fair in 1 case. The mean score on the last followed-up was 22.9 +/- 2.4, and the result was excellent in 19 cases, good in 5 cases, and fair in 2 cases. JOA score at 3 months after operation and that at the last followed-up were significantly different from that before operation (P = 0.00), and there was no significant difference between JOA score at 3 months after operation and that at the last followed-up (P > 0.05). Complete reduction was achieved in 17 degree I case and 5 degree II cases. Two degree II cases were improved to degree I, and 2 degree III cases were improved to degree I. Vertebral fusion was achieved 3 months after operation in 20 cases, and in all cases at the last followed-up. CT examination at the last follow-up showed no stenosis of the vertebral canal, dural sac and nerve root compression. The rebuilt vertebral lamina fused well. No graft bone absorption or failing fixation occurred.

CONCLUSIONPostlaminectomy reconstruction of the vertebral lamina and pedicle screw reduction and fixation can achieve satisfactory reduction and spine biomechanical stability in the treatment of lumbar spondylolisthesis, and can prevent latrogenic stenosis of the vertebral canal due to nerve oppression by the postoperative scar and nerve adhesion, with good early and medium-term curative effects. In addition, it provides a new way of thinking in the treatment of lumbar spondylolis-thesis.

Aged ; Biomechanical Phenomena ; Bone Screws ; Female ; Humans ; Laminectomy ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Spinal Fusion ; Spondylolisthesis ; surgery

Background: The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC). Methods We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3–6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival.

Objective: To identify whether the three imported yellow fever cases in China in March 2016 were infections by wild type strain of yellow fever virus in Angola in 2016, vaccine-associated disease or co-infection of both. Methods: Sequences of three yellow fever virus strains were obtained by high-throughput sequencing with IonTorrent PGM platform from blood or urine samples of three yellow fever cases, and their genomic characteristics were analyzed. Then the regions with relatively great difference between the wild type strain and 17D vaccine strain were identified, and then served as the reference sequences when mapping the reads obtained by high-throughput sequencing. Results: Partial yellow fever virus genomes were obtained from three samples of yellow fever patients, among them a full length coding region sequence was gained in sample 2. Comparing the genome sequences, the three newly obtained strains of yellow fever virus were highly similar to strain CNYF01R / 2016 which was isolated from the first imported yellow fever case to China in 2016 and strain Angola 71 from Angola in 1971, and they all belonged to Angola genotype of yellow fever virus. In this study, we found five regions in yellow fever virus genomes with great diversity between the vaccine strain and the wild type strain. In these five regions, a number of short reads obtained by high-throughput sequencing of the three samples were mapped to the sequence of wild type virus, while no short reads matched the vaccine strain. Conclusions There were no viral nucleic acid of 17D vaccine strain in the blood or urine samples of these three cases of yellow fever. They are all infected by wild type strains of Angola in 2016.