Objective To compare clinical outcomes of percutaneous endoscopic lumber discectomy ( PELD ) versus minimally invasive transforaminal lumbar interbody fusion ( Mis-TLIF ) under the Quadrant system in the treatment of lumbar disc herniation. Methods From January 2010 to December 2013, 60 patients with lumbar disc herniation and failed to conservative treatment were enrolled in this study.According to the random number table, the patients were divided into two groups, with 30 patients in each group.There were no significant differences in age, gender, segment of disease, clinical diagnosis, and imaging results between the two groups (P >0.05).The surgery of PELD under the TESSYS endoscopic system or Mis-TLIF under the Quadrant system was performed by a same surgical team.Follow-up was conducted for 12-24 months (mean, 16.2 months).The operation time, blood loss, hospital stay, visual analogue scores (VAS) for back and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association ( JOA ) scores, MacNab criteria, and complications were compared between the two groups. Results As compared with the Mis-TLIF group, the PELD group had significantly shorter operation time [(72.0 ±18.7) min vs. (137.0 ±48.3) min, t=-6.857, P=0.000], less intraoperative blood loss [(28.0 ±14.7) ml vs.(314.0 ±13.6) ml, t=-11.831, P=0.000], and shorter hospitalization stay [(4.0 ±1.0) d vs.(10.0 ±3.0) d, t=-9.298, P=0.000].The scores of VAS of back and leg pain at 2 weeks and 3 months postoperation in the PELD group was lower than the Mis-TLIF group (P<0.05). The scores of ODI and JOA at 3 and 12 months postoperation in the PELD group were superior to the Mis-TLIF group (P<0.05).No significant difference was recorded in the MacNab criteria at 12 months postoperation between the two groups (P>0.05).There wasno significant difference in complication rate between the two groups. Conclusions Both PELD and Mis-TLIF are safe and effective for lumbar disc herniation.PELD has smaller incision, shorter operation time, and less blood loss as compared with Mis-TLIF.

Objective To investigate the influence of endothelial progenitor cells on the proliferation and differenti-ation of neural stem cells in vitro under the condition of co-culture. Methods We used the mature methods of iso-lation, culture and identification on cells to get the spinal cord NSCs and peripheral blood EPCs from the SD rats, and then put them together in the Transwell chamber in vitro. Set the untreated NSCs as a control group. On the 4th day, we calculated the number and diameter of neurospheres. After that, removing the insert of transwell with EPCs, and inducing the NSCs to differentiate. On the 7th day, we conducted MAP-2 immunofluorescence staining on the cells of induced-differentiation group with fluorescence microscopy, then observed the expression of the anti-gen and calculated the percentage of the differential neurons in the NSCs. All the data were analyzed using statisti-cal method. Results The average number of neurosphere in co-culture group was 10.3±2.2,it was significantly more than that in the control group, and the diameter was under the same situation,the average diameter was up to (49.0±5.3)μm. The percentage of the cells which differentiated into neurons in the co-culture group was signifi-cantly higher than that in the control group, the percentage was(32.1±1.8)%. Conclusion EPCs promote the proliferation of NSCs and induce the differentiation of NSCs into neurons in vitro.

Objective To explore the value of diffusion weighted imaging (DWI)as a quantitative analysis tool for chronic cervical spondylotic myelopathy (CSM)with 3.0T MRI.Methods Cervical routine MR T2-weighted imaging(T2 WI)and diffusion weighted imaging were performed in 38 patients with cervical spondylotic myelopathy (CSM group)and 20 healthy volunteers (control group),and sagittal image of apparent diffusion coefficient (ADC)was reconstructed.The number of high T2 signal of the spinal cord were calculated in both healthy volunteers and CSM patients.The ADC values of CSM groups were measured in C3,T1 -C2 level and the compression or abnormal signal parts of the spinal cord;the control group measured C3、C4-C6 and T1 -T2 level in the spinal cord.Results There were 3 cases,1 case,6 cases and 8 cases high T2 signals in CSM patients from Ⅰ to Ⅳ levels,while there were 2 cases show high T2 signals in control group,respectively.The mean ADC values of the compression part were gradual-ly increased in CSM group from Ⅰ to Ⅳ level.There were significant differences of the mean ADC values of compression part be-tween the control group,CSMⅠ-Ⅱ level and the CSM Ⅳ level.Conclusion From our study,the change of ADC value of spine cord occured earlier than the change of signal in CSM patients.Therefore,the ADC value of spine cord might reflect the degree of spinal cord compression from CSM patients.

Objective To evaluate the curative effects of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) on MMF-related chronic diarrhea in the renal transplant (RT) recipients of long-term stage following transplantation.Methods Twenty-six RT recipients with persistent and severe diarrhea,diagnosed as MMF-related diarrhea after a systemic examining procedure including macroscopic and microscopic examinations of the upper and lower gastrointestinal tracks,serology of the blood for CMV and culture of stool for the bacteria.In all the 26 recipients,the dosage of MMF was reduced to 250 mg,twice every day for 2 weeks.Those without significant improvement at the end of this period were shifted to EC-MPS at a dose of 180 mg,twice every day for 2 weeks.The EC-MPS dose was increased to 360 mg,twice every day if the symptoms were improved significantly at the third week after conversion,or EC-MPS was withdrawn if the diarrhea still existed.The dosage of EC-MPS would be reduced to 180 mg,twice every day if the diarrhea recurred in the next 3 months. The clinical symptoms,biological parameters and renal function were observed for 3 months after the conversion.Results ( 1 ) All the 26 recipients were switched to EC-MPS because of the persistent existence of diarrhea after reduction of MMF.After conversion,the diarrhea disappeared completely in 19 out of the 26 recipients in 2 weeks and 2 patients also showed significantly improvement of diarrhea with the total efficiency being 80.8％ (21/26).In the rest 5 cases,EC-MPS was withdrawn at the second week; (2) The disturbance of internal environment was improved significantly following the EC-MPS conversion.Serum potassium,sodium and TCO2 were elevated to normal level.The benefit was predominantly observed in the recipients with moderate to severe proteinuria.The 24-h urinary protein secretion was significantly reduced from 0.76±0.48 to 0.46±0.53 (g/24 h) (P＜0.05) at the third month.Conclusion In RT recipients with MMF-related chronic diarrhea after long-term stage following renal transplantation,switching MMF to EC-MPS can significantly alleviate the diarrhea and rectify the imbalance of internal environment of the recipients.

Objective To explore the effects of cyclosporin A (CsA) and tacrolimus (Tac) on biological behaviors of lung cancer A549 cells in nude mice.Methods Thirty-six models of transplanted tumor in Balb/c mice were established by using lung cancer A549 cells and divided into three groups:control group,without given any immunosuppressant; CsA group,intraperitoneally given CsA; Tac group,intraperitoneally given Tac.The transplanted tumor growth curve was drawn according to the transplanted tumor volume,and the influencing ratio was calculated according to the final tumor weight.The changes in cell migration ability were observed by using Transwell system.Terminal deoxynucleotidyl transferase mediated UTP nick end labeling (TUNEL) assay was used to examine the apoptosis index of the transplanted tumor.Quantitative RT-PCR was used to detect the expression levels of Bcl-2 mRNA and Bax mRNA.Results The growth of transplanted tumor in CsA and Tac groups was faster than in control group.Final tumor volume and final tumor weight in CsA and Tac groups were greater than those in control group.The influencing ratio in CsA and Tac groups was 19％ (P＜0.05) and 25％ (P＜0.05),respectively.The migration ability was greater in CsA and Tac groups than in control group (P＜0.01).The apoptosis index of the transplanted tumor in CsA and Tac groups was lower than in control group (P＜0.05).The expression level of Bcl-2 mRNA was higher in CsA and Tac groups than in control group (P＜0.05),and that of Bax mRNA was lower in CsA and Tac groups than in control group (P＜0.05).Conclusion Both CsA and Tac can promote the growth of transplanted tumor in nuce mice bearing 549 cells and enhance the invasion forces,which is probably related with the apoptosis induction of tumor cells.

Objective To summarize the clinical experience of combined liver and kidney transplantation (CLKT). Methods CLKT was performed on 22 patients. The orthotopic liver transplantation (LT) was preceded with the classic fashion in 10 patients and piggyback fashion in 12 patients. The renal allograft was implanted to the iliac fossa routinely. After operation, the patients received an induction therapy with anti-CD25 monoclonal antibody or antithymocyte globulin ( ATG) and a maintenance therapy with tacrolimus (Tac), mycophenolate mofetil and prednisone. Results The CLKT was successfully performed on all 22 patients, and the graft function was restored well postoperation. During the perioperative period, an acute rejection episode of liver occurred in one patient and acute renal allograft rejection episode in 2 patients. The Tac toxicity occurred in one patient. The hemorrhage of digestive tract occurred in one recipient and the hemorrhage of peritoneal cavity in one patient. The pleural effusion occurred in 6 recipients. The pneumonia occurred in 2 cases and the peritoneal infection in one patient During a follow-up period of 6 months to 7 years 11 months, three patients died because of cytomegalovirus pneumonia in 2 patients and acute myocardial infarction in, one patient, The 1-, 3-, 5-year survival rate of recipients was 86,4 %, 81.3 %, 72.7 % respectively. Conclusion The CLKT is an effective method for treatment of patients with end-stage liver djsease and chronic renal failure.

Objective To introduce the applied value of Soap-Bubble reformatting and quantitative analysis of coronary MRA.Methods Reformatting and quantitative coronary of 3D coronary MRA were performed in twenty cases by using Soap-Bubble visualization following computer-assisted image segmentation respectively.The average vessel length,diameter and sharpness of coronary vessel can be measured.The imaging of coronary vessel was quantitative analyzed.Results 3D coronary MRA was successfully completed in 20 cases.The average vessel length of RCA /LM+LAD/LCX was(111?31) mm/(84?14) mm/(48?12) mm.The average vessel diameter of RCA /LM+LAD/LCX was(3.0?0.4 mm)/(2.9?0.3) mm/(2.4?0.2) mm.The sharpness of RCA /LM+LAD/LCX was(44?13)%/(43?15)%/(31?18)%.Conclusion Soap-Bubble enables the simultaneous display of multiple coronary segments in one 2D representation.The coronary vessel can be quantitative analyzed.

Objective To assess the change of the CD4~+ CD25~+ Treg after the transplant nephrectomy in recipients suffering from chronic allograft nephropathy (CAN) with normal PRA level.Methods Thirty recipients suffering from CAN,aged 20-55 years old,with norlTlal PRA level,were divided into two groups:removal group (n=17) and preserving group(n=13).CD4~+ CD25~(high)/CD4~+,CTLA-4 and Foxp3 in peripheral blood were tested at two time ends:O month and 2 months after the transplant nephrectomy operation.Results (1) Ratio of CD4~+ CD25~(high)/CD4~+ at the Oth and 2nd month in the removal group was(1.47±0.19)%,(1.08±0.16)%,and that was(1.44±0.25)% and (1.77±0.24)%,at the same time in the preserving group (P<0.01).(2) The expression of CTLA-4 at the Oth and 2nd month in the removal group was (76.82±5.31)% and (72.56±4.99)%,and that was (76.20±4.22)% and (75.24±4.26)% in the preserving group (P>0.05).(3)The expression of Foxp3 was (79.77±1.59)% and (69.07±4.37)% in the removal group,and that was (79.56±1.75)% and (79.09±2.05)% in the preserving group.The expression rate of Foxp3 at the 2nd month in the removal group was significantly lower than in the preserving group (P<0.01).Conclusion Remoral of the graft can reduce the ratio of CD4~+ CD25~(high)/CD4~+ and the expression of Foxp3,suggesting that the removal of the renal graft may inhibit the activity of CD4~+ CD25~+ Treg.

Objective To observe the effects of Dengzhanhua Capsule on kidney tissue inflammatory cytokines in chronic renal failure rats;To explore its possible mechanism for the efficacy in chronic renal failure. Methods Sixty SD rats were randomly divided into normal control group, model group, benazepril group and Dengzhanhua group, 15 rats in each group. Chronic renal failure rat model was established by Platt 5/6 nephrectomized. Benazepril (0.29 mg/100 g) was given to rats in the benazepril group by gastrogavage. Dengzhanhua Capsule (0.3 g/100 g) was given to rats in the Dengzhanhua group by gastrogavage. Normal saline was given to rats in the normal group and the model group by gastrogavage. The whole treatment period was twelve weeks. Expressions of TGF-β1 and PAI-1 were determined by semi-quantitative RT-PCR after treatment. Concentrations of kidney tissue inflammatory cytokines IL-6 and TNF-α were determined by ELISA. Results Expressions of TGF-β, PAI-1 and IL-6, TNF-αin benazepril group and Dengzhanhua group were significantly lower than those in model group (P<0.05). Compared with benazepril group, it was significantly lower in Dengzhanhua group (P<0.05). Conclusion Dengzhanhua Capsule can reduce kidney tissue inflammatory in chronic renal failure rats, and inhibit renal fibrosis.

Objective To determine the frequency of Th22 cells and expression of their related cytokines in peripheral blood of patients with alopecia areata(AA), to investigate their significance, and to explore the role of T lymphocytes in the occurrence of AA. Methods A total of 38 patients with AA were enrolled from Central Hospital of Minhang District in Shanghai between January 2015 and May 2016, and served as the case group. At the same time, 38 healthy people served as the control group. Peripheral blood samples were obtained from these patients and controls. Flow cytometry was performed to determine the percentage of Th22 cells, and enzyme?linked immunosorbent assay(ELISA)to measure serum levels of interleukin?22(IL?22)and IL?17. Results Compared with the control group, the case group showed significantly increased percentages of Th22 cells, Th17 cells, IL?17+IL?22+CD4+T cells and IFN?γ+IL?22+CD4+ T cells(all P < 0.01), as well as serum levels of IL?22 and IL?17(both P < 0.05). A significant increase was observed in percentages of Th22 cells, Th17 cells, IL?17+IL?22+CD4+T cells and IFN?γ+IL?22+CD4+T cells, as well as serum levels of IL?22 and IL?17, in patients with severe AA compared with those with mild AA, and in patients with active AA compared with those with stable AA (all P < 0.05). Conclusion Th22 cells and their related cytokines may participate in the occurrence, development and prognosis of AA.