Objective To discuss the feasibility of application of anterior approach video-assisted thoracoscopic surgery (VATS) in thoracic and upper lumbar spine. Methods In the study there were: 5 patients with tuberculosis of thoracic or lumbar spine (T 6 ～ L 2) undergoing thoracoscopic cleaning of focus,with or without bone grafting; 3 patients with vertebral burst fracture ( T 10 ～ T 12 ) and 1 patient with old burst fracture (L 1) accompanied with cauda equina syndrome undergoing thoracoscopic decompression,bone grafting and plate screw internal fixation; 1 patient with intervertebral disc protrusion (T 3 ～ 4 ) accompanied with spinal compression receiving thoracoscopic decompression and spondylodesis. Results The incisions in all the patients healed by first intention.CT or MRI examinations revealed that: the foci had been cleaned thoroughly and the spinal cords had been decompressed completely; the reduction was satisfactory,except for 1 patient with slight angulation deformity; the internal fixation was stable,with proper position. Conclusions VATS focus cleaning is suitable for patients with diseases in thoracic or upper lumbar spine,regardless of whether there is compression of spinal cord or cauda equine or not,and,if necessary,spinal decompression,anterior bone grafting,or internal fixation may be conducted simultaneously.

Objective To explore the diagnosis ,treatment methods and clinical features of primary ureteral polyps.Methods Clinical data of 27 cases with primary ureteral polyps were analyzed retrospectively .The clinical features and treatment of this disease were analyzed .Results 7 cases were treated with polypectomy ,10 cases with basement fulguration by ureteroscopy operation or polyps-removing by ureter forceps ,4 cases with distal ureter resec-tion and termino-terminal anastomosis ,4 cases with lesions ureter resection and bilateral ureteric reimplantaion and 2 cases with nephrectomy due to nonfunctioning kidney .All cases were confirmed to be primary ureter polyp by pathology.All cases were followed up for 6-12 months with no recurrence and canceration ,only 1 case had ureteral stenosis.Conclusion Primary ureteral polyps is a benign disease with rare malignancy .The primary and effective treatment method is surgery which has few complications and good effect .

Objective: To investigate the effects of complex prescription astragalus mongholicus injection(复方黄芪注射液) on the serum concentrations of neuron-specific enolase(NSE),myelin basic protein(MBP) and S100 protein B(S100B) in cases with acute severe craniocerebral injury.Methods: One hundred and ninety-six patients with acute severe craniocerebral injury were randomly divided into two groups.The treated group was treated with complex prescription astragalus mongholicus injection plus conventional treatments including dehydration,antibiotics,organ functional support,nerve nutrition,prevention of complication,etc;the control group was treated with conventional treatments alone.The concentrations of NSE,MBP and S100B in plasma at admission and at 4,7 and 10 days after treatment were determined;the Glasgow coma score(GCS) at admission and at 1 week and 2 weeks after hospitalization and the Glasgow outcome scale(GOS) after 3 months were compared to observe the long-term efficacy in the patients.Results: After treatment,the concentrations of serum NSE,MBP and S100B in the treatment group were all lower than those in the control group,the differences being significant(NSE(14.62?3.38)?g/L vs.(21.54?5.68) ?g/L,MBP(7.52?1.06) mg/L vs.(10.21?2.01) mg/L,S100B(0.90?0.28) ?g/L vs.(1.20?0.34) ?g/L,all P0.05);the GCSs of the patients at 1 week,2 weeks and GOS at 3 months after treatment in the complex prescription astragalus mongholicus injection group were significantly higher than those in the control group(GCS, 1 week(9.8?2.6)score vs.(7.2?2.1) score,2 weeks(10.6?3.0) score vs.(7.8?2.2) score;GOS,3 months after treatment(4.8?1.0) score vs.(3.6?0.8) score,all P

Objective To study the effect of nucha electroacupuncture (NEA) on 5-hydroxytryptamine (5-HT) in cerebrospinal fluid (CSF) and blood of acute cerebral infarction (ACI) patients. Methods 72 cases with first ACI were randomly divided into NEA group (n= 38) and control group (n=34). Their 5-HT levels in CSF and blood were determined before and 4 weeks after treatment. Results Before treatment, the 5-HT in the CSF was (0.67±0.13) μmol/L in the NEA group and (0.71±0.11) μmol/L in the control group (P>0.05), while that in the blood was (0.44±0.19) μmol/L in the NEA group and (0.41±0.10) μmol/L in the control group (P>0.05). After treatment, the 5-HT in the CSF was (1.12±0.32) μmol/L in the NEA group and (0.83±0.15) μmol/L in the control group (P<0.05), while that in the blood was (0.87± 0.14) μmol/L in the NEA group and (0.63±0.07) μmol/L in the control group (P<0.05). Conclusion NEA can increase the 5-HT in both CSF and blood after ACI, which may facilitate to reduce post-stroke depression.

Objective To approach the methods and effects of internal fixation for Hoffa fracture. Methods A total of 26 patients with 26 condylar Hoffa fractures ( medial condylar fractures in 13patients and lateral condylar fractures in 13) treated from August 1993 to February 2010 were retrospectively analyzed.According to the Letenneur classification,there were 16 patients with type Ⅰ fractures,four with type Ⅱ fractures and six with type Ⅲ fractures.Among them,two patients were with open fractures and 24 with closed fractures.Surgical approaches including screw fixation in 21 patients and lateral support plate fixation in five were selected based on the fracture types and affected sides. Results All patients were followed up for 12.5-48 months (average 18 months),which showed fracture healing in all the patients within 3-4 months (average 3.5 months).Two patients had slight shift together with knee joint pain,ie,one patient had ROM of knee for 95 °,and one failed the functional exercise because of pain and had ROM of knee for 60° during follow up.No complications including infection,delayed union or bone necrosis occurred.According to Letenneur' s functional assessment system,the postoperative outcomes were excellent and good in 24 condyles,fair in one and poor in one. Conclusions Surgical treatment for Hoffa fractures is safe and effective,but the key point is to choose correct screw fixation position and orientation according to the fracture types and fracture fragment size.

Objective To assess the efficiency and methods of the interventional management in acute mesenteric venous thrombosis (AMVT). Methods Fifteen patients with AMVT who diagnosed by imageology were treated by interventional procedures. Eight patients were treated by transcatheter superior mesenteric artery thrombolysis with urokinase, 5 cases by percutaneous transhepatic treatment, 2 cases by transjugular intrahepatic portosystemic shunt approach. Results The technical success was achieved in all the 15 cases without complications. The majority of the thrombus was cleared by interventional procedures and flow restorated on the angiograms. All the patients with follow-up from 10 to 22 months showed no recurrence. Conclusion The minimally invasive interventional techniques are safe and effective in the treatment of mesenteric venous thrombosis without necrosis.

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years (ranged, 19-65 years). The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A (burst in 12 cases, type B (distraction) in 2 and type C (retortion) in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months (12-86 months). The radiograph showed obvious improvement on the injured body height (from 42.62％ preoperatively to 94.33％ postoperatively, P＜0.01) and the canal encroachment index (from 2.67 preoperatively to 0.14 postoperatively, P＜0.01). Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.

Objective:To investigate the effects of high-energy shock and vibration on cortex injury and peripheral blood immune cells in goats.Methods:Seventeen Boer goats without gender preference were selected. By using random number tables, the goats were divided into normal control group ( n=5) and shock and vibration injury group ( n=12). The goats in the normal control group were anatomized routinely and their brain was collected after being sacrificed without any other treatment. The goats in the high-energy shock and vibration model group were placed on a loading table (part of the BY10-100 instant shock and vibration simulation platform) in a restrained state, and made into a high-energy shock and vibration injury model induced by a vertical impact waveform generator. The intravenous blood samples were taken from the goats in the shock and vibration injury group before and at 0, 3, 6 and 24 hours after injury.Then, the goats were sacrificed and the following procedures were the same as the normal control group. At 24 hours after injury, the brain injury and the histopathological changes of the cerebral cortex in the normal control group and shock and vibration injury group were observed by gross pathological and anatomical examination and HE staining. The mRNA expression of zonula occludens 1 (ZO-1), tight junction protein 5 (Claudin-5), glial fibrillary acidic protein (GFAP), ionized calcium binding adaptor molecule 1 (IBA-1), interleukin (IL)-1β, IL-6 and cluster of differentiation antigen 177 (CD177) of the cerebral cortex in the normal control group and shock and vibration injury group were measured through fluorogenic quantitative polymerase chain reaction. The expression of ZO-1 and Claudin-5 proteins of the cerebral cortex in the normal control group and shock and vibration injury group were detected by Western blotting. Hematology analyzer and coagulation analyzer were used to detect white blood cell count, neutrocyte, lymphocyte, monocyte, prothrombin time 1 (PT-1), prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin activity (PTA) and fibrinogen (FIB) levels in goats of the shock and vibration injury group before and at 0, 3, 6 and 24 hours after injury, respectively. Results:At 24 hours after injury, no visible contusion or necrosis was found in goat brain tissue in the shock and vibration injury group; the cerebral micro-vessels presented with a local dilation, hyperemia, edema, aggregation of inflammatory cells, disruption of vessel walls and leakage of red blood cells. These changes were not observed in the normal control group. In the shock and vibration injury group, ZO-1 and Claudin-5 mRNA expressions in the cerebral cortex were 0.25±0.10 and 0.09(0.04, 0.44) respectively, which were significantly lower than those of the normal control group [1.00±0.15 and 0.99(0.80, 1.20)]; GFAP, IBA-1, IL-1β, IL-6 and CD177 mRNA expression levels were 4.40(3.88, 6.75), 2.60±1.07, 3.04±0.51, 2.71±0.45 and 2.93±0.62 respectively, which were significantly higher than those of the normal control group [1.00(0.78, 1.22), 1.00±0.37, 1.00±0.27, 1.00±0.57 and 1.00±0.35]; ZO-1 and Claudin-5 protein expression levels were 0.41±0.06 and 0.42±0.11 respectively, which were significantly lower than those of the normal control group (1.08±0.12 and 0.91±0.23) (all P<0.01). In the shock and vibration injury group, the levels of white blood count, neutrocyte, and lymphocyte in peripheral blood were (13.7±3.3)×10 9/L, (35.3±14.8)% and (57.2±15.1)% respectively before injury, (19.4±3.1)×10 9/L, (60.5±12.5)% and (33.6±14.2)% respectively at 3 hours after injury, and (20.6±3.6)×10 9/L, (63.6±13.0)% and (30.9±15.0)% respectively at 6 hours after injury. By contrast, the levels of white blood count and neutrocyte were significantly increased but the level of lymphocyte was significantly decreased at 3 and 6 hours after injury ( P<0.05 or 0.01); the levels of the above indicators showed no significant changes at 0 and 24 hours after injury (all P>0.05); the level of monocyte did not change significantly at all time points before and after injury (all P>0.05). The levels of PT-1, PT-INR, APTT, TT, PTA and FIB in the shock and vibration injury group did not change significantly at each time point before and after injury (all P>0.05). Conclusion:Cerebral cortex microvascular injury and disruption of blood-brain barrier can be initiated in the early stage of high-energy shock and vibration injury in goats, accompanied by the presence of central and peripheral inflammatory response.

【Objective】 To explore the efficacy of a comprehensive treatment strategy of bladder hydrodistension, transurethral resection of bladder lesions and triple drug instillation in patients with painful bladder syndrome (BPS). 【Methods】 A total of 15 female BPS patients treated during Jan.2020 and Oct.2021 were enrolled. All patients received bladder hydrodistension and transurethral resection. After operation, intravesical instillation of a triple-drug mixture (2% lidocaine hydrochloride 20 mL, heparin sodium 25 000 U, and dexamethasone 10 mg) was administered once a day for 5 days, and then once per week for 4 weeks. The Visual Analogue Scale (VAS) score, quality of sexual life, health-related quality of life, and self-rating anxiety scale score were compared before treatment and 1, 4 and 12 weeks after treatment. The complications were recorded. 【Results】 All patients completed the treatment. Of 14 patients, the VAS score and self-rating anxiety scale score were lower in week 1, 4 and 12 after treatment, while the health-related quality of life score increased. One patient’s symptoms remained unchanged. The VAS score decreased from (5.47±1.81) to (1.87±1.51) (P<0.05), and the self-rating anxiety scale score decreased from (18.13±8.64) to (6.33±8.22) (P<0.05). The score of health-related quality of life increased from (24.47±5.41) to (31.53±6.49) (P<0.05). 【Conclusion】 The comprehensive strategy is effective in the treatment of bladder pain syndrome, which can relieve pain symptoms and improve patients’ quality of life.

AIM: To investigate the relationship between vascular smooth muscle cell (VSMC) injury, organelle stress response and autophagic cell death (autophagy) and ferroptosis induced by the chemical hypoxia inducer cobalt chloride (CoCl2) through the bioinformatics analysis and in vitro cell experimentation. METHODS: The dataset GSE119226 of VSMC treated with cobalt chloride was acquired from the gene expression database (GEO). The R language was used to investigate the relationship between CoCl2 treatment and organelle stress response (Golgi stress, endoplasmic reticulum stress) and two forms of cell death (ferroptosis and autophagic cell death). With primary cultured rat VSMC (rVSMC) and CoCl2-induced anoxia model, the changes in cell viability were detected by CCK-8 method, and reactive oxygen species (ROS) levels were measured using DCFH-DA method. The expression levels of HIF-1α (a key molecule in hypoxia), Golgi stress markers GM130 and p115, endoplasmic reticulum stress markers GRP78 and CHOP, autophagy markers LC3-II / LC3-I and Beclin1, and ferroptosis markers GPx4 and xCT were detected by Western blot. The effect of inducing or inhibiting organelle stress and cell death on the CoCl2-induced cell damage was also observed. RESULTS: Differentially expressed genes analysis of GSE119226 dataset showed that CoCl2 treatment of VSMCs had significant effects on organelle function and stress response, autophagy and ferroptosis-related genes, in which endoplasmic reticulum stress, protein processing in endoplasmic reticulum, regulation of Golgi to plasma membrane protein transport, autophagy / autophagic cell death, and ferroptosis pathways were remarkably enriched. The results of in vitro experiment showed that compared with normal rVSMC, cell viability was significantly decreased after CoCl2 treatment, as well as HIF-1α protein expression and ROS levels in rVSMCs were increased. In rVSMC treated with Co-Cl2, the expression levels of Golgi structural proteins GM130 and p115 (reflecting the occurrence of Golgi stress) were decreased, while the markers GRP78 and CHOP (reflecting the occurrence of endoplasmic reticulum stress) were increased. At the same time, CoCl2 treatment also reduced the expression of autophagy markers LC3-II/LC3-I and Beclin1 (indicating the decrease levels of autophagy), while the expression of ferroptosis markers GPx4 and xCT were decreased (indicating the occurrence of ferroptosis). Compared with CoCl2 treatment group, induced Golgi stress, endoplasmic reticulum stress, or ferroptosis could further reduce cell viability, while inhibition of these processes could improve cell viability. On the other hand, increasing the level of autophagy can improve the cell viability. CONCLUSION: Hypoxia induced by cobalt chloride can lead to VSMC injury. Golgi stress, endoplasmic reticulum stress, ferroptosis, and the reduction of autophagy level play an important role in it. Inhibition of organelle stress response and ferroptosis, or increase of autophagy level can improve VSMC injury caused by cobalt chloride.