Lumbar interbody fusion is a surgical method for treating lumbar degenerative diseases. By establishing the stability of the lumbar segment, it solves the related symptoms caused by lumbar degenerative diseases. Minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) is a mature technology for treating lumbar degenerative diseases and improving the stability of the lumbar segment. In recent years, the emergence of lumbar interbody fusion under the small-channel working tube has made it have more minimally invasive characteristics compared to MIS-TLIF, with smaller incisions, less bleeding, and shorter recovery time. However, due to its long operation time, low efficiency of endplate treatment, and high complications incidence rate, it has not been widely popularized. At present, the large-channel endoscopic system, because of its larger field of view under the endoscope and more efficient endoscopic operation tools, reduces the operation time, improves the efficiency of endplate treatment, and reduces the postoperative related complications incidence rate. According to the surgical approach, it can be divided into transforaminal approach, posterior approach, oblique anterior approach, etc. According to the channel mode, it can also be divided into uniaxial endoscopy and unilateral dual-channel endoscopy, and each has its own advantages and disadvantages. Nowadays, the safety and effectiveness of spinal endoscopic posterior lumbar interbody fusion(Endo-PLIF) under the large-channel have achieved satisfactory results. This article reviews the research progress of Endo-PLIF under the large-channel, including surgical indications and contraindications, anatomical basis, surgical techniques, the choice of cages, the choice of fixation methods, safety and effectiveness, advantages and disadvantages, and explores its clinical application and prospects.

Objective:To analyze the alternative splicing (AS) events of patients with thyroid carcinoma (THYC) and explore the correlation between AS events and the prognosis of THYC.Methods:The clinical data and the Percent Splice In (PSI) value of AS events of THYC were downloaded from The Cancer Gene Atlas (TCGA) database and the TCGA SpliceSeq database respectively. The occurrence of seven kinds of AS events including AA, AD, AF, AP, ME, ES and RI in THYC was investigated and the matrix of AS events and survival data was constructed. Univariate Cox regression analysis was used to screen AS events related to prognosis of THYC. To avoid over-fitting, the least absolute shrinkage and selection operator (LASSO) regression analysis was performed. Then Multivariate Cox regression analysis was used to construct prognosis model. Kaplan-Meier curve and receiver operating characteristic (ROC) curve were performed to evaluate the prognosis ability of the risk model. We also used Pearson correlation analysis to select splicing factors (SF) which were correlated with survival associated AS events. Above SF genes were enrolled to gene ontology (GO) enrichment and KEGG pathway analysis.Results:A total of 10 447 genes and 45 150 AS events in 507 THYC patients were found in the present study. Among them, ES was the main type (38.84%) and ME was the type with the least frequency (0.51%). Totally 1 842 AS events associated with prognosis of THYC patients were identified. Three AS events including USHBP1-48249-AA、CACNB1-40626-AT and BEX5-89679-AP were selected to construct the prognosis model. The risk score of 0.807 was indicated as the best cut-off value of prognosis model. The patients were divided into high-risk group (240 cases) and low-risk group (241 cases) based on the risk score. The results demonstrated that the risk model could be used as a valuable prognostic factor for THYC ( P<0.001, AUC=0.929). The SF-AS network was constructed and several SF genes, including CDK12, RBM25, DDX39B, SRRM2 and DDX46 were identified as hub genes. Conclusions:The risk model based on 3-AS events was valuable prognosis predictor of THYC. The SF-AS network provided new insight for the exploration of tumorigenesis and development of THYC.

Objective To investigate the morphological changes of the brainstem in patients with Alzheimer's disease (AD) and their relationship with hippocampal morphological changes.Methods Sixty AD patients (AD group) and sixty age-and gender-matched normal elderly (normal control group) were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database.The hippocampus and the brainstem of each subject were segmented and their normalized volumes were calculated.According to the hippocampal volume standard value (Z-score),AD patients were divided into two subgroups (hippocampal atrophy group (n=51) and hippocampal spared group (n=9)).A voxel-based morphology (VBM) study was also performed to investigate the morphological differences of the brainstem between the normal control group and the AD group,as well as between the AD subgroups.Results Compared with the normal control group,the brainstem volume in the AD group decreased significantly (16 741.31±1 739.11 vs 15 609.67±1 451.60,t=3.870,P=0.001).In AD subgroups,the volume of the brainstem in the hippocampal atrophy group was significantly smaller than that in the hippocampal spared group (16 556.30 ± 1 514.86 vs 15 442.62 ± 1 389.05,t=2.189,P=0.033).Pearson correlation analysis showed that Mini-Mental State Examination scores were positively correlated with the hippocampal and the brainstem volumes (r=0.590,P＜0.01;r=0.234,P＜0.05),and there was a positive correlation between the hippocampal and the brainstem volume changes in patients with AD (r=0.315,P=0.014).VBM results showed that both the bilateral midbrain and the bilateral pons in the AD group had significant atrophy compared with the normal control group (P＜0.05).In the AD subgroups,the bilateral midbrain and the left pons in the hippocampal atrophy group were significantly atrophied compared with the hippocampal spared group (P＜0.05).Conclusion The brainstem showed morphological changes in patients with AD,and the morphological changes of the brainstem in AD patients with different degrees of hippocampal atrophy were different,indicating the morphological changes of the hippocampus and the brainstem may have an interrelated relationship.

¹⁸F-FDG PET-CT is recommended for the diagnosis and treatment of non-small cell lung cancer (NSCLC), and guiding the optimization of radiotherapy planning. The target area determined by biological information carried by functional images is defined as biological target volume (BTV). However, BTV significantly differs from the gross tumor volume (GTV) and internal target volume (ITV) defined by the International Commission on Radiation Units and Measurements (ICRU) report. It is still a challenging task to directly apply BTV to radiotherapy planning. The limitation of PET image, the accuracy of fusion with auxiliary anatomic images and the influence of respiratory movement cause the uncertainty of BTV definition in NSCLC patients. Referring to different anatomical images, multiple approaches can be employed to achieve BTV motion information compensation. Application of PET-CT in predicting the prognosis of NSCLC patients after radiotherapy and distinguishing the recurrence risk of biological sub-target contribute to achieving the dose planning for radiotherapy planning.

Objective: To investigate the influencing factors of the dose coverage of unplanned internal mammary lymph node (IMN) irradiation in patients receiving chemotherapy after mastectomy. Methods: Clinical data of 138 patients receiving radiotherapy in the upper and lower lymph node drainage area of the thoracic wall and clavicle [three-dimensional conformal radiotherapy (3DCRT), field-in-field forward intensity-modulated radiotherapy (F-IMRT) or inverse IMRT (I-IMRT)] were retrospectively analyzed. The IMN was delineated according to the Radiation Therapy Oncology Group (RTOG) criteria. The unplanned irradiation dose of the IMN was obtained. The correlation between the IMN irradiation dose, clinical characteristics and specific parameters of radiotherapy during the unplanned irradiation was statistically analysed. Results: The mean dose of unplanned IMN irradiation was 32.85 Gy (range: 2.76-50.93 Gy). In total, 7.3% of breast cancer patients obtained the therapeutic dose of≥ 45 Gy. Body weight, body mass index (BMI), body surface area (BSA) and thoracic transverse diameter (D_T) were lower, whereas the planning target volume of IMN (VIMN) included in the chest wall PTV (IMNin) and the ratio of IMNin to V_IMN were higher compared with those of their counterparts with insufficient therapeutic dose. Multivariate regression analysis demonstrated that body weight, thoracic anteroposterior diameter (D_AP), D_T, R_IMNin and PTV volume were the influencing factors of the dose coverage of unplanned IMN irradiation (P=0.000, 0.000, 0.001, 0.000 and 0.034). Conclusions For patients receiving chemotherapy after mastectomy, the dose coverage significantly varies when the IMN is the unplanned target. Partial patients achieve the therapeutic dose. The dose coverage of unplanned IMN irradiation is influenced by physical characteristics, anatomical features and technical parameters of radiotherapy, which should be emphasized during the study design and result analysis.

Objective To investigate the clinical significance of individualized neoadjuvant chemotherapy for renal carcinoma to reduce side effects under the guidance of gene detection.Methods From January 2011 to March 2014,two hundred and twelve patients with renal carcinoma treated in Cangzhou Central Hospital were enrolled in the study and randomly divided into the gene detection group (102 cases) and non-gene detection group (110 cases).The gene detection group was detected by the real time fluorescence quantitative (RT-PCR) method and the drug sensitivity test was carried out,and the patients were given neoadjuvant chemotherapy based on the results of drug sensitivity test.The patients in the non-gene detection group were treated with the national comprehensive cancer network (NCCN) experience regimen.The incidence of chemotherapy side effects was compared between the two groups.Results The 1 year survival rate of the gene test group was higher than that in the non-gene detection group (87.25％ (89/102) vs.77.27％ (85/ 110),x2 =4.67,P＜0.05),and the 3 year survival rate increased (70.58％ (72/102) vs.64.54％ (71/110),x2 =4.510,P＜ 0.05) as well,the differences were statistically significant (P ＜ 0.05).The incidence of liver injury in the gene detection group was 17.64％ (18/102),which was lower than that in the control group 30％ (33/110),the difference was statistically significant (x2 =4.42,P ＜ 0.05).In the gene detection group,the incidence of leukocyte 3～4 level inhibition was 27.5％ (28/102),which was higher than that in the non-gene detection group 21.8％ (24/110).The difference was statistically significant (x2 =4.940,P ＜ 0.05).Conclusion Genetic polymorphisms detection is a guide to the application of tumor sensitive drugs in the individualized neoadjuvant chemotherapy of renal carcinoma.It can improve the therapeutic effect,and also reduce the occurrence of liver injury caused by side effects of chemotherapy and has high clinical application value.

Objective To evaluate the effect of α7 nicotinic acetylcholine receptor (α7nAChR)agonists on lung injury caused by cardiopulmonary bypass (CPB) in rats.Methods Eighteen healthy clean-grade adult male Sprague-Dawley rats,weighing 350-400 g,were divided into 3 groups (n =6 each)using a random number table method:sham operation group (group S),CPB group and α7nAChR agonist PHA568487 group (group PHA).The rats underwent no CPB and were mechanically ventilated for 60 min in group S.PHA568487 0.8 mg/kg (diluted to 2 ml in normal saline) was intraperitoneally injected at 30 min before CPB,and then CPB was performed for 60 min in group PHA.Normal saline 2 ml was intraperitoneally injected at 30 min before CPB,and then CPB was performed for 60 min in group CPB.Blood samples were collected from the internal jugular vein for determination of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations by enzyme-linked immunosorbent assay.Lung tissues were obtained for microscopic examination of the pathologic changes and for determination of wet/dry weight ratio (W/D ratio) and matrix metalloproteinase-9 (MMP-9) expression (by Western blot).Results Compared with group S,the W/D ratio and serum concentrations of TNF-α and IL-6 were significantly increased,and the expression of MMP-9 was up-regulated in CPB and PHA groups (P＜0.05).Compared with group CPB,the W/D ratio and serum concentrations of TNF-α and IL-6 were significantly decreased,the expression of MMP-9 was down-regulated (P＜0.05),and the pathological changes of lung tissues were significantly attenuated in group PHA (P＜0.05).Conclusion α7nAChR agonists can reduce the acute lung injury caused by CPB in rats,and the mechanism may be related to down-regulating MMP-9 expression and inhibiting systemic inflammatory responses.

Platinum-based anticancer drugs have been becoming one of the most effective drugs for clinical treatment of malignant tumors for its unique mechanism of action and broad range of anticancer spectrum. But, there are still several problems such as side effects, drug resistance/cross resistance and no-specific targeting, becoming obstacles to restrict its expanding of clinical application. In recent years, supramolecular chemistry drug delivery systems have been gradually concerned for their favorable safety and low toxicity. Supramolecular macrocycles-platinum complexes increased the water solubility, stability and safety of traditional platinum drugs, and have become hot focus of developing novel platinum-based anticancer drugs because of its potential targeting of tumor tissues/organs. This article concentrates in the research progress of the new drug delivery system between platinum-based anticancer drugs with three generations of macrocycles: crown ether, cyclodextrin, cucurbituril and calixarene.

OBJECTIVETo investigate the influence of digit-sucking habit on palatal features in pre-school children by using a laser scanning system.

METHODSForty pre-school children were chosen according to the results of questionnaires, among which 20 with digit-sucking habit(digit-sucking group) and 20 without any oral habits(control group). Impression of the upper jaw was taken from each child. After laser scanning the plaster casts, and three-dimensional reconstruction by the computer, parameters of anterior and posterior palatal length, width and height were measured, ratios of height/width, length/width and width ratio of anterior and posterior palatal were analyzed. The differences of palatal features between two groups were analyzed by t test.

RESULTSThere was statistical significance between digit-sucking group and control group in posterior palatal width, anterior palatal length and anterior palatal height. The ratios of height/width and length/width in both posterior and anterior areas were statistically significant (P < 0.05). Compared to the control group, the results indicated that palatal features were relatively deeper, narrower and more protrusive in digit-sucking group.

CONCLUSIONThe digit-sucking habit may have some deleterious impacts on the palatal features in pre-school children with primary dentition. And it is practical to measure the spacial palatal features by using laser scanning system to some extent.

Objective To explore the relation between IL-10 promoter region gene polymorphism and irritable bowel syndrome (IBS).Methods By polymerase chain reaction combined with restrition fragment length polymophism (PCR-RFLP),gene type of IL-10 promoter -1082 and -819 sites in 313 IBS patients and 281 controls was analyzed.Results The distribution of IL-10-1082 and-819 allele frequencies in IBS group,control group and total was in accordance with Hardy-Weinberg equilibrium law.The frequency of IL-10-819 T allele in diarrhea subtype (79.8％) and mixed IBS subgroup (77.1％) was significantly higher than that in control group (65.7％).There were no significant differences in IL-10-1082 A/G allele frequency between each subtypes and control group (P＞0.05),however there was statistically difference between diarrhea subtype and mixed IBS subgroup (P＜0.05).The frequency of-819 T/T genotype in IBS group (51.1 ％ )was significantly higher than that of control group (40.2％),the frequency of C/T genotype was significantly lower than that of control group,and the difference was statistically significant (all P＜0.05).The IL-10-819 T/T allele frequency of all IBS subtypes was significantly higher than that of control group; however C/T allele genotype frequency of all IBS subtypes was significantly lower than that of control group,and the difference was statistically significant (all P ＜ 0.05). There was no significant difference of C/C allele genotype between subtypes (P＜0.05).There was no significant difference of -1082 allele genotype between IBS group and control group (P＞0.05).The frequency of -1082 A/A genotype in diarrhea subtype of IBS patients (93.3％) was significantly higher than that of mixed IBS subtype (82.4％),while the frequency of A/G genotype was lower than that of mixed IBS subtype,and the difference was statistically significant (all P ＜ 0.05 ); there was no significant difference between other IBS subtypes and control group (P＞0.05).Conclusion IL-10-819 promoter T/Tgenotype may be related to IBS pathogenesis.