[Objective]To discuss the surgical treatment of huge tumor invovled sacrum.[Method]A review of records in 18 patients with tumors invovled sacrum was made.Age at surgery averaged 43 years(range:31~65),eleven patients were male,seven patients were female.In this series,malignant tumor was in 14 cases,according to Enneking classification,these cases were classified toⅠA~ⅠB subtypies,which concluded chordoma(8 cases),giant cell tumor(5 cases)and osteochondroma(1 case).Benign tumor was in 4 cases with neurogenic tumor(3 cases)and aneurysmal bone cyst(1 cases).[Result]Over all,no patients were dead in the operation,no other major complications were occurred,the blood loss during surgery was 1 000 ml to 5 000 ml.All incisional wound were primary healing except 4 cases,two of them gained secondary closure after gluteus maximus pushing flap.Eighteen patients gained follow-up visiting,the average time of follow-up was 30 months,only 2 cases were tumor recurrence.[Conclusion]Huge tumors invovled sacrum present a great challenge,because of many organs surrounding sacrum invovled and complexity in anatomic region,sacrectomy of sacral tumor always complic generous blood loss,disorder of urination and defecation,disorder of sexual function et al.Abdominosacral approach can lead to a safer and relative radical local control of tumor,it is benefit to protect blood vessel and nerves.

Objective To present a modified technique of total cystectomy and ileal neobladder. Methods Radical cystectomy and ileal neobladder were performed for 25 male patients. The dome, the upper part or the lateral walls and the base of the bladder were dissected antegradly. After cutting the ureters, the mobilization was then made retrogradly.For the construction of the reservior, the isolated 40 cm ileal segment was opened along its antimesenteric border and then arranged into a W shape. The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum. The ureters were implanted at the two corners of W shape with antireflux nipple. Results 24 of 25 cases of ileal neobladder have been followed up for 2 to 84 months with a mean of 24 months.The operation took 150 to 310 minutes with a mean of 240 minutes. The intraoperative blood transfusion was 0 to 1200 ml.1 patient died of cancer metastasis. 23 patients have achieved excellent daytime continence,whereas only 14 had nighttime continence. The mean bladder capacity for the entire group was 310 ml. Renal functions of 2 patients were mildly abnormal.Hypokalemia occurred in 2.There was no metabolic acidosis.There were 3 cases of hydroureter or hydronephrosis on one side. 1 calculus of neobladder was discovered on BUS. On voiding cystography, no reflux has been noted in all.And no patient suffered from urethral recurrence. Conclusions The modified total cystectomy and ileal neobladder takes less time and is more feasible.

Objective To investigate the effect of stress level on blood coagulation and fracture healing in fracture patients.Methods The clinical data of 50 fracture patients (fracture group) and 50 healthy volunteers (control group) were analyzed retrospectively.The oxidative stress indexes [superoxide dismutase (SOD) and malondialdehyde (MDA)] and blood coagulation indexes [plasma fibrinogen (Fib),activated partial thromboplastin time (APTT),thronbin time (TT),and prothrombin time (PT)] were compared between the 2 groups.Correlation between stress level and coagulation indexes in the fracture patients was analyzed by Spearman correlation coefficient.The correlation between stress level and the progress of fracture healing in fracture patients was analyzed.Results There were no significant differences in APTT,TT,PT or other blood coagulation indexes between the 2 groups (P ＞ 0.05).The fracture group had a significantly lower SOD level but significantly higher MDA and Fib levels than the control group (P ＜ 0.05).Spearman analysis showed that the SOD level was negatively correlated to the Fib level (P ＜ 0.05) while the MDA level was positively correlated to the Fib level in the fracture group (P ＜ 0.05).The MDA level was negatively correlated to the process of fracture healing (P ＜ 0.05) while the SOD level was positively correlated to the process of fracture healing in the fracture group (P ＜ 0.05).Conclusions Traumatic fracture can cause stress reaction.It should be kept in mind that the severity of stress reaction is closely related to the Fib level and the process of fracture healing.

Objective To explore the diagnosis and treatment of tumor associated gastrocolic fistula (GCF).Methods The records of the 4 patients with GCF between August 2008 to February 2014 were retrospectively analyzed.Three female and one male patients,those whose average age were 61 years,have been pathologically diagnosed postoperatively as gastrocolic fistula caused by malignant diseases.The main clinical symptoms were diarrhea (3 cases),fecal vomitus (3 cases),weight loss (4 cases),and abdominal pain (4 cases).Positive diagnostic tests for GCF included gastroscope (3 cases),colonoscope (1 case),barium enema (1 case),upper gastrointestinal contrast (2 cases).Results En-bloc resection of the involved gastrocolic region have been performed for all,2 patients underwent radical gastrectomy and colon resection and 2 patients were taken on palliative procedure.Pathology indicated adenocarcinoma all,Immunohistochemical detection for CK20,CDX-2 were applied for identifying the originations of tumors.Delayed gastric emptying and DIC occurred in one patient who died in 3 months after the operation,anastomotic leakages were found in 2 cases.The survival patients were all discharged and taken capecitabine combined with Oxaliplatin for chemotherapy.Conclusions Endaoscopy and gastrointestinal imaging are main evidences for diagnosis of GCF.En-bloc resection of the involved gastrocolic region were recommended,enterostomy was safer than entero-anastomosis in one stage procedure.The originations of tumors may be identifying according to the pathological characteristic and CDX-2,CK20 staining.Adjuvant chemotherapy should be applied.

Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

Objective To explore the effect of Latexin (Lxn) gene transfection on proliferation of CD13;MIAPaca-2 pancreatic cancer stem-like cells.Methods CD133+ MIAPaca-2 cells were isolated and sorted by magnetic activated cell sorting from pancreatic cancer MIAPaca-2 celt line.CD133+ MIAPaca-2 cells were cultured in serum-free medium and the capacity for proliferation,and tumorigenicity of CD133+ MIAPaca-2 cells was determined by the floating spheres test and tumor xenograft assays.The CD133+ MIAPaca-2 cells were transfected with Lxn plasmid (1,3,5 μg).After transfection,the protein and mRNA expression of Lxn in CD133+ and CD133+-MIAPaca-2 cells were detected by Western blotting and RT-PCR,respectively.Cell proliferation was assayed by CCK-8.Results CD133+ MIAPaca-2 cells were successfully isolated,and it grew into a ball-suspended way,the tumorigenicity rate in nude mice with subcutaneous injection 1 × 105 cancer cells was 100％.After Lxn plasmid transfection,the expression of Lxn in CD133+ MIAPaca-2 cells was increased in a dose dependent manner,the Lxn protein and mRNA expression of tumor cells transfected with 5 μg plasmid was 20.80 ±0.98,16.80± 2.73,which was significantly higher than that in non-transfected cells (1.02 ± 0.01,1.01 ± 0.01),and the difference between the two groups was statistically significant (P ＜ 0.05).After transfection,cellular proliferation activity also showed a transfection dose and culture time-dependent decrease,the inhibition rate of tumor cells transfected with 0.4 μg plasmid was 36.2％,which was significantly different from that in non-transfected cells (P ＜ 0.05).Conclusions CD133+ MIAPaca-2 pancreatic cancer cells have some characteristics of cancer stem cells.Lxn gene transfection can inhibit the proliferation of CD133+ MIAPaca-2 cells.

Objective To explore the necessity and effectiveness of type-based acupuncture treatment for cervical spondylosis. Method Two hundred and forty patients with clinically common cervical spondylosis, cervical spondylotic radiculopathy or cervical spondylotic vertebral arteriopathy, 80 cases each type, were enrolled. Every type of patients was randomly allocated to observation and conventional groups. The observation group (120 patients) received type-based acupuncture treatment. Cervical spondylosis was treated by syndrome differentiation; cervical spondylotic radiculopathy, from the spleen and stomach; cervical spondylotic vertebral arteriopathy, with nape five-needle acupuncture. Every type of the conventional group (120 patients) received the same therapeutic method (conventional selection of acupoints). Before and after five and ten sessions of treatment, cervical spondylosis and cervical spondylotic radiculopathy were scored using the CSAS and the VAPS and cervical spondylotic vertebral arteriopathy was scored using the ESCV. The overall therapeutic effects were evaluated after ten treatments. Result Of the patients with cervical spondylosis, there were statistically significant pre-/post-treatment differences in the CSAS and VAPS scores in the two groups (P<0.05, P<0.01) but no statistically significant differences in the scores between the groups (P>0.05). Of the patients with cervical spondylotic radiculopathy, there were statistically significant differences in the CSAS and VAPS scores in the two groups after five treatments compared with before (P<0.05) but no statistically significant differences in the scores between the groups (P>0.05);after ten treatments there were statistically significant differences in the scores in the two groups compared with before (P<0.01) and also between the groups (P<0.05). Of the patients with cervical spondylotic vertebral arteriopathy, there was a statistically significant difference in the ESCV score in the observation group after five treatments compared with before (P<0.01);the score also decreased in the conventional group (P<0.05);there was a statistically significant difference between the groups (P<0.05);after ten treatments there was a statistically significant difference in the ESCV score in the two groups compared with before (P<0.01) and also between the groups (P<0.05). After ten treatments, the cure and marked efficacy rate and the total efficacy rate were 76.6%and 92.8%, respectively, in the observation group and 54.2%and 86.0%, respectively, in the conventional group. There was a statistically significant difference in the cure and marked efficacy rate between the two groups (P<0.01). Conclusion Type-based acupuncture can markedly improve the clinical therapeutic effect on cervical spondylosis.

Objective To observe the changes of telomere length and MMPs level in human fibroblasts induced by UVB, and to explore their roles on skin photoaging .Methods Human skin fibroblasts were extracted and cul-tured.The 5th fibroblasts were irradiated by UVB .The morphology of fibroblasts were microscoped , and the length of telomere and the mRNA expression of COL1a1 and hTERT were detected by RT-qPCR.The expression of MMP-3 and MMP-1 were detected by Western blot .Results The fibroblasts gradually became round , wrinkled and disorderly arranged after 30 mJ/cm2 UVB irradiation for 24 h.The mRNA level of COL1a1 and hTERT and the expression of MMP-3 and MMP-1 were significantly increased after UVB irradiation compared with control , and the length of telomere was shortened .Conclusions UVB may frigger the early process of photoaging by the morphologi-cal changes of human skin fibroblasts and increasing the expression of MMP-3 and MMP-1 .

BACKGROUND:Clinical resection of thoracolumbar spinal tumor has a great impact on the spinal stability. Positive internal fixation is required clinicaly in order to maintain the spinal stability. The use of titanium mesh implantation can provide a firm internal fixation folowing resection of tumors. OBJECTIVE:To explore the spinal stability undergoing titanium mesh implantation with internal fixation folowing thoracolumbar tumor resection. METHODS:Twenty-four patients with thoracolumbar tumor admitted at the Central Hospital of Suining City from September 2013 to September 2014 were randomly selected and given tumor resection folowed by titanium mesh implantation with internal fixation. After treatment, patients were folowed up for 1-12 months to observe and analyze the neural functional recovery and spinal stability of the patients. RESULTS AND CONCLUSION:Al the 24 patients successfuly completed the operation treatment, and there was no case of death at the end of folow-up. During the folow-up, patient's clinical symptoms and neural function were significantly relieved, and Frankel classification was significantly improved after treatment. Regular X-ray examination showed that there was no change in the position of titanium mesh and anterior internal fixation system. There was also no titanium mesh colapse, internal fixation fracture and loosening, and the spinal stability was stil excelent. These findings indicate that patients were not changed, and did not appear because the amount of loose, good spinal stability. Resection of thoracolumbar tumors showed that the thoracolumbar spinal reconstruction with titanium mesh implantation combined with internal fixation folowing tumor resection can obtain good clinical effect and excelent biocompatiblity.

Objective To investigate the effect of ultrasound-guided serratus plane block onefficacy of postoperative analgesia in patients undergoing radical mastectomy. Methods From January 2013 to December 2016, sixty-eight ASA physical statusⅠorⅡ patients scheduled for radical mastectomy under general anesthesia were randomly divided into two groups (n = 34 each): SP block group (observation group) and control group. After induction of anesthesia, ultrasound-guided homolateral SP block was performed, and 0.375% ropivacaine 20 ml was injected in observation group, while the equal volume of normal saline was used instead in control group. The patients received patient-controlled intravenous analgesia (PCIA) with sufentanil after operation in two groups. The scores of prince henry pain scale (PHPS) were evaluated at the 2nd, 4th, 8th, 12th and 24th hour (T1, T2, T3, T4, T5) after operation. The consumption of sufentanil, propofol and remifentanil was recorded.Meantime, the times of successfully delivered doses (D1) and attempts (D2) within 24 h after operation were added up, and D1/D2 was calculated. The adverse effects were also recorded. Results The scores of PHPS at T1 [(1.4 ± 0.5) scores vs. (3.1 ± 0.6) scores], T2 [(1.5 ± 0.6) scores vs. (2.9 ± 0.8) scores], T3 [(1.7 ± 0.5) scores vs. (2.8 ± 0.7) scores], and the consumption of sufentanil [(53.4 ± 16.7)μg vs. (87.8 ± 24.5)μg], remifentanil[(288.7 ± 42.1)μg vs. (376.5 ± 61.6)μg] were significantly lower in observation group than those in control group, while D1/D2 (0.89 ± 0.12 vs. 0.57 ± 0.18) was higher (P<0.05). The incidence of adverse reactions was significantly lower in observation group: 0 vs. 20.6% (7/34), P<0.05. Conclusions Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.