Objective To explore application value of transaxillary single-port gasless endoscopic-assisted fibroadenomas excision in adolescents.Methods A retrospective analysis was conducted on clinical data of 60 cases of fibroadenoma from June 2019 to June 2023.The patients were 17.3(range,13-19)years old.There were 54 cases of unilateral tumors and 6 cases of bilateral tumors.The average number of tumors was 2.5(range,1-13),and the mean tumor diameter was 4.0(range,3-10)cm.The fibroadenoma excision was performed by using transaxillary single-port gasless endoscopy.Results Of the 60 patients,the average operation time was 64.9(range,35-130)min and the intraoperative blood loss was less than 20 ml.Postoperative complications occurred in 5 cases(8.3％).At 3 months after surgery,the psychosocial well-being scores of BREAST-Q Scale were increased from(79.2±8.9)to(83.4±9.9)(P＜0.001).Conclusion Transaxillary single-port gasless endoscopic-assisted fibroadenomas excision is safe and effective for multiple or large fibroadenomas in adolescents,offering minimal invasion and concealed incision.

Objective:To explore the optimal match degree between thoracolumbar kyphosis (TLK) and lower lumbar lordosis (LLL) in adult spinal deformity (ASD) after correction surgery.Methods:Data of 119 ASD patients (male: 28, female: 91), belonging to the Affiliated Hospital of Jining Medical University (19 cases), the Affiliated Hospital of Shandong University of Traditional Chinese Medicine (11 cases), and the First Medical Center of Chinese PLA General Hospital (89 cases) were reviewed and documented from March 2019 to March 2020. All patients (age, 64.48±8.88 years; range, 45-79 years) underwent the surgical procedure of thoracolumbar fusion with instrumentations were followed up over 24 months (51.68±15.60 months; range, 24-87 months) after surgery. Postoperative proximal interface failure, Oswestry disability index (ODI) score and Scoliosis Research Society-22 (SRS-22) score were recorded for all patients. The immediate match of TLK to LLL postoperatively was calculated as follows: TLM=TLK/LLL. The data of those individuals with excellent improvements in the ODI (>50%) at the final follow-up were recorded and analyzed. Then the mean value and the 95% CI of TLM in those individuals were calculated. All participants were subdivided into three groups according to the 95% CI value of TLM. After the receiver operating characteristic curve (ROC) analyzing, the area under the ROC curve (AUC) was the best cutoff value of TLM. The association of proximal junctional failure (PJF) developing with the abnormal TLM postoperatively was analyzed with logistic regression, and the odds ratio (OR) was calculated. Results:62 patients had significant improvements in ODI (>50%) at the final follow-up, and the mean TLM in those individuals was 0.41 [95% CI (0.2, 0.5)]. All patients were divided into three groups: TLM<0.2 (35 cases), 0.2≤TLM≤0.5 (48 cases) and TLM>0.5 (36 cases). The preoperative TLK (13.87°±16.61°) and T 1 pelvic angle (19.69°±10.55°) in the those patients with TLM<0.2 were the smallest, and those were the largest in those with TLM>0.5 (30.59°±16.68°, 28.30°±14.46°). The individuals with TLM<0.2 still had the smallest TLK (2.89°±1.78°), however, those with TLM>0.5 had the largest TLK (17.13°±12.13°) and the smallest LLL (-26.16°±11.02°) accordingly. Additionally, the ODI and SRS-22 for those with 0.2≤TLM≤0.5 at the final follow-up were the best ( P<0.05). ROC curve analysis results showed that the best cutoff value of TLM was 0.4 (sensitivity=78.9%, specificity=76.2%; AUC=0.802, 95% CI (0.708, 0.896) , P<0.001). During the follow-up after orthopedic surgery, there were 19 patients with postoperative proximal junction failure, including 16 patients in the mismatched group (6 patients in the TLM<0.2 group, 10 patients in the TLM>0.5 group) and 3 patients in the matched group (0.2≤TLM≤0.5 group), with the incidence of 23% (16/71) and 6% (3/48), respectively. The difference was statistically significant (χ 2=5.66, P=0.017). Thoracolumbar mismatch was significantly associated with proximal borderline failure after orthosis [ OR=4.35, 95% CI (1.196, 15.924)]. Conclusion:The abnormal correction in thoracolumbar kyphosis and lower lumbar lordosis may result in mismatch between thoracolumbar segments, which would undermine the quality of life, and increase the incidence of proximal junctional failure developing in those ASD patients underwent long-fusion surgeries. The match between TLK and LLL should be 0.2 to 0.5.

Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.

Objective To explore the influence factor of the stability of L5S1 fusion and the relationship between the stability of sacrum fusion and the clinical outcome for degenerative lumber scoliosis with long-segment fusion.Metheds Fifty patients with degenerative lumber scoliosis who underwent the long-segment fusion from June 2010 to January 2015 were included in this retrospective study.Based on post-operative L5S1 fusion,patients were divided into two groups.There were 15 patients(30％,9 male and 6 female patients) with a failing sacrum fusion whose average age 60±7.6 years (range from 58 to 78 years).6 patients had the situation at T12-S1,7 at L1-S1 and 2 at L2-S1.There were 35 patients (70％,26 male and 9 female patients) with a satisfying sacrum fusion whose average age 58.4±4.8 years (range from 50 to 80 years).Among them,16 were at T12-S1,12 at L1-S1 and 7 at L2-S1 levels.The interbody fusion rate and accuracy of pedicle screws were evaluated by anteroposterior and lateral spine radiographs in standing and CT scanning during the postoperative follow-up.The age,body mass index (BMI),bone mineral density,Cobb's angel,lumbar lordosis (LL),sagittal vertical axis (SVA),thoracic kyphosis (TLK),sacral slope (SS),pelvic inclination (PI) and pelvic tilt (PT) were compared between the 2 groups to analysis the relevant factor of the failing L5S1 fusion.Oswestry disability index (ODI) and visual analogue scale (VAS) were compared between the 2 groups in the postoperative follow-up.Results There were no statistically significant difference between the 2 groups preoperative in the age,BMI,lumbar Cobb angel,LL,SVA,TLK,SS,PI and PT.But there was a significant difference between the bone mineral density of 2 groups.LL were-40.5°± 8.7° vs.-41.2°±7.9°;TLK were 1.7°±7.4° vs.1.8°±6.7°;SS were 32.1°±5.6° vs.32.4°±5.5°;PT were 18.7°±10.5° vs.19.5°± 10.1°;PI were 42.3°±4.4° vs.40.1°±5.2°;SVA were 9.2±3.5 cm vs.9.5±3.1 cm;T value were-2.7±1.1 vs.-1.2±1.4.There were no statistically significant difference between the 2 groups in the ODI and VAS in the postoperative follow-up.Oswestry disability index were 8.2％±5.2％ vs.7.8％±4.5％;VAS value were 3.4±2.6 vs.3.1±2.1.Conclusion The smaller the bone mineral density of the patients with DS,the higher the incidence of the fusion failure L5S1 fusion.And when the failing L5S1 of fusion happened,the clinical outcome will not always be poor.

Objective: The impact of parenteral fish oil lipid emulsion on liver function and nutritional status of malignant tumors of the liver and gallbladder patients. Methods: From December 2007 to A-pril 2008, 32 post-operative hepatobiliary cancer patients were randomly divided into control and study groups. Two groups were treated with isocaloric, isonitrogenic parenteral nutrition and the study group was added fish oil lipid emulsion. Comparison of plasma protein, glucose, jaundice index, transaminase, ALP and the rate of infection complications was made betweent the two groups. Results: The blood glucose, transaminase and ALP levels were not significantly different between the two groups. But the plasma proteins and bilirubin levels were improved significantly (P < 0.05) with reduced infection complication in the study group. Conclusion : Fish oil lipid emulsion is conducive to the recovery of post-operative liver and gallbladder cancer patients in live function and nutritional status.

In order to investigate the origin of neointimal smooth muscle cells in transplant arteriosclerosis in rat aortic allograft, sex-mismatched bone marrow transplantation was performed from male Wistar rats to female Wistar rats. Four weeks after transplantation, the aortic transplant model was established by means of micro-surgery in rats. The recipients were divided into 4 groups: female Wistar-female Wistar aortic isografts, female SD-female Wistar aortic allografts, male SD-male Wistar aortic allografts, female SD-chimera Wistar aortic allografts. Eight weeks after transplantation, aortic grafts were removed at autopsy and processed for histological evaluation and immunohistochemistry. The results indicated that excessive accumulation of α-SMA-positive smooth muscle cells resulted in significant neointima formation and vascular lumen stricture in rat aortic allografts.Neointima assay revealed that the neointimal area and NIA/MA ratio of transplanted artery were significantly increased in all of aortic allograft groups as compared with those in aortic isograft group (P＜0.01). Neointimal smooth muscle cells were harvested from cryostat sections of aortic allograft by microdissection method. The Sry gene-specific PCR was performed, and the result showed that a distinct DNA band of 225 bp emerged in the male-male aortic allograft group and chimera aortic allograft group respectively, but not in the female-female aortic allograft group. It was suggested that recipient bone-marrow cells, as the origin of neointimal smooth muscle cells, contributed to the pathological neointimal hyperplasia of aortic allograft and transplant arteriosclerosis.

In order to investigate the origin of neointimal smooth muscle cells in transplant arteriosclerosis in rat aortic allograft, sex-mismatched bone marrow transplantation was performed from male Wistar rats to female Wistar rats. Four weeks after transplantation, the aortic transplant model was established by means of micro-surgery in rats. The recipients were divided into 4 groups: female Wistar-female Wistar aortic isografts, female SD female Wistar aortic allografts, male SD-male Wistar aortic allografts, female SD-chimera Wistar aortic allografts. Eight weeks after transplantation, aortic grafts were removed at autopsy and processed for histological evaluation and immunohistochemistry. The results indicated that excessive accumulation of alpha-SMA-positive smooth muscle cells resulted in significant neointima formation and vascular lumen stricture in rat aortic allografts. Neointima assay revealed that the neointimal area and NIA/MA ratio of transplanted artery were significantly increased in all of aortic allograft groups as compared with those in aortic isograft group (P<0.01). Neointimal smooth muscle cells were harvested from cryostat sections of aortic allograft by microdissection method. The Sry gene-specific PCR was performed, and the result showed that a distinct DNA band of 225 bp emerged in the male-male aortic allograft group and chimera aortic allograft group respectively, but not in the female-female aortic allograft group. It was suggested that recipient bone-marrow cells, as the origin of neointimal smooth muscle cells, contributed to the pathological neointimal hyperplasia of aortic allograft and transplant arteriosclerosis.

The eukaryotic expression of human arresten geneand its effect on the proliferation of in vitro cultured vascular smooth cells (VSMCs) in vitro were investigated. COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome. Forty-eight h after transfection, reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of arresten mRNA in the cells,while Western blot assay was applied to detect the expression of arresten protein in concentrated supernatant. Primary VSMCs from thoracic aorta of male Sprague-Dawley rats were cultured using the tissue explant method, and identified by immunohistochemical staining with a smooth muscle-specific anti-αactin monoclonal antibody before serial subcultivation. VSMCs were then co-cultured with the concentrated supernatant and their proliferation was detected using Cell Counting Kit-8 (CCK-8) in vitro. The results showed that RT-PCR revealed that the genome of arresten-transfected cells contained a 449 bp specific fragment of arresten gene, suggesting the successful transfection. Successful protein expression in supernatants was confirmed by Western blot. CCK-8 assay showed that the proliferation of VSMCs were inhibited significantly by arresten protein as compared with control cells (F=40.154, P＜0.01). It was concluded that arresten protein expressed in eukaryotic cells can inhibit proliferation of VSMCs effectively in vitro, which would provide possibility to the animal experiments.

The eukaryotic expression of human arresten gene and its effect on the proliferation of in vitro cultured vascular smooth cells (VSMCs) in vitro were investigated. COS-7 cells were transfected with recombinant eukaryotic expression plasmid pSecTag2-AT or control plasmid pSecTag2 mediated by liposome. Forty-eight h after transfection, reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of arresten mRNA in the cells, while Western blot assay was applied to detect the expression of arresten protein in concentrated supernatant. Primary VSMCs from thoracic aorta of male Sprague-Dawley rats were cultured using the tissue explant method, and identified by immunohistochemical staining with a smooth muscle-specific anti-alpha-actin monoclonal antibody before serial subcultivation. VSMCs were then co-cultured with the concentrated supernatant and their proliferation was detected using Cell Counting Kit-8 (CCK-8) in vitro. The results showed that RT-PCR revealed that the genome of arresten-transfected cells contained a 449 bp specific fragment of arresten gene, suggesting the successful transfection. Successful protein expression in supernatants was confirmed by Western blot. CCK-8 assay showed that the proliferation of VSMCs were inhibited significantly by arresten protein as compared with control cells (F=40.154, P<0.01). It was concluded that arresten protein expressed in eukaryotic cells can inhibit proliferation of VSMCs effectively in vitro, which would provide possibility to the animal experiments.

To express recombinant arresten in Escherichia coli (E. Coli) and investigate its biological activity, prokaryotic expression vector of human arresten gene was constructed by gene engineering. Human arresten gene was amplified from recombinant plasmid pGEMArr by polymerase chain reaction (PCR), and inserted into prokaryotic expression vector pRSET containing T7 promoter. Restriction analysis and DNA sequencing verified that the arresten gene was correctly cloned into the expression vector. The recombinant plasmid pRSETAt was subsequently transformed into E. Coli BL21 (DE3), and the target gene was expressed under induction of IPTG. SDS-PAGE analysis revealed that the recombinant protein with a molecular weight of 29 kD (1 kD=0. 992 1 ku) amounted to 29 % of the total bacterial proteins. After purification and renaturation, the recombinant protein could significantly suppress the proliferation of human umbilical vein endothelial cells (HUVECs). These results suggested that the expression of a biologically active form of human arresten in the pRSET expression system laid a foundation for further study on the mechanistic insight into arresten action on angiogenesis and the development of powerful anti-cancer drugs.