Search

Objective To evaluate the improvement of superficial temporal artery⁃middle cerebral artery (STA⁃MCA) bypass combined with encephalo⁃myo⁃synangiosis (EMS) on cognitive function in patients with moyamoya disease (MMD). Methods Total 37 patients with MMD treated with STA⁃MCA+EMS in Tianjin Medical University General Hospital from July 2017 to June 2020 were reviewed. Mini⁃Mental State Examination (MMSE), Auditory Verbal Learning Test (AVLT), Trail Making Test⁃A (TMT⁃A), Trail Making Test⁃B (TMT⁃B), Verbal Fluency Test (VFT) and Rey⁃Osterrieth Complex Figure Test (ROCFT) were used to evaluate overall cognitive function, memory, attention, executive function, language function and visuospatial function in all patients one week before surgery and 6 months after surgery. Results Compared with one week before surgery, the MMSE score [24 (23, 26) score vs. 25.00 (23.50, 27.00) score; Z=⁃4.201, P=0.000] and ROCFT score [28 (23, 30) score vs. 31.00 (28.50, 32.00) score; Z=⁃3.968, P=0.004] increased, while the TMT⁃A test [69.00 (56.00, 87.50) s vs. 42 (37, 48) s; Z=⁃5.144, P=0.002] and TMT⁃B test [177 (168, 190) s vs. 138 (133, 144) s; Z=⁃5.309, P=0.001] decreased at 6 months after surgery. There was no statistic difference of AVLT⁃1R (Z=⁃1.595, P=0.113), AVLT⁃5R (Z=⁃1.573, P=0.121) and VFT (Z=⁃1.616, P=0.124) before and after surgery. Conclusions STA⁃MCA+EMS can improve the overall cognitive function, attention, executive function and visuospatial ability of patients with MMD, but has no significant effect on short⁃term memory, long⁃term memory and language function, and can improve cognitive function and the quality of life.

Byzantine fault-tolerant algorithm is vital to ensure the distributed system such as blockchain reaching consistency.The performance of algorithm affects the security and stability of the system.In view of the low efficiency and lack of incentive mechanism of existing consensus algorithms,a rational practical Byzantine fault-tolerant consensus algorithm with evolutionary game is proposed.Firstly,the trustworthiness of nodes in the consensus process is determined by node trust evaluation,the reputation value is used as the basis for the consensus enthusiasm of rational nodes,consensus nodes are divided based on reputation value,and the consensus method of node network fragmentation is adopted to improve consensus efficiency;secondly,the evolutionary game model is established for the impact of link dynamics between nodes in the consensus process on the reputation value,and based on the existence of the reputation stabilization strategy,an incentive mechanism based on reputation value rewards is designed to enhance the enthusiasm of consensus nodes to participate in consensus.Simulation results show that the consensus algorithm has a throughput increase of 40%,and the reputation evolution game model designed for nodes has a rapid convergence effect in the consensus process.

High energy ball milling and spark plasma sintering(SPS) were used to make high density pure W bulk, the relative density of samples can reach more than 97.0%. TZM alloy powder was laid on the surface of the W bulk, SPS was used to sinter TZM and join W with TZM at the same time. This experiment realized the joining between W bulk and TZM powder without interlayer. The effects of sintering temperature and cooling rate on the microstructure and mechanical properties of W/TZM alloy joints were investigated.The results show that W is well joined with TZM alloy, and there are no holes, microcracks and unwelded defects in the interface. When the sintering temperature is within the scope of 1400-1600℃, W/TZM joints shear strength increases with the increase of sintering temperature. The shear strength of the joints obtained by rapid cooling is higher than that of the joints with slow cooling at the same sintering temperature. When the sintering temperature is 1600℃ and taken rapid cooling, the shear strength of joint is higher than that of the other samples, the maximum shear strength is 159.7 MPa.

High energy ball milling and spark plasma sintering(SPS) were used to make high density pure W bulk, the relative density of samples can reach more than 97.0%. TZM alloy powder was laid on the surface of the W bulk, SPS was used to sinter TZM and join W with TZM at the same time. This experiment realized the joining between W bulk and TZM powder without interlayer. The effects of sintering temperature and cooling rate on the microstructure and mechanical properties of W/TZM alloy joints were investigated.The results show that W is well joined with TZM alloy, and there are no holes, microcracks and unwelded defects in the interface. When the sintering temperature is within the scope of 1400-1600℃, W/TZM joints shear strength increases with the increase of sintering temperature. The shear strength of the joints obtained by rapid cooling is higher than that of the joints with slow cooling at the same sintering temperature. When the sintering temperature is 1600℃ and taken rapid cooling, the shear strength of joint is higher than that of the other samples, the maximum shear strength is 159.7 MPa.

Objective To evaluate the improvement of superficial temporal artery -middle cerebral artery (STA-MCA) bypass combined with encephalo-myo-synangiosis (EMS) on cognitive function in patients with moyamoya disease (MMD). Methods Total 37 patients with MMD treated with STA-MCA + EMS in Tianjin Medical University General Hospital from July 2017 to June 2020 were reviewed. Mini - Mental State Examination (MMSE), Auditory Verbal Learning Test (AVLT), Trail Making Test - A (TMT - A), Trail Making Test-B (TMT-B), Verbal Fluency Test (VFT) and Rey-Osterrieth Complex Figure Test (ROCFT) were used to evaluate overall cognitive function, memory, attention, executive function, language function and visuospatial function in all patients one week before surgery and 6 months after surgery. Results Compared with one week before surgery, the MMSE score [24 (23, 26) score vs. 25.00 (23.50, 27.00) score; Z = - 4.201, P = 0.000] and ROCFT score [28 (23, 30) score vs. 31.00 (28.50, 32.00) score; Z = - 3.968, P = 0.004] increased, while the TMT-A test [69.00 (56.00, 87.50) s vs. 42 (37, 48) s; Z = - 5.144, P = 0.002] and TMT - B test [177 (168, 190) s vs. 138 (133, 144) s; Z = - 5.309, P = 0.001] decreased at 6 months after surgery. There was no statistic difference of AVLT-1R (Z = - 1.595, P = 0.113), AVLT-5R (Z = - 1.573, P = 0.121) and VFT (Z = - 1.616, P = 0.124) before and after surgery. Conclusions STA -MCA + EMS can improve the overall cognitive function, attention, executive function and visuospatial ability of patients with MMD, but has no significant effect on short-term memory, long-term memory and language function, and can improve cognitive function and the quality of life. [ABSTRACT FROM AUTHOR]

Catharanthus roseus receptor-like kinase1-like kinases (CrRLK1Ls), a class of plant-specific protein receptor kinases, play an important role in maintaining cell wall integrity, cell-to-cell communications, and biotic and abiotic stress response. In this study, StCrRLK1Ls family members were identified, and their physical and chemical characteristics, chromosome location, evolutionary characteristics, subcellular location, and the expression patterns were comprehensively analyzed. The results showed that 17 StCrRLK1Ls members were detected, with amino acid size (753-997 aa), molecular weight (83.34-108.69 kD), and isoelectric point (5.30-7.56). Among them, StCrRLK1Ls were mainly predicted on plasma membrane. Evolutionary analysis indicated that CrRLK1Ls from potato, rice, apple, Arabidopsis, and tomato could be divided into seven subgroups, and StCrRLK1Ls were distributed in subgroups III, IV, V, VI, and VII. Moreover, StCrRLK1Ls were distributed on eight chromosomes, and there are three tandem repeat gene clusters, including six members. In addition, there were many cis-elements in the promoter region of StCrRLK1Ls, which mainly responded to hormones, defense, and stress signals. After the inoculation with Phytophthora infestans (Pi), a large number of StCrRLK1Ls were differentially expressed in Atlantic and Longshu 7, and the relative expression levels of StCrRLK1L8 and StCrRLK1L10 were obviously up-regulated during Pi infection. The relative expression levels of StCrRLK1L11 were 9.74 times compared with the control at eight days Atlantic inoculated Pi. We speculated that they could be used as the candidate genes for disease resistance and further functional analysis, which might play an important role in response to pathogenic fungi of potato. [ABSTRACT FROM AUTHOR]

Clubroot has recently become one of the main diseases of oilseed rape and cruciferous crops in China, which seriously affected the yield of cruciferous crops. Therefore, an efficient method with a high efficiency for molecular detection of P. brassicae was developed for accurate diagnosis in various samples using a pair of specific primers (PbITS1) designed on ITS (internal transcribed spacer) sequence, and the molecular detection of P. brassicae and disease assessment were carried out by PCR procedure. The results indicated that PCR system could specifically detect P. brassicae without any amplification product from representative soil - borne pathogenic fungi, bacteria, nematodes and endophytes. Sensitivity assay showed that the minimum concentration of template DNA was 1 x 10-3 ng/µL, the minimum number of spores in the contaminated soil was 1 x 10 spores/g soil, and the minimum level of spore with seeds was 1 x 10 spores/g seeds. Moreover, rape and other cruciferous plants (e. g., tissues and seeds) and soils could be applied in this detection system, meanwhile roots and surrounding soils collected from the different growth stages could be used for disease assessment. The benefit of this detection system was convenient, sensitive and specific with a wide range of detectable samples, which provided insights on detection of P. brassicae as well as the diagnosis, monitoring epidemic pattern, and integrated management of clubroot. [ABSTRACT FROM AUTHOR]

Copyright of Coal Science & Technology (0253-2336) is the property of Coal Science & Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the expression and role of programmed death ligand-1 (PD-L1) in a mouse model of necrotizing enterocolitis (NEC)., Methods: A total of 20 wild-type C 57 BL /6 J mice were randomly assigned to the control and the model groups. Mice in the control group were breastfed, while mice in the model group were given lipopolysaccharide, formula feeding, hypoxia, and cold stimulation for NEC induction. Then, the intestines of the mice were collected in order to assess the pathological changes through HE staining, to examine PD-L1 expression and localization with immunofluorescence co-localization, and to evaluate intestinal PD-L1 expression with Western blot. Peripheral blood was collected for flow cytometry to examine leukocyte subpopulations and their PD-L1 expression. On the other hand, 14 PD-L 1 (+/+) mice and 14 PD-L 1 (-/-) mice were randomly divided into their respective genotype control groups and model groups. The same induction method as was already mentioned was adopted for the model groups. The intestines of the mice were collected for HE staining to evaluate the pathological change and peripheral blood was collected to examine the expression of inflammatory factors., Results: The NEC mouse model was successfully constructed. PD-L1 was widely expressed in enterocytes and inflammatory cells in the mouse intestines and in T cells, monocytes, and neutrophils in peripheral blood. The expression of PD-L1 in NEC mouse intestines increased in comparison with that of the control group. In the peripheral blood of NEC mice, the proportion of T cells and monocytes and their PD-L1 expression showed no significant changes compared with those of the control group, while the proportion of neutrophils and their PD-L1 expression increased by about 140% and 150%, respectively, in comparison with those of the control group ( P <0.05). According to the results of the PD-L 1 gene mouse experiment, the control groups of PD-L 1 (+/+) mice and PD-L 1 (-/-) mice showed no significant difference in their intestinal conditions and serum inflammatory factor levels, while the PD-L 1 (-/-) NEC mouse had worse intestinal pathological changes and increased mean pathological scores compared with those of PD-L 1 (+/+) NEC mouse ( P <0.05). In addition, serum interleukin (IL)-10 in PD-L 1 (-/-) NEC mouse decreased by about 44% compared with that of PD-L 1 (+/+) NEC mice, and chemokine (C-X-C motif) ligand 1/IL-6/IL-1β all increased by more than 25% (all P <0.05)., Conclusion: PD-L1 is widely expressed in inflammatory cells and enterocytes in mice. Knocking out PD-L 1 aggravates the degree of NEC inflammation and intestinal pathological changes. PD-L1 plays a protective role by reducing inflammation in the pathogenesis of NEC, the mechanism of which may be related to the regulation of neutrophils/enterocytes., (Copyright© by Editorial Board of Journal of Sichuan University (Medical Sciences).)

The present study investigated the therapeutic efficacy and potential mechanism of Jinqi Jiangtang Tablets(JQJT) on pancreatic β cell dysfunction based on network pharmacology and molecular docking technology. TCMSP platform was used to retrieve the chemical components and targets of the three Chinese herbal medicines of JQJT. The genes were converted to gene symbol by the UniProt, and its intersection with targets related to pancreatic β cell function in GeneCards and CTD databases was obtained. The drugs, active components and common targets were imported into Cytoscape 3.8.2 to plot the drug-component-target network. The main effective components and targets were obtained by software analysis. The drug targets and targets related to pancreatic β cell function were imported separately into the STRING platform for the construction of protein-protein interaction(PPI) networks. The two PPI networks were merged by Cytoscape 3.8.2 and the key targets were obtained by plug-in CytoNCA. The targets obtained from drug-component-target network and PPI networks were imported into DAVID for GO analysis and KEGG enrichment analysis. AutoDock was used to carry out molecular docking of main active components and core targets and Pymol was used to plot the molecular docking diagram. The results showed that there were 371 active components and 203 targets related to JQJT and 2 523 targets related to pancreatic β cell damage, covering 136 common targets. The results revealed core targets(such as PTGS2, PTGS1, NOS2, ESR1 and RXRA) and effective key components(such as quercetin, kaempferol, luteolin, β-carotene and β-sitosterol). KEGG enrichment analysis indicated that apoptosis, inflammation, and other signaling pathways were mainly involved. Molecular docking results showed that the main active components could spontaneously bind to the targets. This study preliminarily revealed the mechanism of JQJT in improving pancreatic β cell damage through multi-component, multi-target and multi-pathway, and provided a theoretical basis for JQJT in the treatment of pancreatic β cell dysfunction.

The surge of luteinizing hormone (LH) in preovulatory ovarian follicles triggers the resumption of meiosis in oocytes and induces the proliferation of surrounding cumulus granulosa cells. It is believed that LH receptors are expressed in the mural granulosa cells, but not the oocytes and the surrounding cumulus cells, suggesting that the LH signaling is mediated by factors produced by the granulosa cells. However, the mechanism underlying oocyte maturation induced by LH before ovulation has been controversial. Current studies suggest that LH binds on to its receptor on granulosa cells of the follicular wall to promote the production of EGF-like factors, which activate various signaling cascades and induce oocyte maturation and development. Since the in vitro maturation system is difficult to simulate the in vivo physiological environment, in vitro cultured follicles are likely to be de?cient in the EGF-like factors, which could result in the poor developmental competency of in vitro cultured oocytes and restrict their efficient utilization. In this review, we summarize the EGF-like factor signaling system in granulosa cells and its regulation of oocyte maturation and development. It aims to optimize the in vitro maturation culture system of oocytes and increase the EGF-like factor signaling system in cumulus granulosa cells, thereby providing a framework for improving the efficiency on in vitro maturation of oocytes.

To evaluate the inflammatory factors, the pulmonary function, the efficiency and the safety of Chuankezhi injection for treating acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The randomized controlled trials (RCTs) on Chuankezhi injection for treating AECOPD were collected from 7 databases (PubMed, CNKI, et al) between inception to November 2016. Two reviewers independently screened literature and extracted the data according to the inclusion and exclusion criteria, and assessed methodological quality of included studies according to the criteria from Cochrane Reviewer's Handbook 5.3. Then, Meta-analysis was conducted by using RevMan 5.3 software. A total of 13 RCTs involving 1 016 patients were included. Meta-analysis results indicated that Chuankezhi group was superior to the control group in the clinical effectiveness [RR=1.15, 95% CI(1.06, 1.23), P=0.000 3], improved pulmonary functions including forced expiratory volume in one second (FEV1) [MD=0.21, 95% CI (0.15, 0.27), P<0.000 01], forced vital capacity (FVC) [MD=0.36, 95% CI（0.15, 0.56）, P=0.000 6], the first seconds breathing volume percentage of forced vital capacity (FEV1/FVC) [MD=6.85, 95% CI（4.68, 9.02）, P<0.000 01] and decreased the level of inflammatory factors including interleukin-6 (IL-6) [MD=-6.35, 95% CI (-8.23, -4.47), P<0.000 01], IL-8 [MD = -2.00, 95% CI ( -3.13, 0.87), P=0.000 5], tumor necrosis factor-α (TNF-α) [ MD=-2.79, 95% CI (-4.61,-0.97), P=0.003]. Besides, there were no frequently happened or serious adverse reactions observed in Chuankezhi group. The results showed that Chuankezhi injection could improve the efficiency and the pulmonary function, reduce inflammation for AECOPD with a high safety on the basis of routine symptomatic treatment. However, due to limited quantity and quality of the included studies, the conclusion above should be further verified by conducting more high quality RCTs., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

Objective: To compare the diagnostic accuracy of five internationally used indolent prostate cancer screen protocols in Chinese prostate cancer patients., Methods: Retrospective analysis was made of the consecutive cohort of 314 patients, from Jan. 2006 to Apr. 2014, who had both prostate biopsy and radical prostatectomy in Peking University First Hospital. The Gleason score≤6, pT2, tumor volume≤0.5 mL, margin negative and lymph nodes negative were defined as indolent prostate cancer. The predictive value of five indolent screen criteria including Epstein, Memorial Sloan-Kettering Cancer Center (MSKCC), Prostate Cancer Research International: Active Surveillance (PRIAS), University of California, San Francisco (UCSF), and University of Miami (UM) were evaluated in Chinese prostate cancer patients. Measures of diagnostic accuracy and areas under the receiver-operating curve (AUC) were calculated for each protocol and compared., Results: A total of 16% (49 cases) of the patients met the inclusion criteria of at least one protocol, including 24 cases in Epstein, 33 cases in MSKCC, 28 cases in PRIAS, 34 cases in UCSF, and 22 cases in UM. Three percent were eligible for all the studied criteria. UCSF and MSKCC protocols had the highest sensitivity and specificity than the others. The Epstein and PRIAS protocols demonstrated acceptable positive predictive value, but the specificity and sensitivity were inefficient. The UM protocol was performed unsatisfiedly on sensitivity, positive predictive value and AUC. A strict limited protocol which contained all the five protocols could not improve the predictive accuracy., Conclusion: The UCSF protocol had better diagnostic accuracy than the others, but the results were not satisfied. A further investigation on indolent prostate cancer screening in Chinese patients is needed.

Objective: To analyze the clinicopathologic features of 10 Chinese prostate adenocarcinoma patients under 50 years., Methods: Between January 2007 and April 2012, 10 cases of prostate adenocarcinoma patients under 50 years (age: 36-49) were diagnosed at our institution through prostate biopsy. The indications of biopsy were abnormal digital rectal examination (7 cases) and/or a total prostate specific antigen (PSA) over 4.0 μg/L (4 cases). The clinicopathological data of these patients were reviewed. The results of biopsy were 1 case with Gleason score (GS) 6, 4 cases with GS 7 and 5 cases with GS 9. In the study, 7 patients were diagnosed with cT4. Lymph node metastasis and bone metastasis were found in 5 and 4 cases, respectively. The treatments were hormonal therapy in 5 cases, radical prostatectomy in 2 cases and combination therapy in 3 cases., Results: During the follow-up, 6 patients were in progression within 3 to 7 months, 1 patient died after 3 years, and 4 patients were lost of the follow-up., Conclusion: These findings suggest that the Chinese prostate adenocarcinoma patients with age under 50 years are likely to have more aggressive tumor and combination therapy might be appropriate.

Objective: To evaluate the clinical utility of novel gene urothelial carcinoma antigen 1 (UCA1) as a urinary tumor marker for the diagnosis of bladder urothelial carcinoma., Methods: A cohort of 180 cases of bladder cancer (including 94 cases in previous study), 144 cases of non-bladder-cancer individuals as control group (including 85 cases in previous study) from 2005 to 2009 were recruited. Reverse transcription PCR (RT-PCR) of urinary sediments was performed to detect the expression of UCA1. RNasin was added to the urinary sediments collected after 2007 from 86 cases of bladder cancer and 59 cases in control group to improve the quantity and quality of RNA isolation. The parameters of sensitivity, specificity, area under curve (AUC) of ROC and its 95%CI were calculated.χ(2) test was used to compare the sensitivity of UCA1 with NMP22 and cytology in 116 cases of bladder cancer with the parallel data of UCA1 and NMP22 and in 108 cases with the parallel data of UCA1 and cytology., Results: 95.4% of RNA was isolated successfully from urinary sediments after the addition of RNasin UCA1 was highly specific (92.4%, 133/144) and quite sensitive (84.4%, 152/180) in the diagnosis of bladder cancer with a favorable AUC-ROC of 0.898 (95%CI: 0.851 - 0.945). It was especially valuable for superficial G(2)-G(3) patients (sensitivity: 86.4%, 92.3%) at a high risk for muscular invasion., Conclusion: With a high level of sensitivity and specificity, UCA1 is a promising urinary marker for the diagnosis of bladder cancer.

Objective: To assess the sex differences in pathologic characteristics of Chinese patients with upper urinary tract urothelial carcinoma (UUTUC)., Methods: Between January 2004 and December 2010, 597 patients (253 men and 344 women) underwent surgical management at Peking University First Hospital for pathologically proven UUTUC. We reviewed pathological data from these patients, and used univariate analysis to determine sex differences., Results: Of the 597 consecutive cases, mean age was 67 years ranging from 20 to 94 years. Univariate analyses showed that female patients had less proportion of large tumor (P=0.017), local advanced tumor (P<0.001) and lymph node metastasis (P=0.022). No significant sex-related differences were found in the age, tumor grade, and tumor number., Conclusion: In Chinese UUTUC patients, female patients were more common. Females are less likely to have more advanced pathologic stage than males.

Objective: To assess the clinical utility of a fluorescence in situ hybridization (FISH) assay as a non-invasive method for diagnosing and monitoring urothelial carcinoma (UC) in the upper urinary tract (UUT)., Methods: Urine specimens from 63 consecutive patients with UUT-UC and 69 controls with benign disease were analyzed by means of cytology and FISH. For FISH analysis, labeled probes specific for chromosomes 3, 7, and 17 and for the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy.Sensitivity and specificity of both techniques were determined and compared. The frequency of chromosomal aberrations of malignant cells from UUT-UC was also determined., Results: Of 63 patients with UUT-UC, FISH affords an overall sensitivity of 84.1% (53/63), the figure being 71.4% (20/28) for PTa and PT1 tumors,94.3% (33/35) for PT2-4 tumors. The sensitivities of urine cytology were 35.7% (10/28) for PTa and PT1 tumor,45.7% (16/35)for PT2-4 tumors,with an overall sensitivity of 41.3% (26/63). The sensitivities of the two methods for the low grade tumors were 80% (20/25) and 44% (11/25), and for high grade tumors were 86.8% (33/38) and 39.5% (15/38), respectively. Specificities for FISH and urine cytology were 91.3% (63/69) and 94.2% (65/69)respectively., Conclusion: According to the results,the sensitivity of FISH for the detection of UUT-UC is superior to that of urine cytology and the specificities of FISH and urine cytology are not significantly different. FISH can promote the diagnosis of UUT-UC, especially for the low stage and low grade cases,it may be a new promising non-invasive method for the diagnosis of UUT-UC.

Objective: To evaluate the different influences upon the correction outcomes after anterior or posterior correction and fusion with lowest end vertebra instrumentation in adolescent idiopathic thoracolumbar/lumbar scoliosis., Methods: By reviewing the medical records and roentgenograms of adolescent idiopathic thoracolumbar/lumbar scoliosis patients undergoing anterior (single rod-Group A) or posterior (all pedicle screws-Group B) correction and instrumentation, the parameters of Cobb angle of the curve, correction rate and disc angle were measured and analyzed., Results: There were 18 patients in Group A and 21 patients in Group B. The curve included 5.0 vertebrae and 5.5 vertebrae (P = 0.134) respectively, and the fusion levels were 4.7 vertebrae and 5.4 vertebrae (P = 0.008) respectively. The mean pre-operative and post-operative coronal Cobb angles of the main curve in Groups A and B were 49.2 degrees and 10.3 degrees , 42.2 degrees and 5.0 degrees with an average correction rate of 78.5% and 87.8% respectively. The Cobb angles were all significantly corrected (all P = 0.000), and group B had a better correction result (P = 0.020). At final follow-up, the coronal Cobb angles in the two groups were 21.7 degrees and 7.7 degrees with an average correction loss of 8.3 degrees and 2.7 degrees (P = 0.001) respectively. The disc angles at pre-operation, post-operation and final follow-up were 3.1 degrees , 5.6 degrees and 7.3 degrees in Group A and 2.3 degrees , 4.2 degrees and 4.4 degrees in Group B respectively. The disc angle at post-operation was larger than that at pre-operation and the difference was significant in Group A (P = 0.049) while not in Group B (P = 0.050). The difference of post-operative disc angle between two groups was not significant (P = 0.231). At final follow-up, the disc angle was a little larger than that of post-operation without a significant difference (P = 0.112, P = 0.855) while Group A had a larger disc angle (P = 0.026). At final follow-up, the occurrence of proximal junctional kyphosis between Groups A and B was not significant (P = 0.235)., Conclusion: For adolescent idiopathic thoracolumbar/lumbar scoliosis, in comparison with the anterior approach, the posterior approach using all pedicle screws can achieve a better correction outcome, a less correction loss of coronal Cobb angle and a better disc angle with a longer fusion range.

Objective: To evaluate the orthopedic effects of internal fixation of cervical pedicle screw on cervical spondylotic myelopathy with cervical kyphosis., Methods: Seventeen patients with cervical spondylotic myelopathy with cervical kyphosis with the Cobb's angle >10 degrees underwent internal fixation of cervical pedicle screw. The patients were followed up for 13. 8 months. The Cobb's angle of cervical kyphosis was measured before operation, one week after-operation, and upon the final follow up. The neural function and cervical spine stability were evaluated using Japanese Orthopedic Association (JOA) scoring system., Results: The average preoperative Cobb's angle of cervical kyphosis was -16.1 degrees before operation, was -3.3 degrees one week after operation, and was -3.8 degrees at the final follow-up. Follow-up 6 months after operation and at the final follow up showed that the fused segments were stable. The JOA score improved by 5.2 +/- 1.6 (P < 0.05) with a mean JOA score improvement rate of 64. 3%. No neurovascular and instrumentation-related complications occurred., Conclusion: Internal fixation of cervical pedicle screw is effective and safe in treatment of cervical spondylotic myelopathy with cervical kyphosis.

Objective: To evaluate the clinical results and improve perioperative management in patients with hemophilic arthropathy., Methods: From May 2002 to March 2007, 20 patients with hemophilic arthropathy were admitted. Fourteen patients (20 knees) were performed total knee arthroplasty, and 6 patients (8 hips) were performed total hip arthroplasty, while 2 patients were performed ankle arthrodesis. The average preoperative HSS score, hip Harris score and ankle AOFAS score were 83, 89 and 78 points respectively., Results: All patients had been followed up, and the mean time was 27.3 months. The average postoperative knee HSS score increased to 83 points, and hip Harris score increased to 89 points, while the AOFAS score increased to 78 points. Delayed bleeding and deep venous thrombosis and late infection with loose prosthesis occurred in one case respectively., Conclusions: Arthroplasty and arthrodesis are promising for severe hemophilic arthropathy to obtain pain relief and functional improvement Correct perioperative management is the key to successful treatment in hemophilic arthropathy.

Objectives: To analyze the risk factors of skin necrosis around incision after total knee arthroplasty, and explore measures for prevention and treatment., Methods: From January 2003 to November 2005, skin necrosis around incision occurred to 15 out of the 382 cases (494 knees) treated by total knee arthroplasty. The data of the 15 cases were analyzed. Preoperative hospital for special surgery knee score (HSS) was 60 points on average., Results: All wound were healed after debridement. However, the recover time was over 3 weeks longer than the healing time by first intention. Extensor weakness with anterior knee pain appeared among 9 patients, and 6 months later, the symptoms improved obviously. At two years follow-up, the average range of motion was 92 degrees, and the average HSS improved to 86. There were no secondary infection and deformity in the group., Conclusions: It is the key to prevent skin necrosis around incision during total knee arthroplasty that surgeons must accurately grasp technique of minimally invasive surgery for total knee arthroplasty. To acquire satisfactory outcome, it is imperative to perform debridement as soon as possible while the skin necrosis happens. At the same time, it is important to persist in doing adequate functional exercises throughout the period of treatment.

Objective: To analyze the clinical manifestations and imaging features of hemophilic pseudotumor., Methods: Eight patients with hemophilic pseudotumor, all males, aged 26.1 (18 -38), were hospitalized, underwent resection of pseudotumor and bone reconstruction, and followed up for 38.6 months (7 months to 11 years). The clinical data were analyzed., Results: Femur was involved in 4 patient, and fifth metacarpus, iliopsoas, quadriceps femoris, and gastrocnemius were involved in 1 patient respectively. No recurrence was found. Excellent healing was seen in 6 cases, claudication occurred in 1 case with shortening femur, while unpleasant outcome happened to 1 case because of formation of clotting factor inhibitor, together with poor wound-healing waiting for amputation., Conclusion: Medical history and imaging features are essential for the diagnosis of hemophilic pseudotumor. It is the key for successful treatment to master its clinical characteristics.

Objective: To explore the relationship between the alterations of circulating cell-derived microparticles (MPs) and large-dose glucocorticosteroid application., Methods: Peripheral blood samples were collected from 33 patients with history of large-dose glucocorticosteroid application (glucocorticosteroid group) and 24 age-, sex-, and race-matched healthy controls (healthy control group). Platelet-poor plasma was obtained by centrifugation. Plasma microparticles were labeled with monoclonal antibodies of PE-conjugated mouse anti-human CD31, CD54, and FITC-conjugated mouse anti-human CD42b, CD45, CD51/61, CD105, and PE-Cy5-conjugated mouse anti-human CD62E. Cell-derived microparticles were measured by three-color flow cytometry., Results: The mean ranks of CD31+ MPs, CD45+ MPs, CD51/61 MPs, CD31+ CD42b+ MPs, and CD31+ CD45+ MPs of the glucocorticosteroid group were: 24.1, 25.5, 25.6, 21.6, and 24.8 respectively, all significantly lower than those of the control group (35.7, 33.8, 33.7, 39.3, and 34.8 respectively, P = 0.009, 0.019, 0.045, 0.000, and 0.009)., Conclusion: High-dose glucocorticosteroid application remarkably reduces plasma MPs that may be responsible for microcirculation disturbance.

Objective: To analyze of membrane proteins of human normal prostate epithelial cells., Methods: Laser capture microdissection (LCM) technique was utilized to obtain the epithelial cells of human normal prostate. Shotgun-MS was used to generate protein profiles in the epithelial cells of human normal prostate., Results: LCM technique successfully separated the normal prostate epithelial cells with homogeneity more than 95%. Under a stringent filter condition (charge +1, Xcorr >/= 1.9; charge +2, Xcorr >/= 2.2; charge +3, Xcorr >/= 3.75; DelCN >/= 0.1), 1164 proteins were identified in the human normal prostate cells, of which 799 had a gene ontology annotation (GOA) indicating a cellular component, others have no GOA terms. Among the GOA terms, 377 (49.15%) were known membrane proteins or membrane associated proteins. In addition to the proteins known to be associated with the membrane, a significant number of novel proteins had also been identified, including several hypothetical proteins and cDNA sequences., Conclusion: Shotgun-MS technique coupled with LCM effectively analyzes the proteins of human normal prostate cells, thus helping perfect the complete protein profiles of human normal prostate cells.

Objective: To establish a technological system of proteomics research for displaying the full-scale protein expression spectrum of the prostate cells., Methods: We obtained the epithelial cells from normal prostate tissues by laser capture microdissection (LCM) technology, extracted the proteins from them and established two-dimensional gel electrophoresis (2-DE) profiles of the proteins by immobilized pH gradient (IPG) two-dimensional electrophoresis. Then protein spot detection and matching were performed with the scanner and the ImageMaster 2D Elite analysis software. With the help of the Ettanspotter and digester, protein spots that matched well across the gels were extracted, digested and further identified by assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS)., Results: The 2-DE profiles of prostate cells were established, and one protein spot from normal prostate cells identified successfully., Conclusion: The 2-DE profiles of normal prostate cells have good reproducibility. We have tentatively established the proteomics research technology of normal prostate cells and demonstrated the feasibility of proteomics research with the model of human normal prostate cells.

Objective: To investigate the morbidity and pathological features of incidental prostate cancer and their clinical significance., Methods: 1483 prostate specimens obtained during operation, including transurethral resection of prostate (TURP) and total resection of the prostate, for the diagnoses of benign prostatic hypertrophy (BPH) or bladder cancer between January 1999 and August 2005 underwent pathological examination and 34beta12 and p63 immunohistochemical staining so as to detect incidental prostate cancer. The volume of incidental prostate cancer was calculated by the image analysis system. The clinical data were analyzed retrospectively. Comparison between the clinical and pathological feature of incidental prostate cancer was made., Results: 53 cases of incidental prostate cancer, with the Gleason scores from 2 (1+1) to 9 (4+5) and the volumes from 0.18 to 1440.00 mm(3) were detected. The morbidity of incidental prostate cancer was 3.6%. The volume of 47 cases (88.7%) were less than 0.5 cm(3) as the threshold of insignificant cancer, and the volumes of 6 cases (11.3%) were more than 0.5 cm(3). All incidental prostate cancers of clinical significance were detected in the TURP samples. Among the incidental prostate cancers found in the TURP samples 20% were clinically significant cancers. The clinically significant incidental cancers were located in the central or transitional zone with the Gleason scores of 3 + 4 (2 cases), 4 + 2 (1 case), or 4 + 5 (3 cases). These clinically significant cancers were of diffuse distribution, and their preoperative clinical features were negative in palpation/image examination, elevation of serum PSA, and negative in puncture examination., Conclusion: Nowadays, the morbidity of incidental prostate cancer is lower than that of 1980s'. Among the incidental cancers 11.3% were of clinical significance. That the preoperative clinical examination cannot find these clinical significant cancers is partially caused by the pathological features of these tumors.

Objective: To compare the effect of posterior correction and fusion between segmental pedicle screw instrumentation with hybrid constructs in adolescent idiopathic scoliosis (AIS)., Methods: Study the clinical data of 40 AIS patients retrospectively. They were underwent posterior fusion and be distributed into two group, group A was hybrid instrumentation (20 cases) and group B was pedicle screw instrumentation (20 cases). Compared therapy effect, operative time, intraoperative blood loss., Results: The average major curve correction was 82.4% in the screw group and 71.8% in the hybrid group (P = 0.004). After one to three years follow-up, major curve correction was 77.0% and 62.5% respectively (P = 0.001). Average apical vertebral derotation showed 63% correction in the screw group and 32% in the hybrid group (P = 0.001). There was no statistical significance between two group in thoracic sagittal correction, the lowest instrumented vertebra below the lower end vertebra, trunk shift, operative time, and average estimated blood loss. There were no neurologic complications related to hybrid or pedicle screw instrumentation., Conclusion: Pedicle screw instrumentation was significantly better than hybrid constructs.

Objective: To compare the intra-observer reproducibility and inter-observer reliability regarding the results of Lenke's and Peking Union Medical College (PUMC) classification systems for adolescent idiopathic scoliosis (AIS)., Methods: Five spine surgeons independently measured the X ray films of 62 AIS patients using both Lenke and PUMC classification systems. Three weeks later, the spine surgeons repeated the same classification process. No measurement trace was allowed to be left on the X ray films. SAS software was used to calculate the Kappa values and analyze the intra-observer reproducibility and inter-observer reliability, Results: The overall reliability and reproducibility rates of the Lenke classification system were 69.8% (Kappa value = 0.675) and 74.2% (Kappa value = 0.690) respectively, in which the curve characteristic parameter reliability and reproducibility rates were 86.5% (Kappa value = 0.808) and 87.4% (Kappa value 0.826) respectively, the lumbar correction reliability and reproducibility rates were 95.2% (Kappa value = 0.919) and 94.5% (Kappa value = 0.908) respectively, and the sagittal thoracic correction reliability and reproducibility rates were 85.2% (Kappa value = 0.734) and 89.0% (Kappa value = 0.805 respectively). The reliability and reproducibility rates of the PUMC classification system were 91.0% (Kappa value = 0.896) and 90.2% (Kappa value = 0.892) respectively., Conclusion: The reliability and reproducibility rates of the Lenke classification system were better than the previously reported results. However, the PUMC classification system expresses better reliability and reproducibility. The PUMC classification system is relatively easier with fewer curve types, hence leading to less divergence among the clinicians. Comparing to the classifications used in the past, both classification systems have the advantages of correctly categorizing AIS according to its individual traits, as well as accurately examining the X ray results, hence achieving significance in terms of surgical outcome and design.

Objective: To analyze the correction results of the adolescent idiopathic scoliosis patients with a proximal thoracic (PT) curve., Methods: There were 13 cases of double thoracic curve (PUMC IIa) and 13 cases of triple curve (PUMC IIIa 11 cases, IIIb 2 case). The upper instrumented vertebra were at T(3) or above (fusion level including PT curve, Group A) in 18 cases, and at T(4) or T(5) (PT curve not fused, Group B) in 8 cases. Reviewing the medical records and radiographs of 26 adolescent idiopathic scoliosis patients with a proximal thoracic curve that underwent corrective surgery, the changes of the curve and the shoulder balance were analyzed., Results: The coronal Cobb angles of the PT curve and the main thoracic (MT) curve before operation were 45.3 degrees and 61.2 degrees in group A, 35.6 degrees and 58.9 degrees in group B. After operation, they were corrected to 24.2 degrees and 20.1 degrees , 26.4 degrees and 20.3 degrees , respectively. The correction rates of the PT curve and MT curve were 48.2% and 68.7%, 24.5% and 66.3%, respectively. The correction rates of the PT curve of group A was significantly better than group B (P = 0.006), but for the MT curve, the difference was not significant (P = 0.694). The incidence of radiographic shoulder height (RSH) over than 10 mm (shoulder imbalance) after operation in group B was higher than group A significantly (P = 0.038). The incidence rate of shoulder imbalance after operation of the patients with a left higher shoulder or balance shoulder was significantly higher than that of the patients with a right higher shoulder (P = 0.015)., Conclusions: Fusing the PT in patients with a left shoulder not lower than right side will make better coronal correction results of the PT curve and reduce the incidence of postoperative shoulder imbalance.

Objective: To investigate the impact of upright posture on spine susceptibility in scoliosis and scoliotic curve progression patterns., Methods: There were 3 groups designed in the experiment: bipedal rats group (n = 26), quadrupedal rats group (n = 26) and sham operation bipedal control (n = 12). Taking the advantage of bipedal rats' upright-posture simulating effect, operations were exerted with posterior central approach between scapulas. Along the spatial of erector spinae muscle and trunk muscles, left side upper (T2-3 or T3-4) and lower (T10-11 or 11 - 12) ribs were tethered with type4 thread to make asymmetrical stress and simulate a primary thoracic curve. At time of 1, 2, 3, 4, 6 and 8 weeks post-operation (PO), each group were taken dorsoventral X-ray photographs for dynamic observation on the difference of scoliosis turnover and to compare the curvature progression difference between bipedal and quadrupedal rats., Results: Operation resulted in a primary single thoracic curve or thoracolumbar curve convex to the right in both bipedal and quadrupedal rats. At 1 - 4 weeks PO, all asymmetrical tethers became loose because of rib fracture or osteolysis at the tether sites. All scoliosis of quadrupedal rats disappeared and spine resume straight in 1 - 4 weeks later. Analogically, scoliosis disappeared in bipedal rats for those tethers loose in 1 w PO. But prolonged tethering, scoliosis progression rates increased conspicuously. 3 - 4 weeks' tether time led to irreversible scoliosis. Meanwhile, the curvature progression patterns of bipedal rats presented to be various, including the stable single thoracic curve, progressive thoracolumbar single curve and progressive double curve. These curvatures were much alike that of human idiopathic scoliosis. No scoliosis appeared in sham operation bipedal control., Conclusions: The upright posture increased spinal susceptibility in scoliosis; Upright posture changes the progression pattern of scoliosis, leading to variegated scoliotic morphouses during primary thoracic curve progression, while inducing curve compensation phenomenon in scoliosis.

Objective: To investigate the expression of hypoxia-inducible factor (HIF)-1-alpha, HIF-2alpha, and vascular endothelial growth factor (VEGF) in sporadic clear cell renal cell carcinoma (CCRCC) and to analyze the relationship among them., Methods: Samples of CCRCC were obtained from 107 patients during resection. Immunohistochemistry was used to detect the expression of HIF-1-alpha, HIF-2alpha, and VEGF in the tumor tissues and normal kidney tissues distant from the tumor. The microvessel density (MVD) was observed by microscopy., Results: HIF-1-alpha and HIF-2alpha were not expressed in the normal kidney tissues. However, in the tumor tissues the HIF-1-alpha positive rate was 69.2% (74/107), significantly lower than that of the HIF-2-alpha (80.5%, 88/107, P = 0.001), the VEGF positive rate was 78.5% (84/107). The VEGF positive rate of the HIF-1-alpha-positive group was 90.5%, significantly higher than that of the HIF-1-alpha-negative group (51.5%, P = 0.001). The VEGF positive rate of the HIF-2-alpha-positive group was 89.8%, significantly higher than that of the HIF-1-alpha-negative group (26.3%, P = 0.001). The MVD of the 64 HIF-1alpha, HIF-2alpha, and VEGF positive samples was 697, significantly higher than that of the 13 HIF-1alpha, HIF-2alpha, and VEGF negative samples (391, P = 0.001). The MVD of the HIF-2alpha positive samples was 678 +/- 324, significantly higher than that of the HIF-2alpha negative samples (383 +/- 293, P = 0.001). The MVD of the VEGF positive samples was 692 +/- 325, significantly higher than that of the VEGF negative samples (384 +/- 269, P = 0.001). Spearman correlation analysis showed that MVD was strongly positively correlated with HIF-2alpha and VEGF. Mann-Whitney U test showed that HIF-1alpha and HIF-2alpha were not correlated with the staging of CCRCC., Conclusion: HIF-2alpha is expressed more frequently in sporadic CCRCC than HIF-1alpha. Both HIF-1alpha and HIF-2alpha upregulate the VEGF expression and angiogenesis, especially HIF-2alpha.

Objective: To investigate the in vitro efficiency of recombinant adeno-associated virus (rAAV2) vector-mediated gene transfection into the rabbit articular chondrocytes., Methods: Articular chondrocytes were isolated from New Zealand rabbits, cultured, and transfected with rAAV2 containing enhanced green fluorescent protein (eGFP) gene at different values multiplicity of infection (MOI). Successful transfection of chondrocytes was confirmed by detection of recombinant enhanced green fluorescent protein using inverted fluorescence microscopy. The transfection efficiency was determined using the fluorescence-activated cell sorter. A maximum level of 4.76% was set as the background autofluorescence in live, uninfected chondrocytes., Results: The percentage of eGFP-positive chondrocytes increased in a vector dose-dependent manner. When the MOI value was <1 x 10(5) v.g./cell the transfection rate was positively linearly correlated with the dose. However, the MOI > 10(5) v.g./cell did not markedly increase the transfection rate. The greatest population of eGFP-expressing cells was 97.7% and the highest mean fluorescence intensity was 17.4 7 days after transfection. EGFP gene expression remained high until 56 days after transfection., Conclusion: The in vitro efficiency of rAAV2 vector-mediated eGFP gene transfection into rabbit articular chondrocytes was high. The eGFP expression can be maintained for a rather long time. EGFP gene is an ideal tracer for chondrocytes transduction.

Objective: To explore the causes, methods and outcomes of reoperative treatment after lumbar disc surgery., Methods: Nine hundred and twenty eight patients with lumbar disc herniation were treated surgically from January 1995 to January 2004, of whom 43 patients (4.6%) underwent reoperation due to persistent pain or recurrence of symptoms. Forty patients were followed up from 3 months to 84 months (mean 30 months)., Results: According to Macnab's criteria, outcomes were excellent in 11 cases (27.5%), good in 16 cases (40%), fair in 8 cases (20%), and poor in 5 cases (12.5%)., Conclusions: The major causes of reoperation after lumbar disc surgery included incomplete removal of herniating discs and recurrent disc herniation of primary interspace, secondary lumbar canal stenosis, and adhesion of nerve roots. Prior to primary surgical treatment of lumbar disc herniation, operative indications must be strictly accurate, surgical methods should be correctly selected, and improved and refined surgical skills should be guaranteed. Satisfactory outcomes can be gained with reoperation for patients who still requiring treatment.

Objective: To investigate the characteristic of the expression of collagen type I in the articular processes of apex from adolescent idiopathic scoliosis (AIS) patients., Methods: The apical processes of 11 AIS patients were collected. The techniques of HE staining and In-cell Western were adopted in this research. We studied the pathological changes of the apical processes and collected and cultured the osteoblast from the apical processes on both sides in vitro separately. After cell identification, we compared the secretion of collagen type I in the osteoblast from concave side to that of convex side., Results: The cartilages of the apical processes showed some signs of regression. The secretion of collagen type I of the osteoblast in vitro from the concave side of the apical articular process was significantly higher than that from the convex side (P < 0.05)., Conclusion: Significant difference of the gene expression of the osteoblasts from the apical process exists between the concave side and the convex side.

Objective: To evaluate the expression of hypoxia inducible factor (HIF)-1alpha, 2alpha in sporadic clear cell renal cell carcinoma and their relationships to the mutations of von Hippel-Lindau (VHL) gene., Methods: Mutations of VHL gene, expression of HIF-1alpha and 2alpha were detected by polymerase chain reaction (PCR), direct DNA sequencing and immunohistochemistry in 77 cases of Chinese sporadic clear cell renal cell carcinoma (CCRCC). The stage was pT(1)N(0)M(0)in 55 patients (71%), pT(2)N(0)M(0) in 7 patients (9%), pT(3)N(0)M(0) in 14 patients (18%), and pT(4)N(0)M(0) in 1 patient (1%). The classification according to the tumor nuclear grading system showed 15 carcinomas (19%) of tumor nuclear grade 1, 56 (73%) of tumor nuclear grade 2 and 6 (8%) of tumor nuclear grade 3., Results: None of the VHL gene mutations were found in all the normal tissue specimens. VHL gene mutations were detected in 40 (52%) cases of CCRCC. The positive rate of HIF-2alpha (81%) was higher than that of HIF-1alpha (66%) (chi(2) = 23.310, P < 0.01); The positive rate of HIF-1alpha and HIF-2alpha in the cases of mutations (98% and 93% respectively) was higher than that of them in non-mutations (32% and 68% respectively) (chi(2) = 36.386, 7.617, P < 0.01); The correlation between HIF-1alpha and VHL gene mutations was closer than that between HIF-2alpha and VHL gene mutations (partial correlation coefficiency was 4.481 and 2.027 respectively, P < 0.01). The expression of HIF-1alpha and 2alpha in different pathological grade and stage of CCRCC showed no significant difference (P > 0.05)., Conclusions: Our study suggests that VHL gene mutations are frequent in sporadic CCRCC, and the high expression of HIF-1alpha and 2alpha are found in the group of VHL mutations. However, we have not found significant correlation between the expression of HIF-1alpha and 2alpha and pathological grade and stage of CCRCC in our study.

Objectives: To evaluate the incidence of immediate postoperative pulmonary complications and their correlation to preoperative pulmonary function tests (PFTs), preoperative pulmonary symptoms and surgical approaches., Methods: The case records of 298 patients, who underwent anterior or posterior fusion, were reviewed. Preoperative PFTs were recorded and abnormal PFTs were defined as forced vital capacity (FVC) is less than 80% of FVC predicted. Preoperative pulmonary symptoms (breathless on exertion) were noted, and postoperative pulmonary complications were defined when the presence of atelectasis, infiltrates, pneumothorax, hemothorax, pneumonia or requirement of postoperative ventilatory support was noted., Results: The mean age of this group was 16.4 years (range from 6-62 years). The average coronal Cobb angle was 73.26 degrees (range from 45 degrees-141 degrees ). Of all the patients, 115 patients had normal preoperative PFTs, the other 183 cases had abnormal PFTs. Nineteen cases of all the patients were found with postoperative pulmonary complications including postoperative ventilatory support in 6 cases, atelectasis in 4 cases, infiltration in 2 cases, pneumothorax in 3 cases, pneumonia in 3 cases and hypoxemia in 1 case. The incidence of postoperative pulmonary complication was 6.4% in all the patients, while 18.99% in the 79 patients with thoracotomy and 1.85% in the 216 patients without. The correlation between postoperative pulmonary complications and the surgical approach was statistically significant (P=0.0000). When the patients were classified into 3 groups: 60%< FVCR <80%, 40%< FVCR <60%, FVCR <40%, the incidence of postoperative pulmonary complications were 2.72% (3/110), 7.40% (4/54) and 31.6% (6/19) respectively, which showed an increasing complication incidence. In the 115 patients with normal PFTs, 3 patients had preoperative pulmonary symptoms (2.68%), while 14 of the 183 patients with abnormal PFTs had preoperative pulmonary symptoms (7.65%). The correlation between presence of preoperative respiratory symptoms and abnormal results on PFTs was statistically significant (P=0.01). No significant correlation was found between preoperative respiratory symptoms and postoperative pulmonary complications (P=0.52)., Conclusions: The incidence of postoperative pulmonary complications increases with the deterioration of PFTs. The posterior procedure has a very low incidence of postoperative pulmonary possibility of complications, but a transthoracic procedure increases the complications significantly. Preoperative respiratory symptoms usually predict abnormal results of PFTs but have no correlation with postoperative pulmonary complication.

Objective: To evaluate the relationship between the mutation of the von Hippel-Lindau (VHL) gene and expression of vascular endothelial growth factor (VEGF) in sporadic clear cell renal cell carcinoma (CCRCC) and angiogenesis., Methods: Polymerase chain reaction (PCR) was used to detect the mutation of VHL gene in the specimens of cancerous tissue and normal tissues away from tumor from 77 patients with CCRCC. Immunohistochemistry was used to examine the expression of VEGF. CD34 staining was used to measure the microvascular density (MVD)., Results: VHL gene mutations were detected in 40 cases (51.9%). The expression rate of VEGF was 79.2% (61 cases). The positive rate of VEGF in the cases with VHL mutation was 92.5%, significantly higher than that in the cases without VHL mutation (64.9%, P = 0.003). The levels of MVD was higher in the cases with VHL mutation and those with VEGF expression were 760.80/mm2 and 715.95/mm2 respectively, both significantly higher than those in the cases without VHL-mutation and those without VEGF expression (547.03/mm2 and 437.44/mm2 respectively, all P = 0.001). The cases with expression of VEGF were divided into two groups according the presence or absence of VHL gene mutations or not. The MVD of the cases with VEGF expression and VHL mutation was 760.80 mm2, significantly higher than that of the cases with VEGF expression and without VHL mutation (547.03 mm2, P = 0.011)., Conclusion: The mutation rate of VHL gene is high among the Chinese with sporadic CCRCC. VHL gene mutation increases significantly the VEGF expression, thus, and perhaps via other mechanism too, promoting the angiogenesis in tumor. The high level of MVD of the cases with VHL gene mutation may be related to the high malignant potential of CCRCC.

Objective: To observe the expression of MAGE-1 MAGE-3 genes and MAGE-3 gene product in renal and urinary bladder tumor, and to explore the possibility of MAGE-1 and MAGE-3 genes encoding proteins or MAGE-3 gene product used as a target for immunotherapy in renal and urinary bladder tumor patients., Methods: Reverse transcriptase polymerase chain reaction for MAGE-1 and MAGE-3 genes was performed using 39 renal and urinary bladder tumor specimens. Immunohistochemical technique for MAGE-3 antigen was performed using formal infixed paraffin embedded section of 121 renal and urinary bladder tumor specimens., Results: MAGE-1 and MAGE-3 mRNAs were detected in 23(59.0%) and 22(56.4%) of 39 patients with renal and urinary bladder tumor without expression in 10 tumor surrounding tissues.MAGE-3 antigen was detected in 56(46.3%) of 121 patients with renal and urinary bladder tumor without expression in 10 tumor surrounding tissues. The expression rates of MAGE-1 and MAGE-3 mRNA and MAGE-3 gene product were significantly higher in renal and urinary bladder tumors tissues than in tumor surrounding tissues. The frequency of MAGE-3 gene product expression was examined according to clinical stage and differentiation of histopathology. The results revealed no significant differences in MAGE gene product expression among the clinical stage and the grade of differentiation of histopathology according to Logistic Regression test(P>0.05)., Conclusion: The tumor-specific antigens might be used as molecular markers and targets for human renal and urinary bladder tumor.

Objective: To assess efficacy and safety of alendronate sodium treatment in osteoporosis patients with hip fracture., Methods: One year randomized, double-blind clinical trial was carried out in 77 osteoporosis patients with hip fracture. The bone mineral density (BMD) in lumbar spine (L(2 - 4)), femoral neck (Neck), Wards triangle (Wards) and great trochanter (Troch) was measured by dual energy x-ray absorptiometer (DEXA)., Results: In our study, alendronate sodium induced marked increases in BMD of the L(2 - 4) (7.0% +/- 13.0%), Neck (7.3% +/- 11.1%), Wards (4.6% +/- 5.9%), Troch (4.5% +/- 3.2%) (mean +/- s) versus decreases of 2.0% +/- 4.5%, -0.9% +/- 6.9%, 3.6% +/- 4.9% and 1.14% +/- 6.0% with placebo (P < 0.05). Blood Ca, P, ALP, BGP and Urine Pyd/C were no significant difference between before and after therapy. There were usually mild and transient side-effect, such as gastrointestinal symptoms., Conclusion: Alendronate is an efficacy and safety drug in treatment of osteoporosis.

Objective: To discuss the effect of the posterior minimally-invasive surgical treatment of root type cervical spondylotic myelopathy., Methods: A posterior minimally-invasive operation was given to 32 nerve root type cervical spondylotic myelopathy patients, and the clinical result was followed., Results: An operation of enlargement of intervertebral foramen and disc excision was given for 14 young patients whose ligamentum flavum incrassated a little and the disc was soft. An operation of enlargement of intervertebral foramen only was given for 18 old patients whose ligamentum flavum incrassated much with ossification, and the disc was tenacious. All the patients' sign of nerve root was improved after operation. Twenty-eight patients were followed up 3 to 16 months, and there were no obstacle of neck movement and recurrence of clinical sign., Conclusion: This method for the posterior minimally-invasive neurosurgical operations of cervical spondylotic myelopathy is safe, simple and effective. By this operation, we can removal most of the herniative cervical disk and decompression for the nerve root and get good stable of spondylopathy.

Objective: To define the criteria of selective thoracic fusion in adolescent idiopathic scoliosis patients., Methods: By reviewing the roentgenograms of adolescent idiopathic scoliosis patients undergoing selective thoracic fusion, the curve type, Cobb angle, apical rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed., Results: There were 12 King type II patients (PUMC type: IIb1 9, IIc3 3). The coronal Cobb angle of thoracic curve before and after surgery were 54.0 degrees and 19.0 degrees respectively, and the average correction rate was 62.7%. The coronal Cobb angle of lumbar curve before and after surgery were 34.6 degrees and 12.5 degrees respectively, and the average spontaneous correction rate was 64.7%. At the final follow-up, the coronal Cobb angle of thoracic and lumbar curve was 18.8 degrees and 15.9 degrees respectively. There was no significant change in the coronal Cobb angle, apical vertebral translation and rotation compared with that after surgery. 1 patient had 12 degrees of thoracolumbar kyphosis after surgery, no progression was noted at the final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.5 levels were saved compared with fusing both the thoracic and lumbar curves., Conclusion: Selective thoracic fusion can be safely and effectively performed in patients with a moderate and flexible lumbar curves, which can save more mobile segments to maintain a good coronal and sagittal balance.

Objective: To study the impact of short-term neoadjuvant hormonal treatment on neuroendocrine (NE) differentiation and the relation of NE differentiation and tumor regression., Methods: The radical prostatectomy specimens and the biopsy specimens of the same 18 patients with prostate cancer were compared. The effect of hormonal treatment on NE-differentiation was evaluated by specific antibodies against chromogranin A (ChA) and serotonin (5-HT)., Results: The ChA-positive cell count was 3.2 x 10(-5)/microm(2) [(0-5.7) x 10(-5)/microm(2)] before hormonal treatment and 2.3 x 10(-5) microm(2)[(0-6.6) x 10(-5)/microm(2)] afterward (P > 0.05). For the proportion of NE-positive tumor, it was 7.0% (0%-14.9%) and 4.5% (0%-13.1%) (P > 0.05). No correlation existed between NE-differentiation and the neoadjuvant hormonal treatment. The NE cell density did not differ significantly between 12 non-/slightly regressive tumor foci and 6 highly regressive ones (P > 0.05)., Conclusion: Short-term neoadjuvant hormonal therapy does not induce clonal propagation of NE cells. The degree of tumor regression following short-term neoadjuvant hormonal therapy is not correlated with the NE differentiation.

Objective: To investigate the prognostic value of some clinicopathologic indexes and biologic tumor markers in predicting recurrence in T1 transitional cell carcinoma (TCC) of the bladder., Methods: The expressions of p53, E-cadherin and VEGF of 75 patients with T1 primary bladder TCC were detected by streptabitin peroxidase (SP) immunohistochemical methods. The effects of clinicopathologic indexes and biologic tumor markers on recurrence were assessed by Kaplan-Meier and Cox proportional hazards model., Results: The 1-, 3-, and 5-year recurrence- free survival rates were 68.0%, 45.3% and 20.9%. In Kaplan-Meier analysis, tumor mutifocality and the expression of p53, E-cadherin and VEGF were associated with recurrence. In multivariate analysis, the independent recurrence variables were tumor mutifocality, the expression of p53 and E-cadherin., Conclusion: Tumor mutifocality and the abnormal expression of p53 and E-cadherin are the variables that independently predict recurrence in T1 transitional cell carcinoma of the bladder.

Objective: To investigate the expression and significance of Clusterin in normal prostate, benign prostate hyperplasia (BPH) and prostate cancer., Methods: Clusterin expression in samples of 12 normal prostate, 15 BPH, and 56 prostate cancer were studied by immunohistochemical stain., Results: Of 83 cases, 67 are positive or weak positive (81%). The rate of positive or weak positive for normal prostate, BPH and prostate cancer was 17% (2/12), 73% (11/15), and 96% (54/56) respectively. The expression level of Clusterin in prostate cancer was much higher than in normal prostate (t = 8.82, P < 0.01). BPH (t = 7.63, P < 0.01) was related positively with pathological grade (r = 0.649, P < 0.01) and stage (r = 0.609, P < 0.01) of prostate cancer., Conclusion: Clusterin may play an important role in the biological characteristics of prostate cancer by the anti-apoptosis pathway.

Objective: To analyze the causes of the complications associated with the pedicle screw fixation during and after operation, as well as the methods for prevention and treatment., Methods: From January 1988 to December 1999, 475 patients who underwent pedicle screw fixation for various spinal disorders were reviewed retrospectively with statistical analysis., Results: Four hundred and twenty-eight patients (90.1% of all) were followed up for (6.0 +/- 3.7) years. Complications of CD, DRFS, Dick, RF and steffee among 72 cases (80% of all) occurred during the operation of pedical screw fixation in 26 cases with the incidence of 5.5% and after the operation in 64 cases with the incidence of 15%. The incidence of operative/postoperative complications were 0-12.9% in CD, 6.8%-11.9% in DRFS, 7.3%-12.7% in Dick, 2.4%-19.5% in RF, and 10.1%-21.5% in Steffee respectively. The main complications included pseudoarthrosis, pedicle screw broken, pedicle screw malposition and so on. The complications were mainly due to unskilled technique of pedicle screw fixation, implant defect in design and so on., Conclusions: The complications associated with the technique of pedicle screw fixation must not be neglected. The main causes are laid on unskilled technique of pedicle screw fixation and implant defect in design.