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Objective: To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery. Methods: The efficacy of intraoperative neuromonitoring (IONM) was analyzed retrospectively in 18 patients, including 6 males and 12 females, aged from 15 to 74 years, treated in Affiliated Drum Tower Hospital, Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring. Results: All 18 patients had complete tumor removal, including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve. Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve, and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve. The total incidence of motor nerve injury was 11.1% (2/18). All patients were followed up for 6 to 45 months, with no tumor recurrence. Conclusion: Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors, which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.

Objective: To investigate the feasibility of mimics software in analyzing a new type of complex anterior cervical fixation -- anterior transpedicular screw fixation+zero notch internal fixation., Methods: From January 2021 to September 2022, 50 normal pedestrians who underwent cervical spine CT scanning were selected for C 1 -C 7 segment scanning, including 27 males and 23 females, aged from 25 to 65 years old with an average of (46.0 ± 9.0) years old. The dicom format is exported and engraved into the CD, and use the mimics software to perform 3D reconstruction of each segment. A simulated screw is placed on the image according to the critical value of zero notch screw (head and tail angle 44°, internal angle 29°). The position of zero notch screw in each segment is observed to determine the feasibility of anterior transpedicular screw fixation plus zero notch internal fixation., Results: For the upper zero notch screws the three-dimensional images of the cervical spine across all 50 subjects within the C 3 -C 7 segments demonstrated safe position, with no instances of intersection with ATPS. For the lower zero notch screw, in C 3 -C 4 and C 4 -C 5 , 4 out of 50 subjects are in the safe position in the three-dimensional images of cervical vertebrae, and 46 cases could achieve secure screw placement when the maximum caudal angle is(32.3±1.9) ° and (36.1±2.2) °, respectively. In C 5 -C 6 and C 6 -C 7 segments, no lower zero notch screws intersected with ATPS, and all screws are in safe positions., Conclusion: Lower cervical anterior pedicle screw fixation plus zero notch internal fixation can achieve successful nail placement through the selected entry point and position.

To investigate the prevalence of diabetes mellitus (DM) among residents in Chongchuan district, Nantong city in 2012 and 2018, and evaluate the effectiveness of community comprehensive management of DM. Based on the data of 17 780 and 13 382 residents in the cross-sectional surveys of the " National Demonstration Area for Comprehensive Prevention and Control of Chronic Diseases " project in Chongchuan District of Nantong City, Jiangsu Province in 2012 and 2018, 4 583 and 3 996 DM-related information were obtained. The population of Jiangsu Province in 2012 and 2018 was used as the reference for standardization. The rates of prevalence and management (including awareness, treatment, treatment of patients who knew their diabetic situation, control and control of patients under treatment) of DM in the two surveys were compared using chi-square test. The results showed that in 2012 and 2018, the prevalence rates of DM were 12.0% and 15.7% (χ² = 24.25, P <0.05), and the standardized rates were 10.1% and 10.8% (χ² = 1.05, P =0.306). The incidence rates were 5.7% and 2.3%, respectively (χ² = 55.60, P <0.05). The standardized prevalence rates in the two surveys were 9.7% and 11.6% for males (χ² = 3.66, P =0.056) and 10.5% and 9.9% for females (χ² = 0.50, P =0.481), 7.2% and 6.5% (χ² = 0.85, P =0.357) for people aged 18-59 years old and 20.6% and 21.9% (χ² = 0.91, P =0.339) for people aged 60 years and over, respectively. The standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, control, and control of patients under treatment in 2018 were 84.4%, 80.3%, 95.2%, 58.4%, and 70.2%, respectively, higher than 47.2%, 23.4%, 44.8%, 30.4% and 59.4% in 2012 (χ² = 183.33, χ² = 380.65, χ² = 282.99, χ² = 93.24, χ² = 6.22, all P <0.05). Among men, the standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, and control in 2018 were 85.8%, 78.8%, 91.8% and 62.7%, higher than 50.5%, 37.5%, 72.3% and 32.6% in 2012 (χ² = 78.40, χ² = 96.17, χ² = 27.55, χ² = 48.96, all P <0.05). Similarly, the standardized management rates in 2018 were 83.0%, 81.7%, 98.5%, 54.1% and 65.1%, higher than 44.0%, 10.0%, 18.3%, 28.2% and 48.8% in 2012 among women (χ² = 105.52, χ² = 326.36, χ² = 317.22, χ² = 43.34, χ² = 3.87, all P <0.05). The standardized rates of awareness, treatment, treatment of patients who knew their diabetic situation, and control of people aged 18-59 and 60 years and over were 82.9%, 79.7%, 96.1%, 55.0% and 88.0%, 81.8%, 93.0% and 67.2%, higher than 42.6%, 19.8%, 42.2%, 27.5% and 63.9%, 36.8%, 53.9%, 40.8% in 2012 (χ² = 44.51, χ² = 102.17, χ² = 57.78, χ² = 21.65, all P <0.05; χ² = 71.18, χ² = 181.55, χ² = 146.26, χ² = 59.23, all P <0.05). The comprehensive prevention and control system of chronic diseases, which comprehensively covered the life of community residents, had good management effect on DM, and effectively promoted health education and health promotion.

Objective: To investigate the clinicopathological characteristics and prognosis of high-grade B-cell lymphoma (HGBL) involving combined rearrangements of MYC, bcl-2 and bcl-6. Methods: A total of 1 138 cases of large B cell lymphoma (LBL) that were treated at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to September 2020 were analyzed using fluorescence in situ hybridization (FISH) with probes against MYC, bcl-2 and bcl-6. The clinical and pathological data of the 45 patients with HGBL that had rearrangements of MYC and bcl-2 and/or bcl-6 were collected and retrospectively analyzed. Results: Among the 1 138 LBL, 45 (4.0%) cases had combined rearrangements of MYC, bcl-2 and/or bcl-6 that included 6 HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, 14 HGBL cases with MYC and bcl-2 rearrangements, and 25 HGBL cases with MYC and bcl-6 rearrangements. Of these 45 patients, 29 patients were male, and 16 patients were female, aged 29 to 83 years. HGBL with MYC, bcl-2 and bcl-6 rearrangements and HGBL with MYC and bcl-2 rearrangement were reclassified as the germinal center B-cell (GCB) subtype using the Hans algorithm. HGBL with MYC and bcl-6 rearrangement were reclassified as the GCB subtype (68.0%) and the non-GCB subtype (32.0%). The vast majority of HGBL cases had a high Ki-67 proliferation index. Most HGBL patients had advanced stage disease with a high IPI score and an increased LDH level. Also, some patients had clinical features including elevated plasma β2-microglobulin levels, B symptoms, and bone marrow involvement. The IPI scores and LDH levels were significantly different between the HGBL cases with MYC, bcl-2 and bcl-6 rearrangements and the HGBL cases with MYC and bcl-6 rearrangements ( P <0.05). Compared with the HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, the HGBL cases with MYC and bcl-2 or bcl-6 rearrangements had a lower incidence of bone marrow involvement ( P <0.05). There were no significant differences in the prognosis among HGBL cases with MYC, bcl-2 and bcl-6 rearrangements, the cases with MYC and bcl-2 rearrangements, and the cases with MYC and bcl-6 rearrangements ( P >0.05). Conclusions: HGBL with MYC, bcl-2 and/or bcl-6 rearrangements are rare types of B-cell lymphoma with high degree of malignancy and have a short overall survival. To reduce misdiagnosis and improve diagnostic accuracy, it is necessary to assess the patients' clinical features and conduct histopathological, immunohistochemical and FISH analyses.

Chronic pain of knee osteoarthritis (KOA) greatly affects the quality of life and functional activities of patients. It is important to clarify the underlying mechanisms of KOA pain and the analgesic effect of different therapies. Neuroimaging technology has been widely used in the basic and clinical research of pain. In the recent years, neuroimaging technology has played an important role in the basic and clinical research of KOA pain. Increasing evidence demonstrates that chronic pain in KOA includes both nociceptive and neuropathic pain. The neuropathic mechanism involved in KOA pain is complex, which may be caused by peripheral or central sensitization. In this paper, we review the regional changes of brain pathophysiology caused by KOA pain based on magnetic resonance imaging (MRI), electroencephalogram (EEG), magnetoencephalogram (MEG), near-infrared spectroscopy (NIRS) and other neuroimaging techniques. We also discuss the central analgesic mechanism of different KOA therapies, with a focus on the latest achievements in the evaluation and prediction of pain. We hope to provide new thoughts for the treatment of KOA pain, especially in the early and middle stages of KOA.

Objective: To investigate the value of chromosomes 7 and 8 polysomy in circulating tumor cells (CTCs) for the diagnosis of non-small cell lung cancer, and the correlation of CTCs with clinical pathological characteristics and epidermal growth factor receptor (EGFR) mutations in cancer tissue. Methods: Fifty-seven patients with non-small cell lung cancer and 21 patients with benign lung diseases were enrolled at Beijing Chaoyang Hospital, Capital Medical University, Beijing, China from November 2017 to October 2020. Negative enrichment combined with immunofluorescence in situ hybridization (imFISH) was used to identify CTCs polysomy on chromosomes 7 and 8. EGFR mutations in 56 lung cancer patients was detected using ARMS-PCR. Results: CTCs were detected in 93.0% (53/57) of non-small cell lung cancers and 28.6% (6/21) benign lung lesions. The difference between lung cancer patients and the control cohort was statistically significant ( P <0.01). Receive operator curve (ROC) analyses showed that, when the cut-off value was 1 cell/3.2 mL, Youden index had the highest sensitivity of 93.0% and specificity of 71.4% (AUC=0.906, 95% CI :0.833-0.980, P <0.01). The positive rate of CTCs in stage Ⅲ-Ⅳ cancers was significantly higher than that in stage Ⅰ-Ⅱ ( P =0.023). No significant correlation was observed between positive rate of CTCs or chromosome polysomy and age, gender, smoking status, pathologic types and EGFR mutation status. The number of CTCs in EGFR mutated group was higher than that in the non-mutated group (6.5±1.1 vs. 3.7±0.7, P =0.045). The detection rate for CTCs ≥5 in the EGFR mutated group was also higher than the EGFR non-mutated group (52.0% vs. 19.4%, P =0.010). Conclusion: Detection of CTCs with chromosomes 7 and 8 polysomy has potential value in auxiliary diagnosis of non-small cell lung cancer, and the number of CTCs is correlated to TNM stage and EGFR gene mutation status.

Objective: To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis., Methods: From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed., Results: The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups ( P <0.05). The follow up time was (24.2±5.1) months in group A and (24.0±5.0) months in group B, there was no significant difference between two groups ( P >0.05). At the follow-up of 4 months after operation, one patient in group A was found to have enlarged psoas major abscess on the contralateral side, and was cured after secondary operation. No sinus formation, cerebrospinal fluid leakage, internal fixation loosening, fracture or distal junction kyphosis were found during follow-up. The fusion time was (5.1±1.6) months in group A and (5.1± 1.7) months in group B, there was no significant difference between two groups ( P >0.05). The VAS, ODI score, sagittal Cobb angle, ESR and CRP value of the lesion segment at the last follow-up of the two groups were significantly improved ( P <0.05), but there was no significant difference between two groups ( P >0.05)., Conclusion: The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.

Objective: To explore The feasibility of digital guidance drill templates assisted expansive open-door laminoplasty. Methods: Ten specimens of normal adult cervical spine (C 3-7 ) were selected, including six males and four females. The specimens aged 42-67 years, with an average age of (43.6±4.2) years. After CT scanning, the date was imported into Mimics software in DICOM format. 3D models were reconstructed and the position and depth of troughs on the open side and hinge side were selected for expansive open-door laminoplasty. Drill templates were designed and exported in STL, manufactured by 3D printing finally. Then drill templates were attached to the posterior part of cervical lamina and spinous process. Under guidance of templates, troughs of both sides were conducted by using a high-speed drill. Then the lamina is elevated and instrumentations were implanted. Postoperative CT scanning was conducted to record the fracture of trough on the hinge side. 3D reconstruction was performed again to compare the position and depth between theory and actual trough on both sides by paired t test. Results: A total of 50 drill templates were designed and manufactured. There was no occurrence of hinge fracture after operation. In C 3-7 , the distance range between the theory position of troughs on the open side and the midline was 11.8-14.4 mm, while in actual it was 11.4-14.0 mm. The distance range between the theory position of troughs on the hinge side and the midline was 11.6-14.3 mm; in actual, it was 10.9-14.0 mm. The theory depth range of trough on the hinge side was 3.0-3.8 mm, while the actual depth was 3.1-3.8 mm. According to the statistical analysis, the difference in the position of trough on the open side, the position of trough on the hinge side and the depth of trough on the hinge side between theory and actual were not statistically significant (all P >0.05). Conclusion: Digital guided template assisted open-door laminoplasty is a feasible technique, which can improve the accuracy and safety of the position and depth of the trough, and has clinical application value.

Objective: To evaluate the best entry region and trajectory of anterior transpedicular root screws (ATPRS). Methods: From January 2018 to May 2019, 50 cervical CT date integral of healthy people were selected from Ningbo No. 6 Hospital and were confirmed no obvious defect. Of these, 24 cases were males and 26 were females, aged 20-49 (32±5) years. The CT data was imported into Mimics by DICOM format, then 3D reconstruction was performed. In the coronal plane, the area from the centreline of the anterior of C(3-7) to the left Z-line(marked a line through the intersection of the anterior of the luschak joint and upper endplates, parallel to the centralline of the anterior of the vertebral body) was divided into nine areas. Then virtual screw with diameter of 3.5 mm was inserted. Record the length of screw of each area (L), the angle between screw and the posterior of the vertebral body in horizontal plane(α), the angle between screw and the anterior of the vertebral body in sagittal plane (β), individually. The data between groups were compared by independent sample t test. Results: The best regions were zone 9 of C(3), C(4); zone 8, 9 of C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in men. And these were zone 9 of C(3); zone 3, 6, 8 and 9 of C(4), C(5); zone 2-3, 5-9 of C(6); zone 1-9 of C(7) in women. The distribution of best region was almost the same in men and women, zone 9 of each segment was the best region, and the screw length was the longest. It increased gradually from C(3) to C(7). C(3) had the least region, C(4) and C(5) had less, while C(6) and C(7) had the most. The horizontal angle of C(3-7) in men and women were 44.0°-47.2°, 40.2°-45.3° in zone 1, 4 and 7, respectively; 35.1°-41.4°, 34.6°-38.7° in zone 2, 5 and 8, respectively; 30.0°-37.2°, 30.2°-34.5° in zone 3, 6 and 9, respectively; and it demonstrated a gradually decreased trend. The sagittal angle of C(3-7) in men and women was 85.3°-97.4°, 80.5°-88.9° in zone 1-3, respectively; 101.2°-113.7°, 101.0°-109.3° in zone 4-6, respectively; 116.6°-128.8°, 119.9°-125.3° in zone 7-9, respectively; and it demonstrated a gradually increased trend. There was no significant difference in the horizontal and sagittal angle between men and women (both P> 0.05). Conclusions: Anterior transpedicular root screw is a feasible internal fixation technique. It has wide region and the Z-line can be used as a reference for screw placement.

Objective: To investigate the influence of posterior osteotomy on spinopelvic parameters in lumbar degenerative kyphosis (LDK) patients., Methods: The clinical data of 21 patients with lumbar degenerative kyphosis who underwent osteotomy from January 2012 to December 2015 were retrospectively analyzed. There were 5 males and 16 females, aged from 55 to 76 years with an average of (66.24±5.13) years. All patients had taken preoperative and postoperative full length spinal X-ray, analyzing the spinopelvic parameters as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS)., Results: All operations were successful, the average operative time was 190 min (160 to 220 min) and intraoperative blood loss was 1 000 ml (800 to 1900 ml). Parameters of the patients between preoperative and period 1-year follow-up were as follows : preoperative TK increased from (31.67±21.13) ° to (34.67±11.60) °, LL corrected from (4.76±3.17) ° to (37.41±6.28) °, PT reduced from (33.94±5.01) ° to (20.12±5.36) °, and SS improved from (18.47±2.60) ° to (31.71±4.30) °, SVA restored from (13.24±3.60) cm to (2.82±1.33) cm. There were significant differences of spinopelvic parameters between preoperation and postoperation ( P <0.05)., Conclusion: Posterior osteotomy can effectively reconstruct the sagittal balance of spinopelvis in patients with lumbar degenerative kyphosis. The recovery of lumbar lordosis and sacral slope is closely related to the reconstruction of sagittal balance.

Objective: To explore the efficacy of bilateral sagittal cross percutaneous kyphoplasty(PKP) for preventing recurrent fracture of the cemented vertebrae., Methods: From January 2017 to June 2017, 85 patients with single-segment osteoporotic vertebral compression fractures(OVCFs) were treated by bilateral sagittal cross PKP(cross group). There were 35 males and 50 females with an average age of (70.1±8.3) years old in cross group. Another 85 patients with single-segment OVCFs were treated by traditional PKP (traditional group). There were 37 males and 48 females with an average age of (73.3±9.5) years old in traditional group. The cement distribution condition, recurrent fracture of the cemented vertebrae, the anterior vertebral body height and sagittal Cobb angle, visual analogue scale(VAS) were observed in two groups., Results: All patients underwent operation successfully. The follow-up time were (11.8±4.5) months in cross group and (12.1±3.7) months in traditional group. In cross group, all patients' bone cement touched the upper and lower endplates of the vertebral body while 67 cases (78.8%) in traditional group did with significant difference between two groups ( P <0.05). No patient in cross group suffered recurrent fracture of the cemented vertebrae while 10 cases (11.8%) in traditional group did with significant difference between two groups( P <0.05). The anterior vertebral body height, sagittal Cobb angle and VAS in both groups were obvious improved at 2 days after operation ( P <0.05) and there were no significant difference between two groups at 2 days after operation and the final follow-up( P >0.05)., Conclusions: Bilateral sagittal cross PKP was a simple, safe and effective technique which can make bone cement distribute in the fractured vertebral body and contact the upper and lower endplates of the vertebral body, thus preventing the recurrent fracture of the cemented vertebrae., 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© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: The 3D model of lumbar spine was established by using Mimics software. To observe the applicability and needling parameters of lumbar vertebral kyphoplasty with unilateral puncture by backward rotation method using simulated puncture., Methods: Twenty-four patients (12 males and 12 females) with osteoporotic thoracic fracture in the first time and no signs of lumbar misalignment and bone destruction were scanned by spiral CT on the lumbar spine. The original DICOM file was modeled in 3D with Mimics software, and the vertebral bodies were separated. After being imported into 3-matic software, the posterior wall of the vertebral body was restrained for standardized measurement. A sketch perpendicular to the mid-section of the pedicle and the posterior wall of the vertebral body was drawn. The simulated puncture was performed on the sketch. The angle and distance parameters of the range of motion of the puncture needle were recorded, and the puncture needle was recorded at the top. The crossing points of the anterior, middle and posterior zones of the tangential line of the vertebral body were located at the high extraversion angle, and the results were compared and analyzed., Results: All the data in the left and right sides had no significantly differences( P >0.05). Data of different segments in different gender were significantly differences( P <0.05). The maximal extraversion angle in lumbar spine increased gradually from (33.41±1.31) degree to (56.53±4.71) degree in males, as same as in females from(28.58±2.55) to (53.86±2.68) degree. There was no crossing point in area A, 3.3% of males and 26.67% of females in area B, rest in area C. The distribution areas on gender showed statistically significance ( P <0.05)., Conclusions: Backward rotation method can theoretically meet the requirements of puncture point for vertebral compression fracture, especially for males and lower lumbar spine. The determination of the maximum inclination angle is of guiding significance to the backward rotation method., 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© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore the clinical efficacy of electroacupuncture nerve stimulation therapy (ENST) for interstitial cystitis/painful bladder syndrome (IC/PBS)., Methods: A total of 68 patients with IC/PBS were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the observation group were treated with ENST; abdominal four acupoints and sacral four acupoints were connected with a pair of electrodes and treated alternately every other day. The ENST was given 50 min per times, three times a week for 3 months. The patients in the control group were treated with perfusion therapy of four-medication combination (heparin sodinm, lidocaine, sodium bicarbonate, gentamicin sulfate), twice a week for the first 6-8 weeks, followed by twice per month for 3 months. The infusion fluid remained for 1 h before discharging. The O' Leary-Sant score, including interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI), 24 h urination frequency, visual analogue scale (VAS) and maximum bladder volume were observed before treatment and treatment of 1 month, 3 months and 6 months after treatment respectively; the adverse events during the treatment were also recorded., Results: Compared before treatment, the O'Leary-Sant score (ICSI, ICPI), 24 h urination frequency, VAS and maximum bladder volume in the two groups were improved after 1, 3 months treatment and 6 months after treatment (all P <0.05). The scores of ICSI, ICPI, VAS and 24 h urination frequency in the observation group were significantly lower than those in the control group ( P <0.05). The maximum bladder volume in the observation group was significantly higher than that in the control group ( P <0.05). Six months after treatment, the total effective rate in the observation group was 87.5% (28/32), which was higher than 69.7% (23/33) in the control group ( P <0.01). No significant adverse events occurred during the treatment., Conclusion: ENST could effectively relieve the clinical symptoms of IC/PBS, but its long-term efficacy needs further observation.

Objective: To evaluate the clinical effects of French door segmented laminectomy decompression for severe cervical OPLL complicated with spinal cord injury., Methods: The clinical data of 38 patients with serious cervical OPLL complicated with spinal cord injury were retrospectively analyzed and these patients were treated with French door segmented laminectomy decompression and internal fixation from June 2012 to June 2014. There were 25 males and 13 females, aged from 42 to 78 years with an average of 58.2 years. Of them, 35 cases suffered from aggravating neurological symptoms with a definite precipitating factor. Spinal cord injury was related to minor injury of the neck, such as hyperextension of the neck in 3 cases. Preoperative Japanese Orthopaedic Score (JOA) was 8.1±1.7 and Neck Disability Index (NDI) was 19.8±4.4. Preoperative CT scans showed the range of OPLL was more than three segments. The spinal canal was occupied 50% to 85% with an average of 70.7%., Results: All the patients were followed up for 10 to 24 months with an average of 15.6 months. The operative time was 90 to 150 min with an average of 120 min and blood loss was 300 to 800 ml with an average of (480±80) ml. At final follow-up, NDI and JOA were 7.5±2.5 and 13.5±2.0, respectively, and they were obviously improved compared with preoperation. Preoperative cervical Cobb angle was (8.10±2.70)° and at final follow-up was (15.60±1.80)°, and there was significant difference between preoperative and postoperative ( P <0.05). Deep infection occurred in 1 case, epidural hematoma in 1 case, C₅ nerve root palsy in 3 cases, and axial symptom in 8 cases after operation. No serious complications, such as vertebral artery injury, cerebrospinal fluid leakage, deterioration of neurological dysfunction, or internal fixation failure was found., Conclusions: French door segmented laminectomy decompression is safe and feasible for severe cervical OPLL complicated with spinal cord injury, and it is worth to be popularized in future., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objectives: To investigate the expression of migration-inducing gene 7 (MIG7) in different HCC lines and its relationship with vasculogenic mimicry (VM) formation and metastatic potentiality., Methods: Employing immunostaining to detect MIG7 protein expression and VM formation in 40 matched pairs of primary and metastatic HCC specimens from 40 patients, and investigating the correlation of VM formation with MIG7 protein expression. Detecting VM formation in HCC lines with different metastatic ability (MHCC-97H, MHCC-97L, Huh-7) and human normal hepatocyte line (L-02) through three-dimensional culture, and detecting MIG7 mRNA expression with RT-PCR, investigating the correlation of MIG7 protein expression with VM formation and HCC metastatic potentiality with Western blot assay; screening the HCC cell line with high MIG7 expression., Results: In 40 matched pairs of HCC tissue, there was a significant positive correlation between MIG7 protein expression and VM formation ( r s =0.595, P <0.01). The capability of VM formation of MHCC-97H with high metastatic potentiality was stronger than that of MHCC-97L with low metastatic potentiality and Huh-7 with non-metastatic potentiality, and there was no VM formation in L-02. The result of RT-PCR and Western blot assay indicated the same., Conclusions: MIG7 expression in HCC tissue is high and correlated positively with VM formation. MIG7 expression in different HCC cell lines is coincident with theirs VM formation, invasion and metastasis. MIG7 is a potential target for inhibiting the invasion and metastasis of HCC.

Purpose: To analyze and compare the difference of condylar position between Angle Class I and Class II malocclusion patients using cone-beam CT (CBCT)., Methods: Thirty Class I patients, 30 Class II division 1 patients and 30 Class II division 2 patients were selected in this study. Each patient underwent CBCT. The images in the oblique position perpendicular to the condyloid process were reconstructed by Examvision software. The joint space was measured by Exam Vision software. The data were processed with SPSS17.0 software package., Results: The upper joint space was larger in Class II, the posterior joint space was smaller in Class II patients; and in Class II division 1 patients, both of the upper and anterior joint spaces were larger than in Class II division 2 patients，the differences were significant (P<0.05). The length of condyle was longer in Class I patients than in Class II patients., Conclusions: The condylar position in Class II division 2 patients was lower and further backward. The length of condyle is shortest in Class II division 2 patients.

Objective: To investigate the inhibitory effect of migration-inducing gene-7(Mig-7)interfered with retrovirus-mediated RNA(shRNA)combined with recombinant human endostatin(ES)on the growth and metastasis of subcutaneous xenograft of human hepatoma cells in nude mice. Methods: Two Mig-7-mRNA oligonucleotide sequences(Mig-7-shRNA-1 and Mig-7-shRNA-2)and one sequence as a negative control(Mig-7-shRNA-N)were designed. The specific Mig-7-shRNA recombinant retrovirus expression vector plasmid was constructed and used for the transfection of human hepatoma MHCC-97H cells with high expression of Mig-7. The subcutaneous xenograft tumor model of human hepatocellular carcinoma(HCC)in nude mice was established, and according to the condition of transfection and administration, the nude mice were divided into pSIREN-M1 group, pSIREN-MN group, ES group, and pSIREN-M1+ES group. The xenograft tumor volume, mass, and metastasis were compared between groups. Immunohistochemistry was used to observe the formation of vasculogenic mimicry(VM)in xenograft tumor and the difference in tumor microvascular density(MVD), and Western blot was used to measure the expression of Mig-7 and vascular endothelial growth factor(VEGF)in each group. A one-way analysis of variance was used for comparison between groups, and the Fisher's exact test was used for comparison of continuous data between groups. Results: Compared with the pSIREN-MN group, the pSIREN-M1 group had significantly lower xenograft tumor volume, mass, and metastasis rate, Mig-7 expression, and formation of VM( P < 0.05), as well as significantly higher VEGF expression and MVD( P < 0.05). Compared with the pSIREN-MN group, the ES group had significantly lower xenograft tumor volume, mass, and metastasis rate, VEGF expression, and MVD( P < 0.05), as well as significantly higher Mig-7 expression and formation of VM( P < 0.05). Compared with the pSIREN-M1 group and the ES group, the pSIREN-M1+ES group had significantly lower xenograft tumor volume, mass, and metastasis rate, Mig-7 expression, formation of VM, VEGF expression, and MVD( P < 0.05). Conclusion: Mig-7-shRNA recombinant retrovirus combined with ES has a better inhibitory effect on the growth and metastasis of HCC xenograft tumor than Mig-7-shRNA recombinant retrovirus or ES alone. The anti-tumor angiogenesis therapy alone, which targets vascular endothelial cells in vivo, has a limited effect, since it may promote the formation of VM.

Objective: To analyze the mammographic, MRI, and clinicopathological characteristics of primary breast lymphoma (PBL)., Methods: Clinicopathological characteristics were retrospectively reviewed and analyzed in 32 patients with histopathologically proven PBL. All cases were female (mean age, 50 years; median age 46 years; range, 30-68 years)., Results: In the 32 cases, there were bilateral tumors in 5 cases and 27 cases of unilateral involvement. The patients presented with a painless mass in 25 cases and with pain in 7 cases. Rapid enlargement was observed in 6 cases. Mammograms of 17 tumors showed a round, circumscribed mass with high density or iso-density in 9, asymmetry in 7 and no abnormality was found in one. 37 lesions were detected on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in 29 patients, among which 25 (67.6%) lesions appeared as enhancing masses and 12 (32.4%) lesions as non-mass enhancements. All lesions showed iso- or hypo-intense signal on the T1WI and hyper-intense signal on the T2W1. Analysis of the enhancing masses based on the 2013 ACR BI-RADS lexicon revealed that among the mass descriptors in 25 lesions, the most common features were circumscribed or irregular margin in 24 (96.0%) and homogeneous internal pattern in 19 (76.0%). Of the 12 non-mass enhancing lesions, the most common descriptors included regional or multiple regional distribution in 6 (50.0%), and heterogeneous internal pattern in 8 (66.7%). The tumors showed early enhancement with penetrating vessels on DCE-MRI in 16 lesions, associated with skin thickening in 14, and axillary lymphadenopathy in 19. The time-signal intensity curve (TIC) in 14 patients was mainly of type Ⅲ (7/14, 50.0%)., Conclusions: Some imaging features may alert the diagnosis of primary breast lymphoma, but final diagnosis depends on histopathology. Early diagnosis is helpful for selecting appropriate treatment regimens.

Purpose: During orthodontic treatment, the incisors in patients with Class II division 1 and division 2 malocclusion showed different clinical features, which determine the different ways to move the teeth to the suitable position. This study analyzed the morphology of alveolar bone around upper central incisor with cone-beam CT (CBCT)., Methods: The sample consisted of 20 normal malocclusion and 40 patients with Class II malocclusion （division 1 20 cases and division 2 20 cases）. CBCT images before orthodontic treatment were reconstructed by INVIVO 5.0 image processing software. Paired t test was used for statistical analysis with SPSS 19.0 software package., Results: At the upper central incisors, the alveolar thickness between normal malocclusion and Class II division 1 and division 2 malocclusion had significant difference except the palate thickness between normal malocclusion and Class II division 2 malocclusion (P<0.05)., Conclusions: Orthodontist should consider the relationship between the teeth position and alveolar bone shape comprehensively, choose the correct plan in order to avoid root desorption, alveolar bone loss, fenestration and other adverse reactions.

Purpose: To analyze the clinical effect of extraction correction of patients with maxillary protrusion by using Damon high torque appliances., Methods: Forty patients with extraction of four first premolars due to orthodontic treatment were selected. They had protrusion of maxilla and were randomly divided into two groups. Both arches of Damon group were treated with Damon high torque appliances and MBT group were corrected with traditional MBT straight wire appliance; patients in two groups received sliding mechanics for adduction of upper anterior teeth. Cephalometric radiophotographs were analyzed before（T0）and after adduction of upper anterior teeth（T1）. The difference between the two groups was analyzed with SPSS15.0 software package., Results: The upper incisors showed a more retruded position in the two groups at T1,although they showed a similar amount in both groups. The backward movement of upper lip was 2.31mm in Damon group, which was significantly less than that of 2.81mm in MBT group(P<0.05). No significant difference in the first molar mesialization was detected between Damon group(2.33 mm) and MBT group(2.36mm) (P>0.05). For anterior teeth retraction, nasolabial angle (NLA) in MBT and Damon group were 107.44°and 106.33°, increase of NLA in MBT group was 9.17°,which was significantly larger than that of 7.22°in Damon group (P<0.05). U1-MxP in MBT and Damon were 110.61°and 114.11°. U1-MxP decreased 12.06°in MBT group, while significant change was deteced in Damon group of 7.61°(P<0.05)., Conclusions: Application of Damon high torque appliances in extraction treatment of maxillary protrusion patients yielded better control of the labial crown torque of anterior teeth, and avoided excessive lingual inclination of anterior teeth compared with MBT in adduction of upper anterior teeth.

Purpose: To provide some references of using micro-implant anchorage in clinical orthodontic treatment, the thickness of buccal bone of mandible of different vertical facial type in adults with cone-beam CT (CBCT) were measured., Methods: Initial 3-dimensional images of 45 adult patients (15 men, 30 women)were reoriented by using a standardized protocol, and divided into 3 groups by angle of mandibular plane (G1: high angle, 15 patients; G2: average angle, 15 patients; G3: low angle, 15 patients). After signing the informed consent form, three measurement points were defined at 4, 6, and 8mm from the alveolar crest in each measurement area. Statistical analysis was performed with SPSS11.0 software package., Results: The thickness of buccal bone in mandible was thinner in G1 than in G2, and was thinnest in G3. The cortical bone thickness was thickest at the 8 mm level and thinnest at the 4mm level., Conclusions: The study suggested that the cortical bone thickness at 4mm level from the alveolar crest was safe for implantation. It is more stable when the distance of implants was more away from the alveolar crest. Patients with low mandibular plane angle should use self-tapping micro-implant anchorage. Supported by Nantong Science and Technology Fund (HS2013033).

Objective: To explore the relationship between the expression of EIIIA+ fibronectin in incised wound of rat's skin and injury time., Methods: The wounding model was established by cutting the dorsal skin of 48 adult SD rats. The rats were sacrificed at the pre-set injury time as immediately, 0.5 h, 1 h, 2 h, 3 h, 4 h, 6 h, and 8 h. The skin samples were taken at the margin of wound. The expression of the EIIIA? fibronectin was detected by immunohistochemistry and Western blotting and the relationship be- tween its expression and injury time was observed. Results The expression of EIIIA+ fibronectin was not observed immediately. The basal cell of skin began to show positive expression 0.5 h after injury. With the extension of injury time, positive staining became stronger. The value of relative optical density was gradually increased with prolonged injury time by the Western blotting analysis., Conclusion: The expression of EIIIA+ fibronectin could be used for estimation of injury time in the early stage of skin injury.

Objective: To study the curative effect of postural reduction with instrumental reduction in treatment of flexion-distraction thoracolumbar fractures., Methods: A retrospective study was performed on 43 patients with single thoracolumbar flexion-distraction fractures admitted from August 2009 to August 2011, included 28 males and 15 females with an average age of 44 years old (34 to 56 years old). All patients were treated with postural reduction with instrumental reduction. The kyphosis (Cobb angle) recovery of injured vertebral height and complication were analyzed. The visual analogue scale(VAS) and com-plications were followed up and recorded., Results: There was no difference in recovery of injured vertebral posterior height among preoperative, 1 week and 1 year after operation (P > 0.05). There were significantly difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between preoperative and postoperative at 1 week (P < 0.05). There was no difference in kyphosis (Cobb angle) and recovery of injured vertebral anterior height between 1 week and 1 year after operation (P > 0.05). VAS significantly improved from preoperative (7.2 +/- 1.2) to (0.8 +/- 0.7) at 1 year after operation (t = 18.47, P < 0.001)., Conclusion: Postural reduction with instrumental reduction is effective for thoracolumbar flexion-distraction fractures and it is beneficial to the recovery of vertebral height and saggital alignment.

Objective: To evaluate the clinicopathological features and prognosis of primary hepatic lymphoma (PHL)., Methods: Thirty-five patients with PHL who underwent surgical resection and were confirmed by pathology in our hospital from 1982 to 2012 were re-evaluated for clinicopathological data, including their symptoms, radiological features, recurrence interval, histopathological properties and prognosis., Results: Of the 35 patients, 25 were men (71.4%) and 10 were women (28.6%), with an average age of 52.6 years old (range, 17-79 years). Presented symptoms were epigastric phymatosis, abdominal pain and low-grade fever. In the present study, 21 (60.0%) patients were positive for HBsAg, 1(2.9%) patient was positive for anti-HCV, 3 patients were positive for AFP, 12 patients and 2 patients were complicated by cirrhosis and hepatocellular carcinoma, respectively. Pathologically, 35 PHL were classified into 19 DLBCL (54.3%), 13 T cell-lymphoma (37.1%), and 3 MALT lymphoma (8.6%). Patients with DCBCL showed better postoperative survival than patients with T cell-lymphoma (31.7 ± 3.2) months vs. (22.9 ± 2.2) months (P < 0.05)., Conclusions: Hepatitis B virus (HBV) infection may contribute to the pathogenesis of Chinese patients with PHL. Surgical resection followed by comprehensive therapy is the first-line option for PHL. The prognosis of patients with PHL is associated with PHL subtypes.

Objective: To explore the clinical application of Centerpiece titanium plate fixation in open door laminoplasty., Methods: From January 2009 to December 2010,25 patients with cervical spinal stenosis were treated by open door laminoplasty with Centerpiece titanium plate fixation. There were 16 males and 9 females,with a mean age of (57.2 +/- 6.7) years (ranged, 44 to75 years). There were multilevel cervical myelopathy in 8 cases, posterior longitudinal ligament ossification in 12 cases and congenital cervical spinal stenosis in 5 cases. According to Japanese Orthopedic Association (JOA) score to evaluate nerve function and calculate improvement rate. X-ray and CT were used to evaluate postoperative spinal canal enlargement and bone fusion at the hinge side. The sagittal diameter of C5 spinal canal on the lateral X-ray was measured before operation and 6 months after operation respectively, and the expansion rate of spinal canal was calculated [(postoperative sagittal diameter-preoperative sagittal diameter)/(preoperative sagittal diameter) x 100%]., Results: The operative time and intraoperative blood loss were respectively (165.5 +/- 35.6) min and (325.0 +/- 75.1) ml. All patients were followed up from 6 to 18 months with an average of (7.3 +/- 3.8) months. The JOA score increased from 9.3 +/- 1.1 before operation to 14.7 +/- 2.1 at 6 months after operation (t = 4.12, P < 0.05), and the improvement rate was (64.5 +/- 10.2)%. Radiographic data showed spinal canal enlarged perfectly, bone fusion at hinge side and no cervical spinal stenosis was found. The sagittal diameter of C5 spinal canal improved from (9.0 +/- 1.5) mm before operation to (14.3 +/- 2.0) mm at 6 months after operation (t = 7.61, P < 0.05), and the expansion rate was (67.6 +/- 11.8)%., Conclusion: Clinical application of Centerpiece titanium plate fixation in open door laminoplasty is safe and effective. While vertebral plate is elevated to obtain instantly stability, at the same time, the integrity of spinal canal is also recovered.

Objective: To investigate the clinical effects of one-stage posterior-anterior decompression and internal fixation for the treatment of the severe fractures and dislocations combined with the spinal cord injuries of the lower cervical spine., Methods: From August 2005 to August 2009, 48 patients (male 28 and female 20, aged from 28 to 62 years with a mean of 39.6 years) with severe fractures and dislocations of lower cervical spine were treated by reduction and internal fixation with one-stage combined cervical anterior plating and posterior lateral mass screws and rod or plate systems. Frankel grade A was in 8 cases, grade B in 16 cases, grade C in 20 cases, and grade D in 4 cases before operation. Firstly, the posterior approach was carried out. After inserting the mass screws, decompression and reduction were performed, and the rod or plate systems were embedded. After grafting, the skull traction was removed and initiated the anterior reduction, intervertebral decompression, auto-graft and cervical spine auto-locking plate fixation. The stability and fusion rate of the injured segments were evaluated on the regular postoperative X-ray film. The function of the spinal cord was assessed with Frankle classification., Results: All patients were followed up, ranged from 6 to 28 months with an average of 12 months. Solid fusion obtained in the postoperative 6 months. Frankel grade C was in 28 cases, grade D in 14 cases, grade E in 6 cases after operation. There was no complications related to internal fixation breakage, loosening or displacement. There was no vascular and esophagus complications during the operation., Conclusion: One-stage combined anterior-posterior decompression and internal fixation in treating severe fracture and dislocations of lower cervical spine could restore the cervical curvature, and obtain good reduction and complete decompression, and gain postoperative immediate stability. This technique is benefit to the patients for the functional recovery of the spinal cord.

Objective: To assess the value of dynamic contrast-enhanced MRI (DMRI) in predicting early response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) and to assess the accuracy of MRI in evaluation of residual disease after NAC., Methods: Forty-three women with LABC (44 lesions, all were invasive ductal carcinoma) underwent DMRI before, after the first and final cycles of NAC. For each patient, the tumor volume, early enhancement ratio (E1), maximum enhancement ratio (Emax), and maximum enhancement time (Tmax), dynamic signal intensity-time curve were obtained during treatment. The residual tumor volumes obtained by DMRI were compared with pathological findings to assess the accuracy of DMRI., Results: After the first cycle of NAC, the mean volume of responders decreased insignificantly (P = 0.055), but after NAC, mean volume of residual tumor decreased significantly (P = 0.000). Morphological changes: 29 cases showed a concentric shrinkage pattern while 7 cases showed a dendritic shrinkage pattern. Significant differences were found in E1, Emax and Tmax between responders and non-responders (P < 0.05). After the first cycle of NAC, E1, Emax and Tmax of responders changed significantly (P < 0.001), while there was no significant change in non-responders (P > 0.05). After NAC, the dynamic signal intensity-time types were changed in responders, and tended to be significantly flattening, while no significant change was found in non-responders. The residual tumor volume correlation coefficient between MRI and pathology measurements was very high (r = 0.866, P < 0.01)., Conclusion: DMRI is useful to evaluate the early response to NAC in LABC. The presence and volume of residual tumor in LABC patients treated with NAC can be accurately evaluated by DMRI.

Objective: To evaluate the role and the performance of diffusion weighted imaging (DWI) for predicting the early response to neoadjuvant chemotherapy (NAC) in local advanced breast cancer (LABC) and to assess the accuracy of DWI in evaluating residual lesion after NAC., Methods: 88 women with LABC (89 lesions) underwent DWI before and after the first and final cycle of NAC. For each patient, the apparent diffusion coefficient (ADC) values were compared between the baseline and follow-up to predict the early response to NAC. The residual tumor volumes were obtained using 3D maximum intensity projections (MIP) of DWI map, and were compared with pathological findings to assess the accuracy of DWI in detecting and measuring residual tumor. All results were proved or analyzed comparing with the data from histopathology., Results: There were 68 lesions responding to NAC, while 21 non-responders. The baseline ADC values of responders and non-responders were (1.049 +/- 0.135) x 10(-3) mm(2)/s and (1.171 +/- 0.134) x 10(-3)mm(2)/s, respectively, with a significant difference (t = -2.731, P = 0.009 < 0.01). The ADC value measured prior to treatment was (1.087 +/- 0.146) x 10(-3)mm(2)/s, and the degree of the changes in tumor volume after NAC was (70.4% +/- 55.1)%. A negative correlation was observed (r = -0.430, P = 0.025 < 0.05). In the response group, there was a significant difference in ADC value between prior to NAC and 1st cycle of NAC, the final cycle of NAC, respectively (P < 0.001). While no significant differences were found in non-responders during NAC (P > 0.05). The tumor volume correlation coefficient between DWI and pathology measurements was very high (r = 0.749, P < 0.01)., Conclusion: DWI appears to provide functional information regarding changes in ADC value of tumors due to NAC. DWI may be useful in monitoring the early pathological response of tumor after the initiation of treatment and in evaluating the residual tumor after NAC.

Objective: To study the therapeutic effect of recombinant adeno-associated virus carrying human endostatin gene therapy on endometriosis in mice model., Methods: Recombinant adeno-associated virus vector carrying human endostatin gene and enhanced green fluorescent proteins gene (rAAV2-endostatin-EGFP) was constructed. Endometrium was from 12 patients with leiomyoma undergoing hysterectomy in Second Hospital, Tianjin Medical University between November and December 2008. Endometriosis models of nude mice were established by transplanting human endometrial fragments intooperitoneal surface. After 1 week, those 60 mice were divided into 3 groups: treatment group including 20 mice injected with rAAV2-endostatin-EGFP to ectopic lesion, control group including 20 mice injected with rAAV2-EGFP to ectopic lesion and blank control group including 20 mice injected with phosphate buffered saline (PBS) to the ectopic lesion. At 1, 2 and 3 weeks after treatment, those mice underwent laparotomy to observe the location and size of ectopic lesion in abdominal cavity. The expression of endostain protein, number of gland, microvessel density (MVD) and vascular endothelial growth factor (VEGF) were measured in ectopic lesions. The serum level of estradiol and progesterone were detected in nude mice among every groups., Results: (1) All endometriosis of nude mice models were established successfully through peritoneum transplanting. After 1 week's treatment, flat lesion nodes, decreased gland number and narrow and atrophy glandular cavity were observed by light microscope. (2) The endostatin gene was transferred into nude mice successfully and expressed effectively. It was observed that endostatin protein expression was shown with enhanced green fluorescent proteins in ectopic lesion. (3) Glands number of ectopic lesion in rAAV2-endostatin-EGFP group (7.8 ± 1.9, 7.0 ± 1.5 and 5.5 ± 1.7) were significantly less than 10.1 ± 1.7, 10.2 ± 2.0 and 9.8 ± 2.4 in rAAV2-EGFP control group and 10.2 ± 2.2, 10.0 ± 2.0 and 9.7 ± 2.2 in PBS control group at 1, 2 and 3 weeks after treatment (all P < 0.05). Glands number of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (4) MVD of ectopic lesion in rAAV2-endostatin-EGFP group (12.2 ± 1.5, 11.4 ± 2.1 and 9.0 ± 1.4) was significantly less than those at rAAV2-EGFP control group (16.5 ± 1.7, 16.5 ± 1.9 and 16.9 ± 1.9) and PBS control group (16.2 ± 1.6, 16.0 ± 1.6 and 16.3 ± 1.7) at 1, 2 and 3 weeks after treatment (all P < 0.05). MVD of ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (5) The rate and density of VEGF expression at ectopic lesion in rAAV2-endostatin-EGFP group (35%, 30%, 25% and 1.60 ± 0.43, 1.33 ± 0.30, 1.03 ± 0.36) were significantly less than those at rAAV2-EGFP control group (80%, 75%, 85% and 2.43 ± 0.53, 2.43 ± 0.29, 2.66 ± 0.45) and PBS control group (85%, 90%, 90% and 2.36 ± 0.53, 2.64 ± 0.57, 2.53 ± 0.52) at one 1, 2 and 3 weeks after treatment (all P < 0.05). The expression of VEGF at ectopic lesion in rAAV2-endostatin-EGFP group at 3 weeks was significantly less than those at 1 and 2 weeks after treatment (P < 0.05). (6) The level of estradial and progesterone in serum of nude mice of rAAV2-endostatin-EGFP group [E(2): (48 ± 7) pmol/L, P: (61 ± 8) nmol/L] did not reach statistical difference when compared with those at rAAV2-EGFP control group [E(2): (50 ± 9) pmol/L, P: (60 ± 10) nmol/L] and PBS control group [E(2): (48 ± 7) pmol/L, P: (58 ± 10) nmol/L, P > 0.05]., Conclusions: The recombinant adeno-associated virus carrying human endostatin gene therapy could inhibit angiogenesis at endometriotic lesions and not influence steroid level. The antiangiogenic gene therapy might become a novel option for endometriosis.

Objective: To compare the clinical effect difference between acupuncture combined with Chinese herb plus western medicine and simple western medicine in the treatment of compensated liver cirrhosis., Methods: Eighty cases were divided into a high viral load group and a low viral load group according to HBV-DNA test. The patients in two groups were randomly divided into a Chinese medicine plus western medicine treatment group (group A, group C) and a western medicine treatment group (Group B,group D), respectively, 20 cases in each group. The group A was treated with acupuncture at Ganshu (BL 18), Qimen (LR 14), Sanyinjiao (SP 6), etc. and oral administration of Chinese herbal decoction combined with Heptodin tablets; the group B with oral administration of Glucurolactone tablets combined with Heptodin tablets; the group C was treated with acupuncture at Ganshu (BL 18), Qimen (LR 14), Taixi (KI 3), etc. and oral administration of Chinese herbal decoction; the group D with oral administration of Glucurolactone tablets alone. After they were treated for 30 days, their therapeutic effects and the negative conversion rate of HBV-DNA were observed., Results: The total effective rate of 95.0% in the group A was better than 70.0% in the group B, and the total effective rate of 95.0% in the group C was better than 65.0% in the group D (both P < 0.05). There was no significant difference in the negative conversion rate of HBV-DNA between group A and group B or between group C and group D (both P > 0.05)., Conclusion: Acupuncture combined with Chinese herb plus western medicine treatment can more significantly improve clinical symptoms of the patients with compensated liver cirrhosis than simple western medicine therapy.

Objective: To explore the surgical treatment and classification of multiple-level noncontiguous thoracolumbar fractures., Methods: From December 2005 to December 2008, 24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A, 2 cases in grade B, 2 cases in grade C, 8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures (MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively., Results: All patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months (means 18.3 months). All cases achieved bone fusion, without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation, 11 got more than one grade improvement of the ASIA grading, 2 remained unchanged., Conclusion: The traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontiguous thoracolumbar fractures should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures.

Objective: To explore pedicle screw implantation for fracture-dislocation injuries at cervicothoracic junction (C6-T2)., Methods: Pedicle screw implantation was used for twenty-six patients with cervicothoracic fracture-dislocation from May 2001 to Jan 2008. There were 17 males and 9 females with an average of 48.5 years (range,20 to 75 years). Single posterior pedicle screw fixation was performed for 17 cases, and posterior screw fixation combined with anterior reduction and plate fixation for the other nine. The accuracy of the pedicle screws were evaluated by CT views after surgery. Complications and neurological recovery were also recorded after the procedures., Results: All subjects were followed up from 3 to 74 months with average 36.5 months. Four cases of complete paraplegia died of cardiovascular or pulmonary failure within half a year after surgery. There were 104 pedicle screws implanted totallythe including 74 pedicle screws in cervical vertebrae, 16 at C5, 16 at C6, 42 at C7, and 30 pedicle screws in upper thoracic vertebrae,in which 22 at T1, 8 at T2. No injury of spinal cord, nerve roots and vertebral artery was found during operation. Eleven screws (14.9%) were perforated out of the pedicles in cervical spine, in which 7(9.5%) through lateral cortex, 1 (1.4%) through the superior and 3 (4.1%) through the inferior. Three screws (10%) were perforated in upper thoracic spine, in which 2 (6.7%) by lateral cortex and 1(3.3%) by the medial (within 2 mm). Bony fusion was achieved for all cases and all internal fixator was good except 1 screw broken at C5. JOA score increased from preoperative (7.5 +/- 2.0) to postoperative (14.5 +/- 2.3) evaluated in 6 months after operation,with statistic difference (t = 6.34, P < 0.05). Neurological improvement was gotten in all patients according to ASIA classification but three cases who suffered from complete neurological injuries., Conclusion: Implantation of pedicle screws at cervicothoracic junction can be safe and reliable if the urgeonis familiar with the local anatomy of cervicothoracic spine, and the technique for implantation of the screws. Related radiological parameters should be measured for each subject before the operation in attempt to get a therapy individually.

Objective: To explore the clinical effects of posterior monosegmental pedicle screw fixation in selective treatment of thoracolumbar vertebral fractures., Methods: From June 2005 to June 2008, 28 patients (male 17 and female 11, the age was 19- 60-years-old with an average of 36 years) with thoracolumbar fractures were treated with posterior monosegmental pedicle screw fixation in our department. According to the AO classification, 19 patients with type A1 fracture and 9 with type A2. The place of pedicle screw and reduction of injured vertebral body were observed., Results: Postoperative CT scan showed 56 pedicle screws were all placed in the normal part of injured vertebral body. There was no spinal cord injury and infection after surgery. There were restoration of anterior body compression from mean preoperative (42.0 +/- 5.6)% to (12.4 +/- 1.4)% (P<0.05), and restoration of Cobb angle from mean preoperative (25.8 +/- 5.1) degrees to postoperative (1.9 +/- 1.3) degrees (P<0.05). All the patients were followed up for 3-36 months (average in 18.3 months). All fractures achieved bone healing, without significant loss of the vertebrae body height and implant failure., Conclusion: As indication is correctly choosed, posterior monosegmental pedicle screw fixation can be applied to treat thoracolumbar vertebral fractures.

Objective: To offer some reference for micro-implant's development and population by analyzing clinical application of two kinds of micro-implant systems., Methods: 38 patients treated with MIA (micro-implant anchorage) and 28 patients treated with SDIA (self-driven titanium implant for orthodontic anchorage) were included. Analyzing the rate of lost implants, the gum's reactivity and the efficiency of moving teeth summarized the excellences and shortcomings of two systems., Results: 1) Six of MIA implants fell off after being inserted. Seven of SDIA implants lost when they had been implanted for a month. But they were stable after being inserted again. 2) The gum around 12 SDIA implants got inflammation symptom, but the gum around MIA implants was normal. 3) Both MIA implants and SDIA implants could move teeth effectively and persistently when they were stable., Conclusion: When we apply micro-implant in clinic, we should prevent it from closing roots of teeth and choose the small tip micro-implant. The embedded position should be in area of attachment gum. At the same time, the areas around the tip of micro-implant should be keeping clean.

Objective: To compare and analyze the MRI features of different renal cell carcinoma (RCC) subtypes., Methods: The MR images of 81 surgically and pathologically confirmed renal cell carcinomas from 79 patients were reviewed retrospectively. The MR imaging features of lesions in plain scan, the degree and patterns of lesion enhancement (homogeneous, heterogeneous, peripheral), and tumor spreading patterns were analyzed. In order to evaluate the diagnostic validity of differentiating RCC subtypes using signal enhancement, receiver operating characteristic curves (ROC) were generated. The cutoff value of post-contrast signal intensity to noise ratios (SNR) of the tumor parenchyma were also generated in order to differentiate clear cell RCC from other subtypes., Results: Of the 81 lesions, 58 were clear cell carcinomas, 10 chromophobe cell carcinomas, 8 papillary cell carcinomas, and 5 unclassified RCC. All the chromophobe cell subtype tumors showed a homogeneous density (P < 0.05). The clear cell subtype tumors were likely heterogenous, and also showed heterogenous enhancement with mixed signal than other subtypes (P < 0.05). The cutoff value of SNR, which was used to differentiate clear cell subtype from the other subtypes, were 616 (corticomedullary phase), 579 (nephrographic phase) and 278 (excretory phase), retrospectively. The nephrographic phase is the most appropriate for differentiation, with a sensitivity of 62.1%, specificity of 91.3%, positive predictive value of 94.7%, negative predictive value of 48.8% and an accuracy value of 70.3%. No significant difference was found in tumor spreading patterns among all subtypes of RCC., Conclusion: MR imaging features, particularly tumor heterogeneity and degree of enhancement are useful in differentiation of the renal cell carcinoma subtypes, and in choosing an individualized therapy.

Purpose: To analyze the mechanical characteristic changes of teeth and arch under different loading direction during retracting mandibular incisors through implant, simulating clinical loading system., Methods: Three- dimensional finite element model, including brackets, archwire, crampable hooks and implants, was reconstructed. The force direction was determined by connecting the points in crampable hook and the center point of implant, and the force point and force direction were changed with the adjustment of the height of crampable hook and the height of implant. Then three-dimensional movement trend of teeth, stress distribution in periodontal membrane and the largest displacement of archwire nodes in each group were calculated and analyzed. SPSS13.0 software package was used for statistical analysis., Results: It was found that the height of implant and the height of crampable hook were correlated with the movement of teeth and stress distribution in periodontal membrane (P<0.01). The movement trend of teeth in the condition of different height of implant and different height of crampable hook was illustrated as follows:(1)with the height increase of crampable hook, the movement trend of the central and lateral incisors varied from mesial lingual tipping to mesial labial tipping. However, canines tipped distally and lingually; the second premolars tipped mesially and lingually, and the first molar roots tipped distally and buccally with decreasing tipping angle. (2) The largest stress distribution in the whole arch was located in the labial apical one-third area of the lateral incisors, while that of canines and the first molars was located in the alveolar ridges and root bifurcations., Conclusions: These findings indicate that the different movement trend during retracting anterior teeth can be achieved through the adjustment of the height of crampable hook, and implant, anchorage can effectively control anterior movement of the posterior teeth. Supported by Research Fund of Bureau of Science and Technology of Nantong City (Grant No. S40023).

Objective: To analyze the complications occurred in scoliosis surgery and evaluate its prevention strategy., Methods: From June 2002 to May 2007, 86 cases of idiopathic scoliosis were treated. There were 21 male and 65 female with an average age of 17.8 years(range, from 8 to 22 years). According to Lenke classification, 33 cases were type 1, 10 type 2, 18 type 3, 5 type 4, 10 type 5 and 10 type 6. Five cases were Risser 0 to I, 20 cases II to III, 61 cases 1V to V. Cobb angles were from 45 degrees to 85 degrees (mean 60.35 degrees). The pedicle screw technique was used to correct all the scoliasis, and the results and complications were studied., Results: The average operation time was 3.2 hours and average blood loss volume was 1000 ml (800-2400 ml), 924 pedicle screws were inserted and the average postoperative Cobb angle was 18.46 degrees. All the patients were followed up for 5 to 40 months(mean 20.5 months). The complications were as following: 1 case of spinal cord injury; 25 screws misplaced; 2 cases of nerve root injury; 1 case of pleura injury; 1 case of superior mesenteric artery syndrome; 3 cases of wound infection; 2 cases of trunk decompensation; 1 case of junction kyphosis; 3 cases of implant loosening; 2 cases of pseudarthrosis; 1 case of crankshaft phenomenon; 2 cases of flatback syndrome., Conclusion: Many kinds of complications may occur in scoliosis surgery. Exactitude procedures of diagnosis and surgery for the scoliosis are the key to decrease and prevent the complications related to the operation.

Objective: To compare the difference between J-hook and micro-implant anchorage in the treatment of patient with bimaxillary protrusion., Methods: Thirty patients with bimaxillary protrusion were divided into two groups (J-hook and micro-implant groups) and treated with MBT appliance. Four first premolars were extracted in all patients. Cephalometric analyses were carried out before and after treatment., Results: In J-hook group and micro-implant group,computerized cephalometric analysis revealed that before treatment U6C-PP was (12.4 +/- 0.2) mm and (12.5 +/- 0.1) mm, respectively,and after treatment U6C-PP was (12.6 +/- 0.1) mm and (12.8 +/- 0.1) mm,respectively. The difference between J-hook group and microimplant group was significant (P < 0.01). The other differences of cephalometric analyses between J-hook group and micro-implant group was not significant., Conclusions: Both J-hook and micro-implant could provide adequate anchorage in the treatment of patients with bimaxillary protrusion.

A monthly monitoring program of periphyton was conducted on two main urban rivers of Shanghai from April 2005 to March 2006. Parameters of periphyton assemblage and main environmental variations, including physical habitation and hydrological factors, were analyzed by multivariate analyses (cluster analysis, indicator species analysis and canonical correspondence analysis). It showed that a remarkable spatial-temporal variation pattern was observed for periphyton assemblage: taxa numbers and density were abundant at upstream in warm weathers, while diversity decreased significantly at downstream in cold seasons (p < 0.05). The results also indicated that water quality, watershed function zone and nutrients (i.e. nitrogen and phosphorus) were the main environmental factors influencing periphyton species composition. The findings further suggested 12 periphyton species, including Navicula cincta, Chroococcus minutus and Fragilaria capucina, had significant indicator values for water quality and were highly sensitive to the concentrations of nitrogen and phosphorus, and these species could serve as a good bio-indicator of urban watersheds.

Objective: [corrected] To study the expression of EDA-FN variant in injured human skin fibroblast and its relation to wound healing., Methods: Human skin fibroblast cells were separated from human skin and cultured and monoclonal antibody to fibronectin [IST-9] was applied to amplify target segments., Results: Trace amount of EDA-FN was detected in the culture cells. The expression was increased within 8 hours after the injury., Conclusions: The expression of EDA-FN would be an ideal marker for estimation of wound healing

Objective: To evaluate MRI in diagnosing breast lesions which need biopsy., Methods: One hundred and eight patients were admitted to hospital for biopsies due to one hundred and sixteen suspicious lesions detected in their breasts. These lesions were detected by physical examination, mammography or ultrasonography. They were also administrated MRI examination before biopsy. The sensitivity and specificity of each diagnostic method were obtained and the radiologic-pathologic correlation was meanwhile calculated., Results: Seventy (60.3%) breast lesions were diagnosed malignancy. The sensitivity, specificity, accuracy, positive prognostic value and negative prognostic value of ultrasonography were 83.3%, 62.0%, 74.1%, 74.3% and 73.8%. Such data of mammography were 86.8%, 68.1%, 78.0%, 75.4% and 82.1%. And those of MRI were 97.1%, 73.9%, 87.9%, 85.0% and 94.4%., Conclusion: MRI is superior to ultrasonography and mammography in diagnosing breast lesions, especially for the nonpalpable lesions.

The amylose content of rice caryopsis is determined by Wx protein, one kind of granule-bound starch synthetase which is encoded by Wx gene. Different rice types and species have different levels of Wx gene expression and have different amylose contents in their caryopsis. Wuyunjing No.7 (2200), the japonica rice with an amylose content 17% and its transgenic rice lines with antisense Wx gene (2201 and 2203, with amylose contents 8.5% and 2% respectively), and Longtefu (LP03), the indica rice with a high amylose content (28%) and its transgenic rice with antisense Wx gene (A199, with an amylose content 9%) were used to investigate the effects of Wx protein content decrease on the activities of enzymes involved in starch synthesis and thereby starch accumulation. The results indicated that with the decrease in Wx protein, the amylose content in transgenic caryopsis was reduced accordingly, whereas the amylopectin content per caryopsis (mg/grain) was not affected, and made the total starch content in transgenic caryopsis markedly lower than their parents. With the development of caryopsis, the amylose/total starch ratio was not changed significantly in the two parent caryopses, LP03 and 2200, but it went down gradually in their transgenic caryopses. The amylose/total starch ratio in transgenic caryopses was very significantly lower than their parents in the same period. The activities of ADP-glucose pyrophosphorylase (ADPG-PPase), granule-bound starch synthase (GBSS), soluble starch synthase (SSS) and starch branching enzyme (SBE) rose rapidly in early periods of grain filling, and soon reached their maximum, then reduced quickly until the middle and later periods of grain filling. Compared with the parents, the GBSS activity in transgenic caryopsis was significantly lowered, and correlated with the amylose reduction. Besides, the maximum activity of GBSS appeared earlier, and the range of the activity was smaller. In transgenic caryopsis, the activities of ADPG-PPase and SSS were higher than their parents in early and middle periods of grain filling, while the SBE activity was higher than their parents in middle and late periods.

Objective: To compare mini-probe endoscopic ultrasonography (MCUS) with computed tomography (CT) in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph node metastasis for esophageal cancer., Methods: Thirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results., Results: The accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by the two different methods, which were 45.7% and 74.3%, respectively, by CT., Conclusion: MCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis (S/L) combined with short axis is a useful way to determine lymph node metastasis.

Overexpression of recombinant Human Cu, Zn-Superoxide Dismutase (rhCu, Zn-SOD) in E. coli results in the form of insoluble inclusion body. Purity of rhSOD inclusion body was over 80% by isolation and purification. After preliminary renaturation by conventional dilution or dialysis, enzyme preparations was respectively purified by using Copper Metals-Chelating Affinity Chromatography (Copper-MCAC). RhSOD specific activity purified by MCAC (from the sample renatured partly by dialysis) was 2.2 times as much as that by dialysis and protein recovery was 64%. RhSOD specific activity purified by MCAC (from the sample renatured partly by dilution) was 5.3 times as much as that by dilution and protein recovery was 25%. The two rhSOD preparations purified by MCAC had specific activities about 5000 u/mg and activity recoveries were all over 130% of the enzyme activities in the samples renatured partly by dilution or dialysis. The above-mentioned results indicated that Copper-MCAC resulted in a purification and further renaturation of target protein. SDS-PAGE showed that the target protein rhSOD (19 kD) was purified homogeneously and NBT activity identification proved that the purified and renatured rhSOD had very strong SOD activity. In conclusion, Copper Metals-Chelaing Affinity Chromatography appears to be a simple, rapid and efficient procedure for purifying and further renaturing rhCu, Zn-SOD by dilution or dialysis. The method provided a new idea for purifying and renaturing recombinant proteins expressed in the form of inclusion body in E. coli.

Objective: To explore the expression and role of integrin-linking kinase (ILK) in aging rats subjected to unilateral ureteral obstruction (UUO)., Methods: The UUO model and sham-operated rats (SHAM) were established with 3-month-old rats and 26-month-old rats and the rats were sacrificed before UUO and after UUO at 3, 7 and 14 days. Immunofluorescent staining, Western blot, RT-PCR, etc were applied to detect the expressions of ILK and fibronectin (FN) in the renal of UUO rat at each time point., Results: With the time of UUO, the relative interstitial areas and tubulointerstitial fibrotic areas in 26-month-old rats were significantly higher than those in 3-month-old ones at each time point (P < 0.01) and the mRNA and protein levels of ILK and FN are increasing with the time of UUO in both groups (P < 0.01). ILK mRNA semi-quantitative values of 26-month and 3-month rats were 0.98 +/- 0.06 vs 0.72 +/- 0.06, 3 days after UUO (P < 0.01), 1.49 +/- 0.05 vs 1.03 +/- 0.04, 14 days after UUO (P < 0.01), respectively. ILK proteinsemi-quantitative values of 26-month and 3-month rats were 0.57 +/- 0.04 vs 0.52 +/- 0.03, 3 days after UUO (P < 0.01), 0.76 +/- 0.04 vs 0.63 +/- 0.03, 14 days after UUO (P < 0.01), respectively. The expressions of ILK mRNA and protein level were positively correlated with the relatively renal interstitial areas (r = 0.71, P < 0.05 and r = 0.80, P < 0.05, respectively). And the whole levels of ILK and FN in 26-month-old rats are higher than those of 3-month-old rats., Conclusion: With aging, the expressions of ILK and FN increase progressively in UUO rat, and the over-expression of ILK probably promotes renal tubulointerstitial fibrosis and aging.

Objective: To investigate the relationship between the DNA degradation in cells and postmortem interval., Methods: Tissue pieces of the heart, liver, spleen and kidney of one corpse (male, 54 years old, died of mechanical injury, PMI of 6h) were obtained in 6, 12, 24, 48 h after death, fixed in Carnoy fluid, and then paraffin sections were prepared, stained with Feulgen and analyzed by Image analysis technology (IAT). Meanwhile the single-cell suspension of tissues of the man was prepared and inspected by FCM after PI stained., Results: The amount of DNA of in heart, liver and kidney of human had a repid degraded in first 6 hours after death, that in the spleen showed a better relationship between DNA degradation and PMI. The results was verified by FCM and IAT., Conclusion: The degradation of DNA of and human tissues shows a well relationship with PMI, especially in spleen. It is useful in estimation of PMI.

Objective: To investigate the signification of CTnI in acute myocardial infarction., Methods: The model of myocardial infarction was established by ligating the left ventricle branch. Immunohistochemistry and image analysis were used to detect the change of CTnI in the model, and The sensitivity of immunohistochemistry and HE coloration were also compared., Results: The acute myocardial infarction tissue showed obvious depletion of CTnI, there was no characterization of myocardial infarction in HE coloration., Conclusion: CTnI is sensitive to diagnosis of acute myocardial infarction.

Objective: To estimate the effort between antisense RNA probe and random primed DNA probe., Methods: The in situ hybridization was conducted on parafin section from wounding model of rat skin., Results: Although both probes appeared positive staining, RNA probes was superior to DNA probes in terms of depth of staining and background., Conclusion: RNA probe showed more satisfactorily on ISH.