Objective To investigate the significance of myelography for selecting operation methods in microendoscopic discectomy(MED).Methods A total of 196 patients with lumbar disc herniation diagnosed by CT/MRI received a myelography before MED.According to their clinical manifestations,signs,and outcomes of myelography,the patients were given three different operation methods.①Simple discectomy was performed in 105 patients with patent spinal canal,lateral impression at intervertebral level,and shift of the nerve root sleeve;②Discectomy with spinal decompression was performed in 70 patients with patent spinal canal and compression of the nerve root sleeve;③Discectomy with semilaminectomy was performed in 21 patients with patent spinal canal,semispherical compression of the nerve root sleeve,and 7-shaped nerve root.Results The operation time was 30~90 min(mean,50 min) and the intraoperative blood loss was 30~120 ml(mean,50 ml).No intraoperative complications occurred.Conversions to open surgery were required in 21 patients,including partial spinal stenosis in 16 patients and thickened vertebral plate in 5 patients.Follow-ups were carried out in 196 patients for 3~58 months(mean,34 months).According to the Japanese Orthopedic Association(JOA) scoring system,the final scores significantly increased postoperatively(25.86?2.96) than preoperatively(13.21?4.96)((t=)38.24,P=0.00).According to the Macnab and Watts standard,the rate of excellent or good results was 93.7%(164/175).Conclusions Myelography has an important reference value for selecting operation methods of microendoscopic discectomy in patients with lumbar disc herniation.

The specific forms and contents of narrative nursing clinical practice were analyzed. On the basis of a brief review of the concept and origin of narrative nursing and the significance of it, this paper focuses on the field, methods, forms and evaluation methods of clinical practice of narrative nursing. The study found that through the literature review, the value of narrative medicine has been fully affirmed, but how to implement theory to a real clinical nursing practice environment has not yet been reported more. Therefore, exploring the narrative nursing in the clinical workplace, rich forms, contents and methods of clinical practice can provide new methods and new ideas for nursing humanistic care and clinical practice, and has certain social significance, academic significance, individual significance and application prospect.

Objective To study the factors affecting the functional restoration of the hip joint with femoral intertrochanteric fractures.Method44 patients with femoral intertrochanteric fractures were treated from Aprail 2004 to June 2006.The function of the hip joint was evaluated with the Harris hip score. Seven factors including age,sex,preoperative ASA class,preoperative time,fracture type,therapeutic measures,time of functional exercise were analyzed statistically with x2 test and logistic multiple regression with a significant difference (P

[Objective]To explore the mechanism of nucleoplasty combined with oxygen-ozone for the treatment of lumbar disc herniation，and to evaluate its therapeutic effects.[Method]From June 2005 to June 2006，62 patients with lumbar disc herniation were treated by nueleoplasty combined with oxygen-ozone，34 were male and 28 were female，ranging in age from 32 to 76 years，with an average of 53.4 years.The course of this disease ranged from 3 to 56 months，meanly 1.3 years.Thirteen patients had the herniation at L4.5 and L3，4，thirty two patients at L4、5，eight patients at L4、5 and L5S1，and nine patients at L5S1.The curative effect was assessed by using a modified MacNab method.[Result]After 25～35 months'follow-up，there were no servious complications in all 62 cases.According to modified MacNab assessment，50 cases(80.7%)achieved excellent outcomes，8 cases(12.9%)good，2 cases(3.2%)fair and 2 cases(3.2%)poor.The excellent and good rate was 93.5%.[Conclusion]The micro-invasive technique of nueleoplasty combined with oxygen-ozone is effective in the treatment of lumbar disc herniation，and it has maximized the clinical effect and minimized the local damage：it also expanded adaptive cases with lumbar disc herniation and enlarged the applicable scope of minimally invasive technique in treating lumbar disc hemiation.

A retrospective analysis was performed among 8 patients with unilateral intraarticular calcaneal fracture, who were selected from the Department of Orthopaedics in Yangpu District Central Hospital of Shanghai. They were treated with the injectable bone graft MIIG[R] X3 combined with percutaneous reduction by leverage and axial fixation from June 2005 to November 2006. After treatment, the function of affected feet was evaluated according to the ankle-hindfoot score of the American Orthopaedic Foot & Ankle Society (totally 100 points). All the patients were rechecked with X-ray films periodically to observe the reaction between the materials and the host, the healing of fracture, the pain of limbs and joint motion. Eight patients were all followed up, the complication rate reached 12.5% (1/8), the improvement of Bohler angle excelled 18° to 25°, and that of Gissane angle exceeded 30° to 35°. Among the included patients, 6 cases achieved excellent effect and 2 cases good. All developed the bone union. None of all had complications, such as necrosis of skin, hematoma and deep infection.

Objective To investigate the expressions of DKK1,SFRP4 and Wnt1 in cervical squamous cell carcino-ma(SCC), and the clinical significance thereof. Methods There were 76 samples of cervical squamous cell carcinoma were included in SCC group and 36 benign uterine resection specimens were control group (NC). The immunohistochemical meth-od was applied to detect the expressions of DKK1,SFRP4 and Wnt1 in two groups. Results The expression of DKK1 was significantly lower in SCC group than that in NC group (P＜0.05). The expression levels of SFRP4 and Wnt1 were significant-ly higher in SCC group than those of NC group (P＜0.05). There were significant differences in the expressions of DKK1, SFRP4 and Wnt1 between samples of different clinical staging, differentiation, sizes of tumor and lymph node metastasis (P＜0.05). The expression of DKK1 was negatively correlated with SFRP4 and Wnt1 in SCC group (P＜0.05). The expression of SFRP4 was positively correlated with Wnt1 in SCC group (P＜0.05). Conclusion The roles of SFRP4 and Wnt1 are syn-ergistic interactions in the development of SCC. DKK1 is an inhibiting factor of SCC.

Purpose To investigate the effect of anti-HER-2 engineered antibody chA21 on the angiogenesis in nude mice xenografts of human ovarian cancer SKOV3 cells that overexpresses HER-2.Methods An animal model with SKOV3 cells involved in nude mice was established and the mice were randomized into control group and chA21 group;chA21 was administrated via caudal vein for 5 weeks, meanwhile the same volume of chA21 buffer was injected in control group.The mice were terminated after 5 weeks and the xenografts dislodged,VEGF and DLL4 expression in two groups were quantitatively analyzed by immunohistochemistry on tissue microarray sections combined with a micro-image analyzing system, and microvessel density (MVD) values were compared between the two groups by immunohistochemical staining of CD31.Results The expression of VEGF, DLL4 and MVD values in chA21 group were lower than those in control group (P<0.05).Conclusion chA21 inhibits the angiogenesis of transplantations of human ovarian cancer SKOV3 cells effectively.

This study aimed at preparing paeonol thermosensitive gel and preliminary exploring its properties in vitro.Tube inversion method was adopted to investigate the effects of concentrations of poloxamer 407 and poloxamer 188 on gelation temperature.Then,viscosity of the gel was detected by rotary viscometer,and in vitro erosion and drug release characteristics of the gel by no film stripping method.As a result,the gelation temperature of poloxamer 407 decreased with the increase of its concentration,while gelation temperature of poloxamer 407 increased with the accelerating concentration of poloxamer 188.The cumulative drug release of paeonol thermo sensitive gel was up to 70％ in 320 rin.Gel dissolution and drug release were simultaneously performed without burst release phenomenon.It was concluded that the preparation process of paeonol thermo sensitive gel was simple and easy to use with the overt effect of sustained-release.

Objective To analyze the clinical features of patients with subclinical pheochromocytoma(PHEO).Methods Review of clinical features of 22 patients with subclinical PHEO treated in PUMC hospital from 1997 to 2007.Results All patients were asymptomatic.24hr-urinary catecholamine excretion was detected normal in 10 of 22 cases,while increased in the others.Sixteen patients were prepared with ?-receptor blocker before operation.During the operation,BPmax(maximal blood pressure) before tumor resection,BPmin(minimal blood pressure) after resection and ?BP(BPmax-BPmin) were(163?34)/(86?20)mmHg,(105?12)/(61?10)mmHg and(58?37)/(25?21)mmHg,Respectively,in the prepared group.They were(169?36)/(104?20)mmHg,(97?18)/(56?13)mmHg and(71?48)/(48?29)mmHg in the other 6 cases without ?-blocker preparation.DBPmax and ?DBP in the prepared group were significantly lower than the unprepared group.Conclusion Most patients with subclinical PHEO have increased catecholamine secretion.Blood pressure is fluctuant greatly during operation in some patients.Patients should be treated with ?-receptor blocker preoperatively in order to decreasethe operation risk.

Objective To elucidate gene mutation and promoter methylation changes of p16 gene in pheochromocytomas (PHEO) and paragangliomas (PGL) and to assess its relation with tumor clinical characters. Methods A total of 34 tumors (20 PHEO, 14 PG L, 15 benign, 19 malignant) were collected.Direct sequencing of p16 gene after PCR was performed to analyze genetic alterations. Hypermethylation of p16 gene promoter CpG island was analyzed by methylation specific PCR(MSP). In addition, mRNA expression was detected by RT-PCR. Results Homozygous deletion and gene mutation were not observed in 34 PHEO and PGL. Aberrant methylation of p16 gene promoter CpG island was found in 35.3% (12 of 34 tumors, 3 PHEO, 9 PGL). The p16 promoter hypermethylation in PGL was significantly higher than PHEO (P=0. 005). The higher p16 promoter hypermethylation was associated with malignant behavior, tumor number, and younger age at presentation, but no statistical significance, due to the limited number of cases. The p16 mRNA expression in malignant cases was lower than in benign tumors(0.83±0.65 vs 1.12±0.81 ,P=0.278). Conclusion p16 gene homozygous deletion and mutation were not frequent in PHEO and PGL. The promoter hypermethylation is mainly attributed to inactivation of the p16 gene.