Neurologic complications are rare but devastating events after scoliosis surgery;a thorough preoperative work-up and effective intraoperative monitoring of the spinal cord may reduce the incidence.This review discusses the incidence,preoperative work-up,intraoperative monitoring,and managing strategies for neurologic complications of scoliosis surgery.

Objective To investigate the effect of operation timing on patients with rheumatic mitral stenosis underwent valve replacement during perioperative period.Methods Retrospective analysis were performed on 122 cases diagnosed as rheumatic mitral stenosis (mitral stenosis,MS) underwent valve replacement,during January 2012 through December 2013 in the Department of Cardiovascular Surgery,General Hospital of Shenyang military region.According to the mitral valve area (mitral valve area,MVA) measured by echocardiography before operation,patients were respectively divided into three groups,mild stenosis (＞ 1.5 cm2),moderate stenosis (1.0 ～ 1.5 cm2),and severe stenosis (＜ 1.0 cm2).Through the single factor and multi-factor logistic regression analysis on all clinical data collected from patients,the effects of operation timing on patients were confirmed in perioperative period in each group.Results The results were satisfied in the group.Heart function was significantly raised compared to that before surgery,and the life quality of the patients was improved.Two cases died during hospitalization,New York Heart Association Functional Class (NYHA) reached between Ⅰ ～ Ⅱ,Ⅱ,perhaps Ⅰ for survival.Single factor analysis showed that the pulmonary arterial systolic pressure (pulmonary arterial systolic pressure,PASP),left ventricular end diastolic volume,mitral valve area,cardiothoracic ratio,intensive care unit (ICU) staying,ventilator-assistant during hospitalization were influence factors on surgical opportunity of patients with rheumatic mitral stenosis and perioperative outcomes.Multivariate logistic regression analysis showed that pulmonary artery pressure and mitral valve orifice area were the independent influence factors on surgical timing by collecting perioperative outcomes in the groups.Conclusions Mitral valve replacement (mitral valve replacement,MVR) is an effective method in the treatment of rheumatic mitral stenosis.Timely operation can improve the prognosis of patients in the perioperative period,and help to improve the quality of life.Early treatment should be an important factor affecting the perioperative prognosis.Timely operation,early treatment may improve the patient's survival during perioperative period.

Objective　To apply two-dimensional (2-D) gel electrophoresis to resolve specially expressed proteins related to retinitis pigmentosa (RP) in the retina of rds mice.Methods　Proteins, prepared from the retinas of rds mice and normal C3B mice at different ages, were separated by using two-dimensional electrophoresis and then analyzed by 2-DE imaging analyzer.Results　2-D gel electrophoresis was established for the retinal proteome analysis. Retinal neuronal tissue was lysed by using chemical lysis solution and ultrasonic. Using carrier ampholyte to set up pH gradient as first dimension and casting vertical 12% SDS-acylamide-bis slab as second dimension, the major retinal proteins showed maps of proteome on 2-D gels clearly. Retinal proteome of rds and C3B mice at 37d has different expressive patterns. Some proteins only expressed in the retina of rds mice while another only in the retina of C3B mice and others had different level between the two kinds of mice.Conclusion　2-D gel electrophoresis is effective to separate specially expressed retinal proteins. The expressed proteins in the rds retina are different in quality and quantity from that in the normal C3B mice.

Ossification of the posterior longitudinal ligament (OPLL) is common clinical spinal disorders often occurring in the cervical spine,with the main symptom being nerve compression.The specific mechanism of OPLL remains unclear,but genetic factors,single nucleotide polymorphisms (SNPs),mechanical stimulation,metabolism abnormality might be involved in the etiology of the disease.Multiple genetic and environmental factors may contribute to the development of OPLL.OPLL has prominent genetic characteristic,and it is associated with SNPs of several genes.Here we review the SNPs of several genes (COL11A2,BMP-2,TGF-?1,TGF-?3,NPPS,COL6A1 and Runx2) which contribute to the development of OPLL,hoping to lay a foundation for future study.

Objective To determine the effect of resurfacing completely degloved thumbs by free perforator flaps in a spiral fashion.Methods A retrospective case series study was made on 22 patients with completely degloving injury of the thumb treated by different free perforator flaps in a spiral fashion from June 2009 to December 2014,including 19 male and 3 female patients at the age of 18-46 years (mean,27.8 years).A total of 13 patients were reconstructed using the medial arm perforator flaps ranging in size from 8.0 cm × 3.0 cm-14.5 cm × 3.5 cm,and 9 patients were reconstructed using the peroneal artery perforator flaps ranging in size from 6.0 cm × 3.5 cm-21.0 cm × 10.0 cm.Follow-up was made to evaluate the sensation,appearance and function of the thumbs and the recovery of flap donor sites.Results All flaps survived completely,with no occurrence of postoperative vascular crisis and infection.Only one medial arm flap and one soleus perforator flap distal flap showed blood flow disorder in the distal sections and were healed uneventfully after conservative therapy.Function and cosmetic recovery of the reconstructed thumbs were good.Follow-up ranged from 9 to 22 months (mean,14.5 months).Twopoint discrimination test of the flaps was recovered to 6-13 mm.No linear scar contracture was left.Flap donor site wound healed primarily.All patients were satisfied with the overall results.Conclusion The free perforator flap in a spiral fashion can avoid linear scar contracture,maximally decrease donor site morbidity and achieve satisfactory functional recovery and good aesthetic restoration,indicating a good candidate for reconstruction of thumb degloving injury.

Objective To study the therapy for xenograft human bile duct cancer in mice mediated by adenovirus containing Apoptin gene.Methods Subcutaneous human bile duct cancer was established in nude mice.Variations of tumor volume and histomorphology,side effects were observed after intratumoral injection of adenovirus containing Apoptin gene.Finally the mice were sacrificed for calculating the ratio of antitumor.Results Twelve days after treatment,the mean volume of the xenograft human bile duct cancer in the group of intratumoral injection of adenovirus containing Apoptin gene was(92.31?28.31)mm,which was reduced significantly compared with that of adenovirus infection without apoptin gene(288.86?113.13)mm and control group(344.86?113.87)mm.The ratio of antitumor was 72.10%,which was significantly higher than that in control group(11.9%).During the whole experimental course,no side effect was observed.The histological results demonstrated that the reduction of tumor growth was the result of apoptosis in bile duct cells,which was reduced by transfection of Apoptin gene.Conclusion The adenovirus vectors containing Apoptin gene may constitute a safe tool for the treatment of cholangiocarcinoma.

Objective To study the influence of cholangiocarcinoma cells on endothelial cells in a co-culture system. Methods A co-culture system of eholangioeareinoma cell line QBC939> and endothelial cells was established in vitro (co-culture group). Endothelial cells were cultured individually during the same time (control group). The mixed supematant of cholangiecareinoma cells and endothelial cells was in the mixed group. Light microscopy and transmission electron micrescopy were used to observe the morphology of the endothelial cells. Changes in expression of ppI25FAK, MMP-2, MMP-9 and uPA of the endothelial cells were detected by mmunofluorescence, and the activities of MMP-2 and MMP-9 were detected by gelatin zymography. All the data were analyzed by paired t test. Results The intercellular space between endothelial cells in co-cuhure group was wider than in the control group. The expression of pp125FAK, MMP-2, MMP-9 and uPA was 394 ±51,455±82, 377±48,422±55 in control group, and was 1096±128,931±72,815±76,801±56 in the eo-euhure group. The difference between the 2 groups had statistical significance (t = 6.53,4.32, 3.61,3.45, P < 0. 05). The values of gray-scale scanning of MMP-2 and MMP-9 in the mixed group were 240.2±15.2 and 2.4±0.8, respectively. The values of gray-scale scanning of MMP-2 and MMP-9 in the co-culture group were significantly increased, they were 687.4 ± 43.6 and 150.9 ± 13.2, respectively (t = 4.89, 5.43, P < 0.05). Conclusions The intercellular space between endothelial ceils and the expression of the proteolytie enzymes are increased after co-culturing endothelial cells with eholangiocarcinoma cells. Proteolytie enzymes may be involved in the process of degradation of subendothelial matrix, and promotes the metastasis of cholangiocarcinoma.

Objective To explore new methods of innervating the anterolateral thigh flap(ALTF) for repairing widespreadly traumatic soft tissue defects in heel and report their initial results of clinical application. Methods Twenty-five consecutive ALTFs were transplanted in 25 patients for repairing widespreadly traumatic soft tissue defects in heel from October 2005 to October 2010. Three ways were used in this series for sensory reconstruction of ALTFs,which based on the primary researches of the anatomic and histomorphological characteristics of lateral femoral cutaneous nerve (LFCN),medial calcaneal nerve (MCN) and lateral calcaneal nerve (LCN). The first way which was of suture between reshaped LFCN and MCN or LCN was used in 16 cases, the second way which was of perineurial suture combined with epineurial suture was used in 6 cases,and the small-gap-suture way was used in the remaining cases.The section of LFCN 5-7 cm below the anterior superior iliae spine and the initial segment of MCN or LCN were selected as anastomotic position. Postoperative follow-up parameters include pain sensation, touch sensation, thermal sensibility and static two-point discrimination. Results All flaps survived,and the wounds were primary intention.Twentyfive cases followed up 9-36 months (18 months on average).All flaps restored protective sensation,and the rate of good sensory recovery was 60％. All patients restored weighing and walking, and no ulceration happened. Conclusion Satisfactory sensory function restoration can be obtained by paying attention to the distribution and variety of LFCNs, selecting suitable cutaneous nerves and rational coaptated position as well as suitable suturation means which based on the anatomic and histomorphologieal characteristics of LFCN,MCN and LCN when repairing widespread soft tissue defects in heel.

Objective To observe the characteristics and treatment of malignant peripheral nerve sheath tumor originated from neurofibromatosis and the outcome of the patients. Methods A case was reported and the related literatures were reviewed. Results and Conclusion Malignant peripheral nerve sheath tumor is a rare soft tissue malignancy, which is with highly invasion. There are some difficulties with the diagnosis and treatment, and the outcome is poor. Early diagnosis is very important for treatment.

ObjectiveTo observe the microstructure and ultrastructure of platelet-rich plasma gel. MethodsPRP gel samples were obtained by two-step centrifugation. The platelets were counted before and after centrifugation. TGF-β1, PDGF-AB were measured in the PRP gel and the whole blood using the enzyme-linked immunosorbent assay. PRP gel samples were observed with macroscopic observation, HE staining, transmission (TEM) and scanning electron microscopy (SEM). ResultsThe platelet concentration of PRP was 458% of whole blood. TGF-β1, PDGF-AB were found in high concentrations in PRP gel samples. Both SEM and TEM showed that PRP gel mainly contained fibrillar material with striated band similar to fibrin filaments, and platelet. ConclusionPRP gel may be an ideal injectable scaffold material for constructing tissue engineering nucleus pulposus.