BACKGROUND:The development of spinal non-fusion technology promoted movement function protection of adjacent segment and operating segment. In the treatment of cervical spondylosis surgery, non-fusion technology has been widely carried out. For middle-aged patients with cervical spondylosis, the demand for spinal joint movement function is high. Non-fusion technology can improve the postoperative quality of life and slow down the risk of adjacent segment degeneration. OBJECTIVE:To evaluate the clinical efficacy of anterior cervical different implant materials (fusion or non-fusion) in the treatment of single segment of the intervertebral disc degeneration of cervical spondylosis in middle-aged patients. METHODS:This study enrol ed 10 cases of single segmental radiculopathy and cervical myelopathy after cervical intervertebral disc replacement from June 2011 to June 2013. Simultaneously, 10 cases were randomly selected from patients with anterior interbody fusion as the control group. Before treatment, at 1 and 3 months, and 1 year after treatment, changes in range of motion of cervical vertebra were observed using imaging results. Therapeutic effects were assessed using Japanese Orthopaedic Association Scores, Visual Analog Scale and The Neek Disability Index in both groups. RESULTS AND CONCLUSION:Al patients did not suffer from incision fat liquefaction, infection and delayed healing, and had finished fol ow-up for more than 1 year. Results revealed that Japanese Orthopaedic Association Scores and Visual Analog Scale scores were improved at 1 and 3 months, and 1 year after treatment (P<0.05), and no significant difference was detected between the two groups (P>0.05). In the analysis of range of motion of cervical vertebra and The Neek Disability Index, there were significant advantages in non-fusion treatment group (P<0.05). For middle-aged patients with cervical spondylosis, due to its life demand for neck mobility, the repair program of non-fusion cervical intervertebral disc replacement has a clear advantage.

In this paper the latest studies on the role of estrogen for the development of osteoarthritis and osteoporosis in postmenopausal women are reviewed.Estrogen can influence the pathophysiology of osteoarthritis through its interactions with the estrogen receptors,type Ⅱ collagen,cytokines and reactive oxygen species.While in the process of osteoporosis,estrogen can not only influence the estrogen receptors,cytokmes,reactive oxygen species,but also affect the sex hormone binding globulin and estrogen receptor-related receptor.

Objective To investigate the risk factors for cardiovascular complications in the elderly persons undergone with dialysis.Methods One hundred and eighteen patients undergone with hemodialysis(HD)or continuous ambulatory peritoneal dialysis(CAPD)at the Eastern Hospital, Tongji University, Shanghai during January 2002 to December 2006 were retrospectively analyzed.They were divided into four groups based oil their age and mode of dialysis, i.e., 44 patients in the elderly HD group(aged over 60years), 16 patients in the elderly CAPD group(aged over 60), 46 patients in medium-age HD group(aged under 60 years)and 12 patients in the medium-age CAPD group(aged under 60).Routine biochemical parameters were measured for all the patients and their difference was compared among the four groups.Logistic regression analysis was performed for the risk factors of cardiovascular complications.Results Pulse pressure(PP)was(66±21)mm Hg, serum level of triglycerides(TG)was(1.28±0.67)mmol/L, serum level of lipoprotein(a)[LP(a)]was(434±202)mg/L, C-reactive protein was(CRP)(21±15)mg/L, serum phosphorous(P3-)was(2.02±0.77)mmol/L, and product of serum calcium and phosphorous(Ca×P)was(4.3±1.6)mmol2/L2, respectively, in the elderly group with dialysis, all significantly higher than those in the medium-age group with dialysis(t=1.535, 1.016, 2.154, 2.252, 4.676, and 4.534, respectively, P＜0.05).Incidence of cardiovascular events was markedly lower in the CAPD group than that in the HD group(P＜0.05), either in the elderly or medium-aged patients.And, incidence of cardiovascular complications correlated positively with age, PP, LP(a), CRP and Ca×P of the patients with dialysis, but correlated reversely with serum level of albumin(all with P＜0.05).Conclusions There exist a few risk factors for cardiovascular complications in the elderly patients with dialysis, so proper mode of dialysis should be selected for those who need it and adequate intervention should be implemented for them to correct the risk factors.

Objective To screen the genes related with signal transducers and activators of transcription 3 (STAT3) regulating pancreatic cancer invasion and metastasis by gene chips.Methods Human pancreatic cancer cell line SW1990 stably expressing low level of Stat3 was established by lentivirus transfection,while cells transfected with mock plasmid and cells without transfection served as control groups.The differences of invasion and metastasis related genes expression among the three groups were screened by gene chips.STAT3 mRNA and protein expression was measured by real-time PCR and Western blot.Three differentially expressed genes (MMP-7,IL-1β and IgTα7) were verified.ResultsThe expression level of STAT3 mRNA was 0.391 ± 0.037 after pancreatic cancer SW1990 cell trarsfected with STAT3 targeted lentivirus,which was significantly lower than those in mock plasmid group (1.002 ± 0.015) and nontransfected group ( 1.206 ± 0.042,P ＜ 0.05 ) ; the expression level of STAT3 protein was 182.38 ± 65.32,which was significantly lower than those in mock plasmid group (223.40 ±58.40) and non-transfected group (212.33 ±53.69).Eight invasion and metastasis related genes of SW1990 lowly expressing Stat3 were upregulated,while 3 genes were down-regulated.By verification,the mRNA level of MMP-7 and IL-1β were lower than in control group transfected with mook plassmid(0.287 ± 0.115 vs 1.010 ± 0.124,t =19.45,P =0.000;0.490 ± 0.10 vs 1.002 ± 0.002,t =13.83,P =0.000),but the mRNA level of IgTα7 was not decreased (1.173 ±0.280 vs 0.998 ±0.003,t =4.236,P =0.094).Meanwhile,the protein level of MMP-7 was significantly down-regulated when Stat3 was knocked down.ConclusionsStat3 causes changes of expressions of many invasion and metastasis-related genes of SW1990,and MMP-7 may be the main target gene regulated by Stat3.

Objective To investigate diagnosis and treatment of venous cerebral infarction.Methods The reasons, clinical findings, imaging characters, treatment methods and prognosis of 19 patients diagnosed venous cerebral infarction were analyzed.Results The most frequent symptoms were headache, focal deficits, epilepsy, increased CSF pressure.Among 19 cases, multiple cerebral lesions were found in 12 cases, lobes lesions in18 cases, cerebral infarction with hemorrhage in 3 cases. After various treatments, 16 patients were discharged and one patient died and 2 patients gave up treatment. Conclusions Venous cerebral infarction has complicated causes, non-specific chinical manifestations and characteristic MR images. Anticoagulation and thrombolysis treatment in early stage may have good therapeutic effect.

Objective To establish the mice model of immunological tolerance,and investigate the significance of haploidentical allogeneic lymphocytes infusion in induction of graft versus host disease and graft versus tumor in mice.Methods Sixty-four BALB/C female mice were randomly divided into 4 groups with 16 mice in each group.Control group:no special treatment was given after inoculation of tumor cells at the 4th day (CT26 colorectal cancer cell lines with mixture of 1 × 107/mL tumor cells suspension was inoculated to the right subcutaneous axillary of mice) ; Chemotherapy group:chemotherapy was applied at the 7th day after inoculation of tumor cells at the 4th day; DLI group:tumor cells were inoculated at the 4th day,and then haploid donor cells were infused at the 13th,15th and 17th day; Chemotherapy + DLI group:tumor cells were inoculated at the 4th day,chemotherapy was applied at the 7th day,and haploid donor cells were infused at the 13th,15th and 17th day.The pretreatment scheme included haploidentical allogeneic lymphocyte + ring ling amide + haploidentical allogeneic lymphocyte,and the chemotherapy regimen included peritoneal infusion of cyclophosphamide at the 3rd day after inoculation of tumor cells in mice.The time from the first day after vaccination to the day of death of mice and the mass of the tumors were detected to calculate the tumor inhibition rate.The clinical indexes of GVHD were observed,and clinical evaluation was made.The numbers of T lymphocytes in peripheral blood were detected by flow cytometry.Three mice were sacrificed in each group at the 15th day to make the tissue specimens,and they were observed under light microscope after HE staining.All data were analyzed using the analysis of variance or LSD-t test.Results The symptoms of GVHD of mice in the chemotherapy + DLI group were milder than those in other groups.The GVHD scores of the control group,chemotherapy group and the chemotherapy + DLI group were 2.3 ±0.6,1.5 ± 1.1,6.7 ±0.9 and 3.4 ±0.5,respectively,with significant difference between the 4 groups (F =148.68,P ＜ 0.05).The tumor masses of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were (3.40 ± 0.20) g,(0.80 ± 0.10) g,(2.20 ± 0.20) g and (0.50 ± 0.30) g,respectively,with significant difference between the 4 groups (F =149.17,P ＜ 0.05).The tumor inhibition rates of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 0,77％ ± 9％,35％ ± 3％,85％ ± 44％.The levels of CD3 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 52.3％ ± 2.9％,44.8％ ± 3.1％,62.9％ ± 3.5％,65.9％ ± 3.3％,respectively,with significant difference between the 4 groups (F =28.04,P ＜ 0.05).The levels of CD3 + CD4 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 32.1％ ± 2.6％,27.1％ ± 1.1％,42.6％ ± 1.8％ and 41.7％ ± 2.4％,respectively,with significant difference between the 4 groups (F =40.29,P ＜ 0.05).The levels of CD3 + CD8 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 22.7％ ± 2.2％,20.7％ ± 1.8％,26.7％ ± 0.8 ％ and 26.1％ ± 0.7％,respectively,with significant difference between the 4 groups (F =10.74,P ＜ 0.05).The levels of CD3 + CD4 + CD25 + of the control group,chemotherapy group,DLI group and the chemotherapy + DLI group were 8.7％ ±0.6％,6.6％ ±0.6％,11.2％ ±0.4％ and 13.3％ ± 0.7％,respectively,with significant difference between the 4 groups (F =82.88,P ＜ 0.05).Necrosis and bleeding of the tumor tissues were observed in all the 4 groups.Necrosis,shrinking of the tumor cells,inflammatory infiltration were observed in the DLI group and the chemotherapy + DLI group.Proliferation of lymphoid follicles was observed in the chemotherapy + DLI group.The survival time of mice in the control group,chemotherapy group,DLI group,chemotherapy + DLI group were (16.8 ± 2.5) days,(26.3 ± 2.9) days,(23.4 ± 2.5) days and (33.7 ± 4.6) days,respectively,with significant difference between the 4 groups (F =46.45,P ＜ 0.05).Conclusions (1) Pretreatment can induce specific immune tolerance in mice.(2) Haploidentical allogeneic lymphocyte infusion and chemotherapy have synergistic effects,joint application of haploidentical allogeneic lymphocyte infusion and chemotherapy can inhibit the proliferation of tumor cells and prolong the survival time of mice.(3) Chemotherapy can reduce the GVHD of haploidentical allogeneic lymphocyte infusion and enhance the GVT.(4) CD3 + CD4 + CD25 + T lymphocytes play important roles in decreasing GVHD.

BACKGROUND:The three-dimensional structure of acupoint anatomy was integrated into the teaching of acupuncture manipulation. Combined with the implementation and application of the acupuncture and moxibustion in digital virtual human, it can greatly improve the teaching effect and learning interest. OBJECTIVE:To investigate the acupuncture virtual human with integration of virtual reality force feedback technology and tissue deformation. METHODS:Using virtual reality technology, with computer as the core, we generated a specific range of virtual environment with realistic visual, auditory and tactile integration, col ected clinical expert acupuncture technique, matched the sensing equipment that can reflect the intensity, displacement and speed sensing of acupuncture. Based on image segmentation of virtual human, we constructed human tissue mechanics model, built virtual acupuncture-force-feedback system, and faithful y transmitted to the operator by a force feedback device. On one hand, based on VOXEL-MAN virtual human development platform, we finished the three-dimensional browser redevelopment of the science of acupuncture and moxibustion of Shu acupoint, which provided visual perception for people. On the other hand, based on modern biomechanics theory, we established models by graphics and image processing technology and force feedback technology. The stress process of the structure of each layer in the acupuncture point area was given to people in a sense of touch by the manner of virtual reality and force feedback. RESULTS AND CONCLUSION:With the man-machine interactive operation platform of virtual acupuncture force feedback system, operator could see the dynamic process of acupuncture needle into human body, and could feel the real counterforce in the control terminal of force feedback instrument. By operating acupuncture needle in virtual environment of force feedback instrument, acupuncture was performed in virtual human. The system meets the two requirements:the feedback changes produced by tissue interaction were similar to real acupuncture feedback force data measured by instrument. The acupuncture needle entered into different tissues, a sense of power changed significantly;there was progressive feeling with different layers, reaching a realistic experience. During the whole training, the image was smooth;virtual needle was responsive, which better meets the requirements of virtual reality.

Objective To study the application value and safety of sentinel lymph node biopsy ( SLNB) replacing axillary lymph node dissection ( ALND) for patients with early breast cancer .Methods Data was col-lected for patients undergoing SLNB or ALND in the Second Hospital of Dalian Medical University from June 2011 to June 2014.The complication of upper extremity , axillary local recurrence and distant metastasis were retro-spectively analyzed.The patients were followed up to Nov .2014, with the median follow-up of 41 ( 18-52 ) months.Results Patients undergoing SLNB had less postoperative complications of upper extremity ( numb and painχ2 =18.174, P =0.000;Restricted movement χ2 =20.413, P =0.000; Strength loss χ2 =23.785, P =0.000;P<0.05).There was no statistical difference for the postoperative complications of axillary local recur-rence and distant metastasis (χ2 =0.555, P=0.516; P>0.05).Conclusion In early breast cancer without SLN, SLNB can achieve the equivalent effect to ALND with less damage and complications .

Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion(HP) can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD+HP group received MHD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6),β2 microglobulin (β2-MG), parathyroid hormone (PTH), tumor necrosis factor α (TNF-α) and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36Chinese Edition ). Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR), cardiothoracie ratio, left ventricular mass index (LVMI), EPO dose and the types of antihypertensive drugs used were lower in HD +HP group as compared to HD group (all P＜0.05). HD+HP group had higher hemoglobin (Hb), ejection fraction (EF) and body mass index (BMI) (all P＜0.05). No significant differences between two groups were found in terms of serum albumin (Alb), serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO),Kt/V, early/atrial mitral inflow velocities (E/A) (all P＞0.05). Besides, the SF-36 indicated that the total score of overall dimensions in HD+HP group was higher (P＜0.05) and the quality of life of HD+HP group was evidently better as compared to HD group. The Kaplan-Meier survival curves for the 2-year observation period showed that patients in HD +HP group had obvious survival advantage, while Log-rank test results showed P＜0.05. No serious adverse incidents occurred during the HD+HP treatment. Conclusion HD+HP is superior to HD in eliminating regularly middleand large-molecules uremic toxins and has a potential role in improving the quality of life and survival rate of MHD patients.

Objective To evaluate the efficacy and safety of PES14LF polyethersulfone highflux dialyzer on maintenance hemodialysis(MHD)patients. Methods A total of 72 MHD patients from two hospitals in Shanghai were enrolled in a randomized parallel controlled study.Conventional hemodialysis was performed for 4 h with PES14LF dialyzer in trial group and with German F6 dialyzer in control group.For each patient the study lasted one week.The clearances of urea,creatinine and phosphate were calculated.Adverse event and adverse reaction were recorded.Results There were no significant difierences of urea and creatinine clearance and reduction ratio between trial and control group.The phosphate clearance in trial group was significantly higher than that in control group[(144.57±27.83)ml/min vs(117.15±22.77)ml/min,P＜0.051.There was no significant difference of phosphate reduction ratio between trial and control group.The efficiency of urea clearance and urea reduction ratio achieved clinic effective target in two groups and no significant differences in above indexes between two groups were found. Conclusion PES14LF dialyzer is effective and safe for clinical application.