Objective To investigate the clinical characteristic, surgical stage, operative approach, resection and stability reconstruction of dumbbell intra-extradural tumor of cervical spine. Methods From January 1999 to December 2005, 37 consecutive cases with cervical dumbbell intra-extradural tumor were retrospectively studied. 18 males and 19 females ranged from 18 to 80 years old were involved in this study, including 25 schwannomas, 3 neurofibromas, 5 multi-neurofibromas and 4 malignant schwannomas. According to tumor location and involved range, all tumors were divided into five stages: 8 cases in Ⅰ stage, 9 cases in Ⅱstage, 13 cases in Ⅲ stage, 5 cases in Ⅳ stage and 2 cases in Ⅴ stage. Resection and reconstruction were performed at 20 patients through posterior-lateral approach, 17 patients through anterior-lateral combined with posterior-lateral approach. Lateral mass screw internal fixation system were used in 26 cases, while anterior combined posterior fixation were performed in 5 cases and none fixation in 6 cases. Results The follow-up period was from 3 months to 7 years. 1 case developed a transient weakening of upper limb, 1 case developed anesthesia in posterior neck, and 1 case developed Horner's sign. Vertebral artery ligation was performed in 1 case because of vertebral artery injury. 2 cases with malignant schwannoma occurred local recurrence in 1-2 years postoperation and received second operation. The recent effects after operation were satisfactory in majority cases,with complete recovery of spinal cord function in 19 cases. 2 cases without fixation appeared recuration deformity in cervical spine in 1-2 years postoperation. Conclusion The surgical approach and operative methods must be selected according to the location, surgical staging, characters of tumors. Stability reconstruction plays important roles in maintaining stability of cervical spine. More care should be taken in procedure for protecting vertebral artery, cervical nerve and spinal cord.

[Objective]To assess the accuracies and feasibility of computer assisted navigation technique in scoliosis surgery.[Method]In clinical study,5 cases of scoliosis operations assisted by computer navigation technique(Group 1)and 5 cases of scoliosis operations assisted by anatomy and X-ray fluoroscopy(Group 2)were reviewed.The accuracies of screw placement were evaluated by postoperative CT scan.[Result]There were altogether 114 screws inserted in 10 cases.49 screws inserted with CTbased computer assisted navigation system,91.8% excellent,8.2% good.42 screws inserted with anatomy and X ray fluoroscopy,57.1% excellent,23.8 % good,19.1% bad.[Conclusion]CT-based computer assisted navigation system enhances accuracies and further improves the safety of adolescent scoliosis surgery,CT-based navigation method is better than the anatomy and X-ray fluoroscopy methods.

Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation and aggressive arthritis. The basic pathological changes of RA include intra-articular hyperplasia synovitis and extra-articular vasculitis, symmetrical joint cavity effusion and stenosis, and the formation of pannus leading to the destruction of articular cartilage or joint accessory structures. In the course of RA, swelling and pain of the affected joints occur, causing joint deformities, joint stiffness, and joint dysfunction, and eventually disability. In recent years, significant progress has been made in the study of the relationship between nerve growth factor (NGF) and RA immunopathology. The results of existing studies have shown that the level of NGF in the synovial fluid of RA patients is elevated, suggesting that NGF plays an important role in immune inflammation-mediated pain behavior. In addition, nerve growth factor precursors (including proNGF and proBDNF, etc.) can promote cell apoptosis and inflammation. Among them, the levels of proBDNF and its receptors have significant changes in the blood of RA patients. Therefore, it can be inferred that proNGF and proBDNF may become new targets for RA treatment. According to the latest international domestic research results, in this paper the research progress of NGF and RA in immunopathology, immune inflammatory response, pain behavior, etc. were briefly introduced, and the potential application value of NGF in the treatment of RA was summarized.

Objective To evaluate the efficacy of endovascular embolization in intracranial aneurysm treatment .Methods We retrospectively analyzed 130 patients with different locations and types intracranial aneurysms treated by variety endovascular em‐bolization .The postoperative and long‐term follow up results was examined .Results 124 cases with 139 aneurysms was successful‐ly embolized ,1 case failed but clipping successfully .6 cases suffered from intraoperative bleeding ,3 cases died ,3 cases had a good recovery .The results of Glasgow Outcome Scale after operation:1 score 3 cases ,2 score 0 case ,3 score 1 case ,4 score 3 cases ,5 score 123 cases .119 cases(91% ) were followed up for 3‐48 months with an average of 12 months .33 cases(27% ) achieved long‐term follow‐up(exceeded 6 months) .During follow‐up ,1 case had severe stenosis of the parent artery and received angioplasty .The other cases didn′t see aneurysms in cerebral angiography and showed different degree of neurological function recovery .Conclusion According to the different intracranial aneurysm with endovascular treatment of corresponding intravascular can effectively im‐prove the clinical treatment effect ,reduce the risk of aneurysm rupture ,improve the prognosis of the patients .

Objective To investigate incidence,diagnosis and treatment strategy of delayed esophageal complications after anterior cervical spine surgery.Methods The clinical data of 2316 patients who had undergone anterior cervical spine surgery from January 2001 to December 2011 were analyzed.The delayed esophageal complications were defined as esophageal perforation,esophago-tracheal fistula,esophago-cutaneous fistula,diverticulum of esophagus,esophagopleural fistula and esophageal stenosis that occurred 2 weeks after spine surgery.Results Delayed esophageal complications occurred in 4 patients,and the incidence was 0.17％.Esophageal perforation occurred in 2 patients; the incidence was 0.09％.Case 1 was a 31-year-old man who was found to have esophageal diverticulum and perforation 7 years after anterior cervical spine surgery.Then he underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 2 was a 46-year-old man who was found to have esophageal diverticulum 3 years after cervical spine surgery.He also underwent removal of implant,excision of diverticulum,and repair of esophagus with sternohyoid muscle flap and omohyoid muscle flap.Case 3 was a 58-year-old woman who was found to have esophageal diverticulum 5 years after cervical spine surgery.She underwent removal of implant,excision of diverticulum,and repair of esophagus with sternocleidomastoid muscle flap.Case 4 was a 56-year-old woman who was found to have esophageal perforation 3 years after cervical spine surgery.She underwent removal of implant and repair of esophagus with sternocleidomastoid muscle flap.All 4 patients recovered after operation.Conclusion The incidence of delayed esophageal complications after anterior cervical spine surgery is low,and the diagnosis is difficult.X-ray,digestive tract radiography,and gastrointestinal endoscopy are the main diagnostic tools.Surgical treatment is the main and effective management.

Objective:To study the influence of anti-tumor drug incorporation on the physicochemical properties of calcium phosphate cement(CPC).Methods: Methotrexate(MTX),epirubicin(EPI),hydroxy camptothecin(OH-CPT),and arsenic trioxide(As_2O_3) were incorporated,each in a proportion of 2%,5%,and 8%,into the powder-phase CPC.Untreated CPC was taken as control.The setting time,compression strength,and the microstructure of the resultant products were evaluated and tested.Results: Compared with control group,the setting time was significantly prolonged when 2% EPI was incorporated into CPC(P

Objective To evaluate the values of combined detection of soluble mesothelin related proteins (SMRP)and carbohydrate antigen 1 25 (CA1 25)in the diagnosis of malignant peritoneal mesothelioma.Methods 20 patients with malignant peritoneal mesothelioma were selected as the malignant group,50 patients with benign ovar-ian tumor were selected as the benign group,60 healthy women were selected as the control group.Enzyme -linked immunosorbent assay(ELISA)was adopted to detect serum SMRP levels and electrochemiluminescence immunifaction (ECLI)was adopted to detect serum CA1 25 levels.The SMRP,CA1 25 levels were compared among all groups,the sensitivity,specificity of SMRP and CA1 25 in the diagnosis of peritoneal malignant mesothelioma were analyzed. Results Serum levels of SMRP,CA1 25 in malignant group were (1 4.8 ±1 .6 )μg/L,(1 89.1 ±1 5.3 )μg/Lrespectively,which were significantly higher than those in the benign group[(3.9 ±0.9)μg/L,(28.6 ±4.2)μg/L] (t =27.40,49.61 0,all P <0.01 )and the control group[(2.8 ±0.7)μg/L,(1 6.9 ±3.8)μg/L](t =29.877, 53.334,all P <0.01 ).The sensitivities of SMRP,CA1 25 detection alone for malignant peritoneal mesothelioma diag-nosis were 65.0%,50%,respectively,while their specificities were 83.6%,79.1 %.The sensitivity and specificity of combined detection of SMRP and CA1 25 for malignant peritoneal mesothelioma were 95.0% and 93.6%.Conclusion SMRP has some value in the diagnosis of peritoneal malignant mesothelioma.SMRP combined with CA1 25 detection can markedly improve the diagnostic sensitivity and specificity for malignant peritoneal mesothelioma.

Objective To prepare 5-aminolevulinic acid (ALA) and hematoporphyrin monomethyl ether (HMME) hydrogel suppositories and to evaluate their photosensitizer transfer efficiencies in rectal tumor tissue.Methods The BALB/c mice implanted SW837 rectal cancer cells subcutaneously were randomly divided into four groups:intrarectal suppository administration group,cutaneous administration group,intratumoral injection group and intravenous injection group.Fluorescence spectrophotometry was used to measure the concentration of protoporphyrin Ⅸ (PpⅨ) and HMME in rectal wall,skin and tumor tissue.The distribution of photosensitizer was determined by a fluorescence spectroscopy system.Results The concentration of PpⅨ in the ALA suppository administration group was 9.76 times (1 h) and 5.80 times (3 h) higher than that in the cutaneous administration group,and the differences were statistically significant (all P＜0.05).The maximal penetration depth of ALA in tumor tissue was about 3-6 mm at 2 h after the cutaneous administration.After the HMME suppository administration,the concentration of HMME in the rectal wall was very low.The maximal penetration depth of HMME in tumor tissue was less than 2 mm after the cutaneous administration.Conclusions ALA is more likely to penetrate mucosal barrier compared to skin tissue.The hydrogel suppository based rectal administration is expected to be a new administration method for the rectal cancer photodynamic therapy using ALA.

Objective To explore the killing effect of dielectric barrier discharge (DBD) plasma on tumor cells and to analyze the DBD-induced apoptosis mechanism.Methods Thiazolyl blue tetrazolium bromide (MTT) assay method was used to detect the killing effect of low temperature plasma on the cytotoxicity of normal spleen leukocytes and acute promyelocytic leukemia cells (LT-12) at different doses.The changes of reactive oxygen species (ROS) level were measured after plasma treatment.The cell apoptosis rate was detected by Annexin V/PI double staining at different doses.The expression of apoptosis-related genes and proteins was detected by qRT-PCR and Western Blot.Results MTT results showed that the killing effect of plasma treatment was dose-dependent and time-dependent.The cell survival rate after 8 hours of treatment decreased from 98％ to 63％ with the dose increasing from 30 s to 240 s.The survival rate decreased from 78％ (2 h) to 39％ (24 h) after the treatment with a same dose (e.g.240 s).Annexin V/PI double staining results demonstrated that the plasma effect can induce apoptosis,and the apoptosis rate was not only positively correlated with the plasma dose,but also with the post-plasma time.The longer the post-plasma time,the higher was the apoptosis rate.The apoptotic rate of the 60 s dose treatment after 12 h was 48％ that increased to 55.3％ with the dose of 120 s.The production of reactive oxygen species (ROS) detected by flow cytometry also showed a time correlation of the plasma treatment.After the plasma treatment,the ROS level immediately increased to 1.24 times,and sharply increased to 5.39 times after 20 h post-plasma.The experimental results of qRT-PCR and Western blot showed that the expression of the genes and proteins of Caspase family and Bcl-2 family was very active at 8 to 12 h post-plasma treatment.Conclusions Low-temperature plasma can effectively kill tumor cells,and apoptosis is the main mechanism of death.The molecular mechanism of apoptosis of tumor cells induced by low temperature plasma was preliminary confirmed.

Objective To explore the appropriate treatment according to the grading system of adolescent idiopathic cervical kyphosis.Methods A retrospective study was performed in 115 adolescent patients with idiopathic cervical kyphosis.The patients were divided into 4 groups according to the magnitude of kyphosis.The initial Cobb angle of 4 groups were 12.7°±1.4° 25.4°±4.8°,47.2°±4.4° and 62.6°±5.7° respectively.The patients in group I were treated with the collar support for 4-8 weeks.The patients in group Ⅱ were treated with skull traction (3-5 kg) and then fixed by cranio-cervical-thoracic plaster.According to the angles between the tangents of posterior vertebral body at each level on lateral cervical radiograph in extension,the anterior fusion levels of the group Ⅲ and angles and range of osteotomy in the group Ⅳ were decided.In group Ⅳ,the patients were treated by two steps.The anterior release and posterior osteotomy were performed firstly.Then skull traction (1/10 body weight) was maintained in order to correct the deformity for 7-10 days,fusion and anterior fusion with autologous bone graft and internal fixation was completed.Results Post-operative radiograph showed that Cobb angle were -5.5°±2.0°,-8.2°±6.1°,-4.5°±6.6° and -2.9°±7.9° in Ⅰ-Ⅳ group after treatment.The deformed appearance of the patients improved significantly.A improvement neck pain and neurologic function were found in all patients.Post-operative MRI showed that physiological curve of the cervical spine was restored,and the cerebrospinal fluid line was clear in the previous kyphosis area.Conclusion Adolescent idiopathic cervical kyphosis has specific characteristics.Surgical strategy is determined by the severity of deformity.