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.

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 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.

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 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 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 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.

ObjectiveTo observe the early changes of N-methyl-D-aspartic acid (NMDA) receptor subunit NR1 and NR2B expressions in the hypothalamus so as to discuss the underlying mechanism of the excitability alternation of hypothalamus-pituitary-adrenal (HPA) axis following severe burn in rats.MethodsA total of 40 Sprague-Dawley rats were randomized into the control group and the experimental groups ( including 6,24 and 48 hours after burn) and a 30％ total body surface area full-thickness burn was induced by immersing the shaved dorsum into boiling water for 40 s.Then,the expression changes of the NMDA receptor subunits NR1 and NR2B in the hypothalamus tissue were examined by using immunohistochemistry and Western blot.Results There was an obvious enhancement of the excitability of HPA axis and obvious changes of serum concentration of cortisol and hemodynamics.The serum concentrations of cortisol of the experimental groups reached the peak at 6 hour after burn and were significantly higher than the control group even 48 hours later (P ＜ 0.05 ).Systolic pressure (SP),diastolic pressure (DP) and left ventricular systolic pressure (LVSP) of the experimental groups were all decreased at 6 hours after burn,of which SP and DP were still lower than the control group at 48 hours after burn (P ＜0.05).Based on the Western blot assay,the NR1 level was increased and reached the peak (1.12 ±0.27) in the experimental groups and 0.45 -±0.15 in the control group at 24 hours after burn (P ＜ 0.05).In the meantime,the NR2B level was decreased significantly and reached the lowest for 0.65 ±0.21 at 6 hours after burn,with statistical difference in comparison with 1.38 ±0.51 in the control group (P ＜0.05.The NR2B level recovered to pre-burn level for 1.25 ±0.30 at 48 hours in the experimental groups,with no statistical difference compared with 1.38 ± 0.51 in the control group (P ＞ 0.05 ).The immunohistochemistry results on hypothalamus paraventricular nucleus (PVN) was consistent with the Western blot results.ConclusionThe persistent plasticity changes of hypothalamus subunits NR1 and NR2B may be on of important mechanisms for early excitability alteration of HPA axis after severe burn.

Objective To retrospectively review the efficacy of large craniotomy with subtemporal decompression in the treatment of severe craniocerebral injury combined with cerebral infarction.Methods Forty-eight patients suffering from severe craniocerebral injury combined with cerebral infarction were randomized into the treatment group (managed by large craniotomy decompression) and the control group (managed by clearance of hematoma by routine craniotomy ).A retrospective analysis was carried out to compare the cerebral infarction size between the two groups before operation and at day 1 and 1 week after operation and the outcomes of the two corresponding groups three months post-operatively.Results The infarction size of the treatment group was insignificant in comparison with that of the control group pre-operatively and at day 1 post-operatively,but was significantly smaller than that of the control group one week post-operatively (P ＜ 0.05 ).The mortality and moderate disability/good rate of the treatment and control groups presented significant differences three months post-operatively (21％,42％ vs 33％,25％ respectively,P ＜ 0.05 ).Conclusion Large craniotomy decompression is effective in treating severe craniocerebral injury combined with cerebral infarction and plays an important role in reducing disability and mortality.

Objective To investigate effect of single anterior decompression and fusion for pinching cervical spondylosis myelopathy.Methods 82 patients with pinching cervical spondylosis myelopathy,treated with single anterior decompression and fusion,were analyzed,including 43 males and 39 females,with an average age of 54.4 years (range,33-79 years).Occupying rate,anterior occupying rate and posterior occupying rate were measured on pre- and post-operative midsagittal MRIs.Multiple regression analysis was performed between preoperative occupying rate,intervertebral space height,postoperative imaging changes and neural function recovery.Results All patients were followed up for an average of 25.8 months (range,9-72 months).Significant differences were found between pre- and postoperative Japanese Orthopaedic Association (JOA) scores,anterior occupying rate,posterior occupying rate,and intervertebral space height,respectively.Pre- and post-operative posterior occupying rate was averagely 29.0％±10.5％ and 19.9％+11.6％,respectively,and improvement rate of posterior occupying rate was 9.0％±6.1％.Regression analysis found that preoperative intervertebral space height did not relate to posterior occupying rate,while preoperative posterior occupying rate related to improvement rate of posterior occupying rate.JOA scores improved significantly after operation in patients with preoperative posterior occupying rate between 20％ and 40％.However,the decompression results were poor in patients with preoperative posterior occupying rate ≥40％.Conclusion Anterior decompression and fusion can achieve satisfactory results in patients with pinching cervical spondylotic myelopathy.For patients with preoperative posterior occupying rate between 20％ and 40％,the decompression results are better.