BACKGROUND: A variety of cages for lumbar interbody fusion have been used, which have good mechanics and clinical effects. Conventional posterior fusion requires parallel implantation of two cages, but some researchers believe that single lumbar fusion cage in oblique way is also possible.OBJECTIVE: Through in vitro biomechanical tests, to find a method with favorable effect and little trauma by combination of percutaneous lateral oblique way into the single expansive lumbar fusion cage between the fixed-line operations.DESIGN, TIME AND SETTING: A randomized, controlled experiment was performed at the Shanghai Institute of Biomechanical Engineering between May 2005 and May 2008.MATERIALS: Expansile lumbar interbody fusion cage was simulated from B-Twin Cage (Disc-O-Tech, Israel). Fresh calf lumbar specimens were used.METHODS: Biomechanical tests were performed in 18 specimens of calf lumbar function spinal units (FSU), which were divided into 3 groups: 6 in control group, 6 in single cage groups and 6 in two-cage groups. The biomechanical tests of two experimental groups were performed following tests of intact specimens. Stiffness tests were conducted in the WE-10A MTS,including axial compression, flexion, extension, lateral bending, and torsion.MAIN OUTCOME MEASURES: Axial and torsion stiffness results of each group.RESULTS: The stiffness was greater in two-cage groups compared with single cage group in axial compression and extension, but significant differences were only found in axial compression and extension tests (P < 0.05). The torsion stiffness of single cage group was significantly greater than two-cage groups (P < 0.05).CONCLUSION: Percutanous lumbar interbody fusion by single expansile lumbar interbody fusion cage from lateral approach is feasible theoretically. Biomechanical properties of FSU with B-Twin cage are improved, which contributes a lot to lumbar stability. Compared with posterior approach of single cage, two-cage can provide better stiffness and stability but its torsion stability is lower.

Objective To evaluate the clinical efficacy of neoadjuvant chemo radiotherapy combined with surgical treatment for advanced rectal cancer.Methods Fifty-one patients with advanced rectal cancer were randomly divided into treatment group and control group by random number table.In treatment group,26 cases received three-dimensional conformal radiotherapy synchronization XELOX chemotherapy for 2 cycles,then they received radical resection after 4-6 weeks.Twenty-five cases in control group received neoadjuvant chemotherapy with XELOX for 2 cycles,then received radical resection.Results The objective response rate in treatment group was 84.6％ (22/26),and in control group was 60.0％(15/25),there was significant difference between two groups (P =0.049).Radical resection in treatment group was 96.2％ (25/26),significantly higher than that in control group 76.0％ (19/25)(P =0.037).The sphincter preservation rate in treatment group was 61.5％ (16/26),and in control group was 20.0％ (5/25),there was significant difference between two groups (P =0.003).The pathologic complete response rate in treatment group was 26.9％ (7/26),significantly higher than that in control group 4.0％ (1/25)(P =0.024).The 1,2 and 3 year survival rate in treatment group were 88.0％(22/25),60.0％(15/25),32.0％(8/25),which were significantly higher than those in control group 62.5％ (15/24),29.2％ (7/24),8.3％ (2/24) (P =0.038,0.030,0.040).The 1,2,and 3 year recurrence rate in treatment group were 8.0％(2/25),20.0％(5/25),36.0％ (9/25),which were significantly lower than those in control group 33.3％ (8/24),44.8％(12/24),66.7％ (16/24) (P=0.028,0.027,0.032).Conclusion Neoadjuvant chemoradiotherapy can improve the rate of surgical resection,sphincter preservation and prolong survival of rectal cancer,it can be used as a kind of effective treatment for rectal cancer.

Objective To explore the rationality of clinical blood transfusion since the Ministry of Health enacted the The Technical Criterion of Clinic Blood Transfusion' in 2000. Methods Retrieved the literatures on the appraisal of rationality of clinic blood transfusion published in core journal between 2000 and 2010, and analyzed the rationality of clinical blood transfusion in recent 10 years. Results In 35 literatures entered, the proportion of appropriate blood transfusion of platelet was the highest compaved with the lowest proportion of plasma. the proportion of appropriate blood transfusion in operational department is higher than that in non-operational department. The primary reason of inappropriate blood transfusion is transfusion without indications. Conclusion The proportion of appropriate blood transfusion in china is low. The government should enhance the regulation of blood usage,and the public should he educated to realize the importarce of appropriote blood transfusion in order to promote it to develop healthily.

Objective To assess the interobserver reliability and intraobserver reproducibility of Neer classification system and its influencing factors.Methods The present study reviewed the series preoperative radiographs (including those of scapular anteroposterior view,scapular lateral view and modified Velpeau axillary view and an axial CT scan) of 40 patients who had been treated in our department from January 2010 to December 2010 for proximal humeral fractures.The radiographs were assessed by 12 individual observers on 2 separate occasions with an interval of 3 months at least Half of the observers (the professional group; n =6) had received a shoulder fellowship training and the other half (the control group; n =6) had not All the observers were asked to categorize the radiographs according to the Neer classification system of 16 types of fractures in a same process.The reliability and reproducibility of the system were assessed with the Kappa statistics.Comparisons of classification agreement were made between the professional group and the control group.We also evaluated the simplified Neer system of only 6 types of fractures with recombinant data.Results The interobserver reliability coefficients were 0.534 and 0.473 for the first and second assessments,with an intraobserver reproducibility coefficient of 0.669.The agreement level in the professional group was significantly higher than in the control group ( P ＜ 0.05).The interobserver reliability coefficients of the simplified Neer system were 0.581 and 0.502,with an intraobserver reproducibility coefficient of 0.680.Use of the modified Neer system did not elevate the agreement level beyond the moderate range.The classification was agreed on by all the observers in 17.5％ of the fractures during the first assessment and in 15.0％ during the second assessment.Conclusions Neer classification may have fair interobserver reliability and moderate intraobserver reproducibility.Experience of shoulder fellowship training is an important factor influencing the reliability of the Neer system.Simplification of the system may not help increase its reliability.

Objective To investigate expressions of microRNA-21 (miR-21),PTEN,NF-κB,and caspase-9 in colon carcinoma and their possible mechanisms in progression of tumor.Methods Expressions of above-mentioned indexes and percentage of apoptotic cells in colon carcinoma,colon adenoma,and normal tissue specimen were detected.Results Expressions of miR-21,PTEN,N F-κB,and caspase9 in normal tissue were 0.39 ±0.02,50％,25％,and 50％.Expressions of them in colon adenoma were 0.62 ±0.06,50％,35％,and 55％,and those in colon carcinoma were 0.88 ±0.04,30％,75％,and 20％.Percentage of apoptotic cells were (24.64 ± 7.66) ％,(15.86 ± 1.44) ％,and (6.20 ± 2.57) ％,respectively.The above P-values were all less than 0.05.Expression of miR-21 was positively correlated with TNM stage,depth of infiltration,differentiated level and expression of NF-κB while inversely correlated with PTEN and caspase-9 expressions and percentage of apoptotic cells.The r-values were 0.647,0.297,0.259,0.519,-0.299,-0.388,and-0.931,respectively.Conclusions Hyperexpression of miR-21 participated in progression of colon carcinoma probably through down-regulating expressions of PTEN and caspase-9 and up-regulating expression of NF-κB and then suppressing cell apoptosis.

Objective:To observe the anatomic characteristics of supratubal recess and the morphological change of it in the sick ear. To investigate the relation between the morphological changes of supratubal recess and otitis media.Method:Using high resolution CT to observe and measure the supratubal recess of the normal ears and the ailing ones.Result:For the normal adults, the anteroposterior diameter of the supratubal recess is(3.83±1.28)mm,the vertical diameter(3.67±1.14)mm,the height(3.76±0.36)mm;and the length of the cog is(2.84±0.38)mm.The size of the supratubal recess showed no significant difference between left and right(P＞0.05).There was no relationship between the size of the supratubal recess and pneumatization of mastoid cells (P＞0.05).There was significant differences in size of the supratubal recess between normal ears and the ears with cholesteatoma(P＜0.05),but there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells(P＞0.05)in the ears with cholesteatoma.There was no significant differences in size of the supratubal recess between normal ears and the ears with chronic otitis media(P＞0.05).In the ears with cholesteatoma,40% had osseous destruction in supratubal recess.Conclusion:For the normal adults, the size of the supratubal recess showed no significant difference between left and right, and there was no relationship between the size of the supratubal recess and pneumatization of mastoid cells. Anterior tympanic isthmus , posterior tympanic isthmus and supratubal recess which is the supplement of the formers constitute the air way between attic and mesotympanum. The supratubal recess of the cholesteatoma is smaller than the normal, when the eustachian tube dysfunction occurs, the air way in the middle ear would herein be affected, and cholesteatoma forms eventually. There was no significant differences in size of the supratubal recess between normal ears and ears with chronic oti-tis media, as in the clinic.The effect of the supratubal recess should be taken into account when we consider the pathogeny and treatment of the middle ear cholesteatoma.

In clinical practice,regional portal hypertension is infrequent,but it is the only type which could be cured of portal hypertension.Pancreatic diseases are the chief pathogeny of regional portal hypertension,and the obstruction of spleen vein is the basic reason.The common clinical manifestation is isolatism varicose veins of pylorus.The golden standard of its iconography diagnosis is DSA,and the treatment should follow the individual principle.The splenectomy is the basic measure for them who have UGIB or hypersplenism.This is a review about recent advance in regional portal hypertension of etiology and classification,pathology and physiology,clinical manifestation,diagnosis,radiographic examination,cure,and so on.

BACKGROUND: To review progressions in the pharmacological study of natural plant Ficus carica L. (fig), summarize its main pharmacological effects so as to manifest values in clinical practice.DATA SOURCES: .By computer retrieval system, the relevant papers on the researches on Ficus carica were retrieved on Medline from January 1950 to September 2004 and limited at the referred word "Ficus carica" in English. Simultaneously, the relevant papers were searched by the computer on China National Knowledge Infrastructure (CNKI) database from January 1999 to September 2004, focusing on the referred word "Fieus carica" in Chinese.STUDY SELECTION: Of all the relevant papers, ones focusing on the pharmacological study of Ficus carica were selected and the whole text were checked, meanwhile those had no relation with the pharmacological latex as well as various constituents and preparations. Exclusion criterion:repeated studies.DATA EXTRACTION: A total of 226 papers were checked on the study of Ficus carica, 30 papers were consistent with the standards. Among the 196 excluded papers, 189 were excluded because they were clinical experience report or repeated studies, 7 were reviews.DATA SYNTHESIS: Investigations of the fig, its leaves and latex as well as various constituents and preparations, have revealed many pharmacological effects such as: anti-tumor effects, the ability to mediate body metabolism, mediating hyperglycemia, hyperlipidemia and cholesterol levels, enhancing oxidation resistance, antibiotic effects, antivirus effects, the ability to mediate immunity, activating blood coagulation etc. It also may play an important role in supportive therapy in tumor treatment by reducing toxicity and side effects in actinotheraphy and chemotherapy. Several reports of anaphylaxis after fig intake have reported both in China and abroad.CONCLUSION: As an herb, fig has wide pharmacological effects and clinical practise values. The main pharmacological studies of it were focused on its anti-tumor effects and the ability to mediate body metabolism.Separation and purification of its active components and determining the interactions between them as well as the pharmacological and toxicological effects need further study. New pharmacological effect s will be found by studying various fig extracts.

ObjectiveTo investigate the pain relieving degree and the comprehensive efficacy of pricking-cupping bloodletting plus microwave therapy in treating intractable tennis elbow.MethodSeventy-two patients meeting the inclusion criteria were randomly allocated, using a random number table, to a treatment group (pricking-cupping bloodletting plus microwave therapy,n=36) and a control group (electroacupuncture plus microwave therapy,n=36). The pain relieving degree and the overall therapeutic effect were assessed using the Visual Analogue Scale (VAS) and theCriteria of Syndrome Diagnosis and Therapeutic Effect in Traditional Chinese Medicinein the patients after treatment.ResultThe pain relieving degree and the overall therapeutic effect were more remarkable in the treatment group than in the control group (P<0.05).ConclusionPricking-cupping bloodletting plus microwave therapy can effectively heighten the pain relieving degree and the overall therapeutic effect in treating patients with intractable tennis elbow.

Objective To develop secondary nursing discipline system based on the situation of China and the international trends of nursing education,which would be applied as the theoretical guideline for the construction of nursing system in China.Methods An indicator system of entry criteria of secondary nursing discipline was formed by examining the current situation of nursing knowledge body and organizational system in domestic and foreign countries through bibliometric and content analysis,were further supported in the panel meeting.Then the secondary nursing discipline system were constructed according to the entry criteria.Results Knowledge innovation,knowledge dissemination,personnel training and social needs of health were found to be the first indicators of the entry criteria,including 14 secondary indicators,10 secondary nursing disciplines were proposed.Conclusions The secondary nursing discipline system is in line with current situation of nursing at home and abroad,and would be gradually refined with the de velopment of nursing discipline.