The choice of the topic area and specific problem on which to conduct research is the mostimportant step in the research process.This paper focused on the development and execution of a clinical re-habilitation research study. The choice of the topic area. principle of research design. data collection and dataanalvsis of a research study have been discussed.

Objective To evaluate the safety,feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE).Methods We retrospectively analyzed the clinical results of laparoscopic common bile duct exploration for common bile duct stones in 119 cases between July 2009 and August 2012.After all stones were removed,there were 63 cases with primary closure of the common bile duct (group A),and 56 cases with T tube drainage (group B).Results All operations were finished laparoscopically.There was significant difference in terms of operation time,postoperative hospital stay and fluid replacement between the two groups.There was no postoperative extrahepatic duct stenosis and biliary residual stones in the two groups.Conclusions Primary closure of common bile duct after LCBDE for common bile duct stones is safe,efficient and feasible.

Objective To observe the clinical effect of α1-antitrypsin gene therapy in the treatment of diabetes.Methods 81 cases with type 1 diabetes were randomly divided into conventional treatment group,islet stem cell transplantation group and gene therapy group,27 cases in each group.The conventional treatment group received the insulin therapy,the stem cell transplantation group received the islet cell transplantation,and the gene therapy group received stem cell therapy of α1-antitrypsin gene.The clinical effect of these three groups were observed.Results The insulin concentration of the gene therapy group was significantly higher than the islet stem cell transplantation group and the conventional treatment group at five time points(F =1 349.379,1 831.186,1 068.173,416.080,257.810,all P ＜0.05).The glucose concentration of the gene therapy group was significantly lower than the other two groups at six time points (F =1 212.243,586.057,962.495,582.887,650.015,1 181.808,all P ＜ 0.05).The degree of inflammatory cell infiltration in the gene therapy group was significantly lighter than in the islet stem cell transplantation group.Conclusion α1-antitrypsin gene therapy can significantly improve the therapeutic effect of diabetes,which is worthy of clinical application.

This study introduces the core ideas of rehabilitation from United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities, United Nations Convention of the Rights of Persons with Disabilities and WHO resolution on Disability, including prevention, management and rehabilitation, discusses the main contents of WHO action plan from 2006～2011 of disability and rehabilitation, and provides some recommendations for the development of rehabilitation in China.

Autonomic dysreflexia (AD) is a condition of abnormal sympathetic response,which generally occurs in patients with the spinal cord injury (SCI) at levels of T6 and above.AD usually occurs owing to the excessive reaction of the sympathetic nervous system to the adverse stimulus.Since AD can result in fatal complications,such as epilepsy,apnea,heart infarction,acute intracranial hypertension and cerebral hemorrhage,the diagnosis and treatment of AD is very important.This article simply introduces the morbidity,pathogenesis,causative factor,clinical manifestation and treatment of AD by reviewing recent literatures.

The most rigorous and valid spinal cord injury(SCI)clinical trials would be a prospective,double-blind,randomly,control one.The design and conduct of SCI clinical trials should meet appropriate standards to make it of efficacy and safety,trustworthy,and in the best interests of subjects.

This paper reviewed the thoracolumbar pedicle screw internal fixation,including operation,instruments,image guided navigation,robot navigation,electrophysiological monitoring and integrated applications of various methods.It suggested that traditional implantation of thoracolumbar pedicle screw were widely used,computer-assisted navigation is being accepted by more and more surgeons,MR can make special image of the tissue being drilled by the probe tip during operation.However,being expensive,it is difficult for MRI navigation to be popularized.

Objective:To seek better treatments for abnormal pelvic floor muscle tension and pelvic floor dysfunction after spinal cord injury.Methods:The morphology of pelvic floor muscle fibers of rats with spinal cord injury at different levels was observed under the electron microscope. Thirty female adult Sprague-Dawley rats were randomly divided into a suprasacral (SS) cord injury group, a group with spinal cord injury at or below the sacral level (SC) and a normal group (NG), each of 10. The relevant spinal cord injury models were established in the SS and SC groups through spinal cord disconnection. Four weeks later, the pixel area of ATPase-positive fibers was used to quantify the content of type I fibers in the pubococcygeus muscle of each rat through observation under the electron microscope after hematoxylin and eosin staining.Results:The average content of type I muscle fibers in both the SS and SC group was significantly lower than in the normal group. The SC group′s average level was significantly lower than that of the SS group. Under the microscope the stained myofibers were tortuous, deformed in appearance and with proliferated nuclei. Capillary dilation could be seen locally in the SS group 4 weeks after the injury. In the SC group at 4 weeks after the injury the pubococcal fibers were seriously "dissolved" , or disordered, with spherical nuclei and mild hyperplasia. Under the electron microscope, the sarcomeres of the SC group were obviously dissolved, atrophied and broken, though the basic structure persisted, with mild mitochondrial proliferation. The sarcomeres of the SC group were extremely dissolved and broken, completely losing basic structure, with abundant connective tissue proliferation but without obvious mitochondrial proliferation.Conclusions:After suprasacral cord injury, the content of type I muscle fibers in the pubococcygeus muscle of the pelvic floor decreases somewhat, with the basic structure of the muscle fibers remaining intact. However, after spinal cord injury at or below the sacral level, type I muscle fibers decrease significantly in the pubococcygeus muscle of the pelvic floor, and the basic structure is seriously damaged.

Objective To discuss the modification of the ASIA scale (version 2011) and the significance for clinical practice. Methods Through comparing the newest English version of ASIA scale to the previous version, we tried to find the difference between them and interpret the possible influence on clinical practice. Results The study found that there were 15 modifications found after comparing the two versions of scales. Some modifications were just descriptive, some were for emphasis, and the others were fundamental modification. Conclusion The ASIA Committee makes prudent modification according to the advice of the doctors worldwide in the past ten years to make scale more applicable for clinical practice. The modification will influence the neurological examination of spinal cord injuries in clinical practice and relative research