According to the concept of sagittal spinal balance, the alternating curves of cervical and lumbar lordosis and thoracic and sacral kyphosis enable the head to be positioned over the trunk and pelvis. But the sagittal imbalance represents departure from this ideal form. Cervical kyphosis may represent the most disabling of these imbalances, for it can cause pain, postural difficulties, or neurologic deficit. A summary and discussion is reviewed regarding the anatomy, biomechanics, etiology, clinical presentation, laboratory examination and treatment of this condition.

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

BACKGROUND:It has been demonstrated that there are different expressions of fatty acid binding proteins (FABPs) in most malignant tumors such as breast cancer, prostate cancer, liver cancer, lung carcinoma and bladder carcinoma;therefore, FABPs are closely related to the occurrence, metastasis, invasion and drug resistance of malignant tumors. OBJECTIVE:To investigate the effects of fatty acid binding protein-5 (FABP-5) silencing on the proliferation, invasion and apoptosis of U251 cel s (human glioma cel s). METHODS:siRNA molecules targeting the mRNA of FABP-5 was designed and chenical y synthesized, which was transiently transfected into U251 cel s. U251 cel s were divided into three groups:Lv-shRNA-FABP-5 was added into FABP-5-shRNA group, LV-shRNA-NC added into negative control group, and blank control group underwent normal culture. mRNA and protein expressions of FABP-5 were detected by RT-PCR and western blot assay, respectively. The cel proliferation in vitro was determined by cel counting kit-8 assay, the cel cycle, apoptosis and expressions of CD44+and CD133+were detected by flow cytometry, and the apoptosis was observed using TUNEL staining. RESULTS AND COUNCLUSION:mRNA and protein expressions of FABP-5 in the FABP-5-shRNA group were significantly lower than those in the negative control and blank control groups. Compared with the negative control and blank control groups, the cel growth rate was significantly decreased, the cel cycle arrested in the G0/G1 phase, and the cel number in the S phase was decreased, and moreover, the proportion of CD44+/CD133+expression was significantly decreased in the FABP-5-shRNA group (P<0.05). Besides, compared with the negative control and blank control groups, the apoptosis rate was significantly increased, and the cel proliferation and invasiveness were significantly decreased in the FABP-5-shRNA group (P<0.05). In conclusion, it is possible that FABP-5 directly or indirectly regulates the cel cycle and apoptosis of glioma cel s, and its expression changes share a close relationship with the invasiveness of tumor cel s.

Objective To construct the suppression subtractive library of hemin-inducing K562 cells for identifying the cDNA genes of globin synthesis regulatory factors expressed in K562 cells induced by hemin. Methods K562 cells were cultured under different concentration of hemin, both the percentage of positive benzidine staining cells and hemoglobin content were measured, the most reasonable concentration of hemin was chosen for inducing incubation of K562 cells. The poly (A) positive RNA (mRNA) was isolated from the hemin-induced K562 cells (tester) and non-induced K562 cells (driver) respectively, and double-strand cDNA molecules were synthesized by reverse transcription. After two times subtractive hybridization followed by two times polymerase chain reaction (PCR) amplification, the forward subtracted PCR products were ligated with pGEM T-Easy vector and the subtracted cDNA library was constructed. The library clones were selected by blue-white screening. The plasmid DNAs of the single positive colony were purified and digested by EcoRⅠ, and the inserts in plasmid were amplified by PCR. Results The maximum of positive benzidine staining cells percentage and hemoglobin content of K562 cells were obtained in 50?mol/L of hemin inducing condition. The suppression subtractive library of hemin-inducing K562 cells was constructed after K562 cells were induced by 50?mol/L of hemin. The library identification showed that the positive clones contain inserts in different length respectively. Conclusions The suppression subtracted cDNA library of hemin-inducing K562 cells were successfully constructed. This subtracted cDNA library combined with bioinformatics analysis can be used to explore structures and functions of hemin-inducing expression genes in K562 cells.

Objective:To investigate the effects of comprehensive intervention on the quality of life of middle school students. Methods:Eight classes were extracted with striated cluster sampling method from the first grade of two key junior middle schools in city and countryside; four classes (two classes of the urban and rural) were selected randomly as the experimental group and another four classes (two classes of the urban and rural) as the control group. The experimental group received mental-social intervention for three years. No intervention for the control group. The effect was evaluated with the subjective quality of life of children, and a questionnaire on mental health of middle school students. Results:The scores of life quality, cognitive component and emotion component of experimental group were higher than that of control:(172.6?12.8/145.4?17.4,98.7?10.8/85.0?13.3,73.9?4.3/60.4?7.7; t=20.83, 13.20, 25.29 respectively;the average P

Diabetes patients in China is large in number, low level of health literacy, and their self management mainly relies on community doctor's health propaganda and education, as a result, it is very important to train community healthcare professionals to improve their communication skills with patients.Guided by the Social Cognitive Theory (SCT), the researchers developed a literacy-addressing training model specifically through: 1) low literacy healthcare education materials written in plain language, simple text, maximal white space, and behavior-oriented images or pictograms;2) a standardized health communication curriculum to promote simple communication with decreased jargon usage, teach teach back, and enhance shared goal-setting;3) use of standardized patients to enhance doctor-patient communication training;and 4) MOOC and a series of videos demonstrating doctor-patient communication scenarios.The novel training model can be used in continuing medical education through traditional on-site classes or by E-learning platform.It is expected to improve the communication skills of community doctors and patients, improve the satisfaction of both doctors and patients, and the effect of patients' self-management.

Cancer stem cells are special stem cells and are found recently in many tumors,and have the capability of self renewal and differentiation and can gradually differentiate into matured tumor cells to form the primary lesion and the various metastasis lesions of tumors.As well known,cancer stem cells shared strong ability of resistant to chemotherapy and/or radiotherapy,which is mainly related to many kinds of molecules and theirs relative regulation in niche regarding to cancer stem cells.Currently,the strategies of some novel therapies are conducted to detect the targeting sites with relevant to the microenvironments of cancer stem cells,such as the angiogenesis and epithelial-mesenchymal transition of cancer stem cells.Furthermore,insights into drug-resistance of cancer stem cells and its niche may offer new therapeutic strategies for the treatment of tumors.

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

[Objective]To evaluate the surgical results of spinal scoliosis in the elderly and to investigate the indications,surgical techniques and factors which may contribute to the outcome. [Methods]A retrospective study was held.Sixty-four patients≥65 years undergoing different kinds of operation for lumbar spinal scoliosis from Sep.2004 to Apr.2008 were recruited.The mean patient age at surgery was 69.2 years(61~75 years).[Results]There were a variety of treatment methods of degenerative scoliosis based on symptomatology and radiologic measurements of scoliosis and stenosis.Sixty-four patients were followed up for an average of 37 months.The average correction rate of scoliosis was 51.2% after operation.No case was found spinal cord injury.Clinical symptoms and functional tolerance for daily activities improved after surgery.Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument related failures or reoperations in this series.[Conclusion]The surgical results of lumbar scoliosis in the elderly are better than to those reported for the general population.Carefully perioperative preparation is very important in the treatment of elderly patients with lumbar spinal scoliosis.

[Objective]To review the clinical data on patients suffering from multi-level lumbar spine fracture treated with TSRH-3D pedicle screw system,and to investigate the post-operative efficacy.[Method]Eighteen patients with multi-level lumbar spine fracture were treated with TSRH-3D pedicle screw system.The operations were performed 4 hours to 2 days after injury,and the follow-up period was 15-32 months(average,23 months).The X-ray and CT scan were taken preoperatively and postoperatively.[Result](1)Twelve patients injured from height falling(67%),5 from traffic accident(28%) and 1 from crush injury(5%).(2)The improvement rates of the spine motion,back pain and the lower extremity pain were 67%,94% and 78%,respectively.(3) Compared with preoperation,the height of anterior border of vertebra improved by 59.2%,lost by 5.2% on average(P