Objective To study the expressions and clinical significance of E cadherin(E CD) and CD44v6 in bladder transitional cell cancinoma. Methods The expressions of E CD and CD44v6 of 96 cases of bladder transitional cell cancer were detected by streptavidin peroxidase immunohistochemical method. Results The positive expression rates of E CD and CD44v6 were as follows:Grade Ⅰ,86.7%(26/30),80.0%(24/30);Grade Ⅱ,52.8%(19/36),69.4%(25/36);Grade Ⅲ,26.7%(8/30),33.3%(10/30), P

ObjectiveTo evaluate the efficacy about the different wearing manner with Milwaukee and Boston for the treatment of adolescent idiopathic scoliosis (AIS).MethodsRetrospectively summarization and analysis was performed in 85 adolescent patients with idiopathic scoliosis who were treated from February 2004 to March 2009.The skeletal growth of them had not completed.There were 57 cases who received brace treatment.In them,28 were treated with (CTLSO) Milwaukee brace,and the rest were treated with (TLSO) Boston brace and orthopedic gymnastics.The 30 cases wear regularly used for 21 to 23hours per day,and 27 cases could consist on wearing only 6 to 15 hours per day.The other 28 cases of 85AIS cases were only treated with orthopedic gymnastics instead of orthosis treatment.All patients were periodically observed with lateral side (X)-ray photograph at standing position and photograph,and Cobb angle and Risser sign were measured every 3 to 6 months.Since 2008 all adolescent idiopathic scoliosis patients treated with orthosis were requested to fill with simplified Chinese SRS-22.Results73 cases adolescent idiopathic scoliosis patients were followed up for 2 ～5 years [ mean(26.3 ± 33.7)months ].Milwaukee orthosis group showed the regular wearing group had 91.67 ％ ( 11/12) effective rate and the intermittent wearing group had 56.25％ (9/16) effective rate and the group without wearing orthosis only had 20％ (4/20)effective rate.The group regularly wearing Milwaukee brace had superior effect than the other two groups (P ＜ 0.05 ).Boston orthosis group showed the regular wearing group had 88.89％ (16/18) effective rate and the intermittent wearing group had 54.55％ (6/11 ) effective rate and the group without wearing brace with 25％ (2/8) effective rate.The group regularly wearing Boston brace had better effect than the other two groups ( P ＜ 0.05 ).Due to the different choice of AIS patients and orthosis,the effective rate of the Milwaukee and Boston orthosis was not compared.ConclusionsThe adolescent idiopathic scoliosis patients should insist on regularly wearing brace regardless of the Milwaukee or Boston orthosis ( this article suggest that the wearing time should not less than 21 ～ 23 h/d).The group regularly wearing with the Milwaukee or Boston orthosis had better effect than the intermittent group or the group without wearing brace.It's a good treatment for the AIS patients who have with the indication of orthosis treatment.

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if
combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how smal the incision may be (even 3-5 mm).
OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting.
METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar
discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L 3-4 in
one case, L 4-5 in 13 cases and L 5-S 1 in 16 cases. The ruptured disc migrated superiorly in four cases and
inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in al surgeries. The
ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself. RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the fol ow-up period was
(149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in al patients after the operation. Fol ow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in al the patients. Interlaminar endoscopic lumbar discectomy with
ligamentum flavum splitting is a feasible approach.

BACKGROUND:There are few studies concerning estrogen receptorβgene, and its mechanism of regulating the bone metabolism is stil unclear now. OBJECTIVE:To analyze the effect of estrogen receptorβ(ERβ) silencing on the expressions of transforming growth factorβ1 (TGF-β1) and bone morphogenetic protein 2 (BMP-2) in human osteoblasts METHODS:There were three groups:blank control group (hFOB 1.19 uninfected with any retrovirus);negative control group (containing invalid interference fragment ERβ-shRNA-nc);optimal RNAi group (ERβ-shRNA-3). ERβ-shRNA retroviral vectors in the optimal RNAi group were used to transfect human osteoblasts fol owed by resistance screening and cel expansion. MTT assay was used to detect the proliferative activity of ERβ-silenced osteoblasts. Then under estrogen intervention, the stable inhibition rate of ERβwas determined using western blot assay, and the expressions of TGF-β1 and BMP-2 in human osteoblasts after ERβsilencing were detected by RT-PCR technology and western blot assay. RESULTS AND CONCLUSION:Human osteoblasts that were stably transfected by ERβ-shRNA-3 retroviral vector was selected successful y, and ERβsilencing had no significant influence on the cel proliferation (P>0.05). Under the interference of estrogen, the silencing efficiency of ERβprotein was (93.11±0.57)%(P<0.05), and after ERβsilencing, the expressions of TGF-β1 and BMP-2 were increased by (26.65±3.81)%and (16.62±1.71)%at mRNA level, and increased by (23.79±3.76)%and (18.08±3.20)%at protein level (both P<0.05). In conclusion, ERβmay play an important role in bone metabolism by regulating the expressions of TGF-β1 and BMP-2.

Objective To compare the minimum 5?year follow?up outcomes of surgical management by posterior only ap?proaches, anterior only approaches and combined posterior and anterior approaches for thoracic tuberculosis in adults, and evalu?ate the mid term follow?up results of posterior only approaches. Methods All of 184 patients with monosegment thoracic tubercu?losis between January 2003 and November 2010 were studied retrospectively. Among these patients, 62 cases were treated with posterior debridement combine with interbody fusion (PO group), 65 cases were treated by posterior instrumentation, anterior de?bridement and bone graft in one or two?stage procedures (AP Group ), and 57 cases were treated by anterior only approach (AO Group). The operation time, blood loss, Visual Analogue Scale, complications, recovery of neurological function, kyphosis angle, correction rate and loss angle were respectively compared between each group. Results Comparison of postoperative curative ef?fects showed:mean operation time and blood loss:PO group (260.05±30.75 min,735.95±161.43 ml) was better than AP group (411.65 ± 55.61 min, 1178.65 ± 184.50 ml)and AO group (343.65 ± 24.74 min, 965.35 ± 122.59 ml);corrective angle and correction rate:PO group (6.78°±1.13°, 72.48%±12.97%) and AP group (6.97°±1.05°, 73.10%±11.42%) were better than AO group (13.98°± 1.73°, 44.95%±16.84%);bed time:PO group and AO group were shorter than AP group. Mid term follow?up outcomes showed:ky?phosis angle and loss angle:PO group (8.56°±1.09°, 1.89°±1.41°) and AP group (8.55°±1.65°, 1.63°±1.11°) were better than AO group (16.39°±1.59°, 2.80°±1.29°);bone fusion time, VAS and recovery of neurological function:there were no statistically differ?ence in all groups. Conclusion The mid term follow?up outcomes of posterior debridement combined with interbody fusion is sat?isfied in the management of monosegment thoracic tuberculosis. It is a safe and effective method.

BACKGROUND:The monocyte chemoattactant protein-1 gene polymorphism is associated with spinal tuberculosis susceptibility. OBJECTIVE:To investigate the association between serum monocyte chemoattactant protein-1 expression level and spinal tuberculosis susceptibility in Han population of Hunan province. METHODS:The patients with spinal tuberculosis and the healthy volunteers were recruited in Xiangya Hospital of Central South University from December 2004 to December 2010. The empty peripheral venous blood 2 mL were col ected from the subjects in early morning, then the monocyte chemoattactant protein-1-362 genotypes were detected by polymerase chain reaction and DNA sequencing technology. And the serum monocyte chemoattactant protein-1 level was detected by enzyme linked immunosorbent assay technology. The ROC curve was used for diagnostic tests to calculate diagnostic threshold value of serum monocyte chemoattactant protein-1 level to spinal tuberculosis susceptibility, and to analyze the diagnostic titer. RESULTS AND CONCLUSION:208 patients with spinal tuberculosis and 210 healthy volunteers were included. The serum monocyte chemoattactant protein-1 level of the spinal tuberculosis patients was significantly higher than that of the healthy volunteers [(134.58±51.63) ng/L vs. (39.18±17.45) ng/L, P<0.01]. The serum monocyte chemoattactant protein-1 level could not be affected by gender, but over-expressed in patients with monocyte chemoattactant protein-1-362-CC genotypes. The serum monocyte chemoattactant protein-1 level higher than 101.65 ng/L indicated that the patients might suffered from spinal tuberculosis (sensitivity:85.5%, specificity:94.3%, Youden index:0.799, area under curve of ROC:0.946, 95%confidence interval:0.916-0.975, P<0.01). The serum monocyte chemoattactant protein-1 level may be associated with spinal tuberculosis susceptibility in Han population of Hunan province, highly expressed serum monocyte chemoattactant protein-1 can be used as one of the indicators for the diagnosis of spinal tuberculosis.

BACKGROUND:Studies concerning how estrogen receptorβparticipates in bone metabolism are few now. OBJECTIVE:To investigate the effect of estrogen receptorβon the expression of osteoprotegerin and receptor activator of nuclear factor-κB ligand in human osteblast-like cells. METHODS:The retrovirus with the most effective interference sequence and non-specific short hairpin RNA was used to transfect human osteoblast-like cellMG63 in order to screen out the stable colon, and then amplified and cultured. The blank control and non-specific short hairpin RNA were used as control, and the stable inhibition rate of estrogen receptorβwas detected. The 17β-estradiol was added into the cells in three groups, that were MG63 cells, short hairpin RNA retrovirus estrogen receptorβ-mediated MG63 cells and negative control short hairpin RNA retrovirus-medicated MG63 cells, in order to detect the expressions of osteoprotegerin and receptor activator of nuclear factor-κB ligand mRNA in human osteoblast-like cells. RESULTS AND CONCLUSION: The human osteoblast-like MG63 cellline was further stably transfected with pRNAT-H1.4/Retro-estrogen receptorβshort hairpin RNA3, and then compared with the blank control and negative control, and found that estrogen receptorβcould express the stable inhibited human osteoblast-like cellline. The inhibition rate of estrogen receptorβmRNA was (88.17±1.17)%(P<0.05), and the inhibition rate of estrogen receptorβprotein was (89.01±1.22)%(P<0.05), indicating that estrogen receptorβgene knockdown human osteoblast-like cellmodels were constructed successful y. After estrogen intervention for 48 hours, the inhibition of MG63 cells with estrogen receptorβcould up-regulate the osteoprotegerin mRNA and protein expression in the blank control group and the negative control group (P<0.05), down-regulate the receptor activator of nuclear factor-κB ligand mRNA and protein expression (P<0.05), and up-regulate the osteoprotegerin receptor activator of nuclear factor-κB ligand expression. The results indicate that estrogen receptorβmay play an important role in bone metabolism through regulating osteoprotegerin/receptor activator of nuclear factor-κB ligand ratio.

Objective To evaluate the clinical efficacy and feasibility of using the expanding pedicle subtraction osteotomy (E-PSO) technique for the treatment of congenital severe thoracic angular kyphotic deformity.Methods We retrospectively reviewed a cohort of 13patients with congenital severe kyphosis admitted to our hospital from January 2010 to June 2015 including 5 males and 8 females,the average age is (34.9±20.5) years old (ranged 15-55 years old).The vertebral deformity in T7～83 cases,T8～93 cases,T9～102 cases,T10～114 cases,T9～111 case.All cases were treated by E-PSO technique.The multi-malformed vertebrae are considered as a complexus.And the osteotomy was performed within the complexus.The superior and inferior endplate of the complexus were reserved.After the osteotomy was completed,alternately pressed tightly closed the upper and lower parts.Results All cases were followed up for 10-42 months,with an average of 32 months.At the time of preoperation,postoperation andthe last follow-up,the deformity angle was 107.0°±3.5°,23.5°± 1.5° and 23.5°±0.2°;TK was 98.1°±7.6°,28.9°±3.0° and 29.5°±0.1 °,LL was 94.1 °± 1.5°,43.7°± 1.3° and 44.1 °±5.3°;SVA was (-0.6±39) mm,(1.6±7.9) mm and (6±0.7) mm,respectively;PI was 28.9°±1.6°,31.7±12.3°and 31.9°±2.1°;PT was 17.7°±1.9°,13.4°±3.4°and 13.1°±4.2°,SS was 11.3°±0.4°,18.2°±1.1° and 18.7°±2.1°,respectively.The sagittal parameters and spinopelvic parameters except SVA were significantly improved in the post-operation and the last follow-up compared with the pre-operation according to the image data.No significant loss of correction occurred during the follow-up,and there was no statistical difference.The preoperative VAS score was (5.7± 1.4) points,ODI score was (19.8±12.7) points.The last follow-up VAS score was (1.9±0.7) points,the ODI score was (9.2±0.7) points.No case of nerve damage,infection and other complications,and no dissection,displacement and rupture of internal fixation were found during the follow-up.Conclusion The use of E-PSO technique for the treatment of congenital severe thoracic kyphotic kyphosis is feasible and can achieve better curative effect.

Objective:To evaluate the feasibility and clinical efficacy of deformed complex vertebral osteotomy (DCVO) technique on the treatment of angular kyphosis of cured spinal tuberculosis.Methods:A retrospective study was performed on patients with angular kyphosis of cured spinal tuberculosis who underwent the DCVO technique or posterior vertebral column resection (PVCR) technique from Jan, 2007 to Jan, 2019. 33 patients were included, 18 males and 15 females, the average age was 39.5±15.0 years old (ranged 9-78 years old). The vertebral deformity in thoracic vertebrae 14 cases, thoracolumbar vertebrae 16 cases, and lumbar vertebrae 3 cases. 20 cases underwent the DCVO technique, while 13 cases underwent PVCR technique. For DCVO group, the multiple malformed vertebrae were considered a malformed complex, and a larger range and angle wedge osteotomy was performed within the complex using the DCVO technique. PVCR technique would resect the whole deformed vertebrae, and subsequently brought the two separated spinal columns together with instruments and titanium mesh. The intro-operative blood loss, operating time and complications were recorded. The radiological measurements included preoperative and postoperative spinopelvic parameters, which including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and segmental kyphosis. The recovery of neurological function was evaluated by Frankle classification.Results:All patients were followed up for 7-72 months. Comparing with the cases underwent PVCR technique, the DCVO group has a significantly lower blood loss (1315.00±462.57 ml), operating time (293.00±83.86 min) and complications rate (1.5%). At the time of preoperation, postoperation and last follow-up, the deformity angle of DCVO group was 96.80°±6.32°, 29.10°±6.96°and 29.05°±6.49°, which gained an average 69.9% correction rate. The statistical analysis suggested that deformity angle was enormously corrected. And there was an insignificant difference between DCVO group and PVCR group. Meanwhile, the preoperative, postoperative and follow-up TK of DCVO group was 96.96°±29.13°, 37.15°±4.88° and 37.00°±3.89°respectively, whosecorrection rate was 67.1%; LL was 66.70°±21.21°, 42.25°±5.53° and 41.90°±4.98°, which have a significant difference between pre-operation and post-operation/follow-up ( F=23.997, P<0.001) ; SVA was 75.95±18.63 mm, 16.30±6.88 mm and 16.55±7.30 mm. PI was 47.50°±6.12°, 47.35°±5.54°and 47.90°±5.93°, PT was 37.25°±9.63°, 18.50°±1.99° and 19.00°±1.65°; SS was 10.25°±8.27°, 29.15°±5.91° and 28.85°±5.77°. The sagittal and spinopelvic parameters of two groups improved significantly at postoperation and follow-up. No obviously difference of spinal parameters was found between two groups at preoperation and postoperation. Both groups have cases with dysneuria. And all of these cases achieved different degrees of recovery at follow-up. Conclusion:The use of DCVO technique for the treatment of post-tubercular angular kyphosis is safe and efficiency. DCVO leads a better clinical outcomes and lower complication rate than VCR technique.