Objective To investigate the characteristics of HBsAg and HBcAg in combination pulsed monocyte-derived DCs(MoDC) derived from patients with HBV-associated hepatocellular carcinoma(HCC).Methods MoDCs were generated from 20 HBV-associated HCC patients,and pulsed with recombinant human serum albumin(rHSA)as conDC(control DC),or pulsed with HBsAg andHBcAg in combination as scDC.Phenotypic patterns of MoDCs were characterized by flow cytometry,and the levels of cytokines releasedby MoDCs were analyzed by ELISA,and frequencies of IFN-γ-producing antigen-specific autologous T cells were measured by Elispotassay.HBV-specific CD8 T cells proliferation was determined by pentamer staining.Results 1.The levels of MHC and costimulatorymolecules expressed on scDC were significantly higher than those on immature MoDC(imaDC)in two groups,and the levels of MHC andcostimulatory molecules expressed on imaDC,conDC and scDC in HBsAg+,anti-HBe+,anti-HBc+patients(1-4-5 positive group)were significantly higher than those in HBsAg+,anti-HBc+patients(1-5 positive group);2.The levels of IL-12 and IL-10 produced byscDC were higher than those produced by imaDC and conDC in both groups,and the levels of IL-12 produced by imaDC,conDC and scDCin 1-4-5 positive group were higher than those in 1-5 positive group.3.The frequencies of IFN-γ-producing T cells induced by scDC werehigher than those by conDC in 1-4-5 positive group.4.scDCs from 4 cases of HLA-A2+patients in 1-4-5 positive group could induceautologous T cells to generate HBVcore18-27-specific CD8 T cells.Condusions HBsAg and HBcAg pulse in combination couldsubstantially reverse the impaired function of MoDCs in HBv-associated HCC patients,and boost MoDC to induce HBV-specific T cellsresponse,especially in HBsAg+,anti-HBe+ and anti-HBe+ patients.

Objective To discuss the treatment strategy of knee dislocation and to evaluate its outcome.Methods Thirty-six patients with unilateral knee dislocation treated with individualized protocol were studied retrospectively,including 22 males and 14 females with an average age of 35 years (range,19-72 years).There were 30 acute and 6 chronic knee dislocations.According to the modified Schenck's classification of knee dislocation,there were 7 KD- Ⅰ and 23 KD-Ⅲ cases in the acute category,and all 6 chronic cases were KD-Ⅲ.Seven acute KD- Ⅰ and 6 chronic KD-Ⅲ cases underwent one-stage arthroscopic surgery.In 23 acute KD-Ⅲ cases,2 were treated conservatively with splint or brace due to advanced age,18 with staged surgery,3 with one-stage surgery due to concomitant vascular and nerve injury.Functional and clinical evaluation was conducted at final follow-up.Results All 36 patients were followed up for an average of 27 months (range,18-36 months).The Lysholm score (82.0±11.4),Tegner score (5.5±1.3),and knee range of motion (118.3°±19.2°) at final follow-up showed a statistically significant improvement compared with preoperative results (P＜O.O1).Eight (23.5％) patients had residual knee instability:posterior drawer test and Sag sign were positive (++ or +++) in 8 knees,valgus instability (++) in 1 and varus instability (+++) in 1.The remaining 28 knees were stable.Conclusion Special attention should be paid to rotational knee dislocation with single cruciate ligament rupture.Properly individualized treatment plan is the key to optimal outcome.Arthroscopic surgery can lead to successful outcome.Early one-stage arthroscopic surgery is recommended for acute KD-Ⅰ and chronic KD-Ⅲ dislocation,staged arthroscopic surgery for acute KD-Ⅲ dislocation.

Objective To study the developmental patterns and aging characteristics of lumbar pedicle morphology in the adolescents aging from 12~18 years old,and to provide the anatomical basis for image and three-dimensional analysis of the treatment and prevention of spinal diseases. Methods the 30 adolescents with normal spines and without any the problems of nervous system were selected to do thin spiral CT scan that the range was lumbar. The original data imported into three-dimensional reconstruction software with the form of DICOM were to measure and analyze statistically the relevant indicators according to gender and age. Results There was no significant difference in the pedicle height,pedicle width and length of form screw entry point to vertebral anterior cotrex,which were not influenced by age and gender (P>0. 05). The physical development of human increases gradually with age and has some significant differences. Conclusion A regular change process is displayed to provide references for clinic. But it must be combined with the results of individual imaging and the technology of reverse engineering and the support of rapid prototype manufacturing. Only in this way can it meet the satisfaction of individualized treatment.

Objective To study the pedicle of lumbosacral developmental patterns and aging characteristics by means of studying the ado-lescents aging from 12~18 years old,and provide the basis for image and three-dimensional analysis of the treatment of spinal diseases. Meth-ods Select the 30 normal spines of adolescents without any the problems of nervous system,who did thin spiral CT scan of lumbosacral verte-brae. The original data in the form of DICOM were put into three-dimensional software to do the relevant measurement and analyzed according to gender and age. Results There were no significant differences between the pedicle of lumbosacral E/F angle and DSP /DNP and these differ-ences were not influenced by age and gender(P>0. 05). The physical development of human increases gradually with age and has some signifi-cant differences. Conclusion A regular change process and operation in the region value in patients with lumbarsacrum is displayed. But it must be combined with the results of individual imagine and the technology of reverse engineering and the support of rapid prototype manufactur-ing. Only in this way can it meet the satisfaction of individualized treatment.

Objective To explore the morphological characteristics and change rule of thoracic joint angles in children aged from 10 to 12 years through thinner CT scanning and 3D reconstruction,and to provide theoretical basis for early diagnosis,treatment and prevention.Methods Totally 30 normal cases aged from 10 to 12 years were admitted into this study.There was no bone destruction,deformity,fractures,tumors and spine surgery involved.DICOM 3.0 data of multi-slice spiral CT (0.625 ～ 1.25 mm),ranging from T1 to T12,were used for 3D reconstruction,measurement and statistical analysis.Results The difference between left and right sagittal section angle of zygopophysis was less than 10°.There was no significant differences between T1,T11,and T12for sagittal section angle of upper zygopophysis (P ＞ 0.05).So was it between T3,T4,T9,T10 and T11 for sagittal section angle of lower zygopophysis (P ＞ 0.05).While there were significant differences between others(P ＜ 0.05).The was no significant difference between left and right coronal plane angle of zygopophysis (P ＞ 0.05).Coronal plane angle of lower and upper zygopophysis tended to be ‘ spike-like’,and the maximum points were at T7 to T9.For horizontal plane angle,left and right upper zygopophysis made significant differences between T2,T4,T8,T10 and T12 only,so did T7 lower zygopophysis (P ＜ 0.05).Horizontal angle of upper zygopophysis tended to be stable in the upper thoracic both in the left and right side,while a decreasing trend was shown in lower thoracic.Horizontal angle of lower zygopophysis showed a decreasing trend generally except individual vertebrae.Both upper and lower zygopophysis showed negative angle at T11 and T12 levels.Conclusion Thoracic joint angles(coronal,sagittal and horizontal angle) in children aged from 10 to 12 years can directly reflect the developmental regularity with growth,and it verified the tendency that horizontal facet joints of the cervical spine gradually changes to coronal facet joints thoracic spine and then changes to sagittal facet joints of lumbar spine.And the left and right side facet joints are basically symmetrical with the angle difference less than 10°.

BACKGROUND:Articular process of joint is an important bony structure to maintain the spinal stability and normal physiological activities. Clinical study found that bilateral articular process asymmetry is also one of the causes of vertebral degeneration, but the existing research mainly focuses on the adult, and give priority to with cervical vertebra and lumbar vertebra. OBJECTIVE:To explore the morphological and developmental characteristics of thoracic facet joints and bony structures of 10 to 12-year-old children and compare with data of adults. METHODS:A total of 30 normal cases aging from 10 to 12 years were admitted into this study. No cases experienced bone destruction, deformity, fractures, or tumors, and spine surgery was not involved in. DICOM 3.0 data of multi-slice spiral CT (0.625-1.25 mm), ranging from T1 to T12, were used for three-dimensional reconstruction, measurement and statistical analysis. RESULTS AND CONCLUSION:(1) Joint width overal trends in“V”. Joint surface height from T1 to T12 increased gradual y with the increase of the operation sequence. (2) The joint thickness from T1 to T12 showed a gradual y increasing trend with the increase of the job sequence;articular process under the joint thickness was gentle. In the left and right sides of the upper and lower joints, joint surface width, height, and thickness did not show significant difference in addition to the significant difference between the individual vertebral body. Joints spacing on the side and there was no significant difference between upper and lower, articular process spacing between sides showed an increasing trend with the increase of operation sequence;upper and lower joints spacing increased with the job sequence, and showed wide“U”shape. (3) These results confirmed that the application of three-dimensional reconstruction techniques can display shape and characteristics of each vertebral body clearly and intuitively and improve measurement accuracy. Width and height of facet joints in 10-12-year-old school children were overal smal er than those of adults. The distance between upper and lower facet joints changed a little. Distance between left and right facet joints increased from T1 to T12, which complies with the growth and development of children.

Objective To discuss the characteristics,growth and development of atlantoaxial pedicle in preschool children,and to provide the basic theoretical basis for the design,production and clinical application of pedicle screw technique in the treatment of atlantoaxial disease in preschool children.Methods Excluded patients with atlantoaxial fractures,deformities,tuberculosis and tumor,the clinical data of 60 children aged from 3 to 6 years old with cervical spondylolisthesis were collected.The original CT images were reconstructed in DICOM format and the subjects were reconstructed with Mimics software.The subjects were grouped by age to measure and analyze the atlantoaxial pedicle correlation.Results The pedicle width(PW),pedicle height(PH) and total length of pedicle bone channel (PL) increased gradually with age.The PW/PH ratio of the vertebrae(C1) is greater than 1.0,and that is, the width of the pedicle of the C1 pedicle is greater than the height.The PW/PH ratio of the vertebral (C2) is less than 1.0,which means the width of the pedicle of the C1 pedicle is less than the height.Conclusion The growth and development of spine in preschool children are fast, and the pedicle of atlantoaxial calculus in different age groups has different developmental characteristics.In this study,the diameter of the pedicle of the atlantoaxial pedicle in the 3 to 6 year old children is increasing with age.The pedicle screw with the smallest diameter of 3.5 mm can be implanted into the atlantoaxial pedicle with feasibility in theory.

Objective To explore the uncinate-transverse hole spacing developmental patterns and aging characteristics by means of studying the teenagers aging from 6~20 years old,and provide the basis for image analysis of the treatment and prevention of cervical spondy-losis. Method the 66 adolescents without trauma nor problems of nervous system were selected to do thin spiral CT scan(0. 625 ~1. 25 mm) ,the range was C1 ~T1 . The original data in the form of DICOM are analyzed according to gender and age. Results There was no sig-nificant difference in gender and different sides. Overall,the physical development of human increases gradually with age and has some signifi-cant differences. Conclusion There exists a close relationship between cervical hook-transverse process and the incidence of vertebral artery type and nerve root type cervical spondylosis.

BACKGROUND:Many scholars at home and abroad have already attempted to apply the technique of the internal fixation pedicle screw placement to cure children’s spinal injuries in recent years, because the children’s thoracic pedicle is more smal , anatomical structure variation is big and adjacent relationship is complicated, so the application of adult’s pedicle screw technology simply to children who was in a continuous growth and development can increase operation risk greatly. Above this, improving the accuracy of nailing and reducing error rate become keys for further development of cervical pedicle fixation. OBJECTIVE:To provide an individualized and accurate positioning method for screw placement in thoracic pedicle of children by computer aided design and rapid prototyping technology. METHODS:After computed tomography scan of four cases of child specimens, the original data were made for three-dimensional reconstruction by the software, then the specimens were randomly divided into two groups:one group used the traditional pedicle internal fixation method, and the other group, first created the individual navigation template using the principle of reverse engineering and rapid prototyping technology. The lumbar pedicle screws were put into the samples by the individual navigation template. The position of the pedicle screws was evaluated according to the computer tomography scan. RESULTS AND CONCLUSION:The accurate rate of screw placement of the traditional pedicle internal fixation method was 58%;and the accurate rate of screw placement of the individual digital navigation template method was 81%. The success rate was better than the traditional surgery group. Furthermore, chi square test showed that there was a significant difference between two groups (P<0.05). These findings suggested that there has a high accuracy of the screw placement in thoracic pedicle of children assisted by the individual navigation template, ful y reflects the principle of individualization of screw placement, and provides a new feasible method for accurate screw placement in thoracic pedicle of children.

BACKGROUND:With the change of modern living habits, the incidence of cervical disease and cervical related diseases is increasingly at younger age. Based on this feature, the discussion of the relationship between the cervical spine and vertebral body as wel as regular feature can provide theoretical basis for early diagnosis, prevention and treatment of cervical spondylosis. OBJECTIVE:To analyze the correlation structure of the cervical vertebra uncinate process with the vertebral body and intervertebral foramen among adolescents. METHODS:A total of 66 cases without injuries, neurological symptoms or signs of 6 to 20 years old were scanned with multi-row thin-slice spiral CT from C1-T1. The original data were loaded in DICOM format into three-dimensional reconstruction software for measurement and statistical analysis. RESULTS AND CONCLUSION:(1) In addition to uncinate process height and vertebral body height, the uncinate process spacing, uncinate base width and diameter between the vertebrae and a uncinate process base radius vector length and vertebral bodies were positively correlated (P<0.05). (2) Uncinate high uncinate base long uncinate base width and height between the foramen in addition to the uncinate process had a positive correlation with the length of the substrate (P<0.05). (3) In conclusion, there is a certain correlation in juvenile cervical uncovertebral joint between the uncinate process and vertebral body and intervertebral foramen. With the growth of age, cervical activity is increased and the uncinate hyperplasia, trauma, and fracture can oppress spinal nerve within the intervertebral foramen to cause corresponding nerve root type of cervical spondylosis.