Objective To observe the clinical effect of manipulation combined with McKenzie technique on discogenic low back pain. Methods 80 patients were randomly divided into control group (n=39, 1 case was lost) and observation group (n=40). The patients in obser-vation group received manipulation and McKenzie technique, while the control group received manipulation only. All the patients were eval-uated with Oswestry Disability Index (ODI), Visual Analogous Scale (VAS) and Self-rating Depression Scale (SDS) before and 3 weeks af-ter treatment. Results The scores of ODI, VAS and SDS decreased after treatment in both groups (P<0.01). The score of ODI and VAS were lower in the observation group than in the control group (P<0.05), while there was no significant difference in the score of SDS between two groups after treatment (P>0.05). Conclusion Manipulation combined with McKenzie technique is more effective on discogenic low back pain.

Objective To investigate the effects on knee function between patella plasty and patellar replacement in total knee arthroplasty.Methods From August 2010 to November 2010,48 patients (69 knees) of osteoarthritis performed TKA were covered in this study.All the patients were randomly assigned to the following two groups:one group contained 24 patients (34 knees) performed patella plasty,and the other group contained other 24 patients (35 knees) performed patellar replacement.There was no significant difference between the two groups in age,weight,height,BMI,patellar score and the American Knee Society Score (KSS).Every patient was followed up for 6 weeks,3 months,6 months,one year,and two years.All the results,which were used to compare the difference between the two groups,in KSS knee score,knee function score,patellar score,the incidence of anterior knee pain,and imaging findings.Results In this clinical study,20 patients (30 knees) in patellar replacement group and 20 patients (29 knees) in patella plasty group were followed up.No significant difference was found in the postoperative KSS knee score between 2 groups at each time point.The KSS knee function score in replacement group was significantly higher than that in arthroplasty group at 6,12 and 24 months after operation.The incidence of anterior knee pain after the surgery in replacement group was significant different from the plasty group at every time point after operation.There was no significant difference in tibiofemoral angle,patellar ligament ratio,patellar tilt angle,congruence angle and lateral patellar displacement between two groups at last follow-up.Conclusion Total knee arthroplasty with patella replacement can improve both knee function and patella function,and reduce the incidence of postoperative anterior knee pain.

Objective To explore the determinant factors influencing the constituent parts of radiological examination in severe trauma patients so as to provide scientific basis for optimized strategy of radiological examination. Methods A prospective study was carried out from April to July 2010 in a tertiary hospital. Clinical data of 60 severe trauma patients admitted to emergency department and ICU were recorded. The type, number and site of trauma under radiological examination were described and compared among different stages of treatment. The correlation between number of radiological examinations and age, number of injured site, injury severity score (ISS), Glasgow Coma Scale (GCS), ICU stay and overall length of hospital stay were analyzed. Results (1) The majority of radiological examinations in 60 patients were radiography and CT, with a corresponding median number of 6.0(3.0～ 11.0, IQR)and 10.0(8.0 ～ 13.8, Qr) times per patient. (2) The numbers of radiography examinations requested in emergency room, emergency ICU and general ward were quite approximately equal (x2 =4.043 ,P =0. 132), while CT examinations were mainly requested in emergency room and emergency ICU (x2 = 20. 274 , P < 0. 001). (3) The numbers of radiological examinations requested for different sites of injury were quite significantly different between radiography and CT during different stages of treatment (x2 = 114.609, 75.932, P < 0.01). (4 ) The number of CT scan requested was positively correlated with number of injured site, ISS, ICU and overall length of hospital stay (r =0.273,0.369,0.523,0.417,all P <0.05). Conclusions The sum of radiological examinations in severe trauma patients was great mainly in radiography and CT, and CT was more predominantly requested. The number of CT scans examinations was positively correlated with severity of injury and length of ICU stay. Further study is warranted to optimize radiological examination in severe trauma patients.

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were sum-marized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis musculocutaneous flap (TRAM flap) in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. Results The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap (TRAM flap) breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appear-ance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Imme-diate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can se-lectively choose immediate breast reconstruction.

Objective: To analyze the electrocardiographic (ECG) characteristics for the ifrst diagonal branch of infarction related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI) in order to ifnd the rule for physician to make quick diagnosis. Methods: A total of 28 STEMI patients with coronary angiography (CAG) confirmed first diagonal branch of IRA were retrospectively analyzed. The patients were treated in our hospital from 2005-01 to 2014-06 and their ECG changes at admission were studied for ST-segment elevation/depression and q wave, Q wave changes during the period of evolution at different leads in all patients. Results: CAG presented that there were 19/28 (67.9%) patients with single vessel disease, 13 (46.4%) with isolated diagonal lesion. From onset of chest pain to AMI graph shown on ECG was about 240 (252 ± 71) min in all patients. All 28 (100%) patients were with ST-segment elevation in lead aVL, 27 (96.4%) in lead I, and 15 (55.6%) patients with ST-segment elevation by (0.5-1.0) mm. The incidence of ST-segment elevation in the chest lead was, in turn as 21 (75.0%) patients in lead V2, 16 (57.1%) in lead V3 and 12 (42.9%) in lead V1respectively; while ST-segment depression was as 28 (100%) patients in lead III, 27 (96.4%) in lead aVF and 22 (78.6%) in lead II respectively. During the period of evolution, the most q wave or Q wave formation were, in turn as 22 (88.0%) patients in lead aVL, 10 (40.0%) in lead V2, 9 (36.0%) in lead V3 and 7 (28.0%) in lead I respectively. Conclusion: The ECG changes in STEMI patients with diagonal branch of IRA have the high prevalence of ST-segment elevation in lead aVL and lead I, while there is an important feature that the ST-segment elevation < 1 mm in about half amount of relevant patients.

Objective:To analyze the relationship between PD-L1 expression and the degree of infiltration of different types of TILs in triple-negative breast cancer, and the correlation with other pathological features to explore their clinical significance.Methods:Tumor tissues of 199 patients with triple-negative breast cancer in our hospital were selected, and the expression of PD-L1 and the distribution of TILs were analyzed using immunohistochemistry and counted using Image software. The relationship between CD8 +TILs, CD4 +TILs and PD-L1 expression was analyzed and compared, and survival analysis and correlation analysis between PD-L1 expression and pathological information were performed. Results:The density of CD4 + TILs ( χ2=8.75, P=0.003) and CD8 + TILs ( χ2=6.32, P=0.009) infiltration was higher in the PD-L1-positive group compared to that of the PD-L1-negative group. Among PD-L1-positive patients, patients with higher TILs infiltration compared to low infiltrating TILs could achieve longer overall survival time, and the difference was statistically significant ( P1=0.012, P2=0.023, P3=0.010). Patient PD-L1 expression was positively correlated with the number of positive lymph nodes, tumor stage, and ki-67 expression ( Pa=0.032, Pb=0.006, Pc=0.042), and was not related to age or tumor diameter ( Pd=1.031, Pe=0.672) . Conclusions:PD-L1 expression in triple negative breast cancer predicts higher infiltration of CD4 +TILs and CD8 +TILs, while higher infiltration of CD4 +TILs and CD8 +TILs predicts a relatively good survival prognosis.PD-L1 expression is associated with multiple pathological clinical factors and deserves further study to make PD-L1, TILs and other indicators better benefit triple-negative breast cancer patients.