Objective To investigate the changes in myeloid-derived suppressor cells (MDSC), regulatory T cells (Treg) and T helper 17 (Th17) cells in peripheral blood of patients with HPV infection and cervical diseases including ectopic cervical columnar epithelium (CE), cervical intraepithelial neoplasia (CIN) and cervical squamous cell carcinoma (CC), and to analyze the roles of MDSC, Treg and Th17 cells in the development of cervical diseases.Methods This study enrolled 120 HPV-positive patients with cervical diseases (18 cases of CE, 50 cases of CIN, 52 cases of CC), 20 HPV-negative patients with cervical diseases (10 cases of CE and 10 cases of CIN) and 20 healthy subjects from March 2011 to December 2016.Changes in MDSC, Treg and Th17 cells in peripheral blood of all patients were detected by flow cytometry.Results Percentages of MDSC, Treg and Th17 cells in peripheral blood of patients who were positive for HPV were significantly higher than those in HPV-negative patients (P<0.05).Besides, percentages of these cells gradually increased with the exacerbation of cervical disease (CE-CINⅠ-CINⅡ-CINⅢ-CC) (P<0.05).Patients who were infected with high-risk HPV had significantly higher percentages of MDSC, Treg and Th17 cells in peripheral blood than those infected with low-risk HPV (P<0.05).Changes of MDSC, Treg and Th17 cells in peripheral blood of HPV-positive patients with cervical cancer were related to International Federation of Gynecology and Obstetrics (FIGO) stage, tumor differentiation, lymph node metastasis and vascular invasion (P<0.05).MDSC, Treg and Th17 cells in peripheral blood of all patients were significantly reduced after treatment (P<0.05).Patients whose status changed from HPV-positive to HPV-negative following treatment also showed significantly decreased MDSC, Treg and Th17 cells in peripheral blood as compared with those who remained HPV-positive (P<0.05).MDSC, Treg and Th17 cells in peripheral blood of HPV-positive patients with cervical diseases were positively correlated (r=0.599, 0.677, 0.648;P<0.05).Conclusion MDSC, Treg and Th17 cells in peripheral blood of patients with HPV infection are associated with the pathological process, severity and clinical pathological features of cervical diseases as well as therapeutic effects.Therefore, they can be used as biomarkers to detect the occurrence and development of HPV-positive cervical diseases.

[Objective]To evaluate the early-middle stage clinical results of cervical disc hemiation treatment with the Bryan cervical disc prosthesis.[Method]There were 51 patients with cervical disc herniation.There were 16 female and 35 male patients aged between 31 and 57(mean age 43).The herniated disc was located at C3、4 in 8 cases,C4、5 in 4 cases,C5、6 in 31 cases,C6、7 in 2 cases,C4～6 in 2 cases,C3～6 in 2 cases.and C5～7in 2 case.There were 16 patients with myelopathy and 31 with radiculopathy.A total of 57 sets of Bryan cervical disc prosthesis were implanted,with single level disc replaced in 45 cases and bi-level in 6 cases.The Bryan cervical disc prosthesis contained a proprietary,low-fiction,wear-resistant,unique polyurethane nucleus.The nucleus was located in shaped titanium plates(shells) that include convex porous ingrowth surfaces,to allow bony fixation to the adjacent vertebral endplates.The level of stableness and mobility at the implanting location were observed on dynamic radiograph postoperatively.[Result]The average follow-up was 1 year to 4 and half year.There was no prosthesis displacement and loosening in all cases.One patient had a definite spontaneous fusion of treated segment after 4 years of follow-up.Two patient had grade Ⅱ heterotopic ossification(HO).The range of motion(ROM) at implant level was 9.3 degrees on the flexion-extension radiographs.Significant improvement in neurological symptoms were observed in all cases,and radicular pain for patients suffering from raduculopathy was relieved completely.The average improvement was 8.5 points based on CSM criteria.Effective rate was 100%.[Conclusion]Artificial cervical discs prosthesis provides a new effective treatment for cervical disc herniation.Definite stabilization and satisfactory mobility were achieved after the implantation of cervical disc prosthesis.

Objective To evaluate the feasibility of interstitial implantation of ~(125)I seeds for malignant tumor at the Head and Neck. Methods From Oct 2006 to Oct 2008,26 patients received interstitial implantation of ~(125)I seeds in our hospital because of recurrent or metastatic malignant tumors at the head or neck after surgery or chemotherapy. ~(125)I seeds were implanted into the tumor tissues under guidance of CT. Results The operation was completed in all the patients. A median of 23 seeds (12～54) were implanted in each case. No complications, such as hemorrhage, infection, or seed migration, occurred in the patients. The patients were followed up for 3～24 months. During the period,the rate of local control was 54% (15/28) at 3 months,72% (18/25)at 6 months,47% (11/23)at 12 months,and 37% (6/16)at 2 years. Conclusion Interstitial implantation of '2!I seeds is feasible for ecurrent or metastatic tumor at the head or neck with a good short - term outcome.

Objective To study the indications and clinical outcome of the upper cervical spine via the high anterior cervical retropharyngeal approach in treatment of upper cervical spine injuries. Methods There were 41 patients including 32 males and 9 females, at age of 12-67 years. Of all patients, there were 21 patients with Hangman fractures, two with fracture of C2 vertebral body, 12 with irreducible atlantoaxial dislocation secondary to os odontoideum, four with C1,2 tuberculosis and two with C2 gaint cell tumor. All patients underwent the high anterior cervical retropharyngeal approach to expose C1C3. C2,3 fusion followed by self-locking plate was performed for Hangman fractures and C2 fractures. Ventral reduction plud posterior aflantoaxial fusion was done for irreducible atlantoaxial dislocation secondary to os odontoideum. Lesion was cleared for tuberculosis and the tumor was resected and reconstructed. The neurological funcation was evaluated according to the ASIA criteria, the JOA score and Odom' s criteria. Results Successful exposure of arch of atlas to C3 was achived in all 41 patients, with satisfactory reducation, decompression, fusion, lesion resection and reconstruction. The trauma patients with normal neurological function showed no neurological deficit postoperatively, but those with quadriparesis had partial recovery. While the patients with illness obtained marked recovery of neurological function, with the JOA score from preoperative 8.9 to 12.5 at final follow-up. The clinical success rate (excellent/good/fair) reached 94. % according to Odom' s Criteria. Hypoglossal symptom was found in three patients and facial nerve symptom in two, without wound infection. Conclusions Via the high anterior cervical retropharyngeal approach, the upper cervical spine can be thoroughly exposed to facilitate reduction, decompression and reconstruction and maximally restore physiological function of the cervical spine in treatment of the upper cervical spine injuries.

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup.

Objective To explore feasibility and therapeutic effect of posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation in treatment of severe rotational throracolumar fracture and dislocation. Methods From October 2007 to July 2008, nine patients with severe rotational throracolumar fracture and dislocation classified as AO C types under-went decompression by vertebral boby resection, intervertebral bone fusion and transpedicular screw inter-nal fixation via a posterior midline small incision. There were eight males and one female, at age range from 23 to 54 years. All patients involved levels at T_(11)-L_2. According to AO classification, there were three patients with type C1 bursting fractures with rotational dislocation, five with distraction fracture com-bined with rotational dislocation and one with rotational distraction shear fracture/dislocation. The preop-erative Frankel Grading was Grade A in three patients, Grade B in one, Grade C in four and Grade D in one. Postoperative neurological status, the correction and loss of dislocation and the location and union of bone graft were reviewed. Results All patients received successful operation, with operation time of 3.5-5.8 hours (mean 4.4 hours), blood loss of 1 200-3 500 ml (mean 1 800 ml). The follow- up period in nine patients was 3-12 months (mean seven months). Postoperative X-ray photographs showed that the dislocation in all patients was reduced, the spine curvature was recovered to normal and the intervertebral bone graft was well fixed. Three patients at Frankel Grade A had no improvement, one at Grade B was improved to Grade C. Of four patients at Grade C, three patients were improved to Grade D. The follow-up showed bony fusion in all patients, with no loosening, dislocation or breakage of the internal fixation or implants. Conclusions For severe rotational throracolumar fracture and dislocation, decompression, reduction, fusion and fixation are rather difficult, while sufficient posterior decompression by vertebral body resection, rigid interbody bone fusion and transpadicular screw internal fixation can be an effective alternative measure.

Objective To evaluate the accuracy and reliability of O-arm-based thoracolumbar pedicle screw installation.Methods A retrospective review was conducted on 75 patients who had undergone thoracolumbar pedicle screw fixation assisted with O-arm navigation (navigation group,n =32) and C-arm fluoroscopy (fluoroscopy group,n =43) from March to October 2014.All the patients were assessed with X-ray and CT images after operation.Accuracy of screw installation in both groups was compared.In navigation group,screw directions were measured on the sagittal and axial images of intraoperative navigation and post-operative CT scanning to evaluate the concordance.Results In fluoroscopy group,a total of 206 pedicle screws were placed with the one-time success rate of 93.2％ and accuracy of 90.8％ for screw placement,and one misplaced screw (grade llⅢ) led to L3 nerve root symptom.In navigation group,a total of 226 pedicle screws were placed with the one-time success rate of 100％ and accuracy of 96.9％ for screw placement,and no screw was grade Ⅲ.Further,there were no significant differences in screw directions on the sagittal and axial images between intraoperative navigation and postoperative CT scanning (P ＞ 0.05).Conclusion O-arm navigation that provides high-resolution images and high precision improves the accuracy of thoracolumbar pedicle screw installation,and possesses good reliability.

ObjectiveTo retrospectively analyze the treatment of odontoid fractures using percutaneous and open anterior screw fixation,and compare the clinical and radiographic results of the two techniques.MethodsFrom March 2003 to May 2010,115 patients with odontoid fracture were treated with anterior screw fixation,and all patients were followed up.The mean age of the patients was 43.5 years (range,16-71).Forty-seven patients who underwent percutaneous anterior screw fixation were set as the percutaneous fixation group,including 42 cases of type Ⅱ odontoid fracture and 5 of rostral type Ⅲ fracture.Sixtyeight patients who received open anterior screw fixation were set as the open fixation group,composing of 61cases of type Ⅱ odontoid fracture and 7 of rostral type Ⅲ fracture.We compared the operative time,intraoperative blood loss,X-ray exposure time,fracture union and complications between the two groups.Results The average follow-up duration was 37.6 months with a range of 12-70 months.The gender,age,classification of odontoid fractures,time after the injuries and concomitant spinal injuries showed a similar pattern in both groups.The operating time and intra-operative blood loss in percutaneous fixation group were (40.3±9.5)min and (5.6±4.1) ml respectively,and in open fixation group were (62.9±15.3) min and (47.1±28.6) ml respectively,both of them were significantly superior in percutaneous fixation group than in open fixation group (P＜0.05).There was no statistical difference in radiation exposure time,fracture union and incidence of complication between the two groups.ConclusionComparing with open screw fixation,percutaneous anterior screw fixation is a safe and reliable procedure for treatment of type Ⅱ and rostral type Ⅲ odontoid fractures with potential advantages.