With the development of modem tumor diagnostic techniques and therapies, the survival rate of malignant tumor has been remarkably increased. With the increase in survival rate of cancer-beating patients, the chance of tumor metastasis is elevated. Minimally invasive treatment provides a new strategy to the therapy of spinal metastatic carcinoma. Its benefits include smaller surgical wound,, higher efficacy and fewer complications, and thus have a broad application prospects in the field of spinal metastatic tumors. In this article, a general re-view is given on minimally invasive treatments of spinal metastatic carcinoma, as well as the latest progress in the field. It was proposed that the united application of the treatment might be a promising hot spot of tumor therapy.

Poly lactic-co-glycolic acid (PLGA) has been attracting increasing attention in the field of bone tissue engineering because it is a biodegradable polymer with excellent biocompatibility, controllable aperture and porous rate, and a degradation rate which is suitable for bone regeneration, and moreover a suitable carrier for the sustained release of growth factors. This article reviewed the recent research progress in PLGA as a material for controlled drug delivery with emphasis on how to make the scaffold more suitable for the regeneration of the bone and which is the better way to apply sustained release of growth factors embedded in the material in bone tissue engineering. It pointed out that PLGA carrying different growth factors will become the focal point in the field of bone tissue-engineering.

Objective To study the changes of plasma copeptin level in pneumonia patients and to explore the correlation between copeptin and disease severity,outcome as well as stress hyperglycemia.Methods A total of 45 patients with severe pneumonia were included in a prospective observation.The plasma levels of copeptin,CRP and blood glucose were measured after admission,and the APACHE Ⅱ scores were recorded within 24 hours.The patients were given insulin therapy by intravenous micro-dosage pump,and the total doses of insulin were recorded.All the patients with 28-day survival were followed up.Results The plasma levels of copeptin of severe pneumonia patients after admission were positively correlated with APACHE Ⅱ (r =0.481,P =0.001) and blood glucose (r =0.417,P =0.004),and were also correlated with the total insulin doses in patients under insulin therapy (blood glucose ≥ 10.0 mmol/L).The plasma levels of copeptin of the survival group were significanatly higher than the non-survival group,COX regression multivariate analysis showed that copeptin was an independent risk factor of death in severe pneumonia patients (P =0.005,OR =1.022,95％ CI:1.00-1.044),and the area under the ROC curve was 0.740 9 (P =0.006).Conclusion The plasma levels in all patients with copeptin of severe pneumonia after admission is positively correlated with APACHE Ⅱ and stress hyperglycemia,suggesting a useful approach to the judgment of disease severity,outcome and glucose control.

Objective To assess the feasibility of using biodegradable poly (lactic-co-glycolic acid) (PLGA) scaffold with controlled release of rhBMP-2 and its effect on the osteogenic activity of MSCs in vitro. Methods The PLGA scaffolds with rhBMP-2 sustained release system were made by combination of porogen-leaching and freeze-drying. The drug release kinetics was measured by enzyme-linked immunosorbent assay (ELISA) in vitro. MSCs were isolated from the bone marrow of human and cultured for 3 passages. Then, MSCs were seeded onto PLGA scaffolds. PLGA scaffolds without rhBMP-2 were used as experimental controls . Scanning electron microscopy(SEM) was used to observe the morphology of MSCs. The cell proliferation was determined by MTT assay. Results The rhBMP-2 was encapsulated into PLGA scaffolds and it was found to be continuously released from the scaffolds. The scaffolds have evident enhancing effect on ectopia osteogenesis. Conclusion PLGA scaffold containing rhBMP-2 is a new promising tissue engineering scaffold.

Objective Replacement of dexmedetomidine with propofol for maintaining the anes-thesia in elderly patients undergoing laparoscopic cholecystectomy.Methods Ninety patients,over 70 years old,undergoing laparoscopic cholecystectomy were randomly divided into 2 groups,propofol combined with remifentanil (group A),dexmedetomidine combined with remifentanil (group B),45 patients in each group.Group A was not treated with any preoperative medication,while group B was treated with loading dose of 0.5 μg/kg dexmedetomidine intravenously completed within 10 minutes. Induction methods were same in both groups,3 # or 4 # laryngeal mask were inserted after induction in both groups.Maintenance of anesthesia in group A treated with propofol 2.0-3.0 μg/ml + 4.5-5.5 ng/ml TCI;Maintenance of anesthesia in group B treated with dexmedetomidine 0.25 μg·kg-1·h-1 +remifentanil 4.5-5.5 ng/ml (TCI).HR,SBP,DBP,BIS were recorded at inserting the LMA (T1 ), beginning of the surgery (T2 ),dissociate the cholecyst (T3 ),withdrawal of the laparoscope (T4 ), extubate the LMA (T5 ).Postoperative recovery time,Steward awakening score and modified OAA/S score at extubation time were recorded.Results No significant difference was found between BIS val-ue of two groups at different time point.Compared with group A,HR at T1-T5 in group B were sig-nificantly lower,SBP,DBP were significantly decreased (P <0.05).There was no significant differ-ence between Steward awakening score and modified OAA/S score at recovery and extubation time in two groups.Conclusion Dexmedetomidine replacing propofol can be safely used in laparoscopic chole-cystectomy with less hemodynamic changes during maintenance of anesthesia in elderly patients.

Objective:To observe the nutritional status and respiratory function of the patients with mechanical ventilation in Intensive Care Unit after high fat and low carbohydrate enteral nutrition treatment.Methods:271 patients with mechanical ventilation in Intensive Care Unit were randomly divided into two groups:study group and control group.The study group was given high fat and low carbohydrate enteral nutrition treatment,while the control group with Enteral Nutritional Suspension.Thealbumin,prealbumin,blood gas analysis(PaC02,Pa0) and RQ,VC02,V02,IgG,CD4,CD4/CD8 were observed.Results:After nutritional support,nutritional status of two groups were improved,but there was no significant difference regarding the serum albumin and prealbumin.The PaO2,VO2,VCO2,RQ,IgG,CD4,CD4/CD8 and the total time of mechanical ventilation were improved,and the study group was superior to the control group.Conclusion:High fat and low carbohydrate enteral nutrition improves the nutritional status and respiratory function of the patients with mechanical ventilation in Intensive Care Unit,and decreases the total time of mechanical ventilation and total medical expenses.

Objective To compare the clinical results of two different anterior cervical surgical treatment for multi-segmental cervical spondylotic myelopathy (≥3 segments).Methods Twenty-three patients with segmental cervical spondylotic myelopathy,10 cases were treated with anterior cervical discectomy and fusion (ACDF) as ACDF group,13 cases were treated with anterior cervical corpectomy and fusion (ACCF) as ACCF group.The operation time,operative blood loss,JOA scores,neurological improvement rate and the variable of the D value were compared.Results The operation time and operative blood loss in ACDF group was significantly lower than that in ACCF group [(130.0 ±31.5) min vs.(150.0 ±42.5) min,(150.0 ± 120.8) ml vs.(310.0 ± 320.8) ml,P ＜ 0.05].The variable of the D value in ACDF group was significantly higher than that in ACCF group [(3.1 ± 1.4) mm vs.(2.3 ± 0.9) mm,P ＜ 0.05].There was no statistically significant difference in JOA scores,neurological improvement rate between ACDF group and ACCF group.Two cases of cerebrospinal fluid leakage in ACDF group,the oppression and drainage recovery after treatment.One case of 14 d after fistula complications in ACCF group,after patching were cured; 2 cases of titanium mesh shift,follow the fusion.Conclusions Both methods attain good clinical results.ACDF combined with ACCF treatment of multi-segmental cervical spondylotic myelopathy,with shorter operation time,relatively less blood loss,and better restoration of cervical sagittal alignment.

Objective To evaluate the mid-and long-term clinic results of ceramic-on-ceramic joint in total hip arthroplasty (THA) in younger patients.Methods A retrospective review was made on 72 younger patients who had THA with ceramic-on-ceramic bearings due to femoral head necrosis or inborn hip dysplasia between March 2001 and March 2011.There were 32 females and 40 males,at a mean age of (35.2 ± 7.6)years (range,17-45 years).Patients were evaluated with Harris hip score and University of California,Los Angeles (UCLA) activity score.Radiological findings were recorded including component loosening,ostelysis,and ceramic bearing related complications.Results Duration of followup was (8.5 ±2.4) years (range,5-12 months).At the final follow-up,Harris hip score was increased to (93.8 ±4.3)points (range,85-100 points) compared to preoperative (46.1 ± 12.3) points (range,27-70 points) and UCLA activity score was increased to (7.1 ± 1.4)points (range,4-10 points) compared to preoperative (4.0 ± 1.2) points (range,2-6 points) (P ＜ 0.05).At the final follow-up,no osteolysis or prosthesis loosening occurred,but there were ceramic sandwich liner fractures in two patients (two hips),dislocation in one patient (one hip) and squeaking in one patient (one hip).After revision due to the ceramics break,the 8-year survival rate was 97％ (95％ CI91.9-100.0).Conclusion Ceramicon-ceramic joint in THA satisfies the activity demand in younger patients,with excellent mid-and longterm clinical results.

The authors attempted to use information technology in hierarchical management on clinician′s surgical authority. By means of a hierarchical surgery catalogue database, clinicians′ surgical authority is subject to by-level IT-based approval, and such authorities as clinician′s surgical medical advice, application for surgery, and approval of special surgeries are regulated. Thanks to multi-dimensional objective data, clinicians′surgical competence is subject to a dynamic evaluation, hierarchical authorization and reauthorization. These measures further standardize the behavior of the surgeons, and rule out unauthorized operations, thus improving fine management of surgeries and ensuring patient safety.