[Objective]To discuss the basic principles and methods of surgical protocols in treating multilevel cervical disc herniation.[Method]The surgical protocols patients underwent operation based on patient's changes in radiology.Protocols varied from anterior approach discectomy,partial corpectomy with bone grafting and plate fixing;titanium mesh+plate;titanium mesh+plate in major segment and decompression with trepan+cage in secondary segment;combined anterior and posterior surgical procedure.[Result]Totally 96 cases of cervical spondylosis in different types were observed.After average 32 months of follow-up,an overall excellent and good rate in 90% of the cases was obtained.[Conclusion]To choose the appropriate surgical protocol for different multilevel cervical disc herniaion or degenerative myelopathy patients,every treatment should rely on patient's symptoms and changes in radiology.We must check out which vertebra is major segment or secondary segment,generalized or localized,with or without developmental stenosis of cervical spinal canal.Most patients can achieve satisfied prognosis by anterior approach decompression with bone grafting and plate fixing.Intervertebral bone grafting and plate fixing is preferred to single level degenerative.Anterior decompression with approach discectomy,partial corpectomy with bone grafting and plate fixing is preferred to 2 or 3 level degenerative.Combined anterior and posterior surgical procedure is the best method to treat generalized degenerative or obvious stenosis of cervical spinal canal,and continuous type OPLL.In conclusion,the key to excellent prognosis of cervical spondylosis is choosing the right operation for the right patient.

Objective To observe the therapeutic effect of acupuncture plus blood-letting with three-edged needle for the acute stage of Bell's palsy of wind-heat syndrome in TCM.Methods The 100 patients were randomized into treatment and control groups with 50 in each,and treated with acupuncture plus blood-letting with three-edged needle and only acupuncture respectively.Four courses of treatment were given.The main symptoms,signs and clinical efficacy were observed at 1 week,2 weeks and 1 month after treatment.Results In both groups,the scores of symptoms and signs before and after treatment were remarkably different(P

Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.

BACKGROUND: Consummate innervation plays an important role in bone formation. Nerve injury can impact normal bone metabolism, whereas bone regeneration depends on nerve regeneration in the innervation site to some degrees. Modified implant surface structure or usage of growth factors in local region can promote osseointegretion.OBJECTIVE: To retrospectively analyze effects of nervous system dominance bone metabolism and denervation on bone remodeling, innervated establishment and osseoperception during osseointegration following implantation.METHODS: The first author retrieved Pubmed database (http://www.ncbi.nlm.nih.gov/PubMed) and Wanfang database (http://www.wanfangdata.com.cn) (1990/2008) for publications of effects of nervous system dominance bone metabolism and denervation on bone remodeling, innervated establishment and osseoperception during osseointegration following implantation,with the key words of "bone metabolism, innervation, osseointegrationosseoperception" . Articles of repetitive contents were excluded. A total of 54 literatures were primarily obtained. According to inclusion criteria, 28 literatures were selected for summary.RESULTS AND CONCLUSION: Signals derived from the nervous system exert potent effects on osteoclast and osteoblast function. A ubiquitous innervation of all periosteal surfaces exists and its disruption affects bone remodeling. Several neuropeptides, neurohormones, nerotransmitters and their receptors are detectable in bone, and make it clear that nervous system is involved in bone metabolism and regeneration. Establishment of innervation of soft and hard tissue around implants may play an important role in osseointegration and osseoperception. Further studies will be required to explore the basic of anatomy,neurophysiology and neuropathology, which forms osseoperception.

Objective To investigate the role of Wnt signaling pathway hypofunction mediated by dephosphorylation ofβ-catenin in the impaired wound healing of type 1 diabetic rats. Methods The back skin defect wounds were produced in rats with type 1 diabetes. These rats were divided into control, diabetes, lithium chloride treatment, and epidermal growth factor ( EGF) treatment groups. The situation of back wound healing, the ratio ofβ-catenin positive cells,β-catenin, phosphorylatedβ-catenin, and vascular endothelial growth factor ( VEGF) levels were detected. Results Compared to diabetes group, the wound granulation tissue was more mature, wound healing time was shorter, and healing rate, as well as the ratio ofβ-catenin positive cells, dephosphorylatedβ-catenin, and VEGF levels, were higher in normal group, lithium chloride treatment group, and EGF treatment group ( P<0. 05 or P<0. 01). Conclusion The hypofunction of Wnt signaling pathway is involved in the process of wound healing in type 1 diabetic rats, of which the dephosphorylation ofβ-catenin is the key point. EGF may play a beneficial role in the wound healing of type 1 diabetic rat models via Wnt pathway.

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Objective To study the setting up a model of orthotopic liver transplantation (OLT) in pigs. Methods In pigs, OLT were performed based on the porcine anatomical and physiological features, and the extracorporeal veno venous bypass was established during the anhepatice stage. Results Fourteen pigs(87.5%) of 16 OLT survived after the operation, and the haemodynamics?serum biochemical parameters and core temperature were maintained in the normal value during OLT. Conclusions Extracorporeal venovenous bypass and perfect surgical techniques based on the anatomical and physiological features are the key to successful OLT in pigs.

Objective To investigate the feasibility of using leukocytes that were filtered out by LeukoReduction System ( LRS) to replace conventional human peripheral blood leukocytes in experimental researches and to comparatively analyze the differences between them in vitro biological functions and pheno-types of T cells. Methods Mononuclear cells were isolated from LRS-separated leukocytes and whole blood sample that collected from the same person by using Ficoll. Fluorescence-activated cell sorting ( FACS) was performed to analyze the phenotypes of T cells. CD3+T cells were sorted out by using magnetic beads. The T cells that were collected by using two different ways were incubated with anti-CD3 and anti-CD28 antibodies and IL-2 in vitro for 10 days. Several assays including cell counting, FACS and cytometric beads array ( CBA) were performed to comparatively analyze the differences in biological functions and phenotypes of T cells that were isolated by different methods. Results The phenotypes of T cells isolated from LRS filter and whole blood sample were highly similar at the initial stage. The sorting rate of CD3+T cells form LRS filter reached a high level and met the requirements for experimental researches. No statistically significant differ-ences in cell count, phenotype, expression of costimulatory molecules and cytokine secretion were observed between T cells isolated from LRS filter and whole blood sample. Conclusion This study suggested that the T cells isolated from LRS filter could be used as an alternative to whole blood T cells for fundamental resear-ches since they were similar in cell vitality, phenotype and biological functions. It provided a new way to solve the problem of blood shortage in clinic and scientific research.

Objective To investigate the role and mechanism of B7-H4, a negative costimulatory molecule, in mediating the immunomodulatory effects of mesenchymal stem cells C3H10T1/2 (C3H10) on T cell polarization. Methods The lentiviral vectors that carried the shRNA targeting mouse B7-H4 were transfected into mouse mesenchymal stem cells (C3H10-B7-H4). The cells were co-cultured with PHA-acti-vated mice spleen lymphocytes before and after the transfection. ELISA was performed to detect the concen-trations of cytokines in supernatants of cell culture in order to elucidate the effects of B7-H4 expressed by C3H10 on T cell polarization. A mouse model of experimental allergic encephalitis (EAE) was established. Fifty C57BL/6 mice were divided into five groups including control group, EAE group, C3H10 group (injec-ting EAE mice with C3H10 cells), C3H10-NC group ( injecting EAE mice with C3H10-NC cells) and C3H10-B7-H4 group (injecting EAE mice with C3H10-B7-H4 cells). ELISA was performed to detect the soluble form of IL-2, IL-17, IFN-γ and IL-4 in plasma samples. Results Knocking down the B7-H4 gene with shRNA significantly decreased the expression of B7-H4 on C3H10 cells, which weakened the inhibitory effects of C3H10 cells on the secretion of IL-2, IL-17 and IFN-γ by spleen lymphocytes. The therapeutic effects of C3H10-B7-H4 cells on mice with EAE were weakened after silencing the B7-H4 gene expression, which was manifested as higher nerve function score and earlier onset and bring forwarded peak time of EAE than those of the C3H10 group. Treating EAE mice with C3H10-B7-H4 cells was less efficient in inhibiting the expression of IL-2, IL-17 and IFN-γin plasma. However, knocking down the B7-H4 gene had no signif-icant effect on the expression of IL-4 in terms of treating EAE with C3H10 cells. Conclusion The co-inhib-itor molecule B7-H4 expressed on C3H10 cells mediated the treatment of EAE with C3H10 cells by regula-ting Th1 and Th17 effector T cells.

Objective To investigate the risk factors and establish the Cox's regression model and the personal prognosis index for the recurrence of ischemic stroke in 3-year follow-up.methods 1058 patients were retrospectively reviewed consecutively diagnosed with ischemic stroke admitted to the Neurology Department of the Hebei united University Affiliated Hospital from January 1,2013 to December 31,2013.Cases were followed up since the onset of ischemic stroke.The follow-up was finished in January 1,2016.Kaplan-Meier methods were used for recurrence rate description.Monovariant and multivariate Cox's proportional hazard regression model were used to analyze risk factors associated with recurrence.Thus,a recurrence model was set up.Result sDuring the period of follow-up,184 cases relapsed.The 1-year recurrence rate was 29.9 person-year,2-year recurrence rate was 46.6 person-year,3-year recurrence rate was 52.7 person-year.Monovariant and multivariant Cox's proportional hazard regression model showed that the independent risk factors associated with recurrence were age(X1)(RR=1.303;95%CI:1.019~1.666)history of heart disease(X2)(RR=1.788;95%CI:1.127~2.836),hypertension(X3)(RR=1.897;95%CI:1.097~3.280),diabetes(X4)(RR=1.674;95%CI:1.015~2.760),total cholesterol(X5)(RR=2.136;95%CI:1.396~3.266).The personal prognosis index(PI)of recurrence model was as the following: PI=0.265X1+0.581X2+0.640X3+0.515X4+0.759X5.Conclusion sAge,history of heart disease,hypertension,disease progression,and total cholesterol are the independent risk factors associated with recurrence of ischemic stroke.The recurrence model and the personal prognosis index equation are successful constructed.