BACKGROUND: In vivo and in vitro experiments have demonstrated that polyetheretherketone (PEEK) polymer is the best cervical fusion cage material due to its good biocompatibility, elastic modulus similar to human bone, and satisfactory plasticity and hardness.OBJECTIVE: To assess the outcomes of polyetheretherketone (PEEK) cage filled with nano-artificial bone following anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy.METHODS: In total 17 patients with cervical spondylotic myelopathy were collected from the Department of Orthopedics, First Affiliated Hospital of Harbin Medical University between May 2007 and September 2009. There were 12 males and 5 females,averaging 55 (range 42-67) years of age. All patients underwent ACDF using PEEK cage filled with nano-artificial bone. Patients'neurological functions were assessed on the basis of Japanese Orthopaedic Association (JOA) scoring system. The distance between the midpoint of the upper end plate and lower end plate was measured as interboby height. Radiographs with the neck in lateral flexion and extension were obtained to evaluate fusion results.RESULTS AND CONCLUSIONS: Seventeen patients with cervical spondylotic myelopathy participated in the final analysis.Almost all patients had symptomatic improvement. Within postoperative several days, muscle strength of lower limb was increased, and limb was more flexible after surgery than prior to surgery. At 3 months after surgery, JOA scores were significantly increased compared to prior to surgery, the operated segments were stable and disc space height was satisfactory. In addition, no complications were found, and all cases achieved solid fusion, as confirmed by radiographs. These findings suggest that the immediate stability of the operated segments can be obtained by anchoring PEEK cage, and the nano-artificial bone-filled PEEK cage is safe, simple, and with relatively few complications. It is therefore a good choice for patients with cervical spondylotic myelopathy.

Objective To evaluate the optimized simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) plans in cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.MethodsSix patients with cervical esophageal carcinoma were studied.The gross tumor volume (GTV) and clinical target volume (CTV) (including bilateral mid-lower neck and supraclavicular lymph drainage regions,upper mediastinal lymph drainage regions) were delineated on sim-CT images,GTV and CTV were uniformly expanded by 5 mm to create PGTV and PTV.Five fields(5F) ,7F and 9F SIB-IMRT plans were designed.The prescribed doses to PGTV and PTV were 66 Gy and 60 Gy in 30 fractions respectively.The parameters of dose-volume histograms in three groups planning were compared.Results The values of conformity index(CI) of PGTV were 0.56,0.62 and 0.69 (F =6.22,P ＜0.01 ),the V66 with 88.24% ,95.03% and 94.91% ( F = 4.39,P ＜ 0.05 ) and D95 with 6539.67,6601.83 and 6602.00 cGy (F=4.46,P ＜0.05) in 5F,7F and 9F SIB-IMRT plans.The values of CI,V66 and D95 of PTV were 0.80,0.85 and 0.87 (F=11.29,P＜0.01),with 91.64%,94.05% and 95.06% (F=4.10,P＜0.05) and with 5934.00,5987.17 and 6006.33 cGy (F =4.01,P ＜0.05).The values of maximal dose of spinal cord were 4707.17,4497.83 and 4357.00 cGy( F = 11.26 ,P ＜0.011 ) in 5F ,7F and 9F SIB-IMRT plans.The values of all dosimetic parameters about PGTV and PTV were same in 7F and 9F SIB-IMRT plans ( all P ＞ 0.05 ).Conclusion 7F-SIB-IMRT plan is best one scheme for cervical esophageal carcinoma underwent prophylactic lymphatic irradiation.

To explore the experience in teaching of interns in orthopedic,we put emphasis on the knowledge teaching of medical ethics and medical dispute in addition to the teaching of expertise of orthopedic.

Objective To investigate effects of metabotropic glutamate receptor subtype 5 (mGluR5) antagonist MTEP on the nociceptive behavior and the expression of glial fibrillary acidic protein (GFAP) in spinal cord associated with bone cancer pain. Methods C3H/HeNCrlVr 60 male mice were randomly divided into 5 groups: ( 1 ) normal control group: the mice were given food and water ad libitum; ( 2 ) MTEP + Tumor group: the mice were treated by intrathecal gdministration ( once daily on the days 14 ～20 after inoculation of tumor cells)with MTEP (150 nmol); (3) physiological saline + Tumor group:the tumor mice were treated with the same volume of physiological saline; (4) MTEP + Sham group: the sham mice were treated with the same dose of MTEP;(5) physiological saline + Sham group: the sham mice were treated with the same volume of physiological saline.the mice pain behaviors were assessed with the paw withdrawal thermal latency (PWTL) at the corresponding time points, then the mice were killed and the samples of spinal cord were used to real-time PCR and western blot detection of GFAP mRNA and protein expression. Results The basic values of PWTL had no significant differences among all groups (P＜0.05). At day 14 after operation,no significant difference was found in the PWTL value between normal control group and the sham operation group. But in tumor group, the PWTL value was significantly lower than in the normal control group (P＜ 0.05 ). At day 21 after operation,the PWTL and the level of GFAP expression in the spinal cord had no significant differences among normal control group, MTEP + Sham group and physiological saline + Sham group (P ＞ 0.05 ); the PWTL ( (6. 18 ± 1.29 ) s) in physiological saline + Tumor group was significantly lower than in normal control group ( ( 15.91 ± 1.65 )s), physiological saline + Sham group ( ( 16.57 ± 1.86) s) and MTEP + Sham group ( ( 17.05 ± 2.43 ) s) (P ＜ 0.05 ), but the level of GFAP expression was higher than in the above three groups. In MTEP +Tumor group ,the PWTL (9.39 ± 1.94s) was higher than in physiological saline + Tumor group, and the level of GFAP expression was lower than in physiological saline +Tumor group (P ＜ 0.05 ). Conclusion Inhibiting spinal activation of astrocytes may be one of the MTEP anticancer pain mechanisms.

ObjectiveTo investigate the effect of KN93,a CaMKII inhibitor,on the spinal NR2B expression in the bone cancer pain mouse and its underlying mechanism.MethodsThirty-six male C3IL/IIeJ mice were randomly divided into 3 groups:sham group( S,n =8 ),bone cancer pain group( BP,n =8 ) and KN93 group ( K,n=20).The mouse model of bone cancer pain was established by intra-femur inoculation of osteolytie NCTC 2472 cells in BP and K groups.At 14d post operation,mice in K group received intrathecal injection of 60nmol KN93/5μl in 20％ DMSO and mice in BP group and S group received 20％ DMSD 5μl respectively.Eight mice were selected randomly from each group at (1)d before inoculation,at 1 h before administration and at 1,2,4,24h after administration( T0-5 ) to be measured the paw withdrawal threshold(PWT) stimulated by von Frey filaments.Another 3 mice were sacrificed at the corresponding time point and the spinal cord L3 -5 were obtained for determination of NR2B expression by western blot.ResultsPWT was significantly decreased in group BP( (0.50 ± 0.11 ) g) and K( (0.52 ±0.10)g),except for group K at T3(P＞0.05),and NR2B cxpression up-regulated at T2-5 in BP( 1.78± 0.34),K groups ( ( 1.11 ± 0.14),(0.73 ± 0.03 ),( 1.11 ± 0.15 ),( 1.89 ± 0.32 ) ) compared with S group ( ( 1.78 ± 0.31 ) g,(0.33 ± 0.04),P ＜ 0.05 ).Compared with group BP,PWT was increased and NR2B expression down-regulated at T2-4 in group K.In contrast to T1,PWT at T2-4 upgraded in group K(P＜0.05 ),but no significant difference was observed in other groups (P＞ 0.05 ).ConclusionIntrathecal injection of KN93 can attenuate bone cancer pain in mice through inhibiting NR2B with a time-dependent manner and spinal CaMKII-NR2B pathway may participate in the development of bone cancer pain.

Objective To evaluate and analyze the clinical effect of comprehensive rehabilitation therapy after arthroscopic rotator cuff repair using suture-bridge technique for full-thickness rotator cuff tears.Methods Forty-one patients (20 males,21 females; mean age 52.2 years) with full-thickness rotator cuff tears were treated with arthroscopic rotator cuff repair using suture-bridge technique between June 2010 and January 2012 in our hospital.After arthroscopic rotator cuff repair,the patients were randomly assigned to a treatment group (21 patients) or a control group (20 patients).The treatment group received systematic rehabilitation therapy including rehabilitation education,physical modalities treatment and rehabilitative training additionally,while the control group only accepted the routine rehabilitation therapy including stretching and muscle strength training.The outcome was evaluated at 6 months after surgery,by employing visual analogae scale (VAS),the range of motion (ROM) testing of shoulder joint flexion and rotation,the rating scale of University of California at Los Angeles (UCLA),and the shoulder index of American shoulder and elbow surgeons (ASES).Results The mean follow-up period was 15.6 months (8-24 months).Prior to intervention,there was no significant difference in any parameter between the two groups (P ＞ 0.05).Six months later,all scores of assessments changed:in treatment group VAS (1.7 ± 1.5),ROM [flexion (168.3±31.3)°,rotation (47.2±11.2)°],UCLA(30.7 ±4.13) and ASES (85.1 ±15.67); in control group VAS(3.8±2.2),ROM[flexion (121.2 ±53.6)°,rotation (32.9 ±14.9)°],UCLA(18.3 ±4.94) and ASES (36.4 ± 17.70).Significant changes occurred in both groups in all the parameters after treatment when compare to baseline (P ＜ 0.05).Conclusions Comprehensive rehabilitation therapy is an effective approach for improving motor ability of the shoulder in patients after arthroscopic rotator cuff repair with suture-bridge technique for their full-thickness rotator cuff tears.

Objective To investigate the level of CD4+CD25+CD127low regulatory T cells (Tregs) in the peripheral blood of hepatocellular carcinoma (HCC) patients with HBV infection and to explore the relationship between these cells and HBV infection. Methods Peripheral blood mononuclear cells were isolated from 41 HCC patients infected with HBV, 34 HCC patients without HBV infection and 29 healthy persons. These mononuclear cells were labeled with the monoclonal anti-bodies of CD4, CD25 and CD127, and then Tregs level was determined by flow cytometry (FCM). Moreover, the load of HBV DNA in the blood serum of HCC patients with HBV infection was detected by fluorescent quantitative polymerase chain reac-tion (FQ-PCR). Results The percentage of CD4+CD25+CD127low Tregs in CD4+T cells in the HCC patients with HBV infec-tion was higher than that in the HCC patients without HBV infection [(8.24±2.20)%vs (7.06±2.46)%, P＜0.05] and that in the healthy persons [(8.24 ± 2.20)% vs (6.51 ± 1.99)%, P ＜ 0.01]. Furthermore, the percentage of CD4+CD25+CD127low Tregs in CD4+T cells in the HCC patients without HBV infection was higher than that in the healthy persons [(7.06±2.46)%vs (6.51± 1.99)%, P＜0.05]. In addition, the level of CD4+CD25+CD127low Tregs in the HCC patients with HBV infection was gradually increased following the increase of HBV DNA load and there was a positive correlation between the level of CD 4+CD25+CD127low Tregs and the load of HBV DNA (r=0.350,P ＜ 0.05). Conclusion The level of CD4+CD25+CD127low Tregs in HCC patients is increased remarkably and associated with the number of HBV DNA copy, which may be an important mecha-nism of immunologic escape of virus in HCC.

Objective To explore the clinical value of sagittal CT scan in the diagnosis of congenital esophageal atresia and tracheoesophageal fistula(CEA-TEF).Methods Sagittal CT scanning was performed in 1 7 neonates with clinically suspected CEA-TEF preoperatively. Post-processing methods included multiple planar reconstruction(MPR)and volume rendering(VR).The CT manifestations were compared with the surgical findings.Paired-samples t test and Kappa identity analysis were used to analyze the consistency between two esophageal pouches and position of fistula.Results Among 1 7 cases,sagittal CT images clearly showed the distance between two esophageal pouches and position of fistula.Based on Gross classification,2 cases were included in type ⅢA(11.8%),and 15 cases in type ⅢB(88.2%).The results were satisfactory with the surgical findings with 100% accuracy.The distance between two esophageal pouches determined by VR and MPR had no remarkable differences(t=0.991,P>0.05).The position of fistula determined by VR and MPR had high consistency with the surgical findings (Kappa≥0.75).Conclusion Sagittal CT scanning can significantly limit scanning range and reduce the radiation dose as well as improve image quality,and accurately display and assess the distance between two esophageal pouches and position of fistula in CEA-TEF.It has important application value in diagnosing CEA-TEF in neonates.

Objective To explore the effect of invasion and migration of hepatocellular carcinoma (HCC) endothelial cells (TECs) affected by overexpression of microRNA-3178 (miR-3178) through the transfection of miR-3178 mimic.Methods Real-time polymerase chain reaction (Real-time PCR) was used to identify differential expression of miR-3178 in normal hepatic sinusoidal endothelial cells (HSECs) and HCC TECs.Furthermore,HCC TECs were divided into 3 groups:control (CON) group,miRNA-3178 upregulation (Mimics,up-regulation of miR-3178 expression was achieved using miR-3178 mimics transfected into HCC TECs) group and negative control (NC,negative control sequence was transfected into HCC TECs) group.RT-PCR was used to detect expression of miR-3178 in HCC TECs before and after transfection.Transfection efficiency was observed by using an inverted fluorescence microscope.HCC TECs invasionand migration were measured by matrigel invasion and transwell migration assay.EGR3 protein expression of HCC TECs were identified by Western blotting analysis.EGR3 mRNA expression of HCC TECs were identified by RT-PCR analysis.Results The results of RT-PCR showed that miR-3178 was significantly down-regulated in HCC TECs compared to HSECs (P ＜0.05),and expression of miR-3178 was significantly increased after the transcienttransfection (P ＜ 0.05).The transfection efficiency in HCC TECs was morethan 90％.Number of migrated and invaded cells and in miR-3178 group was significantly less than those in other groups.Target gene prediction software showed EGR3 was a possible candidate target.Transfection of miR-3178 mimic significantly decreased the mRNA and protein expression levels of EGR3.Conclusion MiR-3178 was downregulated in HCC TECs and overexpression of miR-3178 can specifically inhibit migration and invasion of HCC TECsin vitro through inhibiting EGR3 expression,thus,miR-3178 might be a critical targeted therapy strategv for HCC.

Objective ToexploretheMRIfeaturesofgrowthhormonedeficiency(GHD)inchildrenwithshortstaturecausedby pituitarylesions,inordertoimprovethediagnosticlevelofthesediseases.Methods MRIandclinicaldataof624patientsofGHD withshortstaturecausedbypituitarylesionswereretrospectivelyanalyzed.Results Inshortstaturecausedbypituitarylesions,there were383caseswithanteriorpituitarydysplasia(61.4%);49casesofpituitarystalkinterruptionsyndrome(PSIS)(7.9%);16cases ofpituitaryhyperplasiaduetoprimaryhypothyroidism (2.6%);41casesofRathkecleftcyst(6.6%);74casesofemptysellasyndrome(11.9%);17 casesofpituitaryinvasionbyLangerhanscellhistiocytosis(2.7%);2casesofsellarregionalarachnoidcyst(0.3%);and42casesof craniopharyngioma(6.7%).MRIshowedtheheightofanteriorpituitarywaslessthannormal,andthelocation,sizeandsignalsof posteriorpituitaryandpituitarystalkwerenormalinanteriorpituitarydysplasia.Noorthinpituitarystalk,anteriorpituitaryhypoplasiawith ectopicposteriorpituitarywereseeninPSIS.Allofthepituitaryhyperplasiawerecausedbyhypothyroidism,inwhich MRIshowed anteriorpituitaryenlargement,upwardapophysis,obvioushomogeneousenhancement,nopituitarystalkinterruptionandabnormal signal,andthepituitaryglandreducinginsizeafterreplacementtherapy.Stalkhypophysialwasthickeningtogetherwithadisappearanceof hyperintenseoftheposteriorlobeofpituitaryglandonT1,andthesizeandsignalsofanteriorpituitarywerenormalinpituitarybeing invadedbyLangerhanscellhistiocytosis.AtrophyofanteriorpituitarywasseeninRathkecleftcyst,emptysellasyndrome,sellarregionalarachnoid cystandcraniopharyngioma.Conclusion MRIcanclearlyshowtheanatomyofpituitaryandsellarregion,whichcanprovideamorphological referencefortheearlydiagnosisanddifferentialdiagnosisofGHDinchildrenwithshortstaturecausedbypituitarylesions,andisof clinicallyimportantfortreatmentandprognosis.