Objective To compare the effect of conservative and operative treatment for cervical spinal cord injury without fracture and dislocation (CSCIWFD)and to detect mechanism of injury as well as its relationship to outcome.Methods A retrospective review was conducted on 688 patients with CSCIWFD treated from August 1994 to March 2013.There were 155 patients managed conservatively (conservation group) and 533 surgically (operation group).Neurological function improvement was compared between two groups to detect the correlation of patents' age and treatment methods with outcome.Results The patients were followed up for mean 17.9 months (range,3-36 months).Neurological function was estimated using Japanese Orthopedic Association (JOA) score:(1) the recovery rate of patients aged over 40 years in operation group was better than that in conservation group (P ＜0.05) ; (2) the recovery rate in patients aged under 39 years was unsatisfactory in both groups,with insignificant difference between the two groups (P ＞ 0.05).Conclusions Different age of patients with CSCIWFD has different injury mechanism,injury severity and outcome.Surgery provides better results than conservative treatment for patients aged over 40 years,but both results are poor for patients aged under 39 vears.

Objective To differential the biologic characteristics and multiple differentiation potential of mesenchymal stem cells in nucleus pulposus in (NP-MSC) scoliosis patient and patient with degenerative interverthral disc.Methods The human nucleus pulposus-mesenchymal stem cells were isolated and cultured with enzyme digestion from 2 patients of scoliosis and 2 patient with degenerative intervertbral disc separately.Cellular proliferation was detected with MTT assay and trypan blue.The immunophenotype expression of NP-MSC was detected by flow cytometry in scoliosis and degenerative group.The multiple differentiation ability of cells was assessed respectively using alizarin red dye,Oil red O dye and immunohistochemical staining.Results The primary cell morphology of scoliosis NP-MSC was the shape of spindle,while the degenerative NP-MSC was inhomogeneous.However,both of them became spindle shape after passages.The scoliosis NP-MSC was stronger than degenerative one in metabolic activity and proliferation.The percentage of positive antigen expression of CD44,CD105 and CD29 was 97％-100％ in scoliosis NP-MSC group,but 88.7％-97％ in the degenerative group.The expression of mature cell marker CD24 was negative in both groups.Furthermore,the MSC i.isolated from both groups differentiated along the osteogenic,chondrogenic but not adipogenic lineages.Conclusion The scoliosis and degenerative NP contains mesenchymal stem cells.Moreover the scoliosis NP-MSC had stronger ability of cell metabolic activity and proliferation.These cells have multiple differentiation potential with the exception of their adipogenic differentiation ability.

ObjectiveTo discuss the selection of surgical approach,operative methods,and stability of reconstitution of affection of cervicothoracic junction.MethodsFrom January 2001 to February 2009,86cases with affection of cervicothoracic junction were treated surgically.The mean age of patients at the time of surgery was 43.1 years (range,17-70).Fifty-seven patients were treated with anterior approach (fixation with autologous bone grafts was done in 38 patients,Cage fixation in 5,titanium mesh in 14),21 with posterior approach(the fixation of lateral mass screw combined with pedicle screw was used in 12 patients,fixation with pedicle screw in 9),and 8 with anterior combined posterior approach.The neurological function of 53 cases of injury of cervicothoracic junction was assessed by American Spinal Injury Association (ASIA) criteria,and the rest was assessed by Japanese Orthopaedic Association(JOA) criteria; bone arthrodesis and restoring lordosis of cervical spine were assessed by Bohlman radiographic criteria.ResultsSixty-nine cases were followed up for an average of 12.4 months(range,3-45).ASIA score increased from 1.8 preoperatively to 2.3 postoperatively,and JOA score increased from 10.3 preoperatively to 12.8 postoperatively.Bone fusion reached in all patients,and lordosis of the cervical spine of 62 cases was restored.One case with respiratory dysfunction,1 case with cerebrospinal fluid leakage,2 cases with hoarseness,and 1 case with loose lateral mass screw were found after the surgery.ConclusionThe advantages of surgical reconstitution of the cervicothoracic junction included promoting recovery of neurological function,restoring the alignment and lordosis of the cervical spine,decreasing the rate of complication,which were dependent on the suitable surgical indications,surgical approach,and way of surgical reconstitution.The selection of reconstituted methods depends on disease,lesion site,type and degree of injury,experience of doctor,decompression and spinal stabilization synthetically.

Objective To evaluate the safety and efficacy of haploidentical hematopoietic stem cell transplan-tation(haplo-HSCT)treatment in children with hematological diseases.Methods Fifty-nine cases of less than 14 years old children with hematonosis were analyzed retrospectively,who were enrolled in the Aerospace Central Hospital from July 2012 to June 2016.And the evaluation was carried out by analyzing the success rate of implantation,occu-rrence rate of graft versus host disease(GVHD),infection rate and transplant related mortality(TRM),cumulative re-currence rate,overall survival rate(OS)and disease-free survival rate(DFS).Results In total of 59 cases,the 59 engraftments were successfully transplanted,the median time of leukocyte engraftment was 18(8-23)days,the median time of platelet engraftment was 21(11-68)days,the bone marrow was assessed 28 days after transplanta-tion,which showed that 59 patients achieved complete remission(CR)and DNA test confirmed complete donor chime-rism.With a median of follow-up time of 19(5-56)months,the cumulative recurrence rates ofⅠ,Ⅱgrade andⅢ,Ⅳ grade acute GVHD were(38.3 ± 6.3)%(23 cases)and(16.7 ± 4.8)%(10 cases),respectively,the chronic GVHD cumulative recurrence rate was(65.6 ± 7.5)%(30 cases),the cytomegalovirus(CMV)viremia cumulative recurrence rate was(45.1 ± 6.5)%(27 cases),the Epstein-Barr virus(EBV)viremia cumulative recurrence rate was(10.0 ± 3.9)%(6 cases),the viral cystitis cumulative recurrence rate was(20.0 ± 5.5)%(12 cases),the transplant related mortality was(12.8 ± 6.0)%,the 2-year cumulative recurrence rate of CR group was(8.0 ± 5.4)%,and that of non-remission(NR)group was(64.1 ± 11.9)%.The 2-year OS of CR group was(78.9 ± 7.5)%,the 2-year OS of NR group was(32.5 ± 12.9)%,the 2-year DFS of CR group was(79.5 ± 9.8)%,the 2 years DFS of NR group was(27.4 ± 7.9)%.Conclusions Haplo-HSCT is safe and effective in treating children with hematonosis,and haplo-HSCT has high survival rate and low recurrent,especially when transplantation is per-formed in the remission stage.But the prognosis of haplo-HSCT is poor in the refractory and relapsed patients,and to explore the preventing recurrence measures are very urgent.

Objective To explore the safety and efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in refractory or relapsed leukemia patients undergoing total body irradiation and FLAG regimen consisting of fludarabine,cytarabine,granulocyte colony stimulating factor (TBI/FLAG).Methods Forty-seven cases of refractory or relapsed leukemia treated in our hospital between May 2012 and December 2015 were analyzed retrospectively,including 14 cases of acute lymphoblastic leukemia,31 cases of acute myeloid leukemia,2 cases of acute transformation of chronic myelocytic leukemia.All patients did not achieve remission before bone marrow transplantation.The proportion of blast cells was 10％-98％.The TBI/FLAG was the main conditioning regimen.Kaplan-meier curve was used to analyze the cumulative incidence of GVHD,cumulative recurrence rate,overall survival rate (OS) and disease-free survival rate (DFS).Results Of 47 cases,there was only one patient with infection during the preconditioning and the cell engraftment was not successful,and the rest 46 patients were successfully engrafted.The median time of leukocyte engraftment was 17 (11-25) days,and the median time of platelet engraftment was 21 (11-70) days.The cumulative incidence of acute GVHD was (62.3 ± 7.3)％,including 51.1％ and 28.4％ in Ⅱ and Ⅲ-Ⅳ grade respectively.Twenty-four patients suffered chronic GVHD in 44 assessable patients,and the cumulative incidence was (77.1 ± 11.2)％.The bone marrow was assessed 28 days after transplantation,and the results showed that 46 patients achieved complete remission,and DNA test confirmed complete donor chimerism.The median follow-up time was 12 (1-44) months,25 patients survived (53.19％,25/47),and 13 relapsed (27.65％,13/47).The 1-yearOS and DFS was 47.9％ and 45.5％ after transplantation.Conclusion TBI/FLAG-based regimen is safe and effective for refractory or relapsed leukemia,and the major risk still is relapse for refractory or relapsed leukemia patients after transplantation.The method of preventing recurrence needs to be further explored.

Objective: To investigate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of leukemia patients also suffering from central nervous system leukemia (CNSL) . Methods: A total of 48 leukemia patients with central nervous system leukemia admitted to our hospital from May 2012 to December 2017 were retrospectively analyzed. Results: ① Including 22 cases of acute lymphocytic leukemia (ALL) , 21 cases of acute myeloid leukemia (AML) , and 5 cases of chronic myelogenous leukemia (CML) . Before transplantation, 19 patients achieved complete remission (CR) , and the rest 29 ones without remission. ②The conditioning regimen used TBI as the main protocol, and 6 patients were combined with whole brain and total spinal cord radiotherapy, 2 with Cyber knife treatment, and children with modified IDA combined with BUCY. ③All 48 patients were successfully transplanted, the median time for leukocyte engraftment was 14 (10-23) days, the median time for platelet transplant 16 (6-78) days. ④Bone marrow was evaluated 28 days after transplantation, all 48 patients reached CR, and DNA testing confirmed that they were all full donor chimerism. ⑤The median follow-up was 14 (2-69) months. Of them, 28 cases survived, 10 relapsed and the rest 3 had recurrence of CNSL after transplantation. One year after allo-HSCT, the overall survival (OS) of CR and non-CR groups were (77.3±10.0) % and (57.6±9.3) % (P=0.409) , respectively, the disease-free survival rates (DFS) were (71.2±11.0) % and (53.9±9.5) % (P=0.386) , respectively. The 1-year OS rates of ALL and AML groups after transplantation were (54.2±10.7) %, (80.1±8.9) %, respectively (P=0.200) , and DFS rates were (49.2±10.8) %, (75.0±9.7) % (P=0.190) , respectively. Conclusion Allo-HSCT was safe and effective for leukemia patients with CNSL.

Objective To investigate the clinical efficacy of pretreatment regimen containing idarubicin (IDA) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk refractory leukemia. Methods A total of 116 patients with high-risk refractory leukemia who received allo-HSCT treated with 7 types of IDA-containing pretreatment regimes were enrolled in this study. The implantation rate of 116 recipients was summed up. The 2-year overall survival (OS), 2-year disease free survival (DFS), cumulative recurrence rate, recurrent mortality, transplantation related mortality (TRM), cumulative incidence of acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) were statistically analyzed by Kaplan-Meier survival curve. Results All 116 recipients successfully implanted. The median follow-up time was 28 (7-70) months. Among them, 64 recipients survived, the 2-year OS was 55.2%, 2-year DFS was 51.7%, 2-year recurrent mortality was 23.3% and 2-year TRM was 18.1%. Among 116 recipients, 72 cases suffered from aGVHD. The 2-year cumulative incidence rate of aGVHD was 62.1% including 20 cases of grade Ⅲ-Ⅳ aGVHD, the 2-year cumulative incidence rate was 17.2%. Among 116 recipients, 59 cases presented with cGVHD. The 2-year cumulative incidence rate was 55.4%, of which the 2-year cumulative incidence rate of extensive cGVHD was 14.7%. Among 116 recipients, 30 cases recurred with a 2-year cumulative recurrence rate of 25.9%. Conclusions IDA-containingpretreatment regime has high safety and effectiveness, and can be used as an effective pretreatment regime for transplantation preprocessing in patients with high-risk refractory leukemia.

Objective:To assess the value of platelet-to-albumin ratio on overall survival(OS) and cancer specific survival(CSS) in patients with upper urinary tract urothelial carcinoma(UTUC).Methods:169 patients with UTUC in Qilu hospital of Shandong University from January 2006 to December 2013 were included in this study, retrospectively. 107(63.3%) were male and 62(36.7%) were female. Their age ranged from 36 to 87 years old, mean 65 years old. 73(43.2%)were less than 65 years old and 96(56.8%) were more than 65 years old. 38 patients had the history of smoking.15 patients had the history of bladder cancer. The single tumor was found in 159 cases (94.1%). 10 patients(5.9) owned more than one site of tumor. For the ECOG, 159 cases (94.1%) were 0 score and 10 cases(5.9%) were ≥1 score. The mean Platelet count was 217.0×10 9/L, ranging (68.0-772.0)×10 9/L. The average serum albumin was 42.0 g/L, ranging (27.3-52.7)g/L. The mean PAR was 5.40×10 9, ranging(0-17.31)×10 9. 147(87.0%) patients accepted radical nephroureterectomy and 22(13.0%) cases accepted segmental ureterectomy.155 cases(91.7%) used postoperative adjuvant chemoradiation. The patients were divided into two groups as low PAR or high according to the receiver operating curve (ROC)analysis of PAR. And the Kaplan-Meier analysis was used to assess the OS and CSS and test the equivalences of the curves by log-rank tests. Univariate and multivariate survival analyses were carried out using Cox proportional hazards regression model. Results:We set 6.67×10 9 was the optimal cutoff value of PAR. Therefore, the cohort was divided into 2 groups, 133(78.7%) patients had low PAR (<6.67×10 9) and 36 patients had high PAR (≥6.67×10 9). The 3-year OS and 5-year OS of high preoperative PAR group were 50.0% and 46.2%, respectively. And low preoperative PAR group were 77.6% and 66.7%, respectively. In univariate analysis, no difference was found in gender, age, tumor size, history of smoking and LVI. Meanwhile, tumor grade (G 1-2 or G 3), pathological T stage (pT a/T 1 or pT 2-4) and PAR (<6.67×10 9 or ≥6.67×10 9) were significantly associated with OS and CSS. Multivariate analysis with a Cox proportional hazards regression model were performed and showed that PAR was significantly associated with OS and CSS (OS: HR=1.850, 95% CI 1.095-3.127, P=0.022; CSS: HR=2.154, 95% CI 1. 242-3.736, P=0.006). Conclusions:Preoperative PAR is an independent prognostic factor in predicting patient with UTUC. And the platelet and serum albumin level are low cost and easy to obtain. PAR may be expected to become a biological factor to predict the prognostic factor in patients with UTUC.

Spinal cord injury (SCI) is a serious nervous system disease that usually leads to the impairment of the motor, sensory, and autonomic nervous functions of the spinal cord, and it places a heavy burden on families and healthcare systems every year. Due to the complex pathophysiological mechanism of SCI and the poor ability of neurons to regenerate, the current treatment scheme has very limited effects on the recovery of spinal cord function. In addition, due to their unique advantages, exosomes can be used as carriers for cargo transport. In recent years, some studies have confirmed that treatment with mesenchymal stem cells (MSCs) can promote the recovery of SCI nerve function. The therapeutic effect of MSCs is mainly related to exosomes secreted by MSCs, and exosomes may have great potential in SCI therapy. In this review, we summarized the repair mechanism of mesenchymal stem cells-derived exosomes (MSCs-Exos) in SCI treatment and discussed the microRNAs related to SCI treatment based on MSCs-Exos and their mechanism of action, which is helpful to further understand the role of exosomes in SCI.

Spinal cord injury (SCI) is a serious nervous system disease that usually leads to the impairment of the motor, sensory, and autonomic nervous functions of the spinal cord, and it places a heavy burden on families and healthcare systems every year. Due to the complex pathophysiological mechanism of SCI and the poor ability of neurons to regenerate, the current treatment scheme has very limited effects on the recovery of spinal cord function. In addition, due to their unique advantages, exosomes can be used as carriers for cargo transport. In recent years, some studies have confirmed that treatment with mesenchymal stem cells (MSCs) can promote the recovery of SCI nerve function. The therapeutic effect of MSCs is mainly related to exosomes secreted by MSCs, and exosomes may have great potential in SCI therapy. In this review, we summarized the repair mechanism of mesenchymal stem cells-derived exosomes (MSCs-Exos) in SCI treatment and discussed the microRNAs related to SCI treatment based on MSCs-Exos and their mechanism of action, which is helpful to further understand the role of exosomes in SCI.