Objective To isolate specific humanized anti-D-dimer scFv(single chain Fv) antibody from scFv phage libraries. Methods Isolate anti-D-dimer positive clones from Tomlinson I + J phage libraries by three rounds of panuing, then sequence monoclonal genes by bideoxy-mediated chain termination and express soluble scFv antibody; Pick out anti-D-dimer antibodies with high specificity and affinity by ELISA.Results After three rounds of selection from human scFv phage libraries Tomlinson I and J, 38 monclonal specific anti-D-dimer scFv fragments were selected. By polyclonal and monoclonal phage ELISA and gene sequencing, 20 different full-length monoclonal scFv phages were identified, the result of soluble scFv ELISA showed that 20 full-length monoclonal scFv were expressed smoothly. According to the result of soluble scFv ELISA, in 5 scFv antibodies with high value of A450 selected, 3 scFv antibody fragments showed high specific and affinity. Conclusion Antibody phage display was an effective, rapid method to isolate anti-D-dimer antibodies with high specificity and affinity.

Objective To evaluate the effects of nursing intervention on the beliefs and behavior of early detection of breast cancer. Methods Four communities in Shanghai were selected by convenient sampling process. Then these four communities were randomly assigned to intervention group and control group. One hundred and eighty women who met the criteria of this study were selected from each group by convenient sampling process.Altogether 739 women were recruited. In intervention group,a one-year nursing intervention guided by health belief model was implemented,such as health education seminars,telephone follow in the third,sixth,and ninth months,and flyers of breast health care in the sixth month. Control group only received conventional education. Results After intervention women became aware of breast cancer (B=0.210,P＜0.01),perceived more benefits from attending early breast cancer detection (B=0.105,P＜0.01),and less difficulties in attending the activities of early detection of breast cancer (B=-0.086,P＜0.05). The number of women who performed breast self-examination once per month increased and more women received clinical breast examination (OR=3.0946) and mammogram after intervention (OR=2.746). Conclusion The nursing intervention,guided by health belief model,is helpful to improve women's beliefs and behaviors of breast cancer detection.

Objective To summarize the clinical features and diagnostic flow of cervical spondylosis with proximal upper extremity amyotrophy;and further analyze the clinical effect of cervical anterior decompression and fusion on cervical spondylosis with proximal upper extremity amyotrophy.Methods Twenty-two cases of cervical spondylosis with proximal upper extremity amyotrophy were analyzed retrospectively from June 2006 to December 2013.Seventeen males and 5 females with an average age of (55.73 ± 8.64) years (38 to 68 years) were included.The mean preoperative course of disease was (19.2 ± 21.86) months (1-72 months).Clinical symptoms,imaging findings and electrophysiological findings were analyzed.The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT).The clinical improvement rate was evaluated by the Japanese Orthopedic Association (JOA) score,and the clinical satisfaction was assessed at followed up.Results The muscles involved in patients of cervical spondylosis with proximal upper extremity amyotrophy are mainly the deltoid muscle,biceps and scapula levator muscle.Most cases of imaging findings showed multi-segmental degeneration,of which C4,5,C5,6 segments were most common.Neuroelectrophysiological examination showed that affected muscles experienced obvious denervation and decreased action potential.The average follow-up time was (44.14 ± 20.51) months (14 to 102 months).At the last follow-up,the JOA score (16.29 ±0.59) in 17 cases was higher than preoperative (15.12 ± 0.93),the difference was statistically significant (F=51.814,P=0.000),and the average improvement rate was 73.3％.MMT assessment showed that 19 patients (86.4％) in this group had muscle strength recovery for more than 1 grade at the last follow-up.The average clinical satisfaction was 83.7％.Conclusion The clinical diagnosis of cervical spondylosis with proximal upper extremity amyotrophy requires a combination of clinical symptoms,imaging findings and neurophysiological examination results for comprehensive judgment.Anterior cervical decompression and fusion in the treatment of cervical spondylosis with proximal upper extremity amyotrophy patients can achieve good clinical results.

Objective:To compare the analgesic effects of naborphine and desorine after surgery for supracondylar fracture of humerus in children.Methods:Eighty-seven children with supracondylar fracture of humerus who received surgical treatment in Zhoushan Hospital of Traditional Chinese Medicine between January 2019 and January 2020 were included in this study. They were randomly assigned to receive postoperative analgesia either with dezocine (control group, n = 44) or naborphine (observation group, n = 43). The postoperative agitation score, postanesthetic recovery score, postoperative visual analogue scale score, and adverse reactions were determined between the two groups. Results:The heart rate and mean arterial pressure at the time of extubation were (102 ± 7) beats/min and (83 ± 6) mmHg respectively in the observation group, which were significantly lower than those in the control group [(115 ± 8) beats/min, (92 ± 7) mmHg, t = 6.214, 8.283, P < 0.05]. In the observation group, the postoperative agitation score was (4.45 ± 0.34) points, (5.02 ± 0.38) points, and (3.65 ± 0.39) points, at the time of spontaneous eye opening, at the time of extubation and at 30 minutes after extubation respectively, which were significantly lower than those in the control group [(5.31 ± 0.48) points, (5.75 ± 0.35) points, (4.12 ± 0.37) points, t = 6.392, 7.194, 7.382, all P < 0.05]. At 30 min, 3 h and 6 h after surgery, the visual analogue scale scores in the observation group were significantly lower than those in the control group ( t = 5.345, 6.124, 7.553, P < 0.05). The time to return to spontaneous breathing, the time to spontaneous eye opening and the time to extubation in the observation group were (7.32 ± 4.17) min, (11.65 ± 3.32) min, (12.13 ± 2.41) min, respectively, which were significantly shorter than those in the control group [(10.34 ± 4.15) min, (14.43 ± 3.18) min, (15.16 ± 2.23) min, t = 7.216, 5.382, 7.319, all P < 0.05]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [6.97% (3/43) vs. 27.27% (12/44), χ2 = 6.280, P < 0.05]. Conclusion:Naborphine for analgesia after surgery for supracondylar fracture of humerus in children can effectively reduce the incidence of agitation during the recovery period, enhance postoperative analgesic effect, and lower the incidence of reverse reactions.

Objective To investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males and 4 females,age at initial surgery was 36 to 68 years old,the mean was 52.0±11.0 years old.The secondary surgery was taken,according to the number of involved segments and other factors.Anterior decompression and fusion and internal fixation was taken to patients who segment number ≤2 without severe ossification of posterior longitudinal ligament or ossification of the ligamentum flava; posterior decompression and laminoplasty was conducted in patients whose segment number ≥3,but not accompanied with significant kyphosis,instability and serious ossification of the ligamentum flava; and posterior laminectomy and fusion was performed in patients with significant kyphosis,instability and not suitable for anterior decompression due to technical reasons,as well as patients with serious ossification of the ligamentum flava.Results The average time of occurrence of ASD after the initial surgery was 9.3±4.4 years,and the average age of reoperation was 61.3±12.4 years old.The overall curvature of the cervical spine,surgical segment local curvature after the initial surgical procedure were 12.4°± 10.8 o,1.5o±6.8o,respectively; and the distances between the plate and the upper and lower interyertebral space were:0.9± 1.8 mm,3.8±3.2 mm.The secondary surgeries were taken as follows:9 cases anterior decompression and fusion and internal fixation,3 cases posterior decompression and laminoplasty,and 2 cases posterior laminectomy and fusion.All 14 patients were followed up 30.4± 17.8 months,and the average improvement rate of Japanese Orthopaedic Association scores at the last follow up was 73.9％±9.7％.Conclusion The smaller distance between the plate and neighboring intervertebral space,and poorer local curvature of surgical segments might be the risk factors for ASD after anterior cervicad decompression and fusion.The appropriate secondary surgery was taken after comprehensive analysis of the number of adjacent segments,compression factors,cervical curvature and other factors.

Objective To determine anatomic parameters related to the surgery of lumbar cortical bone trajectory of normal adults and the feasibility of screw application in cortical bone and its specification and dimension.Methods Lumbar 3D image data of 80 adults between 18 and 40 years old (40 for each gender) were randomly selected as subjects of our research.With the help of the imaging software for 3D interactive viewing,the ideal starting point was supposed to be the junction of the center of the superior articular process and 1 mm below the inferior border of the transverse process.The diameter,length,lateral angle to the vertebral horizontal plane,cephalad angle to the vertebral sagittal plane of the trajectory and the horizontal distance from the insertion point to the lateral edge of the vertebral plate were measured.Differences of anatomic parameters for each gender,side and segment were analyzed.Results Differences of anatomic parameters on both sides of each segment had no statistical significance.At the ideal trajectory,the mean screw length was 37.56±2.41 mm at L1,38.72±2.36 mm at L2,39.51 ±2.51 mm at L3,39.78± 2.87 mm at L4 and 38.83±2.74 mm at L5.The mean screw diameters from L1 to L5 were 6.04±1.23 mm,6.17±1.24 mm,7.15±1.22 mm,8.02± 1.41 mm and 8.68± 1.42 mm respectively.However,differences of ideal entry angle of L1 to L5 had no statistical significance.The mean lateral angle from L1 to L5 were 8.46°±2.11°,9.37°±2.84°,9.62°±2.16°,9.53°± 1.98°,9.04°± 1.97°,while the mean cephalad angle to the vertebral sagittal plane from L1 to L5 were 26.49°±4.97°,25.94°±4.56°,26.42°±4.42°,26.29°±3.48°,26.89°±3.69°.The mean distance from the insertion point to the lateral edge of the vertebral plate gradually increased from L1 to L5,which were 1.19±0.75 mm,1.54±1.08 mm,2.01±1.45 mm,3.49±1.52 mm,4.47±1.32 mm respectively.The screw diameters of each segment for men were greater than those for women.Conclusion The common length of screw for lumbar cortical bone trajectory of normal adults might be from 35 mm to 40 mm.The safe upper limits of the screw diameter were 5.5 mm at L1,5.5-6.0 mm at L2,6.5-7.0 mm at L3,7.5 mm at L4 and 8 mm at L5.The average lateral angle of all 5 lumbar segments was 9.20°± 2.11° and the average cephalad angle was about 26.41°±4.22°.

Objective To investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients.Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach.The operation duration, intraoperative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively.Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group [(2.7±0.5)h vs.(1.9±0.3) h, P＜0.05].The average blood loss of the anterior surgical group was less than that of posterior surgical group [(90.0±50.4) ml vs.(160.7±40.5)ml, P＜0.05].The hospitalization time of the anterior surgical group was less than that of posterior surgical group [(10.3±2.5) d vs.(15.7±3.6) d, P＜0.05].Postoperative JOA score of anterior surgical group was higher than that of posterior surgical group 6 months after surgery [(14.7 ±0.8)vs.(13.8±1.2), P＜0.05], while there was no significant difference in JOA score between the two groups up to the last follow-up [(14.8±1.2) vs.(14.7±1.8), P＞0.05].NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up.Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (＜ 3 mm).Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment.When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients.

Objective:To investigate the influence of chemotherapy on the phenotype of secreted protein, acidic and rich in cysteine (SPARC) in gastric cancer (GC). Methods:Immunohistochemistry was used to analyze SPARC expression in 132 GC patients. Among these patients, 54 with preoperative chemotherapy and 78 without preoperative chemotherapy were selected to analyze the effect of chemotherapy on SPARC phenotype by comparing the postoperative specimens of the two cohorts. Results:SPARC expression was higher in GC lesions than in the desmoplastic stroma surrounding the tumor cells and noncancerous tissues. High SPARC expression was related to invasion depth, lymph node metastasis, and TNM staging. SPARC expression was lower in patients with preoperative chemotherapy than in controls ( P<0.05). Gross type, histology, depth of invasion, lymph node metastasis, TNM staging, and SPARC phenotype correlated with the overall survival of the patients with preoperative chemotherapy. Further multivariate analysis suggested that lymph node metastasis, histology, and SPARC phenotype after chemotherapy were independent prognostic indicators of GC. Conclusion:SPARC expression was associated with invasion depth, lymph node metastasis, TNM staging and GC prognosis. Preoperative chemotherapy may change the phenotype of SPARC in GC patients.

Objective To measure the related anatomical parameters of lumbosacral nerve root and adjacent structures by magnetic resonance neurography,and to analyze operative safety of transforaminal lumbar interbody fusion in Chinese people.Methods A total of 12 healthy volunteers,including 6 males and 6 females,underwent magnetic resonance neurography of lumbosacral nerve root using a Siemens 3.0T MRI machine.The Osirix software was used to reconstruct the three-dimensional imaging and measure the following anatomic parameters: 1) the distance between the nerve root and the superior pedicle; 2) the distance between the nerve root and the inferior pedicle; 3) the angle between the nerve root and the sagittal plane; 4) the distance between the superior and inferior nerve roots; 5) the distance between the superior and inferior pedicles.Results L1-L5 nerve roots got a good imaging by magnetic resonance neurography in all 12 volunteers.The distance between the nerve root and the superior pedicle and the angle between the nerve root and the sagittal plane gradually became smaller from L1 to L5.But the variation in the distance between the nerve root and the inferior pedicle and the distance between the superior and inferior pedicles was not obvious.The distance between the nerve root and the inferior pedicles,which was closely related to the operating space of TLIF,ranged from (8.99±0.88) mm to (10.72±1.01) mm for males and from (7.76±0.46) mm to (8.54±0.65) mm for females; it was less than 10 mm in each segments in the majority of subjects,and the data of females was significantly smaller than that of males.No significant differences were found in parameters between the left and right sides in the same segment.Conclusion Based on the above anatomical study and measurement analysis,we believe that there is some harassment to the upper nerve root in TLIF for Chinese patients,and for some patients there is a certain injury risk.

ObjectiveTo evaluate the surgical techniques and 2-year follow-up results of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion (TLIF).MethodsFrom September 2006 to October 2008,54 patients with single-level lumbar degeneration disease were treated by Mast Quadrantassisted modified TLIF.Under the guidance of C-arm,the Mast Quadrant's retractor was placed and the lower articular process of the upper vertebrae and 1/2-2/3 of the lamina,flavum ligament and hyperplastic cohesive part of the lower articular process were removed,the nerve roots and the central canal were decompressed.After cleaning up intervertebral disc space,bone grafting and pedicle screw fixation were achieved.Visual analogue scale(VAS) and Oswestry disability index(ODI) results,as well as the fusion rate at the last follow-up were analyzed.ResultsAll patients were treated by Mast Quadrant-assisted modified TLIF,in which 51 patients were followed up for 2 years.An average operating time was(178.7±63.2) min,and an average blood loss was (224.2±136.5) ml; an average postoperative drainage loss was (117.2±91.4) ml,and an average postoperative stay was(5.8±3.6) d.There were statistic significances between pre- and post-operative ODI and VAS scores,respectively.At last follow-up,51 patients were achieved radiographic fusion without internal fixation failure and other complications.ConclusionMast Quadrant-assisted modified TLIF had a good vision,was relatively safe and easy to be acceptable by surgeons,and which had a good clinical results for the patients with single-level lumbar degenerative disease.