BACKGROUND: Kinesio taping combined with manual lymphatic drainage for lower limb swelling and pain after total knee arthroplasty (TKA) has not been reported. The existing studies mainly concentrate on the instant effect of kinesio taping, and there is a lack of clinical research on its long-term effectiveness.OBJECTIVE: To observe the curative efficacy of kinesio taping combined with manual lymphatic drainage for lower limb swelling and pain after TKA.METHODS: Sixty patients with lower limb swelling following TKA were randomly divided into control and experimental groups (n=30 per group), followed by treated with kinesio taping, and kinesio taping combined with manual lymphatic drainage, respectively. The swelling degree, visual analogue scale scores and curative efficacy at baseline and 10 days after treatment were compared between two groups.RESULTS AND CONCLUSION: (1) The swelling degree and visual analogue scale scores were significantly decreased in the two groups after treatment (P < 0.05). Compared with the control group, all indicators were significantly improved in the experimental group (P < 0.05). (2) The total effective rate was 80% in the control group and 100% in the experimental group, and the obvious effective rate was 37% in the control group and 63% in the experimental group,both showing significant differences (P < 0.05). (3) These results suggest that the combination of kinesio taping and manual lymphatic drainage can markedly alleviate the low limb swelling and pain after TKA compared with single kinesio taping.

Objective To investigate whether the hyperintensity on T2?weighted MRI affects the outcome of cervical ar?throplasty (CA) for cervical spondylotic myelopathy (CSM). Methods 69 patients with CSM who had undergone CA between June 2005 and December 2007 were retrospectively reviewed. They were divided into three groups according to the intensity of T2?weighted images:Group A, whose intensity of T2?weighted images in spinal cord compression spot was equisignal;Group B, hyper?intensity with obscure border; Group C, hyperintensity with clear border. There were 22 males and 19 females in group A aged from 27 to 63 years old, whose duration of disease was between 3 to 72 months, and there were 34 single?segment cases, 5 double?segment and 2 triple?segment cases. There were 9 males and 9 females in group B aged from 30 to 61 years old whose duration of disease was between 3 to 24 months, and there were 12 single?segment and 6 double?segment cases. There were 4 males and 6 fe?males in group C aged from 28 to 56 years old whose duration of disease was between 1 to 24 months, and there were 8 single?seg?ment and 2 double?segment cases. Two types of artificial cervical disc were used:Bryan Disc in 42 cases and Prodisc?C in 44 cas?es. The duration of Group A (24.7 ± 27.9 months) was significantly longer than that in Group B (6.6 ± 7.4 months) and Group C (11.1±9.5 months). The follow?up period was from 48 to 86 months with an average time of 61 months. The preoperative X?ray and MR as well as postoperative X?ray were collected. The history, compress ratio of MRI, the ROM of cervical segments pre and post?operatively were recorded and Japanese Orthopaedic Association (JOA) was used to evaluate the neurological function. Results Preoperative compress ratio of MRI were 43.3%± 15.2%, 42.4%± 10.7%and 41.9%± 14.8%respectively;preoperative segmental ROM were 9.6°±2.5°, 9.0°±1.7° and 9.1°±1.9° respectively. Preoperative JOA score were 13.6±1.2, 13.1±1.3 and 12.9±1.8, re?spectively. Postoperative JOA score at the latest follow?up were 16.2±1.0, 15.8±1.2 and 15.7±1.6 respectively. There was no statis?tic difference among these groups. Preoperative increased signal intensify on T2?weighted MRI in patients with cervical spondylot?ic myelopathy may not affect the outcome of cervical arthroplasty.

Objective:To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments,with previous open-door expansive laminoplasty,and to evaluate the outcomes.Methods:From May 2006 to July 2012,a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty,who had received the reoperation for cervical myelopathy due to progressing ossi-fication of the posterior longitudinal ligaments.The reoperation was performed based on the clinical mani-festations and segments of responsibility.The anterior approaches were performed in 12 cases,and the posterior approaches in 5 cases.The correlation between the clinical factors and Japanese Orthopedic As-sociation (JOA)scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre-and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test.Results:The mean follow-up was 137.5 months (range 60-348 months).There were no serious complications after surgical procedures.There was one case that had C5 palsy in the first operation and had recovery after one week.Another case had C5 palsy in the reoperation with posterior approach,which had recovery at the end of 6 months post-operation.Three cases had the cerebrospinal fluid leakage of the reoperation,with two cases in the anterior approaches and one case in the posterior approach.There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates.The JOA scores of the patients in the first operation were improved from 9.4 ±4.1 to 12.8 ±2.8 (P<0.01),and the JOA recovery rate was 45.6%.The JOA scores of the reoperation were improved from 10.2 ±2.8 to 12.7 ±2.4 (P<0.05)at the end of 6 months and 14.3 ±1.9 (P<0.01)by the last follow-up.There were significant differences between the JOA recovery rates by the last follow-up (63 .2%)and at the end of 6 months (39 .3%)of the reoperation or 45 .6%of the first opera-tion (P<0.01).Conclusion:The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord,based on the clinical manifestations combined with segments of responsibility of the imaging.

ObjectiveTo prospectively investigate the impact of short-time response on survival of concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small cell lung cancer (NSCLC). Methods From Jan.2003 to Oct.2010,201 patients with pathologically or cytologically proven stage Ⅳ NSCLC were included.All patients received platinum-based chemotherapy.Of the 167 patients eligible for analysis,the median number of chemotherapy were 4 cycles.The median dose for planning target volume (PTV) of thoracic primary tumor was 63 Gy.Response was scored according to WHO criteria. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression model were used to examine the effect of response on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.For the 167 patients eligible for analysis,the CR,PR,NC and PD rate of primary tumor was 5.4％,65.9％,21.0％ and 7.7％,respectively.The effective group ( CR + PR) and ineffective group ( NC + PD) was 71.3％ and 28.7％,respectively.The median survival time (MST) for patients with CR,PR,NC and PD was 22.6,13.4,8.8 and 4.8 months,respectively ( χ2 =44.79,P =0.000).The MST for effective and ineffective group was 13.9 and 7.6 months,respectively in the whole group ( χ2 =8.3 0,P =0.004 ),12.1months and 7.3 months in those treated with 2 - 3 cycles chemotherapy ( χ2 =7.71,P =0.007 ),and 13.9months and 7.9 months in those treated with 2 -5 cycles chemotherapy and radiation dose to PTV ≥36 Gy ( χ2 =4.00,P =0.045 ).No significant MST difference was detected between patients of effective group and ineffective group treated with 4 -5 cycles chemotherapy ( χ2 =0.67,P =0.413),or those treated with 4 -5 cycles of chemotherapy and radiation dose to primary lesion ≥36 Gy (χ2 =0.00,P =0.956).Multivariate analysis showed that 4-5 cycles of chemotherapy and CR and PR achieved in primary tumor (β =0.182,P=0.041 ) were independent favorable factors for survival. Conclusion CCTTRT can improve local control,and prolong the survival time for Stage Ⅳ NSCLC.

Objective To evaluate the importance of three-dimensional radiotherapy for elderly patients of stage Ⅳ non-small cell lung cancer (NSCLC).Methods Comparing with treatment outcome of ≥65 years 67 patients and ＜ 65 years 134 patients using concurrent chemotherapy and thoracic threedimensional radiotherapy during 2003 to 2010 years.Survival analysis was taken by Kaplan-Meier method.The multivariate prognosis was analyzed by Cox model.Results The follow-up was 97.8％.The percentage of ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy were 30％ and 55％,and with 42％ and 49％ patients with radiotherapy ≥63 Gy.The median survival time (MST) were 17 months and 14 months (x2 =0.76,P =0.384) for ≥65 years and ＜ 65 years patients accepted with concurrent 4-5 cycles chemotherapy concurrent ≥63 Gy radiotherapy respectively.The MST and 1-,2-,3year overall survival rate were 17 months and 8 months,65％ and 23％,30％ and 13％,24％ and 9％(x2 =7.90,P =0.005) for whole groups patients treated with chemotherapy concurrent ≥63 Gy and ＜ 63 Gy radiotherapy.And the MST of patients ≥ 63 Gy was significantly longer than those with ＜ 63 Gy either concurrent chemotherapy any cycles (x2 =9.54,P =0.023).The MST were 14 months and 8 months (x2 =1.82,P=0.178),17 months and 17 months (x2 =0.47,P=0.492) for ≥ 65 years and ≥ 63 Gy radiotherapy patients accepted with concurrent 4-5 cycles and 2-3 cycles chemotherapy concurrent respectively.Multivariate analysis showed local response (β =0.600,P =0.003) and numbers of tumor metastasis (β =0.670,P =0.040) were independent factors for survival.Conclusions For a part of elderly patients of stage Ⅳ NSCLC,concurrent chemotherapy and thoracic three-dimensional radiotherapy can prolong survival time with acceptable toxicity.Perhaps radiotherapy is more important.

Objective To analysis the correlation between patient selection and heterotopic ossification (HO) after cervical artificial disc replacement.Methods Data of 48 patients with cervical spondylosis (34 cervical spondylotic myelopathy and 14 nerve-root type) who had undergone Bryan cervicadisc replacement from December 2003 to December 2008 were reviewed retrospectively,and all the patients had been followed up for more than 5 years.There were 21 males and 27 females with an average age of 42 years old (range,20-53 years).There were 38 single level replacement (C3-4 3 cases,C4-5 5 cases,C5-6 28 cases,C6-7 2 cases),9 double level replacement (C4-5,C5 6 4 cases;C5-6,C6-7 5 cases) and 1 three level replacement (C3-4,C4 5,C5-6) as a total of 59 surgical segments.The occurrence of HO was defined by McAfee classification on cervical lateral X-ray.Four factors were used in patient selection including gender,range of motion (ROM) of the target level,alignment of the functional spine unit (FSU) of the index level,and the disc height ratio between surgical level and the adjacent levels.The correlation between these four factors and HO was evaluated by logistic regression.The receiver operating characteristic (ROC) curve and area under the ROC curve were used to evaluate the significant result of logistic regression and the optimal diagnostic value.Results 48 patients were all followed up for an average period of 70.3 months (range,60-120 months).The occurrence rate in this study was 33.9％ (20/59 segments).Only one factor,the disc height ratio of the target level and its adjacent levels,presented statistical correlation with HO.ROC analysis showed that the area under the ROC curve of disc height ratio was 0.813 and the optimal diagnostic threshold was 0.9.Conclusion The disc height ratio of the target level and adjacent levels was the only patient selective factor correlated with the occurrence of HO.For those with disc height loss exceeding 10％ comparing to adjacent levels,it is not indicated for cervical artificial disc replacement with Bryan prosthesis.

Objective To prospectively evaluate the survival of different metastasis organs with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT) for stage Ⅳ non-small cell lung cancer (NSCLC).Methods Two hundred and one patients of stage Ⅳ NSCLC were enrolled from January,2003 to July,2010.Of the 182 patients eligible for analysis,The number of patients with single-organ metastasis or multiple-organ metastasis was 107 and 75,respectively.Patients were treated by platinum-based chemotherapy,the median number of cycle was 4.The median dose to planning target volume of primary tumor (DTPTv) was 63 Gy.Survival was calculated by Kaplan-Meier method and compared using the Logrank.Results The follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years'follow up.Of 182 patients,the 1-,2-,and 3-year overall survival (OS) rate and median survival time (MST) was 41.0％,17.0％,10.0％ and 10.5 months,respectively ;with single-organ metastasis and multi-organ metastasis were 50％,20％,14％ and 13 months and 29％,12％,0％ and 8.5 months ( x2 =10.10,P =0.001 ),respectively; compared with multi-organ metastasis,the 1-,2-,and 3-year OS arte and MST of patients with bone,lung metastasis only was 58％,25％,16％ and 14 months (x2 =10.42,P=0.001 ) and 49％,21％,21％ and 11 months (x2 =6.39,P=0.011 ) respectively;patients with brain metastasis only did not show advantage of survival comparing with patients with multi-organ metastasis (49％,8％,0％ and 12 months and 29％,12％,0％ and 8 months,respectively;x2 =0.71,P =0.401 ) ;the 1-,2-,and 3-year OS rate and MST was 63％,23％,19％ and 15 months and 42％,15％,0％ and 10 months,respectively for patients with single-organ metastasis and multi-organ metastasis patients who accepted 4 - 5 cycles of chemotherapy ( x2 =6.47,P =0.011 ) ; for patients under the same metastasis and 4 - 5 cycles of chemotherapy,no matter whether single-organ or multiple-organ metastases,the 1 -,2-,3-year OS rate and MST of patients with enough radiotherapy on DTPTV ≥63 Gy were better than patients without enough radiotherapy ( DTPTV ＜ 63 Gy ) ( 71％,25 ％,25％ and 16.8 months and 33％,17％,0％ and 10.5 months,respectively;x2 ＝4.73,P =0.030 ;54％,21％,0％ and 14.3 months and 29％,10％,0％ and 7.6 months,respectively,x2 =8.16,P =0.004).The MST of liver metastases was 6 months,there was significantly difference when comparing with non liver matastasis ( x2 =17.21,P =0.000).Conclusions It is very important to treat stage Ⅳ NSCLC with CCTTRT,especially patients with single-organ metastasis.Liver metastases is a unfavorable prognostic factor.

Objective To evaluate the overall survival and safety among patients for stage Ⅳ non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT).Methods From Jan.2003 to July 2010,201 patients with stage Ⅳ NSCLC were included.All patients were treated with CCTTRT.Those patients who received only one cycle chemotherapy were not included in survival analysis,but analysis of toxicity.One hundred and eighty-two patients were eligible for survival analysis.All patients received platinum-based two-drug chemotherapy.The median number of cycles was 4.The median dose to planning target volume of primary tumor ( DTPTV ) was 63 Gy.Treatment-related gastrointestinal and hematological toxicity were scored according to WHO criteria.Radiation-related pneumonitis and esophagitis were evaluated according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTC) version 3.0.Survival was calculated by Kaplan-Meier method and compared using the Logrank.Cox regression model was used to examine the effect of CCTTRT on overall survival.Results The follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up,respectively.Of the 182 patients eligible for survival analysis,further stratified analysis showed that the 1-,2-and 3-year overall survival rate and median survival time (MST) was 54％,20％,13％ and 14.3 months,respectively for patients treated with concurrent 4 -5 cycles chemotherapy and CCTTRT,and 66％,23％,19％ and 16.1 months,respectively for those treated with 4 -5 cycles chemotherapy and DTPTV ≥ 63 Gy.Under similar chemoradiotherapy intensity,the MST of patients with single organ metastasis was significantly longer than that with multiple organ metastases ( 13.0 months versus 8.5 months,x2 =10.10,P =0.001 ).For patients eligible for survival analysis and received 4 - 5 cycles of systemic chemotherapy,MST of patients treated with DTPTV≥63 Gy was significantly longer than those treated with DTPTV ＜63 Gy[14.9 months vs.8.4 months (x2 ＝20.48,P =0.000) and 16.1 months vs.8.8 months ( x2 =11.75,P =0.001 )].For patients with single organ metastasis,MST was 16 months for those treated with DTPTV ≥63 Gy and 9 months for those with DTPTV ＜63 Gy (x2 =10.51,P=0.000) ;for patients with multiple organ metastasis,it was 11 months and 7 months,respectively ( x2 =7.90,P =0.005 ).Multivariate analysis showed that concurrent 4 - 5 cycles chemotherapy and DTPTV ≥63 Gy (β =0.243,P=0.019) and improved KPS (β =1.268,P=0.000) were independent factors for survival.For the whole group,45％ patients had Grade 2 -3 gastrointestinal toxicity,35.0％ grade 3- 4 leukopenia,18％ grade 3- 4 thrombocytopenia.15.0％ grade 3- 4 anemia,9.5％ Grade 2 - 3 radiation pneumonia and 13.4％ radiation esophagitis,respectively.Conclusions For stage Ⅳ NSCLC,CCTTRT can prolong survival time with acceptable toxicity.Radiotherapy to thoracic primary tumor should be under consideration.

Objectives To investigate influencing factors and pattern of posterior shifting of the spinal cord after cervical laminoplasty.Methods Forty three patients with compressive cervical myelopathy,including 32 males and 11 females,aged from 33 to 78 years (average,57.9 years),treated with open-door laminoplasty from C3 to C7 between February 2008 and October 2010,were enrolled in this study.There were 30 cases of cervical spondylotic myelopathy with developmental cervical stenosis and 13 cases of ossification of the posterior longitudinal ligament.Twenty one cases underwent modified open-door laminoplasty using anchor method,and the other 22 cases underwent laminoplasty with preservation of the unilateral muscular ligament complex.According to midsagittal T2-weighted MRI in the neutral position,several parameters indicating shift distance of the spinal cord and dural sac were measured at each level before operation and at 3 months after operation:shift of anterior margin of the spinal cord (SAMSC),shift of posterior margin of the spinal cord (SPMSC),shift of anterior margin of the dural sac (SAMDS) and shift of posterior margin of the dural sac (SPMDS).The line connecting the top of dens and posterior inferior angle of T1 was defined as E line and the length was E.The length of perpendicular line from each base point to E line was Px (x =1-6).The parameter (100×Px/E) was used to represent local curvature at each level,and the curvature index (CI)was used to represent the global curvature of the cervical spine.Then correlation analyses of the parameters above were performed.Results There was no significant change in SAMDS at different level after surgery,however SAMSC,SPMSC and SPMDS changed significantly and synchronously.At the level of C5 and C6,SPMSC was maximum,but not correlated to CI.Actually,SPMSC was correlated to the local curvature and highly correlated to SPMDS at the same level.Conclusion After cervical laminoplasty,posterior shifting of the spinal cord was highly correlated to posterior shifting of the dural sac at the same level,weakly correlated to local curvature and not correlated to the global curvature of the cervical spine.

ObjectiveTo explore the effect of radiation dose on survival for stage Ⅳ non-small cell lung cancer (NSCLC) treated with concurrent chemotherapy and thoracic three-dimensional radiotherapy (CCTTRT).Methods From Jan.2003 to Jul.2010,201 Stage Ⅳ NSCLC patients were enrolled.Nineteen patients who received only one cycle chemotherapy were not included in survival analysis.Of the 182 patients eligible for survival analysis,all patients received platinum-based chemotherapy of two drugs.The median number of cycles was 4.The median dose to planning target volume of primary tumor ( DTPTV )was 63 Gy. Survival was calculated by Kaplan-Meier method and compared using the Logrank. Cox regression models were used to examine the effect of DTPTV on overall survival.ResultsThe follow-up rate of 201 patients was 97.5％.with 201,170 and 134 patients finished ＜ 1,1 -2 and ≥3 years' follow-up.The 1-,2-,3-year overall survival rate and median survival time was 20％,14％,0％ and 7.1 months;27％,10％,3％ and 9.6 months;and 59％,22％,16％ and 14.9 months,respectively for patients treated with DTPTV ＜ 45.0 Gy,45.0 - 62.1 Gy and ≥63.0 Gy,respectively ( χ2 =27.88,P =0.000 ) ;43％,19％,0％and 1 1 months and 2 0 ％,1 1％,5 ％ and 8 months,respectively for those received 2 - 3 cycles of chemotherapy and radiation dose ≥63 Gy and ＜ 63 Gy,respectively (χ2 =2.99,P =0.084) ;66％,23％,19％ and 16 months and 29％,12％,0％ and 8.8 months,respectively for those received 4 - 5 cycles chemotherapy and radiation dose ≥ 63 Gy and ＜ 63 Gy,respectively (χ2=15.87,P=0.000).No significant difference was found for patients received 2 - 3 cycles chemotherapy concurrently with DTP,Tv ≥63 Gy and 4 -5 cycles chemotherapy concurrently with DTPTV ＜63 Gy,respectively (χ2 =1.93,P =0.165).Multivariate analysis showed that 4 -5 cycles chemotherapy concurrently with DTPTv ≥63 Gy ( β =0.243,P =0.019),and improved KPS after treatment ( β =1.268,P =0.000) were independent favorable factors for survival.ConclusionChemotherapy concurrent with CCTTRT can prolong survival time of patients with stage Ⅳ NSCLC,especially for those treated with DTPTV ≥63 Gy.