In this study the relation between the extent and type of disc protrusion and the clinical severity of symptoms of low back pain was observed. Our series consisted of 300 consecutive cases of lumbar disc protrusion,with their diagnosis confirmed by intraoperative observation. Preoperative pain severity was assessed using a back pain scale that combined the symptoms of back pain and sciatica. Intraoperaative pathological findings of disc were documented and comparesd with preoperative symptoms and signs. The pathological changes of disc were classified as following four subtypes: bulging disc (85 cases), protruding disc (104 cases), extruded disc (72 cases) and sequestered disc (39 cases). Our results suggest that severity of pain in patients with herniated lumbar disc is related to position of herniation rather than magnitude and exent of herniation. Inflammed intraspinal tissues are significantly associated with low back pain and sciatica.

Objective To explore the outcome of small external fixation devices combined with flap for fracture and dislocation of articulationes interphalangeaes.Methods Twelve cases (13 fingers) with fracture and dislocation of articulationes interphalangeae were treated with small external fixation devices combined with flap.Blood vessel grafting and crossing anastomosis were performed.The area of the flap was 1.0 cm ×1.5 cm -2.5 cm × 3.0 cm.Results Follow-ups lasting from 6 months to 2 years showed that all fingers and flaps were survived postoperatively.Fixation average time of small external fixation was 37 days.Fracture healing was found in all cases with satisfactory effect and with better apperance.Conclusion Small external fixation devices combined with flap was proper for fracture and dislocation of articulationes interphalangeae.

Objective To study the injuries of avulsion and severance of upper extremity caused by flexion and rotation and application of tissues of chest side and back in functional reconstruction of the upper extremity. Methods The primary or fosterage replantations were performed from 2000 July to 2003 September for 6 cases of the injuries of avulsion and severance of upper extremity caused by flexion and rotation. After the operation, the shoulder joint was immobilized at abduction of 90 degrees and elbow joint was fixated at inflexion of 100 degrees. 4 weeks later, the fixation was removed and the regular functional training was started. Results Follow-ups ranging from 3 months to 2 years revealed that all the cases of replantation were successful. After operation, the shoulder joint could abduct 50?～90?, anteflect 50?～70?, extend backwards 20?～30?, and adduct 20?～40?. The elbow joint could flex 100?～140?and extend -20?～0?. 3 months after reconstruction, the muscle strength of elbow flexion recovered to Ⅳ～Ⅴdegrees. Conclusion Application of tissues of chest side and back to repair avulsion and severance of upper extremity stage by stages and layer by layer is an ideal method to resolve the contradiction between wound coverage and functional reconstruction because it can restore both the function and appearance.

Objective To retrospectively analyze the results of unilater al external fixators in the treatment of the distal third fractures of humeral s hafts. Methods From October 1997 to October 2002, 33 patients from 15y-70y (ave rage 31y) with the distal third fractures of humeral shafts were treated with un ilateral external fixators. They included 3 transverses fractures, 1 oblique fra cture, 9 spiral fractures and 20 comminuted fractures. 15 cases were treated wit h open reduction and fixation with external fixators and limited internal fixati on, 10 cases were treated with open reduction and fixation with external fixator s, and 9 cases were treated with closed reduction and fixation with external fix ators. 9 cases with radial nerve injury undewent nerve exploration. External fix ators were removed after bone healing. Duration of follow-up was 8 to 24 m (ave rage 18 m). Results The time of bone healing was 11 to 22 w (average 14 w). At t he latest follow-up, the function of injured radial nerves in 9 preoperative ca ses and 2 postoperative cases and the motion function of elbow were restored to normal. There were only 7 cases of superficial pin site infection which were cur ed with oral antibiotics and pin site care with mild disinfectants. Conclusion U nilateral external fixators can play special roles and have good results in the treatment of the distal third fractures of humeral shafts, combined with open re duction and limited internal fixation.

Objective To investigate the anatomic structure of the Chinese people,develop the procedure of minimally invasive total hip arthroplasty through the anterolateral intermuscular approach and investigate its clinical outcome.Methods Three fresh adult cadavers(6 hips)were used for study of the anatomic construction of the anterolateral intermuscular approach in Chinese people.Sixteen patients were treated with minimally invasive total hip arthroplasty through anterolateral intermuscular approach.The clinical results and operation technique were recorded.Results The anterolateral intermuscular approach was a triangle muscular interval slightly parallel to the femur.The medial-superior angle of the triangle muscular interval consists of the anterior border of gluteus medius and tensor fascia lata muscle with juncture of muscles,where the inferior branch of superior gluteal nerve entered into tensor fascia lata muscle.The average incision length was 8.8 cm(7-10 cm),with mean blood loss of 350 ml(250-550 ml).The patients took out-of-bed activity 3-5 days after operations.During operations,anterior border injury in deep portion of the gluteus medius muscle was observed in seven patients and the injured muscles were trimed or repaired.All patients were followed up for 18-39 months(averaged 27.7 months).Most of the patients had excellent location of the phantoms,except that one acetabulum had a little pitch angle and two acetabulums had a little abduction angle.No complication was observed.The mean Harris scores of hip for all patients was increased from preoperative(39.1±6.7)points to(80.6±11.3)points on six month,(88.7±9.6)points on 12 month and(91.4±13.5)points on 24 months(11 patients).No patient suffered from gluteus medius muscle weakness during the follow-up.ConclusionAnterolateral intermuscular approach has the advantages of simple anatomic construction,small incision,little operative injury,muscle sparing and fast recovery without separate muscle or tendon and is suitable for the Chinese patients.Exact incision and special operative instruments should be emphasized to avoid the increase of acetabular pitch angle and abduction angle.

Objective To introduce treatment of old scaphoid fractures by internal fixation with common screws which have been modified into compression-like ones.Methods Twenty-five patients with old scaphoid fracture were admitted to our department from January,1995 to December,2002.They were 17 cases of delayed union,and eight cases of non-union and pseudoarticulation formation.All the patients were treated with open re- duction anti internal fixation by modified common cortical bone screws,some threads of which bad been erased so that they could act somewhat like compression ones.The modified screws were driven into the reduced scaphoid by simple surgical instruments to fix and compress the fracture ends.Results Nineteen cases were followed up for one to six years (mean,3 years).Fourteen cases of fracture healed,with an average healing time of 7 months.The mean extension-flexion arc of the injured wrists was between 106 degrees and 128 degrees.Three cases failed to heal,and two cases experienced deformed and sunken proximal scaphoid.Conclusions Common cortical bone screws can be easily changed into compression-like ones to treat old scaphoid fractures and result in satisfactory,clinic outcome.In addition,they are easily available,can be inserted through joint facet with limited negative effect on the joint,and play a double role of compression and fixation.

Objective To investigate the status of the rehabilitation service and rehabilitation medical professionals in Tianjin. Methods130 hospitals and Disabled Persons' Federations in Tianjin selected by stratified random cluster sampling were surveyed by questionnaires.Results About 49.2% institutions had carried out the rehabilitation services; there were 842 rehabilitation medical professionals in total, including237 rehabilitation physicians and 3 prosthetic orthopaedic technicians, with a gap of nearly 3000 people; most of them were in loweducation. Conclusion The rehabilitation service should be developed; the quantities and quality of the rehabilitation medical professionalsshould be improved, the classified structure and the service objects are unbalanced.

Objective To explore the effect of motor imagery therapy combined with balance evaluation and training on balance and performance in the activities of daily living (ADL) after an initial stroke.Methods A total of 48 stroke patients were randomly divided into a control group (n =25) and an observation group (n =23).All of the patients in both groups were given routine rehabilitation and balance training.In addition,the patients of the observation group were given motor imagery therapy.Balance and ADL performance were assessed before the training and 2 weeks and 4 weeks after the training began.The subjects' balance was analyzed using the center of the gravity shift index,shift angle,total length of shift trace and envelope area using a balance evaluation system and the balance subscale of the Fugl-Meyer assessment (FM-B).Performance in the activities of daily living was assessed using the modified Barthel index (MBI).Results Before the training there were no significant differences between the two groups in terms of any of the measurements.After 2 weeks and 4 weeks of training,all the measurements in both groups were significantly better than those before training,but the improvement of the observation group was significandy greater than that of the control group (except in terms of the MBI).Conclusion Motor imagery therapy combined with balance training can distinctly improve the balance and activities of daily living of stroke survivors.The combination is worthy of application in the clinic.

OBJECTIVETo investigate the presence of miRNA-144 in the saliva of patients with esophageal cancer and its value for early diagnosis of esophageal cancer.

METHODSSaliva samples were collected form patients with esophageal cancer admitted in the Fourth Affiliated Hospital of Jinan University and the First Affiliated Hospital of Guangzhou Medical College between January, 2011 and May, 2013, with saliva samples from 50 middle-aged healthy volunteers matched for age and gender ratio as the control group. The contents of miRNA-144 in the samples were detected with RT-PCR.

RESULTSThe levels of miRNA-144 in both the whole saliva and saliva supernatant were significantly higher in esophageal cancer group than in the control group (P<0.05). In the whole saliva, the cut-off point of miRNA-144 was ≥100, with a sensitivity of 74.6% and a specificity of 92.0% for esophageal cancer diagnosis (Az=0.865); in saliva supernatant, the cut-off point was ≥20 with a sensitivity of 53.7% and a specificity of 94.0% (Az=0.754), suggesting a moderate diagnostic value of miRNA-144 in whole saliva and saliva supernatant.

CONCLUSIONmiRNA-144 is highly expressed in the saliva of patients with esophageal cancer and can be used as a genetic marker for early diagnosis of esophageal cancer.

Biomarkers, Tumor ; Early Diagnosis ; Esophageal Neoplasms ; diagnosis ; Humans ; MicroRNAs ; analysis ; Middle Aged ; Saliva ; chemistry ; Sensitivity and Specificity

OBJECTIVETo investigate the effect of CD59 gene inhibition mediated by RNA interference on the proliferation and apoptosis of non-small cell lung cancer (NSCLC) GLC-P cells in vitro.

METHODSRecombinant plasmids for RNA interference of CD59 gene were constructed and transfected into GLC-P cells via lipofectamine 2000. The stably transfected cells were examined with real-time RT-PCR, MTT assay and enzyme-linked immunosorbent assay to investigate the changes in cell proliferation and apoptosis.

RESULTSCompared with the control cells, the cells transfected with CD59-siRNA showed significantly decreased expression levels of CD59 mRNA (P<0.05) and significantly inhibited cell proliferation.

CONCLUSIONCD59 gene is highly expressed in NSCLC and RNA interference-mediated CD59 silencing can strongly inhibit the proliferation and induce apoptosis in GLC-P cells, which shed light on a potentially new target for targeted gene therapy of NSCLC.

Apoptosis ; CD59 Antigens ; genetics ; Carcinoma, Non-Small-Cell Lung ; pathology ; Cell Line, Tumor ; Cell Proliferation ; Enzyme-Linked Immunosorbent Assay ; Genetic Therapy ; Humans ; RNA Interference ; RNA, Messenger ; RNA, Small Interfering ; Transfection