Objective To explore the effectiveness of modified Sundaresans method, including exposure through the incision involving both of the sternoclavicular joint and lower cervical region with sternum retention, in the treatment for upper thoracic spinal tumor. Methods From January 1999 to October 2003, 14 patients, 9 males and 5 females, aged from 26 to 65 years with a mean of 43 years underwent the modified Sundaresans procedure. The anterior cervico-thoracic incision was made, the medial part of clavicle close to the sternoclavicular joint was removed. After the exposure of the tumor, the involved vertebral body and contiguous discs were resected, the spinal cord was decompressed, then followed by implanting part of resected clavicle or titanium mesh with an anterior locking plate system. Neurological status was graded according to Frankel grading system. Results The duration of follow-up ranged from 6 months to 2 years with an average of 10 months. This approach displayed the upper thoracic region clearly for removal of the tumor and internal fixation,in avoiding the neurological injury. All patients had their neurological improvement at different level. According to Frankel grading system, one patient improved from grade A pre-operation to B post-operation, while another patient from B to D. Of 2 cases with grade C before operation, one improved to D and the other to E. Of 4 patients with grade D, 2 improved to E, while the other 2 left unchanged. There were 6 cases keeping the same grade before and after operation. Resection of sternoclavicular joint almost had no effect on the movement of shoulder. The abduction of the shoulder joint in 14 patients from 90?-130?(average, 125?) preoperatively became 80?-120?(average, 110?) postoperatively. Conclusion The modified Sundaresans method for the upper thoracic tumors has many advantages, such as satisfactory outcome, less invasion and no loss of the shoulder function. It is especially indicated to the tumors, where the spinal compression is located anteriorly.

Objective To investigate the correlation between serum HCY (Homocysteine) and carotid artery stenosis,plaque stability in patients with ischemic cerebrovascular disease.Methods 154 patients with ischemic cerebrovascular disease in Tangdu Hospital were enrolled in the study from June to December 2016.The serum levels of HCY were detected.CT angiography (CTA) was uesd for patients with neck vascular scanning.According to the difference of serum HCY level,patients were divided into 80 cases of high HCY group (observation group) and 74 cases of normal HCY group (control group).The degree of carotid artery stenosis,number and stability of plaque were compared between the two groups and the correlation between serum HCY level and degree of carotid artery stenosis and plaque stability were analyzed.Results The total stenosis rate in the observation group was significantly higher than that in the control group,the moderate stenosis rate and severe stenosis rate in the observation group were significantly higher than those in the control group,with the statistically significant differences (x2 =5.594～ 22.506,all P＜0.05).The levels of serum HCY in mild,moderate and severe stenosis group were 13.16 ± 6.73,15.19± 5.93 and 26.13 ±11.18 μmol/L respectively.The levels of H CY in moderate stenosis group and severe stenosis group were significantly higher than that in mild stenosis group,and the levels of HCY in severe stenosis group was significantly higher than that in moderate stenosis group,with the statistically significant differences (t=2.684～ 5.270,all P＜0.01).The rate of carotid plaque in the observation group was significantly higher than that in the control group,and the differences statistically significant (x2 =25.053,P＜0.01).The rate of unstable plaque and mixed plaque in the observation group was significantly higher than that in the control group,and the rate of stable plaque was significantly lower than that in the control group (x2 =4.067～ 14.95,all P＜0.05).The levels of serum HCY in stable plaque group,mixed plaque group and unstable plaque group were 16.14±5.49,21.91 ± 6.32 and 26.74 ± 10.59 μmol/L respectively.The levels of HCY in mixed plaque group and unstable plaque group were significantly higher than that in stable plaque group,and the differences were statistically significant (t=4.370,4.628,all P＜0.01).The level of HCY in unstable plaque group was significantly higher than that in mixed plaque group,and the difference was statistically significant (t =2.249,P＜ 0.05).Conclusion Serum HCY levels were closely related to carotid artery stenosis and plaque stability.Hyperhomocysteinemia can increase the incidence and degree of carotid artery stenosis as well as the number of carotid plaques and unstable plaques.

Objective To investigate the relationship between serum homocysteine (HCY)levels and oxidative stress in pa-tients with coronary heart disease (CHD).Methods According to the diagnostic criteria of CHD in 2010 (WS 319-2010)is-sued by the Ministry of Health,79 patients with CHD in Xi’an Central Hospital from June 2014 to December 2014 were se-lected as the experimental group,and 5 5 cases of healthy physical examination for the same period were selected as the nor-mal control group.The levels of oxidative stress marker malondialdehyde (MDA)and the activity of antioxidant enzyme su-peroxide dismutase (SOD)in serum were detected to analyze the state of oxidative stress.The levels of serum HCY were de-tected,and the correlation between HCY levels and MDA levels and SOD activity was analyzed.Results The levels of MDA in the CHD group were significantly higher than that in the control group,while SOD activity was significantly lower than that in the control group,the differences were statistically significant (t=3.112,2.684,all P<0.05).The levels of HCY in the CHD group were significantly higher than that in the control group,the difference was statistically significant (t=3.268,P<0.05).In the CHD group,the levels of HCY were positively correlated with the levels of MDA (r=0.236,P<0.05),and negatively correlated with SOD activity (r=-0.221,P<0.05).Conclusion Serum HCY levels were increased and oxidative stress reaction was enhanced in patients with CHD.Oxidative stress was associated with elevated serum HCY levels.Serum HCY levels and oxidative stress played an important role in the occurrence and development of CHD.

Object To study the augmentation of the T activated killer (T AK) cell proliferating and tumor killing activities of the polysaccharide fraction from Rhodiola kirilowii (Regel) Regel, Lycium barbarum L., Hedysarum polybotrys Hand. Mazz., Glehnia littoralis F. Schmidt ex Miq., Rehmannia glutinosa (Gaert.) Libosch. ex Fisch. et Mey. and Aloe barbadensis Mill. in vitro. Methods The T AK cells were induced by anti CD 3 antibody (CD 3McAb) and rIL 2 from human peripheral blood mononuclear cells (PBMC). The effects of the above six plant polysaccharides (1～100 ?g/mL) on the proliferation of T AK cell, the cytotoxicity to Raji cells and L 1210 cells, and the IL 2 receptor (IL 2R) expression in T AK cells were determined. Results The six polysaccharides alone had no obvious effect on the proliferation of T AK cells. In the presence of rIL 2 and CD 3McAb, they could reinforce the proliferation of T AK cells and its tumor killing activities against Raji cells and L 1210 cells at a different extent, and a 21%～68% increase of IL 2R expression in T AK cells was observed. Conclusion The plant polysaccharides significantly enhance the proliferation and the tumoricidal activities of T AK cells and the enhancing actions related to the increase of IL 2R expression.

Objective To investigate the correlation between HCY (Homocysteine),folate,vitamin B12 and head and neck vascular stenosis in patients with ischemic cerebrovascular disease.Methods 225 patients with ischemic cerebrovascular disease in Tangdu Hospital of the Fourth Military Medical University were enrolled in the study from April 2016 to October 2016.The serum levels of HCY,folate and vitamin B12 were detected.CT angiography (CTA) was uesd for patients with head and neck vascular scanning.According to whether the presence of vascular stenosis,patients were classified as no vessel stenosis group and vascular stenosis group.According to the degree of stenosis,patients were classified as no vascular stenosis group,mild moderate stenosis group and severe stenosis group.Results The HCY levels in the vascular stenosis group were significantly higher than no vessel stenosis group,while the levels of folate and vitamin B12 were significantly lower than no vessel stenosis group,the differences were statistically significant (t=9.656,7.140 and 8.350,all P＜0,01).The HCY levels in mild moderate stenosis group and severe stenosis group were significantly higher than no vessel stenosis group,and the HCY levels in severe stenosis group were significantly higher than mild moderate stenosis group,the differences were statistically significant (t=6.108,9.401 and 5.273,all P＜0.01).The folate levels in mild moderate stenosis group and severe stenosis group were significantly lower than no stenosis group,the differences were statistically significant (t=5.574 and 5.988,all P＜0.01).The vitamin B12 levels in mild moderate stenosis group and severe stenosis group were significantly lower than no stenosis group,the differences were statistically significant (t=4.548 and 7.816,all P＜0.01).The degree of head and neck vascular stenosis and serum levels of HCY were positively correlated (r=0.331,P＜0.01).The degree of head and neck vascular stenosis and levels of vitamin B12 were negatively correlated (r=-0.279,P＜0.05).Conclusion The levels of HCY,folate and vitamin tB12 were closely related to the degree of head and neck vascular stenosis.HCY,folate,vitamin B12 and head and neck CTA play important roles in patients with ischemic cerebrovascular disease clinically.

Objective To evaluate neurofunctional and radiographic results of transpedicular screw fixation reduction and anterior column fixation with use of screw-red system in treatment of multiple segment lumbar pedicle and vertebral body fractures combined with spondylolisthesis. Methods A consecutive series of 12 patients with unstable multiple segment lumbar pedicle fracture, vertebral body fracture, spondylolisthesis and neurologic deficit were managed with posterior transpedicular screw fixation including fractured pedicle and anterior screw-rod fixation instrumentation from January 2002 to December 2007. Results Patients were followed up for 24-30 months (mean 26 months). All the patients with incomplete neurologic deficits got improvement by at least one Frankel grade. Transpedicular screw brought satisfactory reduction. At the time of the latest follow-up, no screw breakage occurred. Con-clusions Excellent reduction of unstable multiple segment lumbar pedicle fractures combined with spon-dylolisthesis can attain better reduction and maintenance by means of selective pedicle screw fixation via fractured pedicle and anterior screw-rod instrument.

BACKGROUND:At present,using membrane materials to separate spinal dura mater and scar tissue or using semiliquid materials to surround the dimension of operation are very common after laminectomy.However,therapeutic eflfects ale not satisfactory.Inhibition to the proliferation of fibroblasts,which are the main components of repairing cells,and regulating collagen metabolism have become a hot spot for preventing and treating pathological scar by a biological method.OBJECTIVE:To compare the therapeutic effects of topical application of different concentrations of mitomycin C (MMC)on preventing pefidural adhesion in rats after laminectomy by a qualitative and quantitative combined method.DESIGN:A completely randomized grouping.controlled animal experiment.SETTING:Department of Orthopaedics,Second People's Hospital of Lianyungang City.MATERIALS:Forty healthy adult male SD rats,weighing 200-220 g,were provided by the Animal Experimental Center,Nanjing Medical University.MMC was produced in Union Fermentation Co.,Ltd(Batch No.425ACI,Import drugs registration No.H20020163,Japan).METHODS:The study was performed at the Animal Laboratory Center,Nanjing Medical University,and the Basic Experimental Center,Medical College,Jiangsu University from June 2004 to October 2006.The 40 SD rats were ralndomly divided into 4 groups with 10 rats in each group:MMC high-,medium-,and low-concentration groups,and a control group.After anesthesia,each rat was removal of L1 vertebral plate.A defect(0.2 cm×0.5 cm)was created to expose duml mater.After hemostasia,cotton Pads soaked either with various concentrations ofMMC(0.1,0.05,0.01 g/L)or saline were covered on the laminectomy defects in the three MMC-treated groups and the control group for 5 minutes respeetively.The protocol was carried out in accordance with ethical guidelines for the use and care of animals.MAIN OUTCOME MEASURES:After the operation,4 rats were randomly selected from all anesthetized rats in each group,separately.The peridural scar tissue in the laminectomy segment was cut for calculating the contents of hydroxyproline.Spine columns in the laminectomy segment including Surrounding muscle tissue were resected for measuring irregular sear transverse area and counting the number 0ffibroblasts.The degree of peridural scar adhesion was evaluated by the light microscope.RESULTS:Forty rats were included in the final analysis.In the control group,peridural scar tissue was dense and closely adhered to dura mater.In the MMC high-concentration group.no noticeable peridural adhesion was found.and contents of hydroxyproline,collagen tissue area and the amount of fibroblasts in the scartissue were significantly reduced compared to control group(all P＜0.05).In the MMC medium-and low-concentration groups,contents of hydroxyproline,collagen tissue area and the amount of fibroblasts had reduced to different extents compared to control group.There was significant difference only in the amount of fibroblasts between the MMC mediumconcentration group and the control group(P＜0.05).Incontinuous adhesion between scar tissue and dura mater was found in the MMC medium-and low-concentration groups.CONCLUSION:Topical application of 0.1 g/L MMC can effectively reduce peridural scar tissue hyperplasia and avoid peridural scartissue adhesion afterlaminectomy.

Objective To investigate the relationship between manganese superoxide dismutase (Mn-SOD)9 Ala/Val genetic polymorphisms and the levels of blood lipid and homocysteine (HCY).Methods The genotypes of Mn-SOD 9 Ala/Val ge-netic polymorphisms were identified by sequencing method,the serum activities of T-SOD and Mn-SOD were detected by colorimetric method,the serum level of HCY was detected by enzymatic method,and the serum levels of cholesterol (TC), triglyceride (TG),high density lipoprotein cholesterol (HDL-C)and low density lipoprotein cholesterol (LDL-C)were de-tected by end-point method in 137 patients with coronary heart disease (CHD)and 85 controls.Results Compared with the control group,the VV genotype and V allele of Mn-SOD 9 Ala/Val genetic polymorphisms in the CHD group were higher, while the serum activities of T-SOD and Mn-SOD in the CHD group was significantly lower.The serum activities of T-SOD and Mn-SOD of the Mn-SOD 9 VV genotype was significantly lower than the Mn-SOD 9 AA genotype.Compared with the Mn-SOD 9 AA genotype,the serum levels of TC,TG,LDL-C and HCY of the Mn-SOD 9 VV genotype were significantly higher,while the serum level of HDL-C was significantly lower.The serum activity of Mn-SOD was negativelycorrelated with the serum levels of TC,TG,LDL-C and HCY and positively correlated with the serum level of HDL-C.Conclusion The antioxidative ability in patients with CHD was decreased.Mn-SOD 9 Ala/Val genetic polymorphisms led to lipid metab-olism disorders by affecting the Mn-SOD activity,promoting the development of CHD.HCY resulted in increased oxidative substances by self-oxidation and inhibition of the Mn-SOD activity,increasing the risk of CHD.

Objective:To study the relationship between dynamic Hoffmann's sign(DHS) and the early diagnosis of cervical spondylotic myelopathy. Methods:Patients with neck, shoulder and back pain (218 cases) were employed in this investigation. Among them, 96 cases had positive reaction to DHS test and they received 3 7 years follow up as study group. The other 122 cases negative to DHS test were taken as control group. The clinical data included the patient's symptoms and signs, sagittal diameter of cervical spinal canal, Pavlov rate, angular displacement and horizontal displacement between cervical vertebral, etc . Results:There were 72 cases in study group developed cervical spondylotic myelopathy and needed operation during follow up. Meanwhile, 11 cases in control group received surgical treatment. The incidence of stenosis of cervical spinal canal, herniation of cervical intervertebral disc and instability of cervical spine in DHS group were significantly higher than that of the control group. Conclusion:DHS is closely related to the onset of cervical spondylotic myelopathy. The patients should be followed up closely if they present positive reaction to DHS, and should be operated on early when their neurological symptom is progressing.

Objective To observe the changes of the peripheral blood T lymphocyte subsets following acute spinal cord injury and investigate the possible mechanism of these changes. Methods The SCI models of rats were made by Allen's method. Forty SD rats were divided into four groups, ie,normal control group, sham operation group, 100 g·cm group and 200 g·cm group. The expressions of CD4 and CD8 subsets of the peripheral blood T lymphocyte of the injured rats were determined by immunofluorescence labelling and flow cytometry at different times after injury. Results It was found that the expression of CD4 was significantly reduced to (30.40±4.76)% in 100 g·cm group and to (26.54± 9.34) % in 200 g·cm group, which were significantly lower than that of normal control group ( P ＜0.01 ). At 36 hours after injury, the ratio of CD4/CD8 was significantly reduced to 1.81 ± 0.55 in 100 g·cm group and and 1.29 ± 0.50 in 200 g·cm group, with statistical difference (P ＜ 0.05).Conclusions The immunoreaction is significantly depressed at the early stage of acute spinal cord injury. The severer injury results in more significant decrease of CD4 and ratio of CD4/CD8. The changes of CD4 and CD4/CD8 ratio can be used to indicate the severity of spinal cord injury.