Hedgehog( Hh)signaling pathway is evolutionarily conserved in vertebrates,its excessive activation is associated with abnormal cell differentiation, over proliferation, apoptosis resistance and promotion of invasion and metastasis of tumor cells. Hh signaling pathway involves in the formation and maintenance of esophageal columnar epithelium in embryonic stage,however,undetectable or barely expressed in matured esophageal squamous epithelium. Studies have shown that esophageal Hh signaling pathway can be activated by gastric acid and bile salts. Aberrant activation of Hh signaling pathway can cause the gradual transition of squamous epithelium to columnar epithelium and intestinal-type epithelium,ultimately induces the occurrence of Barrett’s esophagus( BE). Therefore,targeted inhibiting the Hh signaling pathway may be a new strategy for the treatment of BE. This article reviewed the advances in study on Hh signaling pathway in the pathogenesis of BE.

[Objective]To study and evaluate the result of the surgical treatment for arthroscopic reconstruction of anterior cruciate ligament(ACL) with double-bundle semitendinosus.[Method]Thirty-one cases who underwent surgical treatment of arthroscopic reconstruction of ACL with double-bundle semitendinosus during 1990～1998 were analyzed retrospectively.The mean follow up time was 127.36 months(98～168 months).Among them,11 case was simplicity ACL injury,15 cases associated with medial meniscus injury,8 cases combined with lateral meniscus injury,6 cases combined with medial collateral ligament injury,2 case combined with lateral collateral ligament injury.All the patients with medial collateral ligament injury were associated with medial meniscus injury.The analysis was performed on the symptom,physical sign,Lysholm score system and IKDC score pre and postoperation recently.[Result]All the patients had good clinical results with no click,locking,"give way",extra-extension pain,and floating patella test were negative.There were no other complications correlated with semitendinosus grafting.But mild pain were seen in 11 cases,Lachman test were positive in 3 cases,anterior drawer test were positive in 8 cases without complications of instability.The Lysholm score:preoperation was 49.62?8.22 and 76.60?7.68 in follow-up time(P

[Objective]To treat stenosing tenosynovitis by a kind of mini-invasion operation with endscopy assisted,and to observe the clinical results,and to discuss the problem of open and percutaneous A1 pulley release.[Method]Eleven cases,suffering from stenosing tenosynovitis,were treated by the technique of mini-invasion operation with endscopy assisted with a kind of special release knife.The clinical results was investigated and the operative methods was investigated.[Result]All of the patients showed relieving of symptoms of disfunction and trigger finger.There was no serious complication,such as injury of nerves,infection,wound ununion and hand disability.None recurrent case in the follow-up period of 6 to 36 months.[Conclusion]The method of miniinvasion surgical treatment of stenosing tenosynovitis by endscopical technique assisted is safe,effective and low-cost with few complications,which fit for treating stenosing tenosynovitis,specially for those patients with cortisone injection,diabetes and thumb stenosing tenosynovitis.

Objective To discuss the design of arthroscopic reconstruction of posterior cruciate ligament (PCL) with quadriceps tendon fixed by a patellar block and an allograft bone plug, and its clinical outcome. Methods Thirteen patients suffering from PCL injury were treated by the technique mentioned above. The connection between quadriceps tendon and superior patellar pole was preserved in the harvest process of quadriceps tendon. The femoral tunnel was made like a bottle neck, which was clogged with the patellar bone block. The quadriceps tendon strip was fixed by an allograft bone plug pressed into the tibial tunnel. Their functional recovery was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee) criteria. Results In the average follow-up period of 19 months, there were not any severe nerve or blood vessel lesions, or failures of transplanted ligament None of the patient complained of knee instability after the operation. The pain was relieved in most patients, but three complained of pain after knee movement A little calcification was found in the quadriceps tendon at the superior patellar pole one year after the operation in the X-ray of a patient There was significant difference in Lysholm scale between pre-operation and post-operation (P

Objective To investigate clinical results of the treatment of posterior shoulder instability in a combined way of bone block procedure and posterior capsulorrhaphy. Methods The double contrast CT arthrography was performed for 5 patients suffering from posterior shoulder instability so as to detect the pathology. The treatments combining bone block procedure and posterior capsulorrhaphy were carried out according to the pathological conditions of bone and soft tissue. Results The double contrast CT arthrography showed posterior bone defects, posterior glenoid labrum tear and enlargement of posterior capsular cavity. After the bone block procedure and posterior capsulorrhaphy, no patients complained shoulder instability in the follow-up of 5 to 38 months. Conclusions Many pathological factors may induce posterior shoulder instability, which should be corrected by an appropriate operation rather than a “standard”method of operation. For patients involving several pathological factors, a combined operation may be needed in order to correct various pathological changes.

Objective To analyze the characteristics, surgical timing and treatment of middle super thoracic fractures. Methods 35 cases of middle super thoracic fractures (T1 10) were retrospectively reviewed. Among them, 25 cases were complete injury of the spinal cord and 10 cases were neurologically incomplete injury. The bleeding in operations at different times, the ASIA grades and the sensorimotor scores were analyzed. Results The follow up showed that the ASIA grade increased by 1 to 2 degrees in 10 cases of incomplete spinal cord injury, while in complete spinal cord injury the ASIA grades hardly increased but the sense and motion scores could be improved by about 20. Conclusions Middle super thoracic fractures often involve multi vertebra body, and the spinal cord is injured severely. Decompression, fusion, internal fixation from posterior approach can obtain a satisfactory result. Neurologically incomplete injury should be treated as soon as possible, while complete injury of the spinal cord should be treated around 2 weeks after the injury.

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 report a familial dentinogenesis imperfecta type Ⅱ (DGI type Ⅱ) with a novel splicing mutation in DSPP (dentin sialophosphoprotein) gene.Methods Based on the result of linkage analysis performed previously to map the candidate gene DSPP in the family, the promoter,the first four exons and exon-intron boundaries of DSPP were directly sequenced for the members of the DGI type Ⅱ family. Denaturing high performance liquid chromatography (DHPLC) analysis was performed to confirm the results of sequencing.Results A novel splicing mutation of 23 bp deletion in intron 2 of DSPP gene was identified by DNA sequence analysis. The mutation changed acceptor site sequence from CAG to AAG, and might result in functional abolition of possible branch point site in intron 2. DHPLC result was consistent with that of sequencing. The mutation may be identified in all affected individuals, but not found in normal members of the family and 50 controls.Conclusion These results suggest the deleted mutation of DSPP gene causes DGI type Ⅱ in the family. The mutation has not been reported before.

Posttraumatic stress disorder (PTSD), the most common mental illness after patients suffer physically or emotionally from traumatic events, can cause persistently strong, painful and terrible avoidance symptoms, emotional and cognitive changes, causing psychologically strong stimulation and heavy burden to patients and even leading to some extreme behavioral reactions. Traumatic brain injury (TBI) is an important factor in the occurrence of PTSD, both of which shares many similar pathological overlaps, and may coexist and interact with each other. The hippocampus and amygdala play a central role in the pathogenesis of PTSD, but the specific cellular and molecular and neural circuit mechanisms are still unclear. About two-thirds of the patients still meet the diagnostic criteria for PTSD after psychotherapy. However, the current treatment methods are complicated and not unified, and patients treated with medications may have adverse drug reactions, poor treatment outcomes and recurrence. Therefore, it is of great significance to further clarify the occurrence and development of PTSD in TBI patients. The authors reviewed the research progress of the pathogenesis and treatment of PTSD in TBI patients, so as to provide reference for the related research and treatment of PTSD in TBI patients.

Craniocerebral injury with seawater immersion is a special kind of compound injury, with low temperature, high permeability, high alkali, high salt content, and bacterial infection being the main causes. The injury is also characterized with complex damage mechanisms, difficulty to treat, and poor prognosis. At present, the damage mechanisms of craniocerebral injury with seawater immersion are mainly studied by establishing the experimental animal models at the levels of tissue, cell, organelle, molecule, etc. However, the craniocerebral injury with seawater immersion is more complex than the simple onshore craniocerebral injury, therefore, a stable disease model is not easy to construct. Most researches on the specific injury mechanisms are relatively single and one-sided, with many different views in existence, and the damage mechanisms of craniocerebral injury with seawater immersion have hitherto not been clear. The authors reviewed the research progress in the damage mechanisms of craniocerebral injury with seawater immersion, in order to promote the in-depth study of the mechanism of craniocerebral injury with seawater immersion and provide reference for its clinical treatment.