Objective To investigate the effect of Lokomat gait training rehabilitation robot on joint motion and lower limb function in hemiplegic patients after stroke.Methods Forty hemiplegic patients after stroke were randomized equally into a robotic group and a control group (20 cases in each group).The robotic group received robotic rehabilitation therapy in addition to routine rehabilitation training,while the control group was only given instructions for routine rehabilitation training.All the patients were assessed at the beginning of the training and at the end of 4,8 and 10 weeks of treatment.The Fugl-Meyer Assessment of lower extremities (FMA),range of motion (ROM) in hip and knee,force and tone of bilateral hip/knee flexors and extensors were used to evaluate stepping function before training,and after 4,8 and 10 weeks of treatment.Results There was no significant difference between the 2 groups with regard to FMA scores,the ROM in hip and knee,as well as force and tone of bilateral hip/ knee flexors and extensors (P ＞ 0.05).After treatment,the robotic group was significantly improved with all the evaluation indexes when compared to its baseline values (P ＜ 0.05).It was also shown that the robotic group improved to a significantly greater extent than the control group (P ＜ 0.05).Pearson's correlation analysis demonstrated a positive relationship between the ROM of knee or hip and lower limb function (P ＜ 0.05).Conclusions The Lokomat gait training rehabilitation robot can improve the lower extremities functions,as indicated by increase of ROM and muscle strength as well as decrease in muscle spasticity in hemiplegic patients after stroke.

Objective To review the efficacy of different rehabilitation training on walking locomotion for chronic incomplete spinal cord injury (SCI) by Meta-analysis. Methods PubMed, CNKI, Wanfang Database, and Google academic search were applied to search for clinical trials on chronic incomplete spinal cord injury to review the efficacy of gait training. Meta-analysis was to assess the clinical trials by Rev-Man 4.2. Results Gait training improved the walking speed for chronic incomplete spinal cord injury. The efficacy of partial body weight support treadmill training combined with functional electrical stimulation was confirmed. The efficacy of artificial aided training and robot-aided training remained uncertain. Conclusion Gait training was effective to improve walking ability for chronic incomplete spinal cord injury, but the evidence was insufficient.

Objective To explore the causes and clinical treatments of recurrent spinal tuberculosis complicated with sinus tract.Methods There were 21 patients suffered from recurrent spinal tuberculosis complicated with sinus tract in 87 patients with complicated spinal tuberculosis from January 1997 to January 2012.The dates of them were reviewed.There were 12males and 9 females with an average age of 38.8 years (range,22-58 years).There were 15 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.All patients were excluded from mixed infection of sinus before the operation.According to the range of the tuberculous abscess,11 patients had undergone one stage sinus clearing and debridement,instrument removal,spinal fusion and internal fixation by anterior approach.The other 10 patients had undergone one stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach.Results All patients were followed up for an average time of 29.7 months.16 patients were recovered.5 patients got recurrence with the rate of 23.8％(5/21).The recurrence rate of anterior internal fixation was 18.2％(2/11),and 30％ (3/10) for posterior internal fixation.3patients got recovered by conservative treatment and 2 patients by re-debridement.15 patients achieved bone fusion 6 months after the operation; 4 patients achieved bone fusion 9 months after the operation; 1 patient achieved bone fusion 12 months after the operation.The kyphosis Cobb' angle was corrected to 5.7°(ranged from 2° to 12°).Conclusion It is difficult for the treatment of recurrent complicated spinal tuberculosis combined with sinus tract.The causes of recurrence include drug-resistant strains of TB,uncompleted debridement,failure of spinal stability reconstruction,and combination with other organ tubeculosis.The key of successful surgical treatment includes effective chemotherapy,radical debridement and proper reconstruction of spinal stability.

Objective To evaluate the reliability and reproducibility of the thoracolumbar osteoporotic vertebral compression fracture (OVCF) severity score system (TLOFS),so as to provide basis for clinical decision-making.Methods A total of 320 cases of thoracolumbar OVCF hospitalized between January 2014 and June 2015 were scored by TLOFS.There were 107 male and 213 female patients,aged 52-90 years (mean,63.78 years).All cases presented with a chief complaint of low back pain.Thirty-nine cases (TLOFS ≤3 in 21 cases,TLOFS =4 in 17 cases) were treated non-operatively,while 259 cases (TLOFS =4 in 23 cases,TLOFS ≥ 5 in 259 cases) were treated surgically.Pain was evaluated by the visual analogue scale (VAS).Reliability,reproducibility and content validity of the TLOFS were analyzed.Results Cronbach' sα coefficients of all TLOFS subgroups including evaluation of morphological changes,MRI,bone mineral density,clinical situation and therapy recommendation and total score evaluation were within the range of higher to high reliability (0.76-0.94).Kappa coefficients of all TLOFS subgroups were within the range of higher to high reproducibility (0.84-0.95).Mean content validity of all TLOFS subgroups was 0.916.VAS improved from preoperative(7.8 ± 2.1) to (1.3 ±0.7) at the final follow-up.Rates of correct diagnosis,sensitivity and specificity were 95.7％,87.6％ and 96.5％ respectively.Conclusion TLOFS exhibits good reliability and reproducibility,easy operation,and accurate and comprehensive evaluation,which is effective in guiding the clinical decision making in treatment of thoracolumbar OVCF.

Objective To compare the efficacy of KumaFix posterior spinal screw/rod system (KumaFix system) and posterior U-shape screw/rod system for treatment of thoracolumbar vertebral body fractures.Methods A total of 131 patients with thoracolumbar vertebral body fractures treated from January 2011 to July 2011 were prospectively analyzed.All patients showed thoracolumbar injury classification and severity score (TLICS) more than 5 points and spinal load-sharing classification (LSC) score of 4-6.The patients were assigned to two groups according to the coin toss method:group A (n =72,treated with reduction and fixation with KumaFix system in combination with transpedicular bone grafting of fractured vertebrae) and group B (n =59,submitted to posterior reduction and fixation with U-shaped screw/rod system in combination with transpedicular bone grafting of fractured vertebrae).In group A,there were 41 male and 31 female patients at age of (41.2 ± 4.9) years (range,20-53 years).In group B,there were 33 male and 26 female patients at age of(40.6 ± 4.5)years (range,21-51 years).The two groups were analyzed and compared in aspects of operation time,blood loss,anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio,kyphosis angle,Oswestry disability index (ODI) and incidence of adjacent segment degeneration.Results All patients were followed up for mean 5.3 years (range,5.1-5.8 years).Operation time and blood loss were (72.5 ±21.8)rain and (320.6 ±90.0)ml in group A,less than (104.3 ±20.7)min and (421.0 ± 84.5) ml in group B (P ＜ 0.05).Both groups achieved obvious improvements in anterior vertebral height ratio,middle vertebral height ratio,posterior vertebral height ratio and kyphosis angle after operation(P ＜ 0.05).At the last follow-up,the middle vertebral height ratio was (92.0 ± 2.8) ％ in group A,better than (84.1 ± 5.1) ％ in group B (P ＜ 0.05).Both groups showed improvement in ODI after operation (P ＜ 0.05).At the last follow-up,ODI and incidence of adjacent segment degeneration were 11.9 ± 7.1 and 0 in group A,decreased compared to 20.9 ± 6.7 and 12％ in group B (P ＜ 0.05).Conclusions For thoracolumbar vertebral body fractures,the KumaFix system has better reduction effect than U-shape screw/rod system.Meanwhile,the KumaFix system can avoid negative effect.

Objective To explore the correlations of coping styles with self-management practices and fear of recurrence in patients having undergone mastocarcinoma resection.Methods Toally 330 patients having received mastocarcinoma resection participated in the investigation by medical coping modes questionnaire (MCMQ),self management scale(SMS) and cancer worry scale (CWS).Pearson correlation analysis was integrated to analyze the correlations of coping style with self-management practices and fear of recurrence.Results The total scores by MCMQ,SMS and CWS were (79.10t7.62),(45.31±4.52) and (14.86±4.36),respectively.Pearson correlation analysis showed that there was a significant negative correlation of the coping styles with fear of recurrence,and a positive correlation with the self management(P＜0.001).The items of avoidance and yielding were both positively correlated with the fear of recurrence,while negatively correlated with the self management (P＜0.001).Conclusions The coping style and fear of recurrence are closely correlated.The staff in the community should take active measures to improve the coping styles to reduce the fear of recurrence of the patients who have received mastocarcinoma resection.

Objective To investigate the clinical prediction value of chemokine CCL21 level for acute coronary syndrome.Methods Totally 212 patients receiving coronary arteriography were divided into acute myocardial infarction group(AMI,n=72),unstable angina pectoris group(UAP,n=76),and stable angina pectoris group(SAP,n=64).The serum level of chemokine CCL21 was detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA)and the pathological changes of coronary artery were measured by Gensini scoring system.All patients were followed up for six months and the cardiovascular adverse events were recorded.Results The serum level of CCL21 was(169.72±14.64)ng/L in AMI group,(154.42±16.50)ng/L in UAP group,and(143.87±9.80) ng/L in SAP group,with statistically significant differences (F =99.818,P =0.000).Serum levels of CCL21 in ACS group and SAP group were positively correlated with Gensini score(r=0.474,P =0.000;r=0.350,P=0.049).Binary Logistic regression analysis revealed that chemokine CCL21 was an independent risk factor for predicting acute coronary syndrome (OR =1.049,P =0.022).The CCL21-judged area under the ROC curve in acute coronary syndrome group was 0.887 ± 0.028 (P =0.000),with diagnostic point of serum level of chemokine CCL21 at 159.15 ng/L,sensitivity of 0.635,specificity of 0.981.Serum level of CCL21 was higher in the patients with cardiovascular adverse events than in the patients without cardiovascular adverse events[(168.57±7.24)ng/L vs.(156.92± 6.53) ng/L],with statistically significant difference (t =16.100,P =0.000).Conclusions Serum level of chemokine CCL21 reflects the severity degree of coronary artery disease.The chemokine CCL21,as an independent and effective marker,can predict acute coronary syndrome.

Objective:To investigate the role of MicroRNA-9-1 in inducing epidermal stem cells(ESCs) differentiation into neurons.Methods:The lentiviral of MicroRNA-9-1 was constructed and transfected into rats epidermal stem cells.The experiment was divided into transfected group,non-transfected group and the negative control group.The β-mercaptoethanol was as an inducer for triggering the ESCs to differentiate into neurons.The GFP fluorescence expression of epidermal stem cells after transfection was observed under inverted fluorescence microscope.The protein and mRNA expression level of microtuble-associated protein 2 (MAP-2) was detected by immunocytochemical method and RT-PCR,respectively.Results:The result of Positive clone PCR confirmed successful construction of MicroRNA-9-1 in rats.Transfection after 48 h,the expressing of GFP fluorescence at peak in transfected group,and transfection efficiency reached (85.6+1.9)％.Most ESCs differentiated into neurons in transfected group after β-mercaptoethanol induction 7 h,and the effect was significantly better than non-transfected group and the negative control group.The protein ((87.3± 0.6)％) and mRNA (about twice over) expression levels of MAP-2 in transfected group was higher than those in non-transfected group and the negative control group (P＜0.05).Conclusion:The lentiviral of MicroRNA-9-1 has high transfection efficiency in rats ESCs,and could promoted ESCs differentiate into neurons under β-mercaptoethanol induced.

Objective To discuss the selection of surgical treatment for lower cervical fractures and dislocations combined with locked-facet. Methods The clinical data of 68 patients with lower cervical spine fracture and dislocation combined with locked-facet were retrospectively analyzed. There were 33 patients with unilateral facet dislocation and 35 with bilateral facet dislocation. According to American Spinal Injury Association (ASIA) score, there were five patients at grade A, 11 at grade B, nine at grade C and 10 at grade D. All patients underwent skull traction. Anterior decompression and fixation were applied for reduction of the locked facet. Posterior unlocking reduction ,anterior decompression and plat fixation were applied for the patients with no reduction. Results There were no injuries on major blood vessels, trachea, esophagus, spinal cord. The follow-up lasted for average 41.5 months, which showed that the intervertebral height and lordosis were maintained normal. At six months postoperatively, bony fusion was achieved, with no plate and screw-related complications. The patients with neurological defect got improved at different degrees postoperatively. Conclusion For different lower cervical spine fractures and dislocations combined with locked-facet, selection of suitable surgical approach can attain satisfactory outcome.

Objective To compare the clinical outcomes of Bryan disc replacement with anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylopathy. Methods Sixteen patients underwent Bryan cervical disc replacement (A group), and 35 patients underwent traditional ACDF (B group) were included in the study. Patients were followed up at regular intervals. The JOA score, SF-36, neck disability index (NDI) score and the dynamic flexion-extension radiographs were used to evaluated the oucomes.Results All the patients were followed up for more than 6 years (mean, 73.5 months). There were no severe adverse events in both groups. In A group, there were no differences between postoperative and preoperative mobility of surgical segments (P＞0.05). All patients obtained bone fusions 6 month after surgery in group B.In both groups, the clinical symptoms relieved obviously after surgery. The postoperative scores of the JOA,SF-36 and NDI significantly improved compared with those of preoperative ones (P＜0.05). In B group, range of motion (ROM) was significantly decreased postoperatively (P ＜0.01); in A group, there were no significant differences between postoperative and preoperative ROM (P＞0.05). The difference between two groups regarding ROM was noted (P＜0.05). Conclusion The mid-term outcomes of Bryan cervical arthroplasty are satisfied. And the cervical arthroplasty which can maintain the mobility of the segment, and decrease the incidence of the postoperative neck axial symptoms is a viable alternative to cervical spondylopathy.