BACKGROUND:Artificial cervical disc prosthesis simulates range of motion and buffer shock function of normal intervertebral discs. Clinical experiments verify that artificial cervical disc prosthesis material has good biocompatibility and mechanical characteristics. OBJECTIVE:To evaluate artificial cervical disc replacement and zero-profile interbody fixation and fusion system for multilevel cervical disease in 2-year folow-up. METHODS:Artificial cervical disc replacement and zero-profile interbody fixation and fusion system were used to treat 42 patients with multilevel cervical disease. The patient presented typical symptoms and signs of spinal cord or nerve root compression. There were 18 cases of cervical myelopathy, 15 cases of nerve root cervical spondylosis and 10 cases of mixed type of cervical spondylosis. After treatment, mean operation time, blood loss and reoperation rate were measured. Postoperative complications, disability index of neck function, visual analog scale, function unit range of corresponding surgery segments of the cervical spine, Cobb angle of C2-C7 vertebral body, range of motion of adjacent segment of proximal and distal vertebral bodies were observed and clinical outcomes were evaluated. RESULTS AND CONCLUSION: Al cases finished the operation and were scored at various time points. After treatment, radiating pain of shoulder and neck and upper extremity were remarkably lessened. Numbness and sensory loss symptoms disappeared obviously. Quality of life elevated noticeably. Visual analog scale and the disability index of neck function score were decreased in final folow-up compared with pre-treatment (P < 0.001). C2-C7 vertebrae Cobb angle, FSU angle, range of motion of proximal surgery adjacent segment and range of motion of the distal surgery adjacent segment were elevated compared with pre-treatment (P < 0.001). These data indicate that cervical spondylosis was improved after treatment. Each index of cervical spondylosis after artificial cervical disc replacement and zero-profile interbody fixation and fusion system was reconstructed to different degrees.

Objective To systematically review the effect of team-based learning (TBL) versus the traditional lecture-based learning (LBL) teaching model on basic medical courses in undergraduate medical education. Methods The CNKI, VIP and Wanfang medical databases were electronically searched to retrieve randomized controlled trial studies on TBL applied in undergraduate basic medi-cal courses up to June 2014. In these studies TBL teaching model was used in experiment group with LBL teaching model as control group and course grades were adopted to evaluate the effect of learn-ing. Literature screening, data extraction, and quality assessment were performed in strict accordance with the inclusion and exclusion criteria, and then data were analyzed using RevMan 5.3 software. Results This Meta-analysis examined 12 studies, all of them with low quality at C level. Meta analysis shows that the score of the course of TBL teaching is better than the traditional LBL teaching, and the difference is statistically significant [weighed mean difference (WMD): 9.33, 95%CI (5.67, 13.00), P=0.000]. Conclusion Compared with the LBL teaching, the application of TBL teaching in medical undergraduate basic medical courses has the promotion effect, but need more rigorously randomized controlled trials to verify.

Objective To investigate the hemodynamic changes of contralateral vertebral arteries with transcranial Doppler (TCD)in patients with subclavian artery steal syndrome. Methods Forty-five outpatients or inpatients with subclavian artery stenosis or occlusion confirmed by TCD and color Doppler flow imaging (CDFI)and treated at Baoan District Center Hospital of Shenzhen from March 2012 to April 2015 were analyzed retrospectively. According to the TCD detection,the degrees of intracranial arterial steal were divided into 4 groups:non-blood steal (n=8 ),blood steal phase Ⅰ(n=21 ),phase Ⅱ(n=11 ), and phase Ⅲ(n =5 );45 healthy subjects from Baoan District Central Hospital were used as a control group. The contralateral vertebral artery hemodynamic indexes of each blood steal group were detected respectively,and they were compared with the control group. Results Of the patients without blood steal,6 patients had mild subclavian artery stenosis,2 had moderate stenosis;of the patients with phase I blood steal,12 had mild subclavian artery stenosis,9 had moderate stenosis;of the patients with phaseⅡblood steal,3 had moderate subclavian artery stenosis,7 had severe stenosis,and 1 had occlusion;of the patients with phase Ⅲ blood steal,3 had severe subclavian artery stenosis,2 had occlusion. The degree of blood steal was positively correlated with the lesion degree of subclavian artery stenosis (r=0. 78, P<0. 05). TCD findings revealed that the contralateral vertebral artery systolic blood flow velocities in patients with phase Ⅰ,Ⅱ,andⅢsteal groups were 70 ± 23,85 ± 30,and 104 ± 32 cm/s,respectively;their mean flow velocities were 39 ± 10,46 ± 16,and 54 ± 17 cm/s,respectively;their pulsatility indexes were 1. 17 ± 0. 20,1. 27 ± 0. 31,and 1. 43 ± 0. 36,respectively,and they were all significantly higher than 49 ± 9,34 ± 7,and 0. 66 ± 0. 08 cm/s of the control group (all P<0. 01),and 50 ± 11,34 ± 10,and0.68±0.12cm/s of the non-blood steal group (all P<0.01),and there were significant differences among the steal blood groups in each phase (all P <0. 01 ). Conclusion Detecting the hemodynamic indexes of contralateral vertebral arteries using TCD can preliminaryly assess the subclavian artery lesions and their steal degree.

Objective To investigate the dosimetric characteristics and their clinical applications of volumetric modulated Arc therapy (RapidArc) with fixed-fields intensity modulated radiotherapy for early stage nasal NK/T-cell lymphoma.Methods Ten patients with stage Ⅰ E and Ⅱ E nasal NK/T-cell lymphoma were enrolled in the study.Five field coplanar plan (5F),nine field coplanar plan (9F),five field non-coplanar plan (5F-N) and RapidArc plans were designed for each patient,in which 5F plan was set as the control group.Conformity index (CI) and homogeneity index (HI) as well as the maximum dose of organs at risks were compared.Results The target CI of 5F,9F,5F-N and RapidArc plan was 0.419±0.159,0.478 ±0.181,0.465 ±0.121 and 0.518 ±0.111,respectively.Compared with 5F (0.136±0.038),the target HI of 9F and RapidArc plan was 0.111 ±0.027 and 0.112 ±0.031 (t =3.11,3.04,P ＜ 0.05).9F plan significantly increased the Dmax of lens in the contralateral side(t =2.82,P ＜ 0.05) and in ipsilateral side (t =3.25,P ＜ 0.05),while 5F-N plan decreased the Dmax of optical nerves by up to 9％.RapidArc plan effectively reduced the radiation to organs at risk in lens (t =3.25,P ＜0.05),eyes (t =3.25,P ＜0.05),optical nerve (t =2.57,P ＜0.05) and optical chaism(t =7.62,P ＜0.05).The delivery efficiency of four plans ranked as RapidArc ＞ 5F ＞ 5F-N ＞ 9F.Conclusions RapidArc produced statistically significant improvement in the dose distributions of targets,and also reduced the Dmax of organs at risk,which would be the better choice of radiotherapy for nasal NK/T-cell lymphoma.

Objective To evaluate the selectively killing effect of adenovirus(Ad)mediated double suicide gene driven by VEGF promoter on pancreatic cancer cell SW1990. Methods VEGFexpressing SW1990 were infected by Ad-VEGFP-CDTK and Ad-null.respectively.The infection rate was observed and the expression of CDTK was detected by RT-PCR and Western blotting.Followed by treatment with 5-FC and GCV killing effects were evaluated and bystander effects were analyzed by MTF.Pathological character of cells was observed by electron microscopy and distribution of cell cycle was detected by flow cytometry.The caspase-3 activity was detected by absorption spectrometry. Results The infection rate of the resultant recombinant Ad to SW1990 cells was not apparently different.RT-PCR and Western blotting demonstrated product of CDTK gene in SW1990 cell infected by Ad-VEGFP-CDTK.Prodrug could inhibit proliferation of SW1990 and the effect was dose-dependent.There was considerable bystander effect as observed by MTF.Apoptotic peak was also shown by flow cytometry.Morphologic features of apoptosis in SW1990 cells were displayed via electron microscopy.Cells at the G0-G1 phase was increasing and the rate at the G2-M and S phase was decreased by prodrug.The caspase-3 activity gradually rised with the increasing concentration of the prodrug. Conclusions The CDTK fusion gene system controlled by VEGF promoter has killing effect on the VEGF-expressing SW1990 cells and inducing the cell apoptosis.

Objective:To explore the clinical effect and safety of modified microvascular decompression (MVD) on the recurrent trigeminal neuralgia.Methods:50 patients with recurrent trigeminal neuralgia from 2010 to 2015 in the Center of Cranial Nerve of Shanghai Jiaotong University (including Shanghai Tongren Hospital and Xinhua Hospital) were retrospectively analyzed,patients before 2012 were given regular MVD (MVD group,n=22),patients after 2012 were given improved MVD (modified MVD group,n=28).MVD group was given trigeminal nenre root decompression by traditional MVD,the method was described as follows:the skin,myofascial was cutted in turn along the first incision,the scar tissue on the edge of bone window was separated,and the bone window was appropriately expanded until the dura mater was fully exposed.Then dura mater was cutted open to sharply dissect the arachnoid,Meckel cavity was probed up to neurological brain regions (REZ),the trigeminal nerve segment was closely examined to separate the responsible blood vessels of oppressive nerve and the Teflon pad of cotton imbedding at the first operation.Modified MVD group was given detection of intracranial trigeminal nerve and its surrounding structures,dissection of brainstem extended segment of trigeminal neuralgia,and the compression of superior cerebellar artery to brainstem extended segment of trigeminal neuralgia was fended off.The postoperative remission rate,recurrence and complications between two groups were compared.Results:The postoperative remission rate in modified MVD group was 100.0％,which was significantly higher than that of the MVD group (P＜0.05).There was no statistical significance in the incidence of postoperative complications between two groups (P＞0.05).The recurrence rate at 1 year after surgery in modified MVD group was 0％,which was significantly lower than that of the MVD group (22.7％,P＜0.05).Conclusions:Decompression of trigeminal nenrerootcombined with brainstem extended segment of trigeminal neuralgia in MVD for recurrent trigeminal neuralgia could effectively relieve the pain,reduce the risk of postoperative recurrence,and wouldn't increase the postoperative complications.

Objective To establish a reproducible and controllable experimental swine model of abdominal multiple organ trauma.Method Fifteen pigs were included in the present study,and the method adopted conformed to the animal ethics.With the self-made explosive device,the electric firecrackers consisting of 0.3g,0.2g and 0.2g black powder were put respectively onto the surface of left lateral lobe of liver,lower pole of spleen and tail of pancreas to produce injuries by explosion.The operation time of exploratory laparotomy and isolation of the organs,blood loss,the maximum diameter and area of injury to the liver and spleen due to explosion,the length and extent of the pancreas that was injured in explosion,as well as the changes in mean arterial pressure(MAP) during the operation were detected and recorded.Finally,the injury severity score(ISS) was calculated.Results The damaged liver area was 9.2?0.3cm2,the maximum diameter of damaged liver was 5.4?0.2cm,the damaged spleen area was 5.2?0.1cm2,the maximum diameter of damaged spleen was 5.6?0.2cm,the damaged pancreas length was 6.3?0.2cm,the time for MAP's to lower by half was 8.8?0.5min,the blood loss for depression of MAP by half was 704.7?14.6ml,the time from injury to death in the first 5 pigs was 25.4?1.8min,ISS was 28.0?0.8.The experimental swine model of abdominal multiple organ trauma was reproduced successfully.Conclusions By using the self-made explosion device and electric firecrackers,the abdominal multiple organ trauma model is reproducible,controllable and stable.It can be generally used in the research of war trauma and traffic accident trauma.

Objective To evaluate the expression of tumor necrosis factor related apoptosis-inducing ligand (TRAIL) and its receptor(TRAILR) in human hepatocellular carcinoma (HCC), and its therapeutic potential for human HCC. Methods Expressions of TRAIL and TRAILR were determined in and adjacent to carcinoma tissues, and normal liver tissues. The cytotoxic effects of TRAIL in combination with chemotherapeutic agents on HCC cell lines were detected. Results Expression of TRAIL in tumor adjacent tissue was higher than in cancer tissue. There were high expression of DR and low expression of DcR in HCC tissue in contrast to normal hepatic tissue(?~ 2=4.68,P

Objective To investigate the distribution and expression of Oceludin in esophageal epithelium in gastroesophageal reflux disease (GERD).Method Immunohistochemistry was used to examine the distribution and expression of Occludin in esophageal epithelium from 62 cases with GERD and 10 Case with other diseases ag control.Results The Occludin was normal continuous membrane expressed in 10 contrast esophageal epithelium,while in 32 nonerosive reflux disease patients,normal expression Was seen in 4 cases,different degree of abnormal expression was seen in 28 cases,including incomplete membrane expression,cytoplasmic expression and expression depletion respectively,and in 30 reflux esophagitis patients were seen all abnormal expression including incomplete membrane expression,cytoplasmic expression and expression depletion respectively.There was significant difference between nonerosive reflux disease and normal contrast,reflux esophagitis and normal contrast(P＜0.01),no difference was seen between reflux esophagitis and nonerosive reflux disease(P＞0.05).Concision The number of esophageal epithelial Occludin in GERD patients diminished and abnormally distributed,interfered the integrity of epithelium mucosal barrier,which might be one ofthe pathogenesis of GERD,there is no difference of Occludin expression between reflux esophagitis and nonerosive reflux disease esophageal epithelium.

Objective To explore whether acute graft versus host disease (aGVHD) could be alleviated by syngeneic bone marrow mixed with granulocyte colony stimulating factor (G CSF) mobilized H 2 haploidentical marrow grafting. Methods Female BALB/c and neonatal BALB/c mice were recipients and male (BALB/c?C 57 BL/6) F 1 (BCF 1) mice were donor mice respectively. Donor mice were injected subcutaneously with G CSF daily at 0.01 ?g/g body weight or saline for 6 days, and splenocytes were harvested on day 6. Spleen index(SI) represented GVHD in neonatal mice after the intraperitoneal injection of mixed spleen cells.Lethally irradiated ( 60 Co, 8.5 Gy) adult mice were transplanted with a mixture of syngenetic plus G CSF mobilized (control diluents) H 2 haploidentical marrow cells.Survival time and survival rate of the recipients were observed after mixed marrow transplantation (MBMT). GVHD was assessed by observing signs of weight loss, ruffled fur, diarrhea and histological change of skin, liver and small intestines. Enzyme linked immunosorbemt assay (ELISA) method was used to detect cytokines (IL 2, IL 4, IFN ?). Fluorescence activated cell sorting (FACS) analysis was used to detect T cell phenotype. Results (1) The neonatal mice subject to injection of 2∶1 and 1∶1 mixed spleen cells and H 2 haploidentical spleen cells all suffered from aGVHD. The severity of aGVHD in recipient mice receiving G CSF mobilized splenocytes was dramatically reduced. (2) The aGVHD signs and histological change were observed in most mice of 2∶1 and 1∶1 MBMT groups. However, the survival time of G CSF mobilized MBMT groups was longer than in control groups ( P