Volume 92  ·   Issue 23  ·  2012

Anterior cervical surgery is one of the important ways to treat cervical spondylosis. Since Cloward in 1955 and Smith-Robinson in 1958, anterior cervical surgery has been used to treat cervical spondylosis for more than 50 years. In recent ten years, with the progress of material mechanics, biomechanics and modern spinal internal fixation, the related anterior cervical surgery methods are more and more diverse, mainly reflected in different ways of decompression and different ways of cervical reconstruction.

Objective To construct the artificial lamina of vertebral arch with bone marrow mesenchymal stem cells transplanted in collagen sponge on a rabbit model and observe the growth of new bone.Methods To draw out the bone marrow blood from the femur of 2 weeks old rabbit and get the bone marrow mesenchymal stem cells by centrifugal and adhesive effect.To induce the MSCs to osteoblasts and transplant the induced cells in collagen sponge to construct the tissue engineering bone.To divide48 rabbits into 3 groups randomly,namely group A,group B and group C.All of the rabbits are taken laminectomy in L6,and to group B and C,collagen sponge and tissue engineering bone are implanted in the operation area respectively.The artificial lamina of vertebral arch is determined qualitatively and quantitatively by methods including imageology and histomorphometry.Results The artificial lamina of vertebral arch is successfully constructed 4 weeks after operation in group C,CT examination at 4 weeks shows that new lamina of vertebral arch is formed,and the vertebral canal is intact.Conclusions The artificial lamina of vertebral arch can be constructed successfully with the usage of tissue engineering bone transplanted bone marrow mesenchymal stem cells.

Objective To establish a reproducible and manipulable model of acute spinal cord compression injury in large mammals so as to provide a technical and experimental platform for the repair and reconstruction of spinal cord injury (SCI).Methods A total of 15 adult male goats,weighting 35 -45 kg,were selected.After intravenous anesthesia,a model of acute spinal cord compression injury was established with the balloon of kyphoplasty through mini-open laminotomy.The animals were divided into 4 groups,i e.3 in group A and 4 each in groups B,C and D.Goats in group A received mini-open laminotomy without insertion of balloon.In group B,balloons were surgically positioned within the T10-T11 spinal canal but not inflated.The spinal cords of goats in group C were partially compressed by inflating the balloon to approximately 30％ of anterior/posterior diameter of vertebral canal.In group D,the balloon was inflated to occupy approximately 90％ of canal on a lateral view.X-ray and thin-section computed tomography (CT)scans were used to determine the balloon location.CT scans were also used to calculate the magnitude of balloon inflation and the degree of spinal cord compression within vertebral canal.Improved Tarlov motor function grade test and somatosensory evoked potentials (SSEP) were employed to evaluate the goat neurofunction 24 hours before and 7 days after surgery.Results Dye volumes of 0,1.26 ± 0.18 and 2.82 ±0.20 ml were injected into the balloon to produce spinal occupancies of 0％,33％ ±2％ and 89％ ±4％ on X-ray and CT scan.There was a significant dose response for the different levels of injury,with reduced conduction of somatosensory evoked potentials and impaired mobility 7 days after injury.Conclusion A model of acute spinal cord injury hy a tunable compression with a mini-invasive balloon in goats is a useful experiment model of spinal cord injury.It may simulate the clinical situations of acute SCI.

Objective To summarize and analyze the complications of posterior vertebral column resection in the treatment of spinal tumors.Methods The complications of 31 patients were recorded and categorized into primary and secondary complications.Many factors such as segment,bleeding volume and surgical duration were reviewed.The SPSS 12.0 software was used to analyze the relations between the complications and these factors retrospectively.Results Two primary and 30 secondary complications were identified.A definite relation existed between the delayed removal of endotracheal intubation and bleeding volume.And a definite relation existed also between transient thrombocytopenia and operative duration.There was no relation between prosthetic subsidence and various factors ( including follow-up period).Conclusion Most complications are secondary and have basically no effect on the recovery of patients.And preventions are feasible in most cases.So a thorough plan should be devised to prevent the occurrences of potential complications,especially primary ones.For any occurrence,active treatment should be offered to improve the surgical safety.

Objective To explore the short-term clinical efficacies of treating esophageal carcinoma surgically by Ivor-Lewis approach so as to summarize the characteristics of lymph node metastasis of esophageal cancer and evaluate the safety and effectiveness of surgical treatment of middle and lower esophagus.Methods Our hospital started the lvor-Lewis approach of esophageal cancer from 2005.During the period of 2007-2010,a total of 404 patients underwent the Ivor-Lewis approach for esophageal cancer.And the AJCC software was used for the probability statistical analysis.Results None of them died.But 89/101 patients (22.0％ ) had the occurrences of postoperative complications.And while still within the original stage of T1,tumor probably metastasized.Conclusion Esophageal cancer has an early tendency of metastasis.Based upon the anatomic locations of metastatic lymph nodes,it is better to predict the prognosis of patients.Thus the combined regimen of Ivor-Lewis surgery plus two-field lymphadenectomy is both safe and efficacious for esophageal carcinoma in the middle and lower segments.

Objective To evaluate the safety and efficacy of radiation plus erlotinib in patients with esophageal cancer older than 70 years.Methods Radiotherapy was prescribed at a daily fraction of 2.0 Gy up to a total dose of 60 Gy over 6 weeks.Concurrent erlotinib was administrated at a dose of 150 mg daily at days 1 - 42.Acute toxicities were assessed by the criteria of Radiation Therapy Oncology Group ( RTOG )and National Cancer Institute (NCI).The results were analyzed by the software SPSS 17.0.Results A total of 33 patients were enrolled.The median survival time was 16.3 ± 8.6 months(95％ CI 0.0 - 33.3 ) and the 1-and 2-year overall survival rates were 66.3％ and 49.7％ respectively.The media progression-free survival was 16.7 ±7.1 months(95％ CI 2.9 - 30.5) and the 1-and 2-year local control rates 73.3％ and 54.9％respectively.Most toxicities were of grade 1-2 and manageable.Conclusion The combined regimen of radiation and erlotinib is effective and safe in elder patients aged ＞70 years with esophageal cancer.However the results of our study should be confirmed in randomized controlled trials of a larger sample size.

Objective To explore the rationality and clinical significance for the old and new surgical-pathological staging in endometrial carcinoma.Methods The clinical profiles and prognostic particulars were analyzed retrospectively in 92 cases of endometrial carcinoma from June 2005 to June 2011 at Xiaoshan Hospital.And the old and new surgical-pathological staging methods were applied to observe their rationality and treatment prognosis.Results There was 72.8％ (67/92) for clinical stage Ⅰ in the old surgical-pathological staging while 7.6％ (7/92) for clinical stage Ⅱ and 19.7％ (18/92) for clinical stage Ⅲ.There was 85.9％ (79/92) for clinical stage Ⅰ in the new surgical-pathological staging,3.3％ (3/92)for clinical stage Ⅱ and 10.7％ (10/92) for clinical stage Ⅲ.The detection rate of cancer cell was 8.7％( 8/92 ) in peritoneal fluid.The positive rate of pelvic lymph node was 12.9％ ( 11/85 ).A period of survival rates were compared among P ＞ 0.05 after 3 years and 5 years of Ⅰ A, Ⅰ B and Ⅱ A.There was no statistical significance; there were statistical significance between Ⅰ B and Ⅰ C periods ( P ＜ 0.05 ).The survival of deep myometrial invasion was significantly shorter than that of superficial muscle layer.The positive rate of abdominal aortic lymph node was 3.8％ (1/26).Six patients with positive lymph nodes died postoperatively of cancer within 4 to 28 months.Conclusion The new surgical-pathological staging is more objective,practical,simple and convenient than its old counterpart.Deep myometrial infiltration and positive lymph node are important prognostic factors of endometrial carcinoma.The positive rate of lymph node remains low in early low-risk endometrial carcinoma and routine excision of lymph node is of little significance.

Objective To analyze the association between the synovial expression of cyclic citrullinated peptide (CCP) and susceptibility variants of HLA-DRB1 shared epitope ( SE ) alleles and/or peptidylarginine deiminase 4 (PADI4) gene single nucleotide polymorphisms (SNP) in patients with rheumatoid arthritis (RA).Methods From October 2008 to December 2011,53 RA patients and 42 controls were enrolled.The expression of CCP in RA synovial tissues was detected by immunohistochemical assay with 6 × His tagged anti-CCP single chain fragment Ⅴ ( ScFv ) antibodies generated by pHEN2 phagemid recombinant antibodies display system.PADI4 SNP was genotyped by reverse transcription cDNA sequencing and heterozygote was DNA haplotype was mapped by TA clone sequencing.HLA-DRB1 SE alleles were analyzed by sequence specific primer-polymerase chain reaction (SSP-PCR).Results The prevalence of synovial CCP expression was significantly different between RA group and the control(76.9％ and 11.4％respectively,P ＜ 0.01 ).The frequencies of 2 SNPs ( PADI4_89 G + and PADI4_104 T + ) varied significantly between the groups ( P ＜ 0.05 ).Compared with the major haplotypes,only these two minor alleles were associated with the increased RA susceptibility( OR =3.67 and 2.53,P ＜ 0.05 ).SE + alleles was strongly associated with RA susceptibility ( OR =5.57,P ＜ 0.01 ).The synovial expression of CCP in RA was strongly associated with SE + alleles,only 2 minor SNPs ( PADI4_89 G + and PADI4_104T + )and the combination.Serum anti-CCP titers were significantly associated with SE + alleles,PADI4_104T +,SE +/PADI4_89 G + and SE +/PADI4_104T + haplotype.Conclusion The synovial expression of CCP and the generation of anti-CCP antibodies are strongly associated with SE alleles and/or certain PADI4 gene SNP in RA.

Objective To investigate the incidence of inherited protein C deficiency in the patients with venous thromboembolism (VTE).Methods From Apr.of 2010 to Apr.of 2011,106 patients with VTE totally from Renji hospital were surveyed by a series of laboratory tests including clinical biochemistry tests,coagulation factors activities and anticoagulation factors activities.PROC gene mutations were screened by PCR-direct sequencing in the 20 patients with decreased PC activity.Results Among the 20 patients with decreased PC activity,the median activity of factor Ⅱ,Ⅴ,Ⅶ,Ⅷ Ⅸ,Ⅹ,Ⅺ,Ⅻ were 97.0％,199.9％,105.5％,254.7％,106.4％,150.4％,123.1％,89.9％,respectively.6 PROC gene mutations were found in 11 patients.Six patients have the same point mutation ( c.565C ＞ T ),the other five mutations were c.508G ＞ T,c.524G ＞ A,c.1174G ＞ A,c.1157T ＞ C,c.577-579del.All of the six mutations were heterozygous,while the c.508G ＞ T,c.524G ＞ A and c.1157T ＞ C were novel in the world.Conclusions In this study,we found that PC deficiency is the major inherited risk factor of VTE.The most common PROC mutation identified in this study was heterozygous c.565C ＞T missense mutation.,c.508G ＞T,c.524G ＞A and c.1157T ＞C were novel PROC mutation.The activities of factor Ⅴ and Ⅷ were elevated dramatically among VTE patients,which may be correlated to the disease.

Objective To explore the clinical and imaging features of anoxic-ischemic encephalopathy (AIE) patients after cardiopulmonary resuscitation.Methods A total of 28 qualified AIE patients during the last decade from Xiangya Hospital,Central South University were recruited and analyzed retrospectively.Results The symptoms of status epilepticus,acute posthypoxic myoclonus,Lance-Adams syndrome,subarachnoid hemorrhage and cognitive deficits were observed.The abnormal findings of magnetic resonance imaging (MRI) or computed tomography (CT),involving neocortex,basal ganglia and paraventricular white matter,were also recorded.During the early phase of disease,swollen cortex was present on MRI/CT.However,encephalatrophy appeared during the late phase.The more severe symptoms were observed,the more foci were present on MRI/CT.Conclusion The etiologies of AIE patients are heterogeneous after cardiopulmonary resuscitation. The clinical symptoms and imaging studies are of prognostic significance.

Objective To screen and prepare the vaccine of human papillomavirus (HPV) 18 E7 peptide target at human leukocyte antigen ( HLA)-A2 plus CpG through SYFPEITHI.Methods ( 1 ) The SYFPEITHI database was employed for predicting and screening of HPV18 E7 HLA-A2 restricted T cell epitopes.(2) The peripheral blood and tumor tissue sample of HLA-A2 positive and HPV18 positive/negative patients were collected and randomly divided into 7 groups,i.e.E7PA + CpG,E7PB + CpG,E7PC +CpG,E7PD + CpG,CpG,IR-T + CpG and control groups respectively.T cell proliferation was detected by thiazolyl blue tetrazolium bromide (MTT) assay at different timepoints.Lactate dehydrogenase delivery method (LDH) was used to test the cytolytic t lymphocyte (CTL) activity of peripheral blood mononuclear cell ( PBMC ) in different ratios of effect and target ( E:T).And the level of activity T cells was evaluated by interferon gamma (IFN-γ)-related enzyme-linked immuno-spot assay (ELISPOT).Results (1) Four peptides named E7PA,E7PB,E7PC and E7PD were obtained separately with high levels of affinity and specificity.(2) During continuous observations after vaccination,the E7PA + CpG group had the most pronounced proliferation rate.When E:T =100:1,the E7PA + CpG group had more powerful CTL effect than the control group with statistic significance (P ＜0.00).E:T was concentration-dependent Except for IR-T + CpG,all other groups had great difference than control group with statistic significance (P ＜0.05 ) but no significant difference between the groups.The levels of IFN-γ spot-forming T cells were higher in the E7PA + CpG group than the control group with statistic significance ( P ＜ 0.01 ).In terms of specificity,E7PA + CpG in the HPV18 positive group could induce the proliferation of IFN-γ-secreting T cells.And there was statistical difference with the control group ( P ＜ 0.05 ).Conclusion Screening the HPV18 E7 peptide target at HLA-A2 plus CpG as the candidate targets by SYFPEITHI may active specific immunological cellular responses to HPV18 positive disease.

Objective To explore the effects of three different treatments,including probucol plus aspirin (PS),lovastatin plus aspirin (AS) and probucol,lovastatin plus aspirin (PAS) on atherosclerotic plaque and adipose.Methods A total of 31 SD rats with established atherosclerosis were randomly divided into control group (n=7),high-fat group (n=4),PS group (n=8),AS group (n =5) and PAS group (n =7).The PS group rats were lavaged with probucol (104.4 mg· kg-1 · d-1) and aspirin 10.4 mg ·kg-1 · d-1),AS group ones aspirin (10.4 mg · kg-1 · d-1) and lovastatin (2.1 mg · kg-1 · d-1) and PAS group ones probucol (104.4 mg· kg-1 · d-1),aspirin (10.4 mg· kg-1 · d-1) and lovastatin (2.1 mg · kg-1 · d -1 ) for 8 weeks.At the same time,the control group received an equal volume of saline.Finally the plaque stability and adipose function of treatment groups were evaluated by the changes of body weight,serum parameters,adipose weights and pathological specimens.Results Body weights in PS and PAS groups significantly increased than those in AS group (251 g ±5 g and 247 g ±7 g vs 220 g ±6 g,P ＜0.01 ).The serum levels of low density lipoprotein cholesterol (LDL),glucose ( Glu),total cholesterol (TC) and high density lipoprotein cholesterol (HDL) were significantly better in PS and PAS groups than those in AS group (P ＜0.01).The level of tumor necrosis factor-alpha (TNF-α) was lower in PAS group than that in high-fat group (27 ± 21 vs 100 ± 34 pg/ml,P ＜ 0.05).The stability level of atherosclerotic plaque was more in PAS group than those in PS and AS groups by oil red staining in aorta,oil red staining in different organs and hematoxylin and eosin staining in different aortal parts.Conclusion Atherosclerosis improves more pronouncedly in PS and PAS groups than that in AS group.Through an analysis of the changes of fat-related indicators,adipose factor may play an important role in atherosclerotic treatment.

Objective To explore the roles of nano-hydroxyapatite/collagen/PLA (nHAC/PLA)plus endothelial progenitor cells (EPCs) in repairing segmental bone defects of rabbit radius and enhancing angiogenesis and new bone formation.Methods EPCs isolated from New Zealand white rabbit bone marrow were cultured,identified and seeded into nHAC/PLA scaffolds.And the growth of EPCs in scaffolds was observed under scanning electron microscopy ( SEM ).Thirty-six were randomly divided into 3 groups to establish segmental bone defect models in radii.Two groups were implanted with EPCs/scaffolds constructs ( group A,n =16) and scaffolds alone (group B,n =16) respectively.The remaining four rabbits were used as negative control (group C) and nothing was implanted.Animals were sacrificed at different timepoints and radii harvested to undergo radiological examination,histological examination and microvessle density test.Results These cells isolated from bone marrow were confirmed as EPCs.SEM showed that EPCs attached to the nHAC/PLA scaffolds, grew and proliferated well.Animal experiments revealed that radiological scores (5w:2.25 ±0.50 vs 1.00 ±0.00; 10w:2.75 ±0.50 vs 1.75 ±0.50; 15w:4.25 ±0.50 vs 3.0 ± 0.0 ; each P ＜ 0.05 ),percentage of new bone formation area in bone defect regions (5w:29.0％ ± 3.5％ vs 8.1％ ±0.8％; 10w:63.4％ ±5.5％ vs 16.6％ ±1.3％; 15w:96.0％ ±4.3％ vs 34.0％ ±6.6％ ; each P ＜ 0.05 ) and microvessel density ( 2w:13.5 ± 0.9 vs 4.3 ± 1.0; 5w:9.8 ± 0.7 vs 4.8 ±0.3 ; 10w:7.0 ± 0.4 vs 4.5 ± 0.4; each P ＜ 0.05 ) in group A were significantly higher than those in group B.No new bone formation occurred in group C.Conclusion The composite structure of EPCs-nHAC/PLA can enhance angiogenesis and new bone formation in segmental bone defects in rabbit radii.It may become a potential candidate of promoting revascularization of tissue engineering bone and repairing large bone defects.

Objective To prepare and characterize the compond Epirubicin hydrochloride and Gadopentetate meglumine (Gd-DTPA) nanoparticles,and evaluate its properties from rabbits in vivo and in vitro.Methods The compond Epirubicin hydrochloride and Gd-DTPA nanoparticles were prepared by double emulsion-solvent evaporation method.The main effective factors were orthogonal designed.The characteristics such as drug entrapment efficiency,drug loading,and drug utilization were assayed in vitro.MR imaging effect of the VX2 rabbit hepatoma model were observed after injecting the drug-loaded nanoparticles through the hepatic artery intubation in vivo.Results The drug encapsulation efficiency of the nanoparticles,drug loading and drug utilization were 33.8％ ±3.4％,0.225％ ±0.052％,and 69.6％ ±4.3％ under the optimized prescription,resepectively.The mean size of the nanoparticles was 180.6 nm,the drug release continued in 48 h with good MR imaging effect.Conclusions Compond Epirubicin hydrochloride and Gd-DTPA Nanoparticles were in simply preparation and showed sustained drug release properties.These novel nanoparticles with detecting function could develop of epirubicin hydrochloride targeted therapy of liver cancer.

Objective To explore the effects of small interfering RNA (siRNA) specific to cox-2 gene on the radiosensitivity of esophageal cancer cell EC9706.Methods The siRNA vector was established for cox-2 gene and then induced into esophageal cancer cell EC9706 by lipofectamine.G418 screening yielded stably transfected cells.After the irradiation of 0,2 and 4 Gy,the cellular expression levels of cox2,matrix metalloproteinase-2 ( MMP2),Bax and Bcl-2 were detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and those of cox-2 protein,AKT protein and phosphorylation AKT protein (pAKT) by Western blot.Cell apoptosis was examined by flow cytometer.Invasion of cells was detected by invasive assay in vitro.The invasive and metastatic capacities of cancer cells were assessed by invasion assay in vitro. Proliferative potential was quantified by clone-forming assay. Results The sequencing result confirmed that siRNA vector pRNA-U6 for cox-2 gene was established.The results of 1-sinCox214,RT-PCR and Western blot showed that cox-2 gene expression of transfected EC9706 cell was silenced efficiently.After the irradiation of 0,2 and 4 Gy,the expressions of MMP2,Bcl-2 mRNA,AKT protein and pAKT in silencing cox-2 gene expression significantly decreased.There was an inverse correlation with irradiation dose.The Bax mRNA expression evidently increased directly with irradiation dose; the apoptotic rate in cox2 silencing groups was evidently higher than the control groups.And the difference was significant ( P ＜0.01 ) ; invasion cells in vitro in Cox-2 silencing groups evidently decreased with significant difference ( P ＜0.01 ).The colony formation rate of cells decreased obviously in cox-2 silencing groups after the irradiation of 0,1,2,4,6,8 and 10 Gy ( P ＜ 0.01 ).Conclusions Small interference RNA in silencing cox-2 gene expression can enhance significantly the radiosensitivity of esophageal cancer EC9706 cells. And the mechanism may be related with MMP2 , Bax, Bcl-2,AKT protein and pAKT protein.

According to Ferri's Global Dementia Patient Prediction Study published in The Lancet in 2005, there were approximately 28 million dementia patients worldwide in 2012, and this number is expected to be as high as 43.2 million by 2020. Patients with dementia often experience psychiatric symptoms and even have a tendency to aggression, so clinicians often prescribe antipsychotics to improve this symptom.Previous studies have shown that antipsychotics are associated with an increased risk of stroke and death in elderly patients with dementia, while stroke and myocardial infarction are both vascular events, so the team led by Pariente hypothesized that antipsychotics can also cause myocardial infarction, and based on this hypothesis, a retrospective cohort study of 37,138 community elderly patients with dementia treated with acetylcholinesterase inhibitors was conducted to see whether antipsychotics increase the risk of myocardial infarction. The results of the study were published in Arch Intern Med, 2012, 172: 648-653 on April 23, 2012.

It has been found that general anesthetic drugs can induce neurotoxicity in the developing brain of primates to produce apoptosis of brain neurons [1-2] and affect cognitive function [3]. Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophic family. It plays a very important bioactive role in the survival, maintenance and growth of neurons during the development of nervous system, and it is also related to synaptic function and plasticity, and plays an important role in learning and memory.

According to the definition of the organization for economic cooperation and development (OECD), human biological resource centers (this term is uniformly used in this paper) are an important component of a biotechnology infrastructure for preserving and providing various biological resources and related information for clinical treatment of diseases and life science research according to quality standards and requirements [1].

Depression is a common mood disorder, and its lifetime prevalence is as high as 5% ~25%. According to the statistics of World Health Organization (WHO), depression ranks fourth in the global disabling diseases. Studies at home and abroad have pointed out that the treatment of depression can be divided into: intervention in acute phase, long-term maintenance of remission state and prevention of recurrence. How to judge the relief of depression symptoms and how to evaluate the treatment effect of depression is still an important issue in the medical field.

A 53-year-old male was admitted to the Department of Vascular Surgery of the Provincial Hospital affiliated to Shandong University on February 27, 2012 due to "numbness, chill and claudication in his left lower limb for more than 10 months, aggravated for 20 days". The patient suddenly developed cold and numbness in his left lower limb without obvious trigger 10 months ago, and appeared sore and swollen discomfort in his left lower limb after walking about 500 m. He was discharged after infusion treatment in the local hospital. In the past 20 days, the patient's symptoms reappeared and aggravated, and the claudication distance was shortened to 50 m. He came to our hospital for treatment and denied the history of previous trauma and surgery. Physical examination at admission showed that there was no swelling in both lower limbs, normal sensory movement, low skin temperature in the left foot, mild cyanosis in the left toe, and Burger sign (+) in the left lower limb.