Objective To investigate the clinical efficacy and safety evaluation of fibrinolytic,anticoagulant and antiplatelet drug combination treatment in patients with progressive ischemic stroke (PIS). Methods Ninety cases with PIS were randomly divided into the treatment group (47 cases) and the control group (43 cases). The patients in the control group were given combination therapy of Diemailing, Nadroparin calcium and Ozagrel,while the combination therapy of Defibrase, Diemailing, Nadroparin Calcium and Ozagrel were given in the treatment group. The plasma fibrinogen (Fib), prothrombin time (PT), part enabled prothrombin time (APTT), liver and kidney function were observed. The clinical efficacy was evaluated after 14 days treatment. Results After treatment,the total effective rate of the treatment group was 89.4% ,which was significantly higher than that of the control group (67.4%) (P ＜ 0.05). After treatment, the PT and APTT levels of the treatment group were respectively (19.76± 5.53)s and (35.43 ± 6.03)s,the control group were respectively(17.26 ± 1.49)s and (35.71±5.64) s, the PT and APTT increased significantly compared with the pre-treatment condition in both groups (P ＜ 0.05), while the difference between the two groups was not statistically significant (P ＞ 0.05). The Fib level was (1.51 ±0.42)g/L in the treatment group,and (3.10 ±0.69)g/L in the control group. In the treatment group the Fib level was significantly lower than the control group and the condition before treatment(P ＜0.05). We found no significant difference between conditions before or after the treatment in the control group (P ＞ 0.05). The incidence of adverse clinical events showed no significantly difference between the treatment group and control (P ＞0.05). Conclusions Applying of fibrinolytic, anticoagulant and antiplatelet drug combination treatment in patients with PIS has a good efficacy and safety,which is good for clinical application.

Pedicle screw fixation is biomechanically most reliable for reconstruction of the cervical spine, which can ef?fectively restore cervical sagittal profiles, provide rigid fixation and higher fusion rate. Because of the large individual differ?ences in cervical pedicle, vertebral artery and nerve root, preoperative evaluation should be individualized. Cervical pedicle screw techniques include freehand technique and the computer-assisted navigation technology developed recently. Although complications associated with cervical pedicle screw fixation cannot be completely obviated, they can be minimized by com?bination of sufficient preoperative imaging studies of the pedicles and meticulous surgical techniques of screw placement. Cervical pedicle screw fixation techniques have been used in the treatment of various cervical disorders, with fewer complica?tions and good clinical efficacy, and a wide range of clinical applications.

Objective To investigate the feasibility and safety of percutaneous interstitial implantation of ~(125)I seeds into the pancreas of pig under CT-guidance. Methods Twelve healthy pigs were equally divided into 6 groups.~(125)I seed implantation into the pancreatic tail under CT-guidance was performed in pigs of study groups (group A-E), while ghost seeds that contained no radioactive materials were used in the control group (group F). Imaging examination and laboratory tests, including serum amylase, hepatic and renal functions, were conducted before and 1, 7, 15, 21, 30, 60 days after the procedure. Every two pigs (group A-E) were sacrificed each time at 15, 30, 45, 60, and 75 days after treatment, and specimens of pancreas, duodenum, liver, kidney, etc. were collected and sent for pathologic examination. Results The ~(125)I seeds were successfully implanted in all pigs. During the follow-up period, no severe complications occurred. Imaging and pathologic studies demonstrated that in study groups necrosis of pancreatic tissue appeared around the implanted ~(125)I seeds in 15 days, the necrosis area increased significantly in 45 and 60 days, and in 75 days the necrosis size remained quite the same as seen in 60 days. No necrosis was found in the control group (group F) 60 days after treatment. No serious complications, such as effusions, hemorrhage or necrosis of the adjacent duodenum, stomach, liver or kidney, occurred 75 days after the treatment. Conclusion Percutaneous interstitial implantation of ~(125)I seeds into the pig's pancreas under CT-guidance is safe and feasible.

Objective To compare the therapeutic effects of CT-guided ~(125)I seed implantation with simple Gemcitabine chemotherapy for the treatment of unresectable pancreatic carcinoma. Methods Forty-six untreated patients with unresectable advanced pancreatic carcinoma were randomly divided into two groups: group A (n = 22), treated with ~(125)I seed implantation and group B (n = 24), treated with intravenous chemotherapy using Gemcitabine only. The clinical benefit response (CBR), objective tumor response (OTR), safety and the improvement of living quality were evaluated and analyzed. Results Three months after the treatment, the OTR rate of group A and group B was 45.5% and 8.33% respectively (P < 0.05). The CBR rate of group A and group B was 47.1% and 25% respectively (P < 0.05). No significant difference in PFS between group A and group B (P > 0.05). And also, the incidence of hematological toxicity and complication between two groups were of no significant difference. Conclusion For the treatment of advanced unresectable pancreatic carcinoma, both simple Gemcitabine chemotherapy and ~(125)I seed implantation are able to obtain a moderate objective response, although ~(125)I seed implantation seems to be more effective than Gemcitabine in improving the living quality and survival rate.

Objective To observe the clinical effects of open kinetic chain and closed kinetic chain exercise in the early period of anterior cruciate ligament reconstruction rehabilitation,provide the theoretical and clinical experiences for the early rehabilitation of the anterior cruciate ligament reconstructed knee.Methods From February 2009 to June 2010,60 patients undergoing single-bundle anterior cruciate ligament reconstructions by using hamstring tendon allograft were enrolled in the study,and were divided into two groups:open kinetic chain group(30 cases,30 knees)and closed kinetic chain group(30 cases,30 knees).In accordance with the rehabilitation procedures for six months,no statistically significant differences were found between the two groups in Lysholm scores,International Knee Documentation Committee(IKDC)scores and one-leg hop test preoperative.The active and passive range of notion,Lysholm scores,IKDC scores,one-leg hop test and KT-1000 were evaluated three and six months after surgery.Results Three months after surgery,no significant differences were found in passive range of motion,Lysholm scores,IKDC scores,but significant differences were found in active range of motion,one-leg hop test and KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Six months after surgery,no significant differences were found in active range of motion,passive range of motion,one-leg hop test,Lysholm scores,IKDC scores,but significant difference in KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Conclusion Closed kinetic chain exercise is benefit for recovery of muscles strength,proprioception and protect the graft in the early rehabilitation period after anterior cruciate liganent reconstruction.

Objective To evaluate the therapeutic effects and pathologic changes of VX2 liver tumor in rabbits treated with CT-guided percutaneous ethanol injection (PEI) with different concentration. Methods Thirty-two New Zealand rabbits with VX2 liver tumor were randomly divided into 4 groups (each n=8), i.e. anhydrous ethanol, 75% ethanol, 50% ethanol and control group (administrated physiological saline). Tumor size, imaging and pothologic changes were observed 7 d, 14 d, 21 d and 60 d after PEI. Results The volume was (4.68±5.05) cm~3 in anhydrous ethanol group, (6.33±6.59) cm~3 in 75% ethanol group, (17.54±5.06) cm~3 in 50% ethanol group and (16.87±5.27) cm~3 in control group 21 d after PEI. Tumor size in control group was larger than that in 75% ethanol group (t=6.32, P＜0.05) and anhydrous ethanol group (t=6.74, P＜0.05), in 50% ethanol group was larger than that in 75% ethanol group (t=4.99, P＜0.05) and anhydrous ethanol group (t=12.77, P＜0.05). No difference of tumor size was found between 50% ethanol group and control group, nor between 75% ethanol group and anhydrous ethanol group. ALT and AST both increased in all groups 1 d after PEI and returned to normal 7 d later except anhydrous ethanol group. ALT and AST in anhydrous ethanol group were higher than those in other groups (t=4.10, 4.49, 3.06, 5.79, 5.91, 4.11, all P＜0.05), and no difference of ALT and AST was detected between other groups. Area of coagulation necrosis enlarged with the increase of ethanol concentration. Conclusion Anhydrous ethanol and 75% ethanol both have obvious inhibition function to the rabbit VX2 tumor, while 75% ethanol has little damage to the liver function and is suitable for PEI.

Objective To investigate the impact of graft position shift on anterior cruciate ligament reconstruction induced by femoral fixation of interference screw. Methods Nineteen fresh cadaveric knees were used and assigned to three groups. 1) Study of graft position shift: 5 knees were randomly selected, interference screws of 7 mm, 8 mm and 9 mm were used in autologous tendon fixation, then the graft position shift were measured. 2) Study of isometry: 7 knees were randomly divided into the isometric reconstruction group (D group). In the D group, Retrobutton, interference screw and interference screw in location-corrected bone tunnel were used respectively as fixation. The isometry of grafts was evaluated. 3) Study of tibia anterior translation: 7 knees were randomly divided into the anatomic reconstruction group (J group). In the J group,the tibia anterior translation was measured in four different conditions in the same joint: intact knee joint,knee joint without ACL, ACL anatomic reconstruction by interference screw fixation, and ACL anatomic reconstruction by interference screw fixation with corrected bone tunnel location. Results 1) With 7 mm, 8mm and 9 mm interference screw fixation, graft position shift were (2.36±0.11) mm, (2.72±0.06) mm and (3.00±0.06) mm respectively. 2) Graft length change: graft length change in Retrobutton group and corrected bone tunnel group were less than 3 mm, while graft length change in those fixed with interference screw were stretched in more than 3 mm. 3) Study of tibia anterior translation: there was no difference among the intact group, the anatomic group and the corrected group at 0° and 15°. However, the difference was found between the intact group and other groups at 30°、60° and 90° of flexion, as well as between these two reconstructed methods at 20° joint flexion (P＜0.05). Conclusion In both isometric and anatomic ACL reconstruction with interference screw, the graft is pushed tightly toward the femoral tunnel wall, which shifts the graft away from the desired position. In our study we find out that the corrected location of the femoral bone tunnel significantly improves the isometry of ACL reconstruction and anatomic reconstruction.

Objective To evaluate the effects of posterior segmental pedicle screw instrumentation and augmentation using calcium sulphate cement in treatment of Denis type B thoracolumbar burst fractures.Methods Forty patients with Denis type B thoracolumbar burst fracture treated between January 2011 and December 2012 were reviewed retrospectively.Twenty patients received posterior short-segment pedicle screw fixation in conjunction with screw placement at the level of fracture and calcium sulphate augmentation without posterolateral fusion (combined treatment group),but 20 patients underwent traditional short-segment pedicle screw fixation (conventional treatment group).Radiographs and CT scans evaluated local kyphotic angle on the spot of injury,anterior height of the injured vertebra,and canal encroachment before and after operation and at final follow-up.Meanwhile,visual analogue score (VAS),Oswestry disability index (ODI),and neurologic status based upon ASIA 2000 were assessed.Results Mean follow-up period was 15 months (range,12-24 months).Vertebral height restoration was equivalent of the two groups immediately after operation,but better result of kyphosis correction was found in treatment group than in control group (P ＜ 0.05).Anterior vertebral height and kyphotic angle significantly improved in treatment group compared to control group at final follow-up (P ＜ 0.05).Clinical and neurologic outcome evaluation were similar between the two groups.No implant failure occurred at follow-up.Conclusion For Denis type B thoracolumbar burst fractures,posterior segmental pedicle screw fixation augmented with calcium sulphate is effective for reducing correction loss and implant failure,compensating for the deficiencies of conventional fixation.

Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.

Objective To explore the incidence of early complications within 72 hours among patients with six kinds of acute organophosphorus pesticide poisoning,thus to provide reference for the clinical treatment.Methods The retrospective study analyzed the clinical data of 335 cases with acute oral organophosphorus pesticide poisoning treated in Emergency Department of 307 Hospital of PLA from July 2008 to December 2015.Patients were divided into six groups according to the results of serum toxicology tests:acute phorate group (group A),acute dichlorvos group (group B),acute omethoate group (group C),acute dimethoate group (group D),acute phoxim group (group E) and acute parathion group (group F).The incidence of complications among the six groups were compared.The main analysis method was ranks test.Results There were no significant differences among the six groups in the incidence of cerebral edema,liver injury,kidney injury,myocardial injury,gastrointestinal hemorrhage and acute pancreatitis (P ＞ 0.05),while the mortality and the incidence of sudden cardiac arrest (SCA),respiratory failure,circulatory failure,multiple organ dysfunction syndrome (MODS),coagulation disorders and capillary leak syndrome (CLS) were significantly different among the six groups (P ＜ 0.05).The incidence of SCA wihin 24 hours in acutedichlorvos group reached up to 17.8％,and in other groups was as follows:acute parathion group (11.1％),acute dimethoate group (8.9％),acute phorate group (7.8％) and acute omethoategroup (1.5％).However,no one developed SCA in acute phoxim group.The total incidence of circulatory failure in all patients was 10.1％;dichlorvos group 31.1％ and dimethoate group (22.2％) had higher rates than other groups.The incidence of respiratory failure in all groups reached over 20％,while the total incidence was 36.7％,whereby,acute phorate group with a high of 46.7％,acute dichlorvos group with 44.4％,acute parathion group with 44.4％ and acute dimethoate group with 42.2％,respectively.The total incidence of coagulation disorders was 9.6％,while the incidences of the acute dichlorvos group (24.4％),acute phorate group (11.6％) and acute parathion group (11.1％) were higher than 10％.CLS confined to occur in acute dichlorvos group (11.1％) and acute phorate group (2.5％).However,MODS occurred mainly in acute dichlorvos group (28.9％) and acute parathion group (22.2％).Conclusions The incidences of early complications among the six groups are different,while acute oral dichlorvos poisoning patients tend to occur SCA.Within 72 h of poisoning,acute phorate poisoning group is more prone to respiratory failure,and acute dichlorvos poisoning group is more likely to develop coagulopathy disorders,circulation failure,CLS and MODS.Those patients in acute omethoate and acute phoxim poisoning groups have less risk to develop life-threatening complications except respiratory failure.