Objective:To investigate the clinical effectiveness analysis on biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice.Methods:98malignant obstructive jaundice patients undergoing percutaneous transhepatic biliary drainage requirement of biliary stent were divided into combined group(n=53) and simple group(n=45).Patients in combined group were taken biliary stent combined with 125I seed implantation,while in simple group were only taken biliary stent.All patients were followed up for 4 to 28 months.The changes of total bilirubin were recorded before percutaneous bile duct drainage,7 d,30 d and 90 d after biliary stent implantation.The recurrences of biliary obstruction of the two groups were recorded.The changes of T lymphocyte subsets in peripheral blood were detected before percutaneous bile duct drainage and after biliary stent implantation 7 d.The survival times of the two groups were compared.Results:All patients were successfully completed biliary stent implantation,surgical success rate was 100％.The total bilirubin levels of patients in combined group 30 d and 90 d after stent implantation were significantly lower than the simple group,the differences were statistically significant (P＜0.05).After surgery 7 d,the CD4 level and CD4/CD8 ratio in combined group were increased compared with before surgery,while in the simple group were declined,the differences were statistically significant (P＜0.05).Compared with the simple group,the CD4 level and CD4/CD8 ratio in combined group after surgery 7d were significantly increased (P＜0.05).2 cases (3.8％) of patients were recurrence of biliary obstruction,which were lower than 17 cases (37.8％) in the simple group,the difference was statistically significant (P＜0.001).The median survival time in combined group was 10.6 months,which was significantly longer than 7.5 months in the simple group,the difference was statistically significant (P＜0.05).Conclusion:Biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice might relieve the symptom of biliary obstruction,and helped to improve cellular immune function of patients and reduce the recurrence of biliary obstruction.It had great significance to improve the quality of life of patients and prolong the survival time.

Objective To evaluate the clinical results of surgical treatment of intra articular fractures of the calcaneus using calcaneal anatomical plate. Methods From January 1999 to September 2003, 82 patients with calcaneal fracture were treated differently based on the results of X ray and semi coronal CT scan performed before and after the treatment. According to Sanders classification system, there were 36 cases of type Ⅲand 9 cases of type Ⅳwho received treatment of lateral L type incision and internal fixation with calcaneal anatomical plate. Results The internal fixation with the calcaneal anatomical plate almost restored the height, length and width of the calcaneus for the 45 patients. Infection of incision happened in 3 patients but healed after debridement and administration of antibiotics. Because of severe subtalar osteoarthrosis, 4 patients experienced subtalar arthrodesis. The follow ups averaged 38 months. According to the classification of calcaneal fractures by the American Surgery Association of Foot and Ankle, the results were excellent in 6, good in 26, fair in 7,and poor in 6. The excellent and good rate was 71.1%. Conclusion The internal fixation with the calcaneal anatomical plate to treat intra articular fractures of the calcaneus of Sanders Ⅲand Sanders Ⅳcan renew the calcaneal configuration and achieve preferable clinical effects.

Objective To study the experiences of severe acute pancreatitis (SAP) treated by combmation of traditional Chinese and western medicine.Methods Two hundred and forty patients with SAP were divided into A and B groups randomly,140 patients of group B were treated by combination of traditional Chinese and western medicine;100 patients of group A were treated by western medicine.Results After treatment in group B, the serum and urine amylase, and c-reactive protein,signiflcantly decreased.The complication rate of group A and group B was 55.00 % and 12.86 %(P

Objective To evaluate the clinical efficacy of monosegmental pedicle instrumentation in management of thoracolumbar burst fractures. Methods A total of 67 patients with traumatic thora-columbar burst fractures (type A3.1 and A3.2) were treated with monosegmental pedicle instrumentation in our department from October 2003 to February 2008. Imageologic effect was observed by measuring sagittal index and wedge index via X-ray and clinical outcomes evaluated by using low back outcome score. Results All operations were performed successfully, with average operation duration of 93 mi-nutes and average intraoperative blood loss of 157 ml. Of all, 65 patients were followed up for 4-27 months (average 19.8 months), which showed that all the patients achieved bony fusion, with no implant failure except for one with screw loosening. The sagittal index and wedge index were 13.06°and 42.9% preoperatively and 4.47° and 21.78% postoperatively, with statistical difference (P <0.01). The final follow-up showed no significant correction loss except for two patients (P < 0.05). The low back outcome scores of all patients at follow-up were improved significantly (P < 0.05). Conclusions Monoseg-mental pedicle instrumentation has advantages of minimal invasion, short operative duration, less blood loss and less vertebral motion segment loss and hence is an effective and reliable operative technique for thoracolumbar burst fractures.

Objective To study the expressions of S100A4 and urokinase plasminogen activator(uPA) in pancreatic cancer cells and their correlation with patients prognosis.Methods The expressions of S100A4 and uPA were examined in 63 surgical specimens of primary pancreatic carcinoma by suing immunohistochemistry PV methods,and correlation of their expressions and prognosis of pancreatic cancer was analyzed.Results ( 1 ) Positive immunostaining for S100A4 and uPA was observed in 74.6％ (47 cases) and 65.1％ (44 cases) of 63 pancreatic cancer samples respectively.(2) The positive expressions of S100A4 and uPA were significantly correlated in pancreatic cancer( P =0.000,r =0.567 ).( 3 ) The expression of S100A4 significantly correlated with TNM stages( P =0.002 ),lymph node metastasis ( P =0.002 ) and distant metastasis ( P =0.007 ).The expression of uPA had a significant correlation with TNM stages ( P =0.002),lymph node metastasis ( P =0.001 )and differentiation(P =0.003).(4) Kaplan-Meier survival analysis showed that the median survival (21 months) of patients with S100A4 ( - ) was significantly longer than the median survival ( 9 months) of the patients with S100A4( + )(P=0.000) ;the median survival(9 months) of patients with uPA( + ) was significantly shorter than the median survival ( 18 months) of the patients with uPA ( - ) ( P =0.000) ; the median survival(23 months)of 13 patients with S100A4( - )/uPA( - )was significantly longer than the median survival of other cases ( Log-rank test,x2 =54.444,P =0.000).( 5 ) Cox regression model ( x2 =53.974,P =0.000 )analysis suggested:the differentiation(P =0.004),lymph node metastasis(P =0.017) 、S100A4( + ) expression ( P =0.000) and uPA ( + ) expression ( P =0.001 ) were independent prognostic factors for pancreatic cancer.Conclusion S100A4 and uPA are highly expressed in pancreatic cancer cells,and S100A4 expression has positive correlation with uPA expression,which indicates that the overexpression of S100A4 and uPA maybe poor prognosis factors for pancreatic cancer patients.S100A4 maybe promote extracellular matrix and basement membrane degradation by up-regulation of uPA protein expression,and ultimately promote tumor invasion and metastasis,which is not favorable to prognosis.They may be potential indicators of metastasis and predictors for prognosis of pancreatic cancer.

BACKGROUND:Hydroxyapatite (HA) artificial bone,as bone grafting substitute,would not cause inflammatory reaction or immunological rejection and possesses good biocompatibility after transplantation into human body.It is a novel implant material with bone conduction ability.OBJECTIVE:To investigate the efficacy of HA artificial bone in bilateral open-door posterior cervical expansive laminoplasty and to make a comparison with autogenous bone.DESIGN,TIME AND SETFING:A retrospective case analysis was performed at the Department of Spine Surgery,Hungpuyuan Branch,the First Affiliated Hospital of Sun Yat-sen University from March 2001 to December 2008.PARTICIPANTS:Seventy patients with cervical spondylosis complicated by compression in 3 or more segments or by cervical stenosis and additional fifteen patients with cervical stenosis complicated by cervical trauma were included in this study.METHODS:A bilateral open-door posterior cervical expansive laminoplasty was performed,in which,23 patients received autogenous bone transplantation (autogenous bone group) and 62 patients underwent HA artificial bone transplantation (HA group).MAIN OUTCOME MEASURES:① Japanese Orthopaedic Association (JOA) score pdor to and after surgery,surgery time,and intraoperative bleeding.② HA artificial bone-host biocompatibility.RESULTS:All eighty-five patients were followed up for more than 3 months.There was no significant difference in JOA scores no matter prior to or after surgery between the autogenous bone and HA groups (P＞0.05).The surgery time averaged 85.2 minutes (range 65-110 minutes) in the HA group and averaged 116.4 minutes (range 75-150 minutes) in the autogenous bone group.The intraoperative bleeding averaged 210 mL (range 130-400 mL) in the HA group and averaged 260 mL (range 170-500 mL) in the autogenous bone group.There were no material-host response and other severe complications found in each group,except HA artificial bone fragmentation in 3 patients from the HA group.CONCLUSION:HA artificial bone yields good efficacy and causes fewer complications in bilateral open-door posterior cervical expansive laminoplasty;in addition,it requires less time for surgery and causes less bleeding.

Objective To compare the dose distribution of postoperative plans with preoperative plans for 3D printing guide template assist radioactive seeds implantations,and explore the accuracy of treatment at dosimetry level.Methods A total of fourteen patients registered from Dec 2015 to Mar 2016 who were applied with 3D printing guide template assisted radioactive seed implantations in the hospital were included in this study.The preoperative planning design and 3D printing template production were performed for all patients.The dose related parameters including D90％,minimum peripheral dose (MPD),V100％,V150％,V200％,conformal index (CI),external index (EI),and homogeneity index (HI) were compared between pre-and post-operation.The paired t-test was used to perform the statistical analysis.Results A total of fourteen 3D printing individual templates were produced which included 16 treatment areas.Compared with preoperative plans,the mean value of V100％,Dg0％ and V150％ decreased while the mean value of V200％ and MPD increased in postoperative plans.However,there was no significant difference between the two groups except for V100％ (t =2.451,P ＜0.05).The differences of CI,EI,HI between two groups were not statistically significant (P ＞ 0.05).Conclusions The validation of actual dose distribution in postoperation assistied by 3D printing template in seed implantation shows that most of parameters could meet the expectation of preoperative plans,which indicates the improvement in accuracy for this new type of treatment.

Objective To explore the executive function in patients with mild traumatic brain injury (mTBI). Methods The evaluation of executive function was conducted in 63 mTBI patients in 1 week, 1, 3 and 6 month after injury and 60 health controls. The executive function was evaluated using Trail Making Test (TMTA), Hopkins Verbal Learning Test-revised (HVLT-R), Brief Visuospatial Memory Test-revised (BVMT-R), Stroop Color Word Tes and Con-tinuous Performance Test (CPT). Results There were significant differences between mTBI patients and controls in TM-TA, HVLT-R, BVMT-R, Stroop Color Word Test and CPT a week following TBI (P<0.05). There were a significant in-crease in scores of TMTA and a significant decrease in HVLT-R, BVMT-R, stroop and CPT-IP at 1, 3 and 6 month compared with 1 week following TBI (P<0.05). There were a significant decrease in TMTA and a significant increase in BVMT-R and stroop 1 month compared with 1 week following TBI (P<0.05). There were a significant increase in stroop, BVMT-R and CPT-IP at 3 month compared with 1 month following TBI (P<0.05). There was a significant increase in stroop and CPT-IP at 6 month compared with 3 month following TBI (P<0.05). Conclusions Patients with mTBI have executive function impairment. The recovery times of different executive function are different in patients with mTBI.

Objective To investigate the indications and clinical effect of the low-big hole choledochoduodenostomy. Methods Two hundred and ninty-eight patients, had bile duct stone accompanied with common bile duct lower segment stenosis, were prospectively enrolled into the study and randomly divided into the low-big hole choledochoduodenostomy (improved CD ) group (n = 148 ) and the Roux-en-Y choledochojejunostomy (CJ) group (n = 150). Their perioperative period and long term effect indices were recorded and compared. Results Perioperative period indices:The time of cholangio-jejunostomy was much shorter in improved CD group than the CJ group ([31.0±10.5] min vs [53.0±12.3] min, P＜0.001);The anastomotic leakage was significantly less in improved CD group than the CJ group (2 vs 9, P ＜ 0. 001 ). The long term effect indices: The occurrence of peptic ulcer (3 vs 15 ) and the bile duct cecum or blind loop syndrome (5 vs 158) were significantly lower in group improved CD group than CJ group (Ps＜0.01);The occurrence of bile duct backflow (70 vs 42) was significantly higher in improved CD group than CJ group (P＜0. 0l). Conclusion The clinical effect of the low-big hole choledochoduodenostomy gastrointestinal had excellent effect for bile duct stone accompanied with common bile duct lower segment stenosis, especially for old,weak and critical patients,and it can not be replaced by the Roux-en-Y choledochojejunostomy.

Objective To investigate the effects of the wound isolation in prevention of abdominal wound infection. Methods 2549 patients who bearded abdominal operation in 3 years in our hospital were randomly divid-ed into wound isolation group (n=1300) and control group(n=1249). The wound infection rates were summarized by operation ways and major influencing factors. Results The overall wound infection rate of control group and wound isolation group was 5.9% (76/1300) and 2.6% (32/1249). The infection rate was 13.4% (40/300) and 3.1% (9/280) in gallbladder resection, 14.7 % (24/165) and 3.5 % (6/159) in radical operation for carcinoma of colon, 13.6% (15/108) and 3.2% (13/114) in intestine block operation, 9.6% (18/187) and 1.8% (3/169) in stomach resection (P<0.01);The infection rate was 9.3% (13/145)and 2.9% (4/153)in biliary exploration, 14.6% (8/55) and 1.8% (1/56) in WHIPPLE, 10.6% (9/85) and 2.3% (2/88) in cholecystectomy (P<0.05);The infection rate was 6.3% (6/95) and 2.3% (2/86) in liver resection, 5.3% (5/95) and 1.2% (1/87) in spleen resection, 4.6% (3/65) and 1.8% (1/57) in porto-azygos venous disconnection (P>0.05). The wound infection rate of type Ⅰ resection of control group and wound isolation group was 2.0% (6/305) and 1.4% (4/280) (P> 0.05);The infection rate of type Ⅱ and Ⅲ resection was 7.0% (70/995) and 2.9% (28/969), for old man (≥60) was 12.6% (36/286) and 3.6% (10/279), the emergency operation was 10.0% (38/381) and 2.8% (10/362), the operation time ≥3 h was 9.0% (39/435) and 2.8% (12/426), with diabetes was 14.5% (21/145) and 4.9% (6/123), with obesity was 12.3% (40/325) and 3.9% (12/310), with malnutrition was 8.5% (39/458) and 3.2% (14/433), with cancer was 8.6% (40/465) and 3.0% (15/496) (P<0.01).;undergoing unemergency operation was 4.1% (38/919) and 2.5% (22/887),for yong persons (<60) was 3.9% (40/1014) and 2.3% (22/970), with operation time<3 h was (37/865) and 2.4% (20/823), without diabetes was 3.9% (45/1155) and 2.3 % (26/1126), without obesity was 3.7 % (36/975) and 2.1% (20/939), without malnutrition was 4.4% (37/842) and 2.2% (18/816)and without cancer was 4.3% (36/835) and 2.3% (17/753) (P<0.05). Conclu-sions The wound isolation can decrease the wound infection rates by reducing the chance of bacterial contamina-tion.