Objective To investigate the methods and clinical outcome of the operative treatment of thoracolumbar fractures with pedicle screw single segment fixation and the approach through paravertebral muscles.Methods One hundred and twenty patients were selected as our subjects,who were suffered from thoracolumbar fracture without neurological deficit and underwent surgical treatment in the Central Hospital of Zibo from Jan.2009 to Dec.2010.All cases were randomly divided into mini-invasion group and control group.Patients in mini-invasion group were received the single segment fixation of the spatium intermusculare of longissimus muscle and multifidus,and in control group were received the traditional approach with short segment fixation group.The muscle gap approach along the longest muscle and multifidus muscle gap enters,preserving the integrity of the paraspinal muscles.Results The operation periods of mini-invasion group and control group were (53.8 ± 12.3) min and (88.5 ± 18.5) min (t =1.731,P ＜ 0.05),the intraoperative bleeding volume were (95.7 ±21.5) ml and (280.3 ±83.1) ml(t =2.414,P ＜0.05),the postoperative drainage volume were (20.4±8.2) ml and (132.9 ±50.3) ml(t =2.068,P ＜0.05) and inpatient time were (13.8 ±2.2)d and (20.4 ±5.5)d(t =1.853,P ＜0.05).However,there was no significant difference in terms of fracture healing time,visual analogue scale,Oswestry disability index and radiology(P ＞0.05).All cases had union of fractures and no reduction loss and fixation failure occurred.Condusion The treatment of pedicle screw single segment fixation and the approach through paravertebral muscles on thoracolumbar fracture is proved to be an effective method with minimally invasive,less bleeding volume,simple procedure and fast recovery method.

OBJECTIVE:To observe the clinical efficacy and safety of leflunomide combined with prednisone in the treatment of polymyositis. METHODS:Totally 98 polymyositis patients in our hospital were divided into observation group and control group by random number table,49 cases in each group. Control group received Prednisone tablet with initial dose of 60-100 mg/d,tid, then gradually reduced to maintaining dose of 10 mg/d,tid,based on patients'improvement of creatine kinase(CK)and clinical symptoms. Observation group was additionally given Leflunomide tablet 10 mg,bid,based on the control group. They all treated for 120 d. Clinical efficacy,muscle strength evaluation,muscle enzymes [including CK,lactate dehydrogenase(LDH),aspartate aminotransferase(AST),creatine phosphokinase(CPK),alanine aminotransferase(ALT)] and serum inflammatory factors(includ-ing IL-2,IL-8,IL-12,TNF-α,hs-CRP)before and after treatment in 2 groups were observed,the incidence of adverse reactions in 2 groups was recorded. RESULTS:After treatment,the total effective rate(87.8% vs. 75.5%)and muscle strength achieving grade 3(81.6% vs. 55.1%)in observation group were significantly higher than control group,and the total adverse reaction rate (12.2% vs. 22.4%)was lower than control,with statistically significances(P<0.05). After treatment,the muscle enzymes and se-rum inflammatory factor levels in groups were significantly lower than before,and observation group was lower than control group,with statistically significances(P<0.05). CONCLUSIONS:Leflunomide combined with prednisone shows good efficacy in the treatment of polymyositis,it can significantly improve the muscle strength,muscle enzymes and serum inflammatory factor lev-els,and dose not increase the incidence of adverse reactions,with good safety.

[Objective]To explore the allograft,as a substitute for autograft,whether can be used to repair the defect of the tendon and restore the stability of joint and the dynamic biomechanical changes of allograft after transplantation.[Method]Deep-frozen allogeneic achilles tendons of rabbits were used as treatment group,and autogenous ones as control.The achilles tendon defects of back limbs were repaired by allograft and autograft separately.The macroscopic,microscopic observation and biomechanical test were performed on both of them before transplantation and in 2,4 and 8 weeks after transplantation.[Result]It was showed that there were no differences in macroscopy,microscopy and mechanical strength between allograft and autograft both before and after transplantation.They may have experienced the similar healing course.The mechanical strength of allograft(except failure strain) was reduced significantly after transplantation.But it had a rising trend with time passing,although it was fairly low in 8 weeks compared with the normal such as maximum load.[Conclusion]The results demonstrate that the deep-frozen allograft can substitute for autograft in repairing the tendon defect,and because of the weakness of allograft after transplantation,it needs appropriate protection to prevent failure by excessive strain in early stage.

[Objective]To study the effect of femoral offset and hip joint center on joint function after total hip replacement,radiographic measurements were taken postoperation.[Method]A series of 92 hip joints(87 patients)were followed up.The average follow up priod was 25 monthes.The femoral offset and the position of the prothesis head center were measured in the orthophoric hip joint X-ray photograph and were compared with anatomic Fo and HJC.H arris evaluation system was used to evaluate joint function in four groups.The results were statistically analyzed,with Fisher' exact probability and P value less than 0.05 indicating significant difference.[Result]The coincidence rate of group A(both FO and HJC,27 hips)was 29.35%,group B(only Fo,23 hips)25.00%,group C(only HJC,31 hips)33.70%,group D(neither FO nor HJC,11 hips)11.96%.93.0% patients got the Harris score more than 80 for group A,73.19%(group B),74.19%(group C),27.27%(group D).The difference of Harris evaluation between A and B,A and C,A and D was significant statistically.[Conclusion]Based on the results of the study,the recovery of femoral offset and hip joint center should be considered to contribute to the healing effect after total hip replacement directly.

Objective To explore the expression of breast cancer susceptibility gene 1 (BRCA1) in human colorectal cancer and its correlation with the efficacy of platinum-based chemotherapy.Methods Seventy-eight cases of colorectal cancer patients treated with platinum-based chemotherapy after surgery were collected.The surgical specimens of them were taken.Fourteen normal colonic mucosa specimens and 12 non-cancerous tissues of colorectal cancer specimens were obtained.The expression of BRCA1 in tissues was detected by immunohistochemistry and analyzed by x2 test.The colorectal cancer patients were followed up for survival time.Comparison of survival analysis was performed by Kaplan-Meier survival curves and Log-rank test.Results The positive rate of the BRCA1 expression in colorectal cancer tissue (52.6 ％,41/78) was lower than that of para-cancer tissue (11/12,x2 =6.518,P=0.011) and normal colonic mucosa tissue (13/14,x2 =7.949,P=0.005).The poorer the differentiation of colorectal cancer,the lower the positive rate of BRCA1 (x2=14.160,P=0.001).The median disease-free survival time of BRCA1 negative colorectal cancer patients was 51.0 months (95 ％ CI:47.7 to 54.4 months),which was longer than that of BRCA1 positive patients (45.0 months,95 ％CI:36.6 to 53.4 months,x2 =4.367,P=0.032).Conclusions Receiving oxaliplatin based chemotherapy may be a survival benefit for BRCA1 negative colorectal cancer patients.The expression of BRCA1 may be an index for chemotherapy options and prognosis evaluation for colorectal cancer patients after surgery.

Objective To investigate the association of age,precipitating factors and seasons of symptom onset of urinary stones with patients who have or have no family history. Methods The questionaires were used to survey 360 urinary stone cases with family history,1200 cases without family history and 1000 normal controls in Chongqing Area. Results In the 360 patients with family history,the morbidity rates of the first degree relatives and second degree relatives were 10.71%(147/1372) and 1.68%(54/3214), respectively.But in those without family history,the morbidity rates of the first degree relatives and second degree relatives was 0.66%(23/3480) and 0.12%(9/7345),respectively.Among the patients with family history,the mean age of morbidity for the males (26.35 years) was younger than that of the females (36.4 years, t=1.75,P 0.05).There was no significant difference of the precipitating factors and symptom onset seasons between patients with or without family history,while the enviropmental factors had significant effects on the morbidity of urinary stone patients,without regard to family history(? 2=0.23, P

Objective To investigate the compensatory changes in morphology,function,and hemodynamic indices of the retained kidney after nephrectomy among living related donors.Method The 170 living related kidney donors underwent assessments before surgery as well as at 1st and 12th month,postoperatively,including length,width,short diameter,glomerular filtration rate (GFR),effective renal plasma flow (ERPF),peak systolic blood flow velocity (Vsmax),resistance index (RI),as well as pulsatility indices (PI) of main renal artery (MRA),segmental renal artery (SRA),and interlobar renal artery (IRA).Results All subjects were followed up for 9 to 68 months,with no observed hypertension or kidney failure.The length,width,and short diameters of the retained kidney were increased significantly (P＜0.01) at 1st and 12th month postoperatively.The renal sizes at 1st month postoperation were similar to that at 12th month postoperation (P＞0.05).GFR and ERPF were increased significantly as compared with preoperative values (P＜0.01) with similar values at postoperative month 1 and 12 (P＞0.05).The Vsmax of MRA,SRA,and IRA in the retained kidney were increased significantly (P＜0.01),and the RI and PI were also increased as compared with the preoperative values (P＜0.05),albeit these indicators were similar at postoperative months 1 and 12 (P＞0.05).Conclusion For all subjects studied after unilateral nephrectomy in a living related donor,the diameter of the retained kidney as well as the GFR and ERPF showed compensatory increases.Various arterial hemodynamic parameters also showed compensatory changes.Under strict donor inclusion criteria,living related kidney donor procedures is safe.

Objective To study the safety and efficacy of low dose Peginterferon-alpha-2a (PEG-INF-α-2a) combined with Ribavirin treating chronic hepatitis C in renal transplant recipients.Methods A total of 13 cases of HCV hepatitis were randomly divided into treatment and control groups.Seven cases in treatment group were given PEG-INF-α-2a (90 μg/week) and ribavirin (600mg/day) for 16 to 48 weeks,and the rest 6 cases in control group were subjected to general liver protection and anti-inflammatory treatment. All patients were followed up for more than 2 years.Results There were 5 cases getting early response in treatment group for 16 weeks,including four cases of complete response and no non-effects response patients. In 4 cases voluntarily receiving treatment for 48 weeks,1 case had facial muscle myalgia and increased Cr level at 35th week,humoral graft rejection was confirmed pathologically,and the treatment was terminated; 1 case had recurrence of HCV RNA replication and PEG-INF-α-2a was withdrawn at 38th week.As results,5 patients in the treatment group obtained complete response after two years,including 2 cases whose HCV-IgG had got negative,HCV RNA replication was significantly lower than in the control group,and the average Cr higher than in control group (P＞ 0.05). There were adverse reactions during this treatment protocol: fever,muscle myalgia,agranulocytosis, anemia and humoral graft rejection.Conclusion The efficacy of low lose PEG-INF α-2a combined with ribavirin is definite in the treatment of chronic HCV hepatitis in kidney transplant recipients.The 16-week treatment duration is reasonable.It is remarkable that PEG-INF-α-2a may cause humoral graft rejection and Cr crawling.

Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible Acinetobacter (mortality 40.0% vs 18.2%,P <0.05).Of the 32 patients who had infections with carbapenem-non-susceptible Acinetobacter,20 received sulbactam-containing antimicrobial agent.The mor-tality of these 20 patients was 20.0% (4/20),significantly lower than that of the 12 patients who did not receive sulbactam-containing antimicrobial agent (66.7%).Conclusions Majority of the bloodstream infections caused by multidrug-resistant Acinetobacter are nosocomial infections.Surgical operation and serious condition may predispose the patients to develop Acine-tobacter bacteremia.Acinetobacter isolates are highly resistant to commonly used antibiotics.The Acinetobacter isolates not susceptible to carbapenem or cefoperazone-sulbactam are associated with poorer outcome and higher mortality.More attention should be paid to prevention and control of Acinetobacter-related nosocomial infections.

Objective To explore the association of transforming growth factor-beta 1(TGF-β1) polymorphisms with coronary heart disease(CHD).Methods The 509C/T polymorphisms of TGF-β1 gene were analyzed by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) in 300 patients of CHD and 300 healthy individuals,the levels of serum lipids and hsCRP were also studied.Results The levels of hsCRP、TC 、LDL、ApoB in serum and the frequencies of C、T allele at position-509 of TGF-β1 gene were statistically significant higher than the controls(P＜0.01,P＜0.05).Conclusion The polymorphisms of TGFβ1-509C/T were associated with CHD.C allele should be the susceptibility gene in the occurence of CHD.