Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.

Objective To summarize the experience of modified mini-cholecystectomy. Methods A total of 128 patients underwent mini-cholecystectomy by using a modified Bookwalter retractor, a self-made deep-site tying tool and an L-shape electrotome from September 1998 to June 2003. Results That the length of incision ≤ 6 cm was regarded as a surgical success. Out of the 128 patients, the surgical success was achieved in 110 patients (85 9%). Conclusions In mini-cholecystectomy, the use of the modified Bookwalter retractor greatly improves the visualization of operation field, and the use of the self-made tying tool facilitates deep-site manual knot tying.

Objective To investigate the clinical efficacy of three-dimensional conformal radiotherapy combined with XELOX program chemotherapy in the treatment of postoperative local recurrence of rectal cancer.Methods One hundred and twenty-nine patients with postoperative local recurrence of rectal cancer were divided by random digits table method into treatment group (65 cases) and control group (64 cases).The patients in treatment group were treated with three-dimensional confonmal radiotherapy combined with XELOX program chemotherapy.The patients in control group were treated with XELOX program chemotherapy.The short-term effect,symptom control rate,long-term efficacy and adverse reaction were observed.Results The efficiency rate in treatment group [ 90.8％ (59/65) ] was significantly higher than that in control group [ 73.4％(47/64) ] (P ＜ 0.05 ).The improvement rates of pain,hematochezia and incomplete obstruction between treatment group and control group had significantly statistical differences [95.2％(40/42) vs.75.0％(27/36),92.9％(26/28) vs.79.5％(31/39),94.7％(18/19) vs.75.0％(9/12)](P ＜0.05).The 1,2,3-year survival rates between treatment group and control group had significantly statistical differences [ 67.7％ ( 42/62 ) vs.43.5 ％ ( 27/62 ),53.2％ ( 33/62 ) vs.30.6％ ( 19/62 ),38.7％ ( 24/62 )vs.14.5％ (9/62)] (P ＜ 0.01 ).The adverse reaction in two groups were mainly bone marrow suppression,gastrointestinal reactions,hand-fcot syndrome and radiation cystitis.The incidence rate of adverse reaction in treatment group was slightly higher than that in control group,but there was no significant difference between two groups (P ＞ 0.05).Conclusion Three-dimensional conformal radiotherapy combined with XELOX program chemotherapy in patients with postoperative local recurrence of rectal cancer can improve the short-term effect,symptom control rate and long-term survival rate.

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of pancreatic pseudocysts,cystadenomas and cystadenocarcinomas,so as to improve diagnostic accuracy of the condition.Methods The results of CEUS and conventional ultrasound for 71 patients with pancreatic cystic lesions were analyzed retrospectively,and compared with the finally obtained surgical-pathological examination to assess the ability of qualitative diagnosis between two methods.Results In 71 pancreatic cystic lesions,there were 32 pancreatic pseudocysts,24 cystadenomas and 15 cystadenocarcinomas.The sensitivity and accuracy of CEUS for pancreatic pseudocysts and cystadenocarcinomas were 84.4％,93.0％ and 86.7％,88.7％,which were higher than those of conventional ultrasound 56.3 ％,80.3 ％ and 53.3 ％,74.6％ (x2 =6.06,4.92,3.97,4.71,all P ＜ 0.05).Conclusion There are some similarities in terms of imaging manifestations among pancreatic pseudocysts,cystadenomas and cystadenocarcinomas.Combining conventional ultrasound with CEUS can help the differential diagnosis of pancreatic cystic lesions.

Objective To establish a learning evaluation indexes systen of flipped teaching method,and provide the basis for evaluating academic performance of each student who majors in nursing.Methods The indexes were determined by Delphi method of two rounds of consultation involving 15 experts,and the weight of every index was set up by analytic hierarchy process.Results The response rates of questionnaire investigation for the two rounds of consultation were 13/15 and 12/13 respectively.The authority value of experts was 0.847.The Kendall concordance coefficients for the indexes of first-level,second-level and third-level were 0.373,0.258 and 0.595 respectively,P＜0.05.Finally,the evaluation indexes system including 3 first-level indexes,5 second-level indexes,and 6 third-level indexes was set up.Conclusions The results of the two rounds of expert consultation are reliable.The consistency of expert opinions is good.The study provides a scientific and systematic evaluation tool for evaluating nursing undergraduates' performance under flipped teaching.

Objective: To explore the expression and gene amplification status of human epidermal growth factor receptor-2 (HER2) in the different stages of invasive urothelial bladder carcinoma. Methods:Tumor tissues from 49 patients with different stages of invasive urothelial bladder carcinoma were tested by immunohistochemical staining for HER2 and HER2 gene fluorescence in situ hybridization. Results:The number of male patients was higher than that of females. The positive rate of HER2 protein expression was higher in the patients with the higher stage of invasive urothelial bladder carcinoma. However, no gene amplification was observed in all patients. Twelve patients had ployploid chromosome 17. More ployploids were observed in the patients with the higher stage of inva-sive urothelial bladder carcinoma. Conclusion:The increase in the protein expression of HER2 in the invasive urothelial bladder carci-noma patients was not caused by gene amplification. Other transcriptional and post-transcriptional mechanisms were probably involved in the regulation of the HER2 protein.

Objective To study the protection of vanillin derivative VND3207 on the cytogenetic damage of mouse bone marrow cell induced by ionizing radiation.Methods BALB/c mice were randomly divided into five groups:normal control group,2 Gy dose irradiation group,and three groups of 2 Gy irradiaiton with VND3207 protection at doses of 10,50 and 100 mg/kg,respectively.VND3207 was given by intragastric administration once a day for five days.Two hours after the last drug administration,the mice were irradiated with 2 Gy γ-rays.The changes of polychromatophilic erythroblasts micronuclei (MN),chromosome aberration (CA) and mitosis index (MI) of mouse bone marrow cells were observed at 24 and 48 h after irradiation.Results Under the protection of VND3207 at the dosages 10,50,100 mg/kg,the yields of poly-chromatophilic erythroblasts MN and CA of bone marrow cells were significantly decreased(t = 2.36-4.26,P ＜ 0.05),and the marrow cells MI remained much higher level compared with the irradiated mice without drug protection (t = 2.58,2.01,P ＜ 0.05).The radiological protection effect was drug dose-dependent,and the administration of VND3207 at the dosage of 100 mg/kg resulted in reduction by 50% and 65% in the yields of MN and CA,respectively.Conclusions VND3207 had a good protection effect of on γ-ray induced cytogentic damage of mouse bone marrow cells.

Objective: To investigate the impact for family history of hypertension on masked hypertension (MH) morbidity with relevant cardiac damage. Methods: Our research included in 3 groups: MH group, n=250 consecutive patients treated in our hospital from 2010-01 to 2015-04, Hypertension group, n=250 and Control group, n=250 subjects with normal blood pressure. The family history of hypertension, general clinical information, routine biochemical indexes and the findings of echocardiography were studied and compared among different groups. Results: ① There were 70 (28%) patients with family history of hypertension in MH group, 87 (34.8%) in Hypertension group and 26 (10.4%) in Control group. The ratio of family history of hypertension in MH group was higher than Control group, P<0.001, while it was similar between MH group and Hypertension group, P>0.05. Logistic regression analysis presented that family history of hypertension and body mass index were positively related to the morbidities of MH (r=1.468, r=0.173) and hypertension (r=1.195, r=0.086). ② Compared with Control group, MH group had increased left ventricular mass index (85.64 ± 17.7) g/m2 vs (80.50 ± 15.53) g/m2 and the maximum blood flow velocity of aortic valve (115.74 ± 16.54) cm/s vs (112.40±14.21) cm/s, all P<0.05. In MH group, compared with those without family history of hypertension, the patients with family history had the higher left ventricular mass index (89.22 ± 19.08) g/m2 vs (84.25 ± 16.99) g/m2 and the maximum blood flow velocity of aortic valve (119.19 ± 14.97) g/m2 vs (114.39 ± 16.96) g/m2, all P<0.05. Conclusion: The subjects with family history of hypertension had the higher risk of MH morbidity with more severe cardiac damage.

Objective To summarize the clinical features of the pancreaticopleural fistula (PPF) in children in order to improve the understanding of PPF and to make early diagnosis and treatment of the disease.Methods Five cases of pediatric PPF in Beijing Children's Hospital Affiliated to Capital Medical University from December 2007 to March 2014 were studied by retrospective analysis.The clinical features, laboratory results, image characteristics, treatment and prognosis were reviewed.Results Five cases of PPF were diagnosed aged between 2 years to 10 years and 5 months old, history from more than 1 month to 6 months.The main symptoms were chest tightness (3 cases), chest pain (3 cases) , fever(3 cases) , wheeze (1 case) , dyspnea (1 case).Only 1 case was with abdominal pain and abdominal distension when he was admitted to hospital.All patients had massive pleural effusions, included right side (3 cases),left side(1 case) ,bilateral sides(1 case), 1 case complicated with massive ascites.Pleural fluid amylase of all the cases was significantly elevated (＞ 1 000 U/L) ,the highest was more than 50 000 U/L.Four cases had positive findings of pancreas by transabdominal ultrasound.Five cases had morphological changes in pancreas by magnetic resonance cholangiopancreatography (MRCP).Four cases had PPF and pancreatic pseudocysts respectively.Conservative treatment was given to 5 cases, but further 3 cases reveived stent insertion by endoscopic retrograde cholangiopanereatography, and 2 cases reveived surgical therapy.Conclusions PPF is rare in children, the main clinical feature is massive pleural effusion with respiratory symptoms.Pleural fluid amylase would be significantly elevated.The diagnosis of PPF generally relies on imaging, MRCP is considered the imaging study of choice for PPF due to its superiority in identifying a fistula in the pancreatic region and its noninvasiveness as compared to endoscopic retrograde cholangio pancreatography.Endoscopic and surgical therapy can be used if internal therapy is not satisfactory.

Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods A retrospective study was conducted within 587 patients (average age 57.1 years,range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital,including 334 males and 253 females.Patients were divided into a symptomatic group and an asymptomatic group.The causes of contralateral neurological symptom were evaluated according to the radiological data.The difference of pre-and post-operative contralateral foramen area (CFA),segmental angle (SA) and the clinical treatment outcomes (VAS,JOA score) were compared between two groups.Results Patients were followed up for 9-21 months,average 15.1 months.Post-operative contralateral radiculopathy occurred in 28 (4.8％) of the patients who underwent unilateral TLIF,including contralateral foraminal stenosis in 16 (57.1％,16/28),screw malposition in 5 (17.9％,5/28),contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7％,3/28),hematoma in 1 (3.6％,1/28),cement compression in 1 (3.6％,1/28),and unknown origin in 2 patients (7.1％,2/28).Nineteen (3.2％,19/587) of the 28 patients received revision surgery because of ineffective conservative treatment.Compared with the asymptomatic group,the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group,while the SA was significantly greater (7.0°±9.8°) in symptomatic group.The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0％±18.1％,P＜0.05).Conclusion The incidence rate of contralateral neurological symptom was 4.8％ in the present study.The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition.The excessive restoration of SA might have an effect on contralateral nerve compression,which should arouse the attention of the surgeon.