Objective To discuss the procedural problems and solution correlatively of CT-guided percutaneous biopsy of spinal diseases,with simultaneous evaluation of the safety and clinical application.Methods Sixty-eight cases with spinal diseases were taken CT-guided percutaneous biopsy under local anesthesia and CT guidance,including 9 in cervical spine,19 in thoracic spine,28 in lumbar spine and 12 in sacral spine.The program of carrying out the procedure was decided according to the site,approach route of the lesion with the destination of sampling,under CT guidance.Results The successful rate of needle puncture was 100%(68/68)with diagnostic accuracy of 92.6%(63/68),and false-negative rate of 7.4%(5/68),together with complications rate of 5.9%(4/68).Conclusions CT-guided vertebral biopsy is safe,reliable,less complication,high accuracy and together with clear demonstration of the position of puncture needle and the complex anatomic structures nearby,providing basic information for further clinical treatment and worthy to be recommended.

Objective To retrospectively analyze the prognostic factors of advanced esophageal carcinoma (EPC) with concurrent chemoradiotherapy.Methods A total of 200 advanced EPC patients between January 2008 and December 2011 were reviewed,and all of them received concurrent chemoradiotherapy,either IMRT or CRT.Among them,there were 92 and 108 patients in the IMRT and CRT group,respectively.The chemotherapy scheme was paclitaxel combined with different platinum drugs (cisplatin,nedaplatin,oxaliplatin or lobaplatin).The number of chemotherapy cycles was 2-4.Results Patients who received IMRT had a significant higher 3-year overall survival (OS) than that who received CRT (63.6 ％ vs 38.9 ％,x2 =12.102,P =0.001).Three-year OS differed no significantly between different chemotherapy regimens.There were 44.6 ％,57.5 ％,52.5 ％ and 52.5 ％ for those who received cisplatin,nedaplatin,oxaliplatin and lobaplatin,respectively (x2 =2.756,P =0.431).Patients received different cycles of chemotherapy had comparable treatment outcome,and the overall survival were 44.1％,51.6 ％ and 57.4 ％ for those who underwent 2,3 and 4 chemotherapy cycles at 3 years,without any statistical significance (x2 =2.497,P =0.287).Univariate analysis indicated that lesion length on X-ray,M stage,6th edition UICC staging and radiotherapy methods were the potential predictive factors.Multivariate analysis shown that gender,lesion length on X-ray and radiotherapy methods were the significant prognostic factors.Conclusion The significant prognostic factors for advanced EPC with concurrent chemoradiotherapy are mainly lesion length on X-ray and radiotherapy methods.

Objective:To establish a GC fingerprint analysis method for identification of volatile oil in ultramicro-powder of Houttuynia cordata from different habitats, then to control the quality sensitively.Methods: GC was used to analyze the volatile constituents of ultramicro-powder of Houttuynia cordata from 12 different habitats;SPDTM-1CapillaryColumn(30m?0.32mm?0.25?m),temperature programming and FID detector were applied.Results: The mutual mode of GC fingerprints was set up and the similar degrees to the volatile oil from of different habitats were compared.Conclusion:The GC fingerprints of volatile oil in ultramicro-powder can be used to identify the Houttuynia cordata from different habitats and evaluate its quality.

Objective To explore the treatment of children with EB virus infection accompanied by facial paralysis. Method The clinical data of a child with EB virus infection accompanied by facial paralysis was analyzed retrospectively, and the related literature were reviewed. Results A 2-year-old boy was admitted to hospital due to fever and mouth askew for 4 days. After admission, he was confirmed to have EB virus infection and viremia by serology and polymerase chain reaction, and then treated with acyclovir. The symptoms of facial paralysis and EB viremia disappeared completely 14 days after antiviral treatment. There was no recurrence in the short-term follow-up. Interestingly, the literature analysis shows that there is still limited evidence for the antiviral treatment by acyclovir in children with acute infection of EB virus associated with facial paralysis. Conclusion Antiviral treatment may be beneficial to EB viremia with facial paralysis.

Objective To explore whether the use of spatiotemporal image correlation (STIC) can supply additional information with respect to conventional fetal echocardiography in the prenatal diagnosis of total anomalous pulmonary venous connection(TAPVC).Methods Twenty-five cases diagnosed as TAPVC received fetal echocardiography examination.Four-dimensional volumes from 19 cases of suspected TAPVC were compared to conventional echocardiography.Echocardiographic characteristics were compared with the results of postnatal work-up and pathology.Results TAPVC was found in 25 cases by fetal echocardiography,four cases were isolated TAPVC,21 TAPVC had associated cardiac anomalies.Among them,nine cases were supracardiac types,six cases were infracardiac types,nine cases were intracardiac types and one was indefinite.Three true positivecases of TAPVC were confirmed after birth.Twenty-two choose to terminate pregnancy,9 of which refused to autopsy,and 10 true positive cases of TAPVC were confirmed at autopsy while 3 were considered false-positive cases.4D ultrasound with STIC clearly visualized the anomalous PV confluence and/or the draining vertical vein in all nineteen cases examined.Conclusions STIC may be proposed to identify abnormal venous drainage at the screening level,thus supplying additional information over that provided by 2D fetal echocardiography.

Objective To analyze the regions of abdominal lymph node metastasis in recurrent thoracic esophageal squamous cell carcinoma ( TE-SCC) after radical surgery, and to guide the design of target volume in postoperative adjuvant radiotherapy. Methods Patients with TE-SCC who were admitted to our hospital from February 2005 to April 2013 were enrolled as subjects. All patients were diagnosed with abdominal lymph node metastasis by imaging after R0 radical surgery. The exact regions of abdominal lymph node metastasis were classified according to the 7th edition of American Joint Committee on Cancer ( AJCC) TNM staging system for gastric cancer, and then retrospectively analyzed. The difference of two group was analyzed by χ2 test. Results Among the 1593 eligible patients, 148( 9. 3%) were diagnosed with abdominal lymph node metastasis after surgery. In the 148 patients, the abdominal lymph node metastasis rates in the upper, middle, and lower thoracic esophagus were 2. 3%, 7. 8%, and 26. 6%, respectively ( P=0. 000);the incidence rates of pathological stages T1/2 and T3/4 were 8. 7% and 9. 5%, respectively ( P=0. 601);the incidence rates of 0-2 and ≥3 metastatic lymph nodes in postoperative pathological examination were 4. 8%and 20. 1%, respectively (P=0. 000). The abdominal lymph node metastasis rate was the highest in the para-aortic lymph node ( 16a2) , followed by para-aortic lymph node ( 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery ( 64. 9%, 41. 2%, 37. 8%, 32. 4%, and 20. 9%) , yielding an overall metastasis rate of 91. 9%. Conclusions The major regions of abdominal lymph node metastasis in esophageal carcinoma after radical surgery include para-aortic lymph nodes ( 16a2 and 16a1) and the lymph nodes around the celiac trunk, posterior area of the pancreatic head, and common hepatic artery. These regions are the abdominal target volumes of postoperative adjuvant radiotherapy.

Objective To retrospectively analyzed the echocardiographic characteristics of ventricular diverticula in fetuses ,children and adults ,and discuss the main points of diagnoses and prognoses of ventricular diverticula . Methods Echocardiographic characteristics ,clinical data and intraoperative findings of ventricular diverticula of 8 fetuses ,3 children and 14 adults were summarized . Results The ventricular diverticula in 8 fetuses and 3 children were all single . Twenty five diverticula were found in the 14 adult patients ;in other words ,there were 3 multiple diverticula found in adult group . A statistical difference was found in ratio of diverticula area and corresponding ventricular area ( P = 0 .021 ) ,and corresponding ventricular fractional shortening ( P =0 .003) between fetal and single adult ventricular diverticula . There were 2 cases with ventricular septal defects ,1 with pericardial effusion ,1 with single umbilical artery ,and 2 with atrioventricular valvular regurgitation in fetal cases . Congenital complex cardiac disease and dextrocardia were found in 1 child . There were 1 case with supravalvular aortic stenosis , 1 with nonobstructive hypertrophic cardiomyopathy ,1 with left ventricular noncompaction ,and 1 with mitral reguigitation in adult group . All the 7 diverticula with ventricular arrhythmias ,ST‐T changes and abnormal Q wave were fibrous type . And 2 multiple diverticula were accompanied with ventricular dysfunction . Among the fetal cases ,2 cases were born ,3 cases were terminated pregnancy ,and 3 cases were lost to follow up . Three children and 2 adults were underwent cardiac operations for diverticula with good outcomes . No such complications as cardiac rupture ,thromboembolism ,and sudden death were found . Conclusions Echocardiography is a useful method to diagnose ventricular diverticulum ,especially for fetuses ,and provide the basis for prognosis consultation .

Objective To investigate the changes and correlation of mitral valve coaptation length index CLI and coaptation area index CAI after mitral valvuloplasty MVP Methods A total of 30 subjects undergoing MVP for mitral regurgitation MR were studied Coaptation length CL CLI coaptation area CA and CAI were determined before and after surgery by 2-dimensional transoesophageal echocardiography 2D-TEE and 3-dimensional transoesophageal echocardiography 3D-TEE Results Compared with preoperative measurements CL CLI CA and CAI were significantly increased in postoperative studies CL 4 7±0 7 mm vs 9 4± 1 1 mm CLI 9 1 ±3 3 vs 38 5 ±4 1 CA 148 9 ± 65 3 mm 2 vs 371 9 ± 144 3 mm 2 CAI 9 3 ±3 1 vs 35 9 ± 7 5 all P < 0 05 CLI was significantly correlated with CAI both preoperatively r = 0 770 P < 0 01 and postoperatively r = 0 771 P <0 01 Furthermore CLI and CAI were significantly negative correlated with the degree of MR r =-0 897 P <0 01 r =-0 886 P <0 01 Conclusions Coaptation variables increased significantly in subjects after MVP CLI by 2D-TEE was related to CAI by 3D-TEE and both were useful for the assessment of mitral valve coaptation But CLI by 2D-TEE was more simple and feasible in clinic.

Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

Objective To investigate the potential values of magnetic resonance elastography (MRE)for evaluating the brain tumor consistency in vivo.Methods Fourteen patients with known solid brain tumor(5 male,9 female;age range:16-63 years)underwent brain MRE studies.Informed consent was obtained from all patients.A dedicated external force actuator for brain MRE study Was developed.The actuator was fixed to the head coil.During scan.one side of the actuator was attached to the patients'head.Low frequency oscillation Was produced by the actuator and caused shear waves propagating into brain tissue.The pulse sequence used in the study Writs phase-contrast gradient-echo sequence.Phase images of the brain were obtained and the shear waves within the brain were directly imaged.Phase images were processed with local frequency estimation (LFE) technique to obtain the elasticity image.Consistency of brain tumors Was evaluated at surgery and Was classified as soft,intermediate,or hard with comparison to the white matter of the brain.Correspondence of MRE evaluation with operative results was studied.Results The elastic modulus of the tumor Was lower than that of white matter in 1 patient,higher inll patients,and similar in 2 patients.At surgery,the tumor manifested a soft consistency in I patient,hard consistency in 11 patients,intermediate consistency in 2 patients.The elasticity of tumors in 14 patients evaluated by MRE was correlated with the tumor consistency on the operation.Conclusion MRE Can noninvasively display the elasticity of brain tumors in vivo,and evaluate the brain tumor consistency before operation.