Objective To observe the operation methods and curative effect of sacroiliac joint screw fixation by using traditional imaging monitoring technique in combination with sacral slope position imaging monitoring technique. Methods After bone traction and enema cleansing, 37 patients with pelvic fractures were fixed with sacroiliac joint screws, which was monitored under C-armed X ray machine at slope position, inlet and outlet views. There were 23 males and 14 females, at average age of 30. 8 years (18-63 years). Results All the patients were followed up for 4-23 months (average 9. 8 months) , which showed basic anatomical restoration in 28 patients, coronal section dislocation for 2 mm in seven and dislocation for 5 mm in two. All fractures were healed, with no nerve or blood vessel complications found. According to Majeed scoring, the excellence rate was up to 94. 5%. Conclusions Combined use of traditional imaging monitoring and sacral slope position imaging monitoring can help improve the safety of percutaneous iliosacral screw fixation, simplify operation process and shorten operation time.

Objective To investigate the feasibility and clinical effect of the posterior single segment anterolateral decompression and anterior column reconstruction in the treatment of thoracolumbar burst fractures. Methods A retrospective study was done on 21 patients with type Denis B thorocalumbar burst fractures who were treated by posterior approach minimal incision pedicle SCreW fixation,single segment anterolateral decompression and titanium mesh and bone graft from August 2007 to August 2009.There were 15 males and six males at mean age of 35.6 years(range,23-50 years).The involved segments included T12 in six patients,L1 in 11,L2 in three,and L3 in one.The preoperative spinal canal enemachment rate was 62.5%and the anterior-middle vertebral compression of all patients was less than 50%.CT scanning showed normal vertebral body and inferior endplate structure.The fracture reduction,graft fusion,neurological function recovery,correction loss,lumbar activities and adjacent lumbar disc degeneration were observed through preoperative,immediate postoperative and final follow up X-ray,CT and neurological examinations. Results The operation duration was 1.5-3.2 hours(average 2.1hours),with the bleeding of 350-1 000 ml(average 580 ml).All the patients were followed up for 4-26months(average 10.3 months),which showed that the vertebral fusion time was 4-6 months,with no loss of the vertebral height,implant breakage,loosening or extrusion.The nerve function was improved for 1-2 grades. Conclusions With correct selection of the indications,the posterior single segment anterolateral decompression and anterior column reconstruction is a reliable fixation,for it takes advantages of simple operation,minor trauma,less fusion segments and fast recovery.

Objective To discuss the formation mechanism of teardrop fracture of the axis and observe the clinical efficacy of anterior or posterior induction operation according to the fracture type.Methods Thirteen patients with teardrop fracture of the axis treated from May 2001 to October 2010 were involved in the study.There were 10 males and 3 females,at age range of 18-55 years (mean,35.5 years).Four patients were combined with cervical spinal cord injury (one patient with grade C and two with grade D according American Spinal Injury Association,ASIA).Injury causes included traffic injury in 11 patients and fall from height in two.After admission,the anteroposterior,lateral and mouth X-ray films,spiral CT sagittal reconstruction and MRI examination of the cervical vertebra were performed in all the patients.According to the injury mechanism,there were 10 patients with extension fractures treated with C2,3 intervertebral bone fusion and internal fixation through submandibular retropharyngeal approach and three with flexion fractures treated with posterior C2,3 intervertebral bone fusion and pedicle screw fixation.The clinical efficacy was also observed. Results All patients received complete exposure and effective reduction and fixation.The average time of anterior exposure and posterior exposure was 77 minutes and 125 minutes,respectively.No surgical complications occurred.All patients were followed up for 9-34 months (mean,13 months).Reexamination at four months after operation displayed bone healing in all patients.There was no lessening or breakage of the internal fixators.The spinal function of three patients with ASIA grade D injury and that of one patient with ASIA grade C injury recovered to normal at postoperative 1.5 and 6 months respectively. Conclusion The surgical approaches for teardrop fracture of the axis developed in the light of the fracture formation mechanism are beneficial and safe.

Objective To investigate the value of urinary liver-type fatty acid-binding protein (L-FABP),neutrophil gelatinase-associated lipocalin (NGAL) and their combination in predicting the development and the severity of acute kidney injury (AKI) following cardiac surgery in adults. Methods Scr,urinary L-FABP and NGAL corrected by urine creatinine at preoperation,0 h and 2 h postoperative time points were examined.The differences of above indexes between AKI and non-AKI groups were compared.Receiver operating characteristic (ROC)curves and area under curves (AUC) were used to evaluate the diagnostic value of urinary L-FABP,NGAL and their combination for AKI. Results The cohort consisted of 109 patients,26(23.9％) developed AKI,and AKIN stage Ⅰ, Ⅱ and Ⅲ was 46.2％,34.6％ and 19.2％ respectively.Levels of urinary L-FABP and NGAL were significantly higher in AKI patients at 0 h and 2 h postoperatively.AUC to predict AKI or AKI stage Ⅱ-Ⅲ was 0.81 to 0.87 using either of the biomarkers.The performance of combining two biomarkers was better with AUC of 0.911 to 0.927. Conclusions Urinary L-FABP and NGAL increase at the early stage after cardiac surgery.Combination of these two biomarkers enhances the accuracy of the early diagnosis of postoperative AKI after cardiac surgery before a rise of Scr.

Objective To determine the incidence and risk factors of acute kidney injury (AKI) in respiratory failure patients.Method Clinical data of 235 patients diagnosed as respiratory failure admitted in respiratory division and internal medicine intensive care unit in Renji Hospital from January 2006 to December 2008 were analyzed retrospectively.Patients'demographics,clinical data and laboratory examinations before and after respiratory failure were collected.The incidence,clinical risk factors and hospital mortality of AKI in the respiratory failure patients were analyzed.Multivariate Logistic regression analysis was used to investigate the independent risk factors of AKI in these patients.Results Of the total 235 patients,the average age was (70.05±12.85) years old,the ratio of male to female was 1.90:1.Seventy-seven patients developed AKI and the incidence was 32.8％.The incidence of AKI in those with hypertension (44.4％ vs 26.6％,P＜0.01) or chronic kidney disease(66.7％ vs 31.3％,P＜0.01) was significantly higher.The incidence of AKI in patients with mechanical ventilation was much higher than those without mechanical ventilation(44.8％ vs 13.3％,P＜0.01).The incidence of multi-organ system failure (33.8％ vs 5.7％,P＜0.01),the failure of weaning from mechanical ventilation(69.2％vs 32.5％,P＜0.01) and the mortality (51.9％ vs 13.3％,P＜0.01) in AK1 patients were higher than those without AKI.Multivariate Logistic regression analysis showed that age (OR=1.668),anemia (OR=0.980),baseline serum creatinine (OR=1.071) and mechanical ventilation (OR=3.222) were independent risk factors of AKI.Conclusions Incidence and mortality of AKI are quite high in respiratory failure patients.Age,baseline serum creatinine,anemia and mechanical ventilation are independent risk factors of AKI.

Objective To validate the effect of Renji acute kidney injury score (RAKIS) on predicting patients with acute kidney injury (AKI) after cardiac surgeries,and make comparison with Cleveland score,simplified renal index (SRI) and acute kidney injury following cardiac surgery (AKICS).Methods Patients undergoing open heart surgery from 2008/01/01 to 2010/10/31 in Renji hospital were enrolled,and their scores of those four scoring models were calculated.AKI patients were diagnosed by KDIGO,and those scores of AKI patients and non-AKI patients were compared.Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to decide the predictive values of those models.Results A total of 1126 patients were chosen in this cohort,with the average age of (58.43±14.88) years (rang from 18 to 88).The male to female ratio was 1.47:1.And 355(31.5％) patients were developed AKI.AKI stage Ⅰ,Ⅱ and Ⅲ were 65.4％,23.7％ and 11.0％ respectively.RAKIS was significantly higher in AKI patients than in non-AKI patients (17.5 vs 9.0,P ＜ 0.001).The AUCs of RAKIS to predict AKI,AKI Ⅱ-Ⅲ stages,renal replacement therapy (RRT)and in-hospital death were 0.818,0.819,0.800 and 0.784 respectively.The AUCs of Cleveland score and SRI were 0.659 to 0.710,lower than those of RAKIS and AKICS.AKICS had lower value for predicting AKI and AKI Ⅱ-Ⅲ stages (AUC 0.766 and 0.793),but good value in predicting RRT and inhospital death after surgery (AUC 0.804 and 0.835) as compared with RAKIS.Conclusions RAKIS is valid and accurate in the discrimination of KDIGO defined AKI patients,while for predicting the composite end point,AKICS may be more useful.

Objective: To investigate the effects of physical activity (PA) intensity and sedentary behavior (SB) on calcanues bone mineral density (BMD) in preschool children, so as to provide a basis for rationalizing the daily physical activity of preschool children to promote bone health. Methods: A total of 673 pre school children aged 3-6 years from nine kindergartens in Pingxiang City, Ganzhou City and Yingtan City of Jiangxi Province, were selected from September to December 2021 by using the whole stratified cluster random sampling method. The PA levels and SB were measured by using a three axis acceleration sensor, and left calcanues BMD was measured by an ultrasound bone densitometer. Multiple linear regression was used to explore the effects of changes in PA on calcanues BMD in pre school children of all ages. Results: Of the 673 preschoolers surveyed, 498 (74.0%) achieved an average of ≥60 min of moderate to vigorous physical activity (MVPA) per day, there were 265 boys (71.2%), and 233 girls ( 77.4 %). The difference between genders was not statistically significant ( χ 2=2.77, P >0.05). There was no statistically significant difference in the BMD test of the calcaneus bones of preschoolers by gender ( Z=0.42, P >0.05). The difference in BMD results of pre school children with 3, 4, 5 to 6 years was statistically significant ( H=2.65, P <0.05). Correlation analysis revealed a negative correlation between SB duration and calcaneus BMD ( r =-0.13), and a positive correlation between low intensity physical activity (LPA) duration, MVPA duration, and calcaneus BMD ( r =0.14, 0.25 ) ( P <0.05). Multivariate linear regression analysis showed that SB duration negatively correlated with calcaneus BMD, whereas LPA and MVPA duration positively correlated with calcaneus BMD ( P <0.05). Conclusions MVPA duration is positively correlated with the growth of BMD in the heel bone and negatively correlated with SB. The kindergartens can adjust their curricula according to the physical and mental developmental characteristics, gender and age differences of pre school children, increase the time of outdoor activities, and reduce the sedentary time to promote the bone health of young children.