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 compare the RIFLE and AKIN diagnosis criteria for acute kidney injury ( AKI) in patients undergoing cardiac surgery. Methods Patients undergoing cardiac surgery from January 2004 to June 2007 were retrospectively evaluated. RIFLE and AKIN criteria were employed for the diagnosis and staging of AKI which occurred 7 d after cardiac surgery. The diagnosis sensitivity and precision for prediction of hospital mortality were compared between these two criteria. Results One thousand and fifty-six patients were included in this study. There was no significant difference between the prevalence of AKI after cardiac surgery diagnosed by RIFLE criteria and that diagnosed by AKIN criteria (29.55% vs 31.06%, P>0.05). There was no significant difference between the total hospital mortality and the hospital mortality of each stage of AKI diagnosed by RIFLE criteria and those diagnosed by AKIN criteria ( P > 0. 05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by AKIN criteria and those diagnosed by RIFLE criteria. The area under the ROC curve for hospital mortality was 0. 856 for RIFLE and 0.865 for AKIN in all patients (P<0.001). Conclusion Compared to RIFLE criteria, AKIN criteria do not improve the sensitivity of diagnosis and predictive ability of hospital mortality of AKI after cardiac surgery.

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 investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.

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 incidence, risk factors and outcome of acute kidney injury (AKI) following cardiac surgeries. Methods Clinical data of 1056 patients undergoing open heart surgery in Renji Hospital from January 2004 to June 2007 were retrospectively analyzed. Univariate and multivariate analyses were used to evaluate possible pre-,intra-, and post-operative parameters associated with AKI according to AKI Network (AKIN). Results Of the 1056 patients, 328 (31.06%) developed AKI. In-hospital mortality was 4.07% in all discharges while 11.59% in AKI patients (P<0.01). Multivariate logistic regression analysis revealed that increased age (OR=1.40), pre-operative hyperurieemia (OR=1.97), pre-operative left ventricular insufficiency (OR=2.53), combined surgery (OR=2.79), prolonged operation time (OR=1.43), post-operative circulation volume insufficiency (OR=11.08) were risk factors of AKI. Conclusions AKI is a common complication and associated with increased mortality following cardiac surgery. Increased age, pre-operative hyperuricemia, pre-operative left ventricular insufficiency, combined surgery, prolonged operation time, post-operative circulation volume insufficiency are useful in stratifying risk factors for the development of AKI.

Objective To investigate the incidence of acute kidney injury (AKI) post-orthotopic liver transplant (OLT) and its association with prognosis. Methods Data of 28 patients received single OLT in our hospital from 2004 to 2006 were retrospectively analyzed. The incidence of AKI was investigated by new acute kidney injury network (AKIN) criteria. The follow-up was over one year. The prognosis of AKI patients at day 28 and 1 year was evaluated by Kaplan-Meier survival analysis. The association between AKI and prognosis was examined. Results A total of 193 patients were enrolled. The average age was (48.07±10.02) years old. The ratio of male to female was 4:1. One hundred and sixteen (60.1%) patients of post-OLT AKI were found, whose AKI stage 1, 2 and 3 were 50.0%, 21.6% and 28.4% respectively. Ten (8.6%) patients required renal replacement therapy (RRT) after OLT. In AKI post-OLT patients, day 28 and 1 year mortality were significantly higher than those in non-AKI patients (15.5% vs 0, 25.9% vs 3.9%, respectively, both P<0.05). Kaplan-Meier survival analysis showed the 1-year survival rates of AKI stage 1, 2, 3 post-OLT and non-AKl were 84.0%, 81.0%, 42.4% and 90.9%, respectively. The 1-year survival rate of non-AKI was significantly higher than that of AKI stage 1, 2, 3. The 1-year survival rate of AKI stage 3 was significantly lower than that of stage 1 and 2. There was no significant difference between AKI stage 1 and 2. Sct at 1 year post-OLT was significantly higher than that of baseline [(88.35±37.15) vs (73.70±33.88) μmol/L, P<0.05). The change of Scr value at 1 year compared to baseline in AKI patients was similar to non-AKI patients. However such change in AKI stage 2 and 3 was higher than that in stage 1. Conclusions The incidence of AKI post-OLT is quite high and associated to the poor prognosis in short and long periods. Renal function may decrease gradually which is associated to the AKI stage pest-OLTI.

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 investigate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding proteins (L-FABP) in early diagnosis of acute kidney injury (AKI) after liver transplantation. Methods During 2007-2008, 25 liver transplant recipients were recruited. Blood and urinary samples were collected before operation and at 2, 4, 6,12, 24, 48, 72, 120 h after portal vein opening, and used to determine serum creatinine (Scr), as well as urinary NGAL and L-FABP, which were normalized to urinary creatinine. According to the Acute Kidney Injury Network (AKIN) criteria of AKI, all the patients were divided into AKI and non-AKI groups. Standard statistics were used along with ROC analysis to evaluate the diagnose value of selected markers. Results There were no significant differences in clinical parameters between non-AKI (n=14) and AKI (n=11) groups. Both groups had a transient rise in Scr 2-12 hours after surgery, but the rise lasted longer in AKI patients (2-24 hours). While urinary L-FABP rose transiently in both groups 2-120 hours following surgery, urinary NGAL was only slightly elevated at 2 h in the non-AKI group, but rose and stayed high from 2 to 6 h in the AKI group.ROC analysis revealed that NGAL (cut-off 43.02, 26.97 and 17.19 ng/mgCr, AUC 0.766, 0.773 and 0.773 at 2, 4 and 6 h, respectively) was better than L-FABP (cut-off 3451.75 ng/mgCr, AUC 0.760 at 4 h). Conclusion Urinary NGAL appears to be a sensitive and specific marker of AKI in liver transplant recipients, but these data need to be validated in larger prospective studies.