Objective To investigate the method and effect of monosegment pedicle instrumentafinn on thoraeolumbar vertebral fracture.Methods Sixteen patients with thoracolumbar vertebral fractures treated by open reduction and monosegment pedicle instrumentation through posterior approach.Posterolateral bone grafting was done in all cases,9 cases were quite decompressed using laminectomy.The follow-up time Was 8-24 months.The spine radiographs and CT scan were taken pre-and post-operation.The parameters used for clinical evaluation were the Denis pain scale,neurological evaluation by the Frankel scale and bone graft healing evaluation by the Suk scale.Results All of the fractures were reduced satisfactorily during the follow-up.The height of the injured vertebral improved rate was 30.8%,kyphosis of the injured vertebral segment rectified obviously.There was no implant break,and no signs of losing were observed in any patient.Nine patients which had neurological deficiency had average improvement more than one degree by the Frankel scale.After operation the pain score was P1 in 14 patients and P2 in 2 patients.Condnsion For the appropriate patients with thoracolumbar vertebral fractures,open reduction and internal fixation of monosegment pedicle instrumentation through posterior approach is a safe and effective method.

Objective To evaluate the results and relating factors in the treatment of proximal humeral fractures by replacement of humeral head prosthesis. Methods From March 2000 to March 2003, 21 cases with proximal humeral fractures, which were 10 males and 11 females aging from 62 to 82 years with an average of 72.3 years, were admitted to our hospital. All the patients were underwent one-stage operation of humeral head hemiarthroplasty through the anteromedial approach of shoulder joint. The average operative time was 60 minutes (range, 40 to 80 minutes) with a blood loss ranging form 200 ml to 300 ml. According to Neer classification, 6 cases were three-part fractures, 13 four-part fractures, and 2 head-splitting fractures. There were 18 fresh fractures and 3 old fractures. All the fractures were treated with replacement of humeral head prosthesis. After operation, the upper extremity was immobilized for 6 weeks, however, physical therapy, including pendulum, isometric elbow, and wrist and hand exercises, was begun on the first day after surgery. Results The follow-up ranged from 6 to 36 months with a mean period of 14.6 months. No lessening prosthesis, prosthesis dislocation, postoperative infection, nerve damage or periprosthesis fractures occurred. According to the scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los. Angeles, California, USA) based on shoulder pain, functional status, muscle strength and range of motion, the average score was 24.5. Furthermore, the score was above 27 (excellent) in 3 cases, and 24 to 27 (good) in 14, and the excellent rate was 86%. The average score of pain was 9.3, function 8.6, muscle strength 8.2 in 21 cases. Conclusion Replacement of humeral head prosthesis is a preferable method for the treatment of proximal humeral fractures in the elderly patients, with significant effects in keeping the function and relieving the pain of the shoulder joint postoperatively.

Objective To observe the clinical efficacy of Na Zhi method (midnight-noon ebb-flow method) plus electroacupuncture in treating poststroke uninhibited neurogenic bladder.Method A total of 120 patients with uninhibited neurogenic bladder due to cerebrovascular diseases were randomized into a treatment group and a control group, 60 cases in each group. The treatment group was intervened by Na Zhi method plus electroacupuncture; the control group was intervened by electroacupuncture. The intervention was conducted once a day, 30 min each time, for a total of 2 weeks. The daily voiding frequency index and maximum cystometric capacity (MCC) in the two groups were measured before and after the intervention, and the clinical efficacies were compared.Result The total effective rate and markedly effective rate were respectively 98.2% and 89.5% in the treatment group versus 93.1% and 72.4% in the control group. There was a significant difference in comparing the markedly effective rate between the two groups (P<0.05). There was no significant difference in comparing the daily voiding frequency index between the two groups before the intervention (P>0.05); the daily voiding frequency index was significantly changed after the intervention in both groups (P<0.01), and the daily voiding frequency index of the treatment group was significantly different from that of the control group after the intervention (P<0.05). There was no significant difference in comparing the MCC before the intervention between the two groups (P>0.05); the MCC was significantly changed after the intervention in both groups (P<0.01); the MCC of the treatment group was significantly different from that of the control group after the intervention (P<0.05).Conclusion Electroacupuncture can produce a significant efficacy in treating uninhibitedneurogenic bladder, while it can produce a more significant efficacy when combined withNa Zhi method.

Objective: To investigate the role of expression of Caspase-9 in megalosplenia of cirrhotic portal hypertension. Methods: Using SP immunohistochemistry method to examine theexpression of Caspase-9 in the specimens of 50 cases of megalosplenia with cirrhotic portal hypertension and 15 cases of traumatic spleen of normal man. Results: The Caspase-9 positive rates in the traumatic spleen and megaloplenia were 26.7% and 76.0%, respectively. There was a significant difference between the groups(P

Objective To investigate the feasibility and effects of modified Stoppa approach in treatment of anterior pelvic ring fractures.Methods The therapeutic effects of 21 patients with anterior pelvic ring fractures treated through the modified Stoppa approach from June 2008 to August 2011 were summarized and analyzed.According to Tile classification,there were seven patients with type A2 fractures,six with type B2 fractures,five type B3 fractures and three type C2 fractures.Surgical treatment through the modified Stoppa approach included anterior pelvic ring plates for 14 patients,anterior pelvic ring plates and external fixators for four and anterior pelvic ring plates and sacroiliac joint compressed cannulated screws for three.The fracture reduction and post-operative function were assessed by Matta criteria and Majeed system respectively.Results The incision length of the modified Stoppa approach ranged from 10 to 12 cm ( average,11 cm).The operation time ranged from 70 to 120 minutes ( average,95 minutes).The intra-operative blood loss ranged from 400 to 1 000 ml (average,700 ml ).According to the Matta criteria,all 21 patients obtained sound reduction,of whom 15 patients had bony union after 8-20 months follow-up post-operatively.The Majeed score in all patients showed a gradual increase postoperatively.Conclusions The modified Stoppa approach is characterized by convenience and directness in making incisions,clear operation field,easy reduction,few complications and fast recovery and hence is an ideal choice in surgical treatment of anterior pelvic ring fractures.

The inhibitors of programmed death 1 (PD-1)/PD-1 ligand (PD-L1) become a highlight in tumor immunotherapy and provide a new direction for immune-targeted therapy for cancer. More and more studies have confirmed that PD-1/PD-L1 inhibitors could improve effects and be well-tolerated. Early clinical trials of PD-1 inhibitors have shown significant clinical efficacy in various solid tumours. The unique role of the PD-1 pathway in lymphoma has been found gradually. This article summarized the advancement of PD-1 in B-cell lymphoma therapy.

Objective:To explore the abnormalities of efficiency in resting state functional brain network in patients with paranoid schizophrenia and the correlations between efficiencies and clinical symptoms.Methods:A total of 73 patients with schizophrenia (SZ group) met with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-Ⅳ) criteria for schizophrenia and 70 healthy controls (HC group) were included .All subjects were checked by using functional magnetic resonance imaging (fMRI), and positive and negative syndrome scale(PANSS) were used to assess the symptoms.Abnormalities of global and local efficiency of brain regions in brain functional network were analyzed by graph theory.Pearson correlation was used to analyze the correlation between the abnormal global efficiency and local efficiency of brain regions of SZ group and PANSS.SPSS 20.0 software was used for dependent-sample t-test, ANOVA test and Pearson correlation analysis. Results:Compared with the HC group, SZ group showed increased global efficiency in bilateral thalamus(left: 0.26±0.06, 0.28±0.04, t=2.03, P=0.044.right: 0.26±0.06, 0.28±0.05, t=2.08, P=0.040), right orbital part of middle frontal gyrus(0.21±0.04, 0.23±0.05, t=2.25, P=0.026), cerebellar lobule Ⅸ(0.19±0.06, 0.21±0.05, t=2.56, P=0.011) and vermis Ⅲ(0.15±0.08, 0.19±0.07, t=3.27, P=0.001), while decreased global efficiency in bilateral parahippocampal gyrus(left: 0.25±0.05, 0.22±0.05, t=-3.34, P=0.001.right: 0.27±0.04, 0.23±0.05, t=-4.96, P=0.000), superior occipital gyrus(left: 0.27±0.03, 0.26±0.03, t=-2.70, P=0.008.right: 0.27±0.02, 0.26±0.03, t=-2.73, P=0.007), superior parietal gyrus(left: 0.27±0.03, 0.26±0.05, t=-2.63, P=0.010.right: 0.27±0.03, 0.25±0.05, t=-2.76, P=0.007), paracentral lobule(left: 0.28±0.03, 0.26±0.07, t=-2.47, P=0.015.right: 0.28±0.04, 0.25±0.07, t=-3.06, P=0.003), left precental gyrus(0.28±0.04, 0.27±0.04, t=-1.98, P=0.049), left cuneus(0.26±0.04, 0.25±0.04, t=-2.08, P=0.039), left lingual gyrus(0.29±0.03, 0.28±0.03, t=-2.28, P=0.024), left middle occipital gyrus(0.29±0.03, 0.28±0.03; t=-2.74, P=0.007), left middle temporal gyrus(0.28±0.03, 0.26±0.03, t=-2.73, P=0.007), temporal pole in left middle temporal gyrus(0.20±0.06, 0.18±0.06, t=-2.59, P=0.011) and right hippocampus(0.27±0.04, 0.26±0.06, t=-2.05, P=0.042).Compared with the HC group, SZ group showed increased local efficiency in bilateral caudate nucleus(left: 0.33±0.06, 0.35±0.05, t=2.54, P=0.012.right: 0.33±0.07, 0.35±0.04, t=2.77, P=0.007) and left superior occipital gyrus(0.39±0.03, 0.40±0.02, t=2.17, P=0.031), while decreased local efficiency in bilateral parahippocampal gyrus(left: 0.35±0.04, 0.32±0.07, t=-3.16, P=0.002.right: 0.34±0.04, 0.32±0.07, t=-2.91, P=0.004), left supplementary motor area(0.36±0.02, 0.35±0.05, t=-2.01, P=0.047), left inferior parietal but supramarginal and angular gyrus(0.35±0.03, 0.34±0.05, t=-2.65, P=0.009), left cerebellar crus Ⅱ(0.37±0.03, 0.36±0.04, t=-2.01, P=0.046), lobule ⅦB(0.37±0.03, 0.35±0.07, t=-1.98, P=0.049), right posterior cingulate gyrus(0.36±0.04, 0.34±0.07, t=-2.07, P=0.041), right superior parietal gyrus(0.37±0.03, 0.36±0.05, t=-2.19, P=0.031), right precuneus(0.36±0.02, 0.35±0.04, t=-2.36, P=0.020), right paracentral lobule(0.37±0.02, 0.36±0.06, t=-2.07, P=0.041) and right temporal pole in middle temporal gyrus(0.33±0.08, 0.30±0.09, t=-2.09, P=0.038).The global efficiency of bilateral paracentral lobule and left temporal pole in middle temporal gyrus in SZ group were negatively correlated with the negative scale scores( r=-0.25, -0.25, -0.26, all P<0.05).The global efficiency of right hippocampus in SZ group was positively correlated with total scores of PANSS( r=0.23, P=0.049).The global efficiency of left middle temporal gyrus in SZ group was negatively correlated with total scores of PANSS( r=-0.23, P=0.049).The local efficiency of right paracentral lobule in SZ group was negatively correlated with the positive scale scores( r=-0.24, P=0.038). Conclusion:The brain networks of patients with first-episode paranoid schizophrenia may have regional dysfunction in the transmission efficiency and fault-tolerant ability of resting state brain functional network, and the abnormalities of efficiency may be associated with the severity of psychiatric symptoms in several brain regions.

Objective To investigate the surgical diagnosis and treatment of late vitamin K deficiency intracranial hemorrhage caused by biliary atresia. Methods Clinical data of six cases of biliary atresia with late vitamin K deficiency intracranial hemorrhage were collected in the Department of Neurosurgery of Tianjin Children’s Hospital from January 2000 to December 2013. Data were analyzed to identify the biliary atresia as soon as possible in the treatment of intracranial hemorrhage and prolonged jaundice in children. Results Six cases (1 male, 5 female), mean age was (16.0±2.6) days, and were treated with external drainage of intracranial hematoma and infusion therapy. In the treatment, children were found jaundice exacerbation and doubted about biliary atresia. After consultation by general surgeons, children were transferred to the department of general surgery for further treatment at an average age of (29.1±1.2) days, and were diagnosed as biliary atresia by intraoperative cholangiography. Conclusion Pediatric neurosurgeon should have a sufficient understanding and make an early diagnosis to late vitamin K deficiency intracranial hemorrhage caused by biliary atresia, to avoid delaying the optimal treatment time of biliary atresia.

Objective To compare the biomechanical difference of two internal fixation approaches for the posterior pelvic ring fracture dislocation.Methods Six fresh adult cadaver pelvic specimens were tested biomechanically.Then,the specimens were subjected to Denis-I sacral pelvic fracture.The specimen was first fixed with improved Galveston fixation and then with improved Galveston fixation plus sacral rod.Biomechanical tests were performed from vertical and reversed directions on the fixed pelvis.Results Under vertical compression,the biomeehanical value of the improved Galveston fixation plus sacral rod was lower than that of the improved Galveston fixation,with no statistical difference between two methods(P ＞ 0.05).Under the reversed compression,the biomeehanieal value of the improved Galveston fixation plus sacral rod was lower than that of the improved Galveston fixation,with statistical difference between two groups(P ＜ 0.05).Conclusion The improved Galveston fixation combined with sacral rod can increase the anti-reverse stability of the posterior pelvic ring.

We retrospectively analyzed clinical and imaging data of 26 children with split cord malformations (SCMs). Based on Pang's classification, 14 SCMs were defined as type Ⅰ and 12 as type Ⅱ.Neural function was markedly improved in 20 patients postoperatively. Three of 4 children who did not undergo surgical treatment had neural function deteriorated. Two children lost follow-up. We suggest that Pang's Classification of SCMs may be useful in describing pathological changes and guiding surgical procedure; imaging examine (including MRI, CT and X-ray) would play a significant role in confirmed SCMs diagnosis; and surgical operation should focus on eliminate and prevent spinal cord damnification.