BACKGROUND:Open reduction and internal fixation cause big trauma and many complications. With the progression of minimal y invasive concept, percutaneous pedicle screw fixation gradual y showed its obvious superiority. ＜br> OBJECTIVE:To compare clinical outcomes of minimal y invasive percutaneous pedicle screw fixation versus open surgery in the treatment of thoracolumbar fracture. ＜br> METHODS:From October 2012 to January 2014, 50 cases of thoracolumbar fractures, including 25 cases in the minimal y invasive percutaneous pedicle screw fixation group and 25 cases in the open surgery group, were retrospectively analyzed. The differences in length of skin incision, intraoperative blood loss, operation time, postoperation hospital stay, and visual analog scale scores were compared. Serum creatine kinase activity and C-reactive protein levels were measured before surgery and at 24 and 48 hours after operation. Imaging results were used to observe vertebral height and kyphosis Cobb’s angle changes. ＜br> RESULTS AND CONCLUSION:Compared with the open surgery group, the length of skin incision was smal er and intraoperative blood loss was less, operation time, bed time and hospital stay were shorter, and pain of the wound was lighter in the minimal y invasive group. No significant difference was found in serum creatine kinase activity and C-reactive protein levels between the two groups. Serum creatine kinase activity and C-reactive protein levels were higher at 24 and 48 hours after treatment compared with before treatment in both groups. Serum creatine kinase activity and C-reactive protein levels were higher in the open surgery group than in the minimal y invasive group at 24 and 48 hours. There were significant differences in vertebral height and kyphosis Cobb’s angle in both groups after treatment compared with before treatment (P＜0.01). No significant difference in vertebral height and kyphosis Cobb’s angle was detected between the two groups after treatment (P>0.05). Results indicated that minimal y invasive percutaneous pedicle screw fixation and open surgery in repair of thoracolumbar fractures had similar outcomes. However, the trauma of minimal y invasive percutaneous pedicle screw fixation was apparently less than open surgery.

Objective To compare the difference of dosimetric results between 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) with 5-field for thoracic middle esophageal carcinoma.Methods Ten patients with thoracic middle esophageal carcinoma were involved in this study.Four treatment plans were designed for each patient,including one 3D-CRT plan and three IMRT plans with 5-field and all evaluation contents were compared.Results There were no significant differences of cord Dmax,total-lung mean dose (Dmean),L-lung Dmean and R-lung V25,V30.Significant differences of heart V30,V40 and Dmean were obtained among the plans,with the lowest of 5IMRT2 (V30:28.67±15.97,V40:13.04±7.28,Dmean:2097.76±718.26) and 5IM RT3(27.39±14.96,13.00±7.32,2096.16±718.85),the highest of 5CRT (43.27±18.69,26.83±19.18,2393.48±896.12) and 5IMRT1 (41.81±17.16,23.08±11.17,2403.77±834.73).There were significant differences of L-lung V5,V10,V15,V20 V25 and V30.All IMRT plans reduce V20,V25 and V30.5IMRT1 did not increase V5 (54.39±7.58) and V10 (44.76±6.30),but reducesd V15 (20.86±5.16),5IMRT2 (V5:70.89±7.95,V10:50.94±8.71,V15:34.20±6.62) and 5IMRT3 (V5:70.26±7.94,V10:49.80±7.62,V15:34.60±5.40)increased V5,V10 and V15.There were also significant differences of R-lung V5.V10,V10,V20 and Dmean.All IMRT plans reduced V20,but increased Vs and V10.5IMRT1 did not increase V15 (23.67±5.73) and Dmean (923.49±182.34); 5IMRT2 did not increases V15 (26.72±±6.79) but increases Dmean (1060.34±205.02); 5IMRT3 increased both V15 (32.40±6.59) and Dmean (1100.54±197.84).Significant differences were found in Dmean,homogeneity index (HI) and conformity index (CI) of PTV,with the best Dmean of 5IMRT1 (6219.80±37.90),the second of 5IMRT3 (6268.91±56.26); the best HI of 5IMRT1 (0.0870±0.0219) and 5IMRT3 (0.0990±0.0219);the best CI of 5IRT2 (0.8682±0.0172) and 5IMRT3 (0.8667±0.0183).Conclusion 5-field IMRT plans have the advantages in the treatment of thoracic middle esophageal carcinoma with better HI,CI of target volume and sparing of lung (V20,V25 and V30) compared to 3D-CRT.5IMRT1 plan has the advantages in reducing low-dose volume (V5,V10,V15 and Dmean) of lung.

Objective To explore the incidence and etiology of infection after heart transplantation and discuss the prophylaxis and management. Methods Retrospective study was conducted on the 140 survival heart transplant recipients (HTs) with detail follow-up information. All patients received preventive therapy against bacterial infections postoperatively, of which 87. 8% patients used antiviral drugs to prevent cytomegalovirus (CMV) infection. The immuosuppressive regiment was as follows: tacrolimus (Tac) or cyclosporine A (CsA), mycophenolate mofetil (MMF),glucocorticoid. Postoperatively all patients had throat swabs, sputum smear Gram stain, sputum culture, blood culture, urine culture and fecal culture for microbiological monitoring. Schedule tables were made to record and analyze the demography of the patients and the timetable of infections. Results The incidence of infections was 42.9 episodes per 100 HTs. Sixty-four cases (76. 2% ) of the infections occurred in the first month after transplantation and all recovered, 20 cases (23.8%) took place after 1 months, and 4 patients died. Conclusion Perioperative infections are mostly caused by bacteria and the prognosis is good. Infections 2 months after operation are commonly caused by virus or fungi with poor prognosis.

Objective To evaluate the cardiopulmonary allograft function and to analyze key factors for long-term survival of heart-lung transplantation in a patient survived more than 5 years. Methods On December 17th, 2003 at Zhongshan Hospital of Fudan University, a homologous heart-lung transplantation was performed on a female who diagnosed with cardiopulmonary failure secondary to congenital atrial septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1 000 mL UW solution and 4 000 mL HTK solution.Postoperative immunosuppressive therapies were managed with Zenapax, cyclosporine A (or tacrolimus), mycophenolate mofetil and corticosteroids. Cyclosporine A maintained with serum trough levels of 100-200 μg/L and tacrolimus with serum trough levels of 8-20 μg/L. Cardiopulmonary allograft functions were evaluated by echocardiogram, pulmonary function test and thoracic CT periodically. Results The patient survived operation and experienced normal daily life with NYHA cardiac function of class Ⅰ-Ⅱ during the follow-up of 5 years and 6 months. Echocardiogram showed left ventricular ejection fraction of 65% to 86%. Pulmonary function test exhibited with nearly normal oxygen exchange, meanwhile, small airway obstruction was detected from one year after operation and keeping stable from then on. Two episodes of severe pneumonia were complicated and treated with antibiotics and fhconazob, no severe acute allograft rejection episode was experienced. Conclusions Heart-lung transplantation proves to be a reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation, accurate balance of the risk between acute allograft rejection and infection, and strict preventive measures against infection are key factors for long-term survival of heart-lung transplantation.

Objective To synthesize N-(4-fluorophenyl)-N-(4-phenoxyphenyl) cyclopropane-1,1-dicarboxamide (NFNPDB) as small molecular c-Met kinase inhibitor analogue.Methods N-( 4-fluorophenyl )-N-( 4-phenoxyphenyl ) cyclopropane-1, 1-dicarboxamide was synthesized by nucleophilicsubstitution, amidation, etherification, reduction and condensation from diethyl malonate.Results The total yield of target compound was 3.79%, its structure was confirmed by 1 H-NMR.Conclusion The synthesis method of NFNPDB in our research can be easily operated with lost cost and short direction, which lays the foundation for designing the synthetic process of newly small molecular c-Met kinase inhibitor.

OBJECTIVE To investigate the distribution of integron in Gram-negative isolates which are causing nosocomial infection the association with drug resistance,and it′s contribution in horizontal transfer of drug resistance.METHODS Drug resistance test was performed by K-B method.ESBL-positive strains were detected by double-disk synergy test.Integron was determined by PCR assay with integron-specific-primer.Conjugative transfer test,plasmid profile analysis,nested-PCR,and DNA sequence analysis were used to investigate the transferable mechanism of integron mediated.RESULTS 66.4% of Strains were shown to be positive for classes Ⅰ integron,no class Ⅱ and Ⅲ integrons were detected.Profiles of class Ⅰ integron were 11 types,which sized from 700bp to 2300bp,gene cassettes included genes encoding resistance to aminoglycosides(aadA1,aadA2,aadA5 and aacA4),sulfamethoxazole/trimethoprim(dfrA12,dfrA5 and dfrA17) and chloramphenicol(catB8).Strains positive for class Ⅰ integron were highly related to multidrug resistance and ESBLs.Class Ⅰ integron could horizontal transfer along with plasmid among bacteria.CONCLUSIONS Class 1 integron is widespread in Gram-negative isolates which are causing nosocomial infection.Drug resistance is more liable to horizontal transfer via class Ⅰ integron along with plasmid.It implies the necessary for surveillance of horizontal transfer of antibiotic resistance gene among bacteria genus.

Objective:To explore the validity of a function assessing tool based on the International Classification of Functioning, Disability and Health′s (ICF′s) rehabilitation set in assessing aging-related disability.Methods:A total of 1610 elderly people from 15 nursing homes across China were assessed using the tool based on the ICF′s rehabilitation set and with the 12-item short form health survey (SF-12). The structural validity of the responses was analyzed using factor analysis, and criterion-related validity was also evaluated.Results:The factor analysis yielded three factors with eigenvalues greater than 1. Their cumulative explanatory power was 74.4%. Item d550 eating had double loading in the factor analysis. The item scores and the total scores of the disability assessment tool were significantly negatively correlated with the physiological function domain scores and the psychological function domain scores.Conclusion:The function assessment tool based on the ICF′s rehabilitation set when combined with a numerical rating scale has good structural and criterion-related validity in the assessment of disability due to aging.

Objective To analyze factors contributing to the quality of life of earthquake victims with nonunion fracture in limbs after medical rehabilitation and to provide a clinical reference for future disasters.Methods Thirty-one wounded who sustained their injuries in the Sichuan earthquake completed the short form-36(SF-36)questionnaire 2 weeks before their amputation,and after 3,6 and 12 months of medical rehabilitation.The SF-36scores were compared with Sichuan population norms.Stepwise multiple linear regression was used to highlight variables which influenced their functional recovery and their physical and mental health.Results The physical and mental health composite scores of the 31 victims were significantly lower than Sichuan population norms before medical rehabilitation,but they had a significant increasing trend after 3,6 and 12 months of treatment.Their scores on all the domains remained significantly lower than Sichuan population norms at a later follow-up.Smoking,external fixations and chronic diseases were related to their recovery of physical function.Age,permanent housing,family income and casualties among family members were related to their mental health recovery.Conclusion The quality of life of patients with nonunion fracture caused by earthquake can be improved significantly through medical rehabilitation.But social factors should be considered in addition to medical rehabilitation after an earthquake.

Objective To determine,in our experience,the prevalence and presence of risk factors for metabolic syndrome (MS) in heart transplant recipients.Methods We studied 135 patients who underwent heart transplantation in our hospital from September 2000 to December 2011,According to the diagnostic criteria of MS,they were divided into two groups.All variables that could be related to the development of MS during the follow-up period were analyzed.The prevalence and presence of risk factors for MS in our experience were determined.Student t-test,Wilcoxon rank sum test and x2 test were used for univariate statistical analysis and logistic regression for multivariate analysis.Results (1) Of the 135 patients,63 developed MS (46.67％) during a mean follow-up period of 47.3 months.The multivariate analysis identified the follows as predictive factors for the development of MS:age (OR=1.09,95％ CI 1.01-1.22,P＜0.05),body mass index (BMI) (OR=1.65,95％ CI 1.16-1.87,P＜0.05),history of DM (OR =3.27,95％ CI 1.12-34.21,P＜0.05).Conclusion In our population,the prevalence of MS after heart transplant is 46.67％ during a mean follow-up period of 47.3 months.Age,pre-operative overweight especially BMI,and history of DM were significant and independent risk factors for the development of MS during the follow-up period.For these patients,dose of immunosuppressant and diet control are important.

Objective To design and synthesize compounds with protein tyrosine kinase(PTK)inhibitory activity with L029 as the lead compound. Methods L029 derivatives were designed and synthesized from L029 by reduction and/or substitution with the 3-dimethylamino-1-propyl,methyl acetate,methyl propionate in its active H and other sites. PTK activity was measured by enzyme-linked immunosorbent assay(ELISA). The inhibitory rate was calculated to screen out the compounds with PTK inhibitory activity. Re-sults Five target compounds were synthesized and their structures were confirmed by 1H NMR and MS. Three compounds T2,T3 and T5 were screened out with strong PTK inhibitory activity. Conclusion The synthetic routes of the target compounds are simple with mild reaction condition,and 3 compounds show strong inhibitory activity by ELISA. These results can provide reference for the further design and synthesis of this kind of molecules.