Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.

Relying on the experience of designing the WLAN commanding system for medical service indemnity in field hospital,this article describes the technique and the secure of WLAN,the component of hardware and the function of software in the commanding system,which gives a reference to set up field commanding system rapidly at wartime.

Objective To observe the transport of hepatitis B virus (HBV)-infected peripheral blood mononuclear cells (PBMC)through placental barrier set up by choriocarcinoma trophoblast cells (Bewo cells),and to explore the biological role of PBMC as a carrier for HBV transport.Methods Bewo cells and PBMC were cultured and their proliferation and activity were detected by cell counting kit (CCK)-8.One hundred μL serum containing 5 ×10 6 copy/mL HBV DNA was used to infect PBMC,and cells infected with HBV were labeled by fluorescent dye carboxyfluorescein diacetate succinimidyl ester (CFSE).A co-culture model of Bewo cells and HBV-infected PBMC was set up by transwell chamber. The migration of HBV-infected PBMC was detected by flow cytometry.Realtime fluorescence quantitative polymerase chain reaction method was used to detect HBV DNA contents of PBMC under transwell chamber.Results PBMC and Bewo cells proliferated at around 24 h and entered into growth stagnation at around 120 h.The contents of PBMC labeled by green fluorescent at 0,12,24 and 48 h during co-culture under chamber were (0.445 ±0.021)%,(21 .180 ± 4.653 )%,(34.830 ± 7.156 )% and (64.185 ± 3.161)%,respectively.The amount of PBMC marked green fluorescence increased over prolonged incubation time (F =68.983,P =0.001 ).PBMC HBV DNA contents at 24 and 48 h of co-culture under chamber were (1.925±0.431)×103 copy/mL and (2.565 ±0.361)×103 copy/mL,respectively,indicating that PBMC under chamber were infected with HBV.Conclusions PBMC may be a target for HBV infection in extrahepatic tissues.Placental trophoblastic barrier built by transwell chambers may provide new ideas to investigate HBV transmission across the placenta in vitro .

ObjectiveTo investigate the safety and early clinical efficiency of dynamic cervical implant (DCI) internal fixation to treat cervical disc herniation.Methods From September 2009 to December 2010,31 patients with herniation of cervical disc underwent DCI implantation.The operation time and blood loss were recorded and analyzed.Neck disability index (NDI),Japanese Orthopaedic Association (JOA) score,and visual analogue scale(VAS) score were used to evaluate neurofunctional recovery pre- and post-operation.Routinely,the patients accepted X-ray examination preoperatively and postoperatively.We used White's measurement to measure the range of motion(ROM) and height ratio of implant segment and the superior vertebra pre- and post-operation.ResultsThe average operation time and amount of bleeding were 45 (30-60) min and (100±30) ml respectively.The average postoperative follow-up was 14 months (range,6-20).The average NDI (50.5±16.2 vs.19.6±4.3,P＜0.05),JOA score (12.3±1.6 vs.13.9±1.8,P＜0.05) and VAS score (6.3±2.6 vs.3.1±2.2,P＜0.05) changed significantly at the last follow-up compared with those pre-operation.There were no significant differences in the average ROM of implant segment (9.6°±4.2° vs.6.9°±5.3°,P＞0.05),the height ratio of implant segment and the superior vertebra(2.6±0.1 vs.2.5±0.1,P＞0.05) and the angle of functional spine unit(2.6°±5.2° vs.1.7°±2.9°,P＞0.05) at last follow-up compared with those preoperation.ConclusionUsing DCI to treat cervical disc herniation had shorter operation time and less bleeding advantages,and the early clinical effect was satisfactory.It may retain the cervical biomechanical movement in some degree,maintain the cervical stability.

In previous studies, we demonstrated 10 types of lymphocytes in lymph nodes, each exhibited a different fluorescent color by our thioflavine staining method. Among them, 4 types were able to differentiate into plasma cells of the same fluorescent colors. In the present study, different types of lymphocytes were demonstrated in human peripheral blood by their different fluorescent colors after thioflavine staining. The lymphocytes from the venous blood of 50 healthy persons were isolated with Ficoll-Conray solution and E-rosette and EAC-rosette tests and fluorescent staining with thioflavine were performed. Most of the lymphocytes in peripheral blood are small ones with nuclei and cytoplasm showing blue fluorescence and the blue fluorescence of the cytoplasm is paler than that of the nuclei. The nuclei in a part of these lymphocytes have distinct boundaries. The nuclei in another part of these lymphocytes are smaller and with indistinct boundaries and indentation on one side and show dim fluorescence. Other lymphocytes show different fluorescence. Some show blue round nuclei with distinct nuclear membrane, and no color of fluorescence in cytoplasm, but with blue white patches on one side of the nuclei. Some show dark blue nuclei and bright blue cytoplasm and others show orange yellow or orange red nuclei and yellow cytoplasm. In addition, lymphocytes of grayish blue or grayish yellow nuclei and bluish green cytoplasm or lymphocytes of yellowish fluorescence may be seen at times. Very few lymphoeytes of orange red nuclei with nearly no cytoplasm may be seen occasionally.The lymphocytes with blue fluorescence and indentation on one side of nucleus, those with blue nuclei and blue white patches in the cytoplasm as well as those with orange yellow nuclei and yellow cytoplasm can form E-rosettes with sheep erythrocytes. They are T cells. The lymphocytes with distinct boundaries of nucleus, small size and blue fluorescence those with dark blue nuclei and bright blue cytoplasm as well as those with orange red nuclei and yellow cytoplasm can form EAC-rosettes with sheep erythrocytes sensitized by specific antibody and complement. They are B cells. The lymphocytes with blue nuclei and blue white patches may transform into lymphocytes with orange yellow nuclei and yellow cytoplasm under ultra-violet light irradiation. The latter are few in number in the blood but may be progressively increased in number on prolonged observation. They belong to Group Ⅲ of lymphocytes and are mainly located in the paracortical thymus-dependent zone of lymph nodes. The sma ller lymphocytes with blue fluorescence and distinct nuclear boundary may transform into lymphocytes with orange red nuclei and yellow cytoplasm, which are also very few in number in the blood and are also progressively increased in number on prolonged observation. They belong to Group Ⅱ of lymphocytes and constitute the main component of lymph nodules in lymph nodes.

Objective:To investigate the main clinical features of critically ill patients with influenza A (H1N1) influenza virus pneumonia, and the relationship between airway secretions and cardiopulmonary pathology change with continuous hypoxemia. Methods: The retrospective analysis was made in critically ill patients with H1N1 influenza virus pneumonia admitted to a respiratory intensive care unit(RICU). Twenty-four patients were all administrated antiviral drugs (oseltamivir 75/150 mg Bid). Twenty of them were subjected to application of hormonal therapy, and 6 of them with mechanical ventilation. Results: The average age of 24 patients was (48.25±19.73) years old. Fifteen of them were pregnant women, obesity and who suffered from chronic underlying diseases. The main symptoms of them were progressive shortness of breath, cough and myalgia. It was found by X-ray that 22 patients(91.67%) had multiple lung consolidation shadow. After admission, airway secretions were collected, and the protein concentration of which was 34.1-37.7 g/L in 5 cases. The concentration of l-lactate dehydrogenase(LDH) was 792-1 890 U/L. White blood cell count was (0.722-1.470)×10~9/L, included 0.21-0.44 neutrophils, 0.111-0.560 mononuclear cells, 0.027-0.110 eosinophils, 0.018-0.054 basophils. Pathological changes of these patients were hyaline membrane formation, alveolar cavity collapse, myocardial cell degeneration and focal myocardial necrosis. Intubation and mechanical ventilation were performed in 6 cases, 5 of them dead and the mortality rate was 20.83%. Conclusion: The lung pathological damages were increased LDH and protein in airway secretions, and increased count of inflammatory cells. Effect of mechanical ventilation was not satisfied in part of patients who had diffuse lung consolidation in X-ray, and the related complications leaded to exacerbation or death in part of them.

Objective To evaluate the systematic and random set-up errors in patients immobilized with thermoplastic device during radiotherapy, and to determine the proper margins extended from clinical target volume ( CTV ) or internal target volume ( ITV ) to planning target volume ( PTV ). Methods From March 2007 to September 2007,120 patients were included in this study, including 13 receiving head and neck irradiation, 67 thoracic irradiation and 40 abdominal irradiation. All patients were immobilized with thermoplastic device and received CT simulation and intensity modulated radiation therapy(IMRT). X-ray cone beam CT was regularly performed before treatment and the images were compared with the simulation CT images. The shift and rotation in right-left( R-L), superior-inferior(S-I) and anterior-posterior(A-P) directions were recorded and analyzed. The shift margin from CTV or ITV to PTV was calculated with the equation, margin = 2'mean + 0.7'standard deviation. Results In head and neck region, the shift errors in R-L,S-I and A-P directions were(0.13 ±0.15) cm, (0.13 ±0.17) cm and(0.11 ±0.14) cm,and the corresponding rotation errors were 1.05°± 0.77°,0.87°± 1.13° and 0.68°±0.89°. The margins from CTV to PTV were 0.37 cm,0.38 cm and 0.31 cm,respectively. In thoraci region,the shift errors in R-L,S-I and AP directions were(0.20 ±0.27) cm, (0.34 ±0.44) cm and(0.25±0.31 ) cm,and the corresponding rotation errors were 1.06°±1.45° ,0.85°±1.23° and 0.78°±1.08°. The shift margins from ITV to PTV were 0.59 cm, 1.00 cm and 0.72 cm. In abdominal region, the shift errors in R-L, S-I and A-P directions were (0.23 ± 0.30) cm, (0.37 ±0.45 ) cm and ( 0.27 ±0.34 ) cm, and the corresponding rotation errors were 1.22°±1.56°, 1.05°± 1.44°and 0.98°± 1.24°. The shift margins from CTV or ITV to PTV were 0.66 cm, 1.05 cm and 0.78 cm. Conclusions Cone beam CT can be used in the precise measure of set-up errors,which can provide institution-specific margins for PTV designing in patients immobilized with thermoplastic device.

Objective To investigate the different operation methods for kyphosis deformity of ankylosing spondylitis(AS)complicated with cervical vertebral fracture and their effects.Methods A retrospective case series study was conducted to analyze the clinical data of 19 patients with AS kyphosis complicated with cervical vertebral fracture admitted to Henan People's Hospital from April 2007 lo October 2017.There were 18 males and one female,aged 28-73 years,with an average age of 38.6 years.Among the patients,17 were complicated with spinal cord dysfunction.According to the American spinal injury association(ASIA)classification,there were four patients with grade A,five with grade B,five with grade C and three with grade D.According to the degree of nerve injury and the displacement of fracture,reduction and fixation or orthopedic fixation were selected;14 patients with severe nerve injury(ASIA grades A-C)were treated with reduction and fixation,of which six were treated by simple anterior approach,two by simple posterior approach,five by combined anterior-posterior approach,and one by combined anterior-posterior approach 2 months after Halo fixation.Five patients with ASIA grade D or E were treated with orthopedic fixation.Firstly,kyphosis was corrected with manual technique and the Halo external fixator was installed,and then surgical fixation fusion was performed via simple posterior approach(one patient)or combined anterior-posterior approach(four patients).Visual analogue scale(VAS)was used to evaluate the relief of neck pain.The improvement of nerve function,the effect of orthopedic fixation,the fracture healing time and the postoperative complications were recorded.Results One patient died 11 days after operation due to pulmonary infection and respiratory failure.The remaining patients were followed up for 1-10 years,with an average of 27.3 months.The neck pain in all patients was relieved significantly,and the VAS score[(2.9±0.9)points]decreased significantly 3 days after operation compared with that before operation[(8.2±1.0)points](P＜ 0.05).The nerve function of 12 patients improved significantly(P＜ 0.05).The chin-brow vertical angle of the patients after orthopedic fixation was 60-180(mean,11.8°),suggesting that the level vision function was restored.Fracture healing time ranged from 3 to 8 months,with an average of 3.9 months.There were 4 patients with cerebrospinal fluid leakage and three patients with pulmonary infection.No complications such as wound infection and aggravation of nerve injury occurred.Conclusions For AS kyphosis combined with cervical spine fracture,if without severe nerve injury,manual correction of kyphosis and installation of Halo frame followed by fixation and fusion can effectively correct spinal deformity and improve the quality of life.Patients with severe spinal cord injury should avoid stage I correction and receive reduction of fracture and long segment fusion fixation as far as possible to facilitate the recovery of nerve function.

Objective To investigate the clinical efficacy of posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 13 patients with anterior atlas arch displaced fracture admitted to Henan Provincial People's Hospital from January 2010 to March 2016.There were eight males and five females,aged 28-62 years[(40,0±9.2)years].According to Frankel grading,there was one patient with grade C and 12 patients with grade D.All patients were treated with posterior cohesive reduction with screw-rod system.Operation time,blood loss,intraoperative and postoperative complications were recorded.The operation time,intraoperative blood loss,internal fixation position,fracture healing and bone graft fusion were recorded.The Japanese orthopedic- association(JOA)score,visual analogue scale(VAS),Frankel grade,and cervical motion range were compared before and at the last follow-up.The intraoperative and postoperative complications were recorded.Results All patients were followed up for 29～68 months[(48.2±14.5)months].The operation time was 50-75 minutes[(59.5±6.5)minutes],and blood loss was 55-80 ml[(62.5±8.3)ml].After operation,fracture lines were well reset,nerve compression was relieved,pillow neck pain was alleviated,and limb function was significantly improved.CT scans confirmed bony union in al 1 patients 6 months after operation.The JOA score at the last follow-up[(15.4±0.7)points]was significantly higher than that before operation[(7.9±1.3)points](P＜ 0.05).The preoperative VAS was significantly decreased from(6.2±0.9)points to(1.9±1.0)points at the last follow-up(P＜ 0.05).The range of motion of cervical spine was close to the normal level with 70°-91°[(80.7±7.0)°]of anteflexion and extension,131°-157°[(142.9±9.1)°]of horizontal rotation,and 78°-89°[(83.8±3.2)°]of lateral flexion.One patient with incision infection and five neck stiffness as well as limited neck movement were reported,but all were cured or improved significantly after symptomatic treatment.No internal fixation lossening or breakage was found.Conclusions Posterior screw-rod single vertebra internal fixation for anterior atlas arch displaced fracture has the advantages of shortened operation time,less bleeding,less complication,good reduction as well as restored motor function of atlantoaxial joint.

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures ( OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78. 5 ± 13. 2) years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II ( APACHE II ) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale ( VAS) and Oswestry dysfunction index ( ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3 ±2.9)months]. The operation time was (69. 2 ± 25. 9) minutes, and the amount of intraoperative bleeding was (7. 5 ± 2. 6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation ( P > 0. 05 ) . No surgical discontinuation or deterioration occurred. The APACHE II score was (15. 2 ± 3. 7) points before operation and (8. 4 ± 0.7)points at 24 hours after operation (P <0.05). The compression height parameter of the injured vertebraewas(17.2±3.6)mmbeforesurgery,(20.4±41.3)mmatoneweekaftersurgery,and(18.8± 1.3)mm at the last follow-up (P >0. 05). The Cobb angle was (25. 6 ± 9. 3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8. 5 ± 1. 2)points before operation, (2. 1 ± 0. 3)points at one week after operation, and (3. 2 ± 1. 1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS ( P<0. 05 ) , but there was no significant difference between the former two (P>0. 05). The ODI value was 39. 9 ± 3. 4 before operation, 20. 2 ± 5. 2 at one week after operation, and 17. 2 ± 2. 0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI ( P <0. 05),showing improvement trend during the follow-up (P<0. 05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine.