Objective To explore the relationship between early changes of central venous-toarterial carbon dioxide difference (Pcv-aCO2) and the prognostic in patients with septic shock.Methods One hundred and three patients with septic shock were retrospectively analyzed.The patients were divided into death group (37 cases) and survival group (66 cases) according to prognosis.The patients were divided into four groups according to the changes of 0 and 6 h Pcv-aCO2:Pcv-aCO2 persistently high group (16 cases),Pcv-aCO2 increased group (19 cases),Pcv-aCO2 decreased group (22 cases),Pcv-aCO2 persistently normal group (46 cases).All the patients were treated with early goal-directed therapy (EGDT),and central venous oxygen saturation (ScvO2) ≥0.70 was the target.The acute physiology and chronic health evaluation (APACHE) Ⅲ score,sepsis related organ failure assessment (SOFA) and mortality were compared.Results There was no statistical difference in 0 h Pcv-aCO2 (P ＞ 0.05).The Pcv-aCO2 in 6,12 and 24 h in survival group was significantly lower than that in death group [(5.0 ± 1.8) mmHg (1 mmHg =0.133 kPa) vs.(6.8 ± 2.3) mmHg,(4.7 ± 2.3) mmHg vs.(7.2 ± 3.0) mmHg,(3.2 ± 1.5) mmHg vs.(7.5 ± 3.3) mmHg],and there was statistical difference (P ＜ 0.05 or ＜ 0.01).The APACHE Ⅲ score in survival group was significantly lower than that in death group [(51.6 ± 23.8) scores vs.(87.7 ± 35.9) scores],and there was statistical difference (P ＜ 0.05).The time of mechanical ventilation,APACHE Ⅲ score,SOFA,length of stay in hospital and mortality in Pcv-aCO2 persistently high group and Pcv-aCO2 increased group were significantly higher than those in Pcv-aCO2 decreased group and Pcv-aCO2 persistently normal group,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).Conclusion The Pcv-aCO2 persistently high during the early resuscitation of septic shock is associated with multi-organ dysfunction and worse prognosis,and provides guidance for clinical treatment.

Objective To discuss the effect of the sustained releasing agent FK506 on the ultrastructure of the regenerative nerve fibers.Methods The new fusiform-shaped double channel nerve conduit was used for bridge the sciatic nerve defects for 10 mm in 32 Sprague-Dawley rats.The rats were divided into Group A(100μl chitin for both channels)and Group B(chitin plus FK506 for B1 and chitin plus normal saline for B2)according to different addition of the drugs.At 8 and 12 week after operation,the middle line of the regenerated nerve was observed under the transmission electron microscope.In the meantime,an analysis was done on the area of the regenerated nerve fibers(myelinated and unmyelinated),diameter and myelin thickness of the myelinated fiber axon at 8 and 16 months.Results There was not significant difference in aspects of type and number of the regenerative nerve fibers between two channels in Group A.However,the myelinated and unmyelinated fibers of the regenerative nerves were increased in Group B1,with larger area than Group B2(P ＜ 0.05).Conclusion FK506 can significantly promote the regeneration of both the myelinated and unmyelinated fibers.

With the aging of population, the incidence of osteoporosis and intervertebral disc degeneration increased remarkably.As a consisting part of spine, vertebrae play important roles in spinal diseases.The microstructure of vertebrae is closely associated with not only its biomechanical properties, but also its adjacent intervertebral discs.A detailed understanding of vertebrae's microstructure can help us understand the initial mechanism, progression and prognosis of vertebrae and its adjacent discs' diseases.On the other hand, traditional examinations are less effective in detecting vertebrae's microstructure.Being a noninvasive, high-resolution and bony-sensitive neo-technology, Micro-CT has obvious advantages in detecting vertebrae's microstructure.Many researches have reported the usage of Micro-CT in reveling microstructures while they also raised problems.Thus, herein we searched the related information of vertebrae's microstructure scanning with Micro-CT, explained its basic mechanism, reviewed its progress in technology and arithmetic, and concluded the latest developments.Depending on the microstructure revealed by Micro-CT, achievements in biomechanical properties of vertebrae and intervertebral disc degeneration have been made,and related problems have been summarized.Also, new applications of Micro-CT in spinal diseases are discussed for acquiring reasonable clinical data in the future.

Objective To retrospectively investigate diagnostic and therapeutic value of intradiscal steroid injection in patients with discogenic low back pain combined with radial fissure of annulus fibrosis.Methods Totally 120 patients who had undergone CT guided intervertebral discography and steroid injections,including 72 males and 48 females,aged from 25 to 60 years (average,48 years),were recruited to this study.According to Dallas discography description system,7 cases were rated as grade 0,36 grade 1,48grade 2,and 29 grade 3.The Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire (RMDQ) were used to evaluate clinical effect at 2 weeks,2 months,6 months,12 months and 24 months postoperatively.Results Most of patients who underwent steroid injection in single highly suspect diseased disc claimed significant symptom improvement.There were statistically significant differences between pre- and post-operative VAS and RMDQ.The clinical effect in grade 3 group was better than those in grade 1 and grade 2 groups,and the differences were significant.Patients with severe disc disruption (grade 3) had a lower recurrence rate of low back pain compared with other patients.Conclusion Intradiseal steroid injection not only can significantly relieve discogenic low back pain,but also can benefit diagnosis of discogenic low back pain,especially in patients who fail to reproduce concordant pain on discography.For patients with severe rupture of the annulus fibrosus,the relief of discogenic low back pain is more significant.

ObjectiveTo observe the change of blood phosphorus and N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with severe acute organophosphorus pesticide poisoning (AOPP)and explore their clinical significance.MethodsSeventy-eight severe AOPP patients were selected and divided into dead group (54 cases) and survival group (24 cases).NT-proBNP and blood phosphorus were examined when the patients were just hospitalized,and after 1,2,4 d and when they were turn out from ICU or before the patients dead.ResultsComparing with survival group,blood phosphorus and NT-proBNP of dead group had no significant difference when the patients were just hospitalized(P＞ 0.05 ).After 1,2 and 4d NT-proBNP of dead group [ ( 1986.5 ± 24.9),(3568.2 ± 56.9),(7829.0 ± 64.3 ) ng/L ]was higher than that of survival group [ ( 1068.4 ± 20.2),(986.6 ± 16.4),(943.7 ± 14.6) ng/L,P ＜ 0.05 or ＜ 0.01 ],while blood phosphorus was significant lower than that in survival group [ ( 1.22 ± 0.13 ),(0.81 ± 0.10),(0.58 ±0.07 ) mmol/L vs.( 1.53 ± 0.16),( 1.48 ± 0.13 ),( 1.46 ± 0.14 ) mmol/L,P ＜ 0.05 or ＜ 0.01 ].NT-proBNP of dead group increased and blood phosphorusreduced gradually by time extending (P ＜ 0.05).NT-proBNP was lower when patients were turn out from ICU than that when the patients were just hospitalized [ (327.5 ±12.3) ng/L vs. (1023.3 ± 18.8) ng/L,P ＜ 0.05].Blood phosphorus had no difference at all time points in survival group (P ＞ 0.05 ).NT-proBNP was higher [ ( 31 486.5 ± 120.7) ng/L vs.(327.5 ± 12.3) ng/L,P ＜0.01 ]and blood phosphorus was lower [ (0.24 ± 0.03 ) mmol/L vs.( 1.57 ± 0.15 ) mmol/L,P ＜ 0.01 ]before death in dead group compared with those at the time turning out from ICU in survival group.Conclusions The value of NT-proBNP increased and blood phosphorus reduced gradually with disease progression.NT-proBNP and blood phosphorus were important factors reflecting the prognosis of blood AOPP patients.

objective To evaluate the prognostic value of five scoring systems including acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ),Ranson score,sepsis-related organ failure assessment (SOFA),Balthazar CT severity index (CTSI) and modified early warning score (MEWS) in early prognosis of severe acute pancreatis.Methods One hundred and fifty-four patients with severe acute pancreatitis from January 2004 to January 2010 were studied retrospectively,and data pertinent to five scoring systems were recorded from day 1 to day 3 after admission in hospital All patients were divided into early non-survival group (43 cases) and early survival group ( 111 cases) by survival time after admission in hospital.Five scoring systems during first 3 days aftter admission and their prognostic value in early prognosis of severe acute pancreatitis was compared between two groups.Results Compared with that of early survival group,every day five scoring systems of early non-survival group were significantly higher in the first 3 days after admission (P ＜ 0.05 or ＜ 0.01 ).On day 1 after admission,APACHE Ⅱ was the most accurate predict of early mortality with area under curve (AUC) value of 0.879,closely followed by MEWS (AUC 0.858).On day 2 and 3 after admission,the MEWS was the most accurate predict of early mortality with AUC 0.900 and 0.942,respectively.Conclusion MEWS is more accurate predict of early mortality in severe acute pancreatitis among different scoring systems,worthy of generalization in clinic.

Objective To prepare nerve growth factor gradient release system,and explore the promotion of the clinical effects of peripheral nerve regeneration.Methods All 57 cases with peripheral nerve injuries were treated with emergency nerve repair from July 2010 to August 2012,a nerve repair,with meanwhile randomly were divided into group A (19 cases),group B (19 cases) and group C (19 cases).The NGF was used to partial release by using the homemade gradient release system in group A,the same amount of NGF was partial injeced to Gelatin sponge surrounding peripheral nerve in group B.The NGF wasn't injected in group C.All patients respectively underwent neurophysiological examination after 4 weeks and 8 weeks.Comparising with the somatosensory evoked potentials (SEP) and muscle action potential (MAP) between different groups,meanwhile analyzing nerve conduction velocity (NCV).The sensory and motor function evaluation score of BMRC were performed after 24 weeks.Results The peak latency of the SEP after 4 weeks in A,B and C groups were (34.80 ± 3.45) ms,(42.85 ± 2.58) ms,and (51.05 ±3.652) ms,respectively; the volatility were (10.673 ± 2.35) μV,(6.30 ± 1.22) μV,and (4.10 ±0.83) μV,the peak latency of the MAP after 4 weeks in A,B,C groups were(5.29 ±0.82) ms,(7.63 ± 1.35)ms,and (9.98 ± 1.15) ms,the volatility were (485.75 ±65.83) μV,(262.510 ±59.90) μV,and (185.64 ±38.35) μV,the NCV were (25.50 ±3.65) m/s,(19.80±2.35) m/s,and (15.50 ±2.61) m/s.The peak latency of the SEP after 8 weeks in A,B,C groups were (24.68 ±4.50) ms,(31.08 ±4.24) ms,and (39.25 ±4.83) ms,the volatility were (21.22 ± 4.63) μV,(13.68 ± 4.14) μV,and (8.90 ± 1.25) μV.The peak latency of the MAP after 8 weeks in A,B,C groups were (4.71 ±0.35) ms,(6.10±1.54) ms,and (8.86±0.75) ms,the volatility were (839.81 ± 111.07) μv,(512.25 ±46.82) μv,and (312.65 ±47.52) μv,the NCV were (26.24±3.22) m/s,(21.23 ±2.40) m/s,and (16.34 ±2.55) m/s.Compared with the group C,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A and B,the NCV was faster significantly in group A and B (P ＜ 0.05).Compared with the group B,the peak latency of the SEP,MAP was shortened significantly and the Volatility was increased significantly in group A,the NCV was faster significantly in group A (P ＜ 0.05).The good rate of the A,B,C groups in BMRC sensory function score were 78.95％,63.15％ and 52.63％ respectively.The good rate in BMRC motor function score were 84.21％,68.42％and 47.37％ respectively.The group A and B were higher than group C,and the good rate of group A was higher than group B(P ＜ 0.05).Conclusion The nerve growth factor gradient release system is safe and effective for early treatment of peripheral nerve injuries.

Objective To clarify the relationship between the basivertebral foramen (BF) and the retropulsed bone fragment (RBF) in thoracolumbar burst fracture (TLBF) and further explain the mechanism of RBF formation.Methods From June 2013 to June 2016,Sixty-two patients suffering from TLBF with RBF were collected.The characteristics of RBF as well as the parameters of vertebral body were studied using CT reconstruction imaging.In the transverse images,the lengths of RBF (RL) and vertebral body (VL) were measured.In median sagittal images,the heights and widths of RBF (RH,RW) and vertebral body (VH,VW) were also obtained.The ratios of different parameters of RBF and vertebral body (RL/VL,RW/VW,RH/VH) were calculated,and then defined the location relationship of RBF and BF.Eight frozen cadaveric spine were selected and evaluated by Micro-CT scans.Each vertebral body was divided into three layers (Superior,Middle,Inferior).Each layer was further divided into 9 regions (R1-R9),named as SR1-SR9,MR1-MR9,IR1-IR9.Microarchitecture parameters of each region in each layer,including bone volume fraction (BV/TV),bone mineral density (BMD),trabecular connectivity (Corn.D),and trabecular number (Tb.N) and thickness (Tb.Th) were calculated,and their differences were also analyzed to see if the trabecular bone distribution would be affected by BF.In vitro study,burst fractures were simulated on cadaveric spines by using bursting fracture simulator,aiming to observe the RBF morphology and imaging findings to future investigate the relationship between RBF and BF.Results The length and height of RBF were close to half of vertebral body length and height (RL/VL:0.497±0.059,RH/VH:0.485±0.036).The width of RBF was usually one-third of vertebral body width (RW/VW:0.319±0.025),which indicated that the fracture block was often located in the posterior of vertebral body above the BF.BV/TV,Tb.N in the MR2 and MR5 regions were lowest than other regions and the SMI of MR2 and MR5 was largest than others.SR5 was the lowest region in superior lawyer that was corresponded to regions most affected by burst fracture.In simulated burst fractures,the fracture line of RBF went across the vertex or upper surface of the BF and the lower boundaries of RBF were also the upper bound of the BF.Moreover,the damage sites of posterior longitudinal ligament were mainly located at the edge of the BF.Conclusion At the bone defect region,the BF is the weakest area in the vertebral body which may affect the distribution of trabecular bone surrounding it.When subjected to vertical violence,these regions undergo fracture first which impact the anterior and lower boundaries of RBF.Ultimately,RBF was produced upon the BF,involving all or part of the upper bound of the BF.

Objective:The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods:The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed. The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery (VATS). The success rate, complications, pathological results and localization operations related data were statistically analyzed.Results:The success rate of localization was 97.63% (206/211), and the success rate of VATS removal was 99.53% (210/211). The average operation time was (7.19 ± 2.62) min, and the average time required for resection of lesions was 27 min (10 to 126 min). During the surgery, the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall. The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface. It was found that the hook-wire was located in the interlobar fissure in 3 patients. The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range. A minor pneumothorax occurred in 49 patients, but no closed drainage was needed; 12 patients developed intrapulmonary hematoma; 15 patients with chest pain were treated with analgesia.Conclusions:For small pulmonary nodules requiring thoracoscopic surgery, the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient, safe and effective, and is worthy of promotion to use.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.