AIM: To study the role of liver in immune regulation in experimental endotoxemia. METHODS: 17 castrated male goats were subjected to simultaneously installing catheters in jugular, hepatic and portal veins by surgery. Four days later, lipopolysaccharide (LPS) was infused in term of three groups as followings: In group ①, LPS of 20 EU (endotoxin unit, EU)?kg -1 was infused into portal vein; In group ②, LPS of 20 EU?kg -1 was infused into jugular vein and LPS of 1 500 EU?kg -1 infused into jugular vein in group ③. Before and after infusion, blood samples were collected from the three veins through the catheters for 8 h. The plasma levels of TNF-? were measured by RIA. RESULTS: In group ①, the plasma TNF-? levels of hepatic and portal vein rose to peak value at 5 h, but that of the jugular vein did not changed. In group ②, the plasma TNF-? levels in hepatic vein rose to peak value at 3 h. The TNF-? levels of jugular vein rose to peak value at 1 h and the one in portal vein enhanced continuously between 0-8 h. In group ③, the plasma TNF-? levels in jugular, hepatic and portal vein rose to significant peaks at 1 h simultaneously. CONCLUSION: During experimental endotoxemia,liver showed different dynamic characteristics in TNF-? secretion according to the pathway and doses of LPS delivery. [

Objective To evaluate the efficacy of proximal percutaneous pedicle screw fixation combined with distal open osteotomy for sagittal plane imbalance of adult spinal deformity.Methods From January 2011 to June 2015,23 patients with diagnosis of adult spinal deformity were treated with proximal percutaneous pedicle screw fixation combined with distal open osteotomy,there were 8 males and 15 females,aged from 52 to 67 years old (average,62.1 years old).The operation time,blood loss,drainage and perioperative complications were recorded;standing anteroposterior and lateral radiographs of the whole spine were taken and the following parameters were measured:sagittal vertical axis (SVA),lumbar lordosis(LL),pelvic tilt (PT),sacral slope (SS),pelvic incidence/lumbar lordosis mismatch (PI-LL),the above parameters were compared between preoperation and postoperation.Oswestry disability index (ODI) was used to evaluate the clinical efficacy.Results The mean operation time was 253.9±52.1 min,the mean blood loss and drainage was 1 258.5±272.2 ml and 725.1 ± 135.2 ml.No patient got infected,died or had deep vein thrombosis.All patients were followed up for an average of 21.2 months (range,13-52 m).The SVA was restored from 12.6±1.4 cm to 3.5±0.7 cm.In addition,LL,SS,PT,and PL-LL were improved from 13.5°±2.3°,13.9°±2.3°,29.7°±9.6°,29.5°±13.7° to 38.8°±9.6°,25.5°±5.8°,18.9°±8.2°,7.1°±3.6°.The ODI score decreased from 40.3％±12.5％ to 13.6％±2.57％ at the time of the last follow-up compared with preoperation.Conclusion Proximal percutaneous pedicle screw fixation combined with distal open osteotomy for sagittal plane imbalance of adult spinal deformity could restore the sagittal balance and improve the quality of life.

BACKGROUND: The evaluation of stereoacuity can provide an unambiguous assessment of haplopia. It is valuable in assessing the diagnosticaccuracy and the therapeutic effect in strabismus, amblyopia and ametropia. OBJECTIVE: This investigation was designed to evaluate the stereopticdevelopment and the occurrence rate of strabismus in 3-6 years old children, and so that to provide objective data for prevention and treatment of strabismus and steropsis. DESIGN: It was a randomized sampling investigation. SETTING: Department of Ophthalmology,Haikou People's Hospital. PARTICIPANTS:Totally 8326 children in 25 urban and suburban kindergartens, with an age of 3-6 years old, were selected randomly in Haikou city from June 2000 to April 2002. METHODS: 8 326 3-6 years old children in Haikou city underwent vision examinations on hyperopia, eye position and the myopia. Those having eyesight lower than 1.0D or abnormal eye position received atropine drops to dilate the pupil of the eye for optometry. ① 4-6 years old children were examined using standard visual chart and logMAR chart (logarithm of the minimum angle of resolution chart), 3 years old children were examined using hroken wheel acuity cards or symbols chart. The results of the exminations were conversed and recorded in form of decimal fraction uniformly. ②The corneal reflection and the cover test procedure were used for the position of gaze. ③ Stereoacuity were examined using the stereoptic visual testing cards (made by the Institute of Biophysics, Chinese Academy of Sciences). Stereoacuity were defined as normal when the test value was ≤ 60 s and were defined as abnormal when it was ≥ 100 s. Each examination was performed by same selected physicians. MAIN OUTCOME MEASURFS: The main outcome measurements included ① results of eye position examination and stereoptic examination in children in all age brackets, ② results of optometry in children with strabismus, ③ The relation between eyesight and stereopsis in participants,④Stereoacuity of children in all age brackets, ⑤and possible causations involve in stereopsis. RESULTS: Practically, 8326 participants receiving examinations of eysight and eye position entered the statistical analysis procedure, while an other 662 children were omitted for their poor expression for the examinations. ① Results of stereoptic examination and eye position examination for participants in all age brackets: 165 (2％) with strabismus, in which 89.7％were first diagnosed; 2016 (27.5) with myopia, whose stereoptic value were ≥ 100 s. ②Results of optometry in children with strabismus: 93.5％ esotropia occurred in children with hyperopia. The rate of hyperopia/myopia was not significantly different between exotropia and vertical strabismus.③ Relation between eyesight and stereoacuity of participants: 75.5％ children have a normal stereoacuity.With a decreasing in eyesight,the stereoacuity decreased (P ＜ 0.05 or P ＜ 0.01). ④ Stereoacuity of the children in all age brackets: With an increasing age, the rate of children with normal stereoacuity increased. ⑤ Possible causations involved in stereopsis: strabismal amblyopia might have the greatest influence on stereopsis. CONCLUSION: ①About 90％ children with strabismus were firstly diagnosed in the investigation. Causations responsible for abnormal stereopsis include ametropia, strabismus, and amblyopia, and so on. ② Concomitant esotropia has close relation with binocular accommodation, while exotropia and vertical strabismus are not linked to refractions. Stereoacuity decreases with a decreasing in eyesight. ③ The results of the investigation support the view that mature stereopsis is achieved early than 4 years old although certain variance of stereoptic development can be observed among individuals.

In order to provide anatomical basis for transoral approach (TOA) in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults' fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2+/-3.5 mm and 39.3+/-3.7 mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1+/-5.2 mm and 50.2+/-4.6 mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0+/-2.9 mm and 24.0+/-3.5 mm respectively, and the distance of bilateral axis screw inserting points was 18.0+/-1.2 mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces: mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.
Atlanto-Axial Joint/*anatomy & histology ; Atlanto-Axial Joint/*surgery ; Bone Plates ; Bone Screws ; Cadaver ; Cervical Vertebrae/*anatomy & histology ; Cervical Vertebrae/surgery ; Equipment Design ; Internal Fixators ; Joint Prosthesis ; Models, Anatomic ; Odontoid Process/*surgery ; Prosthesis Design

Objective To evaluate the clinical features, treatment outcome, and prognostic factors in patients with primary Waldeyer’ s ring diffuse large B?cell lymphoma (WR?DLBCL). Methods This study included 200 patients with a confirmed diagnosis of primary WR?DLBCL admitted to our hospital from 2000 to 2013, who consisted of 50 stage I patients, 125 stage II patients, and 25 stage III?IV patients. Most patients received 4?6 cycles of CHOP or CHOP?based chemotherapy with or without involved field radiotherapy (Waldeyer′s ring+cervical lymph node region). Results The 5?year sample size was 71. The 5?year overall survival (OS), progression?free survival (PFS), and locoregional control (LRC) rates for the whole group were 78%, 72%, and 87%, respectively. In the 175 early stage patients, chemoradiotherapy resulted in significantly higher OS, PFS, and LRC than chemotherapy alone (86% vs. 70%, P= 0?? 001;84% vs. 58%, P= 0?? 000;97% vs. 66%, P= 0?? 000). Univariate analysis showed that age, tumor size, stage, lactate dehydrogenase level, and International Prognostic Index were prognostic factors for OS, PFS, and LRC ( P= 0?? 000?0?? 036), while the prognostic factors for PFS also included Eastern Cooperative Oncology Group score and cervical nodal involvement (P= 0?? 018). Multivariate analysis showed that age and stage were prognostic factors for OS and LRC (P= 0?? 003?0?? 022), and age was the prognostic factor for PFS (P= 0?? 000). Conclusions WR?DLBCL has distinct clinical features and favorable prognoses. For early stage patients, combined?modality therapy results in significantly higher OS, PFS, and LRC.

Objective To evaluate the value of radiotherapy following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone ( R?CHOP )?based chemotherapy for patients with early?stage Waldeyer’ s ring diffuse large B?cell lymphoma ( WR?DLBCL). Methods Eighty?three patients diagnosed with early?stage WR?DLBCL who were admitted to our hospital from 2000 to 2013 were enrolled in the study. In these patients, twenty?five had stageⅠdisease and fifty?eight had stageⅡdisease. All patients received R?CHOP?based chemotherapy with ( n= 62 ) or without ( n= 21 ) involved?field radiotherapy ( Waldeyer’ s ring plus cervical lymph nodes ) . The overall survival ( OS ) , progression?free survival ( PFS) , and local?regional control ( LRC) rates were calculated using the Kaplan?Meier method. The univariate analysis was performed using the log?rank method. The multivariate analysis was performed using the Cox regression model. Results In all patients, the 5?year sample size was 18;the 5?year OS, PFS, and LRC rates were 89%, 84%, and 90%, respectively. According to the univariate analysis, patient age greater than 60 years, an increased lactate dehydrogenase level, Eastern Cooperative Oncology Group ( ECOG ) performance status no less than 2, and International Prognostic Index ( IPI ) no less than 2 were poor prognostic factors. Patient age greater than 60 years, a tumor size no less than 5 cm, ECOG performance status no less than 2, and IPI no less than 2 were influencing factors for PFS and LRC rates. In addition to the treatment with rituximab, patients treated with consolidative radiotherapy had significantly higher PFS and LRC rates (94% vs. 58%, P=0?003;100% vs. 61%, P=0?000) as well as slightly higher OS rate ( 9 4%vs . 7 1%, P=0?0 6 3 ) than those treated without radiotherapy . Conclusions Consolidative radiotherapy following R?CHOP?based chemotherapy significantly improves PFS, LRC, and probably OS rates for early?stage WR?DLBCL. This conclusion still needs to be confirmed by prospective studies with a large sample size.

Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.

In order to provide anatomical basis for transoral approach (TOA) in dealing with the ventro lesions of craniocervical junction, and the design and application of artificial atlanto-odontoid joint, microsurgical dissecting was performed on 8 fresh craniocervical specimens layer by layer through transoropharyngeal approach. The stratification of posterior pharyngeal wall, course of vertebral artery, adjacent relationship of atlas and axis and correlative anatomical parameters of replacement of artificial atlanto-odontoid joint were observed. Besides, 32 sets of atlanto-axial joint in adults' fresh bony specimens were measured with a digital caliper and a goniometer, including the width of bony window of anterior arch of atlas, the width of bony window of axis vertebra, the distance between superior and inferior two atlas screw inserting points, the distance between two axis screw inserting points etc. It was found that the width of atlas and axis which could be exposed were 40.2±3.5mm and 39.3±3.7mm respectively. The width and height of posterior pharyngeal wall which could be exposed were 40.1±5.2mm and 50.2±4.6mm respectively. The distance between superior and inferior two atlas screw inserting points was 28.0±2.9mm and 24.0±3.5mm respectively, and the distance of bilateral axis screw inserting points was 18.0±1.2mm. The operative exposure position through TOA ranged from inferior part of the clivus to the superior part of the C3 vertebral body. Posterior pharyngeal wall consisted of 5 layers and two interspaces: mucosa, submucosa, superficial muscular layer, anterior fascia of vertebrae, anterior muscular layer of vertebrae and posterior interspace of pharynx, anterior interspace of vertebrae. This study revealed that it had the advantages of short operative distance, good exposure and sufficient decompression in dealing with the ventro lesions from the upper cervical to the lower clivus through the TOA. The replacement of artificial atlanto-odontoid joint is suitable and feasible. The design of artificial atlanto-odontoid joint should be based on the above data.

Objective:To investigate the efficacy of screw-rod fixation and fusion in revision surgery after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) for osteoporotic vertebral fractures (OVFs).Methods:A retrospective case series study was carried out on clinical data of 19 patients treated by revision surgery after PVP or PKP at Zhejiang Ningbo No.6 Hospital from January 2014 to December 2017. There were 5 males and 14 females, with age of (70.7±6.0)years (range, 58-81 years). Injured segment was located at T 9 in 1 patient, T 11 in 3, T 12 in 5, L 1 fracture in 5, L 2 in 2, L 3 in 2 and L 4 in 1. Caused for revision and operation methods were as follows, 5 patients underwent debridement, screw-rod fixation and fusion due to infection, 9 patients underwent osteotomy due to progressive kyphosis, screw-rod fixation and fusion, 5 patients underwent spinal canal decompression, screw-rod fixation and fusion due to neurological dysfunction. The operation time, intraoperative blood loss, and perioperative complications were recorded. The white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the control of infection before operation, before discharge and at postoperative 3 months. The changes in Cobb angle were measured before and after operation and at the final follow-up. The American spinal injury association (ASIA) scale, visual analog scale (VAS) and Oswestry disability index (ODI) were evaluated at the final follow-up. Results:All patients were followed up for 24-46 months [(32.7±8.3)months]. The revision operation time was 135-320 minutes [(226.3±75.6)minutes]. The intraoperative blood loss was 350-1 500 ml [(825.5±230.6)ml]. There were 1 patient with poor wound healing, 2 with pulmonary infection, and 2 with hardware loosening. The WBC, ESR and CRP decreased from preoperative (9.2±1.7)×10 9/L, (88.7±19.2)mm/h, (58.7±22.9)mg/L to (7.3±0.9)×10 9/L, (42.5±13.7)mm/h, (37.3±16.3)mg/L before discharge, and (6.6±0.7)×10 9/L, (26.8±9.5)mm/h, (17.8±8.6)mg/L at postoperative 3 months ( P<0.01). The Cobb angle improved from preoperative (29.3±5.2)° to (4.8±1.2)° ofter operation and (7.3±1.6)° at the final follow-up ( P<0.05). The patients with ASIA grade C ( n=2) and grade D ( n=1) improved to grade E, and the patients with ASIA grade C ( n=2) improved to grade D at the final follow-up. Imagines showed good bone fusion in all patients at the last follow-up. The mean VAS decreased from preoperative (7.5±0.8)points to (2.1±0.5)points at the last follow-up ( P<0.05). The ODI decreased from preoperative (60.7±15.2)% to (19.9±5.9)% at the last follow-up ( P<0.05). Conclusion:For patients with OVFs undergoing revision surgery after PVP or PKP, debridement, kyphosis correction, spinal canal decompression combined with screw-rod fixation and fusion can reduce infection, correct kyphotic deformity, improve neurological function, relieve pain and improve quality of life.

Objective:To explore the difference in properties of anterior occipital condyle plate screws compared with common anterior occipitalcervical fusion internal fixation.Methods:A 28-year-old healthy adult male volunteer's CT data of the occiput and neck was selected to establish finite element models：including the normal model，simple artificial vertebral fixation model（special-shaped titanium cage+clival screws），anterior occipital condyle plate and screw fixation model，and clival plate and screw fixation model，then a 50 N gravity and a torque of 1.5 N m were exerted upon the upper surface of the occipital bone to make the model produce flexion and extension，lateral bending and rotation. The motion range，internal fixation stress distribution and occipital bone stress distribution of each model under varying conditions were compared.Results:Under the conditions of flexion，extension，lateral bending and rotation，the range of motion of the normal model was 18.65°，15.35°，9.82° and 34.68°，respectively；that of the simple artificial vertebral fixation model was 3.20°，3.63°，2.94° and 3.92°，respectively；that of the clival plate and screw fixation model was 0.40°，0.50°，0.35° and 0.89°，respectively；that of the anterior occipital condylar plate and screw fixation model was 0.27°，0.33°，0.13° and 0.30°，respectively. Compared with the simple artificial vertebral fixation model，the range of motion of the clival plate and screw fixation model decreased by 87.5%，86.2%，88.1% and 77.3% in flexion，extension，lateral bending and rotation. The range of motion of the anterior occipital condylar plate and screw fixation model decreased by 91.5%，90.1%，95.6% and 92.3%，respectively. Under the conditions of flexion and extension，lateral bending and rotation，the stress peak of the simple artificial vertebral fixation model was 52.3 MPa，51.9 MPa，52.6 MPa，respectively；that of the clival plate and screw fixation was 100.1 MPa，158.1 MPa，170.6 MPa，respectively；that of the anterior occipital condylar plate and screw fixation was 114.2 MPa，62.9 MPa，132.9 MPa，respectively. Under the condition of flexion and extension，lateral bending and rotation，the stress peak of the occipital bone in the simple artificial vertebral body internal fixation model was 52.9 MPa，50.9 MPa and 62.3 MPa，respectively；that of the clival plate and screw fixation model was 19.7 MPa，55.9 MPa and 38.3 MPa，respectively；that of the anterior occipital condylar plate and screw fixation model was 37.8 MPa，15.0 MPa and 16.3 MPa，respectively. The stress in bone near the hypoglossal canal was close to 0 MPa，much smaller than the stress peak in occipital bone.Conclusion:Anterior occipital condylar plate and screw fixation in front of the special-shaped titanium cage can improve the stability of occipitocervical fusion with little effect on the occipital bone and hypoglossal canal or without obvious stress concentration，and hence is a safe and reliable anterior fixation method for upper cervical spine instability.