Objective To explore the value of laparoscopic appendectomy (LA) in children. Methods A total of 52 children underwent laparoscopic appendectomy by using the 3-port technique from October 2002 to December 2004. Results The operations were performed smoothly in all the 52 cases. The operating time was 20~50 min (mean, 30 min). The patients were discharged from hospital at 2~4 postoperative days. Peri-port subcutaneous emphysema occurred in 2 cases. No other complications were found. Follow-up checkups for 3~29 months (mean, 14 months) in 49 cases found no intestinal obstruction or abdominal residual infection. Conclusions Laparoscopic appendectomy in children is safe, effective and minimally invasive.

Objective To evaluate the value of computed tomography(CT) and magnetic resonance imaging(MRI) in diagnosis of avascular necrosis of the femoral head(ANFH). Methods The literatures of ANFH diagnosed with CT and MR imaging published in the last ten years were collected by searching. Of that,21 literatures were correspond for the standards in this study and were select-ed. These literatures in diagnosing ANFH with CT and MR imaging were analysed with Meta-analysis by the sofeware of StataSE10.1. Results MRI was more effective than CT in diagnosing ANFH. There was significantly different in statistics between them [OR=0.13,95%CI(0.03～0.51)]. Conclusion In comparison with CT,MRI is the better method in diagnosing ANFH.

Objective To investigate the effect and the mechanism of parecoxib sodium pretreatment on permeability of blood-brain barrier in a rat model of focal cerebral ischemia-reperfusion injury.Methods Sixty male SD rats weighing 300g were randomly divided into 5 groups (n=12 each):sham operation group (group S);focal cerebral I/R group (group I/R);parecoxib sodium 5 mg/kg pretreatment group (group L);parecoxib sodium7.5mg/kg pretreatment group (group M);parecoxib sodium 10 mg/kg pretreatment group (group H) Middle cerebral artery occlusion models were made by reforming Longa suture method in SD rats.Thirty minutes before ischemia,rats in group L,M and H were injected with 5 mg/kg、7.5 mg/kg and 10 mg/kg parecoxib sodium through the internal jugular vein.Group S and group I/R received equal volume of normal saline.ELISA technique was used to determine the content of S100 β,TNF-α,IL-1 β in Plasma.The changes of cerebral water content and the Evans Blue exudation from brain capillaries were observed.Results Pretreated with parecoxib sodium (5mg/kg、7.5 mg/kg and 10 mg/kg),the content of S100 β,TNF-α,II-1 β in plasma were reduced.The cerebral water content and the EB in brain were reduced.Pretreated with parecoxib sodium 10 mg/kg,Longa scores were reduced.Conclusion Pretreatment with Parecoxib can protect blood-brain barrier against focal cerebral I/R injury by inhibition of the inflammatory reaetion.

Objective To investigate the expression levels of Interleukin(IL)?6 and matrix metalloproteinases(MMP)?13 in synovial fluid by in?vigorating kidney and activating blood formulae in treating rabbit knee osteoarthritis model. Methods A total of 30 New Zealand rabbit were ran?domly divided into blank group,model group,invigorating kidney group,activating blood group and invigorating kidney and activating blood group. Rabbits model with knee osteoarthritis were established by improved Hulth method. To give corresponding respectively the medicinal broth,model group was given saline,knee joint synovial fluid was collected after 4,8 and 12 weeks. Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of IL?6 and MMP?13. Results The levels of IL?6 in rabbit knee osteoarthritis were obviously higher than that of normal control group at both 4 weeks and 8 weeks(P<0.001). But there was no statistical difference on the levels of IL?6 compared with controls in 12 weeks. In addition,the level of MMP?13 at 4 weeks,8 weeks and 12 weeks were significantly higher than the blank control group(P<0.001). After 8 weeks of Chinese medicine administration,the levels of IL?6 in synovial fluid were significantly decreased in invigorating kidney group,activating blood group and invigorating kidney and activating blood group(P<0.001),but there was no statistical difference among groups in 12 weeks. The MMP?13 levels of synovial fluid was significantly lower than the model group(P<0.001). Conclusion Our results indicate that IL?6 and MMP?13 par?ticipate in the pathological development of the rabbit knee osteoarthritis. Invigorating kidney and activating blood formulae could reduce the expres?sion of IL?6 and MMP?13 and alleviate osteoarthritis progression,and which is superior to the pure invigorating kidney formulae and activating blood formulae.

Objective To explore clinical characteristics of patients with Klinefelter′s syndrome(KS; 47,XXY).Methods 227 male patients with 47,XXY treated by artificial insemination with donor(AID)were included.Age, education, height, weight, body mass index(BMI), testicular volume, FSH, LH, testosterone(T), prolactin(PRL), estradiol(E2)were analyzed retrospectively.Results Of these patients, their height were(176.4±5.5)cm, weight(74.5±12.7)kg, BMI(23.89±3.66)kg/m2[77 of overweight(33.92%)and 34 of obesity(14.98%)], FSH(38.35±14.33)IU/L, LH(19.40±9.00)IU/L, T(132.00±194.50)ng/dl, E2(23.90±15.00)ng/L, PRL(10.50±8.20)μg/L, E2/T 0.21±0.80.Testicular volume had the positive association with the level of T(r=0.197, P=0.003).BMI had the negative association with the serum concentration of T(r=-0.284, P=0.000), while positive association with the E2(r=0.174, P=0.009)and ratio of E2/T(r=0.323, P=0.000).Age had no association with T, E2, and E2/T(P>0.05), but had negative association with the serum concentration of LH(r=-0.154, P=0.02)nd FSH(r=-0.196,P=0.03).The higher education group were older(P<0.01), while the level of T were lower(P<0.01).Conclusion In patients with Klinefelter′s syndrome(KS; 47,XXY), level of T may associate with testicular volume.T, E2, and the ratio of E2/T seem to associate with their height, BMI, and education level.

Objective To observe the changes in the transforming growth factor-beta 1 (TGF-β1 ) mRNA expression in the lung in a dog model of cardiopulmonary bypass(CPB)-induced acute lung injury. Methods Thirty-six healthy adult mongrel dogs of both sexes weighing 15-16 kg were randomly assigned into control group and CPB group ( n = 18 each) . Lung injury was produced by CPB according to the method described by Williams. Six animals were killed at each of the following time points: before CPB (T0 ) and 30 and 60 min after termination of CPB (T1 , T2) in each group. Lung specimens were obtained for microscopic examination and determination of TGF-β1 mRNA expression (by RT-PCR) and MDA content. The lungs were lavaged and the protein concentration in the brancho-alveolar lavage fluid (BALF) was determined and pulmonary permeability index (PPI) was calculated. Results Microscopic examination showed massive inflammatory cell infiltration, alveolar capillary dilatation, congestion, widened alveolar septum, massive RBC in the alveolar space and focal atelectasis in the lung in CPB group. The TGF-β1 mRNA expression and MDA content and PPI were significantly higher in CPB group than in control group. The TGF-β1 mRNA expression and MDA was positively correlated to PPI (MDA: r = 0.867, P < 0.01; PPI: r = 0.821, P < 0.01) . Conclusion TGF-β1 mRNA expression in the lung is significantly up-regulated after CPB and is an important factor contributing to CPB-induced acute lung injury.

Objective:To investigate the differences of psychological condition of erectile dysfunction (ED) patients in different age groups.Methods:The emotion, personality and interpersonal relationship outpatients with ED were evaluated by the method of Symptom Checklist-90 (SCL-90), State Trait Anxiety Inventory (STAI) and Eysenck Personality Questionnaire (EPQ). A retrospective analysis was conducted and a total of 401 ED patients (aged 20-60) were divided into 4 groups [20-29(n=158), 30-39(n=182), 40-49(n=38), 50-60 (n=23)years old] from July 2018 to July 2019. The erectile function of the patients was evaluated by the international erectile function scale (IIEF-5). The symptoms of hostility, anxiety, psychotic, horrible, paranoid, obsession, somatization, interpersonal relationship and depression were evaluated by SCL-90. Furthermore, STAI was used to distinguish whether the patients had state or trait anxiety. Then EPQ was used to analyze the personality types of patients. The differences of SCL-90, STAI and EPQ between the patients and the national norm group were analyzed by the two sample t-test. The variance analysis was conducted to compare the score differences of scales among different age groups of ED patients. The chi square test was conducted to compare the distribution differences of personality types among different age groups. Results:The scores of hostility(1.64±0.67, t=4.81, P<0.001), anxiety(1.58±0.66, t=6.83, P<0.001), psychotic(1.62±0.68, t=11.87, P<0.001), paranoid(1.55±0.66, t=3.58, P=0.0004), obsession(1.95±0.70, t=9.56, P<0.001), somatization(1.43±0.58, t=2.10, P=0.036), interpersonal relationship(1.74±0.74, t=2.79, P=0.005), depression (1.66±0.74, t=4.50, P<0.001)and the total scores (1.53±0.63, t=3.07, P=0.002)of SCL-90 in the patient group were significantly higher than those of the national norm group, and there were significant differences in the scores of interpersonal relationship among different age groups(1.72±0.78, 1.65±0.69, 1.58±0.92, 1.43±0.59, F=2.84, P=0.038). The scores of state anxiety( t=7.35, P<0.001), trait anxiety ( t=6.31, P<0.001)and the total scores ( t=8.41, P<0.001)of STAI in the patient group were significantly higher than those of the national norm, and there were significant differences in the scores of state anxiety( F=5.29, P=0.001), trait anxiety ( F=5.54, P<0.001)and total scores ( F=5.66, P<0.001)among different age groups. There were significant increases in the scores of psychoticism( t=30.56, P<0.001), emotion( t=45.94, P<0.001), extraversion and introversion( t=11.72, P<0.001), concealment factors ( t=29.16, P<0.001)and total scores ( t=30.56, P<0.001)in the patient group. The proportion of depressive personality was highest in the ED patients(n=183; 45.64%), but there was no significant difference in the distribution of personality types among different age groups[20-29(depressive, choleric, mucinous and sanguine): 76, 35, 26, 21; 30-39: 87, 40, 32, 23; 40-49: 14, 10, 6, 8; 50-60: 6, 9, 2, 6; χ 2=10.65, P=0.30]. Conclusions:ED patients have a series of abnormal emotions, somatized discomfort, sensitive interpersonal relationships, introverted and unstable emotionally personality characteristics. In addition, the younger the patients are, the more serious their anxiety are, the more sensitive their interpersonal relationships are, which may be related to their introverted personality characteristics and emotional instability.

Objective To investigate the feasibility of setting mAs in liver enhanced CT scan according to plain scan noise with fixed mA CT scanner,in order to reduce the radiation dose.Methods One hundred continuous patients underwent liver enhanced CT scan (group A) prospectively.Two hundred and fifty mAs was used in plain and enhanced CT scans.Noises of plain and venous phase CT images were measured,and the image quality was evaluated.The equation between mAs of enhanced scan and noise of plain scan image was derived.Another 100 continuous patients underwent liver enhanced CT scan (group B).Enhanced scan mAs was calculated from noise on plain scan by using the equation above.Noises on venous phase images were measured and the image quality was measured.Based on body mass index (BMI),patients in groups A and B were divided into three subgroups respectively:BMI ＜ 18.5 kg/m2,18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2 and BMI ≥ 25.0 kg/m2.Image quality score was compared with nonparametric rank sum test,CT dose index (CTDI) and effective dose (ED) were measured and compared between each subgroup with 2 independent samples t or t' test.Results The equation between enhanced scan mAs (mAsX) and plain scan noise (SDp) was as follows:mAsX =mAs1 × [(0.989 × SDp + 1.06) /SDx]2,mAs1 =250 mAs,SDx =13.In patients with BMI ＜ 18.5 kg/m2,ED of group A [(6.86 ±0.38) mSv,n =12] was significantly higher than group B [(2.66 ±0.46) mSv,n =10)] (t =18.52,P ＜0.01).In patients with 18.5 kg/m2 ≤ BMI ＜ 25.0 kg/m2,ED of group A [(7.08 ± 0.91) mSy,n =66] was significantly higher than group B [(4.50 ± 1.41) mSv,n =73] (t' =10.57,P ＜ 0.01).In patients with BMI ≥25.0 kg/m2,there was no significant difference between EDs of group A (7.54 ± 0.62 mSv,n =22) and group B [(8.19 ±3.16) mSv,n =17] (t' =0.89,P =0.39).Image quality of 5 patients in group A and none in group B did not meet the diagnostic requirement.Conclusion Setting mAs of enhanced scan according to plain scan noise could reduce the radiation dose with maintainence of image quality.

This study examined effect of a new intervertebral cervical disc prosthesis in relieving the neurological symptoms and signs, improving the patients' ability to perform daily activities, reducing pain, and maintaining the stability and segmental motion. From December 2003 to October 2004, 12 patients, who had received 14 replacements of cervical artificial discs, were followed-up for 2 to 8 months (with a mean of 5.2 months). Of them 5 had cervical spondylotic myelopathy and 7 had cervical disc herniation. The patients included 7 males and 5 females, with their age ranging from 35 to 62 y and a mean of 50.3 y. Single-level replacements were performed in 10 cases and 2 cases received two-level replacement. Operation time of the single-level surgery averaged 130+/-50 min and the time of two-level surgery was 165+/-53 min on average (from skin incision to skin suturing). Neurological or vascular complications during or after surgery was not observed. Japanese Orthopedic Association scores (JOA scores) increased from 8.6 to 15.8 on average. There was no prothesis subsidence or excursion. Replaced segments were stable and the range of motion was partially restored, being 4.68 degrees (3.6 degrees -6.1 degrees ) in flexion and extension position and 3.51 degrees (2.5 degrees -4.6 degrees ), 3.42 degrees (2.6 degrees -4.3 degrees ) in left and right bending position. No obvious loss of physiological curvature was noted. CT or MRI follow-up showed that excursion was less than 1.5 mm) in 2 of 14 levels and between 1.5 mm and 3 mm) in 1 of 14 levels. No ossification in the replaced levels was observed. It is concluded that satisfactory short-term results were achieved in the 12 cases of artificial disc replacements. Different from anterior cervical discectomy and fusion, the replacement could achieve quick functional recovery and did not lead to the movement limitation of cervical vertebrae. At least a 5-years follow-up was needed to assess the long-term effect of the prosthesis on its neighboring segments.

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