Sagittal spinal deformity is one of the common reasons of sagittal disequilibrium which can cause torso forward,cardiopulmonary dysfunction,fiat back syndrome,intractable low back pain and a series of cases,affecting the patients' life quality and increasing huge economic burden on society.The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body,which would relieve pain and improve life quality.Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal deformity with excellent reconstruction of sagittal plane balance.However,the calculation of the angle required during surgery is still a problem,because insufficient or excessive correction will lead to the secondary sagittal disequilibrium.Therefore,an accurate calculation of the angle required during pedicle subtraction osteotomy is particularly important.In recent years,scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature,pelvic shape and position of the lower limbs.Scholars have developed a standard of sagittal equilibrium based on their own research,and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy:trigonometric method,exact angle calculation method,overall balance method,spine femoral angle measurement method,digital virtual method,graphic method,acoustic meati to hip axis method and hilus pulmonis to hip axis method,which provide important theoretical bases for the treatment of sagittal spinal deformity.

PurposeCT myelography (CTM) and gadolinium-enhanced MR myelography (Gd-MRM) are essential methods used for localizing spinal cerebrospinal fluid leaks in patients with spontaneous intracranial hypotension (SIH) and are significant for diagnosis and guided epidural blood patches. This paper analyzes the rate and imaging features of unsuccessful myelography due to misinjection of contrast into epidural space to guide prompt and correct clinical judgment of unsuccessful myelography.Materials and Methods Myelography from 121 patients with SIH was retrospectively reviewed and the image features of the unsuccessful myelography were analyzed.Results A total of 128 myelography examinations were done. Contrast media was accidently injected into the epidural space in 33 examinations. The failure rate was 25.8%. In all 33 failed exams, bilateral spinal nerve roots on both sides of the dural sac passing through contrast media was observed without visualization of anterior and posterior nerve roots. Cauda equina was not seen within contrast media in 29 cases (87.9%); non-diffusion of contrast media into cisterns and ventricles in 26 cases (78.8%). Contrast was not continuous in spinal canal in 16 cases (48.5%), heterogeneous in 10 cases (30.3%). In 4 cases (12.1%) the inner contour of contrast was not smooth.Conclusion The unsuccessful rate of myelography is relatively high in SIH patients. A prompt and correct decision could be made based on the knowledge of contrast misinjection imaging features.

Objective To develop a simple mobile lead room to reduce the scattered radiation to adjacent patients and medical staffs. Methods The triple ply, lead protection sheet, lead glass stainless steel plate, hinge, rotating wheel and the plank were used to build the lead room. Results The dose of the scattered radiation to adjacent patients and medical staffs was decreased and the expenditure of the hospital on the lead room was saved.

Objective To show the distinctive resonance pattern in 7 cases of intracranial abscess and 19 cases of cystic lesions as to evaluating these specific resonance peaks. Methods Characteristics of ~1H-MRS in 7 patients with brain abscesses and 19 with cystic or necrotic intracranial tumors were analyzed and compared. Peak assignment was based on reference values from in vivo and in vitro studies. Results Among 7 patients with brain abscesses, 6 showed the presence of cytosolic amino acid (AA) at 0.9 ppm, 5 showed alanine (Ala) at 1.5 ppm, 2 showed acetate (Ac) at 1.9 ppm and 1 patient showed succinate (Suc) at 2.4 ppm. None of the above resonances had been detected in spectra from 19 cases of cystic or necrotic intracranial tumors. Conclusions ~1H-MRS might reflect the different histochemical specificity of abscesses and cystic or necrotic tumors effectively. It should have special values in diagnosis and differential diagnosis of the brain abscess.

Objective To compare the diagnostic value between spinal MR myelography (MRM) and intrathecal Gadolinium MR myelography (GdM) in detecting spinal cerebrospinal fluid (CSF) leaks of spontaneous intracranial hypotension (SIH). Methods Retrospective analysis of imaging findings in 158 cases with SIH was performed. Both MRM and GdM were available in 24 cases, and MRM was performed first, followed by GdM within one week. Morphological abnormalities of nerve root, CSF leaks along the nerve roots, and abnormal CSF collections were observed and compared between the two methods by using McNemar statistics and Kappa test statistics. Results Morphological abnormalities of nerve root were detected in 176 lesions on GdM and 163 lesions on MRM, respectively, and GdM was more sensitive in the detection of morphological abnormalities of nerve root (χ2=6.26,P=0.011). CSF leaks along nerve roots were identified in 15 patients on both GdM and MRM while in 5 cases on neither GdM nor MRM, and identified in 4 patients on GdM but not on MRM. CSF leaks along the nerve roots were detected in 67 lesions on GdM and 55 lesions on MRM, respectively, and GdM was more sensitive in the detection of CSF leaks along nerve (χ2=6.05,P=0.012). MRM and GdM showed good consistency(Kappa =0.837,P=0.001)in detecting CSF leaks for patients with SIH. Six and 14 lesions of abnormal CSF collections in bony rims of spines were respectively detected by GdM and MRM, 12 and 28 lesions of abnormal CSF collections in bony rims of the ribs were respectively detected by GdM and MRM. MRM was more sensitive in the detection of abnormal CSF collections in bony rims of the spines and the ribs(χ2=6.13 ,14.06 ,P=0.008 ,0.001). Eleven and 10 lesions of CSF collections in epidural space were respectively detected by GdM and MRM, 1 and 3 lesions of CSF collections of C1—2 retrospinal space were respectively detected by GdM and MRM. No statistically significant differences existed between MRM and GdM in detecting CSF collections of epidural space and C1—2 retrospinal space (χ2=0.01,0.50,P=1.000,0.500). Conclusions MRM and GdM have their respective advantages in detecting spinal CSF leaks along the nerve roots, morphological abnormalities of nerve root and abnormal CSF collections. MRM combined with GdM can provide more information in localizing spinal CSF leaks for patients with SIH.

Objective To compare the effect of repairing large perimembranous ventricular septal defect (VSD) with a new continuous stitching and two classical methods. Methods From January 2005 to January 2008,321 cases with VSD were operated. All the cases were divided into 3 groups according to operational way, with discontinuous stitching in group A (70 cases), continuous stitching in group B(116 cases),new continuous stitching in group C (135 cases). All the patients were total corrected with hypothermic cardiopulmonary bypass. Results Group C had the shortest cardiopulmonary bypass and aortic cross-clamp times [(48 ± 36) min and (26 ± 18) min]among the three groups (P < 0.05). Group C had not residual shunt and incidence rate was lowest among the three groups (P < 0.05). Temporary second degree auriculo-ventricular bolck (AVB) was found in the early stage and no third degree AVB among the three groups. Tricuspid regurgitation was higher in group A,but there was no significant difference between group B and group C. Follow-up was completed in a duration of 1-3 years and all the cases had a good health after discharged. Conclusions The new continuous stitching method has short eardiopulmonary bypass and aortic cross-clamp times. It has fewer residual shunt than other two classical methods and has no evidence of higher AVB occurrence.

Objective This study on a medium-fidelity simulator (SimMan , Laerdal Medical Corpo-ration,Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by residents of anesthesiology and the effect of training in this context.Methods 30 residents of anesthesiology were devided into two groups (T and E). There were two scenarios investigated:'can't intubate, can oxygenate'(CI) and'can't intubate, can't oxygenate'(CICO). The E group was trained by scene simulation in the second, fourth, sixth month respectively before and after the training, and the T group received the same situation simulation training on the same day after the theoretical training and in the second, sixth month after the training. In con-trast to standard operating procedures, the performance of two groups of trainees was recorded on the basis of pre established evaluation criteria. Data differences between the two groups were analyzed using SPSS 23.0,t test, M-W test andx2 test.ResultIn CI, success rate of placement of astandard and intubating laryngeal mask air-way were high in T group (87％ vs. 55％ ,P=0.037). This was sustained over time. There was no difference in duration and incidence of desaturation between two groups. In CICO, there was a more structured approach following training in T group (P<0.05), which wasn't sustained over time. But this was sustained over 6 months in E group.ConclusionSituational simulation training can significantly improve the anesthesiology residents' ability to take proper response measures to the unexpected difficult airway, and significantly shorten the training time for emergency airway treatment. Repeated situational simulation training should be conducted at intervals of 2 months or less, allowing residents to maintain emergency response to the emergency airway.

OBJECTIVE： To study the improvement effects of Atorvastatin calcium tablets on renal injury in nephrotic syndrome model rats， and to explore its possible mechanism. METHODS： Wistar rats were randomly divided into normal group， model group and Atorvastatin calcium tablets group， with 10 rats in each group. Model group and Atorvastatin calcium tablets group rats were given adriamycin 6 mg/kg intravenously for consecutive 21 d to induce nephrotic syndrome model. Since 22th day， Atorvastatin calcium tablets group was given drug 8 mg/kg intragastrically while normal group and model group rats were given equal amount of distilled water intragastrically， once a day， consecutive 6 days every week， for consecutive 10 weeks. At the second day after last medication， the plasma levels of albumin （ALB）， total protein （TP）， cholesterol （CH）， urine albumin excretion rate （UAE） were determined in each group. RP-PCR and Western blot assay were used to detect mRNA and protein expression of AMP-activated protein kinase （AMPK）， silent information regulator 1 （SIRT1） and nuclear factor κB （NF-κB） in liver tissue. RESULTS： Compared with normal group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were decreased significantly in model group （P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were increased significantly （P＜0.05 or P＜0.01 or P＜0.001）. Compared with model group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were increased significantly in Atorvastatin calcium tablets group （P＜0.05 or P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were decreased significantly （P＜0.05 or P＜0.01 or P＜0.001）. CONCLUSIONS： Atorvastatin calcium tablets has significant improvement effect on the renal injury of nephritic syndrome model rats， the mechanism of which may be associated with up-regulating the expression of AMPK and SIRT1 and down-regulating the expression of NF-κB.

Objective To analyze the correlation between covalently closed circular DNA (cccDNA) in the peripheral blood mononuclear cells (PBMC) of hepatitis B virus (HBV)-infected patients and serum HBV DNA,hepatitis B surface antigen (HBsAg),hepatitis B e antigen (HBeAg) and liver histology of hepatitis B patients,and to explore the clinical significance of HBV cccDNA detection in PBMC.Methods One hundred and eight patients with chronic HBV infection were involved in this study.PBMC were extracted using density gradient centrifugation.HBV cccDNA in PBMC and serum HBV DNA were detected by real-time fluorescence quantitative polymerase chain reaction.HBsAg and HBeAg were detected by chemiluminescence immunoassay.Liver biopsy was conducted in 59 out of the 108 patients.Chi-square test was used to compare the categorical variables.Correlation analysis was used to compare quantitative variables.Nonparametric test was used to compare the non-normal distribution parameters.Results In the overall population,HBV cccDNA in PBMC was positive in 59 patients (54.6％).Eleven of the 15 patients with liver failure were found to be HBV cccDNA positive,which was significantly higher than that in the acute hepatitis B group (only 2 of the 8 patients were HBV cccDNA positive; x2 =4.960,P＜0.05).One hundred and eight patients were categorized into three groups according to their serum HBV DNA levels,with group A:＞5 lg copy/mL,group B:3-5 lg copy/mL and group C:＜3 lg copy/mL.The proportions of HBV cccDNA positivity in PBMC in three groups were 76.1％ (51/67),5/18 and 13.0％ (3/23),respectively.Comparing with patients with lower HBV DNA (group B and C),the proportion of HBV cccDNA positivity was higher in patients with higher HBV DNA (group A; x2=14.751,P＜0.05 and x2 =28.384,P＜0.05,resepectively).The HBV cccDNA quantitation in PBMC was positively correlated with the serum HBV DNA level and HBsAg quantification (r=0.554,P＜0.05 and r=0.497,P＜0.05,respectively).The proportion of HBV cccDNA positivity in PBMC of patients with liver histology ≥G2 and/or ≥S2 was significantly higher than that in patients with liver histology ＜ G2/S2 (x2 =9.159,P＜0.05).Conclusions HBV cccDNA exists in PBMC of hepatitis B patients.The HBV cccDNA quantitation in PBMC is positively correlated with the serum level of HBV DNA and HBsAg quantification,and is also associated with liver histology injury.

Objective To summary the clinical data of pediatric renal transplantation from multiple renal transplant centers in China,and analyze the factors influencing the therapeutic outcomes of pediatric renal transplantation.Methods From March 1986 to May 2010,the clinical data of 138 children who underwent renal transplantation in eight centers of renal transplantation in China were retrospectively analyzed.Results The one-year patient and graft survival rate was 99.3％ and 95.7％respectively.Acute rejection episodes occurred in 38 cases (27.5％),15 cases suffered delayed graft function (DGF),and graft functions were returned to normal in all recipients within one month.Moreover,other complications included transplant renal artery stenosis in 8 cases (5.8％),ureteral necrosis in 2 cases (1.4％),urinary fistula in 5 cases (3.6％),hypertension in 57 cases (41.3 ％),hyperlipidemia in 38 cases (27.5％),hirsutism in 32 cases (23.2％),drug-induced liver damage in 26 cases (18.8％),urinary tract infection in 25 cases (18.1％ ),gingival hyperplasia in 22 cases (15.9％),pulmonary infection in 21 cases (15.2％),bone marrow suppression in 12 patients (8.7％),herpes simplex in 10 cases (7.2％),and diabetes in 8 cases (5.8％).The body weight was increased by 4 to 13 kg and the body height was increased by 2 to 7 cm during the first year posttransplantation. Conclusion The careful perioperative management, rational use of immunosuppressive agents,strengthening the follow-up management of children and social support,and improving compliance were the key points to obtain good outcomes in pediatric renal transplantation.