ObjectiveTo assess the value of simulation craniotomy (SC) technique in evaluation of superficial cerebral veins(SCVs)and its relationship with convexity,parasagittal and falcine meningiomas.MethodsForty-nineconsecutivepatientswithconvexity,parasagittal,andfalcine meningiomas performed SC technique and three-dimensional contrast enhanced MR venography (3D CE MRV) in a prospective study.The number of SCVs ( diameter ＞ 1 mm) within 2 cm around the margin of tumors detected by two techniques were compared with the paired t test.Furthermore,49 cases were divided into groups according to the tumor largest diameter,position,and dural enhancement.The image quality of SC technique in different groups were analyzed by Wilcoxon test in order to find influence factors.Results The number of SCVs within 2 cm around the margin of tumor in SC was 4.4 ± 1.9,which was significantly less than that on 3D CE MRV (5.1 ± 2.7) ( t =3.131,P ＜ 0.05 ).The relationship between meningiomas and the SCVs was demonstrated well on SC in majority of cases with the score of image quality was 2.5 ±0.7.The score of image quality of 12 patients with obvious dural enhancement was 1.5 ± 0.5,which was significantly lower than that of 37 patients without dural enhancement ( 2.8 ± 0.3 )( Z =- 3.093,P ＜ 0.05 ).The score of image quality of 18 patients with tumor larger than 4 cm in diameter ( 2.2 ± 0.9 )was significantly lowed than that of 31 patients with small tumors (2.7 ± 0.5 ) ( Z =- 2.057,P ＜ 0.05 ).The score of image quality of convexity group ( n =10) and parasagittal and falcine group ( n =39 ) was 2.2 ± 0.9 and 2.6 ± 0.6,and there was no significant difference between different location group ( Z =- 0.604,P ＞ 0.05).ConclusionsSimulation craniotomy can exactly display SCVs avoiding the influence of deep cerebral veins and skull veins.This simple technique can provide useful information about the SCVs and their relationships with cortical structures and tumors for preoperative surgical planning.

ObjectiveTo observer the effect of autograft of semitendinosus and interference screws for reconstruction of lateral ankle ligaments. MethodsA total of 12 cases of injured lateral ankle ligaments were selected, including 7 males and 5 females with an average age was 29.4 years, with a course of disease from 3 to 6 months. All lateral ligaments were reconstructed by autograft of semitendinosus & bio-interference screws. A 4.5 mm diameter tunnel was drilled on the lateral ankle, where the tendon of semitendinosus was permeated through, both ends of semitendinosus tendons were fixed with bio-interference screws on talus of at the end of anterior talofibular ligament and calcaneus of at the end of calcaneofibular ligament, maintaining ankle neutral and moderate valgus position. Following operation, the ankle was fixed in neutral position and slightly valgus position with plaster cast. The wound healing, the outcomes of American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and stress radiographic evaluation were assessed at the follow-up. ResultsAll 12 patients showed no infection and the wound healed well at the primary stage. At 3, 6, 12, 24 months after operation, all patients were followed-up. According to AOFAS and FAOS of preoperation and final follow-up postoperation, function of ankle in all patients was significantly improved (P＜0.01), the scores of Chrisman-Snook group were more lower than this approach. No patients complained of instability of the ankle, and stress radiograph confirmed this improvement. ConclusionReconstruction of lateral ligaments of the ankle with autograft of semilendinosus & biointerference screws is a practical and reliable treatment, which restores stability and function of the ankle.

Objective To discuss the application value of shear wave elastography (SWE) and superb microvascular imaging (SMI) in pathological grading of breast invasive ductal carcinoma (IDC).MethodsSixty patients with breast tumor were selected,which were totally 64 lesions.Before operation,SWE and SMI pattern were started to detect the lesions.And images in SWE and SMI pattern were saved.All lesions were proved to be IDC and pathological gradings were got according to the pathological result.The mean of Young′s modulus(AveT1) and maximum of Young′s modulus(AveT2) were recorded in SWE pattern,and degree of blood was recorded in SMI pattern followed Adler′s grading standard.Then differences of AveT1,AveT2 and degree of blood in different pathological grading of invasive ductal carcinoma were evaluated.Results ①In pathological grading 1 group,the average of AveT1 was (62.1±10.4)kPa,and the average of AveT2 was (93.0±20.1)kPa.In pathological grading 2 group,the average of AveT1 was (79.8±8.6)kPa,and the average of AveT2 was (120.6±18.7)kPa.In pathological grading 3 group,the average of AveT1 was (92.6±12.1)kPa,and the average of AveT2 was (137.3±21.5)kPa.The AveT1 and AveT2 were gradually growing with higher pathological grading of breast invasive ductal carcinoma,which were statistically significant (P<0.05).②In pathological grading 1 group,there were 7 cases in the degree of blood 0-Ⅰ and 14 in the degree of blood Ⅱ-Ⅲ.In pathological grading 2 group,there were 3 cases in the degree of blood 0-Ⅰ and 18 cases in the degree of blood Ⅱ-Ⅲ.In pathological grading 3 group,there were only 1 case in the degree of blood 0-Ⅰ and 21 cases in the degree of blood Ⅱ-Ⅲ.There were more lesions of rich blood with higher pathological grading of breast invasive ductal carcinoma,which was statistically significant (P<0.05).Conclusions There are differences of elastography and degree of blood in different pathological grading of breast invasive ductal carcinoma,SWE and SMI can prompt pathological grading and provide important clinical reference value.

BACKGROUND:There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture.
OBJECTIVE:To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for > 60-year-old patients with femoral neck fractures.
METHODS:According to the search strategy of Cochrane colaboration network, we searched PubMed (1966 to December 2014), EMbase (1974 to December 2014), Cochrane Library (Issue 3, 2011), China Biology Medicine database(1978 to December 2014), China National Knowledge Infrastructure (1994 to December 2014), VIP database (1989 to December 2014), and Wanfang Database (1979 to December 2014). Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included. Two reviewers independently evaluated the quality of the included studies and extracted the data. In case of disagreement, settlement was made by negotiation. Meta-analysis was performed by RevMan 5.0 software in the included studies.
RESULTS AND CONCLUSION:(1) Literature analysis: five randomized controled studies, three quasi-randomized controled studies, and thirteen retrospective cohort studies were included, containing 2 250 patients. (2) Meta-analysis: No significant differencein rate of dislocation, deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures (dislocation rate:RR=1.38, 95%CI: 0.81-2.34; deep infection rate RR=1.12, 95%CI: 0.60-2.11; mortality rateRR=0.90, 95%CI: 0.69-1.18). Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group (RR=0.46, 95%CI: 0.32-0.66). Harris score on the affected side between1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group (MD=5.64, 95%CI: 2.82-8.46). (3) Results suggested that if physical conditions permit, compared with hemiarthroplasty group, femoral neck fractures patients aged > 60 years old in the total hip arthroplasty group had better hip function, but no significant difference was found in dislocation, deep infection and mortality between both groups.

Objective:To evaluate the effects of increasing end-tidal concentrations of sevoflurane and increasing stimulation voltage on motor evoked potentials,so as to provide evidence in making anesthesia plan for intraspinal tumor surgery.Methods:In the study,48 patients scheduled to undergo intraspinal tumor surgery [American Society of Anesthesiology,(ASA)Ⅰ-Ⅱ,18-65 years old]were enrolled. After general anesthesia induction,the patients were assigned to receive sevoflurane anesthesia of increa-sing end-tidal concentration in the sequence of 0.0%,0.5%,1 .0% and 1 .5% respectively,under a background of propofol and remifentanil.All the observations were done before the important steps of sur-gery.Remifentanil infusion rate was 0.2 μg /(kg·min),while the propofol infusion rate was adjusted to maintain the bispectral index values within the range of 30-50.At each concentration,4 stimulation voltages of 300 V,400 V,500 V and 600 V were employed to elicit motor evoked potentials (MEPs). The amplitude and latency of each MEP were compared.The success ratio was also recorded.Results:The concentration of sevoflurane and the stimulation voltage had impacts on the amplitude and latency of MEPs.Under each stimulation voltage,the MEPs amplitude decreased following increasing end-tidal sevoflurane concentrations,and significant differences were found in comparing 1 .5% sevoflurane (left 20.50 μV,70.71 μV,135.97 μV,190.00μV ,right 14.29 μV,50.71 μV,73.10μV,77.50μV) with 0.0% sevoflurane (left 143.00 μV,388.10 μV,484.53 μV,500.00 μV,right 176.00 μV, 407.60 μV,384.35 μV,451.00 μV)and 0.5% sevoflurane (left 100.00 μV,362.57 μV,444.05μV,435.00 μV,right 115.00 μV,207.15 μV,258.34 μV,358.50 μV),left χ2 =27.46,P<0.01,right χ2 =60.49,P<0.01;left χ2 =20.73,P<0.01,right χ2 =55.05,P<0.01;left χ2 =34.25,P<0.01,right χ2 =33.58,P<0.01;left χ2 =28.61,P<0.01 ,right χ2 =49.04,P<0.01;while there were no statistical differences in the latency changes (P =0.26 ).Under each end-tidal sevoflurane concentration,the MEPs amplitude increased following increasing stimulation voltages,and significant differences were found in comparing 300 V (left 143.00 μV,100.00 μV,61.50 μV,20.50μV ,right 176.00 μV,115.00 μV,41.07 μV,14.29 μV)with 400 V (left 388.10 μV,362.57μV,198.81 μV,70.71 μV,right 407.60 μV,207.15 μV,89.00 μV,50.71 μV)and 500 V (left 484.53 μV,444.05 μV,216.24μV,135.97 μV,right 384.35 μV,258.34μV,187.50μV,73.10μV)and 600 V (left 500.00 μV,435.00 μV,344.00 μV,190.00 μV,right 451.00 μV,385.50μV,156.00μV,77.50μV),leftχ2 =45.55,P<0.01,rightχ2 =25.73,P<0.01;leftχ2 =46.67, P<0.01,right χ2 =55.30,P<0.01;left χ2 =47.36,P<0.01,right χ2 =47.82,P<0.01;left χ2 =38.67,P<0.01,right χ2 =45.87,P<0.01;while the latencies were decreased,and significant dif-ferences were found in comparing 300 V with 400 V and 500 V and 600V(left F=7.50,P=0.01 ,right F=13.33,P<0.01),but the differences had little clinical significance.The success ratio decreased by increasing end-tidal sevoflurane concentration,and significant differences were found in comparing 1 .5%sevoflurane (left 43.8%,70.8%,77.1%,81.3%,right 37.5%,60.4%,75.0%,66.7%)with 0.0%sevoflurane (left 79.2%,87.5%,95.8%,93.8%,right 75.0%,95.8%,95.8%,95.8%)and 0.5%sevoflurane (left 72.9%,89.6%,95.8%,95.8%,right 66.7%,89.6%,95.8%,97.9%);the suc-cess ratio increased by increasing stimulation voltage,and significant differences were found in comparing 300 V(left 79.2%,72.9%,62.5%,43.8%,right 75.0%,66.7%,60.4%,37.5%)with 400 V(left 87.5%,89.6%,77.1%,70.8% ,right 95.8%,89.6%,79.2%,60.4%)and 500 V(left 95.8%, 95 .8%,9 1 .7%,77 .1%,right 95 .8%,95 .8%,8 1 .3%,75 .0%)and 600 V (left 93 .8%,95 .8%, 89.6%,81.3%,right 95.8%,97.9%,89.6%,66.7%),but there were no statistical differences in the success ratio of MEPs between the group with stimulation voltage of 600 V ,end tidal sevoflurane concen-tration of 1 .5% and the group with stimulation voltage of 300 V,end tidal sevoflurane concentration of 0.0% (P=0.22).Conclusion:Sevoflurane inhibited MEPs in a dose-dependent manner.It can de-crease the amplitudes and prolong the latencies.But increasing stimulation voltage will facilitate MEPs monitoring and increase the success ratio.Sevoflurane can be used in larger parts of MEPs monitoring surgery by increasing the stimulation voltage.

Primary intraventricular hemorrhage is a rare type of non-traumatic cerebral hemorrhage neurological disorder.Not only has it higher mortality and morbidity,but also complicated etiologies.However,there is still lack of standard diagnostic techniques and treatment methods for decreasing mortality rate and improving prognosis of primary,intraventricular hemorrhage.Rational use of ultra-early hemostatic therapy and acute surgery therapy are considered as clinical treatment strategies to increase survival rate and improve the quality of life for primary intraventricular hemorrhage patients.This paper aims to give review on some etiology,diagnosis and therapy methods of primary intraventricular hemorrhage,and to provide new ideas for the treatment.

The rates of chronic obstructive pulmonary disease ( COPD) and lung cancer morbidity in Xuanwei city of Yunnan province are among the highest nationwide , and COPD is an major risk factor for lung cancer .The concur-rence of COPD and lung cancer is a common disease .There are common causative environmental risk factors and pathogenic processes between the two diseases , which provides new ideas for the research , prevention and treatment of both diseases .Additionally the discussion of the relationship between COPD and lung cancer can provide refer -ences for further studies of both diseases .

OBJECTIVE: To review the characteristics changes of calcium phosphate cement (CPC) as drug delayed release carrier before and after carrying different drugs, analyze dynamic principle and influential factors of drug delayed release system, and summarize new advances of CPC in animal experiments and clinical studies.DATA SOURCES: A computer-based online search of CNKI (www.cnki.net/index.htm) and PubMed (http://www.ncbi.nlm.nih.gov/PubMed) was performed for articles published between 1985 and 2009 with the key words of "calcium phosphate cement, CPC, drug delivery system, release" in Chinese and English.DATA SELECTION: Articles highly related with CPC; articles concerning CPC as drug delivery system. Repetitive articles were excluded.MAIN OUTCOME MEASURES: Changes in physico-chemical properties and drug release dynamics of CPC as delivery carrier of different drugs.RESULTS: CPC is an outstanding skeletal defect restorative material. Considering physico-chemical properties, drug release dynamics and histocompatibility, CPC is good delayed release carrier of drugs. However, its clinical application is limited only in bone defect repair of unloading sites due to its bad compressive strength and adhesivity. Therefore, studies on these aspects require exploration.CONCLUSION: CPC as a drug delivery system is a novel administration method. It can repair bone defect and release drug to achieve favorable treatment effects. CPC has been extensively used in osteomyelitis, bone tuberculosis, bone tumor, bone fracture, bone nonunion, and artificial joint replacement.

Objective To evaluate the relationship of oncosis and the expression of microvessel density (MVD) in colorectal carcinoma and its clinical significance Methods The expression of MVD and oncosis were detected by immunohistochemical method and transmission electron microscope in 64 cases of colorectal carcinoma Results Oncosis existed in colorectal carcinoma Oncosis index (OI) in tissues of colorectal carcinoma decreased with the decrease of differentiation grades ( F=8 590?2, P