Objective To evaluate the clinical outcome of the technique of step-by-step in situ rod bending used in posterior internal fixation of lumbar burst fractures.Methods A retrospective case control analysis was conducted on 76 cases of lumbar burst fractures hospitalized between March 2007 and March 2014.There were 48 males and 28 females,with a mean age of 40.4 years (range,18-57 years).Fractured segments included L1 in 32 cases,L2 in 24,L3 in 14 and L4 in 6.According to the different rod bending methods,the subjects were divided into preliminary rod bending group (34 cases) and in suit rod bending group (42 cases).Operation time,amount of bleeding during and after operation,restoration of anterior vertebral height and Cobb angle,and visual analogue score (VAS) were compared between groups.Results Seventy patients were followed up for 12-36 months (mean,20.9 months).One patient in preliminary rod bending group presented internal fixation loosening,and had implant removal 9 months after operation.No implant breakage occurred.Comparison of preliminary rod bending group and in situ rod bending group showed significant differences in operation time [(88.1 ± 16.0)min vs.(79.9 ± 14.7)min],amount of bleeding during operation [(88.3 ± 21.2) ml vs.(74.0 ± 12.5) ml],amount of bleeding after operation [(71.5 ± 17.3)ml vs.(62.1 ± 16.0) ml],restoration of anterior vertebral height [(74.1 ±7.8) ％ vs.(79.5 ± 8.5) ％],and restoration of Cobb angle [(10.2 ± 2.7) °vs.(8.8 ± 2.6) °] (P ＜0.01 or 0.05).VAS presented no significant differences between preliminary rod bending group and in situ rod bending group before operation [(7.5 ± 0.9) points vs.(7.2 ± 1.0)points] and 1 week after operation [(2.9 ± 0.7) points vs.(3.0 ± 0.7) points] (P ＞ 0.05),while there was significant difference 9 months after operation [2.2±0.7)points vs.(1.9 ±0.7)points] (P＜0.01).Conclusion In suit rod bending for lumbar burst fractures has advantages over preliminary rod bending in terms of operation time,blood loss,precise restoration and back pain.

Objective To explore the differences of serum expression of cystatin C,macrophage migration inhibitory factor (MIF)and matrix metalloproteinase-1 (MMP-1)in elderly patients with coronary artery disease.Methods 120 cases of senile cor-onary heart disease patients in the department of cardiovascular medicine from July 2010 to August 2012 were selected and divided into the control group (n=30),stable angina pectoris group(SAP group,n= 34),unstable angina group (UA group,n=28)and a-cute myocardial infarction group (AMI group,n=28)according to the results of coronary arteriography combined with the electro-cardiogram and myocardial enzyme spectrum test.The serum levels of cystatin C,MIF,MMP-1 and C reactive protein (hs-CRP) were compared among the four groups,and correlations of the four indicators were analysed as well.Results There were significant differences in the serum levels of cystatin C,MIF,MMP-1 and hs-CRP among the four groups(P <0.05).The serum levels of cys-tatin C,MIF and MMP-1 were gradually increased with the progression of disease,and significant differences were found between any two groups(P <0.05).There were significant differences in the levels of hs-CRP between the AIM group and the other three groups(P <0.05).While among the control group,SPA group and UA group,no significant differences were found in the levels of hs-CRP between any two groups(P >0.05).The significant positive correlations were observed among cystatin C,MIF and MMP-1.Conclusion The serum levels of cystatin C,MIF and MMP-1 have a gradually increasing trend with disease progression in pa-tients with coronary heart disease,which could be important indicators of disease evaluation.

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

Objective To evaluate effectiveness and safety of the transobturator tension-free vaginal tape technique (TVT-O) for the treatment of female stress urinary incontinence(SUI). Methods Twenty-six cases of SUI patients with average (52.6±6.3) years old were included. Mean course of disease was (9.2± 2.3) years. Two cases were type Ⅱ ,23 cases were type Ⅱ/Ⅲ,and 1 case was type ID. One case had history of pelvic operation procedure,2 cases accompanied by urgent urinary incontinence. All cases were undergone TVT-0 procedure. The methods of this procedure and the outcomes and complications were closely analyzed. Results The average operating duration was (18.0 ±2.3) min (15-20 min) and average blood loss was (20.0±3.4)ml (10-40 ml). Twenty-four cases (92.3%) were cured, 2 cases (7.7%) were improved, 2 cases (7.7% ) had dysuria, 1 case improved after prolonged indwelling of catheter, 1 case was recovery with urethral dilations. Four cases (15.4% ) suffered pain of thigh skin around the wound, and relieved by analgesia. One case (3.8%) complained of frequency of micturition, and improved by medicine. Twenty-six cases were followed up of 8-16 months with no recurrence. Conclusion TVT-0 for the treatment of SUI is a simple optimal and reliable method with less complications and eusemia.

The relationship between the precision of the estimated sampling variances and the number of samples was quantitatively established. It revealed that the product of the standard deviation of the estimated samplingvariance and square root of the number of samples was a constant. Monte Carlo simulation technique was employed to verify the equation. Populations with Gaussian,unifohn random and multi-nomial(taking silicon carbide material as an example) distributions were studied with satisfactory results.

ObjectiveTo analyze the internet-based cognitive behavior therapy (ICBT) intervent medical university students' social anxiety,and provide experiences and theoretical basis for future social anxiety interventions.Methods45 medical students of social anxiety were voluntarily divided into the one-to-one intervention group,one-to-five intervention group and control group.The control group did not intervene,one-to-one intervention group and one-to-five intervention group were interfered single person or team by cognitive behavioral therapy,respectively.The level and symptom of social anxiety of the 3 groups were assessed before and after the intervention by social phobia inventory(SPIN) and Social anxiety symptoms interview inventory.ResultsAfter the intervention,the scores of SPIN and the 3 subscales within it (fear,avoidance and physiological) of one-to-one ICBT group and one-to-five ICBT group were lower than those of the control group (SPIN scores:one-to-one ICBT group 15.60 ±7.87,one-to-five ICBT group 14.87 ± 8.83,control group 20.20 ± 11.46).Variance analysis showed that,in addition to physiological subscale(F =0.641,P ＞ 0.05 ),the scores of SPIN,fear and avoidance subscales had significant differences among the3 groups (F=3.764,P=0.018; F=3.606,P=0.021 ; F=5.444,P=0.005).In the analysis of participants'social anxiety symptoms,after treatment,in one-to-one ICBT group,there was 1 participant changed into subthreshold social anxiety and 1 participant into normal in the 2 threshold social anxiety participants.All the 3 subthreshold social anxiety participants changed into normal.In one-to-five ICBT group,there was 1 threshold social anxiety participant lapsed to subthreshold social anxiety,1 subthreshold social anxiety participants still remained in subthreshold social anxiety,2 symptomatic social anxiety participants changed into normal.But there were no significant changes in control group.ConclusionsAll the two methods of intervention have a certain effect.The effect of one-to-one intervention therapy is most significant.

Objective To investigate and analyze the health care seeking behavior,financial burden and relative factors of patients with rheumatic diseases in Fujian Province.Methods Patients diagnosed with rheumatic diseases were investigated in Fujian Provincial Hospital from December 2013 to February 2014,including demographic data,health care seeking behavior and financial burden.Relevant factors were analyzed by Logistic regression.Results ① In this study,474 patients were enrolled.The ratio of male to female was 1∶2.38.② At the onset of symptoms,51.9％(246 cases) of patients visited a doctor as soon as possible,and 36.1％(171 cases) of them went to hospital within a month after disease onset.③ 74.1％(351 cases) of patients could adhere to medication regimen prescribed by doctors,and the most common reason for stopping medication was symptoms relieved (33.3％,41 cases).④ 63.1％(299 cases) of patients learned about the knowledge of rheumatic diseases from hospitals and doctors.⑤ 34.2％(162 cases) of patients spent 1 000-5 000 yuan every month on treatment.⑥ Insurance type could affect the time of first visit to hospital (P=0.004),while income and cost of therapy might impact patients' compliance (P=0.013,P=0.004).Conclusion Most patients will go to hospital as soon as possible and adhere to treatment.Economic situation is the main factor influencing health care seeking behavior of patients with rheumatic diseases.

ObjectiveTo determine the current students' social anxiety status and maternal factors in school students( grade 5-7) in Harbin,and provided scientific guidance relevant to students'social anxiety.Methods 1526 mother-child pairs collected by random cluster sampling,children completed the social anxiety scale for children (SASC),security scale,coping strategies questionnaire( consist of ambivalence and avoidance subscale),acceptance scale and psychological control scale,and mothers completed the center for epidemiologic studies depression inventory (CES-D),self-rating anxiety scale (SAS).ResultsThe total positive detection rate of social anxiety was 13.6％,there was no significantly difference between boys and girls (P ＞ 0.05) ; the positive detection rate of Grade 6 was higher than Grade 5 and Grade 7.There were positive correlation between social anxiety and mother's psychological control,mother's depression,mother's anxiety ( r =0.228,0.143,0.122) ; negative correlation with mother's acceptance( r =-0.214).Linear regression indicated that only three variables (mother's psychological control,mother's acceptance,mother's depression) were at the P ＜ 0.05 level.The regression coefficients for the three variables were 1.557,- 1.092 and 0.040,respectively.ConclusionMaternal highly psychological control,lowly acceptance and maternal anxiety depression all play a role in promoting the occurrence of students' social anxiety.

Objective To analyse the clinical value of bronchial artery embolization in treatment of massive hemoptysis.Methods 87 patients with hemoptysis included bronchiectasis in 46 cases,pulmonary tuberculaosis in 18 cases,bronchial carcinoma in 15 cases,bronchial arteriovenous malformation in 2 cases and unknown hemoptysis in 6 cases underwent embolized treatment of bronchial arteriography or intercostal arteriography.Of them,bronchial artery embolization were performed in 78 cases,intercostal artery embolization were done in 6 cases,both embolization of bronchial artery and intercostal artery were in 3 cases,2 cases underwent superselective embolization with coaxial microcatheter.In the total 87 cases,gelatin sponge particles(GSP) alone was used in 85 cases,GSP and polyvinyl alcohol(PVA) were used in 2 cases.All the patients were followed up for 12~18 months.Results The hemoptysis was immediately stopped in 58 cases, remarkable improvement were 19 cases after operation. Recurrence of hemoptysis was found in five, three and two cases at one, two and four weeks respectively after embolization. All of the ten recurred cases accepted re-embolization and hemoptysis had been well controlled. The effective rate was 89%(77/87). There was not any severe complication in all the patients.Conclusion Bronchial artery embolization is a safe, effective and less invasive method in treatment of massive hemoptysis. It can be recommended to the non-surgical treatment patients.

Objective To analyze the clinical features,therapy and outcome of systemic lupus erythematosus (SLE) combined with lupus myelopathy (LM).Methods Ten SLE patients combined with LM treated in Department of Rheumatology and Immunology,People' s Hospital from 1990 to 2011 were retrospectively analyzed and 43 cases of SLE combined with LM reported home and abroad were reviewed.Results All the ten patients were women with age of 23-53 (36.9 ± 3.4) years old and duration of 1-18 years.MRI of spinal cord revealed long T2 signal in one case,and normal in two cases.Seven patients received methylprednisolone pulse plus cyclophosphamide (CTX),two were given glucocorticoid pulse only,and one was given moderate dosage of glucocorticoid,CTX and plasma exchange (PE).The results revealed that four patients received complete recovery,four received partial recovery,and two received no improvement.Conclusions LM is a rare but severe complication of SLE with poor prognosis,which usually occurs in early phase of young SLE patients.Pulse methylprednisolone and CTX may be effective.Early and active treatment may improve the outcome.