Objective To analyze the clinical value of X ray examination, CT examination and MRI examination in the diagnosis of giant cell tumor of bone.Methods 50 patients with giant cell tumor of bone confirmed by postoperative pathology were selected.The patients' X ray, CT scan and MRI imaging examination data were retrospectively analyzed, and the imaging features of giant cell tumor of bone were discussed and summarized.Results The rate of CT examination and MRI examination in the diagnosis of bone destruction was higher than X ray examination, but the difference was not statistically significant (x2=4.181,P>0.05).CT examination and MRI examination in the soap bubble sign, bone crest, liquid plane and soft tissue mass in the diagnostic rate compared with X ray examination was significantly higher, the difference was statistically significant (x2=5.333,22.941,30.000,38.400,64.000,14.166,6.102,all P<0.05).Conclusion The diagnostic accuracy of CT and MRI in giant cell tumor of bone is higher than X ray, but the value of MRI examination in the diagnosis of edema near the tumor is better.

Background Cardiac mast cell-derived chymase is involved in myocardial fibrosis,but the underlying mechanisms remain unclear. Objective To investigate the effect of chymase on the collagen synthesis and its relationship with transforming growth factor-?1 (TGF-?1)/Smad pathway in rat cardiac fibroblasts (CFs). Methods CFs,from neonatal SD rats,were isolated by trypsinization. The collagen synthesis of CFs was determined by 3H-proline incorporation. The protein expressions of TGF-?1,phosphorylated Smad2/3 (P-Smad2/3) and total Smad2/3 were determined by immunoblotting in CFs. Results Chymase (15,30 and 60 ?g/L) increased the 3H-proline incorporation in a concentration-dependent manner. 30 ?g/L chymase stimulation increased the protein expressions of TGF-?1 and P-Smad2/3 in a time-dependently,while little effect on Smad2/3 protein expression was found. The stimulatory effect of chymase on 3H-proline incorporation elicited by 30 ?g/L chymase was blocked in the presence of TGF-?1 antibody or staurosporine,a P-Smad2/3 inhibitor. Conclusion Chymase promotes collagen synthesis of rat CFs,TGF-?1/Smad might be involved into the signal pathway.

Objective To evaluate the validity and reliability of simplified Chinese version Scoliosis Research Society-22 (SRS-22) questionnaire on assessment of life quality of adolescent idiopathic scoliosis (AIS) patients at different time points pre-and post-operation. Methods Translation and cross-cultural adaptation of the English version of SRS-22 questionnaire was done. 177 AIS patients were involved in present study and the life quality before and 6-and 12-months after operation was assessed by SRA-22 and Short Form-36 (SF-36) questionnaire, of them 145 cases (26 males and 119 females; 11.1-17.9 years old, averaged 15.8; Cobb angle 41?-109?, averaged 63?) completed all the 3 steps. To evaluate the reproducibility, 65 patients were assessed twice in an interval time of 4-6 days (averaged 4.6 days) before operation and 55 valid questionnaires were received, 65 patients were assessed twice in an interval time of 7-21 days (averaged 14.7 days) at 12 months following up and 57 valid questionnaires were received. The two measures of reliability as internal consistency and reproducibility were determined by Cronbach's ? coefficients and intraclass correlation coefficient (ICC), respectively. Concurrent validity was measured by comparing with SF-36 questionnaire. Measurement was made using the Pearson correlation coefficient (r). Results The Chinese version SRS-22 questionnaire had a satisfactory validity and reliability, with average Cronbach's ? coefficients of 0.79-0.85 and average ICC of 0.77-0.87. Considering concurrent validity, 2 domains had excellent correlation (r=0.75-1.00), while 12 had moderate correlation (r=0.50-0.75). The function/activity (SRS-22) and role-physical or physical functioning (SF-36), pain (SRS-22) and pain index (SF-36), mental health (SRS-22) and mental health (SF-36) had good correlation (r=0.70-1.00). For the 145 patients, there were some differences in 5 various domains between the three measurements (pre-operation and 6 and 12 months post-operation). The scores of all domains 12 months after operation increased significantly than those of pre-operation and 6 months post-operation (P

Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.

Objective To analyze the related risk factors for delayed gastric emptying ( DGE) after pancreaticoduodenectomy .Methods Clinical data on 308 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili hospital from January 2009 to December 2014 were retrospectively analyzed , and patients were divided into DGE group and non-DGE group.Univariate analysis and multivariate logistic regression analysis were used to study the risk factors associated with DGE during perioperative period .Results DGE occurred in 55 patients (17.9%).The incidences of grade A, grade B and grade C DGE were 7.1%(22/308), 6.2%(19/308) and 4.5%(14/308), respectively.The univariate analysis showed the method of pancreatic digestive tract reconstruction ( pancreaticogastrostomy or pancreaticojejunostomy ) , postoperative pancreatic fistula, postoperative biliary fistula and postoperative intraabdominal infection were risk factors for DGE after surgery. Multivariate analysis indicated that the method of pancreatic digestive tract reconstruction (OR=1.19, P=0.046), postoperative pancreatic fistula ( OR=1.33, P=0.014), postoperative biliary fistula (OR=1.43, P=0.047) and postoperative intraabdominal infection (OR=1.51, P=0.001) were independently associated with DGE . Postoperative pancreatic fistula (OR=3.692, P=0.021) and intraabdominal infection (OR=3.725,P=0.003)were also the independent risk factors for Grade B and Grade C DGE. Conclusions DGE after pancreaticoduodenectomy was strongly related to the postoperative complications .Postoperative pancreatic fistula , biliary fistula and intraabdominal infection were associated with increased risk of DGE , while pancreaticogastrostomy reduced the incidence of DGE by decreasing the incidence of pancreatic or biliary fistula .

OBJECTIVE To investigate the characteristics and regularity of denosumab-associated atypical fractures （AF）， so as to provide references for clinical rational use of drugs. METHODS The case reports of AF related to denosumab were retrieved from PubMed， Web of Science， CNKI， Wanfang data and VIP databases， and the reports were descriptively analyzed. RESULTS A total of 19 references were retrieved， including 20 patients. There were 3 males and 17 females， with an average age of （69.80± 15.39） years. Among 20 patients， primary diseases of 14 patients were osteoporosis， and 6 cases were malignant tumor bone metastasis and giant cell tumor of bone. The occurrence time of AF ranged from 3 to 132 months after the administration of denosumab， with an average of （42.14±29.49） months. Fourteen cases had prodromal symptoms before AF. There were 3 cases of ulna fractures， and the remaining 17 cases were femoral fractures. The vast majority of patients recovered well after discontinuing medication and undergoing surgical fixation， but some patients experienced delayed fracture healing. CONCLUSIONS Long-term use of denosumab should be vigilant against AF. When patients experience prodromal symptoms such as thigh， groin， hip joint and forearm pain， they should seek medical attention in a timely manner to ensure medication safety.

Objective To analyse the cement distribution after vertebroplasty and investigate the feasibility and clinical significance of its typing.Methods A retrospective case-series study examining the bone cement distribution on anteroposterior radiograph after vertebral augmentation was conducted on 1 324 patients (2 119 vertebrae) with osteoporotic vertebral compression fractures (OVCF) from May 2009 to May 2016.Among the patients,due to refracture,147 patients suffered two or more surgeries with a vertebral refracture rate of 11.1％.One or more adjacent vertebrae refracture occurred in 105 patients with the adjacent vertebrae refracture rate of 7.9％.The vertebral body was split into four regions on the basis of the central vertical and bilateral pedicle of vertical line.According to the bone cement distribution in the four regions,there were five distribution types:type Ⅰ:1-4 regions;type Ⅱ:2-3 regions;type Ⅲ:1 and 4 regions;type Ⅳ:3 and 4 or 1 and 2 regions;type Ⅴ:1 or 4 regions.The X-ray of 40 patients was randomly typed by three orthopedics physicians,and the complication rate and refracture rate of adjacent vertebrae in each type were calculated.Credibility and repeatability analysis were performed.Results The average credibility of the typing was 92.5％.The Kappa coefficient was 0.850 on average.The repeatability of two times of typing was on average 95％,and the Kappa coefficient was 0.900 on average.From type Ⅰ to Ⅴ,there were 26 cases (3.5％),16 cases (4.5％),29 cases (7.3％),40 cases (9.9％),and 41 cases (18.1％) of adjacent vertebral refracture.There were 10 cases of the same vertebral refracture and 5 cases of scoliosis deformity in the type Ⅴ,with incidence rates of 4.4％ and 2.2％,respectively.Conclusions Being reliable and repeatable,the typing for cement distribution after vertebral augmentation is simple and practicable.The type Ⅳ and Ⅴ cement distribution carries higher risk of refracture in adjacent or the same vertebral body and long-term scoliosis than others types.

Objective To explore epidemiological characteristics of brucellosis in Shanxi Province during 2011-2015,and to provide evidences for making control and prevention strategy.Methods Data and surveillance data of disease outbreaks in Shanxi Province from 2011 to 2015 were collected.The retrospective analysis method was used to analyze the population distribution,regional distribution,time distribution,outbreak situation,serological and pathogenic test results of brucellosis.Results During 2011-2015,totally 33 697 brucellosis cases were reported,with an average annual incidence of 18.65/100 000,and one death case was reported.Brucellosis distributed in 119 counties (districts) of 11 cities.The area with most reported brucellosis cases was Datong City.The incidence of the disease had seasonal fluctuation and the incidence peak was from March to July.The male/female ratio of the cases was 3.69 ∶ 1.00 (26 515/7 182).Totally 75.77％ (25 531/33 697) were at the ages of 40-＜ 70 years.The yearly proportion of the cases occurred in the age groups was significantly different (H =146.263,P ＜ 0.05).Farmer was the predominant occupation group among the cases [82.90％ (27 935/33 697)].Totally 16 cases of human brucellosis outbreaks were occurred during the five years.The epidemic spread to seven counties in five cities.Totally 144 136 cases received serological test,the positive rate was 5.85％ (8 426/144 136),and 6 759 cases were found.Totally 164 strains of Brucella melitensis were isolated in human blood culture samples.All of which were Brucella melitensis biotype 3.Conclusions In recent years,the epidemic situation of brucellosis in Shanxi is severe,the total incidence has presented a rising tendency.There are outbreaks of human brucellosis in some countries.Brucella melitensis biotype 3 is the epidemic strain in Shanxi.

Objective To analyze the epidemiological surveillance results of human brucellosis in Shanxi Province from 2012 to 2017,to know the epidemic status of brucellosis,and to provide evidence for prevention and control of brucellosis.Methods Incidence date and surveillance date of disease outbreaks in Shanxi Province from 2012 to 2017 were collected,the retrospective analysis method was used to analysis the "three distribution" of brucellosis,outbreak situation and the results of serological and pathogenic surveillance in the 4 surveillance stations.Results A total of 36 220 brucellosis cases were reported from 2012 to 2017,the average incidence was 16.62/100 000;8 540 brucellosis cases were reported in 2014,with incidence 23.53/100 000;a total of 23 197 cases of brucellosis were reported mainly in Datong,Shuozhou,Jinzhong and Xinzhou,accounting for 64.04％ of the province total.The onset was seasonal,and the peak of the epidemic was from March to August,accounting for 67.23％ (24 350/36 220).The brucellosis cases were mainly youth (23 084),male (28 317),farmers and herdsman (32 616).In the 4 surveillance stations of the brucellosis,39 140 cases were investigated,of which 10 536 cases did serological test,in which 585 were positive for Brucella (5.55％).The highest positive rate of serological test was 9.50％ (226/2 738) which was found in Tianzhen.A total of 626 samples carried out pathogen culture,in which 107 strains of brucellosis were detected,the detection rate was 17.09％,and 106 strains Brucella were melitensis biovar 3 of the total strains except 1 mutant.Conclusions The reported incidence in Shanxi Province is in a decline tendency,but the situation of brucellosis epidemic is still relatively serious.It is suggested that the surveillance work should be strengthened;the epidemic situation of brucellosis should be mastered in time and effectively controlled.