ObjectiveTo explore the clinical effect of internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach.MethodsFrom June 2008 to June 2011,26 patients were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach.Sixteen cases were diagnosed as fractures of the acetabular anterior column,and ten as fractures of the pubic rami.The patient was positioned supine or lateral floating.The incision included two parts.The lateral part along the anterior one-third of the iliac crest about 3-5 cm.The insertion of the abdominal muscles and the origin of the iliacus were sharply incised from the crest.By subperiosteal dissection,the iliacus was elevated from the internal iliac fossa as far medially as to expose the anterior inferior iliac spine,iliopubic eminence and acetabular anterior column.The medial part of the incision was from the pubic tubercle transverse lateral extend 2-3 cm.Subperiosteal dissection to expose the superior pubic ramus.Two windows were dissected subperiosteal to connect through a tunnel along the anterior column of the acetabulum and pubic ramus.Fractures were reduced,and reconstruction plates were contoured and placed through the tunnel.Two or three screws were used at each window to fix the fractures.ResultsAccording to Matta evaluation system,anatomic reductions of the hip were in 13 cases,good in 11 and fair in 2 cases.Twenty-three patients were followed up from 6 to 30 months(mean,15.6 months).Hip functions were excellent in 13 patients,good in 6,and fair in 4 patients according to the D'Aubigne scores system.Pelvic functional results showed 12 were excellent,9 were good and 2 were fair according to Majeed scores system.No complications such as infection or deep venous thrombosis occurred.ConclusionThis modified ilioinguinal approach,with less operation time and low rate of complications,is simple and minimally invasive.It is easy for surgeons to perform plate moulding and could provide firm fixation.

Objective To study the values of quantitative assessment of extraocular muscles in diagnosing the thyroid associated ophthalmopathy(TAO).Methods The maximum section area,short and long diameters of extraocular muscles on orbital coronal CT were measured and the value of R was calculated in 50 healthy persons and 50 patients with TAO.Results The maximum section areas of 228 extraocular muscles in 50 patients with TAO increased,of them,inferior rectus(30.3%) and mediate rectus muscle(23.2%) were common,followed by superior rectus,lateral rectus and superior oblique muscle.Their maximum section areas(70.21 mm2,56.93 mm2,64.06 mm2,58.51 mm2,20.65 mm2,respectively) and the values of R(0.61,0.55,0.61,0.50,0.52,respectively) were larger than that in healthy group(27.72 mm2,27.07 mm2,26.93 mm2,36.74 mm2,9.42 mm2 respectively in maximum section areas) and(0.41,0.35,0.60,0.34,0.44 in the values of R,respectively).There were statistical significant differents between them.Conclusion The quantitative coronal CT measurement,especially the values of R can assess enlargement of extraocular muscles accurately,which may be helpful in diagnosis of TAO.

Objective To explore the clinical effects of pyloroplasty on proximal gastrectomy in patients with lesions in cardia of the bottom of stomach.Methods One hundred cases of the proximal gastric diseases who were enrolled in the second affiliated hos-pital of Chongqing medical university from the January 2010 to December 2013 were selected in this prospective randomized con-trolled experimental study.Among them,6 cases were excluded,and the other 94 cases were divided into two groups:the experimen-tal group (A),in which 54 patients were underwent additional pyloroplasty surgery;the control group (B),in which 40 patients were underwent with no strings attached pyloroplasty.All patients were followed up.Then,the clinical indicators during hospitaliza-tion,term complications and repeated endoscopy prompted pyloric stenosis and reflux esophagitis situation three months after dis-charged from hospital were observed.Results There was no significant difference in the incidence rate of gastroplegia (P >0.05);there were significant differences in other clinical indicators during the postoperative hospitalization and the incidence rate of compli-cations (P <0.05).Conclusion Proximal gastrectomy additional pyloroplasty could reduce gastric retention,decrease the incidence of reflux esophagitis,shorten the hospital period and could be helpful for recovery,thus it is recommended to be further promoted.

Objective In order to investigate the relationship between Borna disease virus(BDV) and the viral encephalitis,and whether BDV infection exists in Ningxia or not.Methods The p24 fragment of BDV in peripheral blood mononuclear cells(PBMC) and cerebrospinal fluid mononuclear cells(CSFMC) in 52 patients with viral encephalitis and 32 healthy donors were examined by nested reverse transcriptase polymerase chain reaction(RT-PCR) and fluorescence quantitative(FQ) PCR to analysis gene sequence,homogenicity and amino acid sequence of positive products.Results The positive rate of BDV p24 in PBMC and CSFMC in viral encephalitis(9.6%,11.5%) was significantly higher than that in healthy donors(0,P

Objective To study the accuracy of the anteversion of femoral prosthesis in hemiarthro-plasty for treating femoral intertrochanteric fracture in the elderly.Methods Twenty femoral neck antever-sions of specimens were measured, which were control group(A).The femoral specimens were made into the model of femoral intertrochanteric fracture, which were installed femoral prosthesis according to minor trochanter(B),identifying the max diameter of cavum medulla(C),ocular estimating femoral condylar line ( D) ,combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line( E) respectively.All the anteversion of femoral prosthesis were measured.Results The anteversion were:A group(8.98 ±4.31)°,B group (9.12 ±4.87)°,C group (9.57 ±6.49)°,D group (13.18 ± 5.83)°,E group (10.37 ±4.56)°respectively.The difference among the five groups was statistically sig-nificant.There was difference between D and A, there were no differences between B and A, C and A, E and A respectively.Conclusions In hemiarthroplasty for treating femoral intertrochanteric fracture, the an-teversion of femoral prosthesis is according to minor trochanter possibly; if the minor trochanter can not be got reduction, it is a good option according to combination of identifying the max diameter of cavum medulla and ocular estimating femoral condylar line to make sure the accuracy of the anteversion of femoral prosthe-sis.

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation.Methods From January 2011 through January 2015,9 complicated open tibial plateau fractures were treated with Hybrid external fixation.They were 6 males and 3 females,with an average age of 33.8 years (range,from 18 to 53 years).According to the Schatzker classification,there were 5 cases of type Ⅴ and 4 ones of type Ⅵ.According to the Gustilo classification,there were 5 cases of type Ⅱ,3 ones of type Ⅲ A and one of type Ⅲ B.All the patients were treated with Hybrid external fixation with or without minimally open reduction.Results The average operation time was 185.6 minutes (from 140 to 240 minutes).The average time for hospital stay was 18.4 days (from 10 to 45 days).The patients were followed up for an average of 15.6 months (from 6 to 36 months).All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months).The external fixation was removed after confirmation of fracture union.According to Merchant scores,the clinical results were evaluated as excellent in 4 cases,as good in 3,as fair in one and as poor in one.The knee joint was stable in each case.Pin tract infection was observed in one and wire loosening in one.Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures.

Objective To study the species and amount of bacteria in sputum of patients with ventilator associated pneumonia (VAP) by using 16S rDNA sequencing analysis,and to explore the new method for etiologic diagnosis of VAP.Methods Bronchoalveolar lavage sputum samples were collected from 31 patients with VAP.Bacterial DNA of the samples were extracted and identified by polymerase chain reaction (PCR).At the same time,sputum specimens were processed for routine bacterial culture.The high flux sequencing experiment was conducted on PCR positive samples with 16S rDNA macro genome sequencing technology,and sequencing results were analyzed using bioinformatics,then the results between the sequencing and bacteria culture were compared.Results ① 550 bp of specific DNA sequences were amplified in sputum specimens from 27 cases of the 31 patients with VAP,and they were used for sequencing analysis.103 856 sequences were obtained from those sputum specimens using 16S rDNA sequencing,yielding approximately 39 Mb of raw data.Tag sequencing was able to inform genus level in all 27 samples.② Alpha-diversity analysis showed that sputum samples of patients with VAP had significantly higher variability and richness in bacterial species (Shannon index values 1.20,Simpson index values 0.48).Rarefaction curve analysis showed that there were more species that were not detected by sequencing from some VAP sputum samples.③ Analysis of 27 sputum samples with VAP by using 16S rDNA sequences yielded four phyla:namely Acitinobacteria,Bacteroidetes,Firmicutes,Proteobacteda.With genus as a classification,it was found that the dominant species included Streptococcus 88.9％ (24/27),Limnohabitans 77.8％ (21/27),Acinetobacter 70.4％ (19/27),Sphingomonas 63.0％ (17/27),Prevotella 63.0％ (17/27),Klebsiella 55.6％ (15/27),Pseudomonas 55.6％ (15/27),Aquabacterium 55.6％ (15/27),and Corynebacterium 55.6％ (15/27).④ Pyrophosphate sequencing discovered that Prevotella,Limnohabitans,Aquabacterium,Sphingomonas might not be detected by routine bacteria culture.Among seven species which were identified by both methods,pyrophosphate sequencing yielded higher positive rate than that of ordinary bacteria culture [Streptococcus:88.9％ (24/27) vs.18.5％ (5/27),KlebsieHa:55.6％ (15/27) vs.18.5％ (5/2 7),Acinetobacter:70.4％ (19/27) vs.37.0％ (10/27),Corynebacterium:55.6％ (15/27) vs.7.4％ (2/27),P＜0.05 or P＜0.01].Sequencing positive rate was found to increase positive rate for culture of Pseudomonas [55.6％ (15/27) vs.25.9％ (7/27),P=0.050].No significant differences were observed between sequencing and ordinary bacteria culture for detection Staphylococcus [7.4％ (2/27) vs.11.1％ (3/27)] and Neisseria bacteria genera [18.5％ (5/27) vs.3.7％(1/27),both P＞0.05].Conclusions 16S rDNA sequencing analysis confirmed that pathogenic bacteria in sputum of VAP were complicated with multiple drug resistant strains.Compared with routine bacterial culture,pyrophosphate sequencing had higher positive rate in detecting pathogens.16S rDNA gene sequencing technology may become a new method for etiological diagnosis of VAP.

Objective To investigate the serum level of anti N-methyl-D-aspartate (NMDA) receptor antibody in patients with cognitive dysfunction of systemic lupus erythematosus (SLE) and its clinical significance.Methods The levels of anti NMDA receptor antibody in blood samples from 36 patients with cognitive dysfunction of SLE,30 cases with normal cognitive function of neuropsychiatric lupus erythematosus (NPSLE) groups,64 patients with no-NPSLE,100 patients with other connective tissue diseases and 30 healthy controls were measured by enzyme linked immunosorbent assay,and the reports of Mini-Mental State Examination and the laboratory indexes were recorded in those groups,then these index were measured again when patients were treated for 2 weeks.The comparison of multi-group was conducted by means of single factor analysis of variance or rank test,the Pearson or Spearman correlation analysis was used to analyze the correlation between variables.Results ① The level of anti NMDA receptor antibody in the patients with cognitive dysfunction of the NPSLE group (1.30±0.27) was higher than those with normal cognitive function of NPSLE group (0.47±0.08),No-NPSLE group (0.47±0.07),the other connective tissue disease (0.42±0.04) and the healthy controls (0.35±0.06) (P＜0.05),the difference was statistically significant.The levels of anti NMDA receptor antibody before treatment were higher than those after the treatment,and the difference was statistically significant (t =2.296,P＜0.05).② The serum levels of anti NMDA receptor antibody in patients were negatively correlated with the intelligent score (r=-0.330,P＜0.01),and were positively correlated with the levels of IgG (r=0.684,P＜0.05).Conclusion The anti NMDA receptor antibody can be used as a new autoantibody in the early diagnosis of cognitive dysfunction in patients with SLE,and can be used for monitoring the activity of disease in cognitive dysfunction of SLE.

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

Objective To investigate the clinical outcomes of extraperitoneal pelvic packing combined with temporary occlusion of abdominal aorta in treatment of pelvic fractures with hemodynamic instability.Methods A retrospective case series study was made on 14 patients with pelvic fractures with hemodynamic instability managed by extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta between December 2006 and December 2013.There were ten males and four females,with mean age of 38.2 years old (range,18-63 years).The fractures were classified according to the Tile classification,including two patients with type B1,two with type B2.2,one with type C1.1,two with type C1.2,two with type C1.3,three with type C2,and two with type C3.In addition,10 patients were with closed pelvic fractures and four with open pelvic fractures.All patients were diagnosed as hypovolemic shock once they were admitted.Every patient was given anti-shock treatment,temporary occlusion of abdominal aorta,and extraperitoneal pelvic packing instantly,in order to control hemorrhage of pelvic fracture after they were admitted.The operation time,red blood cell transfusion volume,preoperative and postoperative blood pressures,heart rates as well as other relevant parameters concerning death and survival were recorded and compared.Postoperative infection and wound healing status were recorded as well.Results The operation time was 50-70 minutes (mean,61 minutes).After surgery,the length of ICU stay was (10.9 ± 9.8) days and hospital stay was (23.1 ± 14.9) days.Red blood cell transfusion volume before and after surgery was (17.7 ± 2.2)U and (8.4± 1.7)U,respectively (P ＜ 0.05).The parameters of systolic pressures varied from preoperative (63.6 ± 2.1) mmHg to postoperative (90.9 ± 1.1) mmHg,and the parameters of heart rates declined from preoperative (106.2 ± 5.9) beats/min to postoperative (94.0 ± 6.2) beats/min,(P ＜ 0.05).Ten patients were available for follow-up of 8-24 months (mean,11.5 months).There were four deaths (29％) postoperatively,among which three were died from multisystem and organ failure,and one from severe brain injury.There were statistically significant differences between the survivors and the deaths in terms of time from injury to operation,average systolic pressures,and average heart rates (P ＜ 0.05).None had complications and wound was well healed.Conclusion For pelvic fractures with hemodynamic instability,extraperitoneal pelvic packing plus temporary occlusion of abdominal aorta has advantages of short manipulation time and effective outcomes,which can control the hemorrhage of pelvic fracture and ameliorate the hemodynamic status.