Objective To investigate the cause, the prevention, the clinical manifestation,the diagnosis and the treatment of afferent loop syndrome following Billroth-Ⅱ-subtotal gastrectomy.Methods 10 cases of afferent loop syndrome whose history of operation, clinical manifestation, imaging examinations, and treatment were analyzed.Results Laparotomy was done again for all the 10 patients. Different extent of dilated afferent loop were seen intraoperatively. 6 patients underwent the Roux-en-Y anastomosis and the other 4 patients underwent the Braun anastomosis. No patients were died perioperatively. No recurrence was observed in followed up for 2 to 5 years after the operation.Conclusions Occurrence of afferent loop syndrome is associated with the incorrect operation technique. Improving the operation technique should be emphasized for preventing afferent loop syndrome. Once the definite diagnosis of afferent loop syndrome was worked out, the laparotomy shoud be done again as soon as possible. The optional operation can choose the Billroth-Ⅰoperation, the Roux-en-Y anastomosis, the Braun anastomosis or jejunal interposition,respectively.

Simultaneous determination of zinc, cadmium, tin, lead and copper was studied in 0.2-0.3M hydrochloric acid-methanol by 1.5 grade differential anodic stripping voltammetry. A stick silver base mercurial film electrode was used as a working electrode. The peak potential of Zn, Cd, Sn, Pb and Cu was distinctly separated each other being -1.05V, -0.74V -0.55V, -0.44V and -0.25V vs SCE, respectivly, in the above solvent electrolyte.Calibration curves of Cd, Sn, Pb and Cu in range of 20 to 600 ng/ml and Zn in range of 0.2 to 4 ug/ml showed linear relation. Canned foods could be analyzed, by dilution with the supporting electrolyte after digestion of the samples with mixed acid. The juice samples could be analyzed directly without digestion, by simple 5-2000 times dilution with the supporting electrolyte. Coefficient of variation and recovey was 6.7-8.0% and 91.2-107% respectively.

In this paper, duloxetine was chosen as the lead compound. The pharmacophores with 5-HT(1A) antagonism activity were used to replace the naphthyl of duloxetine. A series of duloxetine derivatives had been designed and synthesized and whose structures were confirmed with elemental analysis, MS and H NMR. All synthesized compounds were tested by tail suspension test and forced swimming test in vivo. The test results revealed that most of the compounds have shown better activity than duloxetine at the same dosage. Some of them are worth to be studied further.

Objective To establish a simple, feasible and precise quality control method for the determination of contents and related substances of demethyl levophencynonate hydrochloride (L-LPC)tablets.Methods The mobile phase consisted of methanol,acetonitrile and sodium acetate buffer solution(pH 5.0),at a ratio of 4∶3∶3,at a flow rate 1.0 ml/min and a detection wavelength of 220 nm.Samples were injected 100 μl and determined at room temperature.Results The calibration curves showed good linearity (R2 =1) within the test range of 0.1-50μg/ml.The recovery of the method was about (100.15 ±0.73)%, and the stability of working solutions was acceptable in 8 h (RSD=0.36%).Conclusion The results indicated that the developed method can be readily used as a quality control method.

ObjectiveTo investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.MethodsThree male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years(range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.ResultsTwo cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.ConclusionAscending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated.

Objective:To investigate the risk factors of postoperative persistent ureteral stricture by collecting and analyzing the clinical pathological data of patients after radical hysterectomy.Methods:The clinicopathological data of patients with cervical cancer and endometrial cancer diagnosed in Guangxi Medical University Cancer Hospital from December 2013 to December 2018 who needed radical hysterectomy were retrospectively analyzed, and the incidence of postoperative persistent ureteral stricture, related risk factors and their impact on the prognosis of patients were analyzed.Results:Finally, a total of 1 068 patients were included in the study. Among them, 194 patients developed persistent ureteral stricture after radical hysterectomy, with an overall incidence of 18.2%, of which the incidence of cervical cancer was 18.7%(151/807), and the incidence of endometrial cancer was 16.5%(43/261). There was no significant difference in the incidence of ureteral stricture after radical hysterectomy between the two types of tumors ( P>0.05). Univariate analysis showed that International Federation of Obstetrics and Gynecology (FIGO) stage, postoperative adjuvant chemotherapy, vascular invasion, lymph node metastasis, postoperative adjuvant radiotherapy, postoperative ureteral fistula, postoperative lymphatic cyst, preoperative albumin were associated with persistent ureteral stricture after radical hysterectomy (all P<0.05); Multivariate analysis showed that postoperative adjuvant radiotherapy, postoperative adjuvant chemotherapy, postoperative ureteral fistula and postoperative lymphatic cyst were independent risk factors for persistent ureteral stricture (all P<0.05). There was a statistically significant difference in the survival rate between patients with and without persistent ureteral stricture ( P<0.01). Conclusions:The incidence of persistent ureteral stricture after radical hysterectomy is relatively high in patients with cervical cancer and endometrial cancer, and postoperative ureteral fistula, postoperative adjuvant radiotherapy, postoperative adjuvant chemotherapy and lymphocyst may be independent risk factors. Postoperative persistent ureteral stricture may affect the outcome of patients.

Objective To compare the Iso-C 3D navigation system versus the traditional X-ray fluoroscopy in minimally invasive surgery for Kümmell disease.Methods Included for the present retrospective study were 42 patients with Kümmell disease who had been treated by percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) at Department of Spine Surgery,Honghui Hospital from October 2016 to June 2018.They were 11 men and 31 women,aged from 43 to 72 years (average,57.4 years).The operation was aided by Iso-C 3D navigational system in 21 patients (observation group) and by X-ray fluoroscopy in the other 21 patients (control group).The 2 groups were compared before operation,one day and 6 months after operation in terms of visual analogue scale (VAS),Oswestry disability index (ODI),cobb angle and anterior vertebral height.Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data (P ＞ 0.05).All the patients were followed up for an average of 9.6 months (from 6.0 to 18.5 months).At one day after operation for the observation andcontrol groups,the VAS scores (2.2 ±0.7 and 3.9 ± 1.5),ODI scores (15.6 ±2.8 and 26.2 ±6.9),cob angles (19.5° ± 1.7° and 20.8° ± 0.8°) and anterior vertebral heights (20.7 ± 1.4 and 18.7 ± 1.5 mm) were all significantly improved compared with those before operation (P ＜ 0.05).At 6 months after operation for the observation and control groups,the VAS scores (1.6±0.6 and 2.7±1.0),ODI (14.2±3.1 and 21.5 ±4.2),cob angles (18.6°± 1.8° and 19.0°± 1.7°) and anterior vertebral heights (19.9 ± 1.8 and 17.8 ± 1.6 mm) were not significantly different from those at one day after operation (P ＞ 0.05).The VAS,ODI,cobb angle and anterior vertebral height at one day after operation for the observation group were all significantly better than those for the control group (P ＜ 0.05).The VAS,ODI and anterior vertebral height at 6 months after operation for the observation group were significantly better than for the control group (P ＜ 0.05),but there was no significant difference between the 2 groups in the cobb angle (P ＞ 0.05).No complications were observed in the observation group but 6 cases in control group reported cement leakage.Conclusion In the PKP/PVP treatment of Kümmell disease,Iso-C 3D navigational system may be superior to traditional X-ray fluoroscopy in that it can lead to better recovery of anterior vertebral height,kyphosis correction,pain relief and quality of life.

Objective:To compare the effect of robot navigation system (Tian Ji robot system) plus 3D printing and traditional C-arm X-ray fluoroscopy in assisting percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) for treatment of Kümmell disease.Methods:A retrospective case-control study was conducted to analyze the clinical data of 40 patients with Kümmell disease treated at Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine from December 2017 to February 2019, including 12 males and 28 females, with an average age of 56.4 years (range, 42-71 years). In observation group, 20 patients underwent PKP or PVP assisted by the robot navigation system and 3D printing. In control group, 20 patients underwent PKP or PVP assisted by the traditional C-arm X-ray fluoroscopy. The operation time and incidence of complications were observed. The visual analogue scale (VAS), Oswestry disability index (ODI), Cobb angle and anterior vertebral height were compared before operation, 1 day and 3 months after operation.Results:All patients were followed up for 3.5-8.6 months (mean, 6.7 months). The operation time in control group was (32.2±5.8)minutes, compared with (26.7±3.6)minutes in observation group ( P<0.05). The incidence of cement leakage was 0% (0/20) in the observation group and 5% (1/20) in control group ( P>0.05). One day after operation, in observation group and control group, the VAS was (2.1±0.3)points and (3.7±0.8)points, the ODI was 14.3±1.8 and 25.5±5.7, the Cobb angle was (20.6±1.2)° and (22.4±0.6)°, and the anterior height of vertebral body was (21.2±0.8)mm and (17.6±0.7)mm, respectively, showing significant improvement compared with those before operation ( P<0.01). Three months after operation, in observation group and control group, the VAS was (1.8±0.4)points and (2.8±0.8)points, the ODI was 12.3±1.5 and 21.6±2.3, the Cobb angle was (18.1±0.8) ° and (20.5±1.6)°, and the anterior height of vertebral body was (20.1±1.8)mm and (16.8±1.3)mm, showing no significant difference compared with those at day 1 after operation ( P>0.05). There were significant differences in the VAS, ODI, Cobb angle and anterior vertebral height between the two groups 1 day and 3 months after operation ( P<0.01). Conclusion:For Kümmell disease, with assistance with the robot navigation system combined with 3D printing, PKP or PVP can more effectively reduce the pain of patients, improve the quality of life, restore the anterior height of vertebral body, and realize the individualized treatment in comparison with the traditional C-arm X-ray fluoroscopy.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.