[Objective]To study the screw trajectory in the posterior atalanto-axial transarticular screw fixation.[Methods](1)The anatomical parameters related to the screw fixation were measured on 30 paired dry atlantoaxial specimens;(2)The X ray and CT scan were taken after C1、2 was fixed by posterior transarticular screws on 6 cadavers.These iterms were used to explore the anatomical relation of the vertebral artery and the screw trajectory in the posterior C1、2 fixation.[Results]The depth of the vertebral artery groove on the inferior surface of the superior facet of the axial was(5.86 1.45)mm;the vertebral artery groove extented the superior facet up to its medial third in 15 sides,up to the middle third and its lateral third respective in 35 and 9 sides,and the ideal screw trajectory medial angle of these specimens were(26.4?3.44)?,(16.1?2.44)?,(15.1?2.24)? respectively。The shortest distance between the vertebral artery and the screw trajectory lied in the topmost point of the vertebral artery groove of the axial on CT images,and the interval was(2.75～5.78)mm.[Conclusion]The position of vertebral artery groove of the axial is the key to decide the angle of the screw trajectory.The shortest interval between screw trajectory and vertebral artery,safe for posterior atalanto-axial transarticular screw fixation,locates on the inferior surface of the superior facet of the axial.

Objective To identify the clinical risk factors of refractory Mycoplasma pneumoniae pneumonia (RMPP) and their values in early diagnosis. Methods The retrospective analysis of clinical data was conducted in 142 children with Myco-plasma pneumoniae pneumonia (MPP) admitted to Changhai Hospital of Second Military Medical University from Jan. 2012 to Jan. 2014. All children were divided into two groups, RMPP group (n=112) and MPP group (n=30). The comparison was made between two groups in clinical data. The factors were analyzed by the multifactor logistic regression. Results As compared to MPP, RMPP had longer fever duration, the higher ratios of large consolidation shadows, extrapulmonary complications and in-creased CRP level (P<0.05). The results of logistic regression indicated that the clinical risk factors included large consolidation shadows (OR=6.57, 95%CI:2.10-20.56), extrapulmonary complications (OR=11.66, 95%CI:2.42-56.08) and CRP (OR=14.87, 95%CI:2.67-82.79) (P<0.01). Conclusions Large consolidation shadows, extrapulmonary complications and CRP are clinical risk factors of RMPP. CRP elevation and lung imaging changes are valuable in early diagnosis of RMPP.

Objective To compare the effects of SFE - CO2 extraction and steam- distillation extraction for the extraction of volatile constituents from Huoxiang Zhengqi prescription. Methods The recovery rate of the volatile constituents and GC- MS method were used to compare the two different extraction methods. Result The recovery rate of volatile constituents was 0.45 % when extracted by steam distillation for 5 hours and 2.40 % by SFE - CO2 extraction for 3 hours. A large amount of peaks were detected in the SFE - CO2 extraction, while few compounds could be detected in the steam distillation extract 15 minutes later. Conclusion SFE - CO2 extraction method is a better method for the extraction of volatile constituents from Huoxiang Zhengqi prescription,with higher recovery rate, obtaining more ingredients and costing less time compared with those by steam distillation extract method.

Intrahepatic bile duct stones located at the upper part of the hepatic duct.The percentage of intrahepatic biliary cholesterol calculus is increasing in recent years,and the incidence of this type of bile duct stones is free from infection or obstruction.The formation of intrahepatic bile duct stones might not only related to the micro-environment changes in the biliary tract,but also related to the changes of metabolic function of hepatocytes or cholangiocytes.In this article,the mechanism of biliary hydrodynamics on the formation of intrahepatic bile duct stones was reviewed.

Surgical resection remains the only curative option of treatment for hepatocellular carcinoma,but centrally located tumors remain problematic.Extended right or left hepatectomy removes 60％ to 85％ of the hepatic parenchyma and is associated with more hepatic failure.Mesohepatectomy,resection of central hepatic segments (Couinaud's segments Ⅳ,Ⅴ,Ⅷ) and leaving the right and left segments in situ,preserves more functional hepatic tissues than extended hepatectomy.Despite its technical demands,mesohepatectomy should be considered as an alternative treatment for central huge hepatic tumors.

Problem-based learning (PBL)was used in resident standardized training in depart-ment of pediatrics of Changhai Hospital. Attending doctors with authority were taken as leaders teach-ing group and 3-5 resident doctors as team members. Cases were set up according to the targets of resident standardization training and common clinical diseases in each system. According to the results of the questionnaire after the teaching , both teachers and students were satisfied with the teaching effect and expected targets were reached. Residents made great progress in handling clinical problems.

Objective To evaluate the feasibility and clinical efficacy of intraperitoneal laparoscopic partial nephrectomy for T1a peripheral renal neoplasms. Methods Intraperitoneal laparoscopic partial nephrectomy was performed without renal artery occlusion for T1a peripheral peripheral renal neoplasms. The operative time, bleeding volume and complications were observed and the clinical experience was summarized. Results From October 2014 to January 2017 ,there were 10 patients:7 males and 3 females. All patients had T1a peripheral renal tumors. 10 patients underwent operation successfully ,of which 1 case developed temporarily blocked renal artery in the surgery due to hemorrhage. There was no referral during surgeries. The operative duration was 108 to 210 min,with a median of 135 min. The estimated blood loss was 100 to 750 mL,with a median of 320 mL. Followed up duration was 2 to 24 months (median 12 months),there were not postoperative renal secondary bleeding , leakage and other complications. No recurrence of tumor was found. Conclusion It is feasible and safe to exercise intraperitoneal laparoscopic partial nephrectomy without renal artery occlusion in the treatment of T 1a peripheral renal tumors,which can protect renal function to the greatest extent.

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.

Objective To evaluate the efficacy and safety of intradetrusor injection of botulinum toxin type A in the treatment of ketamine-related cystitis.Methods A retrospective analysis of clinical data of 36 ketamine-related cystitis patients with intradetrusor injection of botulinum toxin type A treatment in our hospital during August 2010 to December 2015 was conducted, including 31 males and 5 females with a mean age of 25.5 years.All patients had failed to conventional treatment options including cessation of ketamine, antibiotics, M-blockers.At the time of the first injection, patients were injected with 200 U botulinum toxin type A diluted in 15 ml of 0.9％ saline into the detrusor muscle at 30 sites, sparing the trigone, under cystoscopic guidance.3-d voiding diary, interstitial cystitis symptom index (ICSI),interstitial cystitis problem index (ICPI), pelvic pain and urinary frequency/urgency symptom score (PUF) were recorded to evaluate the efficacy.The treatment-related complications were recorded.When the efficacy of botulinum toxin type A decreased and the patient's symptoms returned to baseline before treatment, the patient received repeated injections of botulinum toxin type A with the same dose and method as the first injection.Results Thirty-six patients with ketamine-related cystitis were treated with intradetrusor injection of botulinum toxin type A.Sixteen patients received two injection treatments and two patients received three injection treatments.During the follow-up, 3-d urinary diaries, ICSI, ICPI, and PUF showed a significant improvement in outcome at 4 weeks after the first injection.The efficacy of the second and third injection treatment was also remarkable.Three patients developed urinary tract infection after the first injection, and two patients developed urinary tract infection after the second injection.Mild hematuria occurred in 15 patients after the first injection, and mild hematuria occurred in 7 patients after the second injection, which was improved in 1 to 2 days.All patients did not appear acute urinary retention and other adverse drug reactions.Conclusions Intradetrusor injection of botulinum toxin type A could be a safe and effective method for the treatment of ketamine-related cystitis.Repeated injection therapy is still safe and effective.

Objective To analyze the etiology and treatment of autoimmune hemolytic anemia. Methods The clinical data of 29 children with autoimmune hemolytic anemia during January 2013 to December 2015 were retrospectively analyzed. Results In 29 children, 10 cases were idiopathic 19 cases were secondary and 11 cases occurred after infections. The main clinical manifestations were pallor, jaundice, dark urine, and hepatosplenomegaly. 21 cases were Coombs test positive. In 29 children, 22 cases had a good response to adrenocortical hormone therapy while in 7 cases which had not response to adrenocortical hormone, good efficacy was achived after combined with the gamma globulin treatment. Conclusions The first line drug for autoimmune hemolytic anemia treatment is adrenocortical hormone. The gamma globulin can improve the efficacy.