Objective To investigate the manifestations of MRI for congenital coarctation of aorta. Methods Twenty-five patients with coarctation of aorta were studied, including 11 cases of simple type and 14 cases of complex type. All of them were examined by transthoracic echocardiography and MRI including SE sequence, Cine MRA,3 dimension dynamic contrast enhanced magnetic resonance angiography scanning. Results Among 25 cases of coarctation of aorta, MRI could directly show the whole picture of abnormality, including the scop, degree and kinds,obviously better than diagnosis by trimsthe rack echocardiography,according to operation. The accuracy of diagnosis for congenital coarctation of aorta and complicated malformation of congenital coarctation aorta was respectively 100% and 78% .Conclusion MRI examination for coarctation of aorta is important not only for diagnosis but also for the treatment and follow up,MRI can clearly show the kinds,scope and degree of congenital basically replacey X-ray angiography.

Objective To observe the changes of serum endotoxin and interleukin-6 level before and after treatment at intestine get rid of filth and adjustment intestine microenviroment in patients with advanced stage liver cirrhosis and to oberserve the incidence of spontaneous bacterial peritonitis(SBP) and to research a method that can more efficient reduce the incidence of SBP.Methods Group A was given conventional treatment such as protection liver,supplement human albumin and uragogue;goup B was given FPA 0 2g tid po,continuous three days on the basis of two weeks conventional treatment,group C was given Tab comfort get 0 5g tid po,Changtai orally taken liquid,10ml tid po,lactulose 10ml tid po, for all 8 weeks,on the basis of group B treatment after pausing use FPA.Results Serum endotoxin and interleukin-6 levels in group A was not significantly changes after treatment,,SBP incidence was higher than both group B and group C;at group B,serum endotoxin and interleukin-6 levels decline,SBP incidence significantly drop afer treatment,at group C,serum endotoxin,interleukin-6 level and SBP incidence significantly drop,the difference was significant at statistics as compared with group A and B.Conclusions The treatment at intestine get rid of filth and adjustment intestine microenviroment can effectively reduce serum endotoxin and interleukin-6 levels and can significantly reduce the incidence of SBP.

Objective To strengthen the ability of clinical thinking and the ability to solve practical clinical problems for medical students.Methods Medical undergraduates studying in affiliated hospitals of Tongji university from 2005 to 2010 were enrolled The clinical thinking training and assessment in clinical teaching were enhanced by introducing problem-based learning,case-based learning and by strengthening the role of interns in clinical work and emphasizing clinical thinking ability assessment during various kinds of clinical skills examinations.Meanwhile,the teaching management and supervision were improved.The awareness and ability of clinical teachers to train students′ clinical thinking were aroused and cultivated through teaching staff training so as to ensure that clinical thinking training and assessment were involved in the whole process of clinical teaching.Results The students' abilities of self-study,scientific thinking and oral expression were improved.The passing rates of our graduates in national general medical practitioner test were increasing yearly from 2006 to 2008.Conclusion Strengthening clinical thinking ability training during clinical teaching plays an active role in improving clinical skills in medical students.

Objective To evaluate the clinical outcome of artificial cervical disc replacement and cage fusion in the treatment of multi-segmental cervical disc herniation. Methods A total of 39 patients with multi-level cervical disc herniation were treated with disc replacement and adjacent segment cage fusion at one stage. There were 29 patients with two level cervical disc herniation, nine with three level cervical disc herniation and one with four level cervical disc herniation. Of the patients, there were 17 male and 22 female, aged between 35 and 63 years ( mean age 47 years). The herniated disc was located at C3-4 and C4-5 in two patients, C4-5 and C5-6 in 15, C5-6 and C6-7 in nine, C4-5 and C6-7 in three, C3-4,C4-5 and C5-6 in four, C4-5, C5-6 and C6-7 in five and C3-4, C4-8 , C5-6 and C6-7 in one. There were 18 patients with myelopathy and 21 with radieulopathy. The stabilization and the range of motion of implanted disc,the fusion of cage and the displacement of cage were observed on dynamic radiograph postoperatively. The clinical symptom and the neurological function were evaluated according to JOA score and odom' s criteria. Postoperative clinical symptoms and daily function were evaluated by using neck disability index (NDI) scale. Results Twenty-nine patients with bi-level cervical disc herniation underwent single level disc replacement and cage fusion on adjacent segment. Nine patients with three level disc herniation underwent single level disc replacement in seven and level cage fusion on adjacent segment in two. Twopatients underwent two level disc replacement and one level cage fusion. One patient with four level disc herniation was treated with two level disc replacement and two level cage fusion. The patients were followed up for from 6 moths to 3 years, which showed that definite stabilization was achieved for all disc with average range of motion for 9.3 degrees postoperatively. Solid fusion was achieved in all cage, with no subsidence or displacement of cage. The JOA score was increased from 9.1 to 13.2 at final follow up and the NDI (neck disability index) score decreased from 41.8 reduced to 29.5 at final follow up. The clinical success rate (excellent/good/fair) according to Odom' s Criteria was 85%. Conclusion Cervical disc replacement and cage fusion can attain definite stabilization and satisfactory mobility and provide a new effective treatment for cervical disc herniation. The long-term outcome needs further clinical followup.

Based on the analysis of the current status and limited factors of MISS at home and aboard,this paper discussed on the importance of MISS training base construction and explored the construction from the aspects of infrastructure constructing,teaching staff training,teaching materials compiling and teaching practice(teaching forms,contents and evaluation)researching.

Objective To study the indications and clinical outcome of the upper cervical spine via the high anterior cervical retropharyngeal approach in treatment of upper cervical spine injuries. Methods There were 41 patients including 32 males and 9 females, at age of 12-67 years. Of all patients, there were 21 patients with Hangman fractures, two with fracture of C2 vertebral body, 12 with irreducible atlantoaxial dislocation secondary to os odontoideum, four with C1,2 tuberculosis and two with C2 gaint cell tumor. All patients underwent the high anterior cervical retropharyngeal approach to expose C1C3. C2,3 fusion followed by self-locking plate was performed for Hangman fractures and C2 fractures. Ventral reduction plud posterior aflantoaxial fusion was done for irreducible atlantoaxial dislocation secondary to os odontoideum. Lesion was cleared for tuberculosis and the tumor was resected and reconstructed. The neurological funcation was evaluated according to the ASIA criteria, the JOA score and Odom' s criteria. Results Successful exposure of arch of atlas to C3 was achived in all 41 patients, with satisfactory reducation, decompression, fusion, lesion resection and reconstruction. The trauma patients with normal neurological function showed no neurological deficit postoperatively, but those with quadriparesis had partial recovery. While the patients with illness obtained marked recovery of neurological function, with the JOA score from preoperative 8.9 to 12.5 at final follow-up. The clinical success rate (excellent/good/fair) reached 94. % according to Odom' s Criteria. Hypoglossal symptom was found in three patients and facial nerve symptom in two, without wound infection. Conclusions Via the high anterior cervical retropharyngeal approach, the upper cervical spine can be thoroughly exposed to facilitate reduction, decompression and reconstruction and maximally restore physiological function of the cervical spine in treatment of the upper cervical spine injuries.

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.

Objective To evaluate the feasibility and safety of percutaneous posterior pedicle screw fixation in treatment of traumatic thoracolumbar fracture without neurologie deficits. Methods From January 2007 through December 2007, there were 15 patients with traumatic fracture of the thoracic or lumbar spine without neurologie deficits treated within 10 days after injury. There were 10 males and 5 females at age range of 31-65 years (average 45.6 years). The fracture was located at T11 in 1, T12 in 4,L1 in 7, L2 in 2 and L3 in 1. Preoperative anteroposterior and lateral radiographs of the fractured spine as well as CT and MRI were done to evaluate injury severity of the vertebral body, spinal canal and diseolig-amentary structures. According to Magerl classification criteria, there were 10 patients with type A3 frac-ture, 3 with type A2 fracture and 2 with type A1 fracture, which were treated with pereutaneous posterior pediele screw fixation. Operative time and intraoperative blood loss were recorded to observe clinical re-suits. Results The average operation time was 82 minutes (65-110 minutes), with a mean intraopera-five blood loss of 35 ml (20-50 ml ). There were no conversions to open surgery, new neurological deficits or other surgery-related complications. All patients were followed up for 3-11 months (average 7.6 months), which showed that Cobb angle was corrected from preoperative (15.7±6.3)° to postoperative (3.5±1.2)°. Postoperative CT showed sound reduction of posterior bone displacement in all patients compared to preoperative CT results. Conclusions Percutaneous posterior pedicle screw fixation is fea-sible and safe surgical procedure with fine short-term outcome in treating traumatic thoracolumbar fracture without neurologic deficits. This technique offers serveral potential advantages over open approaches inclu-ding less tissue trauma and blood loss as well as quicker recovery.

Objective To determine the safety and efficacy of minimally invasive surgical treatment for post-traumatic thoracolumbar kyphosis. Methods A retrospective review was performed on seven patients with post-traumatic thoracolumbar kyphosis admitted from April 2009 to February 2010.There were four males and three females, at average age of 45.3 years. After general anesthesia, minimally invasive transarticular osteotomy and multi-level SextantTM percutaneous reduction and internal fixation were performed under QuadrantTM working tube system. The status of pain and ability was evaluated by using visual analogue scale (VAS) and Oswestry disability index (ODI). The kyphotic deformity was evaluated by using the Cobb's angle. Results The operation lasted for mean 135 minutes, with mean perioperative blood loss of 106 ml but with no any complications occurred. The mean follow -up period was 5.5 months ( range 4 -16 months ). The mean VAS score was improved from preoperative ( 7.6 ±3.5) points to postoperative (2.5 ± 1.3) points, with statistical difference (P ＜0.01 ). The mean ODI was improved from preoperative 53.6 ± 24.2 to postoperative 20.6 ± 6.3, with statistical difference ( P ＜0.01 ). The Cobb angle was also improved from preoperative ( 32. 1 ± 4.5 ) ° to postoperative ( 7.3 ±2.9 ) °, with statistical difference ( P ＜ 0. 01 ). Conclusion Minimally invasive transarticular osteotomy under QuadrantTM working tube system is a safe and effective alternative for dealing with post-traumatic thoracolumbar kyphosis.

Objective To explore feasibility and therapeutic effect of posterior decompression by vertebral body resection, interbody bone fusion and transpedicular screw internal fixation in treatment of severe rotational throracolumar fracture and dislocation. Methods From October 2007 to July 2008, nine patients with severe rotational throracolumar fracture and dislocation classified as AO C types under-went decompression by vertebral boby resection, intervertebral bone fusion and transpedicular screw inter-nal fixation via a posterior midline small incision. There were eight males and one female, at age range from 23 to 54 years. All patients involved levels at T_(11)-L_2. According to AO classification, there were three patients with type C1 bursting fractures with rotational dislocation, five with distraction fracture com-bined with rotational dislocation and one with rotational distraction shear fracture/dislocation. The preop-erative Frankel Grading was Grade A in three patients, Grade B in one, Grade C in four and Grade D in one. Postoperative neurological status, the correction and loss of dislocation and the location and union of bone graft were reviewed. Results All patients received successful operation, with operation time of 3.5-5.8 hours (mean 4.4 hours), blood loss of 1 200-3 500 ml (mean 1 800 ml). The follow- up period in nine patients was 3-12 months (mean seven months). Postoperative X-ray photographs showed that the dislocation in all patients was reduced, the spine curvature was recovered to normal and the intervertebral bone graft was well fixed. Three patients at Frankel Grade A had no improvement, one at Grade B was improved to Grade C. Of four patients at Grade C, three patients were improved to Grade D. The follow-up showed bony fusion in all patients, with no loosening, dislocation or breakage of the internal fixation or implants. Conclusions For severe rotational throracolumar fracture and dislocation, decompression, reduction, fusion and fixation are rather difficult, while sufficient posterior decompression by vertebral body resection, rigid interbody bone fusion and transpadicular screw internal fixation can be an effective alternative measure.