Objective To explore clinical outcomes of using improved 2D computer-assisted fluoroscopic navigation of inu'tation 3D vertebra image to guide the pedicle screws in lumbar disease. Methods The anterio posterior, lateral and oblique radiographic materials were got in 43 lumbar disease patients performed neck of vertebra internal fixation, and used the method of improved computer-assisted fluoroscopic navigation to imitate anterio posterior, lateral spinal and axial pedicle virtual image to guide the pedicle screws implantation. Results One hundred and eighty-eight lumbar pedicle screws were implanted, deviation mean position 1.5 mm and mean angle deviation 0.8° in match navigation virtual path with real pedicle screws image. Postoperative CT showed all pedicle screws contained within the pedich, without invasion to lateral and inner bone cortical of the pediele. Deviation mean 1.0° by measured pedicle screws with longitudinal axis vertebra compared with preoperational predict implant screws sagttial angle. Conclusions Improved 2D computer-assisted fluoroscopic navigation is simple and convenient, use anterio posterior,lateral and oblique radiographic materials to imitate anterio posterior,lateral spinal and axial pediele virtual image can precisely guide the pedicle screws implantation.

Objective To determine the prevalence of pain beyond the osteoporotic vertebral com-pression fracture (OVCF) in patients undergoing percutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation (pereutaneous vertebroplasty and pereutaneous kyphoplasty) was performed to examine the lo-cations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale (VAS,10-point scale) and Activities of Daily Living (ADL, 5-point scale) were used. Results Of the 104 patients, 48 (46.2%) suffered pain beyond the OVCF. The pain was firstly located in the sacrococeygeal region and buttocks (26.0%), secondly in the abdomen and sub-xiphoid process (10.6%) and thirdly in the flank, ribs and chest (9.6%) . For all the cases, the mean VAS score decreased from 8.9±0. 8 before vertebral augmentation to 2.9±1.4 after augmentation (t=37.410, P=0.000), and the mean ADL score decreased from 4.1±0.6 before operation to 2.0±0.7 after operation (t=25.331, P =0.000) . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8±0.9 before vertebral augmentation to 2.8±1.5 after augmentation (t=23.722, P=0.000), and the mean ADL score decreased from 4.2±0.7 before operation to 2.0±0. 7 after operation (t=15.373, P=0.000). The decreases in VAS and ADL scores were not affected by the pain. Conclusion The pereutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.

Objective To find an ideal operative method of i nteral fixation for supracondylar a nd in-tercondylar femur comminuted fractures.Methods 30cases with supracondylar and inte rcondylar femur frac-tures were treated percutaneously with retrograde femoral intramedullary nail(GSH)in condition of close reduction technique with assistance of endosc ope and fluroscope.Results The mean 115ml blood loss was seen in 30cases without grafting intraoperatively.Thigh edema recovery and over90?knee flexion motion were seen one week after the operation.All fractu res were united in 6months.Postoperative following-up for 18months revealed the mean 125?knee motion,normal gait in all cases,no varus or valgus defo rmities and no osteoarthotitis.Conclusion The percutaneous tech.of retrograd e nailing with assistance of endosco pe and fluroscope is an ideal surgery method to treat supracondylar and intercondylar femur factures.

AIM To study the chemical constituents from the stems of Clausena lansium (Lour.) Skeels.METHODS The n-butanol fraction of Clausena lansium stems' 95％ ethanol extract and herb residue's 50％ ethanol extract were isolated and purified by silica,RP-MPLC and PHPLC column,then the structures of obtained compounds were identified by spectral data.RESULTS Eight compounds were isolated and identified as marmesinin (1),nodakenin (2),decuroside Ⅳ (3),3,4-dimethoxyphenyl-β-D-glucopyranoside (4),glucosyringic acid (5),2-(3-methoxy-4-hydroxyphenyl)-ethanol-1-O-β-D-glucopyranoside (6),4-hydroxy-2-methoxy-phenyl-β-D-glucopyranoside (7),4-hydroxy-2,6-dimethoxyphenyl-β-D-glucopyranoside (8).CONCLUSION Compounds 4-6 and 8 are isolated from genus Clausena for the first time.

Objective To explore the efficacy of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures. Methods 18 patients with thoracolumbar unstable fractures were treated with short-segment vertebral pedicle screw fixation guided by computer-assisted fluoroscopic navigation, and fractures were reinforced with CPC cement vertebroplasty. Postimplantatively, the implants' images-error between virtual image of fluoroscopy and X-ray image was measured. Results The implant's location was excellent. All patients were allowed sitting-up or bearing body weight one week after operation. The vertebral height restored 40% postoperatively. 12 months after operation the vertebral height only changed 0.15%. Dynamic X-ray films showed no abnormal segment instability and no instrument breaking. Conclusion Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle srew fixation could determine the internal fixation approach and let implants to the precise position by one time of X-ray image. It increases the security of pedicle screw fixation and vertebroplasty.

Objective To explore the clinical application of computer-assisted three-dimensional navigation system for thoracic pedicle screw placement. Methods From May 2003 to May 2004, the computer-assisted three-dimensional navigation system was used for thoracic pedicle screw placement in 80 screws of 15 cases, including 30 in the upper thoracic spine and 50 in the middle or lower thoracic spine. These fifteen patients included ten male and five female with a mean age of 47 years (range 13-76 years). In this series of 15 patients, thoracic spinal surgery was performed for tumor resection and reconstruction in 5, burst fracture in 4, ossification of thoracic ligamentum flavum in 2 and thoracic scoliosis in 4. The pedicle screw position was assessed with "C"-arm fluoroscopy during operation and with CT post-operation. The cost of time for pedicle screw installation and amount of bleeding were recorded. Results The cost of time averaged 15 minutes (range 10-20 min) for each pedicle screw placement. The amount of bleeding varied, it averaged 1200 ml in thoracic tumor resection and reconstruction, 800 ml in posterior fixation for burst fracture, 300 ml in resection of ossified ligamentum flavum, and 500 ml in surgery for scoliosis. The pedicle screw position was graded post-operatively with CT scanning into three groups: gradeⅠ, perfectly placed, grade Ⅱ, cortical perforation less or equal to 2 mm, and grade Ⅲ, perforation more than 2 mm. Of these 80 screws, 76 screws (96%) were found in gradeⅠ, 2 in gradeⅡ, and 2 in grade Ⅲ. All of the 4 screws in gradeⅡor Ⅲ were placed deviating to the lateral portion of pedicles, and no neurological deficit was resulted. Conclusion The computer-assisted three-dimensional navigation system is a valuable tool both for improving the accuracy of thoracic pedicle screw installation, and increasing the overall safety of the procedure during thoracic spine surgery.

BACKGROUND: There are some reports about the relationship between atherosclerotic cerebral infarction and apolipoprotein E and B, but the results are still controversial. The relationship between apolipoprotein E and B and young adult atherosclerotic cerebral infarction has not been reported yet in China.OBJECTIVE: To investigate the relationship between the polymorphism of apolipoprotein E and B gene and young adults atherosclerotic cerebral infarction (ACI).DESIGN: A controlled case analysis of young adult atherosclerotic cerebral infarction patients.SETTING: Department of Neurology, Shengjing Hospital of Chinese Medical University.PARTICIPANTS: This study was conducted in the Department of Neurology, Shengjing Hospital of Chinese Medical University from January of 1998 to December of 2000. Thirty-six young adult patients with atherosclerotic cerebral infarction, including 30 males and 6 females, with the meaage of (41.6±6.54) years, and 100 healthy young adults, including 66 males and 34 females, with the mea age of (36.16±6.12) years were included in this study.METHODS: 8 Ml venous blood was collected after fasting for 12 hours to assay serum lipid and apolipoprotein. The gene polymorphism of apolipoprotein E and B were detected with PCR method. Enzymic method was used to detect total cholesterol, total triglycerides and high density lipoprotein-cholesterol (HDL-C). Apolipoprotein AI.B was measured with immunoturbidimetry method and lipoprotein (a) with ELISA method.Lipids, lipoprotein and apolipoprotein of six control blood samples couldn't be measured because of hematolysis.MAIN OUTCOME MEASURES: ① The distribution characteristics of genotypic frequency of apolipoprtein E and B in the two groups. ② The relationship between gene polymorphism of aoplipoprotein E and B and the level of blood lipids, lipoprotein and apolipoprotein. ③ The correlation intensity between genotypes of apolipoprotein E and B and onset of young adult atherosclerotic infarction.RESULTS: ① In ACI group, ε3/4 counted for 36.1% and ε2/4 for 27.7%, but was 12% and 7% in control group respectively. The gene frequency of ε4 was 0.320. All these values were higher than that in control group 0.95 (P ＜ 0.05). ② The levels of TG, TC, and LP (a) in ACI group were higher than that in control group. The level of HDL-C was much lower than the control group's (P ＜ 0.05-0.01). ③ ε4 allele caused the increase of the content of TG, TC, and LP (a) so as to induce the relative risk rates of decrease of HDL-C which were 8.23, 4.85, 29.9,4.39 (P ＜ 0.01-0.001) respectively. ④ AI content of the gene frequency of ApoB XbaⅠ X+X- was (1.01±0.30) g/L in ACI group, which was lower than (1.33±0.15) g/L in X-X- subgroup (t=2.55, P ＜ 0.05). The level of ApoA I in X+X group (244.3 mg/L) was remarkably different from that (183.0 mg/L)in control group (t=4.50, P ＜ 0.01). ⑤ Three cases had both ε3 and X+X-in ACI group, 10 had both ε3 and X-X-, 2 had both ε4 and X+X-, and 19 had both ε4 and X-X-. The risk of ACI was 2.85 with the linkage of allele ε4 and allele X-X- in ACI patients (x2=1.52, P ＞ 0.05).CONCLUSION: Allele ε4 is a genetic facilitated factor of young adults ACI. Xba Ⅰ X+X- is another probable genetic symbol. The correlation between atherosclerotic cerebral infarction of young patients during the combination of apolipoprotein E and B should be researched further.

Objective To explore the association between genetic polymorphism of a disintegrin and metalloprotease 19 (ADAM19) and chronic obstructive pulmonary disease (COPD).Methods Totally 116 patients with COPD (the COPD group) and 82 healthy volunteers (the control group) were enrolled in this study.Fasting peripheral blood was taken and whole blood corpuscle genomic DNA was extracted.The genetic polymorphism of ADAM19 (rs1422795) was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).Results The difference in genotypes frequencies (GG,AG,AA) distribution of the ADAM19 between patients (73.3％,22.4％,and 4.3％) and controls (68.3％,28.0％,and 3.7％) showed no statistically significance (x2 =0.887,P=0.634).There were also no significant differences in the distribution of the different allele gene frequencies(A,G) between patients (84.5％,15.5％) and controls(82.3％,17.7％)(x2=0.582,P=0.446).No differences were found in the distribution of the genotypes between patients of different COPD severity classified according to FEV1 (％ pred),and healthy controls(x2=3.325,P=0.787).Conclusions ADAM19 (rs1422795) genetic polymorphism is not related to the development of COPD,which may not be the COPD-related gene.

Objective To explore clinlical outcomes of using improved computer-assisted fluoroscopic navi-gation to guide the percutaneous vertebroplasty to treat multiple osteoporotic spinal compression fractures. Methods Twenty-eight multiple osteoporotic spinal compression fractures patients with 73 painful vertebral body were got an-terio posterior,lateral and oblique radiographic imaging by using computer-assisted fluoroscopic navigation to imitate anterior- posterior. Lateral spinal and axial pedicle virtual image was obtained to guide the percutaneous kyphoplas-ty. Results All painful vertebral body were one-sided punctured,all percutaneous kyphoplasties were succeed by guiding with computer-assisted fluoroscopic navigation. Navigation virtual puncture needle image basically matched with reality view. PMMA dosage was 2.5 ～ 4 ml. Postioporational CT showed that the PMMA filled spinal focus very well. 11 cases completely relieved and 17 cases partially relieved. Conclusion Using improved computer-assisted fluoroscopic navigation to guide the PKP to treatment multiple osteoporotic spinal compression fractures decreases op-erative time and radiation injury. It is a safe,precise,minimally invasive method.

Objective To investigate the clinical efficacy of laparoscopic versus open omental patch repair for perforated peptic ulcer. Methods One hundred and twenty-seven patients who underwent omental patch repair for perforated peptic ulcer were analyzed retrospectively. There were 74 cases in the laparoscopic repair group (LR group) and 53 cases in the open repair group (OR group) respectively. Operative time, intraoperative blood loss,postoperative pain at 1 d and 3 d.time to first flatus and resumption of diet, time to drainage removal,surgical site infections (wound infection and intra-abdominal abscess),systemic complications and length of postoperative hospital stay were compared. Results LR group experienced less intraoperative blood loss[(32.7 ±25.6) ml], lower postoperative pain at 3 d[(2.8 ±1.5) scores], earlier time to first flatus [ (25.8 ± 20.1) h] and resumption of diet [ (2.7 ±2.1) d ], shorter time to drainage removal [(2.0±1.5) d], less wound infection (0) and shorter hospital stay[(4.8 ±2.3) d] than those in OR group [(53.2±30.0) ml, (36.9±27.9) h, (3.7±2.0) scores, (3.6±2.3) d,(2.9±2.2) d,9.4%(5/53), (6.6±4.0) d](P< 0.01 or <0.05). There were no significant differences in operative time,postoperative pain at 1 d, incidence of intra-abdominal abscess and systemic complications between the two groups. There were no suture-site leakage, reoperation and death in two groups. Conclusions Laparoscopic omental patch repair for perforated peptic ulcer is safe and efficacious. It has significant advantages over open approach with respects of less postoperative pain,earlier return of bowel function,less wound infection and shorter hospital stay.