, but the amount decreased significantly. Conclusions Peri-operative nursing can promote the recovery of patients with pelvic floor hernia, rectal prolapse combined with colonic slow transit constipation.

OBJECTIVETo investigate the feasibility of posterior fixation with 3.5-mm pedicle screws in the atlantoaxial vertebrae of children.

METHODSIn this study, atlantoaxial vertebrae specimens were obtained from 10 cadavers of children aged 6-8 years. We measured the height and width of the C(1) pedicle and the midportion of C(1) lateral mass; the width of C(1) posterior arch under the vertebral artery groove and the height of the external and internal one-third of this part; the external, internal height and the superior, middle, inferior width of the C(2) pedicle (transverse foramen). Furthermore, computed tomography (CT) axial scan was performed on 20 age-matched volunteers to obtain relative data of their atlantoaxial vertebrae. We measured the length and width of the C(1) and C(2) pedicles in the atlantoaxial cross-sectional plane. On CT workstation, we also measured the angles between the longitudinal axes of the atlantoaxial pedicles and the midsagittal plane.

RESULTSFor the cadaveric specimen group, the height and width of the C1 pedicle were (5.26+/-0.44) mm and (6.26+/-0.75) mm respectively. The height of the medial one-third of the C1 posterior arch under the vertebral artery groove was (4.07+/-0.24) mm. The external, internal height and superior, middle, inferior width of the C2 pedicle was (6.86+/-0.48) mm, (6.67+/-0.49) mm, (6.63+/-0.61) mm, (5.41+/-0.39) mm and (3.71+/-0.30) mm, respectively. For the volunteer group measured by CT scan, the height and width of the C(1) pedicle were (5.47+/-0.34) mm and (6.63+/-0.54) mm respectively, while (6.59+/-0.51) mm and (5.13+/-0.42) mm of the C2 pedicle. The angles between the atlas, axis pedicles and the midsagittal plane were (9.60+/-1.32) degree and (27.80+/-2.22) degree respectively.

CONCLUSIONIt is feasible to place a 3.5-mm pedicle screw in the C(1) and C(2) pedicles of children aged 6-8 years old.

Axis, Cervical Vertebra ; anatomy & histology ; diagnostic imaging ; surgery ; Bone Screws ; Cervical Atlas ; anatomy & histology ; diagnostic imaging ; surgery ; Child ; Humans ; Radiography

Objective To evaluate the acute and delayed killing effect of high intensity focused ultrasound (HIFU) on Echinococcus granulosus(E. granulosus)protoscolices in vitro.Methods E. granulosus protoscolices were treated with different dosage of effective power(0,25,50,100,200,250 W)and time(5,10,20,30,40,50,60 s)of HIFU in vitro to obtain the dosage-effect curves.Then the survival pmtoscolices were incubated,and the mortality of each group was counted daily.The protoscolicidal effects were investigated by trypan blue exclusion assay.Results Compared with the untreated group,the Vitality of E.granulosus protoscolices significantly decreased immediately after treated by HIFU of different dosage(F=5201.59 vs 1865.65,P＜0.05),there were the interaction both different dosage and time(F=214.50,P＜0.05).The protoscolices were broken into pieces by HIFU of 250 W×40 s,whereas the growth of the surviving protoscolices after exposed to HIFU was obvious suppressed.Both the acute killing effect and the delayed inhibitory effect showed a dosage-dependant manner.The inhibitory effect increased along with the increased dosage of HIFU(P＜0.05).The inhibitory effect in 50 W×10 s group was stronger than 25 W×20 s group(P＜0.05).The mortality was increased in parallel with the increase of HIFU dosage.Conclusions HIFU show an effective immediately killing effect,as well as a growth-inhibiting effect on the E.granulosus protoscolices in vitro.

OBJECTIVETo find out a possible approach to improve the effectiveness of radiotherapy and chemotherapy for Ewing's sarcoma by constructing a eukaryotic expression vector expressing herpes simplex virus-thymidine kinase (HSV-TK) regulated by hypoxia responsive element (HRE) under hypoxia and to evaluate the effects of this HRE regulated HSV-TK system on killing effect of gancyclovir (GCV) on Ewing's sarcoma cell line SK-ES under hypoxic condition.

METHODSThe HRE was synthesized according to the literature and cloned into the enhancer site of pIRES(2)-EGFP vector to obtain the pHRE recombinant plasmid. The HSV-TK was amplified by PCR and cloned into the multiple clone site of pIRES(2)-EGFP and pHRE to obtain pTK and pHRE-TK recombinant plasmid. The human Ewing's sarcoma cell line SK-ES was transfected by pTK or pHRE-TK recombinant plasmid with liposome and then was exposed to normoxic (21% oxygen) or hypoxic (3% oxygen) condition. The expression of enhanced green fluorescent protein (EGFP) was monitored by fluorescent microscopy. The sensitivity of human Ewing's sarcoma cell line SK-ES transfected with pTK or pHRE-TK recombinant plasmid to the anti-tumour drug GCV was determined with the method of tetrazolium (MTT) after treating with GCV for five days.

RESULTS(1) The result of sequencing showed that the recombinant plasmid pHRE contained HRE, and that the recombinant plasmid pTK and pHRE-TK contained HSV-TK gene in the sense direction. (2) Comparison of fluorescent optical density (FOD) showed that (1) the EGFP FOD value of pHRE and pHRE-TK group cells exposed to hypoxia was significantly higher than those exposed to normoxia (P < 0.01); (2) when the cells were exposed to hypoxia, the EGFP FOD value of pHRE and pHRE-TK group cells was significantly higher than that of pTK and empty vector group (P < 0.01); (3) there was no significant difference among the four groups of cells when they were exposed to normoxia (P > 0.05). (3) Comparison of the sensitivity of four groups of cells to GCV showed that (1) the cells in pHRE-TK and pTK groups were much more sensitive to GCV than the cells in pHRE group under hypoxia condition (P < 0.01), the higher the GCV concentration, the greater the difference; (2) the cells of pHRE-TK group were more sensitive to GCV than those in pTK group under hypoxic condition (P < 0.01), but was almost equally sensitive under normoxic condition (P > 0.05); (3) the pHRE-TK group cells had higher sensitivity to GCV under hypoxia than normoxia (P < 0.01) while the pTK group cells had almost the same sensitivity to GCV under hypoxia and normoxia (P > 0.05).

CONCLUSION(1) The eukaryotic expression vector expressing herpes simplex virus-thymidine kinase (HSV-TK) regulated by hypoxia responsive element (HRE) under hypoxia was constructed successfully. (2) HRE could up-regulate expression of EGFP by SK-ES cells under hypoxia condition. (3) HRE could enhance the killing effect of HSV-TK/GCV system on human Ewing's sarcoma cell line SK-ES under hypoxic condition.

Antiviral Agents ; pharmacology ; Cell Hypoxia ; drug effects ; genetics ; Cell Line, Tumor ; Ganciclovir ; pharmacology ; Gene Expression Regulation ; drug effects ; Genetic Vectors ; Green Fluorescent Proteins ; metabolism ; Humans ; Microscopy, Fluorescence ; Plasmids ; Polymerase Chain Reaction ; Response Elements ; genetics ; Sarcoma, Ewing ; drug therapy ; metabolism ; Simplexvirus ; genetics ; metabolism ; Thymidine Kinase ; genetics ; metabolism ; Transfection

OBJECTIVETo discuss the mechanism, clinical characteristics, diagnosis and treatment of thoracolumbar Chance fractures.

METHODSAmong all the 21 patients, 13 patients were male and 8 patients were female, ranging in age from 23 to 57 years, with an average of 32 years. The injury was at the level of T11 in 3 patients, at the level of T12 in 9 patients, at the level of L1 in 8 patients and at the level of L2 in 1 patient. According to Denis classification, 10 patients were type A, 2 type B, 5 type C, and 4 type D. All the patients were treated with pedicle screw internal fixation and posterior lateral fusion at the level of injury.

RESULTSTwenty-one patients had been followed up for an average of 18 months (13 to 28 months). According to ASIA neurologic grading system, 4 cases in grade C or D recovered to grade E postoperatively and one case in grade B was not improved. Postoperative X-ray showed good reduction and fixation in all cases and no looseness or breakage in the fixation system. The results of postoperative back pain and function assessment were mostly satisfactory.

CONCLUSIONThoracolumbar Chance fractures are due to flexion-distraction injuries and regarded as unstable, which are uncommon and usually not present with a neurologic deficit. Reduction and stabilization with posterior pedicle screw internal fixation is suggested in patients with thoracolumbar Chance fractures.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries

Adult ; Clavicle ; injuries ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

OBJECTIVETo assess the efficacy and safety of carotid ligation in the treatment of the carotid artery rupture(CAR).

METHODSA series of 30 patients who had CAR treated with carotid ligation were reviewed. There were 24 males and 6 females ranging in age from 32 to 76 years, with a mean of 53.9 years. The original sites of tumours were hypopharynx (n = 11), larynx (n = 5), thyroid (n = 6) and others (n = 8). Of the 30 patients, 24 patients had received radiotherapy from 40 - 126 Gy and 10 patients underwent one or more surgical treatments. CAR in all cases occurred after surgical operation. CAR occurred in 5 - 21 days after operation.

RESULTSBy pressing the carotid and keeping breathe of the patients immediately after CAR, 25 patients were conscious, 2 patients in coma, and 3 patients died before carotid ligation. Seven cases were applied with carotid ligation, 3 cases with the combined ligation of carotid and brachiocephalic arteries, and 17 cases with carotid ligation plus the repair by pectoralis major myocutaneous flap. The causes of CAR concluded fistula, wound dehiscence, wound infection and transferred flap necrosis. The mende hemorrhage occurred in 14 patients. Of 25 cases with the treatments of carotid ligation, 22 patients survived with no complication, 1 with brief muscle weakness and 2 with unconscious. Clinical follow-up period lasted more than 5 years at least in 6 patients.

CONCLUSIONSCAR is the most dangerous complication in advanced carcinoma of the head and neck. The prompt hemostasis and carotid ligation are effective methods to rescue patients of CAR. It is important to keep patients conscious before carotid ligation surgery, with low rates of death and hemiplegia postoperatively.

Adult ; Aged ; Carotid Artery Diseases ; etiology ; therapy ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Ligation ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; therapy ; Rupture

OBJECTIVETo evaluate long-term outcomes of minor liver resection for hilar cholangiocarcinoma (HC) of Bismuth-Corlette type III.

METHODSFrom January 1997 to December 2007, the clinical data of 91 patients with Bismuth-Corlette type III HC underwent hepatectomy were collected and analyzed retrospectively.

RESULTSThere were 60 patients underwent minor hepatectomy, and 31 undergoing major hepatectomy. Hepaticojejunostomy was made conventionally in an end-to-side fashion in the patients undergoing major liver resection, and a new technique of hepaticojejunostomy used in the patients undergoing minor liver resection. That was the anterior edges of bile duct stumps which were not sutured after suturing of posterior edges. Instead of, the anterior edge of jejunum loop to the remnant liver on the top of the bile duct stumps were sutured with intermittent "U" sutures. In all patients, in-hospital mortality rate was 0 and rate of bile leakage was only 2.1%. The actual 1-, 3- and 5-year survival rates were 91.6% and 87.0%, 61.6% and 62.0%, 31.6% and 33.0%, respectively (P > 0.05).

CONCLUSIONSMinor liver resection for the selected patients with HC of Bismuth-Corlette type III according to our criteria achieved better long-term outcomes. A new hepaticojejunostomy used in the patients undergoing minor liver resection is a safe and effective method.

Adult ; Aged ; Bile Duct Neoplasms ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo study the low back pain(LBP) and its cause on female workers in flat-grained veneer wood industry.

METHODSBending posture was analyzed by observation and the prevalence of low back pain was investigated by physical examination and questionnaire among 299 female workers.

RESULTSThe prevalence of fatigue compliant in selecting, remending and sticking workers was 68.8%, 66.7% and 59.0%, respectively, which mainly involved in the part of low back. The prevalence of low back pain in selection (53.8%) and remending (58.7%) workers was higher than that in sticking workers (30.1%), which was in accordance with the tenderness between L4/L5 or L5/L6 and on the psoas major. Posture analysis indicated that the biggest bending range of selecting and remending workers (80 degrees ) was larger than that of sticking workers (60 degrees ), as well as the daily bending times[(4396+/-817), (1696+/-286), (1094+/-476)] and the time they kept bending[(6.5+/-0.6), (6.2+/-1.3), 4.5+/-0.9) h].

CONCLUSIONBending posture is common among female workers especially those who work in selecting and remending and might be the major causes for the high prevalence of LBP in flat-grained veneer wood industry.

Adult ; Female ; Humans ; Low Back Pain ; epidemiology ; etiology ; Occupational Diseases ; epidemiology ; etiology ; Posture ; Prevalence ; Risk Factors ; Surveys and Questionnaires ; Wood

OBJECTIVETo explore the clinical significance of multiple radiography of the pelvis in the evaluation of surgical outcomes for patients with slow transit constipation complicated with outlet obstruction.

METHODSPatients with slow transit constipation complicated with outlet obstruction were diagnosed by multiple radiography of the pelvis after screening using colon transit study. Surgery was performed according to the cause of the obstruction. Anorectal angle and the locations of perineum, pelvic peritoneum, and bladder were assessed by multiple radiography of the pelvis one month after surgery. The changes in locations of pelvic organs were assessed and the imaging appearance after the release of obstruction was observed.

RESULTSA total of 48 patients were included. Rectocele repair, partial mucosectomy with rectopexy, and hysteropexy were performed. All the patients were followed up with a mean length of 19(6-58) months. Excluding 2 patients who had no symptomatic improvement, the mean bowel movements was 1.9 times per day in the remaining 46 patients(95.8%). Preoperative anorectal angle at the squeezing phase was(128.09±13.82) degree and the difference between squeezing and resting phase was (11.14±12.58) degree, while the postoperative angle was (180.26±9.98) degree and the difference(20.01±13.11) degree(P<0.05). Preoperative location of the perineum at the squeezing phase was(-2.05±0.83) cm and the difference was(2.23±0.78) cm, while postoperative location was (-0.50±1.13) cm and the difference was (2.18±1.04) cm(P<0.05). Preoperative location of the pelvic peritoneum at the squeezing phase was(4.91±1.32) cm and the difference was (1.32±0.89) cm, while postoperative location was (2.62±2.53) cm and the difference was (3.28±0.68) cm (P<0.05). Preoperative bladder location at the squeezing phase in patients with urological symptoms was (3.92±2.51) cm and the difference was(1.39±1.27) cm, while postoperative location was (2.15±1.55) cm and the difference was (1.98±1.54) cm(P<0.05).

CONCLUSIONMultiple imaging of the pelvis provides objective evidence in the evaluation of surgical outcomes for patients with chronic slow transit constipation complicated with outlet obstruction.

Adult ; Aged ; Constipation ; complications ; diagnosis ; surgery ; Diagnostic Techniques, Digestive System ; Female ; Humans ; Intestinal Obstruction ; complications ; diagnosis ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Young Adult