[Objective] To investigate the stability and function of atlantoaxial segment after atlas odontoid process artificial joint replacement.[Method]Ten fresh adult human head and neck specimens were chosen for biomechanical models.The range of motion(ROM),neutral zone(NZ)and stiffness under intact state,post-decompression,post-replacement surgery and post-fatigue were measured respectively.[Result]After decompression,ROM,NZ and stiffness in flexion,extension,right and left lateral bending,and right and left axial rotation increased significantly(P0.05)than that in intact state group.[Conclusion]Artificial atlantoaxial joint in this study has been proved to have biomechanical significance in morphology and dynamic.It has advantages of stable replacement,simple operation,less injury and low wear characteristics.It provides a new choice for the atlantoaxial fusion of anterior or posterior approach.

[Objective]To determine the initial stability and function of a new artificial joint in a cadaveric cervical spine model by comparing it with a conventional method. [Methods]Twelve fresh human cadaveric cervical spines(C0~3) were randomly divided into 2 groups: group 1,resection of the odontoid with artificial atlanto-odontoid joint(AAOJ),and group 2,resection of the odontoid with Magerl atlas and axis by transarticular screw fixation(Magerl).For each specimen,the intact and resection of the odontoid underwent a flexibility test firstly,followed by the instrumented construct.Rotational angles of the C0~3 segment were measured to study the immediate stability and function of resection of the odontoid and AAOJ,compared with the intact and resection of the odontoid and Magerl.[Results]Compared to the intact state,resection of the odontoid and AAOJ resulted in a significant decrease in the range of motion(ROM) and neutral zone(NZ) during flexion,extension,and lateral bending(P0.05).Compared to the intact state,resection of the odontoid and Magerl resulted in a significant decrease in the range of motion(ROM) and neutral zone(NZ) during all 6 degrees of freedom(P0.05).[Conclusion]A new type of artificial atlanto-odontoid joint has been designed for correcting atlantoaxial instability resulted from C1、2 anterior decompression procedures.It can restore,to a great extent,the C1、2 axial rotation that is lost during current stabilization procedures.

Objective To evaluate the efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal and upper ureteral stones . Methods A total of 97 patients with renal and upper ureteral stones were treated with modular flexible ureteroscopy combined with holmium laser lithotripsy in our hospital from October 2012 to February 2016.Under general anesthesia (90 cases) or epidural anesthesia (7 cases), a flexible ureteroscope was used to find renal or ureteral calculus and holmium laser lithotripsy was applied at a maximum energy of 1.2-1.6 J/10 -12 Hz (12-20 W).F6 or F7 double-J stents and catheters were routinely placed postoperatively .B-ultrasonography , KUB or CT were performed to evaluate the stone free rate 4 weeks after operation . Results Two patients suffered ureteral perforation due to stenosis and tortuosity of the ureter , and were given double-J stent placement under rigid ureteroscopy for 2 weeks and then flexible ureteroscopic treatment .Six patients underwent staged operations because of ureteral strictures .The operations were successful in the remaining 89 patients.Except for unsuccessful exploration in 3 cases of lower calyx calculi , the operation time of other 94 patients was 30-190 min (mean, 100 min).The stone detection rate was 96.9%(94/97), and the stone free rate was 88.6% (86/97).The stone free rates were 100.0% (25/25) for upper and middle calyx calculi, 75.0%(9/12) for lower calyx calculi, and 85.1% (23/27) for pelvis and multiple calyx calculi. Ureteral perforation was encountered in 2 cases.No massive hemorrhage occurred .Postoperative high fever was seen in 5 cases, with a body temperature of 38.5-39.3℃, which were cured after anti-infection treatment for 2 -7 d.The patients were discharged from hospital in 2-7 days (mean, 3.3 days) after operation.Review with B-ultrasonography, KUB or CT at 4 weeks after operation found 5 cases of residual stones >4 mm, including 3 cases located in lower calyx and 2 cases in multiple calyx . Conclusion Modular flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe for the treatment of renal calculi .

Objective To investigate the incidence and the risk factors of anxiety or depression and in the first degree relatives (FDRs) of patients with type 2 diabetes mellitus ( T2DM ). Methods A total of 102 T2DM patients who visited our hospital from May to July 2010 and their FDRs completed SAS,SDS,and life satisfaction evaluation. The medical history of T2DM patients was collected and compared with their FDRs with or without mental disorders. The correlations of risk factors with anxiety or depression were analyzed, t test or X2 test were used for statistical analysis and a P value less than 0. 05 was considered statistically significant. Results The incidence of anxiety or depression of FDRs was 31.4% and 17.6%,respectively. The life satisfaction score of FDRs with mental disorders was significantly decreased ( t = 4. 26 and 4. 09, P＜0. 05 ). Fasting glucose level of T2DM patients with anxious or depressive FDRs was significantly increased ( t = -2. 48 and -2. 15, P＜0. 05 ). Higher medical cost and multiple treatment strategies were positively correlated with SAS and SDS score of the FDRs. Conclusion Higher incidence of mental disorders and lower satisfaction scores could be found in the FDRs of T2DM patients. Better control of blood glucose and reduced treatment cost and strategies may be useful in improving metal condition and life satisfaction of the FDRs of T2DM patients.

BACKGROUND:Open reduction and plate internal fixation has become a major repair and treatment method for clavicle fracture, however, this method often causes postoperative local skin numbness and hypoesthesia. Currently, there was stil controversial about the effect of internal fixation on the free protection of supraclavicular nerve. OBJECTIVE:To investigate the clinical significance of supraclavicular nerve dissection and protection on open reduction and plate internal fixation of clavicle fracture. METHODS:Total y 57 patients with the middle third of the clavicle fracture were randomly divided into control group (n=34) and nerve protection group (n=23). Patients in these two groups al underwent plate internal fixation treatment. Patients in the nerve protection group underwent precious identifications and dissections of supraclavicular nerve when approaches were being done, careful y protections in the process of internal fixation. The incidence of local numbness, numbness severity, size, degree of influence on life, the improvement of the degree of numbness and pain were compared during the telephone fol ow-up after 1 year of surgery. RESULTS AND CONCLUSION:Total y 17 patients were fol owed up in each group. At the time of most serious symptom, 100%of al patients appeared local numbness in the control group, while 16 (94%) patients affected numbness in the nerve protection group. Until the latest fol ow-up, the number of patients with mild numbness symptoms decreased to 7 (41%) in control group and 3 (18%) in the nerve protection group, but there was no significant difference between the two groups (P>0.05). The severity of numbness and the degree of influence on daily life al improved over time. These results suggest that local skin numbness is a higher incidence of complications after the internal fixation for clavicle fracture. The protection of the supraclavicular nerve may help the improvement of the long-term numbness symptoms, but not as good as expected.

The clinical and pathological data of 6 patients with urahcal adenocar,cinoma of the bladder admitted in Beijing Luhe Hospital from 1996 to 2016 were analyzed and relevant literature was reviewed.Urachal carcinoma accounted for 0.66% of the bladder cancers admitted at the same period (6/906) and 6/16 of the bladder adenocarcinomas.Painless hematuria was the most common symptom.One patient had extensive metastasis as shown in biopsy and died 6 month after the diagnosis.Two patients underwent partial excision of bladder with no tumor recurrence.One patient underwent partial cystectomy followed by chemotherapy and radiotherapy, recurrence occurred one year later and he then received radical cystectomy.Another 2 patients underwent laparoscopic cystectomy and en bloc resection of umbilical ligament and umbilicus, and no recurrence was found in the follow-up for 6 years and 15 months, respectively.Pathological and immunohistochemistry are essential for the diagnosis of urachal adenocarcinoma.As it is not sensitive to radiotherapy or chemotherapy,surgery is the preferred treatment for patients with early stage diseases.Individual anticancer therapy may be the trend of treatment.

Hearts from eight adult dogs were perfused through both coronary arteries with methylmethacrylate. Small specimens cut out from the left ventricular wall were eroded in 50% HCL for 5-7 days. The replicas were studied under the SEM (S-450). The main results were outlined as follows: The subendocardial capillary plexus composed of varied shapes and orientation of meshes was present. The capillary network of the myocardial layers was consisted of many parallel capillaries and between them a variety of models of anastomoses, such as "H" "K" and "8" modes etc, were observed. In our findings, it was demonstrated that the arteriole and venule were distributed between the myocardial bundles and their direction was often perpendicular to the myocardial bundles. The postcapillary venules were poured into venule by the "ginger or turnip root" arrangement. The replicas of the Thebesian veins were proved in our specimens. The A-V shunting was not observed.

Three fresh kidneys removed from three adult bodies were perfused through the renal artery with 5％ and 10％ ABS (a copolymer of allylcyanide, butadiene and styrolene). Small specimens removed from the kidney were digested in 50％ HCI. Cast replicas of renal arteries and their branches were taken and examined with SEM (S-450 or S-520). The results were as follows.The capillary network of the area of the polar cushion cell were observed at the hilum of glomerulus in our casts. Their appearances are triangular, tetragonal or comma-like. In general, the shape of the meshes of the capillary network was round, oval, triangular or tetragonal. The diameters of the meshes were smaller than that of the vessels themselves. The microvessels of the area of the polar cushion cell, which mainly originated from the afferent arteriole, were continuous with the capillary of the glomerulus. The afferent arteriole was often traveled in the central part of the area of the polar cushion cell. The function of the microvessels of the area of the polar cushion cell was discussed in this article.

Objective To compare the early result of endovascular repair and conventional open repair for abdominal aortic aneurysm. Methods We analyzed the clinical data of 34 patients with infrarenal AAA. Among them, 15 patients were treated with endovascular repair ( EVR group), 19 with conventional open repair ( COR group). Pre-operative status, intra-operative variables, post-operative outcomes and laboratory findings of the two groups were compared. Results Blood loss and blood transfusion in EVR group were significantly less than COR group (P =0.005, P =0.015). The median fasting period and post-operative hospital stay were shorter in EVR group (P

The vascular architecture of the adult man testis was examined by using thevascular casting method combined with scanning electron microscopy.The circuitousmain branches of testicular artery ran radially from testicular porta towards testicu-lar free border in tunica vasculosa.The test(?)cular surface veins were accompaniedby the main branches of testicular artery and they converged from testicular circum-ference circuitously towards testicular porta.There were centripetal artery andvein as well as centrifugal artery and vein in the septula testis.The intertubularblood vessels and the peritubular capillary plexus were contained in the testicularlobules.The latter was made up of two capillary layers.The outer layer was capil-lary network interwined in fine capillaries.The inner layer was coarse capillarycircles.The interstitial capillary plexus was situated in interstitial tissue between theseminiferous tubules and compose of capillaries arising from the origin of someperitubular capillaries.