[Objective]To observe the clinical results of a hollow compression nail applied to treat the separation of elements of neural arch.[Method]Since February,2003,sixteen cases of separation of elements of neural arch have been treated with a hollow compression nail and bone grafting .The mean age of the group was 32,from 18 to 54.Five cases of separation of elements of neural arch located at L4 and the other 11 at L5.All the patients suffered from severe back pain.During the operation,the presence of the pars interarticularis defect was confirmed.The defects were cleared of any fibrous and cartilaginous tissues.The sclerotic bone margins were curetted until bleeding was noted .Autograft harvested from posterior ilium was done.The hollow compression nail was placed onto the index vertebra.[Result]All the patients were followed-up for more than 14 months (14～26 months).The significant back pain relief was found in all the cases.The bony healing was comfirmed in 11 cases,and the other 5 were in the process of bone growth.[Conclusion]The separation of elements of neural arch can be treated by the hollow compression nail without spinal fusion.The hollow compression nail is proved to be safe and effective.

Objective To assess the inlfuence and safety of early atorvastatin sequential therapy in coronary heart disease (CHD) patients underdoing elective percutaneous coronary intervention on selected indicators of inflammation and serum lipids. Methods A total of 88 CHD patients who got ready to receive the elective percutaneous coronary intervention (PCI) were divided in two groups at random:The sequential dose group was called group A (atorvatatin 80mg as loading dose ,40 mg/d for 1 month after PCI and 20 mg/d subsequently, n=43), and the ordinary dose group was called group B ( atorvastatin 20 mg/d, n=45). During the follow-up, blood samples were taken at baseline, 3 days,1 month, 3 months and 6 months for myeloperoxidase (MPO), matrix metalloproteinase-9(MMP-9), serum lipids, serum alanine aminotransferase (ALT), glutamyl endopeptidase (GGT) and creatine kinase (CK) levels. Main adverse cardiac events and adverse effects were also analyzed. Results Compared with the baseline, the level of low-density lipoprotein-cholesterol (LDL-C) and total cholesterol (TC) was signiifcantly decreased in both two groups after treatment (P < 0.05). The LDL-C and TC in both groups were all decreased after treatment, and the degree of LDL-C and TC decreased at 3 days had signiifcant differences between the two groups (TC:26.6%vs. 14.0%;LDL-C:36.9%vs. 19.4%, both P<0.05). The degree of LDL-C decreased at 1 month between the two groups also had signiifcant differences (45.0%vs. 26.9%;P<0.05). The changes in LDL-C and TC level were also signiifcantly different between the two groups at 3 and 6 months (P<0.05). While TG and HDL-C remained unchanged. MMP-9 and MPO were both reduced post medication compared to pre-treatment levels (P<0.05). MPO was decreased signiifcantly in group A after treatment (F=18.455, P=0.000). And the same differences in group B were also signiifcant (P < 0.05). MPO post medication between the 2 groups were not significantly different (P > 0.05). Reduction in MMP-9 also showed signiifcant in both groups after treatment (group A:F=46.911, P=0.00;group B:F=19.156, P=0.00). The adverse effects had no signiifcant differences between the 2 groups (P>0.05). Conclusions The atorvastatin sequential theapy in CHD patients undergoing elective percutaneous coronary intervention could decrease serum lipids signiifcantly. Pretreatment with atorvastatin for patients undergoing PCI could inhibit inlfammation. The MACE and adverse effects were similar between the two groups.

BACKGROUND: Ilioinguinal approach and modified Stoppa approach are commonly used to treat pelvic and acetabular fractures, but which one is safer and more effective remains controversial, so a meta-analysis is necessary.OBJECTIVE: To compare the efficacy of modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures.METHODS: A computer-based retrieval of Cochrane library, PubMed, Embase, OVID, CNKI, WanFang, CBM and VIP databases was performed for the randomized controlled trials concerning modified Stoppa approach and ilioinguinal approach for pelvic and/or acetabular fractures published before October 2016. Meta-analysis was performed on RevMan5.3 software.RESULTS AND CONCLUSION: (1) Finally 11 randomized controlled trials were enrolled, including 722 patients. (2) Meta-analysis showed that the operation time, intraoperative blood loss, length of incision, volume of drainage and hospitalization time in the modified Stoppa approach group were significantly less than those in the ilioinguinal approach group (P < 0.05), and the clinical efficacy in the modified Stoppa approach group was significantly superior to that in the ilioinguinal approach group (P < 0.05). But there were no significant differences in Matta scores and postoperative complications between two groups (P > 0.05). (3) To conclude, modified Stoppa approach is safer and more effective for pelvic and/or acetabular fractures.

OBJECTIVE To analyze and compare the value of c-reactive protein(CRP) and body temperature in the infection diagnosis and severity of infection among the patients with malignant hematological disease.METHODS According to the microorganism detection and application of antibiotics,we divided the 119 patients into infection group and noninfection group from May 2004 to May 2005 in our ward.CRP and temperature of the patients were measured and.RESULTS There were 88 cases in the infection group and 31 cases in the noninfection group.The CRP plasma concentration had significant difference between too groups(P

OBJECTIVE:To observe the changes of heart type fatty binding protein (H-FABP) and brain natriuretic peptide (BNP)when carvedilol and bisoprolol in the treatment of elderly patients with chronic heart failure(CHF). METHODS:110 CHF patients were randomly assigned into carvedilol group and bisoprolol group (n=55). Carvedilol group was given carvedilol 3.125 mg,bid,doubling dose every 2 weeks to reach target dose 25mg or maximum tolerant dose;bisoprolol group was given bisoprolol 1.25 mg,qd,doubling dose every 2 weeks to reach target dose 10 mg or maximum tolerant dose. Treatment course lasted for 6 months. Clinical effective rate of 2 groups were observed after treatment. Echocardiography was used to measure the changes of LVEDD,LVEF,SBP and DBP before and after treatment. The plasma concentration of BNP and H-FABP were measured by radio-immunoassay. RESULTS:After treatment,total effective rate of carvedilol group(96.4%)was higher than that of bisoprolol group (89.2%),with statistical significance(P<0.05). Compared with before treatment,the levels of LVEDD,LVEF,BNP,H-FABP, SBP and DBP in 2 groups were all decreased significantly after treatment,with statistical significance (P<0.01 or P<0.05). CON-CLUSIONS:Both carvedilol and bisoprolol can significantly improve cardiac function,but carvedilol efficacy is more significant. At the same time,significant decrease of H-FABP before and after treatment indicate that H-FABP can be used as a reliable index of heart failure treatment effect.

Objective To explore the effects of single rectangle cage interbody fusion combined with pedicle screw fixa?tion for isthmic spondylolisthesis. Methods Data of the 34 cases with isthmic spondylolisthesis hospitalized at our department from March 2012 to February 2015 were retrospectively analyzed. All cases were operated by posterior pedicle screw fixation com?bined with single rectangle cage interbody fusion. There were 21 males and 13 females, aging from 18 to 63 years old (with an aver?age age of 41.6±8.2 years). Lesion segments were L4 in 15 cases and L5 in 19 cases;there were 12 cases in Meyerding I degree, 16 in II degree and 6 in III degree;28 patients had lower back pain associated with lower limb pain;19 patients had lower back pain associated with numbness of lower limb;18 patients had lower back pain associated with lower limb muscle weakness and 2 pa?tients had urination and defecation function disturbance. The surgical operation time, bleeding, postoperative drainage flow, graft fusion rate, complications were measured, and the intervertebral disc height, Japanese Orthopaedic Association (JOA), Oswestry disability indes (ODI), visual analogue scale (VAS) score were compared before and after treatment. Results The operation of 34 patients was successfully completed with the average operation time of 1.8 ± 0.8 h, and the bleeding in operation was 362.4 ± 93.7 ml, while postoperative drainage flow was 116.3±54.2 ml. All patients were effectively followed up for 12 months to 46 months (av?erage, one year and 10 months). Two weeks after operation, the intervertebral disc height were obviously increased (9.85±1.11 mm, 9.63 ± 1.04 mm), and there were significant difference compared with preoperative results (6.53 ± 0.98 mm, 6.24 ± 1.07 mm), but there were no significant difference compared with the latest follow?up results (9.23±1.33 mm, 9.30±1.16 mm). At the latest follow?up, JOA score was 13.19±1.08, ODI score 12.34±7.52, VAS score 2.23±1.51, and there were significantly different in each score compared with preoperative results. The symptoms of low back pain, lower limb nerve dysfunction and quality of life were signifi?cantly improved compared with preoperative situation. At the 16 month follow?up, all postoperative patients with vertebral body bone graft were judged to be fused. There was no pedicle screw loosening, fracture and so on. Conclusion Single rectangle cage interbody fusion combined with pedicle screw fixation for the treatment of isthmic spondylolisthesis is a kind of mini?invasive, less bleeding, safe and effective surgical method.

Objective To investigate the influence of preemptive analgesia with Hydr- omorphone Hy-drochloride on postoperative cognitive function and inflammation cytokines in the elderly patients. Methods Ninety ASA I orⅡ elder patients were randomly divided in control group (C)and Hydromorphone Hydrochloride group(H) with 45 cases each. Hydromorphone Hydrochloride 2 mg was injected iv before induction of anesthesia in group H. Observed plasma concentrations of the CRP、 TNF-α and IL-6 at different time. Cognitive function was assessed by minimental state examination. Results Plasma the CRP、 TNF-a and IL-6 concentrations were lower and MMSE scales were higher in group H than in group C. Conclusion Preemptive analgesia with Hy-dromorphone Hydrochloride 2 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.

Objective To evaluate imaging features and clinical significance of anatomical variations of the dorsal pancreas.Methods CT and MR imaging data of 47 cases with variations of the dorsal pancreas were collected.Imaging characteristics of the dorsal pancreas were analysed.Results (1) Narrow dorsal pancreas:the agenesis of dorsal pancreas (7 cases) appeared as short pancreas,their length was (91.59 ± 22.39) mm.4 cases of pancreatic head volume increased,with tadpole-like retention of the pancreas,including 3 cases of annular pancreas.2 cases with polysplenia syndrome and congenital abscence of the hepatic segment of inferior vena cava.(2) Abnormaly enlarged dorsal pancreas:①the broadening of the pancreatic tail (n =18):the maximum diameter of pancreatic tail was (36.12 ± 6.59) mm,the pancreas was similar to the dumbbell-shaped.②Processes locally of pancreatic contour (n =13),which were local process at the ventral aspect of pancreas,the height was (15.72 ±2.65) mm,the width was (18.59 ± 3.64) mm,most often seen on the neck of the pancreas.(3) Dorsal pancreas related divisium:①Pancreas separated by fat spatium (n =7),the width was (3.51 ± 2.42),the deepness was (19.45 ± 5.84),it showed the crack-like fat density (signal) shadow,5 cases (5/7) located in the pancreatic body and tail,2 cases (2/7) located at the junction of ventral pancreas and dorsal pancreas.②The bifurcation of the pancereatic tail (n =3),limitations forked tail of the pancreas was dovetail-like performance.The maximum width diameter was (26.63 ± 1.75) mm,the bifurcation angle was (99.27 ± 30.73) degrees.Conclusions The developmental anomalies of dorsal pancreas can lead to a number of variations of pancreas,some of which can induce corresponding disease and be mistaken for neoplasm.

Objective To explore the effects of ureteral stent on renal pelvic pressure and other urodynamic parameters. Methods Forty-one patients, 28 males and 13 females, with unilateral renal calculi and/or ureteral calculi were recruited in this study. The mean patient age was 47 years old (ranging from 20 to 72 years old). All cases were placed a 4.7 F ureteral stent and 16 F nephrostomy tube after minimal invasive pereutaneona nephrolithotomy (MPCNL). There was no hydronephrosis and residual crushed stone in the ureter after MPCNL in all cases. Renal pelvic pressure, intra-abdo minal pressure, detrusor pressure, bladder pressure changes during the filling and voiding phases with intravesical perfusion flow rate of 40 ml/min were recorded and analyzed. Results At the baseline, IPP0, IAP0, DP0 and BP0 were (33.1±17.0)cm H2O, (27.5±7.0)cm H2O, (3.3±2.9)cm H2O and (30. 9±7.2)cm H2O, respectively; At the maximum cystometric capacity during the filling phase, IPPvol, IAPvol Dpvol and Bpvol were (39.4±67. 3)cm H2O, (31.1±7.3)cm H2O, (10.7±6. 6) cm H2O and (41.6±10.3)cm H2O, respectively; At the maximum bladder pressure during the voiding phase, IPPmax, IAPmax Dpmax and Bpmax were (65.7±17.0)cm H2O, (33.7±9. 7)cm H2O, (41.9±7.8)cm H2O and (75.0±12. 8)cm H2O, respectively;There were statistical significance comparing between any of IPP0, IPPvol and IPPmax(P<0. 01). 27% (11/41)patients were with the pain in kidney area at voiding IPPmax (87.1±14.6) cm H2O, which was significantly higher than IPPmax (57.8±9.5)cm H2O of asyrnptomatic group (30 patients)(P<0. 01). In all cases, the renal pelvic pressure was higher than 40 cm H2O during the voiding phase. Conclusions Renal pelvic pressure increases during the filling phase after placing the ureteral stent, especially during the voiding phase. As renal function will be damaged by the high renal pelvic pressure, we should decrease the utilization of ureteral stent if possible. It is encouraged to remove the ureteral stent as early as possible.

Objective To investigate the evolution of surgical treatment and it's influence on prognosis in reptured liver cystic echinococcosis.Method Clinical data of 110 surgically treated cases of reptured liver cystic echinococcosis from January 1990 to December 2008 were retrospectively analysed,and these cases were divided into three groups by different surgical approach;Group A(22 cases):removal of internal capsule,with formaldehyde or hydrogen peroxide regional anthelminthic,with residual cavity side edge of lock stitching or greater omentum filling or drainage after residual cavity closure;Group B (65 cases):Removal of intemal capsule,with hypertonic saline regional anthelminthic,with external capsule extrahepatic partial resection,with residual cavity bile leakage sutured,and with residual cavity open drainage,Group C(23 cases):the total or subtotal external capsule stripping operation,with hypertonic saline regional anthelminthic and drainage.Result The rate of overall postoperative complications of residual cavity was 40.9%、16.9%、0.0%(P<0.05)respectively and the recurrence rate was 18.2%、4.6%、0.0%(P<0.05)respectively;drainage time needed was the longest in group A,and shortest in group C,whereas the operation time was the longest in group C and it costed higher blood loss.Intraabdominal implantation of the hydatid significantly decreased with hypertonic saline treatment.Conclusion Total or near total removal of the external capsule of the hydatic cyst and hypertonic saline treatment with postoperative external drainage is the therapy of choice for reptured liver cystic echinococcosis.