[Objective]To evaluate the clinical value of surgical treatment of multiple thoracolumbar spinal fractures by pedicle screw/rod Instrumentation system.[Method]Ninteen cases of male 14 and femal 5 of multiple injuries involving thoracic and lumbar spine were surgically treated through anterior approach by open reduction,selective vertebral canal decompression,internal fixation with pedicle screw/Rod spine instrumentation,and followed by anterior lateral bone graft fusion according to complex classification system 19 cases,Ba.m1T_(11) 1 cases,Ba.m.p2T_(11) 2 cases,Ba.m1T_(12) 1 cases,Ba.m.p2T_(12) 1cases,Ba.m.p3T_(12) 1cases,Ba.m1_L 4 cases,Ba.m.p2L_1 3cases,Fa.m.p3(T_(12),L_1) 2cases,Sa.m.p3L_2 1cases,Ba.m.p1L_2 1 cases.[Result]All cases were followed up form 6 to 15 months averageing 10.5 months.No implant failure and late kyphosis deformity was observed.The average vertebra height was improved from preoperative 48.14% to postoperative 92.14%.The postoperative neurological function in two cases of complete spina lcord injuries and 11 incomplete spina lcord injuries were improved according to JOA criterion.Astable bone fusion according to radiological criteria was achieved in call cases postoperatively,and progressive compression did not occur.[Conclusion]Pedicle screw/rod instrumentation system can achieve effective reduction for the fractured vertebrae and simultaneously restore spine stability on the basis of adequate vertebral canal decompression.Posterior spine instrumentation is an ideal choice for surgical treatment of thoracolumbar unstable fractures with or without spinal cord dysfunction.

Objective To evaluate the benefit of three dimensional (3D) reconstruction images with rotational digital subtraction technique for the clinical applications Methods Conventional two dimensional digital substraction angiography ( 2D DSA ) was obtained on A P and lateral view. Three dimensional digital subtraction angiography ( 3D DSA ) images were obtained by reconstruction of a rotational acquisition on a C arm (LCV+, GE Medical Systems) spinning at 40 degrees per second 53 cases of cerebral angiographies were performed (32 men and 21 women; the age ranged from 19 to 72 years, mean 46 3 years) Results In this series of 53 cases of cerebral angiographies, 5 cases of arteriovenous malformation were all correctly diagnosed by 3D DSA and 2D DSA . Seven cases were misdiagnosed as intracranial aneurysms at conventional 2D DSA but confirmed to be kinking of the vessel by 3D DSA . 41 cases were confirmed to be intracranial aneurysms Of the 41 cases, 5 cases were diagnosed as normal at 2D DSA but confirmed to be intracranial aneurysms at 3D DSA . The total consistency rate of 3D DSA and 2D DSA for the diagnosis of intracranial aneurysm is 77 4% (41/53) The consistent test shows that there was consistency between the two modalities (chi square test, ? 2=5 267, P

Objective To analyse the clinical value of bronchial artery embolization in treatment of massive hemoptysis.Methods 87 patients with hemoptysis included bronchiectasis in 46 cases,pulmonary tuberculaosis in 18 cases,bronchial carcinoma in 15 cases,bronchial arteriovenous malformation in 2 cases and unknown hemoptysis in 6 cases underwent embolized treatment of bronchial arteriography or intercostal arteriography.Of them,bronchial artery embolization were performed in 78 cases,intercostal artery embolization were done in 6 cases,both embolization of bronchial artery and intercostal artery were in 3 cases,2 cases underwent superselective embolization with coaxial microcatheter.In the total 87 cases,gelatin sponge particles(GSP) alone was used in 85 cases,GSP and polyvinyl alcohol(PVA) were used in 2 cases.All the patients were followed up for 12~18 months.Results The hemoptysis was immediately stopped in 58 cases, remarkable improvement were 19 cases after operation. Recurrence of hemoptysis was found in five, three and two cases at one, two and four weeks respectively after embolization. All of the ten recurred cases accepted re-embolization and hemoptysis had been well controlled. The effective rate was 89%(77/87). There was not any severe complication in all the patients.Conclusion Bronchial artery embolization is a safe, effective and less invasive method in treatment of massive hemoptysis. It can be recommended to the non-surgical treatment patients.

Objective To evaluate the effect of unipolar versus bipolar hemiarthroplasty for treatment of femoral neck fracture in the elderly Methods Related randomized controlled trials (RCTs) and quasi-randomized controlled trials (qRCTs) were searched from computerized databases MEDLINE,EMBASE,Cochrane Library,and CBM disc.Additional studies were identified through hand searches of 10 domestic journals.Time period of the search was from 1966 to June 2012.RevMan 4.2.8 software was used for data analysis.Results A total of 7 RCTs and 3 qRCTs were included.In this meta analysis,bipolar hemiarthroplasty was associated with better hip function compared with unipolar hemiarthroplasty at postoperative 6 months (RR =0.74,95％ CI0.62-0.88,P ＜ 0.01).However,the two procedures revealed no significant differences in terms of postoperative one-year dislocation rate (RR =1.01,95％ CI0.54-1.89,P ＞ 0.05),reoperation rate (RR =1.13,95％ CI 0.74-1.72,P ＞ 0.05),major complication incidence (except for dislocation) (RR =1.27,95％ CI 0.74-2.18,P ＞ 0.05),and postoperative 2-year mortality (RR1.16,95％ CI 0.73-1.87,P ＞ 0.05).Conclusion Bipolar hemiarthroplasty is preferable to unipolar hemiarthroplasty for hip function improvement,but postoperative one-year dislocation rate,reoperation rate,major complication incidence (except for dislocation),and postoperative twoyear mortality are similar for the two procedures.

BACKGROUND:Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE:To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS:Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, al the patients were evaluated according to Frankel classification:A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION:Al the 16 patients were fol owed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P<0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life.

Objective To evaluate the efficacy and safety of gefitinib combined with concurrent thoracic radiotherapy in the treatment of local - advanced non - small cell lung cancer with sensitive EGFR mutations. Methods From June 2015 to December 2016,fifty-six eligible patients in Chongqing Three Gorges Central Hospital were randomly assigned into two groups by one to one ratio,with 28 cases in each group.A group received treatment of gefitinib combined with concurrent thoracic radiotherapy, and B group adopted concurrent chemoradiotherapy. The toxic effects were recorded and all patients were followed up as defined by the study protocol.Primary study endpoints included:severe toxic effects,objective response rate and disease control rate,progression free survival and overall survival.Results Twenty-six patients in A group completed the study,and the severe toxic effects were as followed:interstitial pneumonia(3/26),radiation esophagitis(4/26),myelosuppression,skin rashes and gastrointestinal disruption. Twenty- eight patients in B group completed the study, and the severe toxicity included: interstitial pneumonia (4/26),radiation esophagitis(3/26),myelosuppression,skin rashes and gastrointestinal disruption.No toxicity higher than gradeⅢdeveloped in both two groups,and there were no statistically significant differences in incidence rates of interstitial pneumonia and radiation esophagitis between the two groups ( all P >0. 05 ). Moreover, there were no statistically significant differences in ORR and DCR between the two groups( ORR:61.5% vs.39.3% ,P=0.102;DCR:84. 6% vs. 71. 4% , P =0. 505 ). A group showed the benefit over B group in PFS ( 12. 45 months vs. 10.35 months,P=0.036).However,OS didn＇t reach and needed further follow-up.Conclusion The modality of gefitinib combined with concurrent thoracic radiotherapy in the treatment of local -advanced non -small cell lung cancer with sensitive EGFR mutations is safe and effective,and it yet needs further follow-up.

Objective To investigate the efficacy and safety of docetaxel chemotherapy combined with androgen-deprivation therapy (ADT) for patients with metastatic hormone-sensitive prostate cancer.Methods One hundred and ninety-two cases of metastatic hormone-sensitive prostate cancer in Renji Hospital between January 2015 and July 2016 were analyzed retrospectively.Patients' age was 39 to 90,the median age was 71 years.The median prostate-specific antigen (PSA) at diagnosis was 90.6ng/ml (4.1-2 556.0 ng/ml).One hundred and eighty were with bone metastasis and 12 were with distant lymphatic metastasis.Sixty-one of them received docetaxel chemotherapy plus ADT for 3 weeks,131 received hormonal treatment alone.The median age of combination therapy group was 67 years (39-80 years),that of single treatment group was 75 years (50-93 years) (P ＜ 0.001).The median PSA baseline of the two groups were 91.6 ng/ml (35.5-157.5ng/ml) and 89.1 ng/ml (59.6-191.0 ng/ml) (P =0.324).Gleason score of combination therapy group showed that 3 cases (4.9％) was 6,23 cases (37.7％) 7,35 cases (57.4％) ≥8.That of single treatment group showed that 17 cases (13.0％) 6,51 cases (38.9％) 7,63 cases (48.1％) ≥8.There was no statistic difference between the two groups (P =0.122).But there was statistic difference in the rate of T3 or T4 clinical stage in primary lesion,that of combination therapy group was 50.7％ (37/61) and 34.4％ (21/61),and that of single treatment group was 60.3％ (79/131) and 21.4％ (28/131) (P =0.011).Imaging showed local lymph node metastasis in the two groups (80.3％ vs.67.9％,P =0.005).As to physical condition,the combination therapy group showed a lower ECOG score than the single treatment group (P ＜ 0.001).All the patients' survival condition,PSA response rate and adverse events were analyzed.Results One hundred and ninety-two patients were regularly followedup.The median follow-up time was 23.3 (14.4-33.4) months.Median progression free survival time of combination therapy group and single treatment group were respectively 24.4 (7.5-31.3) months vs.17.5(3.0-30.7) months (P ＜ 0.001).There were 1 and 16 cases died in the two groups due to disease progression.During the treatment,the rate of PSA level less than 0.2 ng/ml was 29.5％ (18/61) vs.13.7％ (18/131) in combination therapy group and single treatment group.Regarding the tolerance of combination therapy group,the incidence rate of grade 3-4 neutropenia was 27.9％ (17/61).Skin and mucous membrane damaged in 24.6％ (15/61) patients,transaminase rised in 13.1％ (8/61) patients,and peripheral nerve toxicity occurred in 9.8％ (6/61) patients.There was no significant difference between the 2 groups in relevant events caused by ADT,gynecomastia (14.8％ vs.16.3％) and erectile dysfunction (100％ vs.100％).Most of them could be relieved by symptomatic treatment.Conclusions For metastatic hormone-sensitive prostate cancer,docetaxel combined with hormonal treatment showed longer progression free survival than ADT alone with adverse reactions acceptable.

Humans ; HIV-1 ; Leukocytes, Mononuclear ; Lymphoma, Non-Hodgkin ; DNA ; HIV Infections

Presynaptic dopaminergic PET imaging is a useful method for the diagnosis of parkinsonism. Based on the expert consensus on operation and clinical application of dopamine transporter brain PET imaging technology published in 2020, this paper further recommends the relevant elements of result interpretation of presynaptic dopaminergic PET imaging.