[Objective]To explore the clinical outcome of anterior cervical decompression for severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament. [Method]Thirty-three patients with severe cervical spondylotic myelopathy and continuous OPLL underwent posterior longitude ligament resection and floating in anterior cervical decompression.The intervertabral space were stabilized by autoilum graft or titanium cage and fixed with windows plates. [Result]All patients were followed up for 8 to 45 months,mean 22 months.Preoperative JOA scores were 6.7,and the postoperative JOA scores were 10.1 and 10.7(evaluated in 3 months and 12 months after surgery),the mean amelioration rate was 72.7% and 78.8%.Of these 33 patients,no severe complications such as cord or vertebral artery injury occurred. [Conclusion]Posterior longitude ligament resection and floating in anterior cervical decompression is a safe and effective treatment for severe cervical spondylotic myelopathy with ossification of posterior longitudinal ligament.

OBJECTIVE: To analyze the causes for misplacement of pedicle screw in thoracolumbar spine.METHODS: From January 2002 to January 2008, 19 patients with misplacement in thoracolumbar spine were treated in Department of Orthopedics, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, including 12 males and 7 females with an average age of 52.5 years (range 23-68 years). The diagnoses were thoracolumbar fracture in 5 cases, lumbar spondylolisthesis in 8 and degenerative lumbar disease in 6. The fixation systems were Steffee used in 4 cases, DRFS in 3, RF in 6, AF in 4 and GSS in 2. X-ray and CT scanning were used to observe pedicle screw location, including screw,pedicle and membranous sac and great vessels.RESULTS: The time of misplacement of pedicle screw was 5-69 days with an average time of 18.5 days, including 7 cases of screw penetrating into lateral cortex, 4 of screw penetrating into medial cortex, 2 of screw penetrating into pedicle cortex, 2 of overplacement, 2 of intervertebral foremen placement and 2 of intervertebral space placement.CONCLUSION: The causes for screw misplacement were anatomic variation and poor surgical skills, and the key factors in precise insertion of pedicle screw are fine surgical skills, carefully study of preoperative image and the intra-operative monitoring.

The effect of targeted magnetic nanoparticles on hepatoma and the underlying mechanism were examined. Nude mice transplanted with a human hepatoma cell line (HepG2 cells) were randomized into 5 groups, including: (1) group A, receiving normal saline, (2) group B, receiving 5-fluorouracil (5-Fu), (3) group C, receiving magnetic nanoparticles containing 5-Fu, (4) group D, consisting of treatment with magnetic nanoparticles containing 5-Fu and inside magnetic field and (5) group E, receiving pure magnetic nanoparticles and inside magnetic field. Morphological features of transplanted tumors in mice in each group were observed under transmission electron microscope (TEM). The expression of bcl-2/bax protein was immunohistochemically detected by SABC method. The results showed that a large number of apoptotic tumor cells were found in group B and group D under TEM. The expression of bcl-2 protein was significantly decreased and the expression of bax protein increased significantly in both group B and D as compared with those in group A, C and E (P<0.01 for all). The decrease in bcl-2 and the increase in bax were more in group D as compared with group B (P<0.01). It is concluded that the targeted magnetic nanoparticles containing 5-Fu can improve the chemotherapeutic effect of 5-Fu by decreasing bcl-2 expression, increasing bax expression and inducing apoptosis of the liver cancer cells.

Objective To investigate the application value of prophylactic bilateral uterine artery catheterization and embolization in treatment of patients with pernicious placenta previa and accreta.Methods Data of 16 patients with pernicious placenta previa and accreta who underwent prophylactic bilateral uterine artery catheterization and uterine artery embolization and cesarean section were retrospectively analyzed.The amount of intraoperation blood loss,the amount of blood transfusion,cesarean hysterectomy rate,fluoroscopy operative time,radiation dose,complications and neonatal outcome were recorded.Results The technical success rate of the combined treatment was 93.75％ (15/16).The mean amount of blood loss was (1 575.00 ± 1 040.83)ml.The mean amount of blood transfusion was (3.44 ± 2.34)U leukoreduced red blood cells.The mean fluoroscopy operative time and radiation dose before delivery were (0.89±0.24)min and (7.17 ± 2.12)mGy.One newborn was diagnosed as severe asphyxia.The mean Apgar score of another 15 newborns was (9.38± 0.89) at 5 min after birth.One patient underwent hysterectomy due to postpartum hemorrhage complicated with disseminated intravascular coagulation.Buttock pain was found in 2 cases.Conclusion Prophylactic bilateral uterine artery catheterization and embolization can be used for the treatment of pernicious placenta previa and accreta.The combined treatment can control postpartum hemorrhage during placental dissection and reduce transfusion requirements and hysterectomy rate with few minor complications and low radiation exposure dose.

Objective To determine the effect of nanochemotherapy drug on Survivin and p53 ex-pressed by human biliary traet carcinoma cell line QBC939.Methods Culturing the human biliary tract carcinoma cell line QBC939 in vitro and it was divided into five groups including saline,nanochemotherapy drug,nanopartiele withoul nanochemotherapy drug,5-FU and gemcitabine.Using the methods of MTT and flow cytometry to observe the growth of QBC939 which was dealt with different drugs.In addition,RT-PCR and Western blot were used to delect the expression of mRNA and protein by Survivin or p53.Results The expression of mRNA and protein by Survivin decreased in the following set:saline,nanoparlicle withoul nanochemotherapy drug,5-FU,gemcitabine and nanochemotherapy drug,respeclively.However,the ex-pression of mRNA and protein by p53 were in reverse order.The inhibiting action to QBC939 was obvious in nanochenmtherapy drng and the apoplotic rate was higher than others except for gemcitabine(P＜0.05). Conclusion Nanochemotherapy drug has significant effect on treatment cholangiocarcinoma in vilro,which may attribute to the down regulation of Survivin and up regulation of p53.

Objective To investigate the characteristics of hepatitis C viurs (HCV)infection and its genotypes in Yancheng area . Methods A total of 20 185 cases of subjects receiving healthy examination were collected ,and fasting blood levels of serum anti‐HCV were detected .Clinical data of patients with HCV infection were statistically analysed .HCV genotypes and levels of HCV RNA were detected ,and their clinical prognosis was judged by type‐B ultrasonic .Results The total infection rate of HCV was 1 .22% .The infection rate of male was higher than that of female and the infection rate was increased with the elevation of age .The genotype 1b was accounted for 73 .17% .The results of type‐B ultrasonic shown that all patients infected with genotype 6 and 1b/2a HCV only had liver damage .80 .77% of patients infected with genotype 2a HCV had liver damage ,which was higher than that of patients infected with 16 and 3a+3b genotypes .Conclusion Most of HCV infected patients are male ,and the infection rate might be increased with the elevation of age .The prognosis is in various different genotypes of HCV ,which indicates that the prognosis could be evaluated by genotyping .

Objective To evaluate the feasibility and safety of thoracoscopic lung cancer surgery under non-tracheal intubation anesthesia. Methods Twenty patients with peripheral lung cancer were enrolled in experimental group and control group. Then monitored and recorded Systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), electrocardiogram (ECG), heart rate (HR), Oxygen saturation (SpO2), Final moisture CO2 partial pressure (PETCO2), central venous pressure, invasive arterial blood pressure and blood glucose and the related complications like sore throat, hoarse voice, nausea and so onin such time points: before induction (T0), induction of intubation (T1), operation (T2), and sudden removal (T3) of the two groups. Results The laryngeal mask group was given a smaller stimulus to the cardiovascular system during anesthesia.The time of feeding, the exhaust, the time of getting out of bed, the average hospitalization day, the reduction of hospitalization expenses, pharynx, respiratory and cardiovascular complications were shorter and less than intubation group. Conclusion The laryngeal mask ventilation intravenous anesthesia with thoracic vagal nerve block in the thoracoscopic lobectomy is simple, safe, no intubation-related complications and single lung ventilation lung injury, in line with surgery -anesthesia overall minimally invasive development concept, worthy of clinical promotion.

Objective To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.Methods Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classifi cation, tumor differentiation and TNM stage were statistically analyzed. The intratumoralmicrovessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4350.7±2566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12820.3±8331.6 )a.u, (128 240.8±74 487.1) a.u, (71.9±33.1)s. Those parameters in 14 cases of sinusoid-like type were (2471.6±1107.1) a.u, (16.2±4.2)s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6)s. And in 52 cases of mixed type they were (3563.2±2343.1) a.u, (14.1±4.8)s, (519.4±403.2) a.u, (9 015.3±6 884.7)a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were signifi cant (WiR: t=3.87, 3.3, bothP=0.05; WiPI: t=2.96, 2.06, bothP=0.05; RT: t=3.19, 2.34, bothP=0.05). The parameter of PE in capillary-like type HCC patients were signifi cantly higher than that in sinusoid-like type HCC patients (t=2.51,P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no signifi cant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no signifi cant differences. No signifi cant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.Conclusions There were signifi cant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.

Objective To evaluate the efficacy of transcatheter arterial embolization (TAE) in treating oronasal cavity hemorrhage,and to discuss the the occurrence and prevention of complications.Methods The clinical data of 121 patients with refractory and fatal oronasal cavity hemorrhage,who were admitted to authors' hospital during the period from December 2005 to October 2013 to receive treatment,were retrospectively analyzed.A total of 116 patients were treated with TAE,and these patients were followed up for 1-3 months to evaluate the embolization effect and the occurrence of procedure-related complications was analyzed.Results Of the 116 patients,complete control of bleeding after TAE was achieved in 96 (82.7％),rebleeding within one week after TAE was seen in 19 (16.4％) and the bleeding was controlled by medication,and in the remaining one (0.9％) re-bleeding occurred within one week after TAE and embolization therapy had to be carried out again.No obvious complications occurred in 77 patients (66.4％);maxillofacial pain and numbness,low fever,limitation of mouth opening and other mild complications were observed in 35 patients (30.1％);one patient (0.9％) developed facial skin necrosis and severe headache;and 3 patients (2.6％) showed stroke symptoms due to cerebral embolism.Conclusion For the treatment of refractory and fatal oronasal cavity hemorrhage,TAE can quickly and effectively achieve the purpose of hemostasis;careful selection of proper embolization material based on the the different causes of bleeding and the responsible blood vessels is the key to ensure a successful TAE.The common postoperative complications include postembolization syndrome,local ischemia,local necrosis caused by peripheral ischemia;the main serious complications are skin necrosis of maxillofacial region and cerebral infarction caused by ectopic embolization.

Objective To explore the effects of comprehensive rehabilitation on patients with stable chronic obstructive pulmonary disease (COPD) in rural communities.Methods Between June 2010 and June 2012,212 stable COPD patients were randomly divided into management group (n =107) and control group (n =105).All patients received conveutional treatment.In addition,107 stable COPD patients relying on new rural cooperative medical service station in management group underwent community comprehensive rehabilitation including training in respiratory function,exercise training,nutrition intervention and psychological care.Effect of lung function,symptoms (times of acute attack & hospitalization) and quality-of-life (QOL) rated by SF-36 questionnaire between two groups were recorded at Month 6.Results The score changes of QOL had significant inter-group differences between 2 groups for PCS (scores for physical component summary) and MCS (scores for mental component summary) (11.4 ±8.2 vs.1.6 ± 1.2,5.5 ±3.5 vs.2.2 ±0.9,all P ＜0.01).In the scores for physical component summary,the score change of physical function,physiological function,body pain and general health were significantly different between two groups (6.7 ±4.3 vs.1.2 ±0.8,10.9 ±6.3 vs.1.9 ± 1.5,6.4 ±4.7 vs.3.6 ±2.7,3.2 ±2.7 vs.1.6 ± 1.1,P ＜ 0.01).In the scores for mental component summary,the score change of vitality,emotional function,social function and mental health were significantly different between two groups (4.9±3.2 vs.1.9±1.4,2.7±2.1 vs.1.6±1.1,11.6 ±9.2 vs.3.6 ±2.3,6.7 ±4.3 vs.1.4±0.9,P＜0.01).The times of acute attack and hospitalization were obviously lower than those of the control group.No significant inter-group difference existed in lung function.Conclusion Comprehensive rehabilitation may improve the QOL in stable COPD patients in rural communities and reduce their times of acute attack.