Anterior cervical plating has been widely used to treat cervical spine trauma, degeneration, deformity and tumor due to the advantages such as augmentation of cervical stability and promotion of bone graft fusion. This paper introduced the classification and evolution of plate-screw internal fixation system, analyzed the biomechanics of anterior cervical plate, and discussed its clinical application. Although the therapeutic effect of anterior cervical plating is favorable, there are still various complications postoperatively. Therefore, it is necessary to improve the anterior cervical plate from different aspects to expand its clinical application.

Objective To investigate the changes and diagnostic significance in plasma undercarboxylated osteocalcin in children with Kawasaki disease (KD),especially with coronary artery lesions (CALs).Methods The data of 36 KD children were collected,who were inpatients at Department of Cardiovascular and Rheumatology,Shanxi Province Children's Hospital from January 2015 to December 2015,including 20 boys and 16 girls,aged (2.3 ± 1.1)years old.According to the course of the disease,KD children were divided into an acute stage group and a subacute stage group.Based on the echocardiography findings,KD children were subdivided into CALs group and no coronary artery lesions (NCALs) group.Twenty-five healthy children from the physical examination during the same period were selected as the healthy control group,13 boys and 12 girls,aged (2.6-± 1.0) years old.Plasma undercarboxylated osteocalcin level was measured by double antibody sandwich enzyme-linked immunosorbent method.Sigrnaplot 12.5software was used to analyze the data statistically,and the receiver-operating characteristic (ROC) curve was used to evaluate the diagnostic effect of plasma undercarboxylated osteocalcin in KD with CALs.Results The levels of plasma undercarboxylated osteocalcin in the healthy control group,the acute stage group and the subacute stage group were (16.4 ± 1.6) μg/L,(14.2 ± 1.6) μg/L,(14.3-± 1.7) μg/L,respectively.Compared with the healthy control group,the plasma undercarboxylated osteocalcin level in the acute stage and the subacute stage were significantly lower,the differences were statistically significant (q =6.088,5.687,all P ＜ 0.01).But there was no difference of plasma undercarboxylated osteocalcin level between the acute stage group and the subacute stage group (q =0.466,P ＞ 0.05).The levels of plasma undercarboxylated osteocalcin in acute stage group with CALs and acute stage group with NCALs were (12.9 ± 1.2) μg/L,(15.0 ± 1.4) μg/L.Compared with healthy control group,the plasma undercarboxylated osteocalcin levels of children with CALs and with NCALs were obviously decreased,the differences were statistically significant (q =8.711,3.891,all P ＜ 0.01).There was a statistical difference in plasma undercarboxylated osteocalcin level between the acute stage with CALs and the acute stage with NCALs (q =5.171,P ＜ 0.01).The plasma undercarboxylated osteocalcin levels of KD children with CALs in the subacute stage was (13.0-± 1.3) μg/L.Compared with acute stage,there was no statistical difference (t =0.257,P ＞ 0.05).There was a sensitivity of 79％,specificity of 82％,positive predictive value of 88％ and negative predictive value of 70％ for the 15.7 μg/L undercarboxylated osteocalcin for diagnosing KD.There was a sensitivity of 83％,specificity of 88％,positive predictive value of 83％ and negative predictive value of 88％ for the 13.7 μg/L undercarboxylated osteocalcin for diagnosing KD with CALs.Conclusions Osteocalcin is related to the pathogenesis and development of KD.Plasma undercarboxylated osteocalcin contributes to the diagnosis of KD with CALs.

Objective To investigate the biocompatibility of pure titanium (Ti) and Ti-6Al-7Nb surface treated by sanding acid etch (SLA) on rat osteoblasts. Methods Experiments were divided into four groups, Ti mechanical grinding group (S1 group), Ti sand-blasting acid group (SLA1 group), Ti-6Al-7Nb mechanical grinding group (S2 group) and Ti-6Al-7Nb sand-blasting acid group (SLA2 group). The surface topography of samples was examined by microscope. The contact angle measurement instrument was used to analyse surface hydrophily of SLA1 and SLA2 groups. The surface sediment mor?phology and phase were observed by scanning electron microscopy (SEM) and X-ray diffraction (XRD) in two groups after be?ing soaked into simulated body fluid (SBF) for 7 d,14 d and 21 d. Osteoblasts extracted from rats were seeded on titanium sheets, and the osteoblast cells on different titanium surfaces were observed by inverted microscope. MTT colorimetric meth?od was used to measure the proliferation of osteoblasts. Results Compared with S1 and S2 groups, there were more holes on sample surface of SLA1 and SLA2 groups. The sample surface was hydrophilic structure in SLA1 and SLA2 groups. The con?tact angle was smaller in SLA2 group than that of SLA1 group. The hydroxyapatite coating was firstly observed in SLA2 group at 14 d. The hydroxyapatite coating was found in samples of two groups after 21 d. The proliferative ability of osteo?blasts was stronger in SLA1 and SLA2 groups than that of S1 and S2 groups. And the proliferative ability of osteoblasts was stronger in sample surface of SLA2 group than that of SLA1 group (P<0.05). Conclusion Ti-6Al-7Nb by SLA has good biological compatibility, which is helpful to promote the combination of implant and bone tissue.

objective To explore the effect of application of cluster-based strategies on preventing the complication of fibrosclerosis of patients with systemic scleroderma.Methods A total of 59 patients with systemic scleroderma were randomly assigned to the experimental group (34 cases) and the control group (25 cases) during the period of hospitalization in our department.The experimental group took the cluster-based strategies after admission,including a gymnastics,two kinds of respiratory breathing,three kinds of habits,four kinds of protection to prevent the complication of fibrosclerosis.The control group received the conventional care procedures of dermatology.The skin stiffness,joint function,Raynaud's phenomenon and swallowing function were evaluated when patients were admitted and before discharge in two groups.The length of stay between the two groups was also compared.Results The skin stiffness,joint function,Raynaud's phenomenon and swallowing function scored (14.74±1.33),(7.06±0.69),(0.88±0.33),(0.54±0.21) in the experimental group,significantly better than those of the control group,(24.08±1.12),(13.48±0.77),(1.24±0.60),(0.96±0.34),P ＜ 0.01.The length of stay in the experimental group and the control group was (23.65±5.45),(32.00±6.56) days,t=-5.340,P ＜ 0.01.Conclusions Application of cluster-based strategies can be effective against the fibrosclerosis damage of patients with systemic scleroderma and reduce the occurrence of complications.

Objective To quantify the morphometric characteristics of the pedicles of the infantile thoracolumbar spine and to determine the feasibility and safety of pedicle screw fixation in very young children. Methods A total of 52 patients younger than three years of age underwent standard spiral computed tomography (CT) were enrolled in this study. The patients were grouped according to age, group 1 (0 ～ 18months of age) and group 2 (18 ～ 36 months of age). Images were reformatted, and multiplanar reconstructions were used to attain images of thoracic and lumbar pedicles on sagittal, coronal and transverse planes.The measurements included the inner and outer pedicle diameters on the transverse plane, pedicle sagittal diameter, pedicle length and the pedicle angle on the transverse. Characteristics of the pedicles of the immature thoracic and lumbar spine were studied. Results Pedicle diameters on the transverse plane decreased gradually from T1 to T5 and increased gradually from T6 to L5. The shortest transverse diameter of the thoracic pedicle was T5 or T6. The inner diameter of the segment of L4 in infant (younger than eighteen months) was less than 3.0 mm and the external diameter less than 3.5 mm from T3 to T9. The inner diameter of the segment from T5 to T8 in infant (more than eighteen months) was less than 3.0 mm and the external diameter from T4 to T7 was less than 3.5 mm. The sagittal diameter was significantly more than the transverse diameter. Pedicle diameters on the transverse plane, the sagittal diameter, and the length of the pedicle changed significantly with age, but the pedicle angle did not changed significantly with age. Conclusions The pedicles in the segment from T3 to T9 of less than eighteen months and from T4 to T7 of more than eighteen months were too small, there was no feasibility and safety of pedicle screw fixation. So pedicle screw fixation was feasible and safe for below T9 segment in the infants who are younger than three years old.

Objective To investigate the characteristics of upper airway collapse in patients with obstructive slcep apnea hypopnea syndrome (OSAHS) when muscle is fully relaxed.Methods Thirty male ASA Ⅱ or Ⅲ patients with OSAHS aged 20-59 yr with body mass index 21-36 kg/m2 and apnea-hypopnea index (AHI) of 28-102times/h were studied.The patients were sedated with iv midazolam 1 mg and sufentanil 5 μg.Nasotracheal intubation was then performed under topical anesthesia with 1％ dicaine.After confirmation of correct position of nasotracheal tube,anesthesia was induced with propofol 0.5 mg/kg and vecuronium 0.08 mg/kg and maintained with target-controlled infusion of propofol and remifentanil.BIS was maintained at 40-60.Fiberopticnasopharyngoscope and pressure transducer were inserted via contralateral nasal cavity and connected with imaging workstation.The site and length of the obstruction were measured and calibrated.Positive pressure was applied to the pharyngeal cavity and gradually increased in increments of 1 cm H2O until 20 cm H2O.The change in cross-section area and critical opening pressure at different planes in pharyngeal cavity were recorded.Results Complete obstruction occurred at the plane of hard palate in one patient (3％).The soft palate and uvula completely collapsed in all 30 patients (100 ％).The collapse occurred at tongue level in 23 patients (77 ％).Every 1 cm H2O increase in pressure produced increase in cross-section area by (10 ± 4)mm2 at the level of hard palate and by(28 ± 18) mm2 at the level of soft palate and uvula.The critical opening pressure ranged from 3 to 18 cm H2O and was≤ 15 cm H2O in 90％ patients.Conclusion Soft palate and uvula collapse in all patients with OSAHS when muscle is fully relaxed.The critical opening pressure is ≤ 15 cm H2O in 90％ patients.

Objective To evaluate the effect of total alkaloids of Sophora alopecuroides L on the nervous behavior and the expression of neurotransmitters in rats. Methods 48 male SD rats were randomly divided into 4 groups:blank group,total alkaloids of Sophora alopecuroides L treatment with 4 mg·kg-1 ·d-1 ( low dose group) ,8 mg·kg-1 ·d-1( medium dose group) and 16 mg·kg-1 ·d-1( high dose group) groups. After successive intragastric administration for 30 days,the locomotor activity was applied to test the nervous behavior and emotional state of rats in each group. After behavioral tests were finished,the contents of trypto-phan (Trp),5-hydroxytryptophan (5-HTP),5-serotonin (5-HT),5-hydroxyindoleacetic acid (5-HIAA), norepinephrine (NE),epinephrine (E) and dopamine (DA) were detected by ELISA in serum and brain. Results In the experiment of locomotor activity,compared with blank group ((95.33±12.75) times),the numbers of horizontal movement of Sophora alopecuroides L in medium and high dose group ( ( 61. 64 ± 5.91),(64.62±5.79)times both P<0.05) were significantly reduced (P<0.05, P<0.01).Compared with the blank group ((4.33±0.66) times),the numbers of vertical motion of Sophora alopecuroides L in medium and high dose group ((3.05±0.09)times,(3.77±0.69)times) were significantly reduced (P<0.05, P<0.01). Compared with blank group ((2.25±0.39) number),the granule number in high dose group ((3.38±0.40) number) were significantly increased (P<0.05, P<0.01),and emotional stress degree increased. Meanwhile,compared with blank group,the content detection of 5-HT,5-HIAA in different dose groups of the total alkaloids of Sophora alopecuroides L was improved obviously(P<0.01),but there was no significant effect on the content of Trp,5-HTP,NE,E,DA(P>0.05). Correlation analysis indicated that the degree of au-tonomic activity in rats with the content of 5-HT,5-HIAA and DA in serum was negatively correlated (P<0.05, P<0.01) ,the degree of emotional stress and the content of 5-HT,5-HIAA in brain was negatively cor-related (P<0.05, P<0.01) . Conclusion The total alkaloids of Sophora alopecuroides L can reduce the ac-tivity of rats and increase the degree of emotional stress. And the mechanism may be correlated with the in-creasing level of 5-HT and 5-HIAA in serum and brain.

Objective To investigate the causes of misdiagnosis and improve the level of diagnosis and treatment for endocrine myopathy,through the study the clinical data of 20 patients with endocrine myopathy who were misdiagnosed as polymyositis were analyzed.Methods 20 cases were retrospectively analyzed who suffered from proximal weakness as the main performance and misdiagnosed as polymyositis,through the method of supervision to track,review of the observation and methods of medical record information query.Results The main types of diseases which were misdiagnosed including 18 patients of thyroid diseases(13 patients of hypothyroidism,5 patients of hyper-thyroidism),2 patients of parathyroid disease(1 patient of hyperparathyroidism,1 patient of hypoparathyroidism). Conclusion Mastering polymyositis and endocrine myopathy in the identification of main points,improving the ability of differential diagnosis,so that doctor can avoid misdiagnosis.

OBJECTIVE:To analyze the cost-effectiveness of two regimens in the treatment of chronic hepatitis B fibrosis. METHODS:112 cases of chronic hepatitis B fibrosis were divided into Compound biejia ruangan tablet group (group A,n=56) and Anluo huaxian pill group(group B,n=56). Both groups received Entecavir dispersible tablets combined with relevant Chinese patent medicine. The liver fibrosis index and transient elastography of 2 group were detected before and after treatment,TCM symp-tom score and effective rate calculation were conducted to compare the cost-effectiveness of 2 groups. RESULTS:The cost,effec-tive rate and cost-effectiveness ratio of group A were 9 227.10 yuan,74.11% and 12 451;those of group B were 8 202.90 yuan, 69.28%and 11 840;incremental cost-effectiveness ratio was 21 205. Group B showed a better cost-effectiveness. Result of sensitiv-ity test was same to that of cost-effectiveness analysis. CONCLUSIONS:The cost-effectiveness of Anluo huaxian pill combined with Entecavir dispersible tables is better than Compound biejia ruangan tablet combined with Entecavir dispersible tables in the treatment of chronic hepatitis B fibrosis.

[ABSTRACT]OBJECTIVETo assess the upper airway and related structures in different patterns of the upper airway obstruction on cine magnetic resonance (CMR) imaging in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).METHODSCMR images of upper airway were obtained in 30 male patients with severe OSAHS during waking state and natural sleep. The midsagittal plane images were obtained. Patients were classified into 3 groups based on the upper airway obstruction patterns at apnea events and the reference data of the upper airway were measured.RESULTSDuring natural sleep, the diameter of retropalatal region, retroglossal region, retroepiglottic region and the length of suprahyoid muscles were significantly shorter than those during waking state (P<0.01). The maximum angle between the suprahyoid muscles and the apex of the tongue during natural sleep was significantly larger than that during waking state (P<0.01). During wakefulness, there was a significantly difference in the diameter of retropalatal region among 3 obstruction patterns (P<0.01). During natural sleep, there were statistical difference in the diameter of retropalatal region and the upper tongue, the angle between the hard palate and soft palate, the maximum angle between the suprahyoid muscles and the apex of the tongue, and their change values among 3 obstruction patterns (P<0.05). CONCLUSIONThe measurements of the upper airway and related structures on CMR imaging in OSAHS patients could provide useful information in assessing upper airway.