Objective To investigate the clinical value of spiral computerized tomographic shaded surface display (SSD) and multiplanar(MPR) imaging of complex shoulder fractures. Methods Twenty four cases of complex shoulder fractures including 16 cases with displaced proximal humeral fractures and 8 cases with displaced fractures of glenoid fossa were examined preoperatively with X ray, 15 cases of them were examined with SSD and MPR. On the basis of X ray or SSD and MPR of SCT all fractures were classified with Neer and modified Ideberg system; the true rate of fracture classification by use of two methods was compared with each other. Results Evidenced by intraperative observation, 10 of 16 displaced proximal humeral fractures cases were Neer three part fractures, 6 were four part fractures cases. Among the 8 cases of glenoid fossa fractures, there were 2 cases of type Ⅲ, 3 cases of type Ⅳ and 3 cases of type Ⅴ. The true rate of SSD and MPR of SCT is 93.3%(14/15) while X rays is 41.7%(10/24); there was significant difference between two methods (Fishers exact test, P=0.02). All SSD and MPR of SCT play an important role in the treatment of complex shoulder fractures. Conclusion SSD and MPR of SCT is able to clearly display complex shoulder fractures three dimensionally. It is helpful to correctly classify the fractures, select appropriate surgical approach, prepare surgical instruments and understand the complexity of the fractures.

Objective To investigate the influence of common X-ray, two-dimensional computed tomography (2D-CT), spiral computed tomography (SCT), and three-dimensional (3-D) reconstruction on the classification in displaced proximal humeral fractures. Methods Three groups were divided on the basis of various imaging methods, including group A (common X-ray), group B (common X-ray and 2D-CT), and group C (3-D reconstruction of SCT and 2D-SCT). 46 cases of displaced proximal humeral fractures were classified with Neer system. The true rate of fracture classification by use of three methods was compared with each other, and clinical significance of SCT and 3-D reconstruction was evaluated.Results Based on operation, 46 cases of displaced proximal humeral fractures in group A included 26 cases of Neer two-part fractures, 13 cases of three-part fractures, and 7 cases of four-part fractures. The true cases of common X-ray were 22 in Neer two-part fractures and 8 in three and four-part fractures, there was significant difference between Neer two-part fractures and Neer three and four-part fractures (P

Objective To investigate effectiveness of treatment of Upper urinary tract calculus by MPCNL application.Methods From May 2000 to May 2007,causing artificial kidney hydronephrosis for the affected kidney,established renal percutaneous channels(F16～18),which established the single channels of 202 cases,dual-channel of 14 cases,by Ureteroscopic Lithotripsy and holmium laser lithotripsy.Results 183 cases of 216 patients were One-time stone;33 cases were second stone.The average clearance rate is 90.32%,the average operation time is 79min,average valume of about bleeding is 80ml,the average hospitalization days are 8 days,kidney ostomy average stay 7.5 days.Of the operation,9 cases of obviously bleeding(4%)before and after operation,1 case uncontrollable bleeding after interventional treatment failure with Nephrectomy,others to stop beeding by symptomatic treatment,2 cases find urinary extravasation postoperative and cured by adjusting location of renal ostomy.Conclusion Minimally invasive percutaneous nephrolithotomy for the treatment of Upper urinary tract calculus is safe and effective for patients with less trauma,quicker recovery and high learance rate,the efficacy is satifactory.

Objective To discuss the feasibility of the lung transplantation as an effective treatment for end-stage pulmonary diseases domestically and to compare the major issues involving the practice of lung transplantation domestically and overseas.Methods After the foundation of group of lung transplantation in May 2002, lung transplantation models of porcine were set up. From September 2002 to April 2005, in the 18 cases undergoing lung transplantation, there were subjected to single-lung transplantion (SLT, 83.3%) and 3 bilateral sequential single lung transplants without CPB (DSSLT, 16.7%). Indications for SLT (n=15) included emphysema (n=9), pulmonary fibrosis (n=3), pneumosilicosis (n=1), lymphangioleiomyomatosis (n=1) and ventricular septal defect (VSD) induced Eisenmenger's syndrome (n=1); for DSSLT (n=3) bronchiectasis (n=1) and pulmonary emphysema (n=2). Among the 15 SLTs, there were 9 cases of left SLT and 6 right SLT. Among them, 2 cases shared one same donor's lung block, one case received contralateral lung transplantation―a left donor lung implanted in the recipient’s right thorax, and one case simultaneous right SLT and VSD repair. Results In hospital mortality (HM) was 3/18 ( 16.7%). Among SLTs, early death was due to severe rejection on the 30th postoperative day in one patient and acute rejection on the 15th postoperative day in other patients, and another patient died due to pulmonary vein embolism on the 36th day. There were 3 and 2 patients with the survival time longer than 1 and 2 years respectively. The median overall survival was 10 (2 to 32) months. Conclusions Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries. The key of successful operation depends on the establishment of group of lung transplantation and cooperation of multi-department. Ischemic-reperfusion injury, acute-rejection and infection are the major reasons of deaths shortly after the operations.

Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.

Objective To investigate the effect of hypoxia-inducible factor-1α expression (HIF-1α) on toll-like receptor 4 (TLR4) signaling pathway-mediated rat lung ischemia-reperfusion injury (LIRI).Method Forty-five S-D rats were randomly divided into Sham group,LIRI group,LIRI+ TLR4-activated group,LIRI+ TLR4-inhibited group,LIRI + ASK1-inhibited group,LIRI + p38-inhibited group,and LIRI + HIF-1α-inhibited group.The interaction between TLR4 signaling pathway [including TLR4,myeloid differentiation factor 88 (MyD88),TIR-domain-containing adapter-inducing interferon-βTIR-domain-containing adapter-inducing interferon-β (TRIF),Apoptosis signal-regulating kinase 1 (ASK1) and p38] and HIF-1α and the role of TLR4-dependent HIF-1α in LIRI in vivo were analyzed.Result In LIRI,HIF-1α accumulation was induced in a TLR4-dependent fashion,and MyD88,but not TRIF,and activation of ASK1 and P38 were found to be critical for TLR4-mediated HIF-1α accumulation.HIF-1α protein played a critical role in TLR4-mediated lung injury of LIRI.HIF-1α up-regulated TLR4 expression in LIRI in a positive feedback manner.Conclusion We identify that HIF-1α has a damaging effect on TLR4 signaling pathway-mediated LIRI and TLR4-HIF-1 may synergistically involved in the development of LIRI.Therefore we suggest that the interaction between them may represent a novel therapeutic target for the development of novel target-based therapies of LIRI.

Objective To investigate the suitable mode of cognitive-behavioral therapy for lung transplant recipients during waiting for lung and evaluate the effect to improve patients' physical and mental state.Methods 50 cases were randomly divided into the experimental group and the control group,each group with 25 cases.The control group received conventional treatment.The experimental group received cognitive-behavioral therapy in addition to conventional treatment.SAS and vital signs were measured in the two groups on admission,2 weeks and 4 weeks after admission.Results The SAS score of the experimental group was lower than the control group 2 weeks and 4 weeks after admission and SAS score decreased as the intervention extended.The SBp of the experimental group was lower than the control group 4 weeks after admission.There was no significant difference of DBp between two groups.The heart rate of the experimental group was lower than the control group 4 weeks after admission.The heart rate of the experimental group was lower on 2 weeks and 4 weeks after admission than on admission.4weeks after admission,the respiratory rate of the experimental group was lower than the control group and on admission.Conclusions Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness.

Objective To observe the therapeutic effects of lung transplantation for diffuse pulmonary disease. Methods From September 2002 to April 2009, lung transplantation was performed on 72 cases in our hospital. Thirty-seven cases of these recipients were suffered from diffuse pulmonary disease, including idiopathic pulmonary fibrosis (30/37), pneumosilicosis (4/37), vascular leiomyoma (2/37) ,diffuse panbronchiolitis (1/37),30 males and 7 females with age ranging from 22 to 73 years old (mean 52.9 ± 13.2). All the patients received pulmonary function test and echocardiography (ECHO) to test the pulmonary artery systolic pressure before transplantation and artery blood gas to calculate the oxygenation index (PaO2/FiO2 ). Results The systolic pulmonary artery pressure (Ppa,syst) was monitored by Swan-Gans catheterization one week post-transplant, and decreased significantly from 54. 30 ± 17. 41 to 41.52 ± 9. 36 mm Hg (P＜0. 05). Simultaneously, oxygenation index was improved from 185. 89 ± 77. 25 to 392. 12 ± 98. 23 (P＜0. 05). The pulmonary function was also improved significanzly one month post-operation. The volume in the first second was improved from (1.33 ± 0. 64) to (1.81 ± 0. 57) L, and the diffusion capacity of carbonmonoxide was increased from (2. 87 ± 1.26) to (4. 22 ± 2. 05) L. Conclusion Lung transplantation is feasible and efficient to deal with diffuse pulmonary disease.

Objective To discuss the benefits of extracorporeal membrane oxygenation (ECMO) applied in the patients with primary or secondary pulmonary hypertension during the operation of lung transplantation. Methods Thirty cases of end stage lung disease subject to primary or secondary pulmonary hypertension received lung transplantation supported with ECMO between Nov. 2005 and July 2009. The single lung transplantation was performed on 18 cases and bilateral sequential single lung transplantation on 12 cases. ECMO was used in 2 patients as a bridge to the lung transplantation to maintain 19 and 6 days respectively, and ECMO support was given during lung transplantation. ECMO was removed after the transplantation if the oxygenation and hemodynamics were stable, otherwise, ECMO was applied continuously until the situation improved. Results All the operations of these patients were accomplished successfully and the ECMO was removed in 27 patients after the operation immediately. The average time with ECMO was 6. 81 + 0. 95 h, and pulmonary artery systolic pressure after lung transplantation was 31.67 + 8. 42 mmHg. The ECMO was continuously used after lung transplantation in three patients until the hemodynamics was stable, and ECMO in 2 of them was removed at 36th h and 6th day respectively after the operation, and one,receiving postoperative ECMO for 5 days, died of acute renal failure 2 weeks after the operation.Conclusion ECMO can replace CPB safely and effectively in lung transplantations for primary or secondary pulmonary hypertension patients. As a respiratory and circulatory support it can control pulmonary hypertension during operative period and can decrease the complications of lung transplantation.

Objective To analyze the diagnosis and treatment of airway stenosis in a consecutive series of bronchial anastomosis after lung transplantation in our center.Methods We performed a retrospective study on 100 cases of lung transplants in our center from September 2002 to December 2010.Seventy-two cases were subjected to single lung transplants (SLT), and twenty-eight to bilateral sequential single lung transplantation (BSSLT). There were totally 128 bronchial anastomoses.All recipients received long-term follow-up to monitor the lung function.Lung CT and fibrobronchoscopic examinations were done when necessary. Results Twenty-five cases with 37 bronchial anatomoses were died.A total of 12 airway stenosis occurred in 10 cases (12/128,9.4 ％).Four cases underwent telescopic anastomosis and 6 cases underwent end-to-end anastamosis.Mean diagnosis time was 60.1 35.6 days post-operation (ranging from 15-120 days,median 59 days).There were 8 cases of unilateral airway stenosis (3 on the left,and 5 on the right) and 2 cases of bilateral airway stenosis.The number of simple airway stenosis was 3,that of exophytie granulation tissue was 8,and that of bronchus intermedius stenosis was 1.Culture of bacteria by fibrobronchoscopy with protected specimen brush revealed:3 strains of Pseudomonas aeruginosa,2 strains of Klebsiella pneumoniae,2 strains of Aspergillus,1 strain of Escherichia Coli. 10 cases were treated with fiberoptic bronchoscopic balloon dilation:5 cases with high-frequency electrotome,4 cases with stent placement,and 1 case with argon plasma coagulation (APC).Seven cases were cured or improved and 3 cases died.Conclusion Airway stenosis after lung transplantation remains a major problem.The fiberoptic bronchoscopic procedure is the gold standard to diagnose. The preferred treatment is fiberoptic bronchoscopic balloon under expansion,and other approaches include high-frequency electrotome,APC and stem placement,etc.