The quick development of computed tomography (CT) do great help to the improvements diagnosis of clinical disease, however, the radiation dose issue of CT is also attracted more attention by the public. It has been an important research field to reduce radiation dose as low as possible with the premise of maintained image quality. Recently, iterative reconstruction of CT has got great advance. This article mainly introduces the brief principles and research progress of CT iterative reconstruction.

[Objective]The purpose of this study was to determine the treatment odontoid fractures complicated by significant C2、3 displacement.[Method]Sixteen patients with odontoid fractures(12 type Ⅱ and 4 type Ⅲ,according to Anderson-D'Alonzo standard)were treated in this study.There were 11 male and 5 female with an average of 36 years(range 19-54 years).Group A included 9 cases of odontoid fracture with Hangman fracture and group B includcd 7 cases of odontoid fractures with C2、3 anterior fusion and 6 underwent dens screw with C2、3 posterior fusion.Postoperatively,neck collars were applied for 3 months.[Result]Successfully closed reduction of C1～2 was achieved in 16 patients.No complication occurred in the two groups.[Conclusion]Postoperatively there was no motion restriction in the neck or residual neck pain.Direct osteosynthesis of the fractured dens with screws is an effective procedure for unstable type Ⅱ fracture of the dens.Postoperative external immobilization with a neck collar seems to contribute much to the treatment.

Objective To observe the clinical effect of percutaneous vertebroplasty f PVP)and percutaneous kyphoplasty(PKP)in the treatment of ostcoporotic vertebral compressive fracture. Methods Forty-two patients with osteoporotic vertebral compressive fractures were treated with PVP or PKP from August 2007 to July 2009.VAS and SF-36 scoring systems were employed to evaluate the Dain and quality of life.X-ray was used to evaluate the vertehral height restoration rate and the kyphosis correction rate.The bone cement leakage was determined based on the Chest X-ray. Results There was staitistical difference on PMMA leakage between PVP and PKP group.VAS and SF-36 scores at 2 wePks and 6months after operation were much better than those counted before operation in both PVP and PKP groups(P<0.05).The VAS and SF-36 scores at 6 months after operation showed no statistical difference in comparison with those before operation between PVP and PKP groups(P>0.05).At tWO weeks after operation,the height restoration rate of the fractured vertebral body(anterior and central column)in the PKP group waa better than that in the PVP group(P<0.05).The kyphotic correction rate in the PKP group was a little better than that in the PVP group(P>0.05).Conclusions In the treatment of osteoporotic vertebral compressive fracture,PVP and PKP have the similar effect on the pain relief,can refresh the height of the fractured vertebral body and correct the kyphotic angel of the fracture level to some extent.PVP has more PMMA leakage than PKP.

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.

Objective To observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreous retinal surgery and the influencing factors of the imaging quality.Methods A retrospective case study.A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital.All the subjects were taken vitreous retinal surgery and iOCT scanning.The patients included 46 males and 86 females,with an average age of 61.7 years.111 cases had macular diseases and 21 cases had vitreous hemorrhage.Cases are divided into high myopia and non high myopia group according to ocular axial length (AL),28 eyes in high myopia group (AL≥26 mm),104 eyes in non-high myopia (AL＜26 mm).The scanning time,image quality and eye conditions were observed during the operation.The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed.Results The iOCT images were identified in 124 of 132 subjects,while were not identified in 8 eyes.For the macular area morphology change,iOCT tips and surgeon judgment rate was inconsistent in 22 eyes (16.7％).For the operation guidance value,change the operation rate of 12/132,accounted for 9.1％.The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups (x2-17.13,P=0.001).Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups (r =3.75,6.18;P 0.049,0.013).There were no complications such as endophthalmitis.Conclusions The surgeon can observe morphological changes in the macular area through iOCT which is difficult to be observed by operating microscope and selected reasonable operation method during the surgery.High myopia,corneal edema and operation time affect the image quality.

Objective To study the clinical and radiographic characteristics of complicated axis fractures combined with adjacent segment instability and explore reasonable surgical treatment strategy. Methods A retrospective study was performed on 21 patients with axis fractures treated from August 2003 to June 2009. There were 14 males and 7 females at mean age of 34 years. The treatment strategy was based on the fracture type and the stabilities of adjacent atlantoaxial joint and intervertebral C2/3.Treatment strategies included anterior C2/3 interbody discectomy and fusion, anterior cervical plate internal fixation, odontoid screw fixation, posterior C1-2 pedicle screw fixation, cervical lateral mass screw fixation or combined anteroposterior approach. Results All patients were immobilized in a hard collar for thee months and followed up for 6-36 months (average 12 months), which showed bony fusion and cervical stability, with no intraoperative surgery-related complications such as loosening, extrusion or breakage of fixation, vertebral artery injury, nerve damage, cerebrospinal fluid leakage or wound infection. Neurological recovery was observed in five patients. Conclusions For complicated atlas fractures, correct identification of fracture type and instability disturbance of adjacent atlantoaxial joint and C2/3 as well as active treatment can conduce to better effect.

Objective To investigate the potential effect of glucagon-like peptide-1 (GLP-1) analogue exendin-4 (Ex-4) on immune function of T lymphocytes via neuroendocrine modulation mechanism in mice following severe burns.Methods Male BALB/C mice were randomly (ramdam number) divided into thermal injury group (n =50) and sham-thermal group (n =30).The thermal injury model was made by exposing the back skin of 15％ total body surface area (TBSA) to 95 ℃ water for 7 seconds,while in sham-thermal model the mice were immersed in 37 ℃ water instead.The expression of GLP-1 receptor (GLP-1 R) was determined in sorted CM + T cells from normal mice by immunofluorescence method.In ex vivo experiment,the mice were sacrificed at 24 h post-bum,then the mononuclear cells (MNC) from spleen were separated from both groups and cultured in RMPI 1640 with 10％ FCS (fetal calf serum) in presence of ConA (concanavalin A,5 μg/mL).Cells were pretreated with catecholamine receptor antagonist propranolol (prop) for 1 hour,followed by consecutive dose of Ex-4 for another 48 h.In in vivo experiment,prop (30 mg/kg) was i.p.injected 30 minutes before thermal injury,then Ex-4 (2.4 nmol/kg) was injected i.p.immediately after scalding.Mice were sacrificed at 6 h and 24 h after thermal injury,then the serum and the spleens were collected.Results GLP-1R was expressed on splenic CD4 + T cells from normal micc.Ex-4 exerted no marked effect on the functions of T cells in terms of proliferation and IL-2 secretion at all doses examined ex vivo,which was not affected by pretreatment with prop.In vivo,T cell functions were suppressed by Ex-4 in thermal mice (P ＜ 0.05),but was restored by pretreatment with prop.Regardless of ex vivo or in vivo,Ex-4 could induce T cells switched to Th2 response (P ＜ 0.05).Moreover,the Th2 switch by Ex-4 was greatly potentiated by prop intervention in thermal mice in vivo other than ex vivo.Norepinephrine level was increased and epinephrine was decreased by Ex-4 in thermal mice.Both norepinephrine and epinephrine levels were obviously enhanced by pretreatment with prop.Conclusions Ex-4 can inhibit the proliferation and IL-2 secretion of splenic T lymphocytes through the sympathetic nervous system,however,it might induce Th2 switch from Th cells by acting directly on GLP-1R.

Background The introvitreal injection of triamcinolone acetonide (TA) before vitrectomy for retinal with choroidal detachment (RD/CD) can alleviate inflammatory response,but it easily lead to complications under the low intraocular pressure.The study on the efficiency and safety of subtenon injection of TA for treatment of RD/CD is lack.Objective This study was to evaluate the efficiency and safety of subtenant injection of TA with vitrectomy for treatment of RD/CD.Methods A retrospective study was adopted.The data of 22 eyes of 22patients who received subtenon injection of TA with vitrectomy for RD/CD were collected and analyzed in Affiliated Eye Hospital of Wenzhou Medical University from May 2010 to June 2014.TA of 40 mg in 0.4 ml was administered subtenantly 5 days before RD repair surgery.After initiating the treatment,the therapeutic effects on uvitis were analyzed.Intraocular pressure was monitored and CD height and range were determined by B type ultrasonography before injection and 5 days after injection respectively.In addition,blood glucose and blood pressure of the patients were evaluated.Results Ocular inflammation alleviated to some degree after TA injection in all 22 eyes.The mean intraocular pressure was (5.4±2.9) mmHg (1 mmHg =0.133 kPa) in pre-injection and (8.2±4.3) mmHg in postinjection,showing a significant difference between them (t =3.430,P ＜ 0.01).The mean maximum CD height was 5.2 (3.1,6.6)mm in pre-injection and 0.9 (0,3.8)mm in post-injection,with a significant difference between the before and after injection (Z=-4.198,P＜0.01).The mean CD range was 12 (10,12) clock before injection and 3(0,6) clock after injection,and no significant difference was found between before and after injection (all at P＞0.05) (Z=-4.124,P＜0.01).There were no statistically significant difference in the changes of blood glucose and blood pressure between before and after injection.The LogMAR visual acuities were 2.14±0.46,1.29±0.57 and 1.17±0.55 before injection and 1 month,3 months after injection,respectively,with a siginificant difference among them (F =22.060,P＜0.001).The retinal reattachment rate was 95.5 ％.Conclusions Subtenon injection of TA seems to be a good option for perisurgical management of RD/CD patients,which can alleviate uvitis,increase intraocular pressure,reduce CD height and CD range.

Virtual reality is the multi-dimensional sensorial environment produced by the computer, Users can play a part in this virtual environment by particular tools. This technology, possessing the characteristics of being lifelike, interactive and imaginative, plays more and more important part in the medical field. For example, in medical training, in physical and psychological treatments, this technology is of great value.
Computer Simulation ; Computer-Assisted Instruction ; General Surgery ; education ; methods ; Humans ; Surgery, Computer-Assisted ; User-Computer Interface

Background: Sorafenib and sunitinib are widely used as first-line targeted therapy for metastatic renal cell carcinoma (mRCC) in China. This study aimed to compare the efficacy, safety, and quality of life (QoL) in Chinese mRCC patients treated with sorafenib and sunitinib as first-line therapy. Methods: Clinical data of patients with mRCC who received sorafenib (400 mg twice daily; 4 weeks) or sunitinib (50 mg twice daily; on a schedule of 4 weeks on treatment followed by 2 weeks off) were retrieved. Primary outcomes were overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL (SF-36 scores), and secondary outcomes were associations of clinical characteristics with QoL. Results: Medical records of 184 patients (110 in the sorafenib group and 74 in the sunitinib group) were reviewed. PFS and OS were comparable between the sorafenib and sunitinib groups (bothP > 0.05). The occurrence rates of leukocytopenia, thrombocytopenia, and hypothyroidism were higher in the sunitinib group (36.5％ vs. 10.9％, P < 0.001; 40.5％ vs. 10.9％,P < 0.001; 17.6％ vs. 3.6％,P= 0.001), and that of diarrhea was higher in the sorafenib group (62.7％ vs. 35.2％,P < 0.001). There was no significant difference in SF-36 scores between the two groups. Multivariate analysis indicated that role-physical and bodily pain scores were associated with the occurrence rate of grade 3 or 4 AEs (P= 0.017 and 0.005). Conclusions: Sorafenib has comparable efficacy and lower toxicity profile than sunitinib as first-line therapy for mRCC. Both agents showed no significant impact on QoL of patients.