[Objective]To analyze the clinical characteristics and treatment methods of upper-middle thoracic fractures with spinal cord injury.[Method]Forty patients with upper-middle thoracic fracture were retrospectively reviewed.Hanley-Eskay classification was used:compression fractures in 4,burst fractures in 11,fracture-dislocations in 23,and burst dislocation in 2 cases.Neurologicall function(according to the ASIA classification):A in 29,B in 3,C in 4,D in 0,and E for 4 cases.Four cases without spinal cord injury received conservative treatment.Thity-six cases with spinal cord injury underwent laminectomy and reduction followed by posterior fusion with bone graft and pedicular screw instrumentation.All 36 cases received early rehabilitation.[Result]All 40 cases were evaluated clinically,radiographically,and functionally during the follow-up(mean,32 months).Conservative group:one case developed delayed kyphosis deformity with neurological deficit and underwent anterior-posterior surgical treatment 16 months tater.Surgical group:the correction in 3 patients was not complete on radiographs after operation.No loose screw or breakage was found,and the grafted bone was completely fused.Among the patients with spinal cord injury,one case in ASIA A improved to ASIA B,one case in ASIA B improved to ASIA C,two cases in ASIA C improved to ASIA D.All of the 4 cases with hemorrhage less than 4 mm(MIRI) increased 1 grade of ASIA.Activities of daily living(ADL)scores were increased (average,22.53?6.25)at early rehabilitation in all cases.[Conclusion]The upper-middle thoracic fractures are involved in multipla spine vertebral levels,high dislocation incidence,serious spinal cord injury(most cases were complete injury),poor prognosis.Presence of hemorrhage less than 4 mm (MRI) was associated with good prognosis.Posterior approach decompression and reduction followed by fusion with bone grafting and pedicle screws instrumentation are ideal surgical methods for patients with fresh fractures.Early rehabilitation may improve daily life ability and prevent complications.

[Objective]To compare the neurological improvement of the patients with spinal cord injury without radiographic abnormality (SCIWORA)after primary treatment including operation via anterior/posterior approach and conservative management,and to discuss about evaluating standard for this kind of patients.[Method]Eighty adult cervical SCIWORA patients,72 males and 8 females with an average age of 52.7 years(34 to 74 years)and a follow up period of 53 weeks (48 to 60 weeks),were retrospectively studied. They were divided into the anterior operated,posterior operated and conservative treated groups. The motor and sensory scores and impairment scale of each patient were obtained at least three times by international standard for the neurological classification of spinal cord injury (ASIA standard),and those of their first and final visits to the hospital were retrieved and analyzed. Mann-Whitney U Test and Wilcoxon Rank Sum Test were used in statistic study.[Result]All the patients achieved an average increase of 2 to 5 points of motor scores (P

Objective To evaluate the clinical efficacy and safety of bicyelol tablets in treatment of hepatitis B patients infected with YMDD mutation of HBV. Methods Sixty-eight chronic hepatitis patients infected with HBV YMDD mutants and 100 patients with non-mutants HBV were enrolled in the study. All patients received bicyclol tablets orally 150 mg/d, t. i. d, for 24 weeks. Clinical symptoms, signs and adverse effects were observed, and the blood routine, liver function tests, serum HBV markers and HBV DNA loads were examined at 12th and 24th week of the study, Results After treatment for 24 weeks, the normalization rates of ALT and AST in mutant group were 79.4% ( 54/68 ) and 70. 6% (48/68) ; 11 ( 16. 2% ) patients were markedly effective and 14 (20. 6% ) were effective. Clearance rates of HBeAg and HBV DNA were 27.9% ( 17/61 ) and 17.6% ( 12/68 ), while the seroconversion rate of HBeAg was 14. 7% (9/61). The differences of the above indexes were not statistically significant between mutant group and non-mutant group. Conclusion Bicyciol can both protect liver functions and inhibit virus replication in patients infected with HBV YMDD mutants.

Objective To explore the clinical effect of three-dimensional (3D) and two-dimensional (2D) laparoscopic radical resection of colorectal cancer.Methods The retrospective cohort study was adopted.The clinical data of 83 patients who underwent laparoscopic radical resection of colorectal cancer at the People's Hospital of Zhengzhou University from March 2014 to November 2015 were collected.Forty-two patients undergoing 2D laparoscopic radical resection of colorectal cancer between March 2014 and December 2014 were allocated into the 2D group and 41 patients undergoing 3D laparoscopic radical resection of colorectal cancer between January 2015 and November 2015 were allocated into the 3D group.All the patients in the 2 groups underwent 2D or 3D laparoscopic radical resection of colorectal cancer based on the principles of lymph node dissection and tumor-free survival.Observation indicators included:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected,(2) postoperative recovery:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,hospital expenses,(3) postoperative pathological situations:length of colorectal specimens,distance from tumor to distal incision margin,(4) follow-up.All the patients were followed up to detect postoperative survival,tumor metastasis and recurrence using outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed using the t test.Count data were analyzed using chi-square test or Fisher exact probability.Results (1) Surgical situations:all the patients underwent successful laparoscopic radical resection of colorectal cancer,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (171 ±18) minutes,(112±18)mL,14.0 ± 1.4 in the 2D group and (125 ± 13) minutes,(101 ± 16)mL,14.6 ± 0.9 in the 3D group,respectively,with statistically significant differences between the 2 groups (t =-13.091,-2.962,-3.623,P ＜0.05).(2) Postoperative recovery:recovery time of gastrointestinal function was (3.0 ± 0.6) days in the 2D group and (3.0 ± 0.6) days in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =3.423,P ＞ 0.05).Incidence of postoperative complications in the 2D and 3D groups was 7.1％ (3/42) and 4.9％ (2/41),respectively,with no statistically significant difference between the 2 groups (P ＞0.05).One,1,1 patients in the 2D group were respectively complicated with anastomotic fistula,intra-abdominal hemorrhage and intra-abdominal infection,1 and 1 patients in the 3D group were respectively complicated with anastomotic fistula and intestinal paralysis,and they were improved by symptomatic treatment.Duration of postoperative hospital stay and hospital expenses was (10.0 ±0.8)days,(7.0 ± 1.4) × 104 yuan in the 2D group and (10.0 ±0.6)days,(7.3 ± 1.5) x 104 yuan in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =15.716,0.941,P ＞ 0.05).(3)Postoperative pathological situations:length of colorectal specimens and distance from tumor to distal incision margin were (18 ± 7) cm,(4.7 ± 0.6) cm in the 2D group and (20 ± 8) cm,(4.9 ± 0.7)cm in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =0.742,1.401,P ＞0.05).(4)Follow-up:of 83 patients,82 were followed up for 5-24 months with a median time of 12 months.During the follow-up,there was no occurrence of tumor-related death and recurrence and metastasis of sites of puncture.Intra-abdominal tumor recurrence,recurrence of anastomotic tumor and tumor distant metastasis were detected in 3,2,1 patients in the 2D group and 2,1,1 patients in the 3D group,with no statistically significant difference between the 2 groups (P ＞ 0.05).Conclusion Compared with 2D laparoscopic radical resection of colorectal cancer,3D laparoscopic radical resection of colorectal cancer is safe and feasible,and it can also reduce intraoperative blood loss and increase the rate of lymph node dissected,with a good short-term outcome.

Objective To explore the clinical effect of three-dimensional (3D) laparoscopic radical gastrectomy of gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 65 patients with gastric cancer who underwent 3D laparoscopic radical gastrectomy of gastric cancer in the People's Hospital of Zhengzhou University from January 2015 to July 2016 were collected.There were the same surgical procedure and postoperative treatment between 3D and two-dimensional (2D) laparoscopic radical gastrectomy of gastric cancer.Observation indicators:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected;(2) postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay,treatment expenses and postoperative complications;(3) postoperative pathological situations:pathological classification of gastric cancer,T stage,lymph node metastasis,TNM stage,surgical margin;(4) follow-up situations.The follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor metastasis and recurrence up to July 2016.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:all the 65 patients underwent successful 3D laparoscopic radical gastrectomy of gastric cancer and D2 lymph node dissection,without the occurrence of conversion to open surgery,intraoperative complications and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (200± 55) minutes,(110± 80) mL and 32±7,respectively.(2) Postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay and treatment expenses were (3.1 ± 1.0) days,(5.3 ± 1.6) days,(9.4± 3.0) days and (8.1 ± 1.3) × 104 yuan,respectively.Of 65 patients,5 had postoperative complications.One patient with anastomotic leakage underwent percutaneous endoscopic gastrostomy and abdominal drainage again and then was cured.One patient with peritoneal effusion and infection was cured after catheter drainage under CT guided.One patient with delayed gastric emptying was cured after symptomatic treatment.One patient with chylous fistula was cured after short-term fast and total parenteral nutrition treatment.One patient with pulmonary infection was cured after antibiotic therapy.(3) Postoperative pathological situations:① Pathological classification of gastric cancer:high-and moderate-differentiated adenocarcinoma was detected in 30 patients,poor-differentiated adenocarcinoma in 20 patients,signet ring cell carcinoma in 11 patients,mucinous adenocarcinoma in 3 patients and papillary adenocarcinoma in 1 patient.② T stage:27,15 and 23 patients were in T1,T2 and T3 stages.③ Twenty-five patients had lymph node metastases and 40 had no lymph node metastasis.④ TNM stage:19,17,15,12 and 2 patients were in Ⅰ A,Ⅰ B,Ⅱ,Ⅲ A and Ⅲ B,respectively.R0 resection was performed to all the 65 patients,with negative surgical margin under the microscope.(4) Follow-up situations:of 65 patients,61 were followed up for 3-18 months,with a median time of 9 months.During the follow-up,there was no occurrence of surgeryrelated complications,tumor metastasis and recurrence and death.Conclusion The 3D laparoscopic radical gastrectomy of gastric cancer is safe and feasible,with a good short-term outcome.

[ ABSTRACT] AIM:To evaluate the clinical application of single nucleotide polymorphism array ( SNP array) in prenatal diagnosis for screening the abnormality of women with Down’ s syndrome ( DS) .METHODS:The amniotic fluid samples ( n=312) collected by amniocentesis for the DS screening abnormality women were tested by karyotyping and SNP array analysis, respectively.The findings of karyotyping and SNP array analysis were compared.RESULTS:Two cases of trisomy 21 were identified by karyotyping and SNP array analysis, but SNP array analysis failed to identify 6 cases of chro-mosome balanced structural rearrangement.SNP detected 176 cases copy number variants ( CNVs) in 303 cases normal karyotype were detected by SNP, including 106 benign CNVs, 61 variants of unknown significance (VOUS), 9 de novo CNVs, and none of them was pathogenic.The distribution difference of CNVs in DS screening positive group and DS screening positive plus advanced maternal age group was not statistically significant ( P>0.05) .Furthermore, we reported 14 kinds of CNVs for the first time in population.CONCLUSION:SNP array can further assure chromosome microdupli-cation/microdeletion.In normal karyotype fetus of prenatal diagnosis, SNP can detect some clinical significant CNVs.

Objective To study the clinical value of bedside ultrasound in predicting the fluid responsiveness in pa?tients with septic shock in intensive care unit (ICU). Methods Forty-two mechanically ventilated patients with septic shock who admitted to ICU of the Affiliated Hospital of North China University of Science and Technology from January 2015 to April 2015 were included in this study. All patients were treated with volume expansion (VE) text. Hemodynamics in?dexes were obtained by ultrasound before and after each test, including stroke volume (SV), aortic peak blood flow velocity variation rate of breathing (△VpeakAO), inferior vena cava expansion index (△IVC) and brachial artery maximum speed vari?ation rate (△VpeakBA). Clinical data and central venous pressure (CVP) were recorded. Based on the responsiveness of SV, patients were divided into responsive group (R) and non-responsive group (NR), respectively. The differences of the above in?dexes were compared between two groups. The correlation of△IVC,△VpeakAO,△VpeakBA and△SV was determined. The role of the hemodynamic index for predicting volume responsiveness was evaluated by receiver operating characteristic ROC curves. Results A total of 47 VE tests were performed in 42 patients, 25 in R group and 22 in NR group. Before VE test, the hemodynamics indicators of△IVC,△VpeakAO and△VpeakBA were significantly higher in R group compared with those of NR group (P<0.05). The values of△IVC,△VpeakAO and△VpeakBA were positively correlated with△SV in two groups. The areas under the ROC curve of the hemodynamics indicators were 0.825, 0.853 and 0.866 for △IVC, △VpeakAO and△VpeakBA, and they all showed high sensitivity and specificity. Conclusion The hemodynamic index measured by bedside ultrasound can predict the volume responsiveness in mechanically ventilated patients with septic shock fluid therapy, and which can be used to fluid therapy with a high degree of specific and sensitivity in clinical practice.

Objective: To investigate the ultrasound evaluation on lfuid responsiveness in patients with septic shock. Methods: There 42 septic shock patients treated by mechanical ventilation in our hospital from 2015-01 to 2015-04 were studied. All patients received volume expansion (VE) text, ultrasound examination was conducted to measure hemodynamic parameters of inferior vena cava variation rate of breathing (ΔIVC), aortic peak blood lfow velocity variation rate of breathing (ΔVpeakAO), brachial artery maximum speed variation rate (ΔVpeakBA) and stroke volume (ΔSV) at before and after text. Based on the response to VE text, the patients were divided into 2 groups as Responsive group and Non-responsive group, the above indexes and their correlations to ΔSV were analyzed. The clinical values of those parameters for predicting volume responsiveness were evaluated by ROC curves. Results: A total of 47 VE tests were conducted in 42 patients including 25 cases in Responsive group and 22 cases in Non-responsive group. Before VE test, the parameters of ΔIVC, ΔVpeakAO and ΔVpeakBA were higher in Responsive group than Non-responsive group; ΔIVC, ΔVpeakAO and ΔVpeakBA were obviously related to ΔSV (r=0.631, 0.668 and 0.619). The area of ΔIVC, ΔVpeakAO and ΔVpeakBA under ROC curves were 0.817, 0.853 and 0.866 respectively, they were all with the high sensitivity and speciifcity. Conclusion: Ultrasound monitored hemodynamic parameters may predict the volume responsiveness in septic shock patients with mechanical ventilation, it could be used for guiding liquid treatment in relevant patients.

Objective To investigate the possible mechanism of glomerular injury in diabetes mellitus by determining whether epithelial-mesenchymal transition (EMT) is caused by high glucose in mice podocytes. Methods Using mice glomerular podocyte cell line as an in vitro system, podocytes were incubated with glucose(12.5 mmol/L, 25 mmol/L, 50 mmol/L) and mannitol (50 mmol/L) for 36 hours. Then the cells were collected and expression of alpha-smooth muscle actin(α-SMA), fibronectin (FN), CD2 associated protein (CD2AP) and Wilms' tumor 1 gene (WT-1) was detected by Western blot and indirect immunofluorescence staining. Results Under low glucose (5.6 mmol/L) and mannitol (50 mmol/L) condition, there were high expression of CD2AP and WT-1, and low expression of α-SMA and FN in mice podocytes. After 36 hours treatment with high glucose (12.5 mmol/L), the expression of α-SMA and FN in podocytes was significantly increased, and the expression of α-SMA and FN was further up-regulated with the increase of glucose dosage (25, 50 mmol/L). The indirect immunofluorescence staining revealed the similar result, and the percentage of positive α-SMA cells was also increased compared with low glucose and mannital group (P<0.05). Meanwhile, Western blot showed that high glucose could down-regulate the expressions of CD2AP and WT-1 in a dose-dependent manner. Conclusion EMT may be a potential pathway leading to podocyte dysfunction and glomerular injury under high glucose conditions.