Objective To investigate the common causes of hypokalemia of inpatients in department of endocrinology.Methods Fifty-nine inpatients with hypokalemia were analyzed retrospectively.Results 84.7％(50/59) of patients with hypokalemia was clearly caused by endocrine diseases,among which 33.9％ (20/59) was diabetes mellitus,25.4％ (15/59) was hyperthyreosis,others were rare endocrine diseases,for example primary hyperaldosteronism and Cushing syndrome,et al.Conclusions Endocrine disease is an important reason of hypokalemia.The doctor should attach importance to the diagnosis and treatment of hypokalemia caused by endocrine disease.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.

Objective To compare the accuracy,convenience and repeatability of 3DUS-US and CT-US image fusion technology based on electromagnetic positioning.Methods A tissue-mimicking phantom was established and used to obtain ultrasound or CT volume images.Two different operators performed 3DUS-US and CT-US image fusion and repeated 10 times,respectively.The success rate,the registration error distance and fusion time of two techniques were recorded and compared between the different operators.Results The ultrasound and CT images of the phantom and its stability could meet the demands of this experiment.3DUS-US and CT-US image fusions were successful.The registration error distance of 3DUS-US image fusion was (1 .70 ± 0.42)mm and fusion time was (76.00 ± 9.99)s,they were obviously superior to CT-US (P = 0.014,P < 0.001 ).There were no significant differences between the two operators in the registration error distance and fusion time of 3DUS-US (P =0.508,P =0.5 1 7).But the registration error distance of CT-US image fusion in experienced operator was lower than the junior (P =0.009),and fusion time had not statistical difference between the two operators (P =0.234).Conclusions The technique of 3DUS-US automatic image fusion based on electromagnetic positioning has advantages of convenience and no experiential dependence comparing with CT-US in the phantom experiments,so it is worthy of being widely popularized in clinical application.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound (3DUS) automatic image fusion based on hepatic vessel in clinical application.Methods Forty pairs of 3D ultrasound volumetric images from 10 healthy volunteers were acquired and enrolled in the study,including 10 pairs of each following lobe of the liver:left lateral lobe,left medial lobe,right anterior lobe and right posterior lobe.3DUS automatic registrations were performed based on hepatic vessel.The technical successful rate and accuracy of the image fusion using the 3DUS data from four hepatic lobes were observed and compared.Results Thirty-six pairs of volumetric data were successfully fused together by automatic registration.The technical successful rate was 90％ (36/40) and the registration error distance was 1.48 mm (0.98-2.76 mm).There were no statistical differences in the successful rate for the four different hepatic lobes (P =0.891),but the registration error of right anterior lobe was less than left lateral lobe of liver (P =0.014).Conclusions The new technology of 3DUS automatic registration based on hepatic vessel was feasible and reliable,and it has a wide prospect in future clinical application.

Objective To discusse the feasibility and application value of the computer-assisted liver cancer ablation planning based on the three dimensional ultrasound.Methods Forty three-dimensional ultrasound images of 39 patients with 40 tumors'maximum diameter between 21 to 70 mm were collected and then acquired image segmentation and visualzation.The computer-assisted liver cancer ablation planning based on three dimensional ultrasound was comparied with the artificial ablation planning based on two dimensional ultrasound to find out the differences in the success rate,damage rate,time-consuming and the number of insertions between these two methods.Results Compared with the artificial ablation planning based on two dimensional ultrasound,the computer-assisted liver cancer ablation planning had a higher success rate(92.31% vs 53.85%,P =0.000),lower damage rate(7.50% vs 25.00%,P =0.034),shorter time-consuming(44.0 s vs 263.0 s,P =0.000)and less insersion times(3 vs 4,P =0.009).Conclusions The computer-assisted liver cancer ablation planning based on three dimensional ultrasound is more efficient and safety than the traditional way.

Objective: To establish the aortic regurgitation model in Chinese miniature pigs under echocardiography guidance. Methods: The animal models were established by following steps: general anesthesia, measuring body weight and then receiving echocardiography examination to exclude aortic valve lesions; carotid artery was exposured by surgery, catheter was sent to aortic sinus with stiff guide wire penetrates and the position of catheter was adjusted to obtain aortic valve damage. The aortic valve injury and regurgitation were evaluated by ultrasound; then the pigs were killed and the heart was taken to observe aortic valve damage. Results: A total of 7 pigs were used including 4 male and 3 female with the mean body weight of (24.7 ± 3.6) kg. Aortic regurgitation model was successfully established in 5 pigs including 1 mild, 1 mild-moderate, 2 moderate, 1 severe aortic valve regurgitation, and 4 were with valve lealfets perforation and 1 with lealfets tearing. Conclusion:①Echocardiography can smoothly guide wire go through aortic valve and make valve damage at different degrees, it is reliable to establish aortic valve regurgitation model in experimental pigs.②Echocardiography may clearly identify the position and degree for aortic valve injury.

Purpose: Laparoscopy is being increasingly accepted for pancreaticoduodenectomy. Stapled anastomosis (SA) is used extensively to facilitate laparoscopic pancreaticoduodenectomy (LPD); however, the incidence of anastomotic bleeding after stapled gastrointestinal anastomosis is still high. Methods: One hundred and thirty-nine patients who underwent LPD using Whipple method were enrolled in our study. We performed the SA with our reinforced method (n = 68, R method) and without the method (n = 71, NR method). We compared the clinical characteristics and anastomosis methods of patients with or without gastrointestinal-anastomotic hemorrhage (GAH), and operative parameters were also compared between the anastomotic methods. Results: Of the 139 patients undergoing LPD, 15 of them developed GAH. The clinical characteristics of patients with or without GAH were not significantly different except in the anastomotic method (P < 0.001). In the univariate logistic regression analyses, only the anastomotic method was associated with GAH. Furthermore, patients with the NR method had significantly higher incidences of GAH (P < 0.001) and Clavien-Dindo grade ≥ III complications (P < 0.001). Conclusion Our retrospective analysis showed that the SA performed with reinforced method might be a reform of SA without the reinforcement, as indicated by the lower incidence of GAH. However, further research is necessary to evaluate the utility of this reinforced method.

OBJECTIVETo evaluate the biomechanical effects of the anterior cervical transpedicular-screw system (ACTPS), compared to the anterior cervical screw plate system (ACLP), in the subaxial cervical spine after 2-level corpectomy.

METHODSA verified intact finite element subaxial cervical (C3-C7) model was established and analyzed by Mimics 10.0, Rapidform XOR3, Hypermesh 10.0, CATIA5V19, ANSYS 14.0 softwares based on the CT data (C1-T1) was collected from a 28 years old male volunteer. The axial force of 75 N and moment couple of 1N·m was loaded on the upper surface of C3, which made the model movement in flexion extension, lateral bending, rotating direction, respectively. Then, recorded the range of motion, and compared the results with the in vitro biomechanical experimental data to verify the effectiveness of the model. The ACTPS model and the ACLP model were analyzed using the finite element method. The range of motion at the operation segments (C4-C7), the range of motion at the adjacent segment (C3-C4) and stress distribution under flexion, extension, lateral bending, and axial rotation were calculated, and compared the range of motion with intact model.

RESULTSThere were 85,832 elements and 23,612 nodes in the intact model of subaxial cervical spine (C3-C7) in this experiment,and the range of motion of intact model validated with the reported cadaveric experimental data. In ACTPS group the stress was been well-distributed, but the stress concentrated on the interface between screw and the titanium plate in ACLP group. There were obvious differences of the maximum stress value between the two groups. The range of motion of fixed segments in ACTPS group was smaller than ACLP group, however adjacent segment range of motion showed no significant difference. Compared with the intact group, the range of motion in flexion extension, lateral flexion, rotation direction was decreased respectively about 25°, 20° and 8°, the range of motion at adjacent segment (C3-C4) was correspondingly compensated about 0.3°, 3° and 0.1°.

CONCLUSIONSACTPS is better than ACLP in terms of biomechanical properties. It offers rigid stability, and may be more suitable for reconstruction stability of 2-level and more than 2 levels corpectomy in the subaxial cervical spine. Meanwhile, the risk of fracture of ACTPS system is lower than that of the ACLP system.

Adult ; Biomechanical Phenomena ; Bone Screws ; Cervical Vertebrae ; surgery ; Finite Element Analysis ; Humans ; Male ; Models, Anatomic ; Range of Motion, Articular ; Rotation

Objective To analyze the causes of revision surgery after percutaneous transforaminal endoscopic discectomy (PTED) for lumbar spinal stenosis,and to provide references for indications and operative methods.Methods From January 2015 to October 2017,206,491 and 60 patients of lumbar spinal stenosis were treated with PTED in Tianjin Hospital,Shanxi People's Hospital,Ningbo Sixth Hospital,respectively;among them,4,10 and 4 cases received revision surgery.Another 13 patients of lumbar spinal stenosis were treated with revision surgery due to poor results after PTED in other hospitals.Among 31 cases of reoperation,there were 16 males and 15 females,aged 27-82 years (average,66.2±12.7 years).The lesion segments included 1 case of L3,4,23 cases of L4,5,5 cases of L5S1,1 cases of L3-L5,and 1 cases of L4-S1.Patients were followed up after reoperation from 3 to 24 months (average,12.1 months).The causes of poor result and revision surgery were analyzed according to preoperative,intraoperative and postoperative data.Results All of 757 cases of lumbar spinal stenosis were treated with PTED in three hospitals,of which 18 cases (2.4％) were re-operated.The causes of reoperation included:bone slice displacement in 1 case;nerve injury in 4 cases;lumbar instability in 4 cases;disc protrusion in 10 cases (residual or recurrence);insufficient decompression in 21 cases;planed staging operation in 4 cases with bilateral or two-level stenosis.32 revision surgeries were performed for 31 patients,including PTED in 15 cases,microendoscopic discectomy (MED) in 1 case,mobile MED (MMED) in 5 cases,MMED assisted fusion in 2 cases,transforaminal lumbar interbody fusion (TLIF) in 4 cases,Minimally invasive TLIF (Mis-TLIF) in 2 cases,and open decompression and fusion in 3 cases.All patients experienced relieve of symptoms after revision surgery.At final follow-up,VAS leg pain deceased form 7.1±3.9 before revision surgeries to 1.9±1.2,VAS low back pain decreased form 6.3±3.2 to 1.8±1.3,ODI score decreased from 35％± 14％ to 7.6％±5％.According to the MacNab score,the result was excellent in 11 cases,good in 16 cases,and fair in 4 cases.Conclusion The treatment of lumbar stenosis with PTED has high technical requirements,the indications of PTED for lumbar stenosis should be strictly controlled according to technical conditions,and appropriate operative methods should be chosen according to the specific conditions of the lesions.Insufficient decompression,disc protrusion,lumbar instability and nerve injury are the common causes of reoperation.Suitable indications and proper operation should be selected.

Objective Retrospective study and report on cases of "symptomatic facet of residual bone mass" caused by percutaneous transforaminal endoscopic discectomy (PTED),to analysis of its causes and revision strategies.Methods Seven cases of "symptomatic facet of residual bone mass" after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment,to analysis of the causes,clinical features and revision strategies of the rare complication.Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers).The average age of the subject is 67.29±9.64 years (range from 57-83 years).Among them there were 1 male and 6 female.PTED was performed for all cases with lumbar disc herniation or stenosis.The operative segments were 1 of L2,3,2 of L3,4,3 of L4,5,1 of L5S1.Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later.Two cases were appeared symptom of contralateral irritation,and the rest were aggravated by the original symptoms.Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac.The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness.Foraminoplasty was performed during PTED in all patients.After CT scan,5 cases of bone mass were found on the same side of operation,and 2 cases were in the contralateral side.The shortest time for revision was 2 days and the longest 3 months.After conservative treatment,the symptoms were relieved in only one case.Revision surgeries were performed for all the other 6 cases,2 with microendoscopic discectomy (MED),1 mobile microendoscopic discectomy (MMED),1 small incision operation,1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF).The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55.Conclusion FTED may lead to residual bone mass in lumbar foraminoplasty.The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment.The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms.A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective.