Humans ; Nasal Cavity ; injuries ; Paranasal Sinuses ; Pharynx ; injuries ; Wounds, Penetrating ; diagnosis ; therapy

Objective To evaluate the thoracolumbar injury severity score [ thoracolumbar injury classifica-tion and severity score(TLICS)]and repeatability,and analyze its clinical significance in the treatment of injury of thoracolumbar.Methods The clinical and imaging data of our hospital (thoracolumbar X ray,CT examination,MRI examination) of intact thoracolumbar fractures in 90 patients were retrospectively analyzed ,respectively,TLICS score were made for their site of spinal injury morphology ,neural function and the posterior ligament complex three .Three months after reviewed ,TLICS was analyzed by using Cohen weighted kappa coefficient score .Its repeatability was ana-lyzed.Results According to the TLICS system ,spinal injury body ,nerve function and the integrity of the posterior ligamentous complex were evaluated , respectively, the repeatability coefficient of Kappa , the calculated total to 0.47 non operation group,operation group,the total score was 0.46,with a moderate consistency.The neural function evaluation of the highest high consistency ,consistency .No significant differences between the two groups of repetitive Kappa coefficient(statistical values =0.674 5,P>0.05).According to the TLICS system of statistical accuracy ,the diagnostic sensitivity,specificity ratios was 95.8%,86.4%,97.6%,respectively.Conclusion The reliability of TLICS system for thoracolumbar treatment and recovery is higher ,relative comprehensive evaluation ,which can effec-tively guide the clinical treatment .

ObjectiveTo compare the therapeutic effect of mininal]y invasive removal of intracranial hematoma and conservative treatment in curing hypertension cerebral hemorrhage of elderly patients.Methods60 patients with hypertension cerebral hemorrhage were divided into two groups.Group A were adopted minimally invasive removal of intracranial hematoma(YL-1 type puncture needle was used into the hematoma edge,and sucked slowly the hematoma), and group B were adopted medical treatment(antihypertensive drugs, dehydration, free radicals and nutrition conservative treatment) ,then clinical therapeutic effect and activity of daily living were observed.ResultsThe hematoma evacuation time in group A (4.5 ± 1.2) d is shorter than in group B (17.0 ± 1.9) d (t = 6.04 ,P ＜ 0.05) ; The rate of neurological function recovery in group A (66.7％) is higher than in group B(93.3％) (x2 = 5.46,P ＜0.05) ; The activity of daily living in group A (80.0％) was better than group B (50.0％) (x2 = 5.93, P ＜ 0.05).The complication rate in group A (30.0％) is lower than in group B (66.7％) (x2 = 8.08, P ＜ 0.05).ConclusionThe therapeutic effect of minimally invasive removal of intracranial hematoma in curing hypertension cerebral hemorrhage was better than medical treatment.

Objective To evaluate the efficacy and the side effects of whole body hyperthermia(WBH) combined with chemotherapy for the treatment of advanced non-small cell lung cancer. Methods 24 patients were included in trial group(16 male and 8 female), 15 patients in Ⅲb stage and 9 patients in Ⅳ stage.6 patients had received chemotherapy before, received 1 course of WBH combined with Docetaxel; 18 cases were previously untreated, received 1 course of WBH combined with Paclitaxel and Carboplatin, then another course chemotherapy in the same time period. 26 patients were included in control group (17 male and 9 female), 16 patients in Ⅲb stage and 10 patients in Ⅳ stage. 6 patients had received chemotherapy before, were treated with Docetaxel at least 2 courses with 3 weeks interval. 20 cases, previously untreated, were treated with Paclitaxel combined with Carboplatin at least 2 courses with 3 weeks interval. Efficacy was evaluated 4 weeks after 2 courses of chemotherapy. Results The response rate was 58.3, and 30.8 in control group. The common side effects were gastrointestinal toxicity , nerve toxicity and leucopenia, but these side effects were all mild. Conclusions WBH combined with chemotherapy is an effective regimen for the treatment of advanced non-small cell lung cancer with acceptable toxicity.

Objective To investigate the diagnostic value of procalcitonin(PCT)as an early indicator for sepsis.Methods Serum levels of PCT and C-creative protein(CRP)and white blood cell (WBC)count were measured in 30 patients in critical condition hospitalized at an intensive care unit(ICU) with diagnosis of systemic inflammatory response syndrome(SIRS).They were divided into two groups, sepsis and non-sepsis,based on their clinical manifestations and results of lab tests.Blood specimen was collected from each patient for measurement of PCT,CRP and WBC count on the 1~(st),3~(rd)and 7~(th)day after hospitalization and bacteriological culture for blood and sputum,and chest X-ray was performed,as well. Acute physiology,age and chronic health evaluation(APACHE Ⅱ)was made on the 1~(st),3~(rd)and 7~(th)day after hospitalization to assess their ill condition.Their prognosis were judged on the 28~(th)day of the follow-up. Results Serum level of PCT increased significantly in the sepsis group(with the highest of 10.13 ng/ml), as compared with that in the non-sepsis group.Sensitivity,specificity and predictive value of a positive test for a cut-off value of serum level of PCT at 0.5 ng/ml were 97.0%,91.7% and 82.1%,respectively, which were all better than those of serum level of CRP and WBC count.Serum level of PCT in the patients was significantly associated with their prognosis,and PCT in those died was significantly higher than that in those survived.Whereas,serum level of CRP and WBC count elevated in both groups,but the difference between the two groups did not reach a level of statistical significance.Conclusion Serum level of PCT can be used as an early indicator for judgment of sepsis for a patient with infection and reflection of severity of illness.

Objective To Summary the first 40 cases underwent robotic atrial septal defect (ASD) closure or atrial septal defect closure combined bicuspid valve plasty (TVP) using da Vinci S surgical System on beating heart. Methods 40 cases of atrial septal defect or combined sever tricuspid valve regurgitation were repaired using da Vinic S surgical system on beating heart from March 2009 to December 2010 in cardiovascular department of PLA general hospital. The average age was (38 ± 13) yeas old. 23 cases were female and 17 cases were male. All patients were ostium atrial septal defect with or without pulmonary hypertension. The atrial defect diameter was 1.5 -3.5 cm, and the mean diameter was(2. 8 ±1.3)cm. 9 patients had sever tricuspid valve regurgitation. Without sternotomy, the extracorporeal circulation was established through groin artery,groin vein and internal jugular vein cannulation with the guidance of transeophageal echocardiography. 3 ports of 8 mm and 1 working port of 2 cm were made in the right chest wall. After da Vinci S syetem was set up, with the assistant of bed-side surgeon, the surgeon completed the atrial septal defect closure or combined tricuspid valve plasty in the surgeon console with three dimensions visualization. During the operation, without cardioplegia administrated and aortic occlusion, the procedure was completed through right atriotomy. The pleural space was insufflated with carbon dioxide to avoid the air embolism. The direct suturing was used in 22 cases and pericardial patch were used in 18 cases. 9 patients accepted concurrent De Vega tricuspid valve plasty. The transesophageal echocardiography were used to evaluate the result of atrial defect closure or tricuspid valve repair. The operation time, robotic using time and cardiopulmonary time were compared with totally robotic atrial defect repair in arrested heart. Results All cases were accomplished successfully without complication. There was no residual shunt and air embolism. The operation time, robotic using time and cardiopulmonary time were less than the arrested group. Conclusion Robotic atrial septal defect closure or combined tricuspid valve repair on beating heart can avoid aortic ocllusion and can be utilized effectively and safely.

BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method.
OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures.
METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups.
RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

Objective To investigate whether the combination of hydroxyapatite/tri-calcium phosphase (HA/TCP) and distraction osteogenesis technique would greatly reduce the time for the treatment of bone defects and enhance bone consolidation.Methods Osteotomy was made in the left tibia of all the 36 rabbits (age 20-24 weeks,body weight 2.2-2.8 kg),and a 1.0 cm length of the tibial shaft was removed below the tibiofibular junction.All rabbits were randomly divided into 3 groups,12 per group.Group A:The 1.0 cm defect gap was immediately reduced with the tibia shortened for 1.0 cm.Group B:The 1.0 cm defect gap was immediately filled with 1.0 cm restorable porous HA/TCP cylindrical block.Group C:The 1.0 cm defect gap was immediately reduced with the tibia shortened for 0.5 cm,and the remaining 0.5 cm defect gap was filled with 0.5 cm restorable porous HA/TCP cylindrical block.Then all the tibia was fixed with unilateral lengthener.For Group A and Group C,the lengthening started on the seventh day postoperatively,and lasted for 10 days and 5 days respectively.Group B didn't perform lengthening.All the rabbits wore terminated on the 37th days postoperatively.Serial radiographs were taken on the day of surgery,12,17,27 and 37 d postoperatively.The excised bone specimens were subject to micro-CT,mechanical testing,and histological examinations.Results Compared with the other two groups,the results in Group C were better in the terms of bone mineral content 454.44 ±89.98 mg,tissue mineral content 454.40±89.97 mg,maximum torque,maturity of regenerate bone,and the speed of bone consolidation and remodeling.Complete bone healing was achieved in the Group C within 37 days,but not in the Group A and B within 37 days.Conclusion The combination of HA/TCP and distraction osteogenesis technique can reduce the treatment time and promote bone consolidation compared with single treatment.

Objective The aim of this study is to address learning curve and clinical outcomes of totally robotic atrial septal defect repair on the basis of a single - center experience.Methods 54 cases of atrial septal defect (ASD) were repaired using “da Vinic S surgical system on arrested ( group Ⅰ,54 cases) or beating heart ( group Ⅱ,40 cases) from January 2007 to December 2010.Learning curves were assessed by means of regression analysis with logarithmic curve fit.The effect of operative variables on clinical outcome was analyzed by linear by regression using the Spearman's rho coefficient.Results All cases were accomplished successfully without complications.No residual shunt was detected at intraoperative or postoperative echocardiography.Significant learning curves were noted for corss clamp time in group Ⅰ:y (min) =68.741 -8.283 (n) (x)( r2 =0.489 ; P ＜ 0.01 ) ; the operation time in group Ⅱ:y (min) =355.51 - 56.29 (n) (x) ( r2 =0.581 ; P ＜ 0.01 ).No correlation was detected between operation time,cardiopulmonary bypass time,or cross clamp time and intubation time,intensive care unit stay,or total length of stay.Conclusion The robotic atrial septal defect repair can be performed safely.The learning curves is steep and the longer cardiopulmonary bypass times,operation time or cross clamp time had no negative impact on intraoperative and postoperative outcome.