Objective To summarize the curative effect of ERCP and EST before laparoseopic cholecystec-tomy for treatment of patients with cbolelithiasts concurrent with choledoeholithiasis. Methods A retrospec-tive analysis was carried out for 43 cases of cholelithiasis concurrent with choledocholithiasis from January 2006 to December 2008. Results The procedures were successfully accomplished in 40 patients, the suc-cess rate was 93%. The successful clearance rate of common bile duct stone was 95.2%. Complication oc-curred in 2 cases, including 1 case of papilla bleeding and 1 case of hyperamylesemia. All complications were cured with non-operating treatment. Conclusions ERCP and EST before laparoseopic cholecystectomy is the best treatment and diagnosis method in gallbladder stone with common bile dust stone. It is very impor-tant to improve the success rate of LC, decrease complication and occurrence of the open operation of com-mon bile duct stone.

Objective To assess the incidence,risk factors and mortality of acute kidney injury(AKI)in patients with chronic myelogeneous leukemia(CML)after myeloablative allogenetic hematopoietic stem cell transplantation(HSCT). Methods Renal function in 93 CML patients undergone myeloablative allo-HSCT was retrospectively analyzed by the RIFLE criteria. Results Thirty-nine patients (41.9%) developed AKI at a median of 40 days after allo-HSCT, including 24 AKI-R patients(25.8%), 10 AKI-I patients(10.8%) and 5 AKI-F patients (5.4%). The morbidity of AKI in patients with ≥Ⅲ acute graft-versus-host disease (aGVHD) and without ＜Ⅲ GVHD was (81.82±11.63)% and (36.59±5.32)% (P=0.0037)rospectively. The morbidity of AKI in patients with increased total bilirubin and without increased total bilirubin was (72.73±13.43)% and (37.04±5.37)%(P=0.0192) respectively. ≥Ⅲ aGVHD was peor-prognostic factor of AKI and RR was 2.773 [95%CI (1.073-7.167), P=0.035]. RR of AKI-I and AKI-F in patients with ≥Ⅲ aGVHD was 6.320195%CI (1.464-27.291), P=0.013]. The mortality within 100 days after allo-HSCT of patients with AKI was significantly different as compared to patients without AKI (P=0.001). Six-mouth survival rates of different class AKI patients after myeloablative allo-HSCT were (86.96±7.02)% (AKI-R), (70.00±14.49)% (AKI-I), 0 (AKI-F) (P=0.000)respectively. Conclusions AKI is one of the main complications in CML patients after myeloablative allo-HSCT. ≥Ⅲ aGVHD and increased total bilimbin are poor-prognostic factors of AKI, and higher morbidity of AKI-I and AKI-F can be found in patients with ≥Ⅲ aGVHD. With the deteriorated AKI, 6-month survival is decreased. RIFLE criteria is sensitive to the early diagnosis of renal function. Moreover RIFLE can monitor the progression of AKI and predict the clinical outcome.

Objective To analyze morbidity and prognosis of acute kidney injury (AKI) in patients with acute leukemia after myeloablative allogenetic hematopoietic stem cell transplantation (HSCT).Methods Renal function and related clinical data in 66 patients receiving myeloablative alloHSCT were retrospectively analyzed.Renal function was evaluated by RIFLE criteria,which defines AKI as three grades of severity-risk (AKI-R),injury (AKI-I) and failure (AKI-F).Results Thirtyseven recipients (56.1%) developed AKI at a median of 29 days after allo-HSCT,including AKI-R(19 recipients,28.8 %),AKI-I (11 recipients,16.7 %),AKI-F (7 recipients,10.6 %).Compared with baseline value,serum creatinine level in the recipients was significantly increased at the 21st day after transplantation (P＜0.05).During 100 days after HSCT,the morbidity of AKI-F in recipients with HVOD and without HVOD were respectively (55.56 ± 22.22)% and (9.01 ± 4.75)% (P＜0.01).The morbidity of AKI in recipients with or without increased total bilirubin was respectively (68.75 ± 24.54)% and (8.38 ± 4.17)% (P＜0.01).The morbidity of AKI in recipients with or without increased CsA concentration was respectively (66.67 ± 10.29) % and (44.44 ± 8.28) % (P＜0.05).100-day survival rate in recipients after myeloablative allo-HSCT without AKI,with AKI-R,AKI-I and AKI-F was respectively (89.66 ± 5.66) %,(83.88 ± 8.54) %,(81.82 ± 11.63) % and (42.86 ± 18.7) % (P＜0.05).Conclusion AKI is one of the main complications in patients with acute leukemia after myeloablative allo-HSCT.The influence of different class AKI on the mortality was different.The earlier diagnosis,prophylaxis and treatment of AKI by the RIFLF criteria might increase the survival rate in recipients with HSCT.

Objective To investigate the therapeutic effects of enhanced external counterpulsation (EECP) on cerebral edema and cerebral blood flow perfusion with MRI following cardiac arrest (CA) and on successful return of spontaneous circulation (ROSC) by cardiopulmonary resuscitation (CPR) in dogs.Methods Sixteen beagle dogs were induced CA with alternating current on epicardium,then were randomly (random number) divided into the EECP and control group after successful ROSC.MR scanning brain of all animals was carried out by diffusion-weighted imaging (DWI) and perfusion weighted imaging (PWI) before CA and on the first,second and third days after ROSC.Blood pressure,right common carotid artery flow,and intracranial microcirculation perfusion were measured.Results There were no significant differences in mean artery pressure at all intervals between two groups (P ＞ 0.05).There was significant increase in right common carotid artery blood flow and intracranial microcirculation of dogs in EECP group compared with the control group (P ＜ 0.05).Apparent diffusion coefficients (ADC) of water molecule on the first and third days after ROSC were significantly higher in the EECP group than those in the control group (P ＜ 0.05).Ratios of post-ROSC relative cerebral blood flow (RCBF) /original cerebral blood flow were higher in the EECP group than those in the control group on the first,second and third days after ROSC (P ＜ 0.05).Conclusions EECP treatment could improve cerebral blood flow perfusion and relieve ischemic cerebral edema,alleviating brain injury in dogs following CA and successful ROSC.

Purpose/Significance To conduct the real world research on the application and impact of artificial intelligence(AI)technology in medical institutions,and to assist in intelligent governance decision-making in the field of medicine and health.Method/Process Taking Peking University Third Hospital as the research scene,the AI medical social experiment is carried out through literature meta-analysis,knowledge graph construction and mixed methodology research.Result/Conclusion Scholars at home and abroad are cautious and optimistic about the application of AI technology in the field of health.The research,development and application of AI technology in domestic public hospitals are very active,but small-scale field studies suggest that AI technology may lead to problems such as misleading decision-making and weakening of human subjectivity while improving the efficiency of diagnosis and treatment.In-telligent governance in the field of health,represented by AI technology,requires a long period and a wide range of sociological observa-tions.It is recommended to build a research base for medical AI technology R&D and supervision based on public hospitals,and continue to pay attention to issues such as human subjectivity,medical ethics and scientific and technological ethics in AI social governance.

Objective　To investigate the relationship between tinnitus and glucose metabolism in auditory cortex and whether positron emission tomography (PET) can be an objective tool in measuring tinnitus. Methods　Eleven right-handed patients with severe tinnitus and ten right-handed control subjects participated in the 18　 F-FDG/PET study. Analysis with regions of interests was used to calculate asymmetry indices according to the formula: ［(L-R)×100/［(L+R)÷2］］. Results　Glucose metabolism in the auditory cortex of tinnitus patients was asymmetric between the left and right auditory cortices, with that of the left being much higher than that of the right. The asymmetry indices of tinnitus patients was significantly higher than that of the control group (unpaired t test, P<0.001). This revealed that the increased metabolic activity was present in the predominant left hemisphere with a significant focus on the superior and transverse temporal gyri (Brodmann areas 41 and 42, respectively corresponding to primary and secondary auditory cortex), and the results were independent of the subjective localization of the tinnitus sensation. Conclusion　It is suggested that the increased metabolism in the left auditory cortex is related to the tinnitus sensation. PET is capable of providing objective evidence for tinnitus and may be used as a potential tool in measuring tinnitus.

Objective To analyze the outcomes and the prognostic factors of hematopoietic stem cell transplantation (HSCT) in combination with imatinib for Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Methods All 32 patients with Ph+ ALL achieved hematologic complete remission (CR) at time of transplantation, including 27 cases in the first CR (CR1) and 5 in CR2. Nineteen patients achieved molecular remission (MR). Among 32 patients, 4 received autologous HSCT (AHSCT), and 28 allogeneic HSCT (allo-HSCT). The conditioning regimens comprised of total body irradiation (TBI), cyclophosphamide, fludarabine and cytarabine. The median number of transfused mononuclear cells was 5. 6 × 108/kg, and that of CD34+ cells was 2. 94 × 106 /kg. Thirty-one patients were administrated imatinib orally before transplantion, at a dose of 400～600 mg/day, and 16 patients after transplantation, including 7 for prevention at a dose of 300～400 mg/day and 9 for salvage treatment at a dose of 400 ～ 600 mg/day. Results Hematopoietic reconstitution was achieved in all 32 patients. Three-year estimate of overall survival (OS) was (62. 1±8. 6)%, leukemia-free survival (LFS) (59. 2 ± 8. 7)%, relapse rate (RR) (17. 7 ± 7. 2)% and transplant-related mortality (26. 2 ± 8. 0) %. All 4 undergoing AHSCT were alive, and 3 out of them were in continuous CR with durations of 14, 18 and 67 months respectively. The univariate analysis for prognosis in allo-HSCT showed that the OS of HLA-matched sibling donors group was 76. 5 %,higher than that of unrelated or haploidentical donors group (27. 3 %, P＜0. 05), and so was LFS (70. 6 % vs 27. 3 %, P＜0. 05). RR in patients achieving MR at time of transplantation was 5. 6 %,lower than that in those not achieving MR (40. 0 %, P＜0. 05). RR in patients in CR1 at time of transplantation was 12. 5 %, lower than that in those in CR2 (50 %, P ＜0. 05). Conclusion Imatinib improved the outcomes of HSCT for Ph+ ALL, especially to patients achieving MR at time of transplantation and transplantation in early stage (CR1).

Objective:To evaluate the efficacy between pedicle screws combined with vertebroplasty (PSV) and pedicle screws combined with intermediate screws (PSIS) for the treatment of osteoporotic thoracolumbar fracture (OTLF).Methods:PubMed, Cochrane Library, Web of Science, CNKI, VIP and Wanfang database were searched for all randomized controlled trial (RCT) or case-control trial (CCT) studies that comparing PSV and PSIS for the treatment of OTLF. Two reviewers independently screened the studies in the light of the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. The Meta-analysis was performed using the RevMan 5.4 software. The subjects were divided into PSV group and PSIS group according to different treatment methods. Operation time, intraoperative blood loss, postoperative incision infection rate, postoperative short-, mid- and long-term visual analogue scale (VAS) score, postoperative short- and mid-term Oswestry disability index (ODI), hospitalization time, postoperative short-, mid- and long-term Cobb angle, postoperative short-, mid- and long-term anterior vertebral height ratio (VBH) and implant failure rate were compared between the two groups.Results:A total of 12 studies were enrolled for review, involving 870 subjects (433 in PSV group and 437 in PSIS group). The results showed insignificant difference between the two groups in operation time ( WMD=7.07, 95% CI -4.00, 18.13, P>0.05), intraoperative blood loss ( WMD=0.62, 95% CI -7.19, 8.43, P>0.05), postoperative incision infection rate ( OR=0.65, 95% CI 0.10, 4.08, P>0.05), postoperative short-term Cobb angle ( WMD=-0.19, 95% CI -0.43, 0.05, P>0.05) and postoperative short-term VBH ( WMD=0.91, 95% CI -1.30, 3.13, P>0.05). However, there was significant difference between the two groups in postoperative short-term VAS score ( WMD=-0.59, 95% CI -1.02, -0.15, P<0.05), mid-term VAS score ( WMD=-0.41, 95% CI -0.65, -0.16, P<0.05), long-term VAS score ( WMD=-0.51, 95% CI -0.59, -0.43, P<0.05), postoperative short-term ODI ( WMD=-6.26, 95% CI -9.65, -2.87, P<0.05), postoperative mid-term ODI ( WMD=-2.44, 95% CI -3.43, -1.45, P<0.05), hospitalization time ( WMD=-2.65, 95% CI -4.61, -0.68, P<0.05), postoperative mid-term Cobb angle ( WMD=-1.40, 95% CI -2.41, -0.39, P<0.05), postoperative long-term Cobb angle ( WMD=-1.06, 95% CI -1.59, -0.52, P<0.05), postoperative mid-term VBH ( WMD=3.06, 95% CI 1.31, 4.81, P<0.05), postoperative long-term VBH ( WMD=4.11, 95% CI 2.44, 5.77, P<0.05) and implant failure rate ( OR=2.06, 95% CI 0.11, 0.59, P<0.05). Conclusion:Compared with PSIS, PSV can not reduce the operation time, intraoperative blood loss and incision infection in the treatment of OTLF, but it can significantly relieve pain, improve function, decrease reduce hospitalization time, help to maintain Cobb angle and anterior vertebral height after operation, and reduce implant failure rate.

Objective:To compare the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OLCF) via the approach through midpoint transverse process-transition zone of articular process and the unilateral transpedicular approach.Methods:A prospective cohort study was conducted to analyze the clinical data of 794 patients with OLCF treated in Honghui Hospital affiliated to Xi′an Jiaotong University School of Medicine from January 2017 to December 2019. The patients were divided into transitional-zone puncture group (400 patients, 400 vertebrae) and pedicle puncture group (394 patients, 394 vertebrae) according to the envelope method. The transitional-zone puncture group was treated with PVP via the approach through midpoint transverse process-transition zone of articular process, and the pedicle puncture group was treated with PVP via the unilateral transpedicular approach. The operation time and radiation dose were documented. The visual analogue score (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 1 day, 3 months, 1 year after operation. The cement distribution and the incidence of complications such as cement leakage, re-fracture of the injured vertebra, spinal cord nerve injury and facet joint injury were detected.Results:The patients were composed of 270 males and 524 females, at the age of 68.9-78.5 years [(73.7±4.8)years]. All patients were followed up for 12-14 months [(13.4±0.8)months]. The operation time and radiation dose in transitional-zone puncture group were reduced compared with pedicle puncture group ( P<0.01). There was no significant difference in VAS and ODI between the two groups before operation (all P>0.05). The VAS between transitional-zone puncture group [(2.1±0.9)points, (2.3±1.1)points, (2.7±1.3)points] and pedicle puncture group [(2.3±0.7)points, (2.5±0.9)points, (2.9±1.1)points] was obviously reduced from that before operation (all P<0.01), significantly different at 1 day, 3 months, 1 year after operation ( P<0.05 or 0.01). The ODI between transitional-zone puncture group (14.3±1.8, 13.6±3.4, 11.3±4.4) and pedicle puncture group (25.5±5.7, 20.7±6.3, 20.6±6.9) was significantly different at 1 day, 3 months, 1 year after operation (all P<0.01), and all were obviously reduced from that before operation (all P<0.01). With regard to the cement distribution, the number of bilaterally cemented vertebrae in transitional-zone puncture group (324) was more than that in pedicle puncture group (94) ( P<0.01). The incidence of cement leakage, re-fracture of the injured vertebra and facet joint injury was 8.25%(22/400), 0.00%(0/400) and 3.25%(13/400) in transitional-zone puncture group, significantly different from 20.81%(82/394), 2.03%(8/394) and 9.90%(39/394) in pedicle puncture group ( P<0.05 or 0.01). There was no significant difference in spinal cord nerve injury between the two groups ( P>0.05). Conclusion:For OLCF, PVP via the approach through the midpoint transverse process-transition zone of articular process and the unilateral transpedicular approach are both effective, but the former has advantages of shorter operation time, smaller radiation dose, greater dispersion of bone cement and lower incidence of cement leakage, re-fracture of the injured vertebra and facet joint injury.

Objective:To evaluate the efficacy of unilateral and bilateral percutaneous kyphoplasty (PKP) in the treatment of type IIIA acute symptomatic osteoporotic lumbar fracture (ASOLF).Methods:A retrospective cohort study was conducted to analyze the clinical data of 117 patients with type IIIA ASOLF admitted to Honghui Hospital of Xi′an Jiaotong University from April 2016 to February 2018, including 32 males and 85 females, aged 60 to 88 years [(68.3±5.7)years]. Injury segments were located at L 1 in 35 patients, at L 2 in 38, at L 3 in 26 and at L 4 in 18. All patients were treated with PKP. A total of 61 patients were treated using the midpoint of the transverse process-articular process displacement as the puncture point (unilateral puncture group) and 56 patients were treated using the traditional "2" point and "10" point as the puncture point (bilateral puncture group). The operation time, amount of radiation exposure of patients and surgeons and bone cement injection volume were compared between the two groups. The Cobb angle, height of anterior edge of injured vertebrae, visual analogue scale (VAS) and Oswestry disability index (ODI) were compared before operation, at day 1 after operation and at the final follow-up. Intraoperative and postoperative complications were observed. Results:All patients were followed up for 24-35 months [(26.3±4.7)months]. The operation time and amount of radiation exposure of patients were (20.4±5.6)minutes and (1.08±0.44)mSv in unilateral puncture group, significantly different from (37.5±9.2)minutes and (2.24±0.58)mSv in bilateral puncture group (all P<0.01). There were no significant differences in amount of radiation exposure of surgeons and bone cement injection volume between the two groups (all P>0.05). In unilateral puncture group and bilateral puncture group, the Cobb angle of fractured vertebrae at day 1 after operation [(22.4±10.7)°, (23.4±11.1)°] and at the final follow-up [(24.3±8.3)°, (23.5±9.5)°] was significantly decreased from that before operation [(29.6±9.7)°, (30.6±12.9)°] (all P<0.01); the height of anterior edge of injured vertebrae at day 1 after operation [(80.4±12.6)%, (78.8±11.9)%] and at the final follow-up [(79.3±10.7)%, (77.4±11.2)%] was significantly increased from that before operation [(65.7±6.3)%, (66.4±9.7)%] (all P<0.01); the VAS at day 1 after operation [(2.1±0.5)points, (2.3±1.1)points] and at the final follow-up [(1.9±0.8)points, (2.0±0.6)points] was significantly decreased from that before operation [(7.1±0.7)points, (7.2±0.9)points] (all P<0.01); the ODI at day 1 after operation (21.1±9.7, 22.9±7.9) and at the final follow-up (18.5±4.6, 19.8±9.4) was significantly decreased from that before operation (72.7±4.5, 73.1±3.7) (all P<0.01). While the above four parameters between the two groups had no significant differences at each time point, with no significant differences within each group at day 1 after operation and at the final follow-up (all P>0.05). There were 13 patients [21% (13/61)] with cement leakage in unilateral puncture group as compared to 18 patients [29% (18/56)] in bilateral puncture group ( P<0.05). There were 4 patients [7% (4/61)] with adjacent vertebral fracture in unilateral puncture group, similar to 5 patients [9% (5/56)] in bilateral puncture group ( P>0.05). The lower back pain caused by facet injury were noted in 8 patients [14% (8/56)] in bilateral puncture group who were relieved after 1 month of non-surgical treatment, but none occurred in unilateral puncture group ( P<0.01). Conclusions:Unilateral and bilateral PKP can obtain satisfactory clinical efficacy in the treatment of type IIIA ASOLF, but the former has advantages of shorter operation time, less radiation exposure and lower incidence of bone cement leakage and facet injury.