Objective To analyze the reasons and therapeutic effects for revision of spinal fractures.Method Ninteen patients with revised internal fixation on spinal fractures were reviewed in average of 3.5 years follow-up. Neurological function, pain and daily life quality of patients with revision surgery were evaluated by questionnaire.ResultIncomplete spinal canal decompression as well as improper application of instrumentation were the main reasons of failed internal fixation for spinal fractures.All patients with incomplete spinal cord injury had improvement on neurological function to some extent after re-operation, and 17 of 19 patients (89%) indicated improved daily life quality. However, revision surgery failed to have motor recovery in patients with complete spinal cord injury.ConclusionCorrect surgical technique and selection of internal fixation are very important in the treatment of spinal cord injury.

0.05).The operating time in group A was 106?22.3 min,94.1?29.3 min in group B and 81.6?22.3 min in group C.There were no significant differences between group A and B,or between group B and group C,but there was significant difference(P=0.009) between group A and group C.The was Two cases of dura tear occurred at operatiom and one case was converted to open discectomy in group A.There were three cases of reoperation in group B.There were no intra-and postoperation complications in group C.[Conclusion]From the learning curve of lumbar microendoscopic discectomy,surgeons can master such skill only after performing 30 or more cases of lumbar microendoscopic disecetomy.

Objective To evaluate the radical debridement and anterior spinal fusion with strut graft for the treatment of spinal tuberculosis. Methods There were 78 cases in this series, 36 males and 42 females. The age was from 15 to 72 years, the mean was 47 years. The involved vertebral bodies were at 2 segments in 29 patients, at 3 segments in 41 patients and at more than 4 segments in 8 patients. The kyphosis was 13～92 degrees with a mean of 34 degrees. Radical debridement and spinal fusion with strut graft were used in all patients. In addition, the spine was instrumented in 3 cases for further stabilization. Strut grafts consist of ribs in 22 cases, iliums in 44 cases, iliums and ribs in 12 cases. Results The period of follow up lasted from 1 to 16 years with a mean of 5.2 years. 98.7% of the patients have good results and 97.4%have solid bony fusion. The kyphosis deformity was 5～62 degrees, the mean was 22 degrees. Conclusion The present results show that the radical debridement and anterior fusion with strut graft was effective for restoring the local anatomical alignment and the stability with high rate of solid bony fusion and lower rate of postoperative low back pain.

It is an obvious contradiction between the shortage of kidney donors and the increasing demand for kidney transplantation.Living- related donor kidney transplantation may be a proper resolution,which has been academically proved to be superior to cadaveric kidney transplantation.However,there are still many ethical problems unsolved.Based on ethical theory and the"Seven Principles",we explore possible solutions to the ethical problems of living - related donor kidney transplantation.

Objective To assess the feasibility of low voltage with CARE dose 4D computed tomography pul-monary angiography(CTPA)by using image quality and radiation dosage.Methods 92 patients with clinically sus-pected pulmonary embolism(BMI:20 ~30kg/m2)were randomly divided into two groups(group A:n =46,80kV;groups B:n =46,100kV),the male and female of group A were equal to the number.Image quality score(given blind-ly by two senior radiologists ranged from 1 to 5 points).The CT value and standard deviation(SD)were measured and recorded in common pulmonary artery trunk,the main right pulmonary arteries,right low lobar arteries,and erector muscle of spine,calculated the SNR of ROI.Average CT value,signal noise ratio(SNR),CTDIvol,DLP were com-pared between the two groups.Used the CT dose index(CTDIvol)to compare radiation dosage between group A female and male.Results The agent average CT value and SD in arteries in group A [(510.27 ±115.45)HU,(50.06 ± 11.67)HU respectively]were higher than those in group B[(413.32 ±100.38)HU,(35.12 ±11.94)HU respective-ly],there were significant differences between the two groups(t =10.367,8.892,all P =0.000),but the SNR of ROI was (12.36 ±3.90),which was lower than (14.03 ±4.46)in group B,there was significant difference between the two groups(t =-5.238,P =0.001 ).Image quality score of transverse ection(1mm)in group A was (4.20 ± 0.29),which was lower than (4.91 ±0.36)in group B,there was significant difference(t =-20.23,P =0.000), but there was no significant difference in coronal section(5mm),coronal maximum intensity project(MIP)image and the capability of displaying the pulmonary artery branches(all P >0.05 ).The CTDIvol in group A was (2.03 ± 0.39)mGy,which was greatly lower than (5.04 ±1.02)mGy in group B,there was significant difference (P <0.05);but there was no significant difference between female and male in group A[male:(2.05 ±0.39)mGy;female:(2.01 ±0.38)mGy,t =-0.300,P >0.05].Conclusion Radiation dose can be decreased greatly(above 50%)in 80kV CTPA compared 100kV without compressing obviously the image quality for patients BMI 20 -30kg/m2 ,and no significant difference between the group A(80kV)different gender radiation dosage.

The theoretical basis and needling techniques of RUAN's needling method in treatment of insomnia are introduced in this paper. Ruan's needling method follows the theory of traditional Chinese medicine and acupuncture, stresses the theory of taking brain as the marrow sea in treatment of insomnia acupuncture. The characteristics of his needling method are that emphasis on acupoints, including positioning accuracy and proper compatibility; think highly of needling method that combines with perpendicular needling, oblique needling, parallel needling, deep needling and shallow needling; emphasis on manipulation and identify qi under the needle to decide reinforcing or reducing method by arrival of qi, excess or deficiency. And the clinical observation of RUAN' s needling method on 30 cases of insomnia is attached.
Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; therapy

Objective:Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm, which mostly originates from the major and minor salivary glands of the head and neck region. This study aims to provide new information on head and neck ACC with cervical lymph node metastasis. Methods:Out of the 616 patients who underwent primary tumor resection from 1995 to 2008 in the authors' hospital, 62 cases with cervical lymph node metastasis were analyzed. Results:The general incidence rate of cervical lymph node me-tastasis in ACC was approximately 10%. The base of the tongue, mobile tongue, and mouth floor were the most frequent sites of lymph node metastasis with incidence rates of 19.2%, 17.6%, and 15.3%, respectively. Most cases exhibited the classictunnel-stylemetastatic pattern of occurrence, and the levelⅠb andⅡregions were the most frequently involved areas. Primary site and lympho-vascular invasions were significantly associated with lymph node metastasis. High patient mortality rate was also significantly correlat-ed with a high number of lymph node positive cases. Conclusion:Cervical lymph node metastasis has a high tendency of occurrence in the tongue-mouth floor complex, following the classictunnel-stylemetastatic pattern. Peritumoral lymphovascular invasion could be taken as a strong predictor for the occurrence of lymph node metastasis, which ultimately leads to poor prognosis of ACC patients. A selective neck dissection should be considered as a management in such patients.

BACKGROUND:Lumbar spine MRI and electrophysiological test are reliable methods for evaluating nerve root injury caused by lumbar disc herniation.
OBJECTIVE:To analyze the correlation between the MRI-based grading system and the latency and frequency of F wave as wel as latency and amplitude of H-reflex in patients with lumbar disc herniation.
METHODS:MRI imaging of the lumbar spine was performed with a 3.0-T imager and a dedicated TCL coil to classify lumbar disc herniation and nerve root compression. F wave and H reflex were detected on the patient bilateral tibial nerves using Oxford myoelectricity evoked potential instrument.
RESULTS AND CONCLUSION:Spearman correlation analysis showed that the MRI-based grading of patients with lumbar disc herniation had a negative correlation with F wave frequency (r=-0.594 0, P<0.000 1), and a positive correlation with F wave latency (r=0.825 6, P<0.000 1) and H-reflex latency (r=0.875 0, P<0.000 1), but no correlation with H-reflex amplitude (R=0.117 4, P=0.257 3). With MRI grading increased, F wave frequency was decreased, and F wave and H-reflex latency were prolonged gradual y, indicating aggravating nerve root compression.

Objective To investigate the diagnostic value of texture analysis derived from conventional MR imaging in differentiating benign and malignant breast lesions. Methods Thirty-six patients with malignant breast lesion and 33 patients with benign breast lesion were retrospectively analyzed in our study. All patients underwent conventional MR imaging including axial T1WI, T2WI, and contrast-enhanced T1WI before surgery. Texture features were calculated from manually drawn ROIs by using MaZda software. The feature selection methods included mutual information (MI), Fishers coefficient, classification error probability combined with average correlation coefficients (POE + ACC) and the combination of the above three methods(FPM). These methods were used to identify the most significant texture features in discriminating benign breast lesion from malignant breast lesion. The statistical methods including raw data analysis (RDA), principal component analysis (PCA), linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) were used to distinguish malignant breast lesion from benign breast lesion. The results were shown by misclassification rate. Results In the three kinds of sequences, the texture features for differentiating malignant breast lesion and benign breast lesion were mainly from T2WI which had the lowest misclassification rate 4.35%(3/69). The misclassification rates of the feature selection methods were similar in MI, Fisher coefficient and POE+ACC (15.94%to 56.52%for MI;17.39%to 56.52%for Fisher coefficient and 17.39%to 56.52%for POE+ACC). However, the misclassification rate of the combination of the three methods (4.35%to 53.62%for FPM) was lower than that of any other kind of method. In the statistical methods, NDA (4.35% to 27.54%) had lower misclassification rate than RDA (33.33% to 56.52%), PCA (33.33% to 53.62%) and LDA (15.94% to 44.93%). Conclusion Texture analysis of conventional MR imaging can provide reliably objective basis for differentiating benign from malignant breast lesions.

OBJECTIVETo identify the initial effect of dynamic interspinous implant of Coflex on the treatment of lumbar spinal stenosis.

METHODSA retrospective study of 18 patients who underwent posterior lumbar decompression and fixation with interspinous implant of Coflex between March 2008 and October 2009 was taken to compare the Cobb angel of nature and dynamic position on the segment of Coflex fixation at the time of before and after operation and following time,including 10 males and 8 females with average age of 62.2 years old (54 to 71 years). The symptoms of patients included chronic lower back pain and intermittent claudication and lower extremity numbness. All cases including 17 cases of L4,5 and 1 case of L3,4 were central canal stenosis without obviously segmental instability. Clinical outcomes were evaluated with VAS and ODI.

RESULTSAll patients were followed up from 10 to 18 months with an average of 14.4 months. There did not about internal fixation failure. It was found that postoperative Cobb angel of fixation segment [(12.1 +/- 2.6) degrees] was significantly decreased than preoperative [(14.8 +/- 3.2) degrees] (t = 2.61, P = 0.03). But the Cobb angel [(14.9 +/- 4.1) degrees] increased at final follow-up, even reached the level of before operation (t = 1.39, P = 0.65). The Cobb angle of upper adjacent segment did not obviously change in preoperation, postoperation and final follow-up [(12.1 +/- 2.3) degrees, (12.3 +/- 3.2) degrees, (11.9 +/- 3.0) degrees, respectively]. Dynamic measure showed that Coflex can adequately limit the ROM of extension (t = 4.01, P = 0.001), but the ROM of flexion increased (t = 2.57, P = 0.02). The VAS score in follow-up (2.2 +/- 0.7) was significantly decreased than before operation (4.9 +/- 1.1, t = 2.95, P = 0.02). The ODI score in follow-up [(29.1 +/- 9.0)%] was significantly decreased than before operation [(56.5 +/- 14.2)%, (t = 3.02, P = 0.02)].

CONCLUSIONThe Coflex implanting combined with decompression can get good result clinically, but imaging showed that Coflex can not maintain the relatively kyphosis gained after operation except for extension limitation.

Aged ; Female ; Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Prostheses and Implants ; Retrospective Studies ; Spinal Stenosis ; surgery