Hepatitis C virus (HCV) is a global health problem and people are generally susceptible to HCV.Main routes of transmission include blood transmission,sexual transmission,and mother-to-child transmission.Anti-HCV screening of blood products has substantially red uced the blood transmission of HCV.Remarkable breakthrough has been made in the treatment of hepatitis C with direct-acting antiviral agents and the trend of HCV transmission has been significantly curbed.Since HCV infection is occult,hepatitis C vaccine has not been successfully developed,and there lack effective blocking measures for mother-to-child transmission,which will become one of the major route of HCV transmission.Reducing the rate of mother-to-child transmission of HCV is very important in preventing neonatal HCV infection and reducing the incidence rate of HCV infection.In recent years,many researchers have concentrated on the detailed mechanisms and risk factors of mother-to-child transmission of HCV and made great achievements;however,there are still controversies over some issues.This article reviews the research advances in the specific mechanisms of mother-to-child transmission of HCV in China and other countries.

Objective To investigate the surgical management of atrophic gallbladder.Methods The clinical data of 85 patients with atrophic gallbladder surgically treated in our hospital from October 2002 to October 2005 were retrospectively analyzed.Results There were 3 cases of iatrogenic bile duct damage,2 of enteral damage,1of post operative remaining small gall bladder,1 of remain ingstonesinthe bile duct and 1 of gallstone ileum.Two 2 patients died after operation.Conclusion Atrophic cholecystitis is always accompanied by many complex clinical problems.Adoption of proper surgical methods can lower the incidence of postoperative complications.

[Objective]To evaluate the role of three radiographic ways in patients undergoing spinal three-dimensional correction and fusion for adolescent idiopathic scoliosis.[Method]Sixty-three cases of adolescent idiopathic scoliosis(AIS)with 79 structural curves were studied.Preoperative X-ray of standing,gravity-suspendig traction,supine bending and fulcrum bending were compared with postoperative standing X-ray one week after surgery,Cobbs angle of all X-ray were measured and statistical significance was evaluated.[Result]In structural thoracic group and lumbar group the mean Cobbs angle were 40?and 21?in gravity-suspendig traction X-ray,41?and 23?in supine bending X-ray,35?and 19?in fulcrum bending X-ray,36?and 18?in postoperative standing X-ray respectively.In severe group and moderate group the mean Cobbs angle were 52?and 23?in gravity-suspendig traction X-ray,53?and 24?in supine bending X-ray,47?and 20?in fulcrum bending X-ray,44?and 19?in postoperative standing X-ray respectively.In rigid group and flexible group the mean Cobbs angle were 51?and 22?in gravity-suspendig traction X-ray,52?and 22?in supine bending X-ray,48?and 18?in fulcrum bending X-ray,45?and 17?in postoperative standing X-ray respectively.In anterior approach group and posterior approach group the mean Cobbs angle were 47?and 15?in gravity-suspendig traction X-ray,49?and 16?in supine bending X-ray,43?and 11?in fulcrum bending X-ray,42?and 10?in postoperative standing X-ray respectively.All above Cobbs angle were mean numerical value,the mean follow-up period was 1.5 years(range:1~3 years).[Conclusion]The fulcrum bending X-ray are more predicting of correctability of AIS patients than the gravity-suspendig traction and supine bending X-ray.It can provide reference for chosing anterior or posterior approach and chosing fusion levels.

[Objective]To investigate the prevalence rate of adolescent scoliosis in Heilongjiang province. [Methods]A total of 17 525 students(aged 7 ~15 years old) from 28 primary and secondary schools were screened for scoliosis from April 2007 to May 2009.Physical examination,corrugated photography and X-ray were used for the screening,prevalence rate was calculated and correspondent treatment was given to patients.[Results]The result of first check-positive was 911(5.20%),with male 448(4.92%),female 463(5.44%).The second check-positive was 413(2.36),with male 181(2.00%),female 232(2.73%),387 in them received the third check.In the third check,335 patients were found the Cobb's angle ≥10?,with the prevalence rate of 1.91%(male 147,1.63%,female 188,2.21%).[Conclusion]Adolescent scoliosis can be early found,early diagnosed,prevented and treated by general survey.

[Objective]To design a new kind of instrumentation specially to correct scoliosis and kyphoscoliosis.[Method]Through posterior transpedicular and vertebrae,wedged osteotomy was continually performed until anterior substantia compacta of vertebrae.[Result]More than(1 200) patients with scoliosis or kyphoscoliosis were treated with WVOI.The highest ostentomied vertebrae was thoracic 9 and 4 levels were performed for 1 case(mean 2 levels).The average time of osteotomy on one vertebrae was 30 min with 100 ml blood loss.No spine and spinal root injury was detected during the operating procedure.[Conclusion]Osteotomy with WVOI reduced operating time,blood loss,keep spine and spinal root safer during the operating procedure.It also made osteotomical plate fit well and prompted quick ossification.WVOI is an efficient instrumentation to correct kyphosis and kyphoscoliosis.

[Objective]To study the effect of improved universal pedicle screw systems which combined locking pedicle screws with sliding pedicle screws to correct the spinal deformities in growth period through posterior incision.[Method]From June 2000 to June 2006,209 spinal deformities in growth period were treated(106 males and 103 females),including 92 idiopathic scoliosis,72 congenital scoliosis,26 Scheuermanns diseases and 19 other kinds of spinal deformities.The age of patients ranged from 8 to 16 years(average 13.22 years).Locking pedicle screws were placed into pedicles of apical vertebra and the 3 to 5 adjacent vertebrae.Sliding pedicle screws were putted into pedicles of cephalic and caudal vertebrae.Double cross-links and rods were fixed and locked tightly.Sliding cross-links themselves could cannula prolonged to fit for the transverse development of vertebrae.[Result]Totally 209 cases with preoperative Cobbs angle 45 degree to 110 degree(average 68 degree)were instrumented with improved USS systems and 96 cases were followed up for 26～60 month.The length of spines were prolonged 4 cm to 15 cm with average 7 cm.With 26 months to 60 months follow-up,the whole spine growth was 230.4 cm with average 2.4 cm respectively.Rods broken were found in 6 patients and no other cmplication was detected.[Conclusion]Improved USS system which combined locking pedicle screws with sliding pedicle screws had the three dimensional power and intensity of traditional 3D instrumentations.Sliding pedicle screws and cross-links permitted longitudinal growth of the vertebrae and transverse development pedicles.

BACKGROUND: Locking pedicle screw system is commonly used in clinic, but it often suppresses spinal longitudinal growth of adolescent at growth phase. Thus, a pedicle screw system that can reduce even avoid the inhibition to spinal growth is needed. OBJECTIVE: To compare the biomechanical performance of sliding instrumentation of pedicle screw system and traditional locking pedicle screw system. DESIGN: Comparative observation. SETTING: Department of Orthopedics, Xinqiao Hospital of Third Military Medical University of Chinese PLA, and Department of Orthopedics, the 211 Hospital of Chinese PLA. MATERIALS: The experiment was performed at Department of Material Science, Harbin Institute of Technology on June 29th, 2007. Self-designed sliding pedicle screw system was made of Ti alloy by Wujin No. 3 Medical Instrument Factory Co., Ltd., Jiangsu Province. It consisted of sliding pedicle screw, orthopaedic rod and transversal coupling device. Twelve samples of fresh porcine spine were selected, and muscles attached on vertebral bodies of TrL5 were removed carefully but integrity of main ligament and precessus articularis posterior was retained. METHODS: The samples were randomly divided into sliding system group and locking system group with 6 samples in each group. Partial vertebral plate and surrounding ligaments of T12as well as bilateral facet joints between T11-12 and T12-L1 were removed to induce spinal destabilization, then sliding pedicle screw system and locking pedicle screw system were respectively fixed onto T10, T12, and L2 vertebral bodies of two groups. The samples then were fixed into fixture, and put onto INSTAON-4505 axial compressor. The strain gauge was connected with YJ-31 static electricity resistance strain gauge instrument human to simulate human spinal load, and the center of gravity was loaded to induce forward flexion, backward extension, lateral flexion and axial construction. Load of 100, 200, 300, 400 and 500 N was given gradually, and displacement of T12 was measured under different loads. MAIN OUTCOME MEASURES: ①Changns in principal stress and displacement under forward flexion, backward extension, lateral flexion and axial construction; ②Spinal fixation intensity and rigidity. RESULTS: No statistical difference was detected in main straining, displacement of apical vertebrae and intensity of fixation between sliding system group and locking system group under forward flexion, backward extension, lateral flexion and axial construction (P > 0.05). CONCLUSION: Sliding pedicle screw system has identical biomechanical stability as locking system. Furthermore, in sliding pedicle screw system, the screw and rod are coupled by sliding pattern, which extend along with spinal growth. It can be used to treat scoliosis at growth phase.

BACKGROUND:Standing bending, supine bending, lateral pressing, pronation compression films and traction radiography are indeed effective to predict the correction outcome of surgeries by Harrington's method and Lugue's method,however, they are discontented for the correction of three-dimensional pedicle screw of vertebral arch.OBJECTIVE: To evaluate the role of preoperative X-ray films of gravity-suspending traction, supine bending and fulcrum bending in patients undergoing spinal three-dimensional correction and fusion for adolescent idiopathic scoliosis (AIS).DESIGN: Contrast observation.SETTING: Department of Orthopaedics, the 211 Hospital of Chinese PLA (Military Orthopaedics Center).PARTICIPANTS: From January 2003 to December 2005, 63 cases aged 10-21 years were recruited from Department of Orthopaedics in the 211 Hospital of Chinese PLA, including 18 males and 45 females. They were diagnosed as AIS by clinical examinations and X-ray film, with Cobb angle≥40°. Informed consents were obtained from all the subjects.METHODS: All of the 63 AIS cases with 79 structural curves were studied by preoperative X-ray films of standing,gravity-suspending traction, supine bending and fulcrum bending, which were compared with standing X-ray films one week postoperatively.MAIN OUTCOME MEASURES: Cobb angles of preoperative fulcrum bending film and postoperative standing film.RESULTS: All of the 63 cases were involved in the result analysis. There was no significant difference in the Cobb angle between preoperative fulcrum bending X-ray film and postoperative standing X-ray film (P ＞ 0.05). Gravity-suspending traction and supine bending films were significantly different from postoperative standing film (P ＜ 0.05).CONCLUSION: The fulcrum bending X-ray films are superior to gravity-suspending traction and supine bending films in predicting the postoperative correction of AIS patients.

Background and purpose:Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN0 PTC.Methods:Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed.Results:LNM was conifrmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cmvs 33.6% in≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% withvs 31.7% without) showed signiifcant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% <40 yearsvs 3.4%≥40 years ), tumor size(13.4% in >1 cmvs 3.4% in≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% withvs 4.8% without) showed signiifcant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age <40 years (OR=3.959) were conifrmed as independent risk factors of high volume LNM. Male (OR=3.105) and tumor size >1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively.Conclusion:LNM was not “rare” in cN0 PTC patients. Prophylactic central neck dissection should be performed in cN0 patients with tumor size >1 cm. For cN0 microcarcinoma, more active surgical treatment may be considered in male and young patients.

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.