Objective:To analyze the change rules of quantitative parameters of magnetic resonance-perfusion weighted imaging (MR-PWI) in cynomolgus monkeys with different degrees of liver fibrosis, and to explore the best parameter of MR-PWI in evaluating the severity of liver fibrosis.Methods:Liver fibrosis models of twenty-two cynomolgus monkeys were successfully established by subcutaneous injection of carbon tetrachloride and feeding with high-fat food. Among them, 15 cynomolgus monkeys developed into early liver cirrhosis (stage S4 of liver fibrosis). Compatibility group design was adopted, the comparative study on MR-PWI of exchange double blood supply model of liver was carried out in these 15 cynomolgus monkeys with a complete development process of liver fibrosis. The quantitative parameters of MR-PWI included endothelial transfer constant ( ktrans), reflux rate constant ( kep), extravascular extracellular space fractional volume ( ve), fractional plasma volume ( vp) and hepatic artery perfusion index (HPI). The change rules of the above parameters and their correlation with the severity of hepatic fibrosis were analyzed. The best parameter of MR-PWI was explored. Compatibility group design (randomized block design), analysis of variance, SNK- q test, Spearman rank correlation analysis and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. Results:ktrans and kep of MR-PWI of cynomolgus monkeys decreased along with the progress of hepatic fibrosis, and the differences were statistically significant ( F=685.228, 99.718, both P<0.01). There were statistically significant differences between each stage of hepatic fibrosis (S1 to S4) and normal liver tissue (S0) ((0.527±0.038), (0.479±0.035), (0.432±0.032) and (0.387±0.031) mL/min vs.(0.584±0.044) mL/min, all P<0.01; (2.193±0.307), (1.997±0.301), (1.624±0.174) and (1.532±0.130) mL/min vs. (2.565±0.482) mL/min, all P<0.01). There were statistically significant in ktrans and kep between stage S3, S4 severe liver fibrosis and stage S1 mild liver fibrosis, stage S2 moderate liver fibrosis (all P<0.01), however there were no statistically significant differences between stage S3 and stage S4 liver fibrosis, between stage S1 and stage S2 liver fibrosis (all P>0.05). Along with the development of the severity of liver fibrosis, HPIs increased gradually, and the differences were statistically significant ( F=839.883, P<0.01). The HPIs of stage S0 to S4 were 0.244±0.022, 0.317±0.035, 0.421±0.046, 0.546±0.043 and 0.651±0.058, respectively, and there were statistically significant differences between groups (all P<0.01). Along with the progression of the severity of liver fibrosis, vp decreased while ve increased gradually, but there were no statistically significant differences among groups (all P>0.05). The results of Spearman rank correlation analysis indicated that ktrans and kep were negatively correlated with the severity of liver fibrosis ( rs=-0.875 and -0.797, both P<0.01), however HPI was positively correlated with the severity of liver fibrosis ( rs=0.959, P<0.01). The results of ROC curve analysis showed that area under curves (AUCs) of ktrans, kep and HPI in the diagnosis of early cirrhosis were 0.852 (95% CI 0.767 to 0.937), 0.799 (95% CI 0.700 to 0.897) and 0.967 (95% CI 0.932 to 1.002), respectively. The best cut-off values were 0.395 mL/min, 1.561 mL/min and 0.590, respectively. The sensitivity was 86.7%, 79.6% and 97.4%, respectively and the specificity was 77.4%, 71.9% and 93.1%, respectively. The thresholds of HPI in the diagnosis of liver fibrosis at stage S1, stage S2, stage S3 and stage S4 were 0.291, 0.376, 0.503 and 0.590, respectively; the sensitivity was 95.7%, 93.8% and 94.4% and 97.4%, respectively and the specificity was 89.5%, 84.7%, 91.3% and 92.7%, respectively. Conclusions:The parameters of MR-PWI change regularly with the development of liver fibrosis in the cynomolgus monkey model, among which HPI is the best parameter for quantitative evaluation of the severity of liver fibrosis.

Objective To explore the relationships between the alterations of cervical sagittal parameters and clinical outcomes after anterior cervical discectomy and fusion (ACDF).Methods From January 2010 to December 2015,a total of 227 patients with cervical spondylosis who undelwent ACDF in Dongfang Hospital affiliated Tongji University were analyzed in this study.There were 109 male and 118 female,with an average age of 52.2± 10.7 years (ranged from 34 to 78 years).The average duration of follow-up after revision surgery was (21.1 ±9.0) months (12-60 months).Comparing with Japanese 0rthopaedic Association (JOA) score and its improvement rate (IR),visual analogue scale (VAS) scores and neck disability index (NDI) between preoperation and 1 year follow-up.Cervical alignment was assessed with the following 3 parameters:T1 slope (T1S),Cobb's angle of C2 to C7 and C2-7 sagittal vertical axis (SVA).And compared the changes of sagittal parameters and clinical efficacy.Results At 1 year follow-up,T1S was increased from 25.4°±8.5° to 27.9°±8.2°,Cobb's angle was increased from 12.7°±8.5° to 15.3°±9.5°,SVA was increased from (21.0± 12.3) mm to (24.30± 11.4) mm,and the differences were statistical significant (P＜ 0.001).JOA score was increased from (8.5±4.0) points to (13.0±2.4) points at 1 year follow-up,however,VAS score was decreased from 2.7± 1.8 points to 0.2±0.4 points,and NDI was decreased from 48.2％±8.2％ to 27.1％± 11.1％,and the differences were statistical significant (P ＜ 0.001).Preoperatively,T1S had positive correlations with both Cobb's angle and SVA before operation (r=0.311,0.213;P=0.000,0.001),but Cobb's angle had negative correlation with SVA (r=-0.246,P=0.000).At 1 year follow-up,T1S had positive correlations with Cobb's angle and SVA (r=0.390,0.392;P=0.000,0.000),and Cobb's angle had negative correlation with SVA (r=-0.131,P=0.048).At 1 year after operation,the change value of Cobb's angle had positive correlation with the change of JOA (r=0.294,P=0.000),but negative correlation with the change of NDI (r=-0.141,P=0.034).Conclusion ACDF is effective in the treatment of cervical spondylosis which the cervical sagittal alignment remains relatively stable,and there were significant correlation between the alteration of cervical sagittal parameters and clinical outcomes after ACDF.

Objective:To evaluate the availability and safety of laparoscopic pyeloplasty with extracorporeal ureteral tailor.Methods:Clinical data of 26 patients with ureteropelvic junction obstruction (UPJO)who were treated by laparoscopic combined with extracorporeal ureteral tailor pyeloplasty in our hospital from March 2016 to August 2019 were retrospectively analyzed. There were 19 males and 7 females. 22 cases had unilateral lesion, including 6 cases on the right side and 16 cases on the left; 2 cases were bilateral. The average age was 22.3 years old (6-54 years). 19 cases felt discomfort in the renal region and 7 cases were asymptomatic. The mean body mass index was 21.7 kg/m 2 (17.2- 26.4 kg/m 2). 5 cases had mild hydronephrosis, 17 cases had moderate hydronephrosis and 4 cases had severe hydronephrosis. 6 cases combined with cross vessels. In all the 26 cases, the ureter was pulled out of the abdomen through a laparoscopic incision, cut lengthways in vitro, sutured at the lowest point, and then returned it to the abdomen. Then, double J tube implantation and ureteropelvic anastomosis were performed under the laparoscopy. Results:26 cases were completed successfully without conversion, with the average operation time of 99 minutes (50-158 minutes), the average blood loss of 19.4 ml (10-50 ml), the average hospital stay of 6.5 days (5-11 days), and the average drainage indwelling time of 5.3 days (4-10 days). For complications, urine leakage occurred on the 3rd day after the operation in 1 case, and the daily drainage fluid was more than 500 ml, which decreased suddenly after 4 days. Postoperative average follow-up was 10.8 months (6-24 months). Renal region pain disappeared in all patients. CT reexamination 3 months after the operation showed that hydronephrosis was alleviated or disappeared in 24 cases, and there was no significant change in 2 cases compared with the preoperative images, but no progress was found in the subsequent reexamination, so we didn't deal with the hydronephrosis again.Conclusions:Laparoscopic pyeloplasty combined with extracorporeal ureteral tailor is minimally invasive and flexible, which greatly reduces the difficulty and time of operation, and has a high success rate.