[Objective]To evaluate the clinical efficacy of posterior pedicle screw instrumentation followed by anterior debridement and bone grafting through the lateral edge of the rectus abdominal muscle and retroperitoneal approach for the treatment of tuberculosis of the lower lumbar spine. [Methods]From June 2002 to January 2007,27 patients suffering from lower lumbar tuberculosis were treated with this technique.[Results]The surgical average time and amount of bleeding was 4.3 h and 438 ml respectively.The length of anterior incision was 5~7 cm.The average time and the amount of bleeding were 21 min and 48 ml respectively during the anterior lesion exposure.The follow-up period were 12~37 months,mean 17.3 months.The average preoperative,immediate postoperative,and final follow-up local lordotic angles of the affected segments were-2.1??4.0?,4.9??1.4?,3.7??3.0?.All patients had healed of disease and there was no recurrence at final follow up.Bony fusion was obtained in all patients.[Conclusion]Anterior exposure through the lateral edge of the rectus abdominal muscle and retroperitoneal approach is simple and less invasive.The spinal stability is achieved through short-segment pedicle screw fixation while reducing the sacrifice of additional motion segments.This technique is safe and effective for the treatment of tuberculosis of the lower lumbar spine.

ObjectiveTo observe the discoloration of chemical indicator cards in different positions in pressure steam sterilization bags and stetilization effect.MethodsFrom January 2009 to January 2011,168 packages needing sterilization were divided into group A and group B randomiy with 84 packages in each.We put chemical indicator cards on different positions in the packages.Then discoloration of chemical indicator cards and the qualified rate of bacteriology detection were observed.ResultsThere were 9cases of uneven discoloration in group A,and the incidence rate was 10.71％,higher than group B.The unqualified rate of bacteriology detection in group A was 2.38％,higher than group B(1.19％),but the difference was not statistically significant.ConclusionsChemical indicator cards could reflect the effect of sterilization,but placing them in different positions can appear different results.The chemical indicator cards that placed between the two packing layer could provide powerful evidence for sterilization effects for clinicians,and avoid unnecessary economic waste in Sterilization and Supply Center,which is worthy of being widely used in Sterilization and Supply Center.

Protozoans,the natural host of the facultative intracellular pathogen Legionella species,play an important role in survival,proliferation,virulence and stress resistance of Legionella species. By repeating transformation and selection,a spontaneous mutant of plasmid over expressing green fluorescent protein was obtained. This mutant replicates and is maintained stably in Legionella cells. The colonies of L. pneumophila harbouring the mutated plasmid were intense green in colour even under the daylight. After feeding BF1 strain of Tetrahymena thermophila with transformed L. pneumophila,the intracellular dynamic of changing of bacterial shape,bacterial proliferation and lysis of the host cell due to the bacterial proliferation were observed clearly under fluorescent microscopy. Thus,the present paper provides a simple and intuitionistic strategy for investigating the ecological and cellular relationship between L. pneumophila and its host.

OBJECTIVETo explore clinical significance of rotational axis of distal femur on Chinese adults in total knee arthroplasty (TKA).

METHODSThere were 86 Chinese adults (106 normal knees) including 47 males (53 knees) and 39 females (53 knees), 54 knees were on left and 52 on right. The CT scan was employed in the distal femur. The scan direction was aligned to be on the plane perpendicular to the mechanical axis of the femoral. The CT images of cross sections across lateral and medial femoral epicondyle were moved to personal computer,lateral angle between anterior posterior line (APL) and surgical transepicondylar axis (STEA) (ATA),lateral angle between posterior condylar line (PCL) and APL (APA), angle between perpendicularity of APL and PCL (A-PA), posterior condylar angle (PCA), condylar twist angle (CTA), angle between clinical transepicondylar axis (CTEA) and STEA (CSA) were measured. These values were divided into different groups according to gender and side, the values of CTA, PCA, A-PA, angle PT (varus of tibia plateau), constant 3, ATA, APA and constant 90° were compared by statistically. A-PA and PCA, and CTA were analysed statistically with the liner regression, the relationship among CTEA, STEA ,PCL, APL and PLP were performed to assess by liner regression.

RESULTSATA was (89.79 ± 1.22)°, APA was (84.84 ± 1.83)°, A-PA was (5.16 ± 1.83)°, PCA was (4.80 ± 1.23)°, CTA was (8.23 ± 1.40), CSA was (3.45 ± 0.68)°. All the parameters had no differences on sex and side,but CSA had difference on male and female. There was no difference among angle PT, PCA, A-PA. There was significant difference in CAT, constant 30 and angle PT, PCA,A-PA. There was no difference between ATA and constant 90°, but there was difference between APA and constant 90°. There was relativity between PCA and CTA, and also PCA and A-PA, CTA and A-PA. There was significant relativity between STEA and CTEA, between STEA and APL, between STEA and PCL, and also between APLP, APL and PCL, but there was no significant relativity between PCL and CTEA.

CONCLUSIONTKA for Chinese, the section of femoral posterior condyle should be external 5° to obtain the optimum rotational orientation. The property is different entirely between STEA and CTEA, the rotational alignment is not performed according to parallel to the CTEA in distal femur. Among STEA, APL, PCL, the STEA is the most reliable mark ofrotational alignment of the distal femur, and the PCL is the less reliable mark.

Adult ; Arthroplasty, Replacement, Knee ; Female ; Femur ; anatomy & histology ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Rotation ; Tomography, X-Ray Computed

Objective:To explore the influence of ischemia/reperfusion (anoxia/reoxygenation)[FK(W16*2。142mmZQ1mm]on immunofunction of endothelial cells(ECs) and effect of intervention with 2-hydroxymethyl-3,5,6-trimethylpyrazine on it.Methods:Model of ECs induced by anoxia/reoxygenation was established to mimic ECs ischemia/reperfusion injury in vivo with human umbilical vein endothelial cell line ECV304.Then 2-hydroxymethyl-3,5,6-trimethylpyraxine was used to intervene the anoxia/reoxygenation process.Nuclear transcriptional factor-?B(NF-?B) was exhibited by fluorescent staining,HLA-ABC,HLA-DR,CD86 and CD54 were detected by flow cytometry.Mixed endothelial cell-lymphocyte reaction(MELR) was conducted to examine the proliferation of lymphocyte,production of IL-2 and percentage of apoptotic lymphocyte.Results:Anoxia/reoxygenation made the ECV304 cell became round,shrunk and abscised,with increased plasma NF-?B,and changed from positive cytoplasm to positive nucleus.HLA-ABC,HLA-DR and CD86 on surface of cells increased but CD54 showed unchanged.MELR showed the incorporation of ~3H-TdR and production of IL-2 increased significantly and the percentage of apoptotic lymphocyte decreased.After 2-hydroxymethyl-3,5,6-trimethylpyrazine intervention,the ECV304 cell shapes recovered,NF-?B expression didn’t down-regulated,but the percentage of positive cells decreased,changes to positve dominant.Besides,reversal changes were shown in other parameters.Conclusion:Anoxia/reoxygenation influences some important immune related molecules in ECV304 cells.2-hydroxymethyl-3,5,6-trimethylpyrazine could antagonize these influences to maintain the immune function of endothelial cells in a relative normal manner.

Objective To evaluate the efficacy of tibial bone-skin flap grafts in the management of se- vere traumatic osteomyelitis complicated with bone and skin defect in leg to avoid amputation.Methods From March 1998 to Aug.2004,12 cases of the traumatic osteomyelitis complicated with bone and skin defect in leg were treated with vascularized tibial bone-skin flap graft.The longest flap was 17cm,widethest 10cm, The longest bone flap was 12cm.They were followed up for 0.6 to 5 years.Results All the tibial bone-skin flaps survived completely,2 cases of osteomyelitis recurred.The followed-up,from 0.5 to five years,showed good bone union in all cases,averageing 15 weeks.The infection was under control.The leg function and con- tour were satisfactory.Conclusion The tibial bone-skin flap has the advantages of having distinguished sign of anatomy,highly vascularized,easy to obtain,simply and flexible procedure,improving circulation,short- ens hospitalization and suitable for treatment of traumatic osteomyelitis complicated with bone and skin defect in leg.

183 Background More clinical Sdoctors tend to choose minimally invasive treatments for patella fracture. Because patients have lower complications, better function and perfect incision, which makes them early continue working and influences a little on their careers and life. Objective To explore the efficacy of minimally invasive treatment of patella transverse of young people, we choose percutaneous cannulated screw and titanium cable that we design to operate surgery.we observe the surgical incision, hemorrhage and function Methods From February 2009 to June 2012, we applied the minimally invasive technique of percutaneous cannulated screw and titanium cable to treat 30 cases of patella transverse, 16 males and 14 females. Aged 24-45 years, mean 35.4 years.injury mechanism:10 cases in the traffic accident, 6 cases in the fall s injury, 14 cases in the kneeling injury. fracture type:6 cases proximal pole fracture, 11 cases middle pole fracture and 13 cases distal pole fracture. Result All patients healed incision. 30 cases were followed up for mean 18 months. Fracture healed in mean 6.8 weeks. According to Lysholom function score, excellent in 27 cases, good in 2 cases, good rate of 100%. Conclusion Minimally invasive technique of percutaneous cannulated screw and titanium cable to treat the patella transverse fracture is the better choice. It fixes reliable, follow the biomechanical and have low surgical damage. Patients have less complication and get a good clinical efficacy. It is a better choice to treat patella transverse fracture of young fracture.

Objective To evaluate MRI in the diagnosis of the bone contusion of the knee joint and its clinical significance.Methods Using special coil for knee joint,coronal,sagittal,axial and oblique sagittal plane scanning with fast spin-echo sequence(T_1WI,T_2WI,PDWI+FS)was performed on knee joint in 205 patients in three days after injury.According the distributing bone marrow edema and injury mechanism,bone contusion were classified five types as pivot shift injury,clip injury,dashboard injury, hyperextension injury and lateral patellar dislocation.Results One hundred and forty-five cases of the 205 patients were found bone marrow edema without fracture on X-ray films.Among them,pivot shift injury was found in 43 cases accompanied with anterior cruciate ligament rupture in 30 cases,tear of the posterior horn of the lateral or medial meniscus in 12 and tears of the medial collateral ligament in 8 cases;clip injury in 53 cases accompanied with anterior cruciate ligament rupture in 10 cases,tear of the posterior horn of the lateral or medial meniscus in 15 and tears of the medial collateral ligament in 38 cases;dashboard injury 40 cases accompanied with posterior cruciate ligament rupture in 16 cases,hyperextension injury 9 cases accompanied with anterior cruciate ligament rupture in 2 cases,posterior cruciate ligament rupture in 5 cases.No lateral patellar dislocation was found.Forty-eight of 145 patients had undergone arthroscopy, 43 cases(89.6%)of them were in accordance with MRI diagnosis.Bone contusion were defined as geographic regions of abnormal signal intensity,that is,low signal intensity in T_1-weighted images and high signal intensity in PD-weighted or T_2-weigeted images with fat saturation.Conclusion MRI can accurately display the location and area of bone contusion of the knee joint as well as its adjunctive structure injury and deduce their injury mechanism.MRI should be used routinely for knee trauma.

OBJECTIVE To investigate the clinical pathological characteristics of differentiated thyroid carcinoma (DTC) in children and adolescents. METHODS The clinical data of 30 children and adolescents with DTC were retrospectively reviewed. Meanwhile the clinical pathological characteristics of DTC were analyzed according to patients' age and gender. RESULTS Papillary thyroid carcinoma (PTC) was found in 27 cases and follicular thyroid carcinoma (FTC) in 3 cases. The average diameter of tumors was (2.56±1.1) cm. In the group of children, the incidence of lymph node metastasis was 92.3% (12/13), pulmonary metastasis was 46.2% (6/13), and those in the group of adolescents was 88.2% (15/17) and 35.3% (6/17) respectively. Children group tended to present with more vascular invasion, thyroid capsule invasion, and invasion out of thyroid, and a higher rate of cervical lymph node metastasis (P=0.025, 0.007, 0.025, 0.033). CONCLUSION Thyroid carcinoma in childhood and adolescent has a stronger invasive feature. It is easy to local invasion, lymph node and distance metastasis.

Objective To compare the different effects of 1% diatrizoate meglumine,2.5% mannitol and water as oral contrasts in PET/CT scan in gastrointestinal tract delineation and 18F-fluorodeoxyglucose (FDG) uptake. Methods Sixty-one patients referred for PET/CT scan without gastrointestinal diseases were divided into three groups randomly ( random number method). One liter of 1% diatrizoate meglumine,2.5% mannitol,or water was orally taken by groups 1 (25 cases),2 (20 cases) and 3 ( 16 cases),respectively before scan. The scan was performed with GE Discovery LS PET/CT scanner in two-dimensional (2D) mode 50 min after 18F-FDG (5.55 MBq/kg) injection. Patients with abdominal lesions were excluded from this study. The degree of gastrointestinal filling and 18F-FDG uptake was evaluated by 3 nuclear medicine physicians using visual analysis according to a 4-grade classification method:none,mild,moderate,and high. Statistically analysis was performed by Kruskal-Wallis,Mann-Whitney and paired t tests.Results Both the differences of serum glucose and insulin levels were not significant before and after contrast taken in group 2. Group 2 had better gastrointestinal filling than that of group 1 and also better than group 3 except in rectum. The stomach,jejunum,ascending,and transverse colon were better filled in group 1 than in group 3. The degree of 18F-FDG uptake of group 3 was significantly higher than that of group 2 in stomach,jejunum and ileum (z= -3. 192,-3.290,-3.290,all P＜0.05),and was also significantly higher than that of group 1 (z = - 3. 603,P ＜ 0.05) in jejunum. The degree of 18 F-FDG uptake of group 3 was significantly lower than that of group 1 in ascending colon (z = - 2. 706,P ＜ 0. 05 ) and was significantly lower than that of group 1 and 2 in transverse and descending colon (z= - 3. 503,- 2.403,- 4.225,-4. 027,all P ＜0.05),and was also significantly lower than that of group 2 in rectum (z = -4. 128,P ＜0. 01 ). The maximum CT values in stomach,jejunum,ileum and ascending colon in group 1 were ( 132 ±23),(191 ±31),(313 ±47) and (374±53) HU,respectively,whose difference was significant (t = -7.088--1.781,all P ＜0. 01 ). Conclusion Oral iso-osmotic mannitol intake has better gastrointestinal filling and less physiological 18F-FDG uptake compared to diatrizoate meglumine and water.