Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

Objective To observe morphological character of posterior arch of Atlas and lamina of axis,as well as provide anatomical basis to design special guiding device for the operation of upper cervical posterior fixation with Atlas titanium cable so as to make the operation safe and easy.Methods The posterior arch of Atlas and lami- na of axis were observed and measured in 100 adult dry Atlas and axis specimens,then special guiding devices were designed based on the anatomical data.Results (1)The posterior arch of Atlas was thin with a fan-shape section, whose inner plane descended from back to inside and the lamina of axis was stronger and thicker than posterior arch of Atlas,with a vertical inner plane and a ridge near the lower edge.(2)The special guiding device for posterior arch of Atlas should be designed with a bend head as well that for lamina of axis should be designed with a round head. They were used in 61 operations which became safer and easier.Conclusion The operation of upper cervical posteri- or fixation with Atlas titanium cable would be safer with the help of special guiding devices which were designed based on the anatomical character.

Objective To explore the prevalence of ETS gene fusion in prostate cancer and its correlation with patient's clinicopathologic index.Methods Ninety-one samples from prostate needle biopsy cases with median age 75 (55-90) years and 18 samples from radical prostatectomy cases with median age 72 (63-81) years were collected from Oct.2010 to Feb.2012.TMPRSS2-ERG,TMPRSS2-ETV1 and TMPRSS2-ETV4 fusions were tested by multi-probe fluorescence in situ hybridization (FISH) assay.Fusion positive and negative cases were compared with age,TNM stage,Gleason score (median Gleason score 7 (6-9)),and PSA value (median PSA 33.4 μg/L,mcan PSA 118.8 μg/L).In needle biopsy cases,there were early stage 32 (34％),locally advanced prostate cancer 36 (40％),metastasis 23 (26％) ; in radical prostatectomy cases,there were 9 cases in T2 stage,8 cases in T3 stage,1 cases in T4a stage,respectively.Results TMPRSS2-ERG fusions were present in 14.3％ (13/91,95％ confidence interval,0.071-0.215)biopsy specimens and in 11.1％ (2/18,95％ confidence interval,0-0.256) radical prostatectomy specimens.No TMPRSS2-ETV1 or TMPRSS2-ETV4 fusions were found in any cases.Altogether,13 (86.7％)cases possessed deletion pattern.And 7 (46.6％) hold insertion pattern.5 cases had both deletion and insertion pattern.38.5％ (5/13) deletion pattern had distant metastasis.Except one metastatic case harbored both deletion and insertion pattern,there was no insertion pattern accompanied with metastasis.There were no differences between fusion positive and negative cases in the distribution of age (P =1.000),PSA (P =1.138),primary Gleason score (P=2.186),Gleason score (P=2.107),TNM stage (P=2.052) and Risk Degree (P=2.597).Conclusions The TMPRSS2-ERG fusion positive cases harbor more deletion pattern than insertion pattern.There are no differences between fusion positive and negative cases in the distribution of age,PSA,Gleason score,TNM stage and Risk Degree.

The surface-enhanced Raman spectra of bilirubin and biliverdin were obtained.By the bands analysis of the spectra,the orientation of bilirubin and biliverdin on the surface of silver colloid was discussed.In such case,the bilirubin was adsorbed on the silver colloid particle with the two planar pyrromethenone groups intercalated into the globe silver colloid particle,however,the biliverdin might lie flat on the surface of silver colloid with syn-synsyn conformation.

Objective To evaluate the efficacy and safety of one-stage posterior wedge osteotomy ffor correction ot kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Methods From January 2002 to December 2012,we retrospectively reviewed 18 patients with tuberculosis of the spine in healed stages which underwent one-stage posterior wedge osteotomy.There were 6 males and 12 females,whose average age was 8.2 (4 to 15) years and average followed-up time was 37.1 (10 to 120) months.The apical vertebrae were located at cervicothoracic segment in 2 cases,thoracic segment in 10 cases,thoracolumbar segment in 5 cases and lumbar segment in 1 case.The lesions involved 2 segments in 3 cases,3 to 5 segments in 9 cases and more than 5 segments in 6 cases.There were 6 cases with neurological dysfunction whose Frankel' s classification was C in 2 cases and D in 4 cases.The coronal and sagittal Cobb angels,thoracic kyphosis,lumbar lordosis,sagittal trunk shifts,number of fixation and fusion segments and bony union were measured on the standing AP and lateral radiographs before,after surgery and at the final follow-up.Results The Cobb' s angels in the sagittal plane were corrected from 71.6° to 14.5°,representing 79.7％ correction rate.The Cobb' s angels in the coronal plane were corrected from 9.4° to 0.7°.Sagittal trunk shift was obviously improved from 3.7mm to 0.5mm.The average fixation segment was 9.6 (5 to 17) segments while the average fusion segment was 4.4 (2 to 8) segments.The neurological function had all been improved at final follow-up.Perioperative complications consisted of fixation loosening in 4 cases,gastrointestinal dysfunction in 2 cases,pleura injury in 5 cases,and cerebrospinal fluid leakage in 3 cases.Conclusion One-stage posterior wedge osteotomy is a safe and effective surgical technique for correction of kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Both the selection of fusion levels and the appropriate technique of osteotomy are crucial to good outcomes.

Objective To establish the method of contact heat evoked potential(CHEP)and to explore the value of this evoked potential in pain testing of patients with cerebral infarction.Methods A total of 100 healthy volunteers and 30 patients were examined.The healthy volunteers were divided into 3 groups according to the length of their arms:(Group A:56.0～65.0 cm ;Group B :65.5～74.0 cm ;Group C :74.5～83.0 cm).A recently de- veloped heat-foil technique with a rapid temperature rising rate at 70℃/s was used to elicit pain and contact heat e- voked potentials.Contact heat was delivered via one circular thermode(diameter 27 mm,area 573 mm~2)and set at two intensity levels(49.5℃and 54.5℃)to three body sites:the thenar eminence,the dorsum of hand and proximal volar forearm.The subjects were asked to rate the pain with numerical rating scale after each stimulus and CHEP was recorded from Cz and Pz.The association between stimulus intensities and pain rating was explored,the main compo- nents of the evuked potential were watched.CHEP,sensory conduction velocity(SCV)and somatosensory evoked potentials(SEP)were performed in patients with hemi-anesthesia caused by cerebral infarction.Results The pain intensity ratings were 3.2?0.3 and 4.4?0.5 at thenar eminence,5.0?0.7 and 6.3?0.8 at the dorsum of hand and 5.3?0.6 and 7.2?0.5 at the proximal volar forearm when the temperature of 49.5℃and 54.5℃was applied, respectively;Three components,Cz/N550,Cz/P750 and Pz/P1000,were identified in the evoked potentials.Cz/ N550 and Cz/P750 appeared when the dorsum of hand and proximal volar forearm were stimulated.In contrast,Pz/ P1000 could be identified when nociceptors of thenar eminence and proximal volar fbrearm were excited.In the pa- tients with cerebral infarction,CHEP disappeared or became abnormal on one side,while SCV and SEP were normal on that side.Conclusion It was suggested that CHEP could be elicited reliably in the controls.CHEP is helpful in the assessment of analgesia in patients with cerebral infarction.

Objective To evoke cerebral potentials by stimulating nociceptive fibers with contact heat evoked potentials stimulator (CHEPS)and estimate the nerve conduction velocities of peripheral nerve fibers mediating these responses.Methods Subjects were set in supine position.A heat-foil technology with a rapid rising speed at 70 ℃/s was used to elicit pain and contact heat evoked potentials(CHEP).Contact heat was delivered via one circular thermode (diameter 27 mm,area 573 mm~2).Thermal stimuli were sent at two intensity levels (49.5 ℃ and 54.5 ℃) to three body sites:thenar eminence,the dorsum of hand and proximal volar forarm.Contact heat evoked potentials were recorded from Cz and Pz.A systemic effect between stimulus intensities and pain rating were observed,the main components of this evoked potential were observed.Nerve conduction velocity was calculated from latency difference of CHEP and center to center distance of distal and proximal stimulus arrays.Results The pain intensity rating was 3.2?0.3 and 4.4?0.5 when thenar eminence was stimulated at the temperature of 49.5 ℃ and 54.5 ℃ respectively;the rating was 6.3?0.8 and 7.2?0.5 when the dorsum of hand and proximal volar forarm were stimulated at the temperature of 54.5 ℃ respectively.Three components,Cz/N550,Cz/P750 and Pz/P1000,were found in the evoked potentials.Nerve conduction velocities of the fibers were (12.9?7.5) and (1.7?0.4) m/s respectively,which were corresponding to those of A8 fiber and C fiber.Conclusions CHEPs can be elicited reliably and stably.Velocities of peripheral nerve fibers demonstrate that A8 fiber and C fiber mediate the response.

Background Glucocorticoid is a common drug for treatment of thyroid-associated ophthalmopathy (TAO) with good effectiveness.But some adverse reactions of glucocorticoid are inevitable.At recent years,99technetium-methylene bisphosphonate(99Tc-MDP) is being paid more and more attentions in the treatment of TAO,but its effectiveness and safety is worthy of comparison to traditional treatment methods.Objective This study was to evaluate the efficacy of treatment with intravenous injection of 99Tc-MDP for TAO.Methods The Cochrane Library,CNKI,PubMed,Wanfang database,Weipu net were searched in computer and Google Scholar was searched manually.The randomized controlled trail (RCT) of intravenous injection of 99Tc-MDP for TAO were collected from establishment of database through April,2012.The quality of included literature was assessed based on the methodology of the study.The evaluating indexes included the primary treating outcomes,such as total efficacy,exophthalmic extent and recurrence rate as well as secondary outcomes such as adverse effect.RevMan 5.1 software was used for Mate analysis.Results A total of 11 RCTs were identified with 706 patients.Subgroup analysis was carried out based on the outcome measures and intervention.No significant difference was found in the overall effective rate between intravenous injection of 99Tc-MDP and immunosuppressive treatment (RR =0.96,95 ％ CI:0.76 to 1.22,P=0.740).However,the effective rate was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =1.25,95 ％ CI:1.06-1.46,P =0.007) or between intravenous injection of 99 Tc-M DP and the blank control group (RR =2.53,95 ％ CI:1.68-3.81,P =0.000).Significant difference also was found in the total effective rate between intravenous injection of 99Tc-MDP with methyprednisone and methyprednisone alone (RR =1.27,95％ CI:1.05-1.53,P =0.010).There were significant differences in the effective rate of proptosis between intravenous injection of 99Tc-MDP and oral prednisone (RR=2.02,95％ CI:1.44-3.56,P=0.020).The recurrence rate of TAO was significant different between intravenous injection of 99Tc-MDP and oral prednisone (RR =0.51,95％ CI:0.33-0.78,P=0.002).Less adverse responses were seen in the intravenous injection of 99Tc-MDP group than the oral prednisone group and immunosuppressive treatment group.Conclusions Intravenous injection of 99Tc-MDP for TAO appears to be of a similar effectiveness to immunosuppressive method.The combination of intravenous injection of 99Tc-MDP with methyprednisone seems to be more effective than methyprednisone alone,with little systemic adverse effect after application.

Objective To explore the application of high-frequency oscillatory ventilation(HFOV)postoperatively after open heart surgery in children with congenital heart disease.Methods From Jun.2007 to Jun.2008,a total of 1 957 cases were operated in pediatric center of Fuwai cardiovascular hospital.Thirteen cases of 1 957 were given HFOV.Among these 13 patients,8 were male and 5 were female;Age was(13.4?15.4)months.The range of weight was 4.2-12.5 kg.Four cases were tetralogy of Fallot,3 cases were transposition of the great arteries(1 case was corrective transposition of the great arteries),2 cases were total anomalous pulmonary venous connection,2 cases were total endocardial cushion defects,2 cases were pulmonary artery atresia,all patients were under cardiopulmonary bypass repaired operation except 1 patient with PAA under Blalock-Taussig procedure.All patients were mechanical ventilated after surgery.Results The duration of switching general mechanical ventilation to HFOV was(15.70?20.33)days and patients continued to be on HFOV about(10.0?7.5)days.In short term,the lung function of ventilation and gas exchange were be improved by HFOV,but the long-term result was not sa-tisfactory due to a high mortality.There were 5 survived(38.4%)in this group.Six cases of the patients succumbed to consolidation of lung.The commonest complication was pneumothorax(7 cases).Conclusions Short term of HFOV in children with congenital heart disease was satisfactory postoperatively.But there was a high mortality.HFOV can be regarded as a transition method for unsatisfactory long-term.

Objective Explore the clinical application values of Golgi Protein 73 ( GP73 ) , AFP variants (AFP-L3) , Alpha fetoprotein ( AFP) and α-l-Fucosidase ( AFU) detection in the diagnosis of hepatocellular carcinoma ( HCC) .Methods From January of 2013 to June of 2014, 84 case of HCC Patients( HCC group ) who presented at interventional department; 64 case of cirrhotic patients ( liver cirrhosis group ) , 86 case of chronic hepatitis patients ( chronic hepatitis group ) and 120 healthy people ( normal control group) were selected from Shanghai Tongren Hospital.GP73 was detected by the enzyme-linked immunosorbent assay (ELISA), AFP-L3 was isolated with ACSC, AFP and AFP-L3 were detected with ECLIA and calculated the percentage content of AFP-L3 ( AFP-L3%) , AFU was detected with enzyme kinetic method.Adopted the SPSS 19.0 statistical software for data analysis.The rank sum test was used in the multi group comparison;the chi square test was used in the comparison group.Results Serum levels of GP73, AFP-L3, AFP and AFU in HCC group were 202.1 μg/L, 9.5%, 68.3 μg/L, 33.2 μg/L respectively.Their difference from those of the normal control group(69.0 μg/L,2.5%,4.5 μg/L,24.2μg/L) was of statistical significance (U was 1126.59, 204.67,1247.68,564.08,respectively,all P <0.05).GP73 and AFP in the hepatic carcinoma group was significantly higher than that in the cirrhosis group(151.1 μg/L、18.5 μg/L) (U was 463.47, 368.56,respectively, P<0.05).GP73, AFP-L3 and AFP in the hepatic carcinoma group was significantly higher than that in the chronic hepatitis group(93.6μg/L,3.5%,5.7μg/L) (U was 1 116.52,213.42,1 166.52, respectively, all P<0.05).The content of AFU in HCC group (33.2 μg/L), normal control group and chronic hepatitis group were compared (24.2μg/L,24.1 μg/L), respectively ,no significance was found(U was 564.08,487.24,P>0.05) Sensitivity of GP73 and AFP in individual inspection was 95.24%, significantly higher than that of AFU, AFP-L3. Specificity of AFP-L3 was 94.81%respectively, with an accuracy of 85.88% respectively.Specificity and accuracy of the allied detection of GP73, AFP-L3, AFP and AFU for HCC diagnosis were 98.52% and 84.75% respectively.Conclusions The allied combination of serum GP73, AFP-L3, AFP and AFU makes up for the insufficient clinical applications of individual serum markers. It is of great clinical significance to improve the diagnosis of HCC.