Objective To evaluate the clinical efficacy of percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic vertebral compression fractures (OVCF).Methods Clinical datas of 90 cases patients with postmenopausal suffered single segment vertebral compression fracture who were treated in Beijing ShiJingshan Hospital of Capital Medical University from March 2010 to March 2013 were retrospectively analyzed.The patienrs were randomly divided into three groups according to the different treatment methods,20 patients receivedbed rest treatment as conservative group,40 patients were undergone percutaneous kyphoplasty as operation group,30 patients were given percutaneous kyphoplasty combined with zoledronic acid as combination group.Visual analogue score (VAS) were recorded before treatment and 1 week,6 months after treatment,and lumbar vertebrae bone mineral density (BMD) was measured before treatment and 2 years after treatment.The subsequent fracture of the vertebrae was analyzed after 2 years of treatment.Results There were 4 patients were not followed up.Three patients in conservative group suffered complications,but no complications were observed in operation group and combination group.The VAS score of the combination group and operation group at 1 week after treatment was significantly different compared with conservative group((3.0± 1.4) points vs.(3.2± 1.2) points vs.(8.0± 1.1) points,P＜0.05).At the 6 months after treatment,there were no significant differences among the 3 groups on VAS score (P ＞0.05).Lumbar vertebrae BMD of combination group increased at 2 years after treatment,compared with conservative group and operation group the difference were significantly((-1.8±0.6) vs.(-3.1±0.5) vs.(-2.7±0.3),P ＜0.05).The incidence of the subsequent fracture of the vertebrae reduced of combination group,compared with conservative group and operation group the difference were significantly (3.3％ (1/30) vs.27.8％ (5/18)vs.21.1％ (8/38),P＜ 0.05).Conclusion Percutaneous kyphoplasty combined with zoledronic acid for the treatment of OVCF-patients with postmenopausal and single segment fracture is not only safe,effective,but also can obviously relive pain and reduce the risk of subsequent fracture of the vertebrae.

Objective To compare the clinical effects of conservative therapy and radiofrequency ablation in the treatment of cervical spondylotic radiculopathy,to analyze the reason and discuss the surgical indications.Methods Fifty-five patients with cervical spondylotic radiculopathy treated in Shijingshan Hospital from May 2013 to May 2016 were selected and retrospectively analyzed,including 30 patients received conservative treatment (conservative group),25 patients undergone radiofrequency ablation (operation group).Visual analogue score (VAS) was used to assess the degree of pain relief in the two groups before treatment and 1 week,1 month after treatment.The side effects in the two groups and the postoperative complications of the patients were observed.Results The VAS score of the operation group and the conservative group in 1 weeks after treatment were (3.2±0.5) points,(5.2±0.7)) points,1 months (2.8±0.3) points,(5.8±0.4) points,respectively,the degree of pain were lower than those collected before treatment (8.0±0.9) points,(7.6±0.8) points,separately,the differences were statistically significant (P<0.05),and the degree of pain relief in the operation group was more obvious than that in the conservative group,there was significant difference between the two groups (P<0.01).Two groups of patients were treated with medication without any obvious discomfort.The surgery of the operation group was successful,and no complications such as nerve and spinal cord injury,vascular injury,local hematoma,puncture needle breakage and intervertebral space infection were found.Conclusion Radiofrequency ablation is more effective for the treatment of cervical spondylotic myelopathy in the short term than conservative treatment,and radiofrequency ablation treatment is a recommended choice for patients with no surgical contradiction.

Objective To investigate the common reasons,prophylaxes and treatment of postoperative complications in orthotopic liver transplantation (OLT).Method Seventy two patients who underwent OLT during recent three years were collected and analyzed retrospectively.Results OLT was performed on 50 cases with benign diseases including terminal liver cirrhosis 34;and 22 cases with and malignant diseases including hepato cellular carcinoma 19 cases.Fifty four complications were occurred postoperatively,including secondary abdominal cavity bleeding (4 cases ),severe infection of ascites (2 cases),stress gastric ulcer with bleeding and perforation (1 cases),biliary leak (6 cases),pulmonary infection (21 cases),and enteric fungal infection (5 cases).There were no primary dysfunction of liver and vascular complications.Follow up 2-41 months, without biliary complications and chronic liver dysfunction occurred 6 cases death postoperative,6 cases death on follow-up period.Total surrival rate is 83.33%, 32 cases alive more than 1 year,the longest surrival cases is 41 months postoperative.Conclusions It is suggested that the cases with cirrhosis are main indication for liver transplantation.The patients with liver cirrhosis always combinated of liverdisfunction,coagulopaphy,malnutrition and poor immune functions and we should pay attention to replace that of coagulation factors,antibiotics using and nutrition support perioperatively.Good surgical technique is the key point for preventing vascular complications.

Objective To investigate the etiology and management of early postoperative hyperbilirubinemia after liver transplantation. Methods The etiology and dynamic alteration of early postoperative hyperbilirubinemia in 50 liver transplants were retrospectively analyzed by a comparative trial of clinical manifestation with serial liver biopsy. Results The total serum bilirubin (TB) level profile presented like a invert "S" curve. At the first week, second week and 4th week after liver transplantation the serum TB levels were in average ( 127.19? 113.15)? ( 135.45? 124.6) and ( 73.1? 49.52)??mol/L respectively. Three months later, the serum TB level approximated to normal TB level ( 29.8? 37.56)??mol/L. The dynamic alternations of total serum bilirubin level were incorporated with the morphological improvement under microscopy of liver allograft following liver transplantation. The initial hyperbilirubinemia of reciepient before liver transplantation (10 cases, 20?%), preservation injury (containing 44 cases of ischemic reperfusion injury, 88?%), acute cellular rejection (13 cases, 26?%) and bile duct leakage (4 cases, 8?%) were 4 essential causes responsible for the early postoperative hyperbilirubinemia. The total serum bilirubin level profile was not characteristic of each catergory. Those 4 casuses mentioned above presented either independently or concomitantly in concrete case. No primary hepatic failure (PHF) occurred and curability of hyperbilirubinemia was about 100?% in our series. Furthermore, the perioperative survival rate of the recipients and liver allograft was 90.6?% and 1-year accumulative survival rate was about 80?%.Conclusions The hyperbilirubinemia is common clinical manifestion within 3 months after liver transplantation. Preservative injury, acute rejection, preoperative hyperbilirubinemina and bile duct leakage are four essential causes. The comprehensive management targeted to etiology can usually achieve a good outcome for the reciepients with hyperbilirubinemia.

Objective To investigate the effect of liver transplantation on extensive intrahepatic duct stones with biliary cirrhosis and unresectable intrahepatic alveolar echinococcosis.Methods Orthotopic liver transplantation was performed on 2 patients with extensive intrahepatic stones with biliary cirrhosis and 4 cases of unresectable alveolar echinococcosis. The pre- and intraoperative condition and postoperative complications were evaluated. All patients were regularly followed up. Results Two patients with intrahepatic stones have survived for more than 2 years after the transplantation. Three of 4 patients with alveolar echinococcosis have survived for 9, 15 months and 2 years respectively, up to now. Another one died of heart failure at the postoperative 3rd month. All survivors have recovered well their normal life and work. Conclusion Liver transplantation could be regarded as effective therapeutic means for extensive intrahepa- tic stones and unresectable alveolar echinococcosis.

Objective To summarize the clinical experience of liver transplantation in the treatment of hepatocellular carcinoma(HCC).Methods From June 2004 to March 2007,70 consecutive HCC patients underwent liver transplantation in our hospital,including classic orthotopic liver transplantation in 41 cases,and piggyback liver transplantation in 29 cases.All data of patients were retrospectively analyzed.Results All liver transplantation were successfully conducted.The average warm ischemia duration was 4.5 minutes,and cold ischemia duration was 8 hours.There were 3 cases of postoperative deaths.Surgical complications were intra-abdominal hemorrhage in 2 cases,and biliary anastomotic stricture in 4 cases.Sixty-seven cases were followed up for 12-33(average 21) months,10 cases had recurrence of liver cancer after transplatation and 1 dead.Conclusions Liver transplatation can used on selected patients with HCC.Successful liver transplantation relies on good quality of liver graft,and idealized technique of vascular and bile duct reconstruction are key factors of liver transplantation.Proper postoperative management can effectively reduce the complications of operation.

Objective:To investigate the specific interference of OX40 gene expression induced by RNAi technique in 293T cell lines transfected with rat OX40 gene.Methods:293T cells were transfected with recombined plasmid pEGFP-N1-GFP/OX40,and the positive cell clones were selected by fluorescence protein observation and RT-PCR.One specific dicer siRNA targeted to OX40 mRNA was designed and synthesized,which shared no homology with exons of known human gene.Quantitative real-time PCR was performed to measure the inhibitory rate of target gene expression by comparing OX40 mRNA concentrations before and after siRNA transfection.Results:10 nmol/L siRNA-OX40 elicited the highest level of gene silence in 293T cells which was transfected with siRNA after 48 h (68.3?8.7)%);The time of maximal inhibitory effect was at 48-72 h [(61.7?8.4)%,(39.6?5.6)%].Conclusion:The exogenous OX40 expression can be significantly inhibited by treatment with specific siRNA in a dose and time -dependent manner in 293T cells,which may provide a useful profile for further investigation of inhibition of OX40 protein,and a promising control approach for preventing immune reaction.

Objective To investigate the role of cytokines combined with CLIF Consortium organ failure score (CLIF-COFs) in determining the prognosis of liver transplant in hepatitis B-related acute-on-chronic liver failure (HB-ACLF) patients.Methods Thirty-seven cases of HB-ACLF patients undergoing liver transplantation were divided into HB-ACLF patients with complications group (n =15) and those without complications (n =22).Plasma were prospectively collected immediately before LT and on the 1st,3rd,5th,7th day after LT in HB-ACLF patients.The serum levels of twenty-seven cytokines were determined by 200 LUMINEX liquid chip technology.Cytokines and CLIF-COFs were analyzed with logistic regression and the receiver operating characteristic to confirm the correlation with the total complications post-LT.Results The serum levels of post-transplant G-CSF and MCP-1 in HB-ACLF patients with complications were higher than those of without complications (P ＜ 0.05).The COX analysis indicated that MCP-1 and CLIF-COFs were predictors of post-LT complications [A UC:0.821,95％ CI:0.668-0.974;AUC:0.738,95％ CI:0.578-0.898].The discriminatory power of MCP-combined with CLIF-COFs [AUC:0.839,95％ CI:0.703-0.975] was better than that of either.Conclusions MCP-1 combined with CLIF organ failure score can better predict the short-term outcomes of liver transplantation in HB-ACLF patients.

Objective To evaluate the clinical effect of Kangai injection combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatic cancer.Methods We searched CBM,CNKI,WanFang and VIP,clinical studies of Kangai injection combined with TACE in the treatment of hepatic cancer were included and compared.The methodological quality of included studies was assessed and Meta analysis was performed by Rev Man 5.2 software.Results 9 studies involving 595 patients were included.Meta analysis results indicated that the difference of effective rate was significant [RR =1.32,95 ％ CI(1.10,1.58),P =0.003] ; The quality of life improvement rate also had significant difference[RR =1.85,95％ CI(1.42,2.41),P ＜ 0.000 01].Conclusion Kangai injection combined with TACE in the treatment of hepatic cancer can get extra benefits compared with TACE alone.It can improve the curative effect,significantly improve the quality of life.

Objective To observe the effects of intermittent hypoxic preconditioning on the expression of apoptosis-related Bcl-2 and Bax protein after 70％ hepatectomy combined with ischemia-reperfusion injury.Methods A total of fifty-four SD rats were randomly divided into three groups (n =18).Partial hepatectomy hroup (PH Group):Rats underwent the left and middle lobectomy of liver(70％ hepatectomy).Ischemia reperfusion group (IR group):The left and middle lobes of liver were resected during the occlusion of the hepatoduodenal ligament for 20 minutes.Residual liver underwent the process of ischemia-reperfusion.Intermittent hypoxia preconditioning group (IHP group):rats were exposed to hypoxic environment of 10％ oxygen for 1 h/d.After 7 consecutive days,the left and middle lobes of liver were resected under the portal triad clamping.At 12,24 and 48 hours after the operation,the rats were killed and detected.The serum levels of ALT and AST were determined by automatic biochemical analyzer.The expression of Bcl-2 and Bax protein in liver tissue were measured by immunohistochemistry.Results At each time point after surgery,the serum levels of ALT and AST in IR group and IHP group were higher than that of PH group,and IHP group were lower than in IR group.Compared with IR group,the expression of Bcl2 protein significantly increased and Bax protein expression significantly decreased in IHP group.All these differences were statistically significant (P ＜ 0.05).Conclusions Intermittent hypoxic preconditioning might protect residual liver against ischemia reperfusion injury,through increasing the expression of Bcl-2 protein and reducing the expression of Bcl-2 protein to decrease liver cell apoptosis.