Objective To explore the technique outcome of fixing the ventral stress pedicle screws into the injured vertebrae, as a method to enhance the posterior internal fixation. Methods From March 2002 to March 2005, 33 single thoracolumbar fractures were studied retrospectively. Among which, 16 cases were treated with the above method(group A), and the other 17 were treated with traditional two-level fixation(group B). Group A involved 11 males and 5 females, aged 48 years averagely(range, 32-74 years); and group B included 12 males and 5 females, aged from 21 to 61 years(mean, 40 years). All the patients underwent the operation within up to 3 weeks after fracture. For the injured vertebral bodies, their pedicles were intact on either unilateral or bilateral side, and their lower half and endplate were free from split. In group A, the pedicle screws in the injured vertebrae were used to achieve the ventral press vertical to the distraction for the stress neutralization, and also with the routine distraction and lordosis restoration, simultaneously. The mean follow-up period was 11 months with a range from 6 to 24 months. Results After operation, the optimal Cobb angle and anterior column restoration were achieved through the ventral reduction from the injured vertebral body, which was the contribution from the vertical stress pedicle screw. The degree in anterior movement of injured vertebrae pre- and postoperatively was much more in group A than group B, and the difference was of statistical significance(P

Objective To explore major risk factors for postoperative biliary tract infection associated with endoscopic retrograde cholangiography (ERC), and to evaluate endoscopic nasobiliary drainage (ENBD) for intervening the infection.Methods A total of 512 patients who underwent ERC at the First People's Hospital of Yunnan Province from January 2010 to June 2016 were enrolled and divided into group A and B randomly.Group A underwent ENBD after ERC while group B without.The incidence rates of biliary tract infection in different causes and lesions were compared between the two groups.Results Among the 512 patients, there were 276 cases in group A and 236 cases in group B.The overall postoperative biliary infection rate was 4.30%(22/512).Patients in group A showed a smaller chance of developing postoperative biliary tract infection than that in group B [1.09%(3/276) VS 8.05%(19/236), χ2=15.00, P=0.000].Malignant biliary obstruction was the most common cause (13.46%, 14/104) and the most common site was hepatic portal (13.43%, 9/67).Conclusion ENBD can ensure smooth drainage of bile duct therefore effectively prevent biliary tract infection after ERC, especially for patients with malignant biliary obstruction and hepatic portal lesion.

Objective To evaluate two kinds of anterior screw fixations in the treatment of odontoid fractures. Methods A total of 36 patients with D' Alonzo type Ⅱ odontoid process fractures were treated with anterior screw fixation in our department from 1999 to July 2009. There were 28 males and 8 females at mean age of 42.3 years (rang 17-59 years). According to time and surgery procedures, the patients were divided into Group A ( from 1999 to June 2005, n = 11 ) and Group B ( from June 2005 to July 2009, n = 25 ). Patients in Group A received anterior hollow screw fixation of the odontoid process monitored under G-arm or C-arm, while those in Group B received anterior screw fixation of the odontoid process assisted by Iso-C 3D navigation system. The operation time and blood loss in two groups were compared by Student' s t test and analyzed with SPSS 13.0 statistical software. X-ray examination was performed in all patients 3, 6 and 12 months after operation to observe fracture union and stability of the upper cervical spine. Results The operation time was ( 102 ± 12) min ( range, 77-148 min) in Group A and ( 104 ± 14) min ( range, 71-150 min) in Group B, with no statistical difference ( P =0.21 ). The blood loss was (465 ± 5) ml (range, 20-130 ml) in Group A and (42 ± 6) ml (range, 26-150 ml) inGroup B, with no statistical difference (P = 0.16). All patients received reexamination three months after operation, which showed no bony union or dislocation but average 40% restriction of neck rotation. One year after operation, 30 patients (83%) got fracture union and six ( 17% ) got fiber healing, with average 24% restriction of neck rotation. Conclusions There is no statistical significant differences between two groups in aspects of operation time, blood loss and fracture healing. But anterior screw fixation of the odontoid process assisted by Iso-C 3D navigation system can reduce exposure to radiation of both patients and surgeons. Furthermore, solid screws can be applied to augment the fixation intensity and thereby reduce the complications caused by non - union.

Objective To investigate the correlation between vertebral diffusion weigllted imaging (DWI)and dual X-ray absorptiometry(DXA),quantitative computed tomography(QCT)for the evaluation of bone mineral density(BMD).Methods A total of 152 female volunteers[aged from 30 to 80 years,mean age(58.2±14.2)years 1 were recruited in this study.All subjects underwent lateral thoracicolumbar radiographs,dual X-ray absorptiometry(DXA)and quantitative computed tomography(QCT),as well as DWI examination.Lateral spine radiographs(T4-L4)were evaluated with Genant's semiquantitative assessment.BMD was obtained by both DXA and QCT at lumbar spine(L2-L4).Axial vertebral(L2-4)DWI was performed with single shot spin-echo echo-planar imaging(SS-SE-EPI)sequenee (b value=500 s/mm2)after routine MRI examination(saginal T2 WI,T1 WI and axial T2 WI).Apparent diffusion coefficient(ADC)was measured with GE-Functool DWI software.Pearson correlation analysis was used for the statistics.Results There was a decreasing tendency in ADC value with age.A positive correlation was found between ADC(0.241×10-3 mm2/s)and BMD results measured by both DXA (1.038 S/cm3)and QCT(104.2 mg/cm3)examinations(r=0.461,0.731,respectively,P＜0.01).Conclusion DWI is an useful tool for noninvasive evaluation of the pathophysiologic changes of bone marrow in volunteers with difierent bone mineral density.

Objective: To observe clinical efficacy of oral folic acid (FA) intervene in hyper-homocysteinemia (HHcy) patients combining coronary artery disease (CAD) and heart failure (HF), to study the effect of blood level of Hcy on cardiac function. Methods: A total of 126 relevant patients with blood level of Hcy>15 μmol/L were randomly divided into 2 groups:Routine group, the patients received anti-platelet therapy, statins, beta-blockers, diuretics, angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor antagonist and FA group, in addition to above mentioned therapies, the patients also received FA 5 mg/day. n=63 in each group and all patients were treated for 3 months. Fasting blood levels of Hcy, BNP and left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), 6-minute walk test (6MWT) were compared between 2 groups at pre- and 3 months post-treatment. Results: ① Based on NYHA classification, the patients with cardiac function at II, III, IV had accordingly increased blood levels of Hcy, BNP and LVEDD, while decreased LVEF and 6MWT, all P<0.05. ② Blood levels of Hcy were positively related to BNP (r=0.733, P<0.001) and LVEDD (r=0.511, P<0.001), negatively related to LVEF (r=-0.382, P<0.001) and 6MWT (r=-0.410, P<0.001). ③ With 3 months treatment, FA group and Routine group showed decreased Hcy level as (8.43 ± 1.87) μmol/L vs (3.29 ±1.68) μmol/L and BNP (891.84 ± 456.10) pg/ml vs (682.24 ± 463.79) pg/ml, reduced LVEDD (4.33 ± 1.231) mm vs (2.06 ± 1.73) mm, while elevated LVEF (6.59 ± 2.28) % vs (2.52 ± 2.37) % and 6MWT (142.97 ± 55.15) m vs (86.35 ± 59.06) m, all P<0.05. Conclusion: Increased blood level of Hcy is risky for HF occurrence, FA may treat HHcy and further improve the cardiac structure and function in HF patients.

Objective To compare the effect of Acetate Sodium Potassium Magnesium Calcium and lactate ringers′ as priming solution in pediatrics with cardiopulmonary bypass (CPB) during congenital heart surgery. Methods Sixty children, aged 1-6 years, weighting 8 to 20 kg, with ASA Ⅱ to Ⅲ class and with ventricular or atrial septal defect elective , received heart surgery with CPB. They were randomly divided into two groups: the lactate ringers′ group (R) and the sodium acetate, potassium, magnesium and calcium glucose injection pre-filled group (L). Levels of artery blood gas, lactic, gluclose, electrolytes were detected at the time points of induction of anesthesia (T1), aortic cross damping (T2), stopping before (T3), and closing chest later (T4). Results Levels of the blood glucose and lactic acid in the two groups post-CPB were increased (P <0.01) at T2 and T3. Lactic acid level in group L was lower than that in group R (P < 0.05), and the blood glucose level in group L was higher than that in group R (P < 0.01). No significant difference was found in the lactic acid and blood glucose post-closing chestbetween the two groups (P > 0.05). Conclusion Sodium, potassium , magnesium , calcium and glucose injection as children CPB priming crystalloid fluid could provide energy substrate, reduce lactic acid concentration, with little effect on electrolyte and blood gas.

Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.

ObjectiveTo evaluate the impact of anatomic and non-anatomic liver resection on prognosisofpatientswithsmallhepatocellularcarcinoma( HCC ) usingaMeta-analysis.MethodsLiterature on anatomic versus non-anatomic liver resection for the treatment of small HCC ( ≤5 cm) was retrieved. ResultsFour nonrandomized controlled trials were included consisting of 776 patients:484 undergoing anatomic liver resection and 292 non-anatomic resection.The age ranged from 53.4 to 63.0 years.Male ∶ female ratio was 3.56 ∶ 1.87.1％ patients were Child-Pugh class A.Most patients (94.5％ ) had a single tumor.No significant differences were found conceming the 1,3,and 5 year disease-free survival rate between the two groups.There was no significant difference in overall survival and disease-free survival between the two groups at 1,3,and 5 years.Sensitivity analysis found anatomic resection was superior to non-anatomic resection in 3 year disease free survival rate (OR =0.72,95％ CI:0.52 - 0.99,P =0.04). ConclusionsAnatomic liver resection elevated the 3 year disease free survival rate of patients with small hepatocellular carcinoma when compared with non-anatomic hepatectomy but failed to further elevate long-term disease free survival and overall survival.

Objective To measure and assess CT perfusion value for peri-pancreatic metastatic lymph node by using multiple spiral CT (MSCT) with body perfusion software package. Methods The MSCT perfusion imaging was performed for peri-pancreatic metastatic lymph nodes and muscle on a multi-section CT scanner (SOMATOM Sensation Cardiac 64). 4 x 5 mm collimation, 120 kV, 60mA. Contrast injection was done with 40 ml nonionic contrast agent (300 mg l/ml), at a flow rate of 4.0 ml/s, and 5 seconds delay, and data acquisition lasted for 40 seconds. The mean blood flow (BF) were measured and analyzed in patients with pathologically proven peri-pancreatic metastatic lymph nodes(n=29)and hyperplastic lymph nodes(n=15) on work station using body perfusion software (Siemens) with deconvolution method. Results The mean BF in peri-pancreatic metastatic lymph nodes were (53.63±18.82) ml·min-1·100 ml-1, in hyperplastic lymph nodes were 29.78±7.52 ml·min-1·100 ml-1, the difference was significant (P<0.001). Conclusions Perfusion imaging of MSCT was useful in differentiation between peri-pancreatic metastatic lymph nodes and hyperplastic lymph nodes.

Objective To analysis the clinical features of dermatomyositis(DM)complicated with acute interstitial pneumonia(AIP),and to explore the cause of the disease to improve the treatment.Methods Seven cases of dermatomyositis complicated with AIP in our hospital from 1997 to 2005 were studied retro- spectively and the literatures were reviewed.Resets Seven dermatomyositis patients had typical cutaneous vasculitis with slight symptom of myositis.The electromyogram showed myogenic damage.The Jo-I antibodies were all negative.Simultaneously or shortly after the diagnosis of dermatomyositis,all patients presented with high fever,dry cough and progressed dyspnea.The chest X-ray or high-resolution computed tomography dis- played diffuse pulmonary interstitial changes which progressed rapidly.All patients died despites anti-infec- tious treatment and high dose steroid therapy.Conclusion AIP is the pulmonary injury of amyopathic or hy- pomyopathic dermatomyositis.In order to improve the prognosis,early diagnosis should be emphasized and in- terdisciplinary cooperation should be strengthened.