Following thin slice reconstruction by multi-slice spiral CT,the initial data were processed in workstation.Reconstruction methods include two-dimensional multi-plane reconstruction,contour reconstruction,three-dimensional surface shielding,maximum density projection and volume rendering technique.The key parameters of 64-slice spiral CT involve parameters of monitor,time resolution,space resolution,high tension generator and thermal capacity of sucker.Its performance is influenced by many parameters.A balance of monitor,high tension generator and sucker can improve CT time resolution and rendering range.Multi-slice spiral CT multiplanar reconstruction and three-dimensional reconstruction image as important supplement of axial images can directly display fracture condition,and best and rapidly present joint peripheral fracture,providing reliable evidence for surgical protocol.Postoperatively reconstructed images can clear display internal fixtor appearance,location and fracture reduction,and is significant for surgical protocol and prognosis evaluation.

Objective To explore the relationship between 24-hour blood pressure variability after admission and early neurological deterioration in patients with acute non-cardioembolic ischemic stroke.Methods This was a case-control study.Patients with acute non-cardioembolic ischemic stroke within 72 hours after stroke onset were prospectively registered.Clinical and 24 -hour continuous blood pressure monitoring data were recorded, and subsequently compared with regard to whether early neurological deterioration ( END) occurred within 7 days after admission.Factors contributing to END were investigated by logistic regression model.Results Of 221 eligible patients, 59 cases ( 26.7%) exhabited END.Patients with END had higher 24-hour mean systolic blood pressure ( SBP) (145.8 ±18.2 mmHg vs.139.9 ± 20.3 mmHg, P=0.014) and SBP coefficient of deviation (SBP-CV) [9.0(7.3 -11.2) vs.8.4(6.9-10.2), P=0.011].After adjusting for crude variables, multivariate analysis showed that the increase in mean SBP (10 mmHg mean SBP,OR=1.285,95%CI(1.059~1.559) and SBP-CV [1 unit of SBP-CV, OR=1.206,95%CI(1.050~1.384)] was associated with higher risk of END.Conclusions Increased 24-hour blood pressure variability after admission is an independent risk factor for occurrence of END in patients with acute non-cardioembolic ischemic stroke.

Objective To investigate the correlation betw een the short-term blood pressure variability and the recent outcome in patients w ith noncardioembolic ischemic stroke. Methods The patients w ith acute noncardioembolic ischemic stroke admitted to hospital betw een January 1, 2013 to June31, 2015 w ere enrol ed consecutively. The demographic and clinical data w ere col ected, and 24 h ambulatory blood pressure monitoring w as performed and each blood pressure variability parameter w as calculated. The modified Rankin scale (mRS) w as used to evaluate recent neurological outcome at the time of discharge or the fourteenth day in hospital. The mRS score 0-2 w as defined as good outcome, and >2 w as defined as poor outcome. Multivariate logistic regression analysis w as used to determine the correlation betw een the blood pressure and the short-term blood pressure variability indicators and recent neurological outcome. Results A total of 229 patients w ith acute noncardioembolic ischemic stroke w ere enrol ed, and 40.2% of them had recent poor functional outcome. The mean systolic pressure ( 147.8 ±19.6 mmHg vs.137.7 ± 19.1 mmHg; t=3.868, P<0.001; 1 mmHg=0.133 kPa) and the actual variation value of the mean systolic pressure (median, interquartile 11.7 [10.0-14.0] mmHg vs.10.6 [8.2-12.5] mmHg;Z=3.544, P<0.001) of the recent poor outcome group w ere significantly higher than those of the good functional outcome group. Multivariate logistic regression analysis show ed that after adjusting other confounders, the increased mean systolic pressure ( each 10 mmHg increase: odds ratio 1.189, 95% confidence interval 1.013-1.369; P=0.034) and the enlarged actual variation of systolic blood pressure (each 1 mmHg increase:odds ratio 1.182, 95% confidence interval 1.046-1.336; P=0.008) w ere associated w ith the recent poor functional outcome. Conclusions The increased short-term blood pressure variability w as associated w ith the recent poor functional outcome in patients w ith acute noncardioembolic ischemic stroke.

BACKGROUND:Thoracolumbar fracture becomes more in the clinic. The fixation manner of thoracolumbar fracture is controversial. Injured vertebra pedicle screw fixation or traditional cross-segment pedicle screw fixation are controversial and lack the support of evidence-based medicine. OBJECTIVE: To evaluate the outcomes of injured vertebra pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. METHODS: According to Cochrane system evaluation, the folowing databases were retrieved: National Library of Medicine database, China National Knowledge Infrastructure, Wanfang database and VIP database. Conference proceedings were searched by hand. The retrieval time ranged from 2005 to March 2015. Randomized controled trials were colected. Meta-analysis was performed by using Cochrane Colaboration Revman 4.2. RESULTS AND CONCLUSION: By screening, a total of 14 clinical controled trials were selected, including 956 patients. Meta-analysis results showed that postoperative Cobb angle was improved significantly in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=-2.72, 95%CI:-3.08--2.35,P < 0.01). Correction rate of the vertebral height was higher in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=7.45, 95%CI:6.94-7.97,P < 0.01). The failure rate was lower in the vertebral pedicle screw group than in the cross-segment pedicle screw fixation group (OR=0.12, 95%CI: 0.05- 0.27,P < 0.01). Results verify that postoperative Cobb angle improved significantly after the injured vertebrae pedicle screw and cross-segment pedicle screw fixation for thoracolumbar fractures. The height was obviously corrected and fewer complications were caused such as implant failure. The fixation effect was good.

Objective To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy for a tuberculous non-functional kidney. Methods A total of 15 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were encountered from January 2013 to January 2016. There were 12 male and 3 female patients with an average age of 47 (range 36~64 years old) in the cohort. All patients had normal renal function on the contralateral side and underwent the standard three-drug antituberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the enlarged section of the distal ureter was managed using different auto-suture techniques. Results All the operations were successfully performed without conversion. The median operative time was 109 min (range, 75~138 min), the median blood loss was 157 ml (range, 70~230 ml), and the median hospitalization time was 7 days (range, 5~11 days). Renal vein injury, lumbar vein injury and rupture of distal ureter occurred in 1 patient, respectively. Peritoneum injury was observed in 3 patients. No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting five months. No recurrenceof tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 25 months. Conclusion Total retroperitoneal laparoscopic nephroureterectomy is a safe and feasible approach for the treatment of tuberculous non-functional kidneys, and it is minimal and rapid recuperation.

Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity.

Background and purpose:In recent studies, the Notch-1 gene has been found to play an important role in the development of human glioblastoma.Short interfering RNA(siRNA) was used to silence the Notch-1 gene and block its expression.The objective was to determine whether siRNA targeting Notch-1 would inhibit the formation and growth of tumors in nude mice that modeled human glioblastoma.Methods:The human glioblastoma cell line TJ905 were first cultured and transfected with Notch-1 siRNA or nonsense siRNA by OligofectamineTM.The TJ905 cells were divided into 3 groups:the Notch-1 siRNA transfected group, nonsense siRNA transfected group and the control group.Each group's cells were subcutaneously injected into 5 nude mice.The nude mice(males, 3-4 weeks old) were given subcutaneous injections of either 0.2 mL of transfected siRNA or with normal TJ905 cells suspended at a 1?107 cells/mL concentration in a DMEM medium without serum.One week later, when the tumors were palpable, they were directly injected with the Notch-1 siRNA complex, nonsense siRNA complex, or PBS every 4 days for 20 days.Tumor sizes were measured every 3 days and calculated by the formula:volume(mm3) =1/2 length?(width)2.After a 20-day follow-up period, the mice were exterminated.Immunohistochemistry was used to determine the expression of Notch-1 gene.Results:The final tumor volume was less in nude mice injected with Notch-1 siRNA(1 203?206) mm3 compared mice injected with the nonsense siRNA injection(2 241?401) mm3, P

Objective To discuss CT and MRI features of aggressive fibromatosis (AF), especially the characteristic signs of MRI, and to evaluate the value of MRI in diagnosing the disease. Methods The CT and MRI studies in 9 cases with pathologically proven AF were retrospectively analyzed. Results Among 9 cases with AF, one cases could not be discovered by CT and all cases could be discovered by MRI. Appearances of lesion were infiltrating in 7 cases and mass-like in 2 cases. All cases were without calcification and lipo-tissue in the lesion and without edema on adjacent muscle structures. A homogeneous density and high density was seen on CT plain scans and high density on contrast enhanced scans. On MRI scans, variable signal intensity was demonstrated on T 1WI, and high signal intensity on T 2WI, as well as increased signal intensity after contrast enhancement. The signal characteristics primarily reflected the underlying histologic composition of the lesions. Conclusion MRI is more excellent than CT in delineating the site, shape, and extent of these lesions. MRI is valuable in detecting and differentiating AF.

Objective To conclude partial traumatic hemipelvectomy score and assess its value in partial traumatic hemipelvectomy treatment.Methods Data of the managements of 14 partial traumatic hemipelvectomy patients between January 2003 and December 2015 were retrospectively analyzed.10 of these patients were males and 4 females,with an average age of 31 (range,21-55).11 patients were brought directly to the hospital emergency department,and 3 patients were transferred from other hospitals.According to Tile classification system,all pelvic fractures were type C fracture:nine with type C 1,three with type C2 and two with type C3.Partial traumatic hemipelvectomy score was concluded according to soft tissue injury severity,the distance between hemi-pelvic and body axis,injury degree of iliac vessel and nerve.All these factors were further classified into four grades (range,1-4) on the basis of injury severity.Based on clinic outcomes and our experiences,hemipelvectomy should be performed at the early stage when patients had scores more than 12;if the score was between 8 and 12,reassessment should be done according to practical situation and hemipelvectomy was recommended;if the score was between 4 and 8,limb salvage was strongly recommended;if the score was below 4,limb salvage should be done.Results All 14 patients were assessed by partial traumatic hemipelvectomy.The average score was 11 (range,9-14).12 of them were scored at the range of 9-12.2 of them had scores more than 12.3 patients died during the initial resuscitation stage.7 patients underwent completion of the hindquarter amputation after control of hemorrhage and all the patients were successfully survived.Limb preservation was attempted in 4 patients:3 of them died eventually because of infection.1 patient underwent hip disarticulation in emergency operation,but this patient eventually required hindquarter amputation for severe infection.Conclusion Partial traumatic hemipelvectomy score could be a rapid and accurate tool in initial assessment of partial traumatic hemipelvectomy.After the control of hemorrhage,early hemipelvectomy could lower the death rate of this kind of patients.

Objective To investigate the efficacy of external fixators in the treatment of unstable pelvic fractures( Tile B and Tile C ). Methods The different results of 78 patients who had been treated with or without external fixator were compared. Results In 38 cases who were treated without external fixator, the cure rate for hemorrhagic shock was 76%, the mortality 10.6%, and the average ISS score 11.6. In 40 cases who were treated with external fixator, the cure rate for hemorrhagic shock was 90%, the mortality 2.5%, and the average ISS score 9.8. Conclusion The treatment of unstable pelvic fracture with external fixator is simple and reliable, and can reduce the mortality significantly.