Objective To investigate the surgical technique and efficiency of the "Cave-in" 360°circumferential decompression for thoracic spinal stenosis(TSS)with ossification of posterior longitudinal ligament(OPLL).Methods From October 2005 to October 2009,26 TSS cases with OPLL were surgically treated,including 17 males and 9 females.Nineteen cases had upper thoracic spinal stenosis(T1-4)with OPLL,while 14 of them also had ossification of ligamentum flavum(OLF).All the other 7 cases had middle and/or lower(T5-12)TSS with both OPLL and OFL.All patients had severe spinal cord compression,and preoperative Frankel Grade was B in 6 cases,C in 13 cases and D in 7 cases.All these cases were surgically treated by 360° circumferential decompression("Cave-in" technique).Firstly,posterior wall was removed to decompress thoracic spinal cord.Secondly,the residual facets and pedicles were removed and posterior 1/3 of vertebral cancellous bones were cut along pedicles at 60° angle inclination to make a "culvert".Finally,the culvert walls were pressed to collapse and the OPLL blocks were removed to achieve ventral decompression.Pedical screw fixations were performed in all patients.Results All cases had immediate postoperative neurological improvement except 2 who experienced transient postoperative neurological deterioration for 13-27 days.At the end of 6-30 months follow-up,all these patients had neurological improvement.At the last follow-up,Frankei Grade was C in 2 cases,D in 15 cases and E in 9 cases.Conclusion This "Cave-in"360° circumferential decompression removes ventral and dorsal spinal compression from the posterior approach in TSS cases.It is a direct decompression procedure,which reduces the rate of postoperative paralysis.

Objective To investigate the effects of carbon monoxide poisoning on the long-term cognition in elderly patients.Methods Totally 53 patients with carbon monoxide poisoning and 51 healthy persons at our Hospital from June 2005 to June 2008 were enrolled.Mini-mental state examination(MMSE) and activities of daily living(ADL) scale were utilized to evaluale the life quality of the elderly patients through a cross-sectional study on July 2011.Results MMSE score showed that the attention calculation score,delayed recall score,and total score were higher in control group (4.9±0.4,2.9±1.0,28.3±2.3,respectively) than in carbon monoxide poisoning group (4.5±0.8,2.6±0.6,25.5±3.5,respectively) (t＝3.138,3.607,4.802,all P＜0.05).ADL score of carbon monoxide poisoning group was 26.7±7.3,and that of the control group was 2.04±7.6 (t＝1.827,P＞0.05).Conclusions Elderly patients with acute carbon monoxide poisoning may cause long-term cognitive impairment with decreasing attention calculation and delayed recall.

[Summary] Traditional anterior thoracotomy surgery for thoracic idiopathic scoliosis has amount of disadvantages such as large trauma,postoperative pain,and pulmonary function decrease.Video-assisted thoracoscopic surgery (VATS),which is considered as an effective method for the treatment of idiopathic thoracic scoliosis,can avoid those disadvantages as compared with thoracotomy surgery.Common surgical procedures include anterior spinal release with intervertebral fusion and instrumentation through video-assisted thoracoscopic surgery (IVATS).This article reviewed the history,indications,contraindications,advantages,disadvantages and outcomes of VATS in the treatment of idiopathic thoracic scoliosis.

To explore the role of cerebro-spinal flu id(CSF)glutamate and nitric oxide (NO) in the pathogenesis of neonatal hypoxic- ischemia encephalopathy (HIE), glutamate and NO in CSF were determined in 24 new born infants with HIE and 8 normal control infants, respectively. The results sh owed that the levels of glutamate and NO in CSF were significantly higher in the neonates with moderate and severe HIE than those in both of the control group an d neonates with mild HIE.There was an obviously positive relationship between le v els of glutamate and NO. It is concluded that glutamate and NO play an important role in the pathogenesis of neonatal HIE.

Objective To discuss the CT and MR imaging appearances and diagnostic value of spinal lymphoma. Methods Sixteen patients with pathologically proved spinal lymphoma (aged 8 to 63 years) were retrospectively reviewed. CT were performed in all 16 patients, and MRwere performed in 12 patients. Results Totally 65 vertebrae (cervical 15, thoracic 22, lumbar and sacrum 28) were involved. Multiple lesions were found in 11 patients. The characters of these lesions were osteolytic, osteogenic or mixed on CT. The signal intensity was hypo or iso on T1WI and iso or slightly hyper on T2WI. The extradural involvements were more extensive than that of the vertebrae both on CT and MR images. Conclusion Lesions of spinal lymphoma usually demonstrate various bone destructions on CT, and hypo or iso intensity on T1WI as well as iso or slightly hyper intensity on T2WI, tending to involve paraspinal or extradural space, and longitudinal involvements are often seen along the vertebral canal. MRI is more sensitive than CT in detecting spinal lymphoma lesions.

Objective To study the CT and MRI features of the chordoma in the mobile spine.Methods The CT and MRI fea-tures were retrospectively analyzed in twenty-four cases of chordoma in the mobile spine.Results In all the twenty-four cases,bone lesions were solitary in eight cases and multiple in sixteen cases,mostly occurred in cervical,occasionally occurred in thoracic or lum-bar vertebra.Both vertebral body and part appendix were involved in all cases.CT imaging showed that all the lesions mainly mani-fested as osteolytic bone destruction,peripheral osteosclerosis and the cortical bone were incomplete.Soft-tissue mass involved para-vertebral and intraspinal.Five lesions appeared vertebrae compression.Eight lesions appeared intervertebral foramen expansion.Le-sions appeared honeycomb or annular enhancement after contrast media injection.Lesions were presented as heterogeneous slightly hypo-isointensity on T1 WI,hyperintensity on T2 WI.Low signal fibrous septa within the tumors were seen.Lesions appeared hon-eycomb enhancement after Gd-DTPA injection.Conclusion CT and MRI findings of chordoma in the mobile spine can be regarded as characteristic,which are helpful for clinical diagnosis.

Objective To explore the methods to reduce the occlusion of perforating arteries after intracranial stenting of the vertebral artery. Methods Clinical data of 32 cases of Gateway-Wingspan stent implantation for intracranial branch of vertebral artery were retrospectively analyzed. The postoperative stricture and perfusion improvement situation were evaluated, the reason of perforating artery occlusion was analyzed. Results Thirty-two patients were implanted with 33 pieces of Wingspan stent and 1 piece of Apollo bracket. The operation success rate were 100%, and the stenosis rate reduced from (76.6±6.1)%to (27.9±5.2)%. After three months, the transcranial doppler sonography (TCD) and CT angiography were checked, showing no in-stent restenosis in all patients. Two patients occurred the perforating artery occlusion within 24 hours after operation. The possible reason was the change of stability of atherosclerotic plaque at the stenosis and the plaque displacement caused by the mechanical action of the balloon or stent, which may lead to medulla oblongata artery block. After drug and rehabilitation treatment, the symptoms in patients were improved significantly. Conclusion The perforating artery occlusion after stent implantation in intracranial branch of vertebral artery can be prevented by strict evaluation and preoperative preparation, the right selection of intraoperative balloon and stent, which still needs larger sample data to prove.

Objective To explore the repair effect of methylcobalamin treatment of nerve after spinal cord injury.Methods 108 cases of patients with acute spinal cord injury were selected treated in our hospital from 2010 April to 2014 April , including 60 cases of male, female 48 cases, were randomly divided into Mecobalamin group(n=56) and control group(n=52), mecobalamin group was treat with a cobalt amine, control group was given conventional treatment (dexamethasone intravenous drip note).According to American spinal cord injury score (ASIA) to set sensory function, motor function and spinal cord function score criteria, observed and record ed the sensory function, motor function, recovery of neurological function and complications the two groups of patients were treated for 6 weeks and followed up for 6 months.Results Spinal cord injury patients after 6 weeks and 6 months follow-up, the improvement of sensory and motor function of mecobalamin group were significantly better than the control group ( P <0.01 );Mecobalamin group patients after first to 3 weeks of recovery of neurological function was higher than those of the control group (P<0.05);the 2 groups were found urinary tract infections, lung infections, vomiting, reaction of ulcer complications, but the difference was not statistically significant ( P>0.05).Conclusion In patients with acute spinal cord injury treated by mecobalamin treatment can improve the nerve function damage condition, improve the prognosis and quality of life.

Objective To investigate the effects of therapeutic hypercapnia on acute pulmonary allograft rejection induced by macrophages in rats.Methods Twenty-four adult male Wistar rats and 12 adult male Sprague-Dawley rats,weighing 250-280 g,were used in this study.The recipient rats were randomly divided into 3 groups using a random number table (n =6 each):syngraft group (group S),allograft group (group A) and therapeutic hypercapnia group (group H).In group S,Wistar rats served as donors and recipients,while in A and H groups,Sprague-Dawley rats served as donors and Wistar rats served as recipients.Orthotopic left lung transplantation was performed using the cuff technique.After transplantation,the rats inhaled 50％ N2-50％ O2 for 90 min during reperfusion in S and A groups,while in group H the rats inhaled N2-O2-CO2 for 90 min during reperfusion and PaCO2 was maintained at 80-100 mm Hg and O2 concentration in inspired air at 48％-50％ by adjusting the concentrations of the three gases.At 7 days after operation,the arterial blood sample was collected for blood gas analysis and for determination of serum concentrations of tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ)by ELISA.The oxygenation index was calculated.Then the rats were sacrificed,and the transplanted lungs were removed for microscopic examination and for detection of infiltration of macrophages (by immunohistochemistry)and cell apoptosis (by using TUNEL) in lung tissues.The rejection was scored and apoptotic index was calculated.Results Compared with group S,PaCO2,serum concentrations of TNF-α and IFN-γ,rejection score,the number of macrophages and apoptotic index were significantly increased,and oxygenation index was decreased in group A (P ＜ 0.05).Compared with group A,pH value and oxygenation index were significantly increased,and serum concentrations of TNF-α and IFN-γ,rejection score,the number of macrophages and apoptotic index were decreased in group H (P ＜ 0.05).Conclusion Therapeutic hypercapnia can reduce macrophage-induced acute pulmonary allograft rejection possibly through inhibiting the inflammatory responses and cell apoptosis.

ObjectiveTo evaluate magnifying endoscopy combined with flexible spectral imaging color enhancement(FICE)for diagnosis of early gastric cancer.MethodsThe suspicious small depressive lesions(SDL) was further studied with magnifying endoscopy or magnifying endoscopy combined with FICE from April 2009 to March 2011 in our hospital.The endoscopic diagnostic criteria of early gastric cancer was made according to the structure of the pit,the microvascular and the demarcation line.ResultsIn 74 SDL,17 were pathologically diagnosed as cancer,and 56 were noncancer.The sensitivity,specificity and accuracy of magnifying endoscopy were 41.18％,94.74％and 82.43％,respectively,which were 86.67％,96.49％ and 91.89％,respectively for magnifying endoscopy combined with FICE.The diagnostic sensitivity of magnifying endoscopy combined with FICE was significantly higher than that of magnifying endoscopy (P ＜0.05 ).ConclusionMagnifying endoscopy combined with FICE can reveal the structure of the pit,microvascular and demarcation line more clearly.The endoscopic diagnostic criteria is a more comprehensive description of the mucosal micro-morphological features of early gastric cancer.