Objective To investigate the correlation between lumbar curvature and lumbar intervertebral disc herniation.Methods 160 cases of young and mid-aged lumbar disc herniation patients were collected.All patients were divided into two groups accord-ing to the curvature.The age,sex,course of disease,occupation and MRI manifestations were recorded.Also,the recurrence and the arch top distance were recorded in 6 months after treatment.Results The age,sex,course of disease were similar between the two groups.70% of the patients in curvature straighten group were sitting or standing for long time in life,while in the other group more people were engaged in traditional manual work(P<0.05).The arch top distance increased in the curvature straighten group when rechecked(P<0.05).There were more patients with L4/L5 segment intervertebral disc herniation in the curvature straighten group,while more patients with L5/S1 segment intervertebral disc herniation in the other group(P<0.001).The recurrence rate was higher in the curvature straighten group,and the arch top distance was less in the patients with recurrence in both groups(P<0.05).Conclusion The patients with curvature straightening have a higher rate of recurrence and intervertebral disc herniation in L4/L5 segment.The recovery and reconstruction of the balance of the lumbar spine biomechanics is beneficial to the patients’cura-tive effect and functional recovery.

Objective To detect the IgM antibodies and epidemiology of pathogens of respiratory tract infection in children ,and to provide the basis for clinical diagnosis and treatment .Methods The serum of 14 379 outpatient and inpatient cases in Tianjin Children′s Hospital from March 2015 to February 2016 were detected by indirect immunofluorescence ,and the respiratory tract in‐fections of different gender ,season ,age and pathogens were analyzed .Results Totally 3 392 specimens (23 .59% ) were positive for IgM antibody detection and the positive rate of MP with 18 .77% was highest ;361 cases were mixed infection ,mainly including two kinds of infection pathogens .The positive rate of respiratory pathogens in male with 21 .46% was significantly lower than in female patients with 33 .92% (χ2 = 274 .73 ,P < 0 .05) .The positive rate in different ages groups (0 - 30 d ,- 6 months ,- 1 years ,- 3 years ,- 9 years ,- 18 years) were 0 .2% ,1 .8% ,15 .36% ,34 .46% ,39 .73% and 30 .73% respectively ,the highest infection rate was found between 3 to 9 years old children ,and the differences among groups were statistically significant (χ2 = 1 407 .87 ,P<0 .05) .The highest rate of MP were found in autumn (24 .42% ) and winter (23 .01% ) ,the highest rate of Influenza B virus (IFu B) was found in spring (15 .13% ) ,the positive rate of Legionella pneumophila (LP) was high in summer (0 .78% ) and autumn (0 .80% ) .Comparison with the 15 departments ,the children of otolaryngology with the positive rate of 43 .9% was the highest . Conclusion The infection ratios of respiratory pathogens were related to gender ,season ,age and pathogen .These findings provided an important reference for clinical diagnosis and treatment in different seasons and population .

Objective To evaluate the therapeutic effects of the accordion technique used in external fixation for long bone hypertrophic nonunion.Methods From August 2013 to December 2015,13 patients with hypertrophic nonunion were treated by the accordion technique (distraction,compression and re-distraction) used together with an Ilizarov ring external fixator or a monolateral external fixator.They were 10 males and 3 females with an average age of 44.6 years (from 18 to 63 years).The nonunion occurred in the middle femur in 5 patients,in the femoral supracondyle in one,in the tibial diaphysis in 4,and in the distal tibia in 3.The procedure was performed with a preassembled external fixator without open surgery or bone graft.The pathological sites were gradually distracted (0.25 mm/day) from the seventh day postoperatively.In case of deformity,correction was conducted to restore the alignment.At the same rate of distraction,compression was started after the equal length was achieved and next followed by distraction.The frequency of cycle depended upon the callus observed in the X-rays.Results The mean follow-up for the 13 patients was 19 months (from 10 to 38 months) after removal of the external fixator.All the cases of hypertrophic nonunion obtained bony union after a mean duration of 7.5 months (from 5 to 13 months).No nonunion or deformity recurred during the follow-up.The complications such as pin-site infection (in 4 cases) and mild Achilles's tendon contracture (in 2 cases) were prevented or treated by careful nursing and rehabilitation.Conclusion The accordion technique together with an external fixator is a reliable and effective treatment for hypertrophic nonunion.

Objective To investigate the clinical features and disease-causing mutations of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis.Methods In February 2016,a 24 year old female patient with left kidney stone and nephrocalcinosis in bilateral kidneys was admitted to our hospital.One month prior to this admission,she had been treated by PCNL to remove the most part of left kidney stone in otherhospital.Mter admission,She was found hypomagnesaemia (serum magnesium 0.65 mmol/ L) and hypercalciuria (24h urine calcium 364.0 mg) but with normal renal function (serum creatinine 101.5μmol/L).And the remained part of left kidney stone was removed by flexible ureteroscope.As she was considered probably with an autosomal recessive FHHNC,an analysis of CLDN16 and CLDN19 gene mutations was performed using her and her parents'peripheral white blood cells.Results Mutation analysis revealed this patient had two heterozygous mutations in the CLDN16.One is an one-base deletion mutation in the 123th codon in exon 2:368delA.The other is a missense mutation in the 139th codon in exon 2:416C →T which resulted in an amino acid change Ala139Val.Her parents respectively had one of each heterozygous mutation.In the six months follow-up,an oral administration with hvdrochlorothiazide,potassium citrate,and calcium magesium supplements significantly reduced her hypomagnesaemia (serum magnesiun 1.0 mmol/L) and hypercalciuria (24-h urine calcium 156.0 mg),and no stone recurrence and aggravation of nephrocalcinosis and renal dysfunction occurred.Conclusions We diagnosed a patient with FHHNC who had a novel compound heterozygous mutation of CLDN16.This rare disease should be suspected if there are three constant clinical features of hypomagnesaemia,hypercalciuria and nephrocalcinosis,and verified with CLDN16 and CLDN19 gene test.Currently the option for treatment of FHHNC is symptomatic treatment until severe deterioration of renal function.The hydrochlorothiazide,potassium citrate,and calcium magesium supplements may have considerable effects on hypomagnesaemia and hypercalciuria.

Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.

Objective To investigate the efficacy and toxicity of sorafenib dose escalation in treating patients with advanced renal cell carcinoma who progressed after rutine dosage of sorafenib.Methods Twenty-four patients with advanced renal cell carcinoma who progressed after 4-22 months' rutine sorafenib treatment(400 mg bid po.) received dose escalation therapy.Nineteen cases were male,5 were female,with the average age of 52 years.Ten cases added their doses to 600 mg bid,and 14 cases escalated to 800 mg bid.Results Four cases(16.7%) progressed after one month's treatment of sorafenib dose escalation,and quited the study.In the other 20 cases,1(4.2%) reached partial remission with a tumor shrinkage of 42.5% and 19(79.2%) maintained stable disease for more than 12 weeks.To Jul 2009,another 10 cases progressed,and the median progression free survival(PFS) for the PR and SD patients was 7 months(3-14 months).The disease control rate was 79.2%,and the median PFS was 5 months(0-14 months) for the entire group of 24 cases.Common toxicities after dose escalation of sorafenib were similar to those of rutine dosage.Although the grade of hand-foot reaction,diarrhea,fatigue,and neutropenia were more severe,no grade 4 toxicities were observed during the treatment.Grade of toxicities would decrease when the time of treatment prolonged.Conclusions Sofafenib dose escalation is a feasible and effective treatment for the patients with advanced renal cell carcinoma who failed to rutine dosage of sorafenib.The disease control rate of this therapy is relatively high.The toxicities do not increase much,and could be well tolerated by most patients.

Objective To investigate the efficacy of sorafenib in treating metastatic non-clear cell renal cell carcinoma(RCC).Methods Twenty-one patients with metastatic non-clear cell subtype renal cell carcinoma were treated with sorafenib.Thirteen cases were male,8 were female,with a median age of 45 years(25-76 years).Metastasis occurred in 12 cases after radical nephrectomy,and the other 9 cases received cytoreductive surgery.Pathological diagnosis showed 15 papillary RCCs,1 chromophobe RCC,and 5 unclassified RCCs.The metastatic lesions were located at lung,lymph node,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sorafenib 400 mg bid,or sorafenib 400 mg bid in combination with interferon-α 3 MIU,IH.5 days per week,and the median time of treatment was 8 months (2-21 months).Results Three cases (14.3%)with 1 papillary RCC,1 chromophobe RCC,and 1 unclassified RCC reached partial remission(PR) and 13 cases (61.9%) maintained stable disease (SD) for more than 12 weeks.And the rest 5 cases(23.8%) progressed(PD).To Jul 2009,13 cases progressed and the median progression free survival was 7 months(0-21 months).Conclusions Sorafenib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,and unclassified RCC.Metastatic lesions in lungs and Lymph nodes might be more sensitive to sorafenib.

Objective To evaluate the efficacy of sorafenib in treating metastatic renal cell carcinoma with sarcomatoid feature.Methods Fourteen patients with metastatic renal cell carcinoma and previous nephrectomy were treated with sorafenib single agent.The average age was 61 years(45-77years).All patients were pathologically confirmed with sarcomatoid features in the primary tumors and the percentage of sarcomatoid element was recorded from 20% to 100%.Eight cases were diagnosed as clear cell carcinoma with sarcomatoid feature,2 cases papillary renal cell carcinoma (RCC) with sarcomatoid feature,and 4 cases with pure sarcomatoid RCC.The metastatic lesions were located at lung,lymph node,adrenal gland,bone,and liver.The median time of treatment was 8 months (3-19 months).Results Two cases who just had lymph node metastasis reached partial remission.Their percentages of sarcomatoid lesion were 100% and 20%.Seven cases maintained stable disease for more than 12 weeks and the last 5 cases progressed.To Jul 2009,9 patients progressed and the median progression free survival was 6 months(0-19 months).No significant correlation was seen between both objective response rate and progression free survival and the percentage of sarcomatoid element.Conclusions Although sorafenib has some effect in advanced renal cell carcinoma with sarcomatoid feature,the prognosis of these patients is relatively poor.The percentage of sarcomatoid element does not seem to correlate with the treatment efficacy.

Background and pnrpose: Renal cell carcinoma (RCC) was the most lethal urological tumor. Not much data mentioned the correlation between the clinical significance of renal capsular involvement status and the clinical symptoms or stage. Our study was aimed to reveal the clinical significance of renal capsular involvement status in RCC. Methods: We retrospectively analyzed 101 consecutive Chinese RCC patients treated in 2006. All the patients received nephrectomy in our hospital. We documented and compared their clinical symptoms, histopathological findings and clinical stages according to 2002 TNM staging systems. Results: Fifty-five patients had no symptoms at diagnosis, 24 complained of lumbago, 18 endured gross or microscopic hematouria, and 14 had generalized symptoms such as cachexia and/or metastatic symptoms. After pathologic analysis, there were 68 cases confirmed as stage T_1, 9 as stage T_2, and the other 24 cases over stage T_2, of which 19 were stage N_(1-2) or M_1. None of those who complained of lumbago had capsular penetration;all 11 patients with capsular penetration did not complain of lumbago. For those with lesion >4 cm, 29% (10/35) with no complaint of lumbago had capsular penetration. Bad general performance status indicated capsular penetration (Pearson Chi-Square, P<0.001). Capsular invasion was found 40% (40/101) in all, and 71% (17/24) in tumor >7 cm;capsular penetration was 11% in all, and 28% (11/40) in cases of capsular invasion. For cancer confined within kidney, lymph nodes or visceral metastases occurred occasionally regardless of capsular invasion (4/29 vs 9/61, Pearson Chi-Square,P>0.05);for cancer with capsular invasion, the incidence of lymph nodes or visceral metastases decreased without further penetration (6/11 vs 4/29, Pearson Chi-Square, P<0.01). Conclusion: Complaint of lumbago indicates organ confined disease in RCC. For large lesions in kidney, absence of lumbago predict renal capsular penetration. Renal capsular involvement status correlates well with clinical symptoms and TNM stages. Capsular invasion is often seen, especially for large lesions, but further penetration is rare. Capsular invasion without penetration does not increase the risk of systematic metastases, and renal capsular has a protective role against the spread of cancer.

Objective To investigate the efficacy of Sunitinib in treating metastatic non-clear cell renal cell carcinoma (RCC).Methods Twenty-two metastatic non-clear cell subtype renal cell carcinoma patients with a median age of 46 years (29 -76 years) were treated with Sunitinib.Fourteen cases were found have metastasis post radical nephrectomy,and the remaining eight cases with metastasis received cytoreductive surgery.Pathological diagnosis showed 12 papillary RCCs,one chromophobe RCC,three collecting duct RCCs,and six unclassified RCCs.The metastatic lesions were located in the lung,lymph nodes,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sunitinib 50 mg qd four weeks on and two weeks off.The median time of treatment was 11 months (4.5 - 24 months).Results The objective control rate was 73％.Three papillary RCC and one chromophobe RCC reached partial remission (PR) and 12 cases maintained stable disease (SD) for more than 12 weeks.And the remaining six cases progressed (PD).Conclusions Sunitinib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,collecting duct RCC and unclassified RCC.Metastatic lesions in lungs and lymph nodes might be more sensitive to Sunitinib.