Objective To investigate the difference in occurrence of pneumothorax and bleeding under lung biopsy between the elderly and the non-elderly. Methods A total of 297 consecutive patients were involved in the study and divided into non- elderly group (＜ 60 yrs,122 cases),and elderly group (≥60 yrs,175 cases).Eighteen gauge (18G) cutting needles were used for biopsy with computed tomography (CT) guidance. Biopsy samples were detected by histology and cytology pathology. Results Pneumothorax occured in 108 of 297 biopsies (36.4％),pneumothorax rate was higher in elderly group (76 cases,43.4％) than in non-elderly group(32 cases,26.2％) (x2=9.19,P＜0.01).No statistical significance was found in different degrees of pneumothorax between the two groups.Perifocal hemorrhage occured in 156 of 297 biopsies (52.5％),higher frequency of hemorrhage occurred in elderly group (105 cases,60.0％) than in non-elderly group(51 cases,41.8％)(x2=9.55,P＜0.01),and the more flake bleeding vas found in elderly group than in nonelderly group(x2 =20.28,P＜0.01). Conclusions In CT guided coaxial cutting needle biopsy,the incidence of pneumothorax and considerably bleeding are higher in the elderly than in non-elderly.

Objective To explore the methods of embolism in simple and complex arteriovenous malformation of body.Methods Ten cases with the body arteriovenous malformations treated with interventional embolization were retrospectively analysed. Coil or detached bollon were used in simple arteriovenous malformations which could be embolized directly, while IBCA were used in complex ones, which could embolize the abnormal vascular group, blocking blood supply of multiple arteries and preventing construction of collateral circulation which could lead to recur. Results The abnormal vasculars were embolized completely in all ten cases, and there were no recurrent followed-up for 1～6 years.Conclusion Interventional embolization is a simple and credible therapeutic method for arteriovenous malformations of body , and it should be the primary plan.

OBJECTIVE To demonstrate a rare case of hepatic abscess caused by amebiasis and to discuss the reason of misdiagnosis.METHODS A fifty years old male patient with amebic liver abscess,misdiagnosed as hepatic(carcinoma),was studied.RESULTS The patient with a huge hepatic mass lesion was misdiagnosed as hepatic(carcinoma) and received interventional therapy four times within 13 months.Amebae were found in the(aspiration) of the lesion and in patient′s sputum.The temperature of the patient returned to normal range after(antibiotics) and anti-amebic therapy.CONCLUSIONS Amebic abscess is a clinically rare encountered pathology now.When to make the diagnosis,hepatic carcinoma should be carefully considered and differentiated.

Anti-angiogenic drugs such as bevacizumab can effectively alleviate the patients′brain edema and clinical symptoms and improve the patients′life quality by reducing vascular permeability and the blood-brain barrier damage.Bevacizumab has got positive efficacy in the clinical,so that it is considered as an effective and safe treatment for malignant brain edema.

Objective To investigate mesenchymal stem cells genetically modified by nerve growth factor to repair acute spinal cord injury in rats. Methods Fifty six Wistar rats of inbred strain were randomly divided into sham operation group cell transplantation group and simple injury group. The spinal cord injury model was prepared according to the modified Allen's method. NGFβ (hNGFβ) and GFP genes were transfected into MSCs by replication-deficient recombinant adenovirus vector (Ad-hNGFβ) and replication-deficient recombinant retrovirus vector (Rt-GFP) respectively. GFP positive MSCs were transplanted into intradural space of injured spinal cord at 7 days after spina coral injury. Spinal cord was dissected at 24 h, 1 and 2 weeks after transplantation. To observe the expression of GFAP and nestin and the distribution of MSCs after transplantation following the spina corol injury. Results MSCs migrated to the injured parenchyma In transplantation group, the expression of GFAP and NGF protein was higher than in the control group (P<0.05), the BBB score in transplantation group was higher than that in the control group (P<0.05). Conclusion The MSCs transplantation repaired the injured spinal cord to some extent.

Radiation therapy is one of the important comprehensive treatment strategies for thoracic neoplasms,but it also can cause radiation-induced heart disease (RIHD) which can affect the quality of life and even endanger the lives of patients while killing tumor.With the development of comprehensive treatment for cancer,the patients achieve better survival outcomes.And the study reported about RIHD increased as well,which made RIHD became an important complication of thoracic neoplasms' treatment.Though modem radiotherapy techniques and new therapeutic principles have significantly made the incidence of RIHD decreased,the harm of RIHD should not be ignored.In this article,we review the research progress of RIHD.

Objective:To analyze the causes and risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) in the treatment of femoral intertrochanteric fractures.Methods:A retrospective analysis was conducted of the 568 patients with femoral intertrochanteric fracture who had been treated with PFNA fixation at Department of Orthopaedic Surgery, The Fifth Central Hospital of Tianjin from March 2013 to March 2018. They were 348 males and 220 females, aged from 44 to 93 years (average, 74.6 years). According to the fracture stability classification, the patients were divided into a stable group of 424 cases and an unstable group of 144 cases. According to the AO classification, the stable group had type 31-A1 and type 31-A2.1 while the unstable group type 31-A2.2, type 31-A2.3 and type 31-A3. The 2 groups were compared in terms of reduction quality, rate of internal fixation failure, and function of the affected hip. Single factor and multi-factor binary logistic regression analyses were conducted to determine the risk factors responsible for failure of PFNA fixation of femoral intertrochanteric fracture.Results:There were no significant differences in the preoperative general data between the 2 groups, showing comparability between groups ( P> 0.05). Internal fixation failure occurred in 19 cases, which was caused by spiral blade withdrawal in 13 cases, femoral neck shortening in 17 cases, hip varus in 14 cases, and spiral blade cut-out in 14 cases. The failure rate for the stable group was 1.2% (5/424), significantly lower than that for the unstable group [9.7%,(14/144)] ( P<0.05). The Harris hip score at the last follow-up for the stable group [98(95,100)] was significantly higher than that for the unstable group [84 (82, 87)] ( P<0.05). There was no significant difference in reduction quality between the 2 groups ( P>0.05). The multivariate analysis showed that osteoporosis ( OR=7.283, 95% CI: 1.626 to 32.623, P=0.009) and unstable fracture ( OR=11.607, 95% CI: 4.039 to 33.355, P<0.001) were risk factors responsible for the failure of PFNA fixation of femoral intertrochanteric fracture. Conclusions:PFNA fixation for unstable intertrochanteric fracture can lead to a high failure rate. It forms a lever like structure so that the main stress is shifted to the internal fixation. Its lever fulcrum is located at the angle of intramedullary fixation so that a long arm forms at the load-bearing side, leading to a high failure rate. The weight-free time should be longer for patients with osteoporosis and unstable fracture after operation.

Objective To observe the clinical effect of arthrodesis in treating severe hallux rigidus. Methods Totally 30 patients (30 feet) with severe hallux rigidus treated by arthrodesis from January in 2010 to January in 2013 were retrospec?tively analyzed. AOFAS and VAS scoring system were employed to evaluate the clinical curative effect including acquiring the fusion rate, the time to fusion and the incidence rate of hallux valgus. Forefoot-plantar pressure values before and after operation were measured by Plantar pressure measurement system. Results The mean follow-up time was 18 months. AO?FAS score was raised from (48.2±7.6) to (72.8±6.2) after operation (P<0.01). VAS score was also increased from (1.7±0.7) to (8.3 ± 1.1) after operation (P<0.01). The average healing time of knitting was 12.1 weeks. None was non-union and devel?oped to hallux valgus. The forefoot-plantar pressure returned to normal postoperatively from abnormal laterally distribution.Conclusion The surgical strategy of arthrodesis is proved to be effective in treating severe hallux rigidus, in terms of capa?bility of relief from pain, recovery of forefoot-plantar pressure distribution, low incidence of complication.

Objective To study the value of magnetic resonance vessel wall imaging in assessing the atherosclerotic plaque burden of rabbit model.Methods We built up abdominal atherosclerotic animal model in 30 New Zealand rabbits by high lipid diet combined with abdominal artery denudation.The animals were divided into 3 groups randomly,which were the 1-week group,1-month group and 2-months group.The MRI and histology examination were carried out at relative time points.The correlations of area or thickness of vessel wall by MRI with histology examination were analyzed.Results Among the 30 rabbits,3 died due to anesthesia or surgery,one rabbit model failed because of the thin vessel,and another 3 died of diarrhea or inflammation during the high lipid diet feeding.Eventually,totally 23 rabbits fulfilled the examinations (7 in 1-week group,7 in 1-month group and 9 in 2-months group).The vessel wall area of histology examination grew larger along with the post-surgery duration,from 1.7663 mm2of 1-week group to 2.4371 mm2 of the 1-month group till 3.5978 mm2 of 2-months group,with statistic significant difference among 3 groups (F=5.052,P=0.017).There were strong correlations of area or thickness vessel wall resulted from MRI with histology examination(r=0.688,0.642;P=0.001,0.002).Conclusions High resolution MR vessel wall imaging technique may evaluate and follow up the plaque burden in the early stage of atherosclerosis.

Objective To observe the clinical effects of double support plate via posteromedial approach in the treat?ment of tibial plateau fracture of posterior column. Methods A total of 21 cases of tibial plateau fracture in closed posterior column with an average age of 34.6 (range, 21 to 56) years old were treated using double support plate through posteromedial approach from January in 2010 to January in 2013(16 males and 5 females). Among all, 4 cases were combined with lateral column fracture and 17 cases were three column fracture. Wound healings were observed after operation. X-ray examina?tions were performed at 2 weeks, 3 months, 4 months, 6 months and 12 months after operation as well as at last follow up. The averaged healing time was calculated. Changes of tibial plateau angle and posterior slope angle were compared between time points at 2 weeks after operation and at last follow up. Rasmussen knee score criteria was employed to assess knee joint recovery. Results The mean follow-up was (18.2 ± 1.8) months. No infection was reported. The average fracture healing time was 3.8(3.8±0.6)months. There was no significant difference between tibia plateau angle and posterior slope angle be?tween time points at 2 weeks after operation and at last follow-up (P<0.05). According to Rasmussen knee score criteria at last follow-up, 13 cases were graded as excellent, 6 cases as good, and 2 case as fair, with an excellent and good rate of 90.5%. Conclusion With posteromedial approach, the fractures of medial column, posteromedial and posterolateral of pos?terial column can be exposed well. Using double support plates to fix posteromedial and posterolateral of posterior column fracture can effectively prevent loss of reduction and the function of knee recovered well postoperatively.