BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. Al patients were subjected to percutaneous bal oon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing ful-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing ful-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P<0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P<0.05). In standing ful-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P<0.05). Al patients were fol owed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous bal oon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous bal oon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.

Objective To design a hemostatic clip and evaluate its efficacy and success rate of closure of stomach wall defect after full thickness resection (FTR).Methods A full thickness circular or linear resection (3 to 5 cm) was made on each model's antrum with needle knife and insulated-tip knife.The specimens were divided into 2 groups, using either an interrupted or continuous suturing method.Then the closure condition, suturing time, number of clips required and success rate of closure were compared.Results All 12 defects were successfully closed.The average closing time of interrupted and continuous suturing group were 13.33 ± 1.09 and 10.17 ±2.11 minutes, and the mean number of clips used were 4.67 ± 0.82 and 2.67 ± 0.82.The success rate was 100％.Conclusion This newly designed clip is a fast, reliable and convenient tool for stomach wall defect closure after FTR.

Objective To evalute the effect of Ilizarov technique in the treatment of hypertrophic nonunion.Methods Form June 2008 to December 2010,12 patients with hypertrophic nonunion were treated with Ilizarov technique,including 10 males and 2 females with an average age of 46.5 years.The pathology sites of nonunion were kept as closed as possible without any bone graft during operation.As to patients who had ever been treated with plate or intramedullary nail,the hardware should be removed by minimal invasive approach.These procedures aimed to keep the vascularity of nonunion site intact.Ilizarov apparatus were preoperatively constructed.Distal segment and proximal segment of nonunion were mounted respectively with two external circle using the smooth wires and half pins.The two-circle stabilizing one segment was nominated with transosseous modules.Distal module and proximal one was connected with a pair of axial hinges.The pathology sites were gradually distracted from the seventh day postoperatively,0.25 mm/d.Accompanying with deformity correction,limb length discrepancy (LLD) also were restored simultaneously.Then,all the screws and nuts in the apparatus should be tightened,which was favourable to the callus consolidation.Results All 12 cases of nonunion healed without any bone graft.The fixator wearing time lasted 6-12 months,with an average of 8 months.Correction of deformity and LLD were achieved.The average lengthening was 3.0 cm (range,2.0-5.5 cm),the average correction angle was 23° (range,10°-30°).After 6-18 months follow-up,all the patients restored satisfactory function.Conclusion Hypertrophic nonunion can be treated successfully with Ilizarov technique.The key of successful callus distraction is strictly identifying the indications.

Objective To improve the differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) by a contrast analysis of imageological features.Methods Thirty-six patients who had postoperative pathological with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC.The imageological results of these AIP and PC patients were analyzed.Results AIP was significantly less than PC in the enhanced CT of a mass or enlargement of the pancreatic head,enlargement of the lymph nodes around the pancreas,dilation and interrupt in pancreatic and bile duct,peripheral vascular and organ involvement (11/27 vs.28/40,2/27 vs.17/40,13/27 vs.32/40,1/27 vs.10/40,8/27 vs.26/40,2/27 vs.15/40,0/27 vs.15/40,0/27 vs.10/40,P ＜ 0.05).AIP was significantly more than PC in the enhanced CT of a diffusely enlarged pancreas,calcification or pancreatic calculus,capsule-like rim or the vague peripancreatic fat interval (4/27 vs.0/40,7/27 vs.0/40,10/27 vs.6/40,P ＜ 0.05).AIP was significantly less than PC in the three-dimensional ultrasonography of dilation diameter of pancreatic duct and dilation of common bile duct [(0.421 ± 0.270) cm vs.(0.594 ± 0.270) cm,1/18 vs.16/26,P＜ 0.05].AIP was significantly less than PC in the magnetic resonance cholangiopancreatography of dilation of common bile duct and interrupt in pancreatic duct (7/13 vs.16/18,1/13 vs.10/18,P ＜ 0.05).Conclusion AIP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive imageological features

Objective To evaluate the safety and effectiveness of a new hemostatic clip with sutures for ESD suspension method in animal models.Methods A total of 20 porcine stomachs were randomly divided into the experimental group (n=10) and the control group (n=10).ESD was done respectively in antrum greater curvature and antrum back wall of porcine stomach in vitro.All procedures were completed by the same endoscopist and nurse.The incidence of perforation,mucosa diameter,total operation time (T),dissection time (T1),the average number of submucosal injection,and one-time complete dissection rate were compared between two groups.Results Procedures were done successfully in antrum of 40 poccine in vitro and all mucosa were dissected completely in one procedure.No perforation occurred.Compared with the control group,the mucosa diameter difference was not statistically significant (P =0.368).The total operating time [(34.70± 1.06) min VS (37.1 0± 2.23) min,P =0.009],dissection time [(31.40± 2.00) min VS (34.80± 2.20) min,P=0.817] and the average number of submucosal injection[(7.60± 1.00) VS (10.60± 1.00),P＜0.001] in antral greater curvature ESD of the experimental group were significantly less than those of the control group.As for the antrum back wall,the mucosa diameter difference was not statistically significant.The total operation time [(37.00± 1.25) min VS (39.60± 1.65) min,P＜0.001],dissection time[(34.50± 1.35) min VS (37.00± 1.25) min,P＜0.001],the average number of submucosal injection [(7.60± 1.27) VS (11.40± 1.00),P＜0.001] were also significantly less than those of the control.Conclusion The new hemostatic clip with sutures for suspension can significantly shorten the operation time,reduce the number of submucosal injections and the difficulty in ESD.

Objective To investigate the pathologic features, diagnosis and differential diagnosis of inflammatory myofibroblastic tumor (IMT) in urinary bladder. Methods It was retrospectively reviewed for the characters of pathologic features and immunohistochemistry type in 3 patients diagnosed IMT in urinary bladder. Results 3 patients including 1 female and 2 male were 15, 36 and 60 years old (mean age 37),respectively. All patients underwent partial cystectomy. All cases presented single or multiple, polypoid or nodular mass(es), ranging in size from 1.8 to 5.5 cm. Microscopically, the tumor cell grew in invasive pattern, and were spindled with prominent nucleoli. The lesions varied from highly myxoid to highly cellular lesions. The mitotic rates were invisible. AE1/AE3, CK18 and ALK were positive in IMT. Follow-up was available for 3 patients (2, 18 and 18 months, respectively). None developed recurrences or metastasis. Conclusion IMT in urinary bladder are rare tumors. IMT grows in invasive pattern, and are spindled with prominent nucleoli.The main differential diagnosis of IMT includes embryonal rhabdomyosarcoma in juvenile, sarcomatoid urothelial carcinoma and leiomyosarcoma in adult.

Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pan-creatography (ERCP) in treatment of pain of chronic pancreatitis (CP). Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed.The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of ther-apy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients ( 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years).The mean follow-up period was 41.9 months (12～131 months). Twenty-eight patients (13. 1% ) under-went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% (P >0. 05 ) respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14.9% (71/476) in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6%, mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub-sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.

Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.

As the global population continues to age,the incidence of neurodegenerative diseases has seen a constant increase in the elderly.Research indicates that neuroinflammation is a significant pathological mechanism in neurodegenerative diseases such as Alzheimer's disease,Parkinson's disease,amyotrophic lateral sclerosis,multiple sclerosis and Huntington's disease.Astrocytes are key glial cells involved in the regulation of neuroinflammation.More studies have revealed that astrocytes closely interact with other glial cells,neurons and peripheral immune cells to regulate synaptic plasticity,neuronal function,glutamate cycling and energy metabolism in the central nervous system,which shows notable therapeutic effects on neurodegenerative diseases.This paper aims to further explore specific manifestations and potential molecular mechanisms of astrocyte-mediated inflammatory processes in neurodegenerative diseases through interactions of astrocytes and other cells,therefore to identify new therapeutic targets from the perspective of astrocytes and then improve the symptoms.

Vascular dementia(VD)is a neurodegenerative disease caused by brain injury.Research on the processes leading to its occurrence is lacking depth.In recent years,it has been proposed that regulatory cell death(RCD)mechanisms,including apoptosis,pyroptosis,autophagy,ferroptosis,and cuproptosis,are related to the pathological mechanisms of VD.Therefore,studies aiming to explain the links between the mechanisms of regulatory death and the pathology of VD would be beneficial to our understanding of VD.This article provides a review of the roles of five mechanisms of RCD in VD and summarizes the recent progress made in researching the treatment of VD with traditional Chinese medicine,providing a resource for the development of new traditional Chinese medicine drugs.