With wide applications of invasive diagnostic and therapeutic techniques,as well as immu-nosuppressors clinically,the morbidity of invasive pulmonary fungal infections( IPFIs)in children were in-creasing considerably and becoming one of the important diseases threat to life. The mortality of IPFIs in chil-dren would be reduced and the prognosis would be improved significantly with early diagnosis and treatment in-time. Radiological examinations were the basal component of the clinical evidences for diagnosing IPFIs. The main presentations include pulmonary nodules,some with“halo sign”in invasive pulmonary aspergillo-sis and pulmonary candidiasis,lobular consolidations and a little pleural effusion. Although there was no spe-cific findings radiologically,they would provide the proofs and clues for diagnosis of IPFIs combining with the data of clinics and laboratory.

ObjectiveTo assess the clinical value of minimally invasive transforaminal lumbar interbody fusion(TLIF) through the Wiltse approach for the treatment of lumbar spondylolisthesis. Methods Sixty-nine patients with lumbar spondylolisthesis were randomly divided into two groups. Group A underwent minimally invasive TLIF via the Wiltse approach, Group B via the traditional approach. There were 31 cases in group A, the affected level was L4.5 in 19 cases and L5S1 in 12. The degree of vertebrae slippage was Ⅰ degree in 17 cases,and Ⅱ degree in 14. There were 38 cases in group B, the affected level was L4,5 in 22 cases and L5S1 in 16. The degree of vertebrae slippage was Ⅰ in 21 cases, and Ⅱ in 17. The Japanese Orthopaedics Association (JOA) score, visual analogue scale (VAS) of low back pain and leg pain were evaluated at 3, 6, and 12 months follow-up. The post-operative dynamic X-rays, CT and/or MRI were used for image evaluation. ResultsThere was no statistically difference in operating time between the two groups. The incision length, blood loss and exposing time of group A were shorter than those of group B. The JOA scores, recovery rate, VAS of low back pain and leg pain, interbody fusion rate and atrophy rate of multifidus in group A were 24.7±3.5, 77.0％±3.1％, 1.0±0.7, 1.1±0.3, 71.0％±5.8％, 2.1±0.2, respectively, and in group B were 24.3±2.8, 73.6％±6.4％, 3.1±0.6, 1.8±0.5, 76.3％±6.1％, 0.5±0.1, respectively. The VAS of low back pain was lower in group A than in group B. The atrophy rate was better in group A than in group B. Conclusion Both TLIF approaches can acquire satisfactory clinical results. Minimally invasive TLIF through the Wiltse approach can significantly reduced damage of multifidus and incidence of chronic low back pain postoperative.

Objective To observe the clinical advantage of treating the dens fracture with cannulated screws by microendoscopy system and navigation system through anterior approach. Methods From October 2002 to August 2004, 6 dens fracture (type Ⅱ) patients had undergone single cannulated screws fixation by the microendoscopy system and image guidance through the anterior approach, including 2 females and 4 males with an average of 53.2 years (range from 23 to 65 years). The preoperative Frankel grade was D in 1 case and E in 5 cases. 4 cases had fracture displacement. All patients accepted skull traction and external fixation before surgery. The patients accepted the MR examination and the images were reconstructed by the Vector Vision spinal navigation system in order to make the proper surgical plan, including the nails' direction and length in three-dimension. After affirming the reduction of the dens fractures according the C-arm fluoroscopy, the work channel was inserted through 2 cm long incision at the C5 level, then extended to the C2 level, to excise part of inferior C2 vertebral body. Under the navigation system guide, a guidance needle was inserted and the fracture was fixed by cannulated screw through the work channel. The patients did not need any C-arm fluoroscopy during the surgery. After the surgery the patients were with external fixation for 2 months. Results The surgery lasted 80 min (range from 50 to 150 min), blood loss was 75 ml (40 to 90 ml). There was no related complication during and after surgery including odynophagia or dysphagia. Follow-up period extended from 6 to 37 months (mean 13.5 months). All dens fractures were reduced and healed satisfactory during the follow up. All patients' postoperative Frankel grade was E in the most recent follow-up. Conclusion To fix the dens fracture through microendoscopy and navigation system guide can reduce the soft tissue injury and the incidence of odynophagia or dysphagia, make the surgery safer, avert the repeated C-arm check-up during the surgery compared with the traditional anterior fixation method. The procedure is very safe, simple and can reduce the surgical time effectively.

Objective To evaluate the clinical effect of thoracic discectomy via trans-facet-joint approach in the treatment of thoracic disc herniation.Methods Thirty-three cases were included in this group from October 1994 to August 2009.There were 27 males and 6 females.The age ranged from 18 to 72 years old,with an average of 41.8 years.The course of disease ranged from 12 days to 36 months and was lesser than one month in 13 cases.The weakness and numbness of lower limbs occurred after trauma in 9 cases.Fifteen cases were diagnosed as simple thoracic disc herniation.Six cases were associated with ossification of posterior longitudinal ligament and 12 cases were associated with ossification or hypertrophy of yellow ligament.A total of 45 discs were involved,including 32 in lower thoracic segments(71.11%),8 in upper thoracic segments(17.78%)and 5 in middle thoracic segments(11.11%).All the herniated discs and the ossified OPLL were excised via the trans-facet-joint approach.For the cases with ossification or hypertrophy of yellow ligament,the laminectomy and replantation were performed.The screw-rod system was used on both sides in 14 cases,on one side in 19 cases.Results Follow-up was acquired in 27 patients,ranged from 12 to 63 months(mean,37 months).According to Epstein and Schwall grade,there were excellent in 15 cases,good in 10 cases,improved in 2 cases and poor in 2 cases.The excellent and good rate was 86.21% and total effective rate was 93.10%.Postoperative complications occurred in 3 cases,including exacerbation of preexisting deficits in 2 cases and implant failure in 1 case.The former 2 cases were treated with methylprednisolone,dehydrant,neural nutrition and hyperbaric oxygen.One patient had recovered to preoperative level,the other had not recovered to the preoperative level.The implant was removed 18 months after operation for the implant failure.The post-operative CT or MRI showed that all the replanted lamina obtained fusion,and the canal decompression was complete.Conclusion Thoracic discectomy via trans-facet-joint approach can improve the clinical result obviously.

Objective To investigate the characteristics of cognitive impairment in neuromyelitis optica (NMO) patients.Methods 12 NMO patients,15 multiple sclerosis(MS) patients and 15 healthy people were collected and grouped as NMO group,MS group and normal control group.The five cognitive domains including working memory and information processing speed,verbal memory ability,semantic fluency,visual spatial structure and visuospatial recall ability,and executive function were evaluated respectively by the five tests,which are the 3/2 second edition of Chinese Version Auditory Continuous Addition test (PASAT3/2),the Chinese Rey Auditory Verbal Learning test (CRAVLT),Verbal Fluency test (VFT),the Rey Complex Figure test (RCFT) and the Chinese Version of the Stroop Colour-Word test (Stroop).The severity of somatic dysfunction and disability,depression,anxiety,fatigue and the sleep quality were evaluated both in NMO and MS patients by the Expanded Disability Status Scale Rating Scale (EDSS),Hamilton Depression Rating Scale (HAMD),Hamilton Anxiety Scale (HAMA),Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI).Analysis of variance,MannWhitney and Kruskal-Wallis H test were performed to determine significant differences among three groups.Results The PASAT3 accomplishments were (33.3 ± 9.6),(38.9 ± 14.3),(45.5 ± 8.6) respectively,the VFT scores were (24.8 ± 8.7),(26.4 ± 8.4),(31.7 ± 4.7) respectively in NMO group,MS group and control group,and the differences of PASAT3 and VFT among three groups were significant (P ＜ 0.05).However,PASAT2,CRAVLT (N1-5,N6,7,8,9),RCFT and Stroop test scores were not significant differenence (P ＞ 0.05).Conclusion NMO patients exist obstacle in working memory and information processing speed,semantic fluency,but still retain other aspects of the verbal memory capacity,executive function,visual-spatial structures and visual memory ability.The characteristics of cognitive impairment in NMO patients are not exactly the same as in MS patients.

Objective To improve recognition of posterior reversible encephalopathy syndrome (PRES) in children. Methods Two children with PRES admitted to children's hospital were included. Clinical data were retrospectively studied and related literatures were reviewed. Results The primary diseases of the two patients are systemic lupus erythematosus and nephritic syndrome, respectively. They all developed an acute onset of headache, visual changes, consciousness disturbance, hypertension and seizures. Cranial MRI showed bilateral parietal, temporal and occipital cortical or subcortical lesions with hypointensity on Tl-weighted imaging and hyperintensity on T2-weighted imaging. Clinical symptoms resolved soon and radiographic recovery occurred within 14 to 21 days with prompt anti-hypertension treatment and supportive care. Among the mechanisms which might contribute to the development of PRES, acute elevated blood pressure seems to be the most important factors in these two cases. Prompt anti-hypertension treatment usually can reverse the PRES lesion. Conclusions It is important to improve cognition of PRES in children. Delayed treatment can cause permanent neurological impairment. Doctors should be alert to this syndrome. Early diagnosis and prompt treatment are very important. (J Clin Pediatr,2010,28(2):168-170)

Background The fibrosis of filtering area caused by proliferation of human Tenon fibroblasts (HTFs) is one of failure causes following glaucoma surgery.Researches revealed that hydroxycamptothecin can induce the apoptosis of HTFs,but its influence on autophagy of HTFs is unclear.Objective This study attempted to investigate whether hydroxycamptothecin can cause an alteration of autophagic activity in HTFs.Methods Human Tenon capsular tissue was obtained from 3 patients during strabismus correction surgery under the informed consent of patients and their parents for the primary culture and passaged of HTFs in DMEM containing 10％ fetal bovine serum.The generation 3 to 6 cells then were incubated with 0.0,0.5,1.0,4.0,10.0 mg/L hydroxycamptothecin for 24 hours,respectively.A cell counting kit-8 (CCK-8) was used to detect the cell viability in different treated groups.The autophagic activity of HTFs was evaluated by a Cyto-ID autophagy detection kit,and then the autophagic flux was evaluated by counting the Cyto-ID positive cells under a fluorescence microscope,and the green fluorescence intensity was determined by flow cytometry.Quantitative reverse transcriptase PCR (qRT-PCR) and Western blot analysis were employed to assay the relative expressions of autophagic-associated genes and their proteins in HTFs,including Beclin-1,autophagy related gene 5 (ATG-5) and light chain 3 (LC-3).Results The cell viability of HTFs in the 0.0,0.5,1.0,4.0 and 10.0 mg/L hydroxycamptothecin groups were (100.00 ± 6.44) ％,(91.70 ± 6.36) ％,(81.47 ± 6.00) ％,(68.43 ± 6.69) ％ and (59.97 ± 6.98) ％ respectively,showing a gradually declining trend with the increase of hydroxycamptothecin doses,with a significant difference among them (F=19.040,P＜0.001),and the viability of HTFs in the 1.0,4.0 and 10.0 mg/L hydroxycamptothecin groups were significantly decreased than the control group (P＜0.05,P＜0.01,P＜0.01).qRT-PCR analysis revealed that the relative expression levels of Beclin-1 mRNA,ATG-5 mRNA and LC-3 mRNA in 4.0 mg/L hydroxycamptothecin group were (3.225 ±0.346),(2.839 ±0.418) and (3.761±0.224) folds higher than those of the control group.The expressions of Beclin-1 and ATG-5 proteins were significantly increased in the 4.0 mg/L hydroxycamptothecin group in comparison with the control group,and the expression intensity ratio of LC-3-Ⅱ/Ⅰ was 0.965±0.159 in the hydroxycamptothecin group,which was significantly higher than 0.275 ±0.860 of the control group (P =0.003).Cyto-ID staining showed that the percentage of autophagic cells increased dramatically from (11.333±4.010) ％ to (55.000±9.013) ％ upon the exposure of HTFs to 4.0 mg/L hydroxycamptothecin (P=0.002).Flow cytometry analysis showed that the green fluorescence intensity in the 4.0 mg/L hydroxycamptothecin group was (3.037 ±0.513) fold relative to that in the control group,showing a significant difference between the two groups (P =0.003).Conclusions Hydroxycamptothecin can induce autophagy in HTFs in vitro.

Objective To measure the average value of CT lung density at the phase of end inspiration and end expiration in children under 5 years.Methods Sixty patients with normal lungs who underwent chest CT for reasons caused by trauma etc.in our institute from January 2010 to March 2012 were enrolled to the study.All of the patients were divided into end inspiration group and end expiration group through random number table.CT images of the phase of end inspiration and end expiration were taken.Three levels of CT images were chosen to measure the lung density,which were 2 cm above the arch,1 cm below the carina and 2 cm above diaphragm.Lung density was measured at anterior,posterior,lateral,medial and central of the images at each level in each lung.The average lung density of each and entire lung were respectively calculated.The influence of phase,level,location was quantified using analysis of variance methods and LSD method.Results The average lung density at end inspiration was (-766 ±56)HU for the left,right and both lung.At end expiration,the average lung density of the left,right and both lungs was (-625 ± 86),(-647 ± 85) and (-636 ± 86) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the left lung at end inspiration were (-798±63),(-733±68),(-767±64),(-754 ±65),(-775 ±63)HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-796 ± 70),(-736 ± 65),(-769 ± 64),(-754 ± 62),(-776-± 59) HU respectively.At end expiration phase,the average densities at anterior,posterior,lateral,medial and central of the left lung were (-692±91),(-555±116),(-639±91),(-598±103),(-640±98) HU respectively.The average densities at anterior,posterior,lateral,medial and central of the right lung were (-712 ± 90),(-575±121),(-657±90),(-619±95),(-670±87) HU respectively.The statistical differences of these five measurement areas were significant at both inspiration and expiration phase (F=12.55,11.29,23.31,25.47,P＜0.01).The posterior lung density was the highest and the anterior was the lowest.As for the other measurement areas,in descending order were medial,lateral,and central.Conclusion The lung density at end inspiration and end expiration in children under 5 years old is described to provide reference for the clinical work.

Objective To analyze the clinical results of mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures combined with kyphosis deformity.Methods A retrospective case series study was made on 14 patients with old thoracolumbar compression fractures combined with thoracolumbar kyphosis undergone mini-incision Schwab grade 4 osteotomy plus percutaneous pedicle screw fixation from January 2014 to May 2015.There were 5 males and 9 females,with mean age of 64.5 years (range,58-70 years).The period between injury and surgery ranged between 6 and 14 months (mean,8.6 months).At the time of surgery,the fracture was already healed in 10 patients,while non-healing was found in other 4 patients.Preoperative visual analogue score (VAS) of back pain was (8.5 ± 1.1)points (range,6.5-10 points).Three patients were associated with neurological dysfunction [American Spinal Injury Association (ASIA) grade D].Apex of kyphosis located at T12 in 6 patients and at L1 in 8 patients.Preoperative kyphosis Cobb angle was (42.5 ± 6.0)° (range,39.5°-47.2°).Operation time,blood loss,perioperative complications,postoperative kyphosis Cobb angle,bone fusion,state of implants,neurological function and VAS were determined.Results Operation time was (280 ± 50) min,and blood loss was (110 ±70)ml.No segmental vessels injury,neurological deficit or dural disruption occurred during the surgery and after surgery.Compared to the preoperative detection,kyphosis Cobb angle was improved to (9.3 ±1.7) ° (range,6.2°-12.1 °) after operation (P ＜ 0.05),with the correction rate of 78.1％.Postoperative CT showed 7 screws (6.3％,7/112) were grade 1 screws.The follow-up was lasted for mean 25.2 months (range,14-28.9 months).At the latest follow-up,the kyphosis Cobb angle was (9.6 ±4.1)°(range,6.0°-13.1°),revealing no correction loss.Interbody bone fusion was good,with no instrumentation-related complications observed.Three patients with neurological dysfunction (ASIA grade D) were recovered to ASIA grade E.Compared to the preoperative detection,back pain was improved with the VAS of (2.6 ± 1.0) points at the latest follow-up (P ＜ 0.05).Conclusion Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation of old thoracolumbar compression fractures with kyphosis deformity can attain satisfactory and reliable efficacy and bone fusion,with low incidence of complications.

Objective To compare the CT findings of different phases in pediatric hepatoblastoma (HB) based on PRETEXT system in order to optimize pediatric HB CT scan protocol. Methods A total of 58 HB patients who were surgical and pathological diagnosed from January 2015 to December 2016 were analyzed. Pre-operation CT exams were analyzed respectively. Observing items included tumor size, intra-abdominal invasion, bleeding, intrahepatic metastasis, lymphatic metastasis, metastasis (except lymphatic in abdomen) main portal vein, three main hepatic vein, inferior vena cava (IVC) invasion, para-tumor hepatic arteries, and its branches. All image findings were compared to pathological and surgical findings to calculate the agreement rate. Exact Fisher test and R × C χ2 test were used. Results According to the surgery and pathological results, the agreement rate of tumor size was n=40 (68.9%) at non-contrast phase, n=43 (74.1%) at artery phase and n=52 (91.2%) at venous phase. Venous phase was adaptive for observing tumor size (χ2=8.16,P=0.018). For main portal vein, three main hepatic vein, and IVC invasion, none was found at both non-contrast and artery phase. N=12 (20.7%, P<0.001) was found at venous phase. For para-tumor hepatic arteries, and its branches, none was found at non-contrast phase. N=46 (79.3%) was found at artery phase. N=17 (29.3%) was found at venous phase. Artery phase was adaptive for observing (P<0.001). There was no statistical significant difference in intrahepatic metastasis, lymphatic metastasis and metastasis. Conclusions Suspected pediatric HB, artery and venous phase CT scan would meet the clinical requirement, there was no need for non-contrast pahse. Follow up cases, a single venous phase was enough. Venous phase contributed much more information on tumor size and high risk prognosis evaluation.