BACKGROUND:Sagittal imbalance induced by vertebral osteoporotic fractures has not been paid enough attention in previous studies.
OBJECTIVE:To assess the correlation of osteoporotic vertebral compression fracture and spinal sagittal imbalance.
METHODS:Sixty patients with old osteoporotic vertebral compression fracture, who were treated in the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Colege from February 2013 to August 2015, were enroled in this study as the observation group. Sixty healthy old people from physical examination center were enroled as the control group. The whole-spine anteroposterior and lateral X-ray films were taken in both groups. The number and the location of fractured vertebrae were recorded. Sagittal parameters of both groups including thoracic kyphotic angle, lumbar lordotic angle, T1-spinopelvic inclination angle and the C7plumb line/sacro-femoral distance (PL/SFD) ratio were measured and compared among groups. The observation group was dividedinto three subgroups according to the number of fractured vertebrae,i.e., single-vertebrae fracture subgroup, double-vertebrae fracture subgroup and above triple-vertebrae fracture subgroup. The C7PL/SFD ratio of the three subgroups was compared. The correlation between the number of fractured vertebrae and the C7PL/SFD ratio was analyzed.
RESULTS AND CONCLUSION:(1) The thoracic kyphotic angle of the observation group was bigger than that of the control group (P< 0.05). The lumbar lordotic angle of the observation group was smaler than that of the control group (P< 0.05). The absolute value of the T1-spinopelvic inclination angle of the observation group (-1.81±1.48)° was smaler than that of the control group (-3.35±1.22)° (P< 0.05). The C7PL/SFDratio of the observation group was significantly bigger than that of the control group (P< 0.05). (2) In the observation group, there were 4 cases of single-vertebrae fracture, 25 cases of double-vertebrae fracture and 31 cases of above triple-vertebrae fracture. Significant differences in the C7PL/SFD ratio were determined among subgroups (P< 0.05). The number of fractured vertebrae was positively correlated with the C7PL/SFD ratio; the correlation coefficient was 0.747. (3) Results indicated that osteoporotic vertebral compression fracture can change spinal local sagittal alignment. Multiple compression fractures of vertebrae can cause spinal sagittal imbalance. The gravity center of human body shifts forward. The number of fractured vertebrae was positively correlated with the range of shift forward.

BACKGROUND:Recent report addressing new vertebral fracture after vertebroplasty or bal oon kyphoplasty has increased gradual y. It remains controversial whether new vertebral fracture is induced by bone cement augmentation or osteoporosis.
OBJECTIVE:To observe new vertebral fracture after conservative treatment and bone cement augmentation for osteoporotic vertebral compression fractures, analyze the relationship between new vertebral fracture and spinal sagittal parameters, and explore the risk factors for new vertebral fracture.
METHODS:From June 2011 to December 2014, 160 patients with osteoporotic vertebral compression fractures in thoracic and lumbar vertebrae were selected from the Department of Spine Surgery, the Affiliated Hospital of Chengde Medical Col ege. According to therapeutic regimen, the patients were divided into two groups. The observation group (n=80) received vertebroplasty or kyphoplasty. The control group (n=80) underwent conservative treatment. At 1 day after surgery in the observation group and after walking in the control group, patients were subjected to anteroposterior and lateral X-ray in the entire length of the spine. Bone mineral density, number and location of new vertebral fractures and sagittal parameters during fol ow-up were recorded and compared between groups. After final fol ow-up, according to the appearance of new vertebral fracture, patients in both groups were assigned to two subgroups. The difference in above indicators was compared between the two subgroups. The relationship between new vertebral fracture and spinal sagittal parameters was analyzed.
RESULTS AND CONCLUSION:(1) There were no statistical y significant differences in gender, age, body mass index, bone mineral density, pelvic index, sacral slope, pelvic tilt, thoracic kyphotic angle, lumbar lordotic angle, C7/sacro-femoral distance ratio and occurrence rate of new fractures between the two treated groups (P>0.05). (2) There were no statistical y significant differences in gender, age, body mass index, pelvic index, and lumbar lordotic angle between new vertebral fracture group and non-fracture group. There were statistical y significant differences in bone mineral density, sacral slope, pelvic tilt, thoracic kyphotic angle and the C7/sacro-femoral distance between the new vertebral fracture group and the control group (P<0.05). (3) Results confirmed that new vertebral compression fractures after vertebroplasty, Kyphoplasty or conservative treatment for osteoporotic vertebral compression fractures were definitely associated with osteoporosis and spinal sagittal imbalance.

Objective To assess the correlation of newly fracture and spinal sagittal parameters.Methods From March 2011 to December 2014,80 patients of osteoporosis vertebral compression fracture treated by PVP as observation group were studied.The whole-spine anteroposterior view and lateral view XRay Photographes of the patients were taken,the sagittal parameters such as Pelvic index (PI),sacral slope (SS),pelvic tilt (PT),thoracic kyphotic angle(TK),lumbar lordotic angle(LL),the C7/SFD ratio were recorded.The whole cases were divided into two groups according to the presence of new fracture or not after the last followup of one year,the index of two groups were compared,and the risk factors of newly vertebral compression fractures were analysed.Results There were no statistically significant difference in gender,age,body mass index,BMD,PI,TK,LL between the two trea ted groups (P＞0.05);there were statistically significant difference in SS,PT and the C7/SFD between the new vertebral fracture group and the control group (P＜0.05).The analytic results of Logistic regression model showed that the smaller SS,larger TK and C7/SFD were risk factors of newly vertebral compression fractures.Conclusion The newly occurred vertebral compression fractures,after the primary treatment of PVP,are associated with changed spinal sagittal parameters.

BACKGROUND: Endothelium-dependent vasodilatation (EDD) has been assessed by intracoronary acetylcholine infusion and digital subtraction angiography. However, its applications in continuous observing on early onset, progression and outcomes of clinical interventions of the disease are limited due to the potential trauma of the method. OBJECTIVE: This study was designed to assess the changes in brachial EDD in patients with hyperlipidemia using high-resolution ultrasound and to compare the outcomes of the patients to those of the healthy individuals. DESIGN: Case-control study SETTING: This study was carried out at the Cardiology Department and the Ultrasound Department of Xinyang CentralHospital PARTICIPANTS: Sixty patients with hyperlipidemia, 37 males and 23females, with an age ranging from 36 to 75 years old, were selected at the Cardiology Department of Xinyang Central Hospital from May 2001 to March 2002. They were divided into 3 groups according to abnormalities in blood lipid, as hypercholesterolemia group (HC, 20 cases),hypertriacylglycerolemia group (HTG, 20 cases) and mixed hyperlipidemia group (HLP,20 cases). Twenty voluntary individuals with normal physical examination findings were allocated into control group, 12 males and 8 females. Informed consents were obtained from all the eligible. METHODS: The brachial artery inner diameter and the changes in blood flow of the brachial artery were assessed using high-resolution ultrasound.After the patients having a rest for more than 10 minutes, the inner diameter (D0) and the baseline blood flow of their brachial artery were measured. The blood pressure cuff was placed under the elbow with a pressure at 300 mm Hg, lasting for 4 to 5 minutes and followed with a sudden deflation. 15 s after deflation, the reactive brachial artery inner diameter (D1) and the blood flow of the brachial artery were detected. The patients took another rest for more than 15 minutes and after the artery restored to a normal condition,the patients took nitroglycerol sublingually at a dose of 400 μg. Three to four minutes later, the brachial artery inner diameter (D2) and the blood flow of the brachial artery were detected. The increasing rate of the inner diameter of brachial artery were calculated, the increasing rate of reactive brachial artery inner diameter (%)= (D1-D0)/D0×100% and the increasing rate of post-treatment brachial artery inner diameter (%)=(D2-D0)/D0 ×100%.Meanwhile, the increasing rate of reactive blood flow (%)=(reactive blood flow-baseline blood flow)/ baseline blood flow (100% and the increasing rate of post-treatment blood flow (%)=(the post-treatment blood flow-baseline blood flow)/baseline blood flow×100%. MAIN OUTCOME MEASURES:In three hyperlipidemia groups and the control group, the inner diameter of the brachial artery were measured under resting conditions, in reactive congestion status and after sublingual nitroglycerol treatment respectively using high-resolution ultrasound. RESULTS: All the 60 patients with hyperlipidemia and 20 healthy controls entered the analysis procedure. In HC group, HTG group and HLP group, the increasing rate of reactive brachial-artery inner diameter were significantly lower than that in control group [(5.7±3.2)%, (5.4±3.0)%,(3.8±2.4)%, (11.3±3.1)%,P ＜ 0.05], which was most significant in HLP group. The increasing rate of both the reactive and the post-treatment blood flow in three experimental groups and the increasing rate of the post-treatment brachial-artery inner diameter were not significant (P ＞ 0.05). CONCLUSION:EDD were impaired significantly in patients with hyperlipidemia. High-resolution ultrasound is capable of assessing EDD accurately and reliably.

Objective To learn the recent development and regional distribution of clinics in China.Methods Based on statistics and a nationwide survey of clinics in the country,a simple linear regression was made to find factors determining clinics regional distribution.Results Clinics in China were found to have grown sizably from 134 000 in 2008 to 155 000 in 2014;medical technology workers to 2.31 per clinic in 2014;and the total revenue of these clinics accounted for only 0.724% of all medical institutions,while there are more clinics in the east than the west regions in China.Conclusions The role of clinics in attracting high quality medical resources to primary care should be further enhanced for development of the hierarchical medical system in China.

ObjectiveTo detect the difference of cytokines and antibodies productions by immunologic system from mice and rabbits vaccinated with the M.RCAg-1 chimeric protein,expressed in E.coli,formulation with different adjuvants,including Freund's adjuvant and three clinically acceptable adjuvants,namely,Al(OH)3,Montanide ISA720 and Montanide ISA51.MethodsSix weeks female BALB/c mice were vaccinated with recombinant protein formulated with different adjuvants through intranasal.Serum were collected to detect specific antibodies of M.RCAg-1 and individual Epitope by ELISA ; natural parasite antigen was recognized by indirect immunofluorescence assay; mouse specific T lymphocyte activation was detected by enzyme-linked immunosorbent spot test (ELISPOT) ; Affinity assay between protein and immune IgG of rabbits with the biosensor,and the growth of Plasmodiumfalciparum in vitro to evaluate by growth inhibition assay(GIA).ResultsDifferent formulation can induce different levels of antibody titers,the effection of ISA51 adjuvant was most closely with Freund's adjuvant,and can induce a higher specific antibody of 11 epitopes within proteins,can effectively stimulate cellular immune response based on the IFN-γ,to avidity Montanide ISA51 adjuvant immune antibodies and M.RCAg-1 protein affinity than the other two adjuvants;and Montanide ISA720 adjuvants and Al (OH)3 adjuvant group in mice can't induce a significant IFN-γresponse(P＞0.05).On avidity assay,the Montanide ISA51 formulation group was better than the other two adjuvants; and Montanide ISA720 and Al (OH)3 adjuvant formulation group can't induce a significant IFN-γresponse in mice(P＞0.05) ; the inhibition rates were 60% and 100% in 3D7 and Dd2 Plasmodium falciparum at a concentration of 2 mg/ml IgG by Montanide ISA51 formulated protein,and IgG of Al( OH)3 formulation could not effectively inhibit the in vitro growth of Plasmodium falciparum( 10% ),while IgG of Montanide ISA720 formulation could not inhibit growth of parasite in vitro.ConclusionBy comparing three clinically acceptable adjuvants and Freund's adjuvant in BALB/c mice and New Zealand rabbit,Montanide ISA51 adjuvants can be acceptable formulated M.RCAg-1 protein induced humoral and cellular immune responses,can be used as one of the candidate adjuvants.

Objective To investigate the clinical application of 99mTc-DTPA renography in evaluating the glomerular filtration rate (GFR) in living donor kidney transplantation and to assess the dependence of GFR on age and gender in living kidney donors. Methods There were 212 consecutive potential donors in the study. The potential donor evaluation process included as follows: general health status, liver and kidney ultrasound, hepatitis virus infection and HLA-DR matching. If the results met the general requirements for the donor selection criteria, the GFR was measured using the 99mTc-IDTPA renography according to standard procedure (gates method). The GFR ≥ 1.33 ml/s was considered normal, ＜ 1.17 ml/s was defined as the lower limit for donor GFR, and 1.17 ml/s ≤GFR ＜ 1.33 ml/s further underwent measurement of creatinine clearance (CCr). If the CCr was normal, the GFR was considered normal, and otherwise, potential donors gave up kidney donation.All the donors meeting the donor selection criteria were divided into four age groups. On the other hand, the total donors were divided into the groups aged ＞ 55 years and aged ≤ 55 years. The impact of gender and age on GFR was evaluated preoperation due to age-related changes and gender using Kendall's tau-b correlation coefficient. Results In 212 potential donors, 137 cases had a GFR ≥ 1.33ml/s, 55 cases 1.17 ml/s ≤ GFR ＜ 1.33 ml/s and 20 cases GFR ＜ 1.17 ml/s. Thirty-one cases of potential donors with 1.17 ml/s ≤ GFR ＜ 1.33 ml/s gave up kidney donation due to abnormal CCr or other security considerations. 161 (56 females, 105 males) were qualified as successful donors, and the donor age was 42. 91 ± 11.90 years (range 20 to 62 years). The preoperative total GFR (ml/s) in living kidney donors was calculated as 1.51 ± 0.22 for males, it was 1.45 ± 0.18 for females respectively (P＞0.05). Among the four age groups, there was no significant difference in GFR (P＞0.05). The GFR in the donors aged ＞ 55 years and aged ≤ 55 years was 1.48 ± 0.22 and 1.49 ±0.17 respectively (P＞0.05). Correlation analysis revealed that the GFR in all the donors was not related with age (r = -0. 033, P = 0. 69). Also, there was no correlation between age and GFR in men and women(r= -0.053, P=0.571; r= -0.019, P=0.754). Conclusion 99mTc-DTPA renography is reliable and reproducible for the determination of GFR in living kidney donors. In view of acute donor shortage and if properly screened, kidneys with 1.17 ml/s≤ GFR ＜ 1.33 ml/s can be used without increasing the risk to donor. The GFR is not correlated with the age and gender.

Objective To summarize the clinical applications and surgical technique of laparoscopic distal pancreatectomy (LDP). Method The clinical data of 10 cases of pancreatic body and tail tumors undergoing laparoscopic distal pancreatectomy were retrospectively analyzed.Results Laparoscopic distal pancreatectomy (LDP) was successfully undertaken in 8 cases (including spleen preserving distal pancreatectomy in one case ). Intraoperatively two cases were converted to open surgery because of peripancreatic organs involvement by cancer in one case and massive bleeding in another case during laparoscopic procedures. The average operation time of LDP was 141 ± 35 min (95 -195 min),mean blood loss was 263 ± 151 ml( 100 -600 ml), average postoperative hospital stay was 7 ± 1 days (5 -9 days ). There was no major postoperative complications and no mortality. Final pathology was solid psedopapillary tumor in 4 cases, mucinous cystadenoma in 3 cases and islet cell tumor in 1 case, pancreatic ductal adenocarcinoma in 2 cases, hence 80% of tumors were benign. Conclusions LDP is indicated for benign body and tail pancreatic tumors and early malignant tumor of pancreatic body and tail. Being less traumatic, and fewer complications, LDP is a safe, effective and minimally invasive therapy.

Objective To explore the indications,surgical techniques and clinical effects of laparoscopic splenectomy on patients with portal hypertension. Methods Analysis the clinical data of 32 patients of portal hypertenision with laparoscopic splenectomy and open splenectomy from March 2006 until June 2009. Results The effectiveness of the procedures for portal hypertension was evaluated.Among 16 patients with LS, 2 patients were converted to open surgery. There is no significant difference with operatative time, blood loss and hospital fees between the two groups, the laparoscpy group had the shorter mean hospitalization, fasting and draining time. Conclusions If there are enough preparation preoperation, skillful laparoscopic technique and micromesh manipulation during operation,laparoscopic splenectomy is a minimally invasive and safe technique in the patients with lower-grade to medium varicose veins.

Objective To compare the effect of naive porto-azygous devascularization and that as a remedy therapy after a failed endoscopy for the treatment of bleeding portal hypertension.Method From June 2005 to June 2010,230 portal hypertension patients were treated with porto-azygous devascularization,among them,202 cases were of portal hypertensive cirrhotics,28 cases of alcoholic cirrhosis.Group A (16 patients)received remedial porto-azygous devascularization after endoscopic treatment failed (esophageal variceal ligation,esophageal variceal selerotherapy).Group B(214 patients)received naive porto-azygous devascularization.Results The average operation time in group A was 198 min(115-335)min,mean bleeding amount was 750 ml(300-2000)ml,average post-operative hospital stay was 11 days (8-15)days.The average operation time in group B was 120 min(90-190)min,mean blood loss was 250 ml(150-500)ml,average post-operative hospital stay was 7 days(6-9)days.The average operation time,bleeding amount and post-operative hospital stay was significantly different between the two groups (P＜ 0.05).212(92.2％)patients were followed up,and the mean follow-up time was 2.5 years (1-6)years,mortality rate was 4.2％,rebleeding rate was 5.7％.Conclusions Surrounding the perioesophageal and gastric tissues were fibrotic and hard after the endoscopic treatment,this significantly increased the difficulty of surgery,therefore,porto-azygous devascularization is the choice of therapy for portal hypertension patients.