Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Turbinates ; surgery ; Young Adult

Objective:To compare the clinical outcomes between pedicle screw internal fixation via the Wiltse approach and conservative treatment in young patients with thoracolumbar fracture with Thoracolumbar Injury Classification and Severity score (TLICS) ≤ 4 points.Methods:This retrospective study included 219 young patients with thoracolumbar fracture with TLICS score ≤ 4 points who had been treated from January 2014 to December 2018 at Department of Orthopaedics, The Second Hospital of Shanxi Medical University and obtained full follow-up. They were assigned into a surgery group of 126 patients subjected to pedicle screw internal fixation via the Wiltse approach and a conservative group of 93 patients subjected to conservative treatment. The surgery group included 65 males and 61 females, aged from 18 to 37 years, with a TLICS score of 1 point in 38 cases and of 2 to 4 points in 88 ones; the conservative group included 48 males and 45 females, aged from 19 to 38 years, with a TLICS score of 1 point in 29 cases and of 2 to 4 points in 64 ones. Patients in both groups underwent thoracolumbar X-ray, CT and MRI before treatment and regular thoracolumbar X-ray reexamination after treatment. Improvements in visual analog scale (VAS) for low back pain were compared between pre- and post-treatment. The 2 groups were compared in terms of VAS, anterior height of the injured vertebra and kyphosis cobb angle between pre-treatment, one month post-treatment and the last follow-up.Results:The 2 groups were comparable due to insignificant differences between them in the pre-treatment general data ( P>0.05). In the surgery group, patients were followed up for 24 to 72 months, the average VAS scores at one month post-treatment (2.5±1.2) and the last follow-up (2.3±0.8) were significantly improved compared to the pre-treatment value (6.8±2.1) ( P<0.05), and no serious surgical complications occurred. In the conservative group, patients were followed up for 30 to 65 months, the average VAS scores at one month post-treatment (3.9±1.9) and the last follow-up (3.5±0.9) were significantly improved compared to the pre-treatment value (6.2±2.0) ( P<0.05), and the rate of complications was 11.8% (11/93, including 3 cases of neural symptoms of the lower limb, 4 cases of bedsore and 4 cases of pulmonary infection). The VAS, anterior height of the injured vertebra and kyphosis cobb angle at one month post-treatment and the last follow-up in the surgery group were all significantly better than in the conservative group ( P<0.05). Conclusion:In young patients with thoracolumbar fracture with TLICS ≤ 4 points, pedicle screw internal fixation via the Wiltse approach can lead to better therapeutic outcomes than conservative treatment, especially in relief of postoperative low back pain.

Objective Malrotation of intestine with midgut volvulus is a special disease in newbo-rns.It is important of early diagnosis to avoid the risk of intestinal infarct and necrosis.We intended to ex-plore the value of early ultrasonographic diagnosis in malrotation of intestine with midgut volvulus,comparing with upper gastrointestinal imaging.Methods Ultrasonographic features and upper gastrointestinal imaging of 48surgically confirmed malrotation of intestine with midgut volvulus between January 2011and December 2014were retrospectively analyzed.Results All patients were comfirmed by operaion.The rotational degree of midgut volvulus were 90to 720°.In 43of 48patients (89.58%)of malrotation of intestine with midgut volvulus were diagnosed by ultrasonography.The typical ultrasonographic features were called “whirlpool sign”,which was the superior mesenteric vein and the mesentery around the superior mesenteric artery.In 35 of 48(72.92%)patients with malrotation were confirmed by the upper gastrointestinal imaging.The typical sign of the upper gastrointestinal imaging was the helical form of the distal duodenum and proximal jejunum located at middle abdomen.Compared with upper gastrointestinal radiographic examination,ultrasonographic examination had more sensitivity in diagnosis of malrotation of intestine with midgut volvulus (P﹤0.05). Conclusion Ultrasonographic examination have more sensitivity in diagnosis.Noninvasiveness,absence of X-rays,and low costs could make ultrasonographic examination a useful screening test in patients with sus-pected malrotation of intestine with midgut volvulus.“Whirlpool sign”could be considered a specific ultra-sonographic sign in diagnosis of midgut volvulus,which could provide reference for the clinical treatment of malrotation of intestine with midgut volvulus.

Objective To explore the value of transperineal prostate biopsy guided by contrast-enhanced ultrasound(CEUS)and MR diffusion weighted imaging (DWI).Methods 128 patients with suspected prostate cancer were analyzed.Both MR diffusion weighted imaging(MRDWI)and contrast-enhanced ultrasound(CEUS) were applied before prostate tissue was biopsied .The suspected lesion was confirmed by specialists of MRI , Ul-trasound and Urological together .The regular six normal sites addition to suspected lesion were biopsied .Biopsy specimens were sent to pathological examination separately with defined puncture site .The sensitivity, specificity and accuracy of MRDWI , CEUS alone and the combination of two methods were analyzed .Results Of the 858 prostatic specimens from 128 patients , 278 specimens were positive , with 172 specimens found by MRDWI and 114 specimens found by CEUS .As for 278 positive specimens , 137 specimens were diagnosed by MRDWI cor-rectly rather than CEUS , and 79 specimens were diagnosed by CEUS correctly rather than MRDWI , 35 specimens were diagnosed by either MRDWI or CEUS and 27 specimens were diagnosed by neither MRDWI nor CEUS .The sensitivity,specificity,accuracy of biopsy guided by MRDWI , CEUS and both of them in diagnosis of prostate cancer were 61.87%,85.00%,77.51%;41.01%,93.97%,76.81% and 90.29%,80.52%,83.68%,respec-tively.The sensitivity and accuracy of biopsy guided by both MRDWI and CEUS were higher than MRDWI or CEUS alone, with statistically significant difference(P<0.05).Conclusions Suspicious lesions may be found more frequently by MRDWI than CEUS , however two methods can complement each other .Sensitivity and accura-cy of biopsy can be improved by the combination of MRDWI and CEUS , which should be recommended in future clinical practice , without increasing the number of needle .

Objective:To detect the expressions of COX-2 protein and BCL-2 protein in transitional mucosa adjacent to rectal carcinoma,and determine whether the transitional mucosa was the cancer precursor event.Methods:Mucin histochemical method was employed to detect the distal mucosa 2 cm away from rectal tumor and the transitional mucosa was found in 54 cases of rectal carcinoma.Immunohistochemical method was used to investigate the expressions of BCL-2 and COX-2 protein in the specimen of rectal carcinoma mass,transitional mucosa and non-transitional mucosa,and 20 cases of normal rectal mucosa,and the points of the expressions of COX-2 protein and BCL-2 protein were counted.Results:35.19%(19/54)of distal mucosa were characterized as the transitional mucosa.The expressions of COX-2 and BCL-2 protein were detected in carcinoma mass and distal mucosa.Significant difference was observed in carcinoma mass and transitional mucosa(p<0.01).But there were no significant differences between the expressions of those in transitional mucosa and non-transitional mucosa(p>0.05),as well as transitional mucosa and normal mucosa(p>0.05).Conclusion:The performance of transitional mucosa was not the cancer precursor event,but the non-specificity reaction of carcinoma or inflammation.

Objective:To provide scientific evidence for infection prevention and control by analyzing the risk factors of surgical site infection, which can move forward the gateway of infection prevention and control.Methods:The surgery-related information of patients admitted to the Department of General Surgery and Department of Orthopedics, People's Hospital of Guangnan Hospital of Yunnan province from November 2016 to August 2019 was retrospectively analyzed. According to whether postoperative surgical site infection occurred, the patients were divided into an infection group and a non-infection group. Logistic regression model was used to analyze the risk factors of surgical site infection.Results:A total of 9 346 patients, consisting of 117 patients in the infection group and 9 229 patients in the non-infection group, were included for final analysis. In the infection group, the incidence of surgical site infection was 1.25%. Multivariate analysis showed that hypoproteinemia ( OR = 2.585), unclean incision ( OR = 3.243 and 5.125), and operation duration more than 3 hours ( OR = 2.315), blood transfusion ( OR = 2.239), drainage tube placement ( OR = 2.133) and indwelling catheter placement ( OR = 1.973) were the independent risk factors for surgical site infection, while prophylactic use of antibiotics was a protective factor ( OR = 0.383). Conclusion:Individual factors, operation-related factors, and treatment-related factors are closely related to the occurrence of surgical site infection. Much attention should be paid to the clinical issues like preoperative hypoproteinemia, perioperative prophylactic use of antibiotics and postoperative drainage tube and indwelling catheter placement.

Prompt gamma rays are a kind of secondary radiation produced in particle therapy, and prompt gamma information largely reflects the incidence of particles. Consequently, use of prompt gamma information to verify the range of particles is a promising verification method. In this article, the concept of prompt gamma ray in vivo range verification and the advantages of prompt gamma verification over existing methods were introduced. Secondly, the progress in developing a method for range verification using prompt gamma in recent years was reviewed, and the advantages and disadvantages of three methods including prompt gamma imaging (PGI), prompt gamma timing (PGT) and prompt gamma spectroscopy (PGS) were discussed. Finally, these three methods were summarized, and the development trend of prompt gamma rays for in vivo range monitoring was prospected.

Objective To describe a novel pubovesical complex preserving technique for laparoscopic radical prostatectomy and to evaluate its postoperative outcomes.Methods From January 2011 to May 2017,168 patients who underwent laparoscopic radical prostatectomy were enrolled and analyzed retrospectively.Their mean age were 62.8 (46-74) years,preoperative PSA 11.3ng/ml,Gleason score 6.7,preoperative prostate volume 46.5 ml.They all got preoperative potency (IIEF-5 score ≥ 15 score).TNM clinical stage:cT1 123 cases,45 cases cT2.There were 59 patients with pubovesical complex preserving technique for laparoscopic radical prostatectomy (group A):without pelvic fascia cut and deep vein complex suture.The preservation of the periprostatic anatomy was kept by preserving the pubovesical complex,including detrusor apron with pubovesical ligaments,DVC and NVB.There were 46 patients with conventional intrafascial laparoscopic radical prostatectomy (group B) and 63 patients with interfascial laparoscopic radical prostatectomy(group C).No differences were found between the three groups in terms of preoperative age,clinical staging,prostate-specific antigen (PSA) values,Gleason score at biopsy and preoperative good potency (IIEF-5 score)(P ＞0.05).Continence was defined as zero to one security pad per day.The three groups were compared for perioperative variables,PSM (positive surgical margin,PSM)rate,postoperative urinary continence functional and potency (IIEF-5 score).Biochemical recurrence-free survival was by Kaplan-Meier and log-rank.Results No differences were found in the three groups in terms of operative times,blood loss,catheterization time and postoperative stay and histologic status (PSM was similar to that of the groups (8.5％ in group A,13.0％ in group B vs.11.1％ in group C).Urinary incontinence:group A,the continence rate was 71％,82％,92％ and 100％ at 1,3 and 6 months after catheter removal,respectively;group B,the continence rate was 63％,80％,89％ and 96％ respectively;group C,it was 24％,54％,79％ and 86％ respectively.The group A showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month after catheter remove (x2 =27.47,P ＜ 0.001;x2 =15.20,P ＜ 0.01).The group B showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month,(x2 =17.00,P ＜ 0.01;x2 =8.20,P ＜ 0.05).No differences were found between the A and B groups at immediately after catheter removal and 1 month,(P ＞ 0.05).Regarding sexual function,at the postoperative 1,3,6 months,median IIEF-score was 10,11,16 in the group A,respectively,8,9,13 in the group B respectively,and 7,8,12 in the group C respectively.No differences were found in the three groups in potency (IIEF-5 score).Baseline IIEF-score was reached by 53％,35％ and 21％ at postoperative 6 months.There were significant differences between the A and the C groups.(x2 =13.45,P ＜0.01).There were no significant differences between the A and the B groups.(x2 =3.30,P ＞ 0.05).Follow-up was 31.6 (6-69) months.Biochemical recurrence-free survival at 3 years was 79.3％,76.3％ and 76.4％ by A,B and C group,respectively.Conclusions The pubovesical complex preserving technique for laparoscopic radical prostatectomy provides early recovery from incontinence,faster recovery of sexual function preoperative levels.

OBJECTIVETo evaluate the prognostic impact of tumor size, ultrasonography, central neck lymph node involvement, and age of patients in papillary thyroid microcarcinoma (PTMC).

METHODSTwo hundred and fifty-four patients who underwent total thyroidectomy and central neck dissection for PTMC between 2012 and 2014 were included in this retrospective study. Statistical correlation between tumor size and various clinicopathological parameters was assessed by univariate and multivariate analyses. The ultrasound findings were also evaluated.

RESULTSA total of 254 patients (199 females and 55 males) were included in this study. PTMC showed a predilection for female patients, 41-50 years of age (43.3% of all cases, 110/254), and ultrasound showed hypoechoic nodules. Statistically significant correlation was demonstrated between central neck lymph node involvement and the following factors: age and tumor size. A tumor diameter greater than 0.5 mm (67.3% of all cases) most commonly occurred in patients older than 41 years, and was associated with a higher risk of metastatic central neck lymph node involvement (P<0.05). Hashimoto's thyroiditis was noted in the background in 39.4%(100/254) of cases.

CONCLUSIONSTumor size appears to have a prognostic impact in PTMC, and larger size is more likely to be associated with a higher risk of central neck lymph node involvement. It is controversial whether the etiology of papillary thyroid carcinoma is related to Hashimoto's thyroiditis.

Adult ; Age Factors ; Analysis of Variance ; Carcinoma ; Carcinoma, Papillary ; diagnostic imaging ; pathology ; surgery ; Female ; Hashimoto Disease ; diagnosis ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; Neck Dissection ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; surgery ; Thyroidectomy ; Tumor Burden ; Ultrasonography

Objective: To explore the relationship between the compression depth and compressive stress of the anterior and posterior cervical spinal cord in different sports positions. Methods: Specimens of ten intact fresh cervical spine (C₁-T₁) from adult cadaver were collected. In order to simulate cervical disc degeneration and abnormal ligamentum flavum, we placed two hemispherical steel balls into the anterior and posterior side of the cervical spinal cord through the bone window of the C_{4, 5}. The measurement was conducted in 10%, 20%, 30%, 40%, 50%, and 60% of the sagittal diameter for the compressive stress of the anterior and posterior cervical spinal cord under different compression depths of flexion, neutral, and posterior extension. Results: The anterior depth of a certain pressure with the posterior pressure depth was increasing in neutral position, the stress on the anterior of the cervical cord-meningeal complex (CCMC) had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion (P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). In extension or flexion position, the stress on the anterior of the CCMC had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The posterior depth of a certain pressure with the anterior pressure depth was increasing in neutral position. The stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion(P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. In extension or flexion position, the stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. Compared with the neutral position, the anterior flexion position and the posterior extension position had different trends in the compressive stress in the anterior and posterior aspect of the cervical spinal cord. Conclusion The stress on the anterior and the posterior of the CCMC has a closely nonlinear relationship with the depth of canal occlusion. With the increase of the depth of canal occlusion, the stress is increasing, especially running over the 30% depress of canal occlusion under neutral position. However, the stress is increased, especially running over the 20% depress of canal occlusion under the flexion and extension position.