Objective To evaluate the value of upright standing myelography in the diagnosis of lumbar disc herniation (LDH). Methods One hundred and ninety six patients with LDH diagnosed by CT or MRI were examined by upright standing myelography before surgery. Results The most diagnosis of myelography were accorded with CT or MRI, but 7 patients of myelography with LDH at L4-5 showed compression of nerve roots, while the images of these on CT or MRI only showed disc bulge or protrusion without nerve root compression. Conclusions Myelography in the upright standing position is perhaps superior to CT or MRI for the diagnosis of LDH, especially LDH at L4-5 with nerve root compression.

Objective To understand the status quo of medical graduates' professional faith and to evaluate the education methods. Methods Questionnaire survey combined with expert inter-view were conducted from two aspects: professional faith condition and educational methods. Medical graduates from an affiliated hospital of a university in Shanghai were investigated in this survey and 392 copies of effective questionnaires were analyzed comparatively. Results 92.6%(363/392) students regarded extreme events as the main factor that influence their further employment. 14.8%(58/392) students had career planning. 79.6%(312/392) students achieved self-improvement from strengthening learning and training. Salary was the main factor that affect medical graduates' career choice (4.47 points). 75.5%(296/392) students considered that the existing professional faith education was out of fashion. 85.5%(335/392) of students thought that education methods should be improved. Strengthen-ing relevant education career planning was considered as the most valuable content (4.22 points) and the most effective form was group learning (4.53 points). Conclusions The main reasons for devia-tion and dissatisfaction are:social factor, lack of professional faith, unique status and obsolete way of education. Professional faith education should take the above factors into consideration.

Objective Using ROC curve to determine the best cut-off point of serum HE-4 in the diagnosis of ovarian cancer and provide important value to diagnosis early ovarian cancer.Methods The levels of serum HE-4 in 68 ovarian cancer pa-tients,42 ovarian benign tumor patients and 30 healthy female were detected by electrochemistry irradiance method.The ROC curve was drawn and the cut-off point of HE-4 was determined by statistical software.Results The levels of serum HE-4 were all non-normal distribution in the groups of ovarian cancer,ovarian benign tumor and healthy controls.Whats more,there was no significant difference between ovarian benign tumor group and normal control group.And compared with benign ovarian tumors and normal control group,the level of HE-4 in ovarian cancers was significantly increased (P <0.01).It would be best for diagnosis when the level of serum HE-4 was 108pmol/L in ovarian cancer.Youden’s index showed the maximum (0.713)and the sensitivity and specificity of diagnosing were 77.9% and 93.1% respectively.The positive predictive value was 91.4% and negative predictive value was 91.4%.At the same time,the positive likelihood ratio was 11.6 and the negative likelihood ratio was 0.2,odds ratio reached to 47.3.Conclusion The detection of HE-4 is an ideal mark for diagnosing and excluding ovarian cancer.Selecting 108 pmol/L as ovarian cancer diagnosis point is relative appro-priate.

Objective To discuss the clinical value of percutaneous vertebroplasty (PVP) in treating severe vertebral compression fracture. Methods During the period from June 2012 to March 2013, PVP was carried out in 30 patients with severe vertebral compression fracture (30 diseased vertebrae in total). The clinical data were respectively analyzed. According to the shape of compressed vertebra , the fractures were divided into three types: wedge-shaped, double concave and oblong-shaped. For wedge-shaped fracture, PVP was performed via the pedicle access of the healthy side. For double concave type , unilateral pedicle access was used, while for oblong-shaped type unilateral or bilateral access was adopted to conduct PVP according to the distribution of the injected PMMA. The therapeutic results were evaluated by using VAS and pain degree classification standard of WHO. The preoperative and postoperative vertebral height was estimated on the lateral projection. All patients were followed up for six months at out-patient clinic or by telephone. Results The success rate of puncturing was 100%. The preoperative mean VAS was 6.9 ± 0.9. The postoperative VAS at one day, one, 3 and 6 months after the procedure was 5.0 ± 0.9, 3.5 ± 0.7, 2.5 ± 0.8 and 1.6 ± 0.7 respectively. Based on WHO pain degree classification standard, complete remission (CR) was obtained in 25 cases, partial remission (PR) in 3 cases, and invalid in 2 cases. The effective rate (CR +PR) was 93.33%. The mean preoperative height of the compressed vertebrae was (5.77 ± 1.09) mm and the mean postoperative height of the compressed vertebrae was (14.33 ± 2.03) mm. Conclusion For the treatment of severe vertebral compression fractures, percutaneous vertebroplasty is clinically feasible with reliable short-term effect.

Objective To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study.A total of 19 lesions were detected. The lesions were 13 - 25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5 - 13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1 - 12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software.Results The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P < 0.01 ), which further decreased to 2.5 in one month (P < 0.01 ), while walking state score increased from a mean of 1.5before surgery to a mean of 2.5 in 24 hours after surgery (P < 0.01 ). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into paraacetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can markedlyimprove the patient's walking ability and the quality of life.

0.01). No serious complications occurred. Conclusion Both PLD+IDET and PLD are very effective in treating lumbar disc herniation. IDET is very helpful in relieving low back pain, although it can hardly improve patient's daily activities.

Objective To discuss the feasibility and short-term clinical effectiveness of DSA-guided percutaneous vertebroplasty (PVP) for the treatment of painful osteoblastic metastatic spinal lesions. Methods During the period from Jan. 2010 to Dec. 2011 at authors’ hospital PVP was carried out in 23 patients with osteoblastic spinal metastases (34 lesions in total). Coexisting osteoblastic pathological fracture was found in twelve patients. The WHO standards, visual analogue scale (VAS) and karnofsky-KPS score were used to evaluate the therapeutic results. Results Technical success was achieved in all patients. All patients were followed up for at least 3 months. Of 20 patients who had complete clinical data, complete remission (CR) was obtained in 6, partial remission (PR) in 10, mild remission (MR) in 3 and no remission (NR) in one. The clinical effectiveness (CR+PR) was 80%. The mean VAS scores dropped from preoperative (7.0 ± 1.6) to (2.2 ± 1.9) at 24 hours after the treatment, and to (2.4 ± 2.1) and (2.5 ± 2.1) at one and three months after the treatment respectively. The mean KPS scores rose from preoperative (76.5 ± 10.4) to (86.5 ± 11.8), (88.0 ± 12.0) and (89.0 ± 10.8) at 24 hours and one, three months after the treatment respectively. Small amount leakage of PMMA was observed in 4 cases (17.4%) with no obvious clinical symptoms. Conclusion DSA-guided PVP is a feasible and effective treatment for painful osteoblastic spinal metastases. This therapy can immediately relieve pain and reinforce spine, besides, it can remarkably improve the living quality and
decrease the incidence of paraplegia.