BACKGROUND: In clinic, many orthopaedic diseases are related to abnormal increase of intraosseous pressure, such as, avascular necrosis of femoral head and osteoarthritis and so on. Percutaneous bone puncture and other methods can decrease intraosseous pressure and release clinical symptoms immediately. Analysis on the changes in intraosseous pressure and medullary blood rheology following drilling decompression can further recognize the occurrence and development of intraosseous pressure OBJECTIVE: To observe the changes in intraosseous pressure and medullary blood rheology following drilling decompression in rabbits.DESIGN: A randomized and controlled trial.SETTING: Department of Orthopaedics, Affiliated Hospital of Youjing Medical College for Nationalities.MATERIALS: This experiment was carried out at Orthopaedic Department, Affiliated Hospital of Youjing Medical College for Nationalities between March and December 2005. Totally 30 New Zealand purebred white rabbits, of either gender, weighing (2.16±0.35) kg, were provided by Experimental Animals Center of Guangxi Medical University.METHODS: ① Animals grouping and modeling: 30 rabbits were randomly divided into 2 groups: model group and experiment group with 15 in each group. Intraosseous pressure models of the proximal right tibia were created on the rabbits in the two groups and drilling decompression was performed in the proximal tibia of rabbits in the experiment group. ②Measurement of intraosseous pressure of proximal tibia: After rabbits were anesthetized, needle for measuring blood pressure was pricked into the medullary canal at 0.5 cm internal plane up at the tubercle of right tibia.Intraosseous pressure of two groups was measured before and 2 days after decompression with BL-410 biologic functional system. ③ Measurement of medullary blood rheology: Before and 2 days after drilling decompression,medullary blood was extracted and blood rheology was measured with Blood Perfusion Monitor R80 (Vertebral plate type, Version 5.0) in the experiment group.MAIN OUTCOME MEASURES: Value of intraosseous pressure and medullary blood rheology before and after drilling decompression in the proximal right tibia.RESULTS: All the 30 rabbits entered the stage of result analysis. ①Measurement of intraosseous pressure: intraosseous pressure was significantly lower after drilling decompression in the proximal right tibia in the experiment group than in the model group (P ＜ 0.01). It approached normal value of intraosseous pressure of control side [(2.50±0.39) kPa]. Intraosseous pressure in the experiment group was significantly lower after than before drilling decompression (P ＜ 0.01). ② Measurement of medullary blood rheology: Medullary blood viscosity, plasm viscisity, whole blood reduced low-shear viscosity, red cell rigidity index, whole blood high-shear relative viscosity, whole blood low-shear relative viscosity, erythrocyte deformation index and erythrocyte aggregation index at the proximal end of tibia following drilling decompression were significantly lower than those before drilling decompression (P ＜ 0.05 or 0.01). Medullary erythrocyte sediment rate and erythrocyte hematocrit did not change significantly (P ＞ 0.05).CONCLUSION: Drilling decompression in proximal right tibia can obviously decrease intraosseous pressure, dilute medullary blood and decrease blood viscosity.

Objective To study the theraputic effect of rebuilt posterior ligamentous complex in the treatment of thoracolumbar fracture.Method From 2003 to 2007,60 patients who had simple thoracolumbar fractures were treated with rebuild of posterior ligamentous complex(group A).At the same time,50 patients with the same condition were treated with ablation of posterior ligamentous complex(group B).Modify Japanese orthopedic association low back pain score(M-JOA)score and Functional Rating scales for Low Back Pain(FRS)score for lumbar function were compared between two groups perioperatively.Results Preoperative M-JOA score for lumbar function of group A was from 19 to 30 score,on average of23.83.M-JOA score of group B was from 17 to 30 score on average of 21.68.There was no significant different between group A and group B(P＞0.05).Postoperative M-JOA score for lumbar function of group A was from 8 to 12 score,on average of 9.05.M-JOA score of group B was from 9 to 14 score.on average of 11.95.There was significant difference between group A and group B(P＜0.01).Preoperative FRS score was 28.85 in group A and 26.56 in group B averagely(P＞0.05)while postoperative FRS score was 68.22(46-84)in group A and 46.87(39-65)in group B(P＜0.05).Conclusion Management with rebuild of posterior ligamentous complex for thoracolumbar fractures contributes to the improvement of the postoperative lumbar function and clinical symptoms.

Objective To analyze the morphological matching rate with a digital image recognition system in pre-and post-orthodontic treatments,and to provide forensic dentistry evidence for individual identification.Methods High-resolution digital images of the palatal rugae were taken under particular conditions from each patient in pre-and post-orthodontic treatments.Features of each digital image were extracted using a digital image recognition system and collected in the palatal rugae database.Data of the palatal rugae werematched by MATLAB software system.Results From the matching results,the accuracy rate of individual identification of orthodontic patients was 100％.The accuracy rate in matching palatal rugae patterns in pre-and post-orthodontic treatments was 95.67％.The results were statistically significant with P＜0.05.Conclusion Palatal rugae pattern is highly individual-specific.The morphologyofpalatal rugaecould bechangedby theorthodontic treatment,however,these changes may not greatly influence individual identification in forensic dentistry,providing a new potential to individual identification.

BACKGROUND: Clinical practice showed that there are certain correlations between postoperative C-reactive protein levels and bone graft fusion time following focal debridement,autologous iliac bone graft,with or without plate internal fixation,for the treatment of spinal tuberculosis.OBJECTIVE: To analyze the correlation between postoperative C-reactive protein levels and bone graft fusion time of spinal tuberculosis patients.METHODS: A total of 60 cases with spinal tuberculosis were selected from January 2007 to December 2009.All patients were underwent focal debridement,autologous iliac bone graft,with or without plate internal fixation,and confirmed by pathology.The C-reactive protein levels were determined at 1,7 and 14 days after operation,and then,according to average changes of C-reactive protein levels,the cases were assigned into 4 groups: 10-25 mg/L served as the mildly increase group,26-50 mg/L as the moderately increase group,51-100 mg/L as the highly increase group,and greater than 101 mg/L as the extremely increase group.Postoperative C-reactive protein levels were examined at 12,16,and 24 weeks after operation,the bone graft fusion was observed by X-ray or CT examination,in addition,bone block fusion time was recorded.All groups of patients with spinal tuberculosis postoperative C-reactive protein diversity and bone graft fusion time were analyzed by variability and correlation analysis.RESULTS AND CONCLUSION: There were 18 cases in the mildly increase group,21 cases in the moderately increase group,13 cases in the highly increase group,and 8 cases in the extremely increase group.The bone fusion time showed that: there were8 cases equal to or less than 12 weeks,34 cases equal to or less than 16 weeks,and 18 cases equal to or less than 24 weeks.There were significant differences among 4 groups in bone graft fusion times(X2=13.990,P=0.003).Spearman correlation analysis showed that,there was a positive correlation between postoperative C-reactive protein levels and bone fusion time(r=0.420,P=0.001).

BACKGROUND: Tuberculosis clearance, bone graft, internal fixation with or without plate for patients with spinal tuberculosis always lead to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) changes, which are associated with bone graft union time to certain degree.OBJECTIVE: To analyze the correlation between CRP, ESR and bone graft union time in patients with spinal tuberculosis.METHODS: A total of 60 patients with spinal tuberculosis underwent tuberculose focus clearance, autologous iliac bone grafting, and internal fixation without or with plate, including 38 undergoing fixation and 22 not undergoing fixation. They were divided into mild elevation, moderate elevation, high elevation, and extremely high elevation groups according to CRP and ESR. Correlation between CRP, ESR and bone graft union time was analyzed.RESULTS AND CONCLUSION: (1) CRP: there were 18 cases of mild elevation, 21 of moderate elevation, 13 of high elevation and 8 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.420, P=0.001, indicating positive correlation between CPR and bone union time. (2) ESR: there were 16 cases of mild elevation, 20 of moderate elevation, 13 of high elevation and 11 of extremely high elevation. There were significant differences in bone union time among groups (P=0.003). Spearman correlation analysis showed a correlation coefficient r=0.414, P=0.001, indicating positive correlation between ESR and bone union time. (3) Bone union was rapider in fixation group compared with non-fixation group, indicating that immediate, strong fixation can benefit bone union.

Objective To establish a digital system for forensic identiifcation of the palatal rugae and evaluate its application effects. Methods High-resolution digital images of the palatal rugae were harvested under the standard condition and processed including data collection, noise reduction, contrast enhancement, image segmentation, feature extraction, edge detection, and information matching. Apply an MATLAB software system to develop a digital system for forensic identiifcation of the palatal rugae ,and its application effects were evaluated. Results A digital system for forensic identification of the palatal rugae was successfully established. The digital system had an accuracy rate of 100%. Conclusion Establishing a digital system for forensic identiifcation of the palatal rugae provides a novel method for forensic identiifcation.

Objective To evaluate the palatal rugae individual-specific properties and stability before and after orthodontic treatments for investigating the reliability of palatal rugae for individual identification of forensic dentistry based on the palatal rugae model ananlysis. Methods Maxillary models of 70 patients were obtained before and after orthodontic treatments respectively. Palatal rugae morphologic changes and individual identification were examined by model analysis including changes in number, orientation, shape, and length of palatal rugae, as well as mesial and distal endpoint displacement in the anterioposterior(AP) and mesiodistal (MD) direction. Furthermore, The examination of palatal rugae average match accuracy(%) was performed between the pre-treatment and post-treatment orthodontics models and post-treatment and duplicated post-treatment orthodontics models. Results ① The palatal rugae morphological changes were found and the incidence of palatal rugae changes were showed in length(28.6%), segmenta-tion(4.3%); unification(2.9%); orientation(1.4%) and shape(1.4%) after orthodontic treatment. Also the displacement of the distal endpoint of palatal rugae was 45.7% for anterioposterior indirection, 40% for mesiodistal indirection after orthodontic treatment, while the anterioposterior displacement of the mesial endpoint of palatal rugae was 32.9% and mesiodistal displacement was 17.1%. ② The identical palatal rugae patterns were not found both the pre-treatment and post-treatment groups. ③ The palatal rugae average match accuracy was 92.19% between pre-treatment and post-treatment groups, however, the rate had increased by 99.05% when matching the palatal rugae patterns of post-treatment groups to their duplicates. Conclusion Palatal rugae patterns have the high specific properties to each indivi-dual. Although there are some changes in morphology of palatal rugae after orthodontic treatment, it still can be used as a novel method for individual identification in forensic dentistry.

Objective:To investigate the clinical efficacy of laparoscopic radical resection of hilar cholangiocarcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 25 patients with hilar cholangiocarcinoma who were admitted to Henan Provincial People′s Hospital from January 2017 to July 2019 were collected. There were 16 males and 9 females, aged from 51 to 75 years, with a median age of 64 years. All the 25 patients underwent laparoscopic radical resection of hilar cholangiocarcinoma. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using out-patient examination and telephone interview was performed to detect local recurrence and distant metastasis of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 25 patients, 15 patients in Bismuth typeⅠunderwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ Roux-en-Y choledocho-jejunostomy, 2 patients in Bismuth type Ⅱ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ perihilar resection+ regional lymph node dissection+ Roux-en-Y choledochojejunostomy, 2 patients in Bismuth type Ⅲa underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ right hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅲb underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ left hemihepatectomy+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy, 3 patients in Bismuth type Ⅳ underwent laparoscopic radical resection of hilar cholangiocarcinoma+ regional lymph node dissection+ hepatic caudate labectomy+ Roux-en-Y choledochojejunostomy. The operation time was (388±118)minutes, and volume of intraoperative blood loss was 200 mL(range, 50-2 000 mL). Six patients were treated with blood transfusion intraoperatively. The operation time of 2 patients in Bismuth type Ⅲa was 375 minutes and 465 minutes, and the volume of intraoperative blood loss was 200 mL and 1 000 mL, respectively; 1 case received blood transfusion. The operation time of 3 patients in Bismuth type Ⅲb was 410 minutes, 465 minutes, 501 minutes, and the volume of intraoperative blood loss was 300 mL, 400 mL, 450 mL, respectively; neither had intraoperative blood transfusion. The operation time of 3 patients in Bismuth type Ⅳ was 415 minutes, 560 minutes, 600 minutes, and the volume of intraoperative blood loss was 300 mL, 600 mL, 800 mL, respectively; 1 case had intraoperative blood transfusion. (2) Postoperative situations: of the 25 patients, 4 patients had grade Ⅰ complications, including 2 cases of biliary fistula (1 case in Bismuth type Ⅰ and 1 case in Bismuth type Ⅲa), 1 case of pulmonary infection (Bismuth type Ⅳ), and 1 case of postoperative liver insufficiency (Bismuth type Ⅲa), all of them were improved after conservative treatment. Results of postoperative pathological examination: bile duct adenocarcinoma and high-grade intraepithelial neoplasia were detected in 23 and 2 patients; there were 8 cases with nerve invasion, 3 cases with lymph node metastasis and no vascular thrombus. The duration of hospital stay and hospitalization expenses were 24 days (range, 10-45 days) and 9.4×10 4 yuan [range, (5.3-18.7)×10 4 yuan] for all the 25 patients; the above indicators were 36 days, 45 days, 15.1×10 4 yuan, 18.7×10 4 yuan for the 2 patients in Bismuth type Ⅲa, 15 days, 26 days, 33 days, 7.3×10 4 yuan, 11.5×10 4 yuan, 15.9×10 4 yuan for 3 patients in Bismuth type Ⅲb, 24 days, 39 days, 41 days, 12.1×10 4 yuan, 15.2×10 4 yuan, 16.7×10 4 yuan for the 3 patients in Bismuth type Ⅳ, respectively. (3) Follow-up: 25 patients were followed up for 2-36 months, with a median follow-up of 16 months. Of the 25 patients, 18 had no recurrence or metastasis, 2 patients in Bismuth type Ⅳ had extensive intraperitoneal metastasis, 1 patients in Bismuth type Ⅲa had trocar hole metastasis, and 4 patients died. Conclusions:Laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible. Surgeries should be selected strictly based on surgical indications and the Bismuth type.

Objective:To investigate the application value of peripheral blood circulating tumor cell (CTC) classification in the prediction of preoperative microvascular invasion of hepato-cellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinico-pathological data of 102 HCC patients who were admitted to Zhengzhou University People's Hospital from September 2018 to September 2020 were collected. There were 71 males and 31 females, aged from 29 to 80 years, with a median age of 57 years. Observation indicators: (1) surgical situations; (2) results of CTC detection and microvascular invasion in HCC patients; (3) results of CTC classification and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC; (4) influencing factors for microvascular invasion in HCC; (5) comparison of clinicopathological features in HCC patients with different cell counts in mesenchymal phenotype of CTC (M-CTC). Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the nonparametric rank sum U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value for the risk of microvascular invasion in patients. Univariate and multivariate analysis were performed using the Logistic regression model. Results:(1) Surgical situations. All 102 patients underwent surgery successfully, including 17 cases undergoing local hepatectomy, 43 cases under-going segmentectomy, 22 cases undergoing hepatic lobectomy, 13 cases undergoing hemilectomy and 7 cases undergoing enlarged hemilectomy. The operation time and the volume of intraoperative blood loss were 235(147,293)minutes and 300(110,500)mL of the 102 patients, respectively. (2) Results of CTC detection and microvascular invasion in HCC patients. Of 102 patients, there were 36 casas with epithelial phenotype of CTC (E-CTC), 86 cases with hybrid phenotype of CTC (H-CTC), 30 cases with M-CTC, respectively, and the total CTC (T-CTC) were positive in 89 cases. Results of postoperative pathological examination showed that there were 40 cases with micro-vascular inva-sion and 62 cases without microvascular invasion in the 102 patients. Of the 40 patients with micro-vascular invasion, the count of E-CTC, H-CTC, M-CTC and T-CTC were 0(0,1) per 5 mL, 4(2,5) per 5 mL, 1(0,2) per 5 mL and 5(3,8) per 5mL, respectively. The above indicators of the 62 cases without microvascular invasion were 0(0,1) per 5 mL, 3(1,5) per 5 mL, 0(0,0) per 5 mL and 3(2,6) per 5 mL, respectively. There were significant differences in the count of M-CTC and T-CTC between patients with and without microvascular invasion ( Z=-4.83, -2.96, P<0.05). (3) Results of CTC classi-fication and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC. The ROC curve showed that best cut-off value of M-CTC and T-CTC counts in the prediction of microvascular invasion in HCC were 1 per 5 mL and 4 per 5 mL, respectively, with the area under curve, the corresponding specificity, sensitivity were 0.70 (95% confidence interval as 0.60-0.81, P<0.05), 75.8%, 62.9% and 0.67 (95% confidence interval as 0.57-0.78, P<0.05), 60.0%, 72.5%, respec-tively. (4) Influencing factors for microvascular invasion in HCC. Result of univariate analysis showed that alpha fetoprotein (AFP), aspartate aminotransferase (AST), tumor diameter, tumor number, tumor margin, Barcelona clinic liver cancer staging, M-CTC counts and T-CTC counts were related factors influencing microvascular invasion in HCC ( odds ratio=3.13, 0.43, 4.92, 5.65, 2.54, 2.93, 8.25, 4.47, 95% confidence interval as 1.34-7.33, 0.19-0.98, 2.09-11.58, 2.35-13.63, 1.13-5.75, 1.27-6.74, 3.13-21.75, 1.88-10.61, P<0.05). Result of multivariate analysis showed that tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL were independent risk factors influencing microvascular invasion in HCC ( odds ratio=2.97, 4.14, 4.36, 95% c onfidence interval as 1.01-8.70, 1.14-15.02, 1.36-13.97, P<0.05). (5) Comparison of clinicopathological features in HCC patients with different cell counts in M-CTC. The 102 HCC patients were divided into the high M-CTC group of 30 cases with M-CTC counts ≥1 per 5 mL and the low M-CTC group of 72 cases with M-CTC counts <1 per 5 mL, according to the best cut-off value of M-CTC counts. Cases with hepatitis, cases with AFP >400 μg/L, cases with AST >35 U/L, cases with irregular tumor margin, cases with tumor diameter >5 cm, cases with tumor number as multiple and cases with micro-vascular invasion were 22, 17, 13, 21, 18, 16 and 22 in the high M-CTC group of 30 cases. The above indicators were 35, 18, 48, 26, 25, 21 and 18 in the low M-CTC group of 72 cases. There were significant differences in the above indicators between the high M-CTC group and the low M-CTC group ( χ2=5.25, 9.42, 4.80, 9.79, 5.55, 5.35, 20.75, P<0.05). Conclusions:The epithelial-mesen-chymal phenotype of peripheral blood CTC can be used to predict the preoperative microvascular invasion in HCC. Tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL are independent risk factors influencing microvascular invasion in HCC patients.

Objective:This study aimed to compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD).Methods:The clinical data of 386 patients who successfully underwent pancreaticoduodenectomy at the People's Hospital of Zhengzhou University from June 2017 to December 2019 were retrospectively analyzed. According to the different surgical methods, patients were divided into the LPD group ( n=122) and the OPD group ( n=264). The differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative oncology survival outcomes and prognosis between groups were compared. Results:Of 386 patients in this study, there were 232 males and 154 females, aged (57.8±11.0) years. The operation time of the LPD group was (330.69±80.55) min which was significantly longer than that of the OPD group (241.13±77.24) min. The intraoperative blood loss 300.00(200.00, 400.00) ml was also significantly less than the OPD group 400.00(262.50, 500.00) ml, and the length of postoperative stay in the LPD group (12.21±5.24) d was significantly less than the OPD group (16.61±6.63) d, (all P<0.05). There were 36 patients (29.51%) in the LPD group and 81 patients (30.68%) in the OPD group who developed postoperative complications, with no significant difference between groups ( P>0.05). Postoperative oncology outcomes showed that the number of lymph nodes dissected in the LPD group was significantly more than that in the OPD group [(12.65±5.03) vs (10.07±5.09)], ( P<0.05). There were no significant differences between the two groups in tumor pathology type, size, degree of differentiation and R 0 resection rates (all P>0.05). All patients were followed up for 6-36 months, with a median follow-up of 20 months. The survival rates of patients with malignant tumors after following-up for more than 1 year in the LPD group was 84.72%(61/72), that in the OPD group was 85.81%(133/155), with no significant difference between groups ( P>0.05). Conclusion:LPD was safe and feasible with its advantages of minimally invasiveness.