[Objective] To discuss the operation and clinical results about surgical treatment of scoliosis of thoracic hemivertebra and diastematomyelia of adolescent.[Methods]From Jan 2001 to June 2007,15 patients were treated with one-stage posterior hemivertebrae and osseous divide resection combined with transpedicular instrumentation and bone graft.There were 6 males and 9 females with an average age of 21.2 years(range 16 to 24 years).All cases were segmented hemivertebrae.Hemivertebrae were located at T11(n=3)and T12(n=12).The status of the spinal fusion,correction rate and instrumentation were evaluated after surgery.[Results]All cases were followed up for 19 to 45 months with an average of 34 months.Cobb's angles of the main curve were 52.3??3.8?before surgery,10.2??1.4? after surgery.At the final follow-up there was 1.6? loss of correction.The mean height was increased by 3.76 cm.The district of bone graft showed good bone fusion.The time of vertebra fusion was 3 to 5 months(mean 3.6 months).No instrumentation,spinal fusion failure or other severe complications were noted.[Conclusion]One-stage posterior hemivertebrae and osseous divide resection combined with transpedicular instrumentation and bone graft can achieve a satisfactory result for the treatment of scoliosis of thoracic hemivertebra and diastematomyelia of adolescent.It can be recommended in clinical practice because of a good stability of fixation and fine spinal fusion.

Objective To assess the value of susceptibility-weighted imaging (SWI) in staging hepatic fibrosis (HF) in rabbits. Methods Sixty healthy rabbits were randomly divided into HF group (n=44), control group (n=16). Rabbits in the HF group and supplementary group were injected subcutaneously with 50%CCl4 oily solution to establish hepatic fibrosis model. On the basis of preliminary test, 8 rabbits in the HF group and 4 rabbits in the control group were selected randomly at the 4th, 5th, 6th, 10th week after CCL4 injection ,respectively , to undergo liver MR scan,including conventional axial T1WI, T2WI and axial SWI, DWI scan. All rabbits were sacrificed after MR scan and the tissue of liver were sampled for pathological test and hepatic fibrosis staging. Rabbits were classified into group F0, F1-2 and F3-4 based on pathological results. Liver signal intensity (SI), and liver-to-muscle SI ratio were measured on SWI images and ADC values were measured on DWI images correspondently. One-way ANOVA analysis was performed to compare difference in liver SI, liver-to-muscle SI ratio and ADC values among group F0 (no fibrosis), F1-2 (mild-moderate fibrosis) and F3-4 (severe fibrosis) . Spearman correlation analysis was performed to correlate pathological staging and liver SI, liver-to-muscle SI ratio and ADC values. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of SWI and DWI for staging HF. Results Two and 5 rabbits in the HF group died at the 5th and the 6th week after CCL4 injection , respectively due to acute hepatic necrosis, hepatorrhexis and systemic failure. Seven rabbits in supplementary group were used as supplement. Of the 16 rabbits in the control group, 1 was excluded from the study due to liver fibrosis. Fifteen rabbits in group F0, sixteen rabbits in group F1-2 and sixteen rabbits in group F3-4 underwent MRI and were included into this study. Liver-to-muscle SI ratio in group F0, F1-2 and F3-4 were 0.973 ± 0.020, 0.880 ± 0.090 and 0.649 ± 0.140, respectively. Liver SI were 378 ± 45, 374 ± 19 and 317 ± 34. ADC values were (1.473 ± 0.320) × 10-3, (1.311 ± 0.310) × 10-3 and (0.942 ± 0.180) × 10-3mm2/s. There were statistically significant differences in liver SI, liver-to-muscle SI ratio and ADC values among group F0, F1-2 and F3-4 (F=46.571,15.803 and 15.317, P< 0.01). Liver-to-muscle SI ratio was highly negatively correlated with HF staging (r=-0.818,P<0.01), while liver SI and ADC values were moderately correlated with HF staging (r=-0.565,-0.630;P<0.01). Area under ROC curve (AUC) of liver-to-muscle SI ratio, liver SI and ADC value for differentiating hepatic fibrosis stage F0 and stage F1-4 were 0.916, 0.695 and 0.768, while the AUC for differentiating hepatic fibrosis stage F0-2 and stage F3-4 were 0.951, 0.904 and 0.900. Conclusion Liver-to-muscle SI ratio on SWI provide added diagnostic value and could be an useful parameter for staging hepatic fibrosis.

BACKGROUND:Thoracic lumbar segment is prone to spinal tuberculosis, caseous necrosis tissue, dead bone compression of spinal cord and nerve root may cause neurological symptoms, and the majority of them is accompanied with mild and moderate spinal kyphosis deformity. Surgical treatment of spinal tuberculosis has been frequently reported in recent years, the commonly used treatment includes lesion clearance, bone graft fusion and internal fixation. OBJECTIVE:To investigate the principle of choosing different internal fixation treatment for thoracolumbar spinal tuberculosis. METHODS:42 patients with thoracolumbar spinal tuberculosis were involved in this study from January 2001 to December 2011. Al patients suffered from waist and back pains, with the disease course range of 1 month to 7 years. Four cases showed neurological deficit before surgery. According to the Frankel classification, 1 case was graded as Frankel C and 3 cases as Frankel D. The preoperative average Cobb angle of kyphosis was 27° (range 12°-45°). The internal fixation approaches were chosen according to the tuberculose focus and vertebral fracture extent. Thoraco-abdominal approach for thoracolumbar spine via diaphragm with the removal of 11 rib and(or) 12 rib was performed for al patients. Among these protocols, 25 cases underwent anterior focal debridement and bone grafting. 17 cases had anterior focal debridement and posterior pedicle screw internal fixation (one-stage surgery in 7 cases and second-stage surgery in 10 cases). Al patients received anti-tuberculosis chemotherapy before and after operation. 36 cases used rib and 6 cases used iliac bone as bone graft. Al patients were fol owed up from 17 months to 9 years. The correction of spinal deformity, spinal stability and spinal functional recovery were observed. RESULTS AND CONCLUSION:30 patients were fol owed up after operations and the back pains disappeared. X-ray examination showed that, al patients were fixed wel without no loosening and rupture, and achieved bony fusion (the mean time were 5.4 months). No tuberculosis recurred. Four cases complicated with spinal cord injury were E grade according to the Frankel classification. The Cobb angle was 0-26° (mean 14°) at 12 months after operation. On the premise of standard anti-tuberculosis chemotherapy, various internal fixation methods can be determined according to general conditions of patients and tuberculose focus site.

Objective To investigate the principal indicators of self-care ability in activities of daily living for the persons with physical disability. Methods Persons with physical disability were asked to select the top 3 items out of 27 items of activities of daily living in 3 levels. Results A total of 1960 questionnaires were send out, and 1862 were returned. For all the subjects, the items related with personal hygiene, such as toileting, self-cleaning and bathing, were selected 899 times (16.1%). The items related with personal health, as visiting community clinics and community exercising, were selected 570 times (10.2%). The items related with social interaction, as making a telephone and chatting, were selected 500 times (9.0%). For the persons with physical disability of first grade, the major items most selected were eating, entertaining, self-cleaning and transferring; and self-cleaning and housework for those of second grade; self-cleaning, community activities and housework for those of third grade; and community and interaction for those of fourth grade. Conclusion The persons with physical disability mostly focused on the activities related with personal hygiene, health and social interaction, and varied with the severity of disability, from self-cleaning to housework and social participation.

【Objective】 To investigate the knowledge acquisition status for blood transfusion of transfusion related medical staff in underdeveloped cities in western China and explore its influencing factors. 【Methods】 A questionnaire consisted of blood transfusion laws and regulations, clinical blood transfusion theory and blood transfusion technology was designed, randomly distributed to medical staff and blood transfusion departmenttechnicians of 17 secondary/tertiary hospitals in Wuwei and then collected on the spot. The knowledge acquisition of blood transfusion of each group was compared using statistical description method, and its influencing factors were analyzed by multivariate logistic regression analysis. 【Results】 A total of 507 questionnaires were issued, and 498 valid questionnaires (98.22%) were collected. The scores of transfusion related laws and regulations, blood transfusion theory and blood transfusion technology of doctor group(n=158), nurse group(n=239) and transfusion technician group(n=101)were 4.56-5.97(5.06±0.73)(P<0.01) vs 4.23-5.87(4.98±1.24)(P<0.01) vs 3.71-0.78 (4.15±1.34), 3.67-5.02(4.27±1.02) vs 3.76-5.12(4.06±0.75) vs 4.71-5.98(5.16±0.64)(P<0.01) and 3.41-5.76(3.82±0.56) vs 3.78-5.24(4.01±0.56) vs 3.77-5.46(3.82±0.59). Among the seven departments, blood transfusion department(n=51) won the highest score of above three types of knowledge [4.91-5.97(5.28±0.43) vs 5.03-5.92(5.36±0.59) vs 4.39-5.77(4.97±0.79)(P<0.01) ]. Univariate logistic regression analysis showed that age, occupation, professional titles, training times and hospital grade had an impact on the degree (score) of blood transfusion knowledge acquisition (P<0.05), and multivariate unconditional logistic regression analysis indicated that training times was an important influencing factor(P<0.01). 【Conclusion】 This survey revealed that the level of knowledge acquisition for blood transfusion among medical staff in Wuwei is generally low, and there is a significant difference between staff from hospitals of different grade and different departments. It is urgent to strengthen the training of blood transfusion for medical staff in western China.

Objective To explore the effects of family-based symptoms self-management program on quality of life,psychology,physiologic function and other rehabilitation indexes in myocardial infarction(MI) patients. Methods A total of 146 myocardial infarction patients from Nanjing Gaochun People′s Hospital, the Branch of Nanjing Drum Tower Hospital were selected by convenience sampling from January 2013 to January 2016. They were divided into control group(n=72,routine health education provided by cardiovascular specialist nurse,three times a week,12 weeks)and experimental group(n=74,family-based symptoms self-management program,12 weeks)with the random number table. And then,the quality of life,psychology, physiologic function and other rehabilitation indexes were compared between two groups. Results The scores of four dimensions on physical activity,diet,concerns over medication and medical side effects of the myocardial infarction dimensional assessment scale(MIDAS)in experimental group were lower than those in control group with significant differences(t=53.31,60.90,71.89,24.69;P<0.05). The scores of two dimensions on anxiety and depression of the hospital anxiety and depression scale(HADS)in experimental group were significantly lower than those in control group(t=36.76,30.05;P < 0.05). The total cholesterol,triglyceride,blood pressure,body mass index and preprandial blood glucose in experimental group were lower than those in control group with significant differences(t=31.86,29.34,36.28,35.34,33.55,31.86;P < 0.05). Compared with control group,the family-based symptoms self-management program could effectively reduce the readmission rate of myocardial infarction patients,the incidence of complications,quit smoking rate and increase the exercise time weekly with significant differences(χ2/t=5.13,4.00,4.78,38.90;P<0.05). Conclusions The family-based symptoms self-management program for 12 weeks can improve the quality of life of MI patients, relieve anxiety and depression and debase the levels of MI related physiological indexes and other rehabilitation indexes.

Damp-heat syndrome is one of the common syndromes of various clinical diseases.Current studies have shown that intestinal flora is closely related to damp-heat syndrome,but the specific molecular biological mechanism related to intestinal flora and damp-heat syndrome is not yet clear.In this paper,the molecular biological mechanism of damp-heat syndrome is discussed from the perspective of intestinal flora related signaling pathways,so as to provide ideas for the essence of damp-heat syndrome and clinical diagnosis and treatment.

Objective To explore the clinical characteristics and prognostic outcomes of patients with acute myocardial infarction complicated by Coronavirus Disease 2019(COVID-19).Methods A retrospective study was conducted in 76 patients with acute myocardial infarction.Based on the pres-ence of COVID-19,they were divided into the COVID-19 group(n=42)and the control group(n=34).General clinical conditions,laboratory examination indicators,interventional treatment charac-teristics,incidence of complications during hospitalization and prognosis were compared between the two groups.Independent influencing factors for coronary thrombotic lesions in acute myocardial infarc-tion patients were analyzed.Results The diastolic blood pressure,left ventricular ejection fraction and lymphocyte count were significantly lower,while lipoprotein a,C-reactive protein,serum ferritin,fi-brinogen,and D-dimer were significantly higher in the COVID-19 group than those in the control group(P＜0.05).The proportions of coronary thrombotic lesions,baseline TIMI flow of grade 0 to 1,thrombus burden of grade 4 to 5,use of GP Ⅱb/Ⅲa inhibitors and thrombus aspiration in the COVID-19 group were significantly higher than those in the control group(P＜0.05).Multivariate Logistic regres-sion analysis revealed that COVID-19 and increased D-dimer were independent risk factors for coronary thrombotic lesions in acute myocardial infarction patients.The average length of hospital stay was sig-nificantly longer in the COVID-19 group than that in the control group(P＜0.05).A 6-month follow-up showed that the incidence of major adverse cardiac events(MACEs)was significantly higher in the COVID-19 group than that in the control group(P=0.014).Conclusion Patients with acute myocardial infarction complicated by COVID-19 exhibit a higher coronary thrombus load and have a poor prognosis.

Objective To explore the clinical characteristics and prognostic outcomes of patients with acute myocardial infarction complicated by Coronavirus Disease 2019(COVID-19).Methods A retrospective study was conducted in 76 patients with acute myocardial infarction.Based on the pres-ence of COVID-19,they were divided into the COVID-19 group(n=42)and the control group(n=34).General clinical conditions,laboratory examination indicators,interventional treatment charac-teristics,incidence of complications during hospitalization and prognosis were compared between the two groups.Independent influencing factors for coronary thrombotic lesions in acute myocardial infarc-tion patients were analyzed.Results The diastolic blood pressure,left ventricular ejection fraction and lymphocyte count were significantly lower,while lipoprotein a,C-reactive protein,serum ferritin,fi-brinogen,and D-dimer were significantly higher in the COVID-19 group than those in the control group(P＜0.05).The proportions of coronary thrombotic lesions,baseline TIMI flow of grade 0 to 1,thrombus burden of grade 4 to 5,use of GP Ⅱb/Ⅲa inhibitors and thrombus aspiration in the COVID-19 group were significantly higher than those in the control group(P＜0.05).Multivariate Logistic regres-sion analysis revealed that COVID-19 and increased D-dimer were independent risk factors for coronary thrombotic lesions in acute myocardial infarction patients.The average length of hospital stay was sig-nificantly longer in the COVID-19 group than that in the control group(P＜0.05).A 6-month follow-up showed that the incidence of major adverse cardiac events(MACEs)was significantly higher in the COVID-19 group than that in the control group(P=0.014).Conclusion Patients with acute myocardial infarction complicated by COVID-19 exhibit a higher coronary thrombus load and have a poor prognosis.

Objective:To investigate the efficacy and safety of tenofovir amibufenamide in patients over 65 years old with chronic hepatitis B and liver cirrhosis.Methods:We recruited 45 patients in Linyi People's Hospital with chronic hepatitis B and liver cirrhosis who were treated with TMF antiviral therapy for 48 weeks, compared the virologic response rate and HBV DNA decrease level at 12, 24 and 48 weeks, and the changes in hepatitis B surface antigen, alanine aminotransferase, glomerular filtration rate, creatinine, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum phosphorus and blood lipids, and the changes in ALT normalization rate at 48 weeks. P<0.05 was statistically significant. Results:The age of the enrolled patients was 69.0 (67.0, 72.5) years. At 12, 24, and 48 weeks of treatment, the complete virological response rates were 32.4% (12/37), 70.0% (28/40), and 84.6% (33/39) respectively, and the level of HBV DNA decreased from baseline ( P＜0.05). After 48 weeks of treatment, the level of HBsAg decreased ( P<0.05), and there was no negative HBsAg conversion and seroconversion. After 48 weeks of treatment, the level of ALT decreased ( P<0.05). At 48 weeks of treatment, the rates of ALT reverted to normality were 88.9% (16/18) and 70.4% (19/27), respectively. There was no significant difference in the levels of glomerular filtration rate, creatinine, phosphorus, triglycerides, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol estimated at baseline before and after treatment ( P＞0.05), and no serious adverse events were observed. Conclusions:For patients over 65 years old with chronic hepatitis B and liver cirrhosis, TMF can significantly inhibit HBV DNA replication, and the ALT normalization rate is high and well tolerated.