BACKGROUND: The existing technique takes articular process and lateral mass as a reference mark. Due to differences of subjective judgment in operation and the impact of articular hyperplasia, some errors of screw entry point selection and serious complications such as vertebral artery or cervical spinal cord injury easily occurred, which limit the clinical application of the technique. At present, it is very important to select a constant reference mark of cervical pedicle screw entry point.OBJECTIVE: Three-dimensional reconstruction CT images were made to measure the relationship between the lower cervical pedicle screw entry point and the lateral concave between articular process.METHODS: Three-dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the occurrence rate and morphological characteristics of the lateral concave between articular process were observed. The following parameters were determined on specific reconstructed CT image of C3-C7: (1) the distance between pedicle axis projection point in the posterior surface and the outer edge of lateral mass in transversal section through bilateral pedicle axis and (2) the distance between the point and the lateral concave between articular process in oblique sagittal section through homolateral pedicle axis. Mean value and standard deviation were counted and statistics difference was compared.RESULTS AND CONCLUSION: (1) The lateral concave between articular process in lower cervical vertebrae was a obvious and less constant proliferative anatomical landmark and its occurrence rate was 100%. (2) Using CT technology of 3D reconstruction, C3-C7 lower cervical transversal section through bilateral pedicle axis and oblique sagittal section through homolateral pedicle axis were successfully obtained. (3) In transversal section, the left and right distances between C3-C7 pedicle axis projection point in the posterior surface and the outer edge of lateral mass were (4.1±0.9)mm and (4.3±0.9) mm, and the difference was not statistically significant (P=0.609). Except for C3 and C7, C4 and C7,there was no significant difference in the measured values of the same side (P > 0.05). (4) In oblique sagittal section, the left and right distances between C3-C7 point and the lateral concave between articular process were (-0.3±1.7) mm and (-0.3±1.6) mm, and the difference was not statistically significant (P=0.916). Except for C3 and C4, there was significant difference in the measured values of the same side (P < 0.05). (5) The above results suggest that the lower cervical pedicle entry point and the lateral concave between articular process have a relatively constant orientation relationship in transversal section and a large variation in the sagittal section.

Objective To define that human cytomegalovirus (HCMV) can cross the placenta of the Balb/c mice and induce liver damage in developing fetus. Methods HCMV AD169 (6.0 logTCID 50 , 3.0 logTCID 50 , 1.5 logTCID 50 per mouse respectively) was injected into the peritoneum of mice (half of mice were female) when they were about 10 weeks old (weight 25 30g). Then, these mice were paired to mate. Fetus on day about to give birth was removed from the uterus and liver was obtained for virus isolation, pathological studies, examination of the viral DNA positive cells by in situ hybridization using digoxigenin labelled HCMV DNA oligonucleotide probe. Results HCMV could be isolated from the supernatant of tissues; HCMV DNA was found by PCR in supernatant of cell culture with CPE; the presence of viral DNA sequence in hepatocytes was confirmed by in situ hybridization; pathological changes in liver consist of swollen cytoplasm and destroyed nuclei of hepatocytes and distinct intranuclear inclusion in hepatocytes with a cellular infiltrates of predominantly phagocytic cells. All above were found more obviously in fetal mouse liver tissues from the group inoculated with 6.0 log TCID 50 HCMV AD169 as compared with 3.0 log TCID 50 group. In contrast, these positive results couldn't be well found in 1.5 log TCID 50 group. Nothing could be found in normal controls. Conclusions Our research suggests that primary maternal HCMV infection during pregnancy could induce congenital infection in fetus by transplacental transmission and induce fetal liver damage. The mouse model will provide the basis for the study on pathogenesis of congenital HCMV infection in liver and the development of prevention, diagnosis and antiviral agents for congenital HCMV infection in human being.

Objective:To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation (LDH) patients with high intensity zone (HIZ) in lumbar disc annulus fibrosus on MRI T2 weighted imaging.Methods:136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods.In group A,75 patients were injected with 2 ～5 mL of 40 μg/mL mixture of O3 and O2 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm.In group B,61 patients were treated with conservative treatment.MacNab score criterion and Oswestry disability index (ODI) were used in assessment of the efficacy.Results:Except 24 patients,all the other cases were followed up for 18 ～ 44 months.At the postoperative 1st,2nd,3rd,6th,9th,12th and 18th month,according to MacNab score criterion,the effective rates were respectively 88.00 ％,90.67 ％,93.33 ％,89.39 ％,84.85 ％,78.13 ％ and 73.44 ％ in group A and respectively 68.85 ％,62.30 ％ 55.74 ％,61.82 ％,58.12 ％,54.17 ％ and 47.92 ％ in group B.There were significant differences between two groups at the same time point (P＜0.05).At the postoperative 12th and 18th month,ODI was lower in group A,and there was no significant difference between two time points (P＞0.05).But it was significant different with that preoperatively and in group B at the same time point (P＜0.05).Conclusion:Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.

Objective To propose a novel regional injury classification for open pelvic fractures and characterize its application in clinical treatment.Methods The clinical data of 67 open pelvic fractures were retrospectively analyzed which had been treated from January 2001 through December 2017 at Department of Orthopedics,Affiliated Hospital to Chengdu University.They were 48 males and 19 females,from 12 to 68 years of age (average,34 years).According to the Tile classification,23 cases were type A,19 Type B and 25 Type C.Their main injuries were located at pubic perineum in 29 cases,at ilioinguinal region in 20,at sacroiliac region in 7,at ilioinguinal-perineum in 5 and at sacroiliac-perineum in 6.Our novel regional injury classification was proposed according to the assessment of soft tissue injuries at the Faringer regions.The mortalities and complications were compared between types of our regional injury classification to find associations between them.Results Despite active treatment 28 patients died,giving a mortality of 41.8％ (28/67).Our regional injury classification grouped the open pelvic fractures into 4 types:perineal type (type Ⅰ),ilioinguinal type (type Ⅱ),sacroiliac type (type Ⅲ) and composite type (type Ⅳ).The mortalities for the 4 types were respectively 20.7％ (6/29),45.0％ (9/20),71.4％ (5/7) and72.7％ (8/11).The mortality of open pelvic fractures was positively correlated with our classification (y =0.620,P =0.001).Type Ⅰ mainly included cystourethral injury,anorectal injury and infection,type Ⅱ and Ⅲ injury to iliac vessels and Type Ⅳ injury to iliac vessels and infection.The incidences of complications for type Ⅲ (100.0％,7/7) and type Ⅳ (100.0％,11/11) were significantly higher than those for type Ⅰ (82.8％,24/29) and type Ⅱ (85.0％,17/20) (P ＜ 0.05).Conclusions Our regional injury classification gives clear criteria.The mortality increases gradually with the 4 types.The incidence of complications for each type varies and thus leads to different therapies.

CT three-dimensional reconstruction has been widely used in the diagnosis and classification of fractures. Fracture mapping based on the CT three-dimensional reconstruction can visually display the morphology of fracture lines by drawing a fracture model, showing the starting and ending points, progress and area of the fracture lines. It provides a new method for diagnosis and classification of fractures, operative plan and design of implants for fractures, statistic analyses of predominant fracture sites, and developing standardized fracture models. This review gives a brief introduction of the research progress at home and abroad in fracture mapping for scapular fracture, pilon fracture, ulnar coronoid fracture, tibial plateau fracture, radial head fracture, intertrochanteric lateral wall fracture and acetabular quadrilateral surface fracture, summarizes the likely sites in the above fracture models and clinical application of fracture mapping in fracture classification, and discusses the prospects and problems of this technique in clinical application.

Objective:To explore the imaging measurement and clinical significance of the angle between the axis ofpedicle and the plane of lamina in lower cervical vertebra.Methods:Three dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity,and the angle between the axis ofpedicle and the plane of lamina was measured with the specific reconstructed CT image of C3-C7.Results:1) The left and right transverse angle of C3-C7 between the axis of pedicle and the ipsilateral plane oflamina were 98.3°±6.3°,98.0°±5.1°,97.5°±6.9°,95.1°±5.0°,85.8°±5.4°and 96.7°±8.2°,98.7°±7.1°,97.8°±3.6°,93.2° ±6.2°,86.8° ±5.7°,respectively,which showed a gradual decreasing trend.Meanwhile the angle ofC3-C6 was more than 90 degrees and C7 was less than 90 degrees.In addition to C6 with C3 and C7 with other segments,the rest of the differences between the sections was not statistically significant (all P＞0.05).2) The left and right transverse angle of C3-C7 between the axis of pedicle and the pedicle of vertebral arch of lamina were 0.2°±4.5°,1.2°±7.2°,-0.8° ±6.8°,-3.3°±5.4°,-14.7° ±4.0° and-1.6°±5.4°,1.9°±4.6°,-0.5° ±6.0°,-4.6° ±5.3°,-13.7°±3.4°,respectively,which showed a first increasing and then reducing trend.Meanwhile the angle of C4 was maximum angle.In addition to C6 with C3;C6 with C4,and C7 with other segments,the differences between the sections was not statistically significant (all P＞0.05).3) The left and right sagittal angle of C3-C7 between the axis of pedicle and the ipsilateral plane of lamina were 77.7°±7.6°,77.0°±7.1°,85.3° ±8.4°,94.1°±2.2°,94.9°±3.8° and 78.5° ±7.1°,76.2° ±6.2°,86.4°±6.4°,94.0°±2.7°,95.6°±3.8°,respectively,which showed a gradual increasing trend.The angle of C3-C4 was less than 90 degrees.Cs showed large variation and C6-C7 was more than 90 degrees.In addition to C3 with C4 and C6 with C7,the differences between the sections was statistically significant (all P＜0.05).There was no significant difference between the two sides of the above indexes (all P＞0.05).Conclusion:In low cervical vertebra,there is a certain angle relationship between the axis of pedicle and the plane of lamina,which can provide reference for the clinical determination of angle of pedicle screw insertion.

Objective: To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model. Methods: A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated. Results: Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ²=2.921, P=0.712) showed that the model had a good calibration. Conclusion The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.

Objective To explore the expression levels of YBX1 and FOXA1 in gastric cancer tissues and determine their relationship with prognosis. Methods A total of 131 patients with gastric cancer were studied, and the corresponding adjacent normal tissues of each patient were selected as the control. qRT-PCR and immunohistochemistry were used to detect the expression levels of YBX1 and FOXA1 in cancer tissues and adjacent tissues. The correlation between YBX1 and FOXA1 protein expression in gastric cancer tissues was expressed by Crammer's V coefficient, and the correlation between YBX1 mRNA and FOXA1 mRNA was analyzed by Pearson method. Kaplan-Meier method was used to analyze the relationship between YBX1, FOXA1 protein expression in gastric cancer tissues and the 5-year overall survival rate of patients. Univariate and multivariate Cox regression analyses were used to analyze the factors affecting the prognosis of patients with gastric cancer. Results Compared with paracancerous tissue, the levels of FOXA1 and YBX1 in cancer tissues were lower and higher, respectively (P < 0.05). A negative correlation was observed between YBX1 mRNA and FOXA1 mRNA in gastric cancer (r=-0.675, P < 0.05). The expression of YBX1 and FOXA1 proteins in gastric cancer tissues was negatively correlated (Crammer's V=-0.497, P < 0.001). The expression of YBX1 and FOXA1 proteins in gastric cancer tissue was related to the degree of differentiation, lymph node metastasis, and TNM staging (P < 0.05). The 5-year survival rate of the YBX1 negative expression group and the FOXA1 positive expression group were higher than those of the YBX1 positive expression group, and the FOXA1 negative expression group both P < 0.05). TNM staging and YBX1 were independent risk factors for death in patients with gastric cancer (P < 0.05), and FOXA1 was a protective factor (P < 0.05). Conclusion YBX1 is highly expressed and FOXA1 is lowly expressed in gastric cancer tissues; they are closely related to the disease progression and prognosis of patients with gastric cancer.

Endoplasmic reticulum (ER) stress is involved in the development and progression of tumors.In recent years, great attention has been paid to the study of the interplay of ER stress and T cell differentiation and functionality.Intense ER stress in the tumor-infiltrating T cells exacerbates T cell exhaustion and impairs T cell anti-tumor immunity.Therefore, a variety of ER stress inhibitors have been developed and utilized to alleviate T cell exhaustion, which improves T cell function in tumor microenvironment.Furthermore, the downregulation of several circadian clock genes like Per1 and Per2 also aggravates T cell exhaustion, and the key downstream effector molecules in ER stress regulate the transcription of Per family, thus enhancing the T cell function.In the present manuscript, we particularly summarize how ER stress impacts the anti-tumor immunity of T cells, and further discuss potential strategies for improving tumor immunotherapy via targeting ER stress.

Objective To observe the metabolic changes of subcortical structures in children with intractable epilepsy using 18 F-FDG PET/CT,and to investigate the mechanism of subcortical structure involvement in epileptic seizures and its clinical significance.Methods Features of 18F-FDG PET/CT imaging in 611 intractable epilepsy children were analyzed.The metabolic changes of cortex and subcortical structures (basal ganglia,thalamus and cerebellum) were observed.The children were divided into three groups (young,middle and older groups) according to age,also mild group and severe group according to the number of involved lobar,respectively.The incidence of metabolic abnormalities in subcortical structures of different groups were analyzed.Results Among 611 children,unilateral cortical metabolic abnormality was found in 525,and bilateral cortical metabolic abnormalities were found in 86 children.The involvement of subcortical structures was detected in 190 children,including basal ganglia (n=64),thalamus (n=113) and cerebellum (n=105).The incidence of metabolic abnormality in subcortical structures under different age groups was not statistically different (all P＞ 0.05),while the incidence of metabolic abnormality in subcortical structures of severe group was significantly higher than that of mild group (all P＜0.001).Conclusion 18 F-FDG PET/CT might be able to detect the metabolic abnormalities of subcortical structures,therefore indicating the involvement of cerebral cortex.