Objective:To explore the changes of estrogen, androgen and progesterone in serum of male patients with primary gouty arthritis (pGA) and their possible role in the pathogenesis of gout.Methods:The serum, clinical data and laboratory parameters of 266 patients with PGA [including 93 patients with acute gout (AG), 118 patients with intermittent gout (IG), 55 patients with chronic gout (CG)] and 129 healthy controls (HC) were collected. The serum estradiol (E 2), progesterone (P), testosterone (T) and E 2/T were detected by CMIA Expression level. SPSS 17.0 statistical software was used for analysis, Wilcoxon rank sum test was used for comparison of measurement data between groups, and Spearman correlation analysis was used for correlation analysis between variables. Results:① The level of E 2 and T level in the serum of PGA, AG, IG and CG group was lower than that of the HC group [(30±8) pg/ml, (27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml, (35±10) pg/ml; F=17.770, P<0.05] and [(4.4±1.6) ng/ml, (3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml, (5.8±1.9) ng/ml; F=23.314, P<0.05], but there was no significant difference between HC group and CG group ( P>0.05), The serum E 2 and T levels in AG group were lower than those in IG and CG groups [(27±7) pg/ml, (31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05] and [(3.8±1.4) ng/ml, (4.6±1.4) ng/ml, (5.1±2.0) ng/ml; F=23.314, P<0.05], andthe serum E 2 level in IG group was lower than that in CG group [(31±8) pg/ml, (34±7) pg/ml; F=17.770, P<0.05). The levels of P and E 2/T in HC group were lower than those in pGA and AG group [(0.24±0.10) ng/ml, (0.27±0.11)ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05] and [(0.006 6±0.002 2) ng/ml, (0.007 6±0.003 2) ng/ml, (0.008 0±0.003 8) ng/ml; F=3.787, P<0.05), while those in IG and CG group were lower than those in AG group [(0.25±0.09) ng/ml, (0.26±0.08) ng/ml, (0.30±0.15) ng/ml; F=5.124, P<0.05]; ② Spearman correlation analysis showed that E 2 level in pGA group was positively correlated with T and CysC( r=0.310, P<0.01; r=0.164, P=0.008), negatively correlated with MO ( r=-0.133, P=0.030), P level was positively correlated with MO ( r=0.139, P=0.023), T level was positively correlated with Crea and CysC ( r=0.179, P=0.003; r=0.162, P=0.008), negatively correlated with WBC, GR and MO ( r=-0.140, P=0.022; r=-0.173, P=0.005; r=-0.149, P=0.015), E 2/T was positively correlated with apob1 and Glu ( r=0.131, P=0.032; r=0.140, P=0.023). In AG group, E 2 level was positively correlated with T and Crea ( r=0.234, P=0.024; r=0.245, P=0.018), T level was positively correlated with Crea ( r=0.349, P=0.001), and negatively correlated with apob1 ( r=-0.250, P=0.016), and E 2/T was positively correlated with apob1 ( r=0.276, P=0.007). In IG group, E 2 level was positively correlated with T ( r=0.269, P=0.003), and negatively correlated with MO ( r=-0.183, P=0.048), while P level was positively correlated with MO( r=0.204, P=0.027). Conclusion:The expression of E 2 and T in the peripheral blood serum of gout patients decreases significantly, the expression of P and E 2/T increases significantly, and there is a positive correlation between E 2 and T, as well as the inflammatory and glycolipid metabolism indexes of gout patients, suggesting that estrogen, androgen and progesterone may participate in the pathogenesis of gout by regulating the inflammation and metabolism of gout.

Objective:To study the risk factors and microbial spectrum for infectious complications for patients with biliary tract cancer after major hepatectomy with cholangiojejunostomy.Methods:Enrolled into this study were 78 consecutive patients (57 patients with perihilar cholangiocarcinoma, 17 with intrahepatic cholangiocarcinoma and 4 with gallbladder cancer), who underwent major hepatectomy with cholangiojejunostomy at Nanjing Drum Tower Hospital between September 2010 and March 2019. The clinical data were reviewed using multivariate analysis to find independent risk factors for postoperative infectious complications. Microorganisms isolated from bile and infected sites were determined to study the microbial spectrum.Results:A total of 45(57.7%) patients suffered from postoperative infectious complications. Male sex ( OR=7.765, 95% CI=1.895-31.815, P<0.05) was the independent risk factor, whereas increased preope-rative red blood cell (RBC) ( OR=0.151, 95% CI=0.038-0.592, optimal cut-off value=3.7×10 12/L) and increased total cholesterol (TC) on postoperative day (POD) 1 ( OR=0.227, 95% CI=0.083-0.626, optimal cut-off value=3.5 mmol/L) were protective factors (both P<0.05). The area under the receiver operating characteristic (ROC) curve was 0.805 (95% CI=0.707-0.902, P<0.05). 205 and 230 microorganisms were cultured respectively from 286 and 681 specimens which were collected from pre-/intraoperative bile and potentially infected sites. Staphylococcus, enterococcus, acinetobacter, klebsiella and pseudomonas were the most common pathogens on bile culture. The first 5 most frequently isolated microorganisms from the infected sites were enterococcus, staphylococcus, klebsiella, candida and xanthomonas. Sixteen (61.5%) of 26 patients had at least one pathogen being isolated from the infected sites with the pathogen being previously isolated in bile culture. Conclusions:Male sex were independent risk factors of infectious complications. Increased preoperative RBC and inreased TC on POD were proteetive factors. For patients without a positive bile culture, a third-generation cephalosporin can be considered as a prophylactic antibiotic. It is important to identify high-risk patients and monitor perioperative pathogens actively to prevent and to cure postoperative infectious complications.

Objective To evaluate the prognostic value of pathological characteristics of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods 289 consecutive HCC patients who underwent curative hepatectomy at Nanjing Drum Tower Hospital from January 2007 to December 2015 were retrospectively studied.These patients were divided into three groups:the no-MVI group (n =176),the low-MVI group (the number of invaded microvessels ≤ 5 and the distance of invasion ≤ 1 cm,n =53) and the high-MVI group (the number of invaded microvessels ＞ 5 or the distance of invasion ＞ 1 cm,n =60).The clinical and pathological data and the survival outcomes of these HCC patients were analyzed.We further compared the prognosis among the three groups.Results Kaplan-Meier survival indicated that the number of invaded microvessels ＞ 5 and the distance of invasion ＞ 1 cm were associated with cumulative and recurrence-free survival rates of HCC patients.The cumulative and recurrence-free survival rates of the high-MVI group were significantly poorer than those of the low-MVI and the no-MVI groups.Multivariate analysis showed ICG-R15 (HR =1.049,95％ CI:1.002 ～ 1.097),tumor size (HR =1.138,95％ CI:1.043 ～ 1.241),and high-MVI (HR =3.245,95％ CI:1.946 ～ 5.413) were independent risk factors for cumulative survival.Tumor size (HR =1.117,95％ CI:1.050 ～ 1.188),and high-MVI (HR =2.222,95％ CI:1.540 ～ 3.205) were independent risk factors for recurrence-free survival.The prognosis of the no-MVI and low-MVI groups were significantly better than the high-MVI group (P ＜ 0.05).The recurrence rates of the low-MVI and no-MVI groups (49.4％ and 67.9％) were significantly lower than the high-MVI group (80.0％,P ＜ 0.05).Conclusions The risk classification of MVI based on histopathological features was valuable in predicting prognosis of HCC patients.We could use the risk classification of MVI to establish a follow-up and individualized treatment plan for HCC patients.

Objective To investigate the changes aad possible role of estrogen and its receptor ERα、ERβ、GPR30 in the pathogenesis of asymptomatic hyperuricemia.Methods The peripheral blood of 62 asymptomatic hyperuricemia patients (AH) and 68 healthy controls (HC) were collected.The expression of estradial (E2) in serum was detected by the chemilluminescent microparticle immunoassay (CMIA).The expression of ERα,ERβ,GPR30 mRNA in peripheral blood mononuclear cells (PBMCs) was measured using Real time quantitative polymerase chain reaction (RT-qPCR).Statistical Package form Soci-science (SPSS) 17.0 statistical software was used for data analysis.The measurement data were compared by t test,rank sum test or one factor analysis of variance test.The correlation between variables was used by Spearman correlation analysis.Results ① The expression of E2 in serum of the HC group was higher than that in the AH group [(38.7±10.2) pg/ml vs (33.7±8.6) pg/ml,Z=-0.356,P＜0.05].② The expression of ERα,GPR30 mRNA in PBMCs of HC group was increased,compared with that in the AH group (0.000 17±0.000 23 vs 0.000 12± 0.000 12,0.002 0±0.002 1 vs 0.001 5±0.000 8,Z=-2.112,-2.147,P＜0.05,respectively).No significant difference in PBMCs ERβ mRNA levels was found between HC group and AH group,while a slight but not significant increase was observed in HC group.③ The Spearman correlation analysis found that the expression of ERα and ERβ mRNA,E2 and GR,ERβ and GLU in the AH group were positively related (r=0.259,0.251,0.260,P＜0.05,respectively).Conclusion The expression of E2,ERα,ERβ,GPR30 mRNA in the peripheral blood of patients with AH is decreased,suggesting that the estrogen and its receptor may be involved in the patho-genesis of hyperuricemia.

Objeetive To compare the clinical value of early enteral nutrition (EEN) and combined enteral nutrition (EN) and parenteral nutrition (PN) in patients with hepatocellular carcinoma (HCC) after precise hepatectomy.Methods The prospective study was conducted.The clinical data of 60 HCC patients who underwent precise hepatectomy in the Affiliated Drum Tower Hospital of Nanjing University Medical School between January 2013 and December 2014 were collected.All patients were allocated into the EN group and combined EN+PN group by random number table method.Patients in the EN group and combined EN+PN group respectively received EEN and early combined EN+PN at 24 hours postoperatively for 7 days,total nutrient intakes between groups were consistent,with an average daily intake of nitrogen-feeding of 0.2 g/(kg · d) and an average daily intake of nonprotein calories of 25 kcal/(kg · d).Observation indicators:(1) comparison of nutritional indexes between groups;(2) comparison of liver function between groups;(3) comparison of postoperative conditions between groups.Measurement data with normal distribution were represented as-x±s.Comparisons at the same time between groups were respectively analyzed using the group-design t test.Comparisons of count data were analyzed using the chi-square test.Ordinal data were analyzed by the nonparametric test.Comparison of repeated measurement data were done using the repeated measures ANOVA.Results Sixty patients were screened for eligibility,and 30 in each group.(1) Comparison of nutritional indexes between groups:levels of albumin (Alb),globulin,prealbumin and hemoglobin (Hb) and lymph nodes count in the EN group were respectively (41±4)g/L,(28±4) g/L,(188±37) mg/L,(139± 17) g/L,(1.6±0.6) × 109/L before operation and (32±4) g/L,(23±5)g/L,(114±41)mg/L,(121±19)g/L,(1.1±0.7) ×109/L at 1 day postoperative1y and (34±5)g/L,(26±4) g/L,(169± 41) mg/L,(113 ± 16) g/L,(1.9 ± 1.1) × 109/L at 8 days postoperatively,with statistically significant differences in above indexes (F=2.23,4.45,8.96,5.21,2.18,P＜0.05).There were statistically significant differences in above indexes between pre-operation and 1 day postoperatively (t =9.79,8.53,9.81,4.56,5.77,P＜0.05) and between 1 and 8 days postoperatively (t =5.55,6.31,4.69,3.99,8.26,P＜0.05).There were statistically significant differences in levels of Alb,globulin,prealbumin and Hb between pre-operation and 8 days postoperatively (t=3.48,5.12,6.37,8.20,P＜0.05) and no statistically significant difference in lymph nodes count (t =2.48,P＞0.05).Levels of Alb,globulin,prealbumin and Hb and lymph nodes count in the combined EN+PN group were respectively (42±4)g/L,(28±6)g/L,(188±29)g/L,(142±16)g/L,(1.6±0.6)×109/L before operation and (31±5)g/L,(20±5) g/L,(96±31) g/L,(124± 16) g/L,(0.9±0.4) × 109/L at 1 day postoperatively and (34±4)g/L,(24±4)g/L,(143±18)g/L,(115±18)g/L,(1.4±0.7)×109/L at 8 days postoperatively,with statistically significant differences in above indexes (F=3.21,7.35,4.36,7.78,3.19,P＜0.05).There were statistically significant differences in above indexes between pre-operation and 1 day postoperatively (t =11.95,5.38,9.91,4.84,6.22,P＜0.05) and between 1 and 8 days postoperatively (t =9.45,7.66,4.98,3.15,4.79,P＜ 0.05).There were statistically significant differences in levels of Alb,globulin,prealbumin and Hb between pre-operation and 8 days postoperatively (t=9.31,8.44,6.57,5.25,P＜0.05).There were no statistically significant difference in lymph nodes count (t =3.11,P＞ 0.05) and in changing trends of Alb,globulin,prealbumin,Hb and lymph nodes count (F=8.54,3.83,7.21,6.33,3.91,P＞0.05).Levels of prealbumin at 8 days postoperatively were statistically different between groups (t =3.00,P＜0.05).(2) Comparison of liver function between groups:levels of alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),glutamyl-transpeptidase (GGT),total bilirubin (TBil),direct bilirubin (DBil) and C-reactive protein (CRP) in the EN group were respectively (44±37)U/L,(44±30) U/L,(90± 29) U/L,(85 ± 49) U/L,(15.7± 5.4) μmol/L,(4.6± 2.3) μmol/L,(4.5 ± 3.2) mg/L before operation and (411±375)U/L,(379±323)U/L,(68±26)U/L,(55±49)U/L,(20.3±10.7)μmol/L,(7.8±5.5) μmol/L,(47.9± 30.6) mg/L at 1 day postoperatively and (107± 58) U/L,(43± 21) U/L,(100± 42) U/L,(111±71)U/L,(19.7±10.6) μmol/L,(8.8±5.9) μmol/L,(28.3±23.0) mg/L at 8 days postoperatively,with statistically significant differences in above indexes among pre-operation,1 and 8 days postoperatively (F=5.48,9.44,1.73,5.03,8.42,6.09,6.69,P＜0.05) and between pre-operation and 1 day postoperatively (t=5.12,5.36,5.35,0.45,2.88,3.82,6.95,P＜ 0.05).There were statistically significant differences in levels of ALT,TBil,DBil and CRP between pre-operation and 8 days postoperatively (t =6.71,4.14,5.96,6.33,P＜0.05) and in levels of ALT,AST,ALP,GGT and CRP between 1 and 8 days postoperatively (t =6.23,5.55,3.14,3.56,4.99,P＜0.05).There were no statistically significant difference in levels of AST,ALP and GGT (t =0.13,0.98,1.11,P＞0.05) and in levels of TBil and DBil (t =0.08,0.23,P＞0.05).Levels of ALT,AST,ALP,GGT,TBil,DBil and CRP in the combined EN+PN group were respectively (41±38) U/L,(43±25) U/L,(100±89) U/L,(106±46) U/L,(17.9±9.8) μmol/L,(6.2±3.6) μmol/L,(3.7±2.3)mg/L before operation and (462±409)U/L,(494±162)U/L,(73±53)U/L,(75±57)U/L,(28.1±18.8)μmol/L,(9.1±6.1) μmol/L,(40.7±26.2) mg/L at 1 day postoperatively and (90±47) U/L,(42± 16) U/L,(95±40) U/L,(110±66) U/L,(22.5± 14.5) μmol/L,(8.2±8.1) μmol/L,(26.9±24.6) mg/L at 8 days postoperatively,with statistically significant differences in above indexes among pre-operation,1 and 8 days postoperatively (F=5.96,3.73,6.94,3.88,7.97,4.14,5.25,P＜0.05) and between before operation and 1 day postoperatively (t=5.72,4.96,3.95,0.88,2.83,4.13,6.11,P＜0.05).There were statistically significant differences in levels of ALT and CRP between pre-operation and 8 days postoperatively (t =4.22,6.77,P＜0.05) and in levels of ALT,AST,ALP and GGT between 1 and 8 days postoperatively (t=7.01,5.21,4.38,6.15,P＜0.05).There were no statistically significant difference in levels of AST,ALP,GGT,TBil and DBil (t =0.29,1.65,1.92,0.33,P＞0.05) and in levels of TBil,DBil and CRP (t =0.09,0.37,0.58,P＞0.05).There was no statistically significant difference in changing trends of ALT,AST,ALP,GGT,TBil,DBil and CRP of 2 groups (F=7.18,2.23,3.94,5.88,4.72,2.17,6.53,P＞0.05) and in above indexes among pre-operation,1 and at 8 days postoperatively (t=0.27,0.42,0.91,0.12,0.96,0.24,0.59,0.32,0.49,1.27,0.88,0.07,1.07,1.45,0.23,1.11,0.88,0.32,0.35,0.93,0.21,P＞0.05).(3) Comparison of postoperative conditions between groups:times of initial defecation were respectively (3.2± 1.0) days and (4.2± 1.2) days in the EN group and combined EN +PN group,showing a statistically significant difference (t =3.21,P＜ 0.05).Conclusion EEN and combined EN+PN are safe and feasible in HCC patients after precise hepatectomy,and also can improve liver function recovery,but EEN has advantages of promoting protein synthesis and gastrointestinal function recovery.

Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatocellular carcinoma.Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed.The clinical diagnosis was confirmed by pathology of the resected specimens.Based on postoperative platelet count within 2 h,the patients were divided into the low platelet count (PLT ＜ 100 × 109/L) group (n =24,33.8％) and the normal platelet count (PLT ≥ 100 × 109/L) group (n =47,66.2％).The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and direct bilirubin (DBil) were analyzed,and the incidences of posthepatectomy liver failure was also evaluated in these two groups.Results There was no re-operation and perioperative death in this study.Among the 71 patients,25 patients (35.2％) developed postoperative complications (grade Ⅰ to Ⅲ),and 8 patients (11.3％) suffered from postoperative liver failure (grade A).When compared with the normal platelet count group,the low platelet count group had significantly increased risks of postoperative liver failure (29.2％ vs 2.1％,X2 =11.618,P ＜ 0.05),increased postoperative peaks of ALT,AST,TBil and DBil levels [(462.5 ±135.7)U/L vs (307.9 ± 192.6) U/L,(440.0 ± 163.3) U/L vs (265.8 ± 155.8) U/L,(29.5 ±9.1) μmol/L vs (17.9 ±8.8) μ mol/L,t =3.507,4.385,5.129,P ＜0.05,respectively] and longer normalization time of liver function.Multiple Logistic regression analyses revealed that an immediate postoperative low platelet count was an independent risk factor of posthepatectomy liver failure.Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma.Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.

Objective To investigate effects of ACUMED self-orientated elbow plate system in treatment of comminuted distal humeral fractures (type C) in adults.Methods Thirty-two adult cases of comminuted distal humeral fractures treated by open reduction and internal fixation with parallel dual plates from May 2009 to October 2010 were enrolled in the study.There were 17 males and 15 females,at average age of 60 years (range,21-85 years).All cases were subjected to closed fractures,involving left side in 15 cases and right side in 17.Besides,two cases had associated ulnar nerve injury.According to AO classification,there were 12 cases of type C1,12 of type C2 and eight of type C3 fractures.The time from injury to operation averaged 5.6 days.Distal humeri were exposed through posterior median incision of elbow and V shape osteotomy of olecroanon.Muscular contractile and relaxant functional exercise was taken within 24 hours postoperatively.Clinical results were assessed based on Mayo elbow performance score (MEPS) and X-ray films.Results X-ray films showed that all cases obtained primary bone healing in the follow-up (mean 12 months).Three cases of type C3 fractures had heterotopic ossification.All cases had no complications like infections or implant loosening postoperatively.Range of motion in elbow flexion and extension averaged 85° (range,8°-140°).MEPS was average 90 points (range,60-100 points),including excellent outcomes in 13 cases,good in 15,fair in one and poor in three,with excellence rate of 88％.Conclusion ACUMED parallel dual plate fixation technique based on stability theory of arch structure achieves solid fixation of adult comminuted distal humeral fractures,successfully reconstructs bone structure of distal humeri,and effectively restores elbow joint function in response to early rehabilitation exercise.

Objective To investigate high risk human papillomavirus(HR-HPV)prevalence among married women in Beijing and to study the high risk flactors.nethods During March 2007 to September 2008.a total of 6185 married women sampled from 137 communities in 12 districts were screened bv HR-HPV DNA test and cytogical test.The interview was carried out with unified questionnaires.The databage was set up and twice entered in EpiDam 3.0.After checked up,the data were analyzed in SPSS 15.0.Results (1) The HR-HPV infection rate was 9.89%.The HR-HPV infection rate of the city zone,the suburb and the exurb were 9.34%,10.51% and 9.51% (P>0.05).The HR-HPV infection rate of the native and the oudander were 9.53%,11.30% (P<0.05).(2) The age distribution of HR-HPV infection was that the rate was around 10% among 25 to 44 age groups,which was the highest(11.21%) in 30 to 34 age group;then the rate was descended as the age raising,the rate of 50 to 54 age group was the lowest(7.78%).(3) Multiple logistic regression showed that the related risk factors of HR-HPV infection mainly included 1000 RMB and above of family income per person per month.possessing more than 1 sexual partner of her husband,outlander and hish levels of education.(4) The prevalence of cervical intraepithelial neoplasia(CIN)in HR-HPV positive group wag significantly higher than that in HR-HPV negative group(29.76% vs 3.32%,P<0.01).Conclusions(1)The HR-HPV infection rate among aged 25 to 54 years was 9.9% and there was no significant difference in area distribution.(2)The hish risk population which should strengthen screening was the married bearing-age women with high level of family income,outlander,high levels of education and her husband possessing more than 1 sexual partner.(3)HR-HPV infection is the main risk factor for CIN and cervical cancer.while does not provide a causal relationship with them.The high risk population should be checked regularly to understand the development of HR-HPV infection and CIN incidence.

BACKGROUND: To discuss the feasibility of allogeneic freeze-drying radiation sterilization bone sheet applying in the prevention of post-laminectomy adhesion as an ideal biological material for filling and repairing bone defect. OBJECTIVE: To observe the preventive effect of allogeneic freeze-drying radiation sterilization bone sheet on the postlaminectomy adhesion and restenosis.DESIGN: Follow-up survey on cases.SETTINGS: Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology; Shanxi Medical Tissues of China Institute for Radiation Protection PARTICIPANTS: From March 2003 to June 2005, 58 patients with segmental lumbar spinal stenosis (LSS) were selected from Department of Orthopedics, Union Hospital, Tongji Medical School of Huazhong University of Science and Technology, including 34 males and 24 females, aged 30-78 years, including 25 cases of simple LSS and 33 combined LSS; and including 36 cases in L4-5 and 33 cases in L5, S1 segments. All the patients were similar in age, gender and healthy conditions.METHODS: The segmental whole laminectomies were performed in 58 patients with prolapse of lumbar intervertebral or LSS, and allogeneic freeze-drying radiation sterilization bone sheet in "H" shape was used to cover the vertebral laminae. According to the follow-up standard of lumbar spine operation recommended by the Orthopaedics Branch of Chinese Medical Association, all patients were followed up to evaluate their clinical symptoms, absorption of implanted bone as well as CT and MRI presentations.MAIN OUTCOME MEASURES: Improvements of clinical symptoms;Absorption of bone sheet in lumbar spinal canal.RESULTS: Totally 58 LSS patients were involved in the result analysis.In postoperative 0.5-year follow-up period, 17 of 21 patients showed excellent curative effects while other 4 patients showed fine effects. In postoperative 1-year follow-up period for 23 patients, CT and MRI results demonstrated that the spinal canal had been extended obviously. There was no tilt or displacement of the femoral sheet or compression of the spinal cord. As for 14 patients who were followed up for 1.5 years, CT results displayed that there was no rejective reaction observed in this study. The edgeof the allograft was inosculated with connective lamina of vertebra, and the shape of lumber spinal was good.CONCLUSION: Allogeneic freeze-drying radiation sterilization bone sheet is an ideal dressing material for epidural laminoplasty. The imaging results of patients in postoperative 1.5-year follow-up indicate that it can effectively reduce the post-laminectomy adhesion formation and prevent recurrence of post-laminectomy spinal restenosis, so as to apply on the segmental vertebral plate dressing.

Objective:To study the application and clinical significance of autotransfusion hemodilution inlaryngectomy. Method:Autotransfusion hemodilution was adopted in 30 patients with Ⅲ or Ⅳ stage laryngealcarcinoma during operation as the experimental group, and the blood transfusion only was adopted in the patientswith excessively blood loss. The other 30 patients with the same stages of disease and the same kinds ofoperation were performed as the control group, without autotransfusion hemodilution and the blood transfusionwas adopted if necessary. Result: Blood transfusion was necessary to be performed only in 8 patients of theexperimental group, on the contrary,it was necessary in 19 of 30 patients of the control group (P＜0.01).There were no complications during the operations , and the postoperative complications were no significance (P＞0. 05) between two groups. Conclusion:The application of autotransfusion hemodilution may be of help to aplenty of patients with laryngeal carcinoma in advanced stage to keep off the blood transfusion duringlaryngectomy.