Impact of Coronary Plaque on the Precision of Computational Fractional Flow Reserve Derived from CTA / 中山大学学报(医学科学版)

ObjectiveThe fractional flow reserve （FFR） computed from coronary computed tomographic （CT） angiograms makes it possible to noninvasively assess coronary artery disease， but the impact of plaque on FFR derived from computed tomography angiography （CTA） is still unknown. The study used invasive FFR as the reference standard to analyze the impact of plaque on coronary computed tomography angiography （CCTA）-based quantitative flow ratio （CT-QFR）. MethodsThe retrospective study included 108 patients with suspected coronary heart disease （CHD） who underwent both CCTA and FFR within 60 days. CCTA images were analyzed by the software. We obtained the CT-QFR of target vessels， perfomed the quantitative and qualitative analyses on target vascular plaques， including total plaque volume （TPV）， plaque burden， calcified plaque volume （CPV）， fibrous plaque volume （FPV）， lipid plaque volume （LPV）， and the presence or absence of high-risk plaque. ResultsAccording to the difference between CT-QFR and FFR at blood vessel level， 137 target vessels of 108 patients were divided into the overestimated group （difference＞0.03， n＝29）， reference group （-0.03≤difference≤0.03， n＝88） and underestimated group （difference＜-0.03， n＝20）. The underestimated group （14.81mm3） presented higher LPV than overestimated group （1.97mm3， P < 0.05）. There was a negative correlation between LPV and the difference （P＜0.05）. ConclusionsWhen CT-QFR is used to estimate hemodynamics of coronary artery stenosis， the presence of lipid plaque may underestimate the virtual FFR.

Hemorrhagic Pulmonary Sheath Due to Ruptured Acute Stanford A Aortic Dissection:Incidence,CT Appearance and Consequences / 中山大学学报(医学科学版)

[Objective]To retrospectively investigate the incidence,computed tomography(CT)manifestations and consequences of hemorrhagic pulmonary sheath(HPS)in Stanford A aortic dissection(AD)patients.[Methods]Institu-tional review board approval and informed consents were obtained.CT aortic angiography images of 188 consecutive acute Stanford A aortic dissection patients(mean age,59 years;range:29-78 years;136 males,52 females)were reviewed. CT images were interpreted by two independent radiologists.Clinical records were reviewed for outcomes of patients up to 30 days after the initial CT scan.[Results]18(9.6%)out of 188 patients had HPS.Right pulmonary artery was involved in 9(50%),left pulmonary artery in 2(11.1%)and both in 7(38.9%)of the 18 patients respectively.HPS extending along bronchovascular sheaths(TypeⅡ)was identified in 9(50%)of 18 patients,and 7(77.8%)of them had alveolar opacity around the thickened bronchovascular sheath. Within 30 days of follow-up,61.1%(11/18)patients died and 38.9%(7/18)patients survived with absorption of HPS.TypeⅡHPS was more prevalent in death group(7/11,63.6%) than survival group(2/7,28.6%),but not statistically significant(P=0.335).Patients in death group were more likely to have abdominal visceral arteries involvement(7/11,63.6%)than patients in survival group(0/7,0%)(P=0.010).[Conclusion]HPS was not a rare complication in patients with Stanford A AD.Abdominal visceral arteries involvement in-dicated poor short-term outcome in this study.

Contour-based Registration for Left Ventricular Myocardial Extracellular Volume Fraction Using T1 Mapping in Healthy Adults / 中山大学学报(医学科学版)

[Objective]We aimed to evaluate the role of contour-based registration in quantification of myocardial extracellular volume fraction(ECV)based on T1 mapping technique.[Methods]T1 mapping images of the basal,mid-cavity and apical short axis slices of 26 healthy volunteers(16 males and 10 females)were obtained before and after administration of contrast agent using Modified Look-Locker Inversion Recovery(MOLLI)on a 3.0T Magnetic Resonance Imaging system.ECV was calculated by routine method and registered method.For each slice,subjects were divided into the deformation subgroup and the control subgroup.Routine ECVs and registered ECVs were compared for each subgroup.[Results]Left ventricular deformation among T1 mapping images occurred in 16 subjects(61.5%). In all three slices, registered ECV maps had better image quality and more highest grade images than routine ECV maps. Routine ECVs[(26.81 ± 2.78)%,(25.38 ± 3.05)%,(28.66 ± 4.10)%]were statistically different from registered ECVs in global [(25.75±2.42)%,P=0.001],mid-cavity[(24.30±2.45)%,P=0.016]and apical slices[(27.22±3.38)%,P=0.010]. In deformation subgroups of all the 3 slices,registered ECVs were lower than routine ECVs with smaller SDs(P=0.038, 0.012,0.016).The apical ECVs were higher with larger SDs than the other two slices and the global ECVs(routine:F=4.799,P=0.004;registered:F=4.822,P=0.003).[Conclusions]Contour-based registration can improve the image qual-ity and precision of ECV quantification in cases with ventricular shape deformation among source images.

External fixation versus open reduction and internal fixation for tibial pilon fractures: A meta-analysis based on observational studies / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Tibial pilon fractures remain challenging for an orthopaedic surgeon to repair. External fixation (ExFix) and open reduction and internal fixation (ORIF) are two widely used methods for repairing tibial pilon fractures. However, conclusions of comparative studies regarding which method is superior are controversial. Our aim is to compare ORIF and ExFix and clarify which method is better in terms of reduction and union results and major complications.</p><p><b>METHODS</b>A computerized research of MEDLINE, EMBASE, Springer, and Cochrane Library (before December 2014) for studies of any design comparing ORIF and ExFix was conducted. Weighted mean difference (WMD), risk ratio (RR) and corresponding 95% confidence intervals (CI) were used for esti- mating the effects of the two methods. Statistical analyses were done using Review Manager Version 5.2.</p><p><b>RESULTS</b>Ten cohort studies and one randomized clinical trial were included in our ultimate analysis. And the analysis found no significant difference between the two methods in deep infection (p = 0.13), reduction (p = 0.11), clinical evaluation (p = 0.82), post-traumatic arthrosis (p = 0.87), and union time (p = 0.35). Besides, ExFix group was found to have a higher rate of superficial infection (p =0.001), malunion (p = 0.01) and nonunion (p = 0.02), but have a lower risk of unplanned hardware removal (p = 0.0002).</p><p><b>CONCLUSIONS</b>We suggest that ORIF has a relatively lower incidence rate of superficial infection, malunion and nonunion, but a higher rate of unplanned hardware removal. No difference was found in deep infection, reduction, clinical evaluation, post-traumatic arthrosis and union time.</p>

Advance on genetic mechanism of adolescent idiopathic scoliosis and genetic relationship map / 中国骨伤

Identification of genetic risk factors is the hotspot of adolescent idiopathic scoliosis (AIS). Through candidate gene approach and genome-wide association studies (GWAS), some genes were preliminary identified. To review AIS related genes,and construct the gene network map of AIS gene. We searched on NCBI PubMed and Web of Science database using search terms "adolescent idiopathic scoliosis" and "gene", to classify induction genes. We then constructed gene diagram using string-db. We found 35 AIS genes relating to connective tissue, nervous system active substances, melatonin synthesis and metabolism, puberty and growth, and genes whose function is unknown. Gene diagram shows that a network relationship between gene and other genes,in which IL6, ESR1, ESR2, VDR, TGFB1, IGF1 gene may as the key gene about AIS' genetic mechanism. Two sites of 3 GWAS results outside the network, it is suggesting new pathway that need to be explored. The study about AIS susceptibility gene is still preliminary, requiring in-depth research to identify the new networks.

Numerical simulation study on effects of ambient temperature on airflow in the nasal cavity / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the aerodynamics of the normal human nasal cavity under different ambient temperatures.</p><p><b>METHODS</b>Based on CT scanning, a model of a healthy adult's nasal cavity was established using computational fluid dynamics software from Fluent. Airflow in this model was simulated and calculated at ambient temperatures of 0 °C, 24 °C, and 37 °C during periodic breathing.</p><p><b>RESULTS</b>Ambient temperature only had an impact on the temperature in the nasal cavity during the inspiratory phase, and the temperature distribution was not symmetrical in the inspiratory acceleration and deceleration phases. The ambient temperature significantly affected airflow speed in main nasal passages during the inspiratory process, but had little impact on flow status (proportion and streamline of airflow in different nasal passages). Temperature differences increased the irregular air movement within sinuses. The anterior nasal segment, including the area between the valve and the head of the middle turbinate, was the most effective part of the nasal airway in heating the ambient air.</p><p><b>CONCLUSIONS</b>Our findings describe the effects of ambient temperature on airflow parameters in the nasal cavity within a single respiratory cycle. This data is more comprehensively and accurately to determine the relationship between nasal cavity aerodynamics and physiological functions.</p>

A comparative study on numerical simulation of the normal nasal airflow during periodic breathing and steady-state breathing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the characteristics of normal nasal airflow during periodic breathing and steady-state breathing.</p><p><b>METHODS</b>Fluent software was used to simulate the nasal cavity and paranasal sinus structures following CT scanning of a normal adult subject. Air flow velocity, pressure, distribution and streamlines were calculated and compared during periodic breathing and steady-state breathing.</p><p><b>RESULTS</b>The same flux, the performance of nasal airflow on 15.600 s of periodic breathing and steady-state expiratory (entrance flow was 697.25 ml/s) were as follows: air flow in the common and middle meatus accounted for more than 50% and 30% of total nasal cavity flow during two respiratory status. Flow velocity and pressure of nasal cavity and each paranasal sinus were extremely similar. The flow trace during two respiratory status in the inferior and lower part of the common meatus were predominately straight in form.Flow were parabolic in the middle and superior meatus and the middle and upper parts of the common meatus. The flow trace of nasal airflow on 16.495 s of periodic breathing had wide areas vortex in nasopharynx and limen nasi, the average speed was 0.0706 m/s, while the entrance flow 7.62 ml/s stable state of the left nasal expiratory, the average speed was 0.0415 m/s, the flow trace was similar to 697.25 ml/s.</p><p><b>CONCLUSION</b>The same flow, except in the junction of the respiratory cycle, the performance of normal nasal airflow during periodic breathing and steady-state breathing were similar.</p>

Effective analysis of the posterior vertebral pedicle screw fixation, vertebral body removal, decompression and titanium mesh reconstruction for the treatment of the lower lumbar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the effect of the treatment of the lower lumbar fractures by posterior vertebral pedicle screw fixation, vertebral canal decompression,bone graft and titanium mesh reconstruction.</p><p><b>METHODS</b>From January 2006 to December 2008, 22 patients with lower lumbar fractures were treated by posterior vertebral pedicle screw fixation, vertebral canal decompression, bone graft and titanium mesh reconstruction at same period. There were 18 males and 4 females with an average age of 43.8 years ranging from 22 to 63 years old. The injured vertebrae were L3 in 11 cases, L4, in 8 cases, and L5 in 3 cases. The operative time, blood loss, the preoperative and postoperative vertebral height,sagittal index, and the lumbar lordosis angle were recorded and evaluated.</p><p><b>RESULTS</b>The operative time was 3 to 4.2 hours (means 3.6 h). The blood loss averaged 1300 ml (900 to 1500 ml). The preoperative and postoperative sagittal index were (57.5 +/- 7.6)% and (93.5 +/- 8.1)%, respectively. The preoperative and postoperative lumbar lordosis angle were (34.3 +/- 7.3) degrees and (38.5 +/- 9.8) degrees, respectively. All patients were followed up for 10 months to 3 years (means 2.6 years). No fixation were failed,the segment of titanium mesh reconstruction obtained bone healing, no pseudoarticulation formation. At the last time of followed-up, 15 patients with nerve injuries were evaluated according to Frankel grade, there were 10 cases in grade E, 4 in D, 1 in C. According to the low back outcome scores (LBOS), the results were excellent in 20 cases, good in 1, fair in 1.</p><p><b>CONCLUSION</b>The stability of the lower lumbar spine can be reconstructed by bone graft and titanium mesh combined with transpedicular screw fixation through a posterior approach. The decompression and vertebral body removal can also be performed in this approach. The recovery of the vertebral height and lumbar lordosis can prevent the delayed neurological deficit and traumatic kyphosis.</p>

Anatomic research on the transposition of accessory nerve to phrenic nerve / 中华外科杂志

<p><b>OBJECTIVE</b>To comprehend the anatomic characteristics and correlations between the accessory nerve and the phrenic nerve in the adult corpses.</p><p><b>METHODS</b>The bilateral accessory nerves, phrenic nerves, and their branches of 20 adult corpses (38 sides) were underwent exposure. The morphologic data of the accessory nerves and the phrenic nerves above clavicle were measured. In addition, the minimal and maximal distances from several points on the accessory nerve to the full length of the phrenic nerve above clavicle were measured. Then, the number of motor nerve fibers on different locations of the nerves utilizing the method of immunohistochemistry were counted and compared.</p><p><b>RESULT</b>The accessory nerves after sending out the sternocleido-mastoid muscular branches were similar in the morphologic data with the phrenic nerves. Meanwhile, the accessory nerve had a coiled appearance within this geometrical area. The possibly minimal distance between the accessory nerve and phrenic nerve was (3.19 ± 1.23) cm, and the possibly maximal distance between the starting point of accessory nerve and the end of the phrenic nerve above clavicle was (8.71 ± 0.75) cm.</p><p><b>CONCLUSIONS</b>The accessory nerve and the phrenic nerve are similar in the anatomic evidences and the number of motor nerve fibers. And the length of accessory nerve is sufficiently long to connect with phrenic nerve as needed. It is possible to suture them without strain directly.</p>

The clinical features and surgical treatment strategies of cervical kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis.</p><p><b>METHODS</b>From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed.</p><p><b>RESULTS</b>In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms.</p><p><b>CONCLUSIONS</b>In the early period of cervical kyphosis, adopt postural therapy, plaster braces to correct an imbalance in cervical spine biomechanics can prevent deformity development. According to patients' clinical characteristics, choosing individual treatment programs can correct the severe cervical kyphosis and achieve good outcome.</p>

The surgical treatment of severe adolescent idiopathic cervical kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics of severe adolescent idiopathic cervical kyphosis and the operation method.</p><p><b>METHODS</b>A retrospective study was performed in 12 adolescent patients with severe cervical kyphosis treated from July 2003 to January 2007. Preoperative the Cobb angle of kyphosis range from 55 degrees to 73 degrees (average 61 degrees ). According to the angles between the posterior vertebral body tangents at every involved level on lateral cervical radiograph in extension, the osteotomy angles and range of lamina and facet were decided. The anterior release and posterior osteotomy were performed firstly. Then skull traction was maintained in order to correct the deformity as long as possible, fusion and internal fixation was completed after 7-10 days. The cervical coronal and sagittal planes X-rays and the MR were hold after operation 3 days, 3 months, 6 months, 1 year and 2 years. At the same time the treatment result, bone fusion and the instrumentation were followed up, and the symptoms were compared between pre-operation and post-operation.</p><p><b>RESULTS</b>The defect appearance of the patients was improved significantly, with the total disappearance of neck pain and improvement of nerve function. Post-operational cervical spine MR showed that the physiological curve of cervical spine was restored, cerebral spinal fluid line was clear in the kyphosis area and no spinal cord compression was found. X-ray imaging of post-operation 3 d showed that Cobb angle ranged from -12.3 degrees to 11.2 degrees with an average of -2.0 degrees . Beside one patient's AISA score was D, other patient's AISA score was E.</p><p><b>CONCLUSIONS</b>The severe adolescent idiopathic cervical kyphosis has its own clinical manifestation. It is an ideal treatment to completely assess the deformity, have staging operation and skull traction between two operations.</p>

Clinical research of delayed hyperextension injury concomitance spinal cord injury of cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss Clinic feature and turnover of delayed hyperextension injury concomitance spinal cord injury of cervical spine.</p><p><b>METHODS</b>The clinic data of 30 patients delayed hyperextension injury of cervical spine were reviewed and analyzed. Course of disease was from 3 months to 8 years. Thirty patients were divided into three groups according to course of disease. The first group, 3 - 6 months, 17 cases; the second group, 6 - 12 months, 8 cases; the third group, 12 months-8 years, 5 cases. Neurological function improvement rates were evaluated according to the JOA scores at preoperative, 3 months and 1 year post operation, and complications were observed in three groups. Twenty-six cases were treated with anterior decompression, bone graft and plate fixation. Four cases were treated with posterior decompression, bone graft and plate fixation.</p><p><b>RESULTS</b>The patient number of the three group exist with statistical significance. Thirty patients were followed up for 18 - 39 months, 23 months on average. Neurological function recovery rates were 23.8% in the first group, 53.9% in the second group and 54.3% in the third group at 1 year post operation. JOA scores of the first group and the second group with statistical significance at 3 months and 1 year post operation. JOA scores of the first group and the third group with statistical significance at 3 months and 1 year post operation. JOA scores of the second group and the third group without statistical significance at 3 months and 1 year post operation.</p><p><b>CONCLUSIONS</b>Incidence of hyperextension injury associated with spinal cord injury of cervical spine would degrade along with course of disease prolong. If delayed spinal cord injury occurred earlier, the patient's condition was severer and badly improvement rate.</p>

Sagittal diameters measurements on MR of the cervical spinal cord in normal subjects / 中华外科杂志

<p><b>OBJECTIVE</b>To offer normal reference of diameter of the cervical spinal cord and available diameter of cervical spinal canal and to screen scientific radiographic criteria to define and quantify cervical spinal cord disease.</p><p><b>METHODS</b>The magnetic resonance images of 120 normal people had been measured. The data of diameters of cervical spinal cord, CSF, M, the ratio of diameters of cord and CSF, and the ratio of diameters of cord and M had been collected and statistical analysis was made. And the relationships between the data above and each of gender, the length of C-spine and age were evaluated. In addition, the ratio of diameters of cord and CSF, and the ratio of diameters of cord and M was evaluated.</p><p><b>RESULTS</b>The study showed that in healthy people, the diameters of cervical spinal cord, CSF and M was larger in the males than in the females, decreased with age, and increased with the length of C-spine but the diameter of CSF. And the ratio of diameters of cord and CSF increased with age and not affected by the length of C-spine. However, the ratio of diameters of cord and M was not affected by age and the length of C-spine.</p><p><b>CONCLUSION</b>The ratio of diameters of cord and M is not affected by individual variation and can be used to evaluate cervical spinal cord atrophy, compression and impaired in patients with cervical myelopathy and can be important information in looking for clinically critical points.</p>

Surgical strategy for severe cervical spine dislocations / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the rate of open reduction and surgical strategy of severe cervical dislocation.</p><p><b>METHODS</b>From March 2001 to March 2006, the data of 92 cases of cervical dislocation over 1/2 were retrospectively studied. Garden Well traction with 1 - 3 kg weight were performed before operation. The patients were performed with diskectomy and reduction with anterior approach initially, for those that can not be reduced, corpectomy were performed and reduction procedures were repeated. The posterior reduction and fixation were followed when reduction can not be reached with anterior approach only. The succeed rate of reduction, rate of tracheotomy were recorded and fusion rate, Frankel score and visual analog scale (VAS) were evaluated.</p><p><b>RESULTS</b>Reduction succeed in 38 cases after diskectomy, 44 after corpectomy and 7 after combined anterior-posterior-anterior procedure. Three cases got incompleteness reduction. Tracheotomy was done in 29 cases. The Frankel score increased 0.5 degree and VAS was 2 averagely at the last follow-up.</p><p><b>CONCLUSIONS</b>The succeed rate of anterior open reduction was 89.2%, and only 10.8% patients needs an additional combined posterior and anterior approach. For patients with completed spinal cord injury with dislocation above C(4), or with dislocation below C(5) but the edema on MRI T2 image are above C(4) level need tracheotomy. The operation be done until respiratory function stable. For patients with completed spinal cord injury with dislocation below C(4) and uncompleted spinal cord injury with dislocation above C(4), the rate of tracheotomy is relatively lower and early operation is recommended.</p>

Change of motor evoked potential of the diaphragm after graded upper cervical spinal cord injury in rats / 中华外科杂志

<p><b>OBJECTIVE</b>To study the change of motor evoked potential of the diaphragm after graded upper cervical cord injuries and analyze the prognosis of the respiratory function after upper cervical cord injuries by MEP.</p><p><b>METHODS</b>The C(3, 4) spinal cord of 40 SD rats were injured with modified Allen method by weight drop force of 30 gcf, 50 gcf, 80 gcf, 100 gcf. The change of latent and amplitude of MEP of the diaphragm was observed before and after the spinal cord injuries (followed up for 1 month). At the same time, the femoral arterial blood of 0.2 ml was drawn. The pH value, the partial pressure of oxygen, the partial pressure of carbon dioxide, and the saturation of the blood oxygen were monitored. The change of the respiratory function was evaluated in the rats after cervical cord injuries. The relationship between the recovery of the respiratory function and the latent or amplitude was analyzed.</p><p><b>RESULTS</b>The MEP wave of the diaphragm was stable before the upper cervical spinal cord injury in the rats. It was usually composed of a positive and negative wave. The latent period and peak-peak amplitude of wave were (3.13 +/- 0.29) ms and (6.78 +/- 3.48) mv. The latent period of the diaphragms MEP in rats change with graded upper cervical cord injuries significantly, the more sever the injury, the longer the latent period. There were obvious relationship between the change of the latent period and the recovery of the respiratory function. When the latent period prolonged 101%, the respiratory function is hardly to recovery.</p><p><b>CONCLUSIONS</b>MEP can objectively and sensitively reflect the injury extent of the respiratory function when upper cervical cord is injured. It would be a reliable index to evaluate the long-term prognosis of respiratory function.</p>

Diagnosis and treatment for the injury of cervical disc and longitudinal ligament / 中华外科杂志

<p><b>OBJECTIVES</b>To study the diagnosis and treatment for the injury of cervical disc and longitudinal ligament.</p><p><b>METHODS</b>From 2001 to 2005, the clinical data of sixty-three patients with cervical disc and longitudinal ligament injury were studied. Early treatment was done based on spinal cord injuries and spinal stabilities by X rays and MRI. Early operation was done in fifty-four cases and early non-operation in nine cases.</p><p><b>RESULTS</b>The follow-up time was six to forty-one months in all patients. The neurological recovery was found in two of eight complete SCI post-operation, thirty-one in thirty-nine incomplete SCI. Cervical collar or plaster orthotic were used in nine cases with four to six weeks. Evidence of instability was noted in four patients, who were operated with anterior decompression fusion. Neck chronic pain was found in two patients, anterior decompression and fusion was done in one with cervical spinal cord compression.</p><p><b>CONCLUSIONS</b>MRI examination is the most value measure for the diagnosis of cervical disc and longitudinal ligament injury. Early anterior decompression and fusion was an important approach for cervical disc and longitudinal ligament injury.</p>

Association study of sleep apnea syndrome and polymorphisms in the serotonin transporter gene / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify polymorphisms of the serotonin transporter(5-HTT) gene and to find out whether there was relationship between any such polymorphisms and sleep apnea syndrome (SAS).</p><p><b>METHODS</b>For two polymorphisms of 5-HTT target DNA gene was amplified using polymerase chain reaction (PCR) and 6% non-denaturing polyacrylamide gels electrophoresis. The frequencies of the different forms of the genotypes and alleles of 5-HTT gene were analyzed in 104 patients with SAS and 150 healthy controls.</p><p><b>RESULTS</b>The frequencies of the S or L alleles and the S/S, S/L or L/L genotypes in promoter region of 5-HTT gene in SAS group were not significantly different to those in healthy controls (P > 0.05). However, the frequencies of 10/10, 12/10 genotypes of 5-HTT-VNTR in SAS patients were significantly higher than those in healthy control subjects (P < 0.05). Moreover, the frequency of the allele 10 of 5-HTT-VNTR in SAS patients was significantly higher than that in healthy controls (P<0.01).</p><p><b>CONCLUSION</b>The allele 10 of 5-HTT-VNTR might be a susceptible factor in the pathogenesis of SAS.</p>

Key points about atlanto-axial internal-fixation and fusion using Gallie's technique / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical problems about posterior atlanto-axial internal-fixation and fusion for atlanto-axial instability or dislocation.</p><p><b>METHODS</b>Surgical treatments of 138 cases with atlanto-axial instability or dislocation were reviewed. There were 62 cases of odentoid malformation, 54 cases of odentoid fracture or rupture of transverse ligament, 22 cases of subluxation and rotation. All cases were treated using Gallie's technique. Six cases were also fixed with transarticular screws, and protected with Philadelphia collar. Other patients were fixed with plaster paris brackets. The followed-up period was 1 to 12 years with an average of 3 year and 5 months.</p><p><b>RESULTS</b>According to Sumi's criteria, excellent 70 cases (50.7%), good 40 cases (29.0%), fair 15 cases (10.9%), poor 13 cases (9.4%). 9 cases with bone graft postponed fusion were cured by enhance external-fixation. 2 cases with nonunion were treated with revision surgery. Complication of cord injury happened in 1 case.</p><p><b>CONCLUSION</b>Gallie's fusion technique is an effective method to manage the atlanto-axial instability or dislocation. Skull distraction before operation and reliable external-fixation post operative are important assistant measures. Key points for successful operation are careful wiring or cable traversing, decortication of posterior arc of C1, and maintaining the physiological height between C1 and C2 posterior arc. Indications and objectives should be conformed before revision surgery for failure cases.</p>

Diagnosis and surgical management of Hangman's fracture combined with intervertebral disc injury / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathology characteristics and management of Hangman's fracture combined with intervertebral disc injury.</p><p><b>METHODS</b>Twenty-one patients suffered from this special injury were converged in this study. All patients underwent anterior C(2 - 3) discectomy and fusion, 18 cases were fixed by anterior cervical plate. The type of fractures, radiology characteristics, and clinical outcomes were investigated.</p><p><b>RESULTS</b>No graft displacement or absorption, infection and neurologic deterioration occurred. All fresh dislocation of axis and C(2 - 3) angulation were corrected. Fusion of C(2 - 3) intervertebral space and pedicle fracture were acquired in all of the patients. After a mean follow-up of 31 months, ranging from 8 to 48 months, nearly all of the complains disappeared after operation.</p><p><b>CONCLUSIONS</b>Hangman's fracture is not restricted at pedicle of the axis. Fracture combined with intervertebral disc injury is a special type of Hangman's fracture. Anterior discectomy and fusion of C(2 - 3) intervertebral disc is an effective operation method in accord with the pathophysiology of this special injury.</p>

An experimental study of motor evoked potentials of the diaphragm elicited by transcranial electric stimulation / 中华物理医学与康复杂志

Objective To study the characteristics of the transcranial electric stimulation(TES)-elicited motor evoked potentials(MEP)recorded from different points of the diaphragm,and to determine the optimal record- ing site in the diaphragm.Methods One EEG electrode was placed subcutaneously in the midline of the skull as stimulation electrode and another EEG electrode was inserted into hard palate submucously as cathode in 30 male rats.And single square wave electrical pulse was used for stimulation.The stimulation intensity was 15 mA,the du- ration of the pulse was 0.2 ms,and the stimulating interval was 200 ms.The concentric needle electrode were insert- ed into the following eight sites:the medial,intermediate,lateral crura of the diaphragm,the junction of the posterior axilla line and the inferior border of the eleventh rib,the junction of the anterior axilla line and the inferior border of the ninth rib,the junction of the intermediate line of the clavicle and the inferior border of the eighth rib,the junction of the para-sternal line and the inferior border of the seventh rib,the pars sternalis.The MEP was recorded from each point,respectively.The optimal sites of the diaphragm MEP were found and recorded.Results The MEPs were re- corded from each of the 8 sites of the diaphragm in all the rats after TES.There was no statistically significant differ- ence among the latencies of every site.But the amplitude varied from 6.08?0.46 mV in maximum along the inferior border of the ninth rib at the anterior line of the axilla to the minimum of O.91?0.03 mV at the pars sternalis. Conclusion It is safer to insert the needle along the inferior border of the ninth rib at the anterior line of the axilla, because there was certain distant from the folding part of the pleura and the amplitude of the recorded wave at this point is maximal.