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1.
Article in Chinese | WPRIM | ID: wpr-1036316

ABSTRACT

Objective To investigate the feasibility of developing a grading diagnostic model for schistosomiasis-induced liver fibrosis based on B-mode ultrasonographic images and clinical laboratory indicators. Methods Ultrasound images and clinical laboratory testing data were captured from schistosomiasis patients admitted to the Second People’s Hospital of Duchang County, Jiangxi Province from 2018 to 2022. Patients with grade I schistosomiasis-induced liver fibrosis were enrolled in Group 1, and patients with grade II and III schistosomiasis-induced liver fibrosis were enrolled in Group 2. The machine learning binary classification tasks were created based on patients’radiomics and clinical laboratory data from 2018 to 2021 as the training set, and patients’radiomics and clinical laboratory data in 2022 as the validation set. The features of ultrasonographic images were labeled with the ITK-SNAP software, and the features of ultrasonographic images were extracted using the Python 3.7 package and PyRadiomics toolkit. The difference in the features of ultrasonographic images was compared between groups with t test or Mann-Whitney U test, and the key imaging features were selected with the least absolute shrinkage and selection operator (LASSO) regression algorithm. Four machine learning models were created using the Scikit-learn repository, including the support vector machine (SVM), random forest (RF), linear regression (LR) and extreme gradient boosting (XGBoost). The optimal machine learning model was screened with the receiver operating characteristic curve (ROC), and features with the greatest contributions to the differentiation features of ultrasound images in machine learning models with the SHapley Additive exPlanations (SHAP) method. Results The ultrasonographic imaging data and clinical laboratory testing data from 491 schistosomiasis patients from 2019 to 2022 were included in the study, and a total of 851 radiomics features and 54 clinical laboratory indicators were captured. Following statistical tests (t = −5.98 to 4.80, U = 6 550 to 20 994, all P values < 0.05) and screening of key features with LASSO regression, 44 features or indicators were included for the subsequent modeling. The areas under ROC curve (AUCs) were 0.763 and 0.611 for the training and validation sets of the SVM model based on clinical laboratory indicators, 0.951 and 0.892 for the training and validation sets of the SVM model based on radiomics, and 0.960 and 0.913 for the training and validation sets of the multimodal SVM model. The 10 greatest contributing features or indicators in machine learning models included 2 clinical laboratory indicators and 8 radiomics features. Conclusions The multimodal machine learning models created based on ultrasound-based radiomics and clinical laboratory indicators are feasible for intelligent identification of schistosomiasis-induced liver fibrosis, and are effective to improve the classification effect of one-class data models.

2.
Article in Chinese | WPRIM | ID: wpr-973695

ABSTRACT

Objective To develop an intelligent recognition model based on deep learning algorithms of unmanned aerial vehicle (UAV) images, and to preliminarily explore the value of this model for remote identification, monitoring and management of cattle, a source of Schistosoma japonicum infection. Methods Oncomelania hupensis snail-infested marshlands around the Poyang Lake area were selected as the study area. Image datasets of the study area were captured by aerial photography with UAV and subjected to augmentation. Cattle in the sample database were annotated with the annotation software VGG Image Annotator to create the morphological recognition labels for cattle. A model was created for intelligent recognition of livestock based on deep learning-based Mask R-convolutional neural network (CNN) algorithms. The performance of the model for cattle recognition was evaluated with accuracy, precision, recall, F1 score and mean precision. Results A total of 200 original UAV images were obtained, and 410 images were yielded following data augmentation. A total of 2 860 training samples of cattle recognition were labeled. The created deep learning-based Mask R-CNN model converged following 200 iterations, with an accuracy of 88.01%, precision of 92.33%, recall of 94.06%, F1 score of 93.19%, and mean precision of 92.27%, and the model was effective to detect and segment the morphological features of cattle. Conclusion The deep learning-based Mask R-CNN model is highly accurate for recognition of cattle based on UAV images, which is feasible for remote intelligent recognition, monitoring, and management of the source of S. japonicum infection.

3.
Article in Chinese | WPRIM | ID: wpr-939472

ABSTRACT

Objective: To determine the spatiotemporal distribution of Schistosoma (S.) japonicum infections in humans, livestock, and Oncomelania (O.) hupensis across the endemic foci of China. Methods: Based on multi-stage continuous downscaling of sentinel monitoring, county-based schistosomiasis surveillance data were captured from the national schistosomiasis surveillance sites of China from 2005 to 2019. The data included S. japonicum infections in humans, livestock, and O. hupensis. The spatiotemporal trends for schistosomiasis were detected using a Joinpoint regression model, with a standard deviational ellipse (SDE) tool, which determined the central tendency and dispersion in the spatial distribution of schistosomiasis. Further, more spatiotemporal clusters of S. japonicum infections in humans, livestock, and O. hupensis were evaluated by the Poisson model. Results: The prevalence of S. japonicum human infections decreased from 2.06% to zero based on data of the national schistosomiasis surveillance sites of China from 2005 to 2019, with a reduction from 9.42% to zero for the prevalence of S. japonicum infections in livestock, and from 0.26% to zero for the prevalence of S. japonicum infections in O. hupensis. Analysis using an SDE tool showed that schistosomiasis-affected regions were reduced yearly from 2005 to 2014 in the endemic provinces of Hunan, Hubei, Jiangxi, and Anhui, as well as in the Poyang and Dongting Lake regions. Poisson model revealed 11 clusters of S. japonicum human infections, six clusters of S. japonicum infections in livestock, and nine clusters of S. japonicum infections in O. hupensis. The clusters of human infection were highly consistent with clusters of S. japonicum infections in livestock and O. hupensis. They were in the 5 provinces of Hunan, Hubei, Jiangxi, Anhui, and Jiangsu, as well as along the middle and lower reaches of the Yangtze River. Humans, livestock, and O. hupensis infections with S. japonicum were mainly concentrated in the north of the Hunan Province, south of the Hubei Province, north of the Jiangxi Province, and southwestern portion of Anhui Province. In the 2 mountainous provinces of Sichuan and Yunnan, human, livestock, and O. hupensis infections with S. japonicum were mainly concentrated in the northwestern portion of the Yunnan Province, the Daliangshan area in the south of Sichuan Province, and the hilly regions in the middle of Sichuan Province. Conclusions: A remarkable decline in the disease prevalence of S. japonicum infection was observed in endemic schistosomiasis in China between 2005 and 2019. However, there remains a long-term risk of transmission in local areas, with the highest-risk areas primarily in Poyang Lake and Dongting Lake regions, requiring to focus on vigilance against the rebound of the epidemic. Development of high-sensitivity detection methods and integrating the transmission links such as human and livestock infection, wild animal infection, and O. hupensis into the surveillance-response system will ensure the elimination of schistosomiasis in China by 2030.

4.
Article in Chinese | WPRIM | ID: wpr-951064

ABSTRACT

Objective: To determine the spatiotemporal distribution of Schistosoma (S.) japonicum infections in humans, livestock, and Oncomelania (O.) hupensis across the endemic foci of China. Methods: Based on multi-stage continuous downscaling of sentinel monitoring, county-based schistosomiasis surveillance data were captured from the national schistosomiasis surveillance sites of China from 2005 to 2019. The data included S. japonicum infections in humans, livestock, and O. hupensis. The spatiotemporal trends for schistosomiasis were detected using a Joinpoint regression model, with a standard deviational ellipse (SDE) tool, which determined the central tendency and dispersion in the spatial distribution of schistosomiasis. Further, more spatiotemporal clusters of S. japonicum infections in humans, livestock, and O. hupensis were evaluated by the Poisson model. Results: The prevalence of S. japonicum human infections decreased from 2.06% to zero based on data of the national schistosomiasis surveillance sites of China from 2005 to 2019, with a reduction from 9.42% to zero for the prevalence of S. japonicum infections in livestock, and from 0.26% to zero for the prevalence of S. japonicum infections in O. hupensis. Analysis using an SDE tool showed that schistosomiasis-affected regions were reduced yearly from 2005 to 2014 in the endemic provinces of Hunan, Hubei, Jiangxi, and Anhui, as well as in the Poyang and Dongting Lake regions. Poisson model revealed 11 clusters of S. japonicum human infections, six clusters of S. japonicum infections in livestock, and nine clusters of S. japonicum infections in O. hupensis. The clusters of human infection were highly consistent with clusters of S. japonicum infections in livestock and O. hupensis. They were in the 5 provinces of Hunan, Hubei, Jiangxi, Anhui, and Jiangsu, as well as along the middle and lower reaches of the Yangtze River. Humans, livestock, and O. hupensis infections with S. japonicum were mainly concentrated in the north of the Hunan Province, south of the Hubei Province, north of the Jiangxi Province, and southwestern portion of Anhui Province. In the 2 mountainous provinces of Sichuan and Yunnan, human, livestock, and O. hupensis infections with S. japonicum were mainly concentrated in the northwestern portion of the Yunnan Province, the Daliangshan area in the south of Sichuan Province, and the hilly regions in the middle of Sichuan Province. Conclusions: A remarkable decline in the disease prevalence of S. japonicum infection was observed in endemic schistosomiasis in China between 2005 and 2019. However, there remains a long-term risk of transmission in local areas, with the highest-risk areas primarily in Poyang Lake and Dongting Lake regions, requiring to focus on vigilance against the rebound of the epidemic. Development of high-sensitivity detection methods and integrating the transmission links such as human and livestock infection, wild animal infection, and O. hupensis into the surveillance-response system will ensure the elimination of schistosomiasis in China by 2030.

5.
Journal of Clinical Hepatology ; (12): 2338-2342, 2021.
Article in Chinese | WPRIM | ID: wpr-904894

ABSTRACT

Objective To investigate the mechanism of Fuzheng Huayu(FZHY) decoction in the treatment of liver cancer based on network pharmacology. Methods TCMSP, BATMAN, and Drugbank databases were searched for the main chemical components and corresponding targets of FZHY, and STRING database was used to perform a PPI network analysis. Cytoscape software was used to establish a drug-disease network model and perform a network analysis, and R language was used to perform GO and KEGG enrichment analysis of targets. Results A total of 192 intersection genes between FZHY and liver cancer and 95 potential compounds were screened out, among which quercetin and luteolin were the active components with an important regulatory role. INS, IL-6, and EGFR were the key targets for the potential effect of FZHY. The GO enrichment analysis showed the involvement in various biological processes such as response to drug and response to oxygen level, and the KEGG enrichment analysis showed the involvement in the signaling pathways including apoptosis and tumor necrosis factor signaling pathways. Conclusion Based on the method of network pharmacology, this study reveals the mechanism of action of multiple targets and targets of FZHY in the treatment of liver cancer, which provides a theoretical basis for clinical and basic scientific research.

6.
Journal of Clinical Hepatology ; (12): 2338-2342, 2021.
Article in Chinese | WPRIM | ID: wpr-904944

ABSTRACT

Objective To investigate the mechanism of Fuzheng Huayu(FZHY) decoction in the treatment of liver cancer based on network pharmacology. Methods TCMSP, BATMAN, and Drugbank databases were searched for the main chemical components and corresponding targets of FZHY, and STRING database was used to perform a PPI network analysis. Cytoscape software was used to establish a drug-disease network model and perform a network analysis, and R language was used to perform GO and KEGG enrichment analysis of targets. Results A total of 192 intersection genes between FZHY and liver cancer and 95 potential compounds were screened out, among which quercetin and luteolin were the active components with an important regulatory role. INS, IL-6, and EGFR were the key targets for the potential effect of FZHY. The GO enrichment analysis showed the involvement in various biological processes such as response to drug and response to oxygen level, and the KEGG enrichment analysis showed the involvement in the signaling pathways including apoptosis and tumor necrosis factor signaling pathways. Conclusion Based on the method of network pharmacology, this study reveals the mechanism of action of multiple targets and targets of FZHY in the treatment of liver cancer, which provides a theoretical basis for clinical and basic scientific research.

7.
Journal of Medical Biomechanics ; (6): E047-E056, 2019.
Article in Chinese | WPRIM | ID: wpr-802504

ABSTRACT

Objective To construct a new biomechanical testing system of in vitro spine based on LabVIEW and six-axis robot arm and conduct preliminary reliability studies, so as to make preparation for further studies on coupled motion testing. Methods By programming on LabVIEW platform, using Ethernet and Profibus to communicate the data of the robot arm with PC in real time, the displacement control and load control were realized, and the end position and rotation angle of the robot arm were read in real time. Through the force/torque sensor and data acquisition (DAQ), board DAQ, processing, storage and other functions were acquired. Using the digital micrometer and special stationary fixture, the 6-direction translation accuracy test was completed, and the data were analyzed. The flexion, extension, lateral flexion and rotation were applied on sheep spine specimen to draw the load-displacement curve, analyze and compare the experimental result, and verify the effectiveness of the biomechanical platform. Results A biomechanical test system with high precision for spine in vitro based on LabVIEW and 6-axis robot arm was developed and established, of which the average translational precision was 8.1 μm and the average translational accuracy was 56.7 μm. The program of control, data acquisition, data processing and storage were written, and the biomechanical test of the sheep spine was completed effectively. Conclusions This biomechanical test system based on Labview and 6-axis robot arm could complete the conventional three-dimensional spinal motion test with high precision and be used to conduct coupled motion test research in the next step.

8.
Article in Chinese | WPRIM | ID: wpr-743878

ABSTRACT

BACKGROUND: Zinc, an inorganic antibacterial material, has a suitable degradation rate and good antibacterial property. Adding alloying elements can improve the mechanical properties and biocompatibility of the material, which is the development direction of novel medical biodegradable metal materials. There is still lack a comparable research on the antibacterial properties among zinc-based materials. OBJECTIVE: To investigate the antibacterial properties of pure zine and zinc-based alloys in vivo. METHODS: Eighty Sprague-Dawley rats, SPF grade, were randomized into two groups (n=40/group) , and all rats were injected with Staphylococcus aureus or Escherichia coli solution to prepare infection models. Different materials (Zn, ZnAl, ZnSr, Zn3 Mg, Zn3 Ag, Zn3 Ca and Zn4 Cu; five rats for each material) were implanted into the medullary cavity of femur. The control group without any material was set. At 1, 4, 7 and 14 days after implantation, the changes of body temperature, white blood cell count, serum tumor necrosis factor α and serum zinc content in rats were detected. The secretions and tissues of the surgical site were collected to identify the bacterial species. RESULTS AND CONCLUSION: (1) The body temperature in all the rats was increased to different extents after bacterial infection, but the temperature of the rats implanted with zinc and zinc alloys was always lower than that in the control group at 7 and 14 days (P < 0.05) . The temperature in the Zn3 Ag group was significantly lower than that in the other groups at 7 and 14 days (P < 0.05) . (2) The white blood cell count and tumor necrosis factor α level in the zinc and zinc alloys groups were significantly lower than those in the control group at 7 and 14 days after implantation (P < 0.05) . The white blood cell count and tumor necrosis factor α level in the Zn3 Ag group were significantly lower than those in the other groups (P < 0.05) . (3) The serum zinc content in all groups has no significant difference (P> 0.05) . (4) The bacterial culture results showed S.aureus (+) in the Staphylococcus aureus infection group and E.coli (+) in the Escherichia coli infection group. (5) To conclude, degradable zinc-based alloys exert marked antibacterial effects, and Zn3 Ag alloys have the best antibacterial activity.

9.
Chinese Journal of Orthopaedics ; (12): 361-369, 2018.
Article in Chinese | WPRIM | ID: wpr-708548

ABSTRACT

Objective To evaluate the efficacy of the sleeve type guide growth rod sliding automatically with the growth of piglet spine.Methods Fourteen 4-month-old piglets were randomly divided into growth rod group (n=8) and control group (n=6).Animals in growth rod group were implanted with the sleeve type guide growth rod system through the small incision of the tho racodorsal.Whereas ones in control group were just expose the bilateral lamina.On the day of surgery,6 and 12 weeks of postoperation,all piglets accepted the spinal X-ray examination.Measured the mean height of T8,T9 vertebral bodies,the average height of T7-8,T8-9,Tg-10 discs and the mean length of the rods through X-ray film.Spinal MRI was measured 3 months after the operation.The morphological changes of the plate were observed after HE staining.The morphological changes of the nucleus pulposus cells were observed and the thickness of the growth plate and the length of the growth bar were measured.Results Two piglets of growth rod group did not complete the experiment,1 piglet died of aspiration due to anesthesia resuscitation,and 1 piglet had infection after operation.The average height of T8,T9 vertebral bodies of the piglets in the growth rod group on the day after surgery and 3 months after operation was 18.26±3.26 mm and 27.15±4.18 mm,respectively,and the difference was statistically significant (F=16.868,P=0.002).Similarly,the mean height of T7-8,T8-9,Tg-10 discs of the piglets in growth rod group on the day after surgery and 3 months of postoperation was 1.79±0.24 mm and 2.14±0.23 mm,respectively,and the difference was statistically significant (F=6.455,P=0.029).The average height of T8,T9 vertebral bodies in the control group on the day after surgery and 3 months after operation was 17.86±3.50 mm and 28.63±4.45 mm,respectively,and the difference was statistically significant (F=21.654,P=0.001).Similarly,the mean height of T7-8,Ts-9,Tg-10 discs in control group at the day after surgery and 3 months of postoperation was 1.78±0.27 mm and 2.17±0.30 mm,respectively,the difference was statistically significant (F=5.928,P=0.035).There was no statistically significant difference in average height between T8 and T9 vertebral bodies in growth rod group and the control group at 3 months after operation (F=0.352,P=0.566).Similarly,There was no statistically significant difference in average height of T7-8、Ts-9、Tg-10 discs in growth rod group and the control group at 3 months after operation (F=0.053,P=0.823).The average sliding length of the growth rod in growth rod was 65.74 mm.Furthermore,growth plate chondrocytes and nucleus pulposus cells in EG and SG,all showed that the cells were arranged in order,the cell volume was large,the shape was round and the cytoplasm was rich.Simultaneously,there was no significant difference between the two groups in growth plate chondrocytes (P > 0.05).Conclusion The sleeve type guiding growing rod can automatically slip to extend due to the driving force of young pig's spine growth,without obvious effects on the normal growth of piglet's spine.

10.
Article in Chinese | WPRIM | ID: wpr-618903

ABSTRACT

Objective To report the integrated progress of the hydatid disease information management system,and to pro-vide the reference for further system improvements by analysis of results on simulation test feedback. Methods The work of in-stitutional code matching by collecting fundamental and integrated information of the system in epidemic areas of hydatid disease was carried out,and professional control agencies were selected to carry out the simulation test. Results The results of agen-cies code matching at stage indicated the average completion rate was 94.30% on administrative agencies,69.94% on registered professional agencies and 56.40% on professional institutions matching related to hydatid disease prevention and control imple-ments in seven provinces(autonomous regions)and Xinjiang Production and Construction Corps. Meanwhile,the response rate of open-ended proposals was 93.33% on fifteen feedbacks,and the statistics showed 21.43% believed the system was low fluen-cy,64.29% considered the system was inconvenience for data inputs and 42.86% considered it would be improved on system sta-tistics functions,of which 27.78% were provincial users,22.22% were the city users and 50.00% were the county users. Con-clusion The hydatid disease prevention information management system meets the fundamental needs of the majority agencies in hyperendemic areas of echinococcosis,it needs to develop the further test with more agencies joining after the work of the in-stitutional code matching completion and the system service improvement in the next stage.

11.
Article in Chinese | WPRIM | ID: wpr-618906

ABSTRACT

Objective To understand the spatial distribution characteristics of wild feces in schistosomiasis endemic areas of Jiangling County,Hubei Province and further explore the source of infection efficiently,so as to provide the evidence for the development of corresponding monitoring and response technology. Methods In 2011,the fresh wild feces were investigated every two months in the selected 15 villages by the severity of historical endemic in Jiangling County. The schistosome miracidi-um hatching method was used to test the schistosome infection of the wild feces. The descriptive analysis and spatial analysis were used for the description of the spatial distribution of the wild feces. Results Totally 701 wild feces samples were collected with the average density of 0.0556/100 m2,and the positive rate of the wild feces was 11.70%(82/701). The results of the re-gression analysis showed a positive spatial correlation between the positive rate of wild feces and the rate of human infection,the area with infected Oncomelania hupensis and the number of fenced cattle,and the corrected R2 of the model was 0.58. Conclu-sion The infection rate of wild feces is positively correlated with the rate of human infection,area with infected O. hupensis and number of fenced cattle in space in Jiangling County,so the prevention and control measures could be conducted according to the spatial distribution of the positive wild feces.

12.
Article in Chinese | WPRIM | ID: wpr-605928

ABSTRACT

Objective To investigate the tempo?spatial patterns of schistosomiasis in Jiangling County,Hubei Province,so as to identify the risk areas and provide the scientific evidence in following intervention plans for marshland epidemic areas in the stage of transmission control. Methods The schistosomiasis epidemiological data in Jiangling County from 2009 to 2013 to?gether with the related geographical information were collected and analyzed. The tempo?spatial distribution patterns were ana?lyzed by the spatial autocorrelation analysis and spatial clustering analysis. Results The human infection rate was decreased from 2.15%in 2009 to 0.63%in 2013,which was the historically low level. The results of tempo?spatial analysis showed that there were spatial clustering effects in human schistosomiasis infection for each of the years. The values of spatial autocorrelation index Moran’s I were statistically significant. Eighteen and thirty?five clusters were detected by using SatScan and FlexScan soft?ware,respectively. Conclusions From 2009 to 2013,the schistosomiasis endemic situation in Jiangling County presented a decline trend and reached the historical low level. The identified spatial clustering areas should be targeted as the prioritized ar?eas for schistosomiasis control.

13.
Article in Chinese | WPRIM | ID: wpr-493723

ABSTRACT

Objective To analyze the epidemiological characteristics of the imported malaria cases in 20 counties at the bor?der region of Yunnan Province from 2012 to 2014,so as to provide the evidence?based proof for adjusting the strategies in the elimination stage. Methods The malaria epidemic data of the 20 border counties in Yunnan Province from 2012 to 2014 were collected and analyzed by using Microsoft Excel 2010. Results From 2012 to 2014,a total of 1 558 malaria cases were report?ed in the 20 border counties in Yunnan Province,among which,1 336 were imported cases,accounting for 85.75%(1 336/1 558),and 222 were indigenous cases,accounting for 14.25%(222/1 558). The number of the imported cases in the above years took up 80.00%(544/680),89.10%(425/477)and 91.52%(367/401)of the total reported cases in the whole year,re?spectively. Among all the 1 336 imported cases,1 045(78.22%)were infected with Plasmodium vivax,284(21.26%)were in?fected with P. falciparum,3 were infected with P. malariae,3 were mixed infection and 1 was an unclassified case;2 patients died. And 95.58%of the cases were mainly infected in Myanmar(1 277 cases). Young and middle?aged adult of 20-40 years who worked overseas were the predominant(802 cases,60.03%)and most of the cases occurred from April to June of the year (679 cases,50.82%). Those cases mainly distributed in Tengchong(459 cases),Ruili(366 cases),Yingjiang(191 cases)and Mangshi(78 cases). Conclusions The epidemic situation of imported malaria is serious in the border region of Yunnan Prov?ince. Therefore,the surveillance system of malaria control needs to be well planned and managed to ensure timely case detection and prompt response at the elimination and post?elimination stage.

14.
Chinese Journal of Orthopaedics ; (12): 571-575, 2015.
Article in Chinese | WPRIM | ID: wpr-669893

ABSTRACT

Objective To evaluate the feasibility and efficacy of atlantoaxial fusion by flipping periosteum pedicle occipital outer plate.Methods Between March 2010 and June 2013,27 patients with atlantoaxial instability were treated by atlantoaxial fusion with flipping periosteum pedicle occipital outer plate and combining pedicle screws fixation.There were 16 males and 11 females with the age ranging from 23 to 56 years (with an average of 45.6 years) at time of surgery.There were 12 cases of fresh odontoid fracture with atlantoaxial instability,7 cases of old odontoid fracture combined with uneducable atlantoaxial dislocation,7 cases of congenital loose of odontoid process,and 1 case of rheumatoid arthritis.The visual analog scale (VAS) scores and Frankel grades were respectively used to evaluate the axial neck pain and the neurological deficit,and the results were compared before and after the operation.Bony fusion was observed by the midline sagittal CT scan images.Results All the patients were successfully operated.The operation time was 90 to 140 mins (with an average of 100 mins),and the blood loss was 100 to 600 ml (with an average of 160 ml).All patients were followed up for 18 to 39 months,with an average of 32.6 months.19 cases got solid fusion 3 months after surgery,and 7 cases got solid fusion 6 months after surgery,while 1 case got solid fusion 9 months after surgery.The average VAS score at final follow-up was 2.87± 1.03,which was significantly lower than that preoperatively 7.23± 1.65.Before the operation,nine cases presented spinal nerve function damage.At the final follow up time,7 cases returned to complete normal and 2 cases improved from grade C to grade D according to the Frankel classification.1 case was complicated with veiniplex injury with no heavy blood loss,due to successful hemostasia.Two screws were placed close to the vertebral artery canal,without clinical consequences.Conclusion The flipping periosteum pedicle occipital outer plate as a bone graft is one effective method for atlantoaxial fusion,which got great feasibility and safety.

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