Objective To observe the effects of hydrocortisone on the rate of return of spontaneous circulation(ROSC)and the outcome of patients with cardiac arrest(CA)and cardiopulmonary resuscitation(CPR). Methods A cohort study was conducted,78 non-traumatic patients with CA were divided into hydrocortisone group (31 cases)and control group(47 cases). Conventional treatments were given in the two groups after admission,and additionally intravenous 100 mg hydrocortisone was given to the hydrocortisone group during resuscitation. The ROSC rate and prognosis were compared between the two groups. Multivariate logistic regression analysis was used to predict the impact factor of ROSC. Results The ROSC rate and 24-hour survival rate in the hydrocortisone group were significantly higher than those of the control group(ROSC rate:58.1% vs. 40.4%,24-hour survival rate:48.4%vs. 36.2%,both P<0.05). There were no significant differences between the hydrocortisone and the control groups in duration of CPR〔minute:17.1(6-45)vs. 15.8(7-48)〕,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score in survivors(37.2±8.2 vs. 36.1±8.2),the survival rate(12.9% vs. 12.8%)and hospital discharge rate(6.4%vs. 6.4%)in 7 days. Hydrocortisone〔odds ratio(OR)=3.12,95%confidence interval(95%CI)-1.18-8.29, P=0.017〕and witness(OR=4.24, 95%CI -1.87-12.43,P=0.008) were independent predictors for an increased ROSC rate after multiple logistic regression analysis. Conclusion Giving hydrocortisone during resuscitation may increase ROSC rate in CA patients.

Objective To explore the management of perioperative period on the effect of alimentary tract fistulas after gastric cancer operation.Methods The clinical data of 25 patients with alimentary tract fistulas after gastric cancer operation were reviewed.The location and time of alimentary tract fistulas,and perioperative period of patients were analyzed.Results Of the 25 patients,13 cases(52.0％) were anastomotic fistulas,1 case(4.0％) was bile fistula,2 cases (8.0％) were pancreatic fistulas,4 cases (16.0％) were small intestinal fistulas,and 3 case (12.0％) were duodenal stump fistulas,1 case (4.0％) was anastomotic and duodenal stump fistula,1 case (4.0％) was small intestinal and duodenal stump fistula.The alimentary tract fistulas generally occurred within the first or second week after gastric cancer operation.The incidence rate of gastrointestinal leakage was 64.0％ in gastric cancer with diabetes patients,56.0％ in gastric cancer with elderly patients,40.0％ in gastric cancer with anemia patients,36.0％ in gastric cancer with hypoproteinemia patients,16.0％ in gastric cancer with multivisceral excisions.21 cases of gastrointestinal leakage were healed after conservative treatment.2 cases with gastrointestinal leakage by operation treatment were healed.2 patients died,one died of intra-abdominal hemorrhage,one case died of MODF.Conclusion Strengthening the management of patients with alimentary tract fistulas after gastric cancer operation can promote the healing of fistula in perioperative period.

Objective To investigate the clinical value and effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain. Methods From August 2008 to October 2013 ,96 patients diagnosed as lumbar zygapophysial joint pain were included in the research. 36 patients were treated by spinal nerve medial branch ablation through transforaminal endoscopic ,while 60 patients received conservative treatment. The visual analogue scale (VAS) and Japanese Orthopedics Association(JOA) scores before treatment,1,3,6 and 12 months after treatment were recorded and analyzed. The MacNab scores were recorded and analyzed 12 months after treatment. Results The VAS and JOA scores of surgical treatment group showed significant improvement compared with that before operation (P < 0.05),and there were no significant difference at each time point after surgery. The VAS and JOA scores of conservative treatment group in showed significant improved at 1 months after treatment compared with that before treatment(P<0.05),but there were no significant difference at each time after treatment compared with pretreatment. The VAS and JOA scores of surgical treatment group showed significant improvement compared with conservative treatment group at each time after treatment(P<0.05). The MacNab scores of surgical treatment group(94.44%)was significantly higher than that of conservative treatment group(33.33%). Conclusion The spinal nerve branches ablation under transforaminal endoscopic is an effective and safe minimally invasive spine surgery technique with important clinical value in the treatment of lumbar zygapophysial joint pain.

Objective To observe the expression of transforming growth factor beta(TGF-?)in rats’ spinal cords of acute contusive injury model and try to explore the possible mechanism.Methods 20 Sprague Dawley rats were randomly divided into two groups. Ten rats underwent spinal cord contusive injury opration as the experimental group by using modified Allen’s method (using a weight-drop device) after the T10 spinous process and the corresponding vertebral lamina were removed. The other ten rats received only T10 laminectomy without spinal cord injury as the sham-operated control group. The injured spinal cord in the two groups was taken out respectively at 24h after injury.Results Pathological alterations were detected by H-E staining and the expression of TGF-? was analyzed by immunohistochemistry analyses. From H-E staining, we could see the microstructure of spinal cord was norma1 in sham-operated control group and the pathological alterations were apparent in the injured spinal cord area in the experimental group as a central core lesion which consisted of spared fibers, variable cyst formations, gliosis and scarring with a spare peripheral rim of tissue. We also found TGF-? expression of spinal cord was increased in experimental group when compared with sham-operated control group (P

Objective To investigate changes of surface electromyogr8phic(sEM G)signal of pelvic floor muscles in complete spinal cord injury(cSCI)patients with neurogenic bowel dysfunction.Methods Fifteen hospitalized patients with cSCI(observation group)and fifteen normal subjects(control group)were involved in this study.The root mean square(RMS)of sEMG signals were collected at pelvic floor muscles with rectal surface electrode when subjects'pelvic floor muscles were rest(10 s),fleetly contract(2 s×3),continually contract(10 s).Both groups'data of different contracting states of pelvic floor muscles were analyzed and compared.Results The max RMS and average RMS(16.61±2.83,13.52±2.22)at pelvic floor muscles'rest in observation group were higher than that in control group(8.41±5.55,3.45±1.53).There was statistical difference between two groups(P<0.01).In the subjects of observation group max RMS and average RMS(20.24±13.99,13.36±2.39)at continual contraction and average RMS(13.40±2.31)at fleet contraction were nearly the same as RMS value at pelvic floor muscles'rest.There was no statistical difference between these two states(P>0.05).Conclusion The sEMG could be a quantitative index in assessing function of pelvic floor muscles and the neurogenic bowel dysfunction after cSCI.It can supply some clinical value in framing the training of pelvic floor muscles and improving the bowel dysfunction.

Objective To explore the association of estrogen receptor β expression with different stages and molecular subtypes of invasive breast cancer.Methods The clinicopathologic data of 446 invasive breast cancer cases was retrospectively analyzed.ERβ expression was evaluated by types and stages.Results Of all 446 invasive breast cancer cases,328 (73.5％) were ERβ positive.The ERβ positive rate was 77.9％ (240/308) and 63.8％ (88/138) in ERα + group and ERα-group,respectively.The ERβ expression in breast cancer was positively correlated with ERα (P ＜ 0.01) while it had no correlation with PR,histological grade,HER-2 and Ki-67 (P ＞ 0.05).ERβ expression was not significantly different among different age,tumor size and axillary lymph node groups(all P ＞ 0.05).A total of 418 invasive breast cancer cases were recruited for pathologic stage and NPI analysis,including 168 cases at stage Ⅰ,152 cases at stage Ⅱ and 98 cases at stage Ⅲ.ERβ expression was not significantly different among different stages of breast cancer(P =0.743).Analyzed in these 418 cases,NPI was ＜ 3.4 in 126 cases,3.4-5.4 in 207 cases and ＞ 5.4 in 85 cases.ERβ expression was not significantly different among different NPI group (P =0.644).The ERβ positive rate in Luminal A subtype,Luminal B1 subtype,Luminal B2 subtype,HER-2 subtype and TN subtype was 75.6％ (88/118),75.9％ (110/145),85.2％ (46/54),68.4％ (39/57) and 62.5％ (45/72) respectively.ERβ expression was significantly different between Luminal subtype and non-Luminal subtype (P =0.007).Conclusions ERβ was not differentially expressed among different breast cancer stages and NPI groups.ERβ was differentially expressed in different breast cancer molecular subtypes.

Objective To obtain reasonable treatment by urodynamic detection and analysis in patients with diabetic cystopathy (DCP) complicated with benign prostatic hyperplasia (BPH).Methods Sixty patients with DCP complicated with BPH were selected,among the total 32 patients (duration of diabetes ＞ 12 years,blood glucose control was not ideal) were recognized as experimental group,and 28 patients (duration of diabetes ≤ 8 years,blood glucose control was stable) were recognized as control group.Using the Laborie UDS-120XLT urodynamic detection instrument,the urodynamic was detected and the international prostate symptom score (IPSS) was evaluate,and the results were compared between the 2 groups.Results There was no statistical difference in residual urine volume between experimental group and control group [(146 ±71) ml vs.(160 ±64) ml,P ＞0.05].The maximum urinary flow-rate in experimental group was significantly lower than that in control group [(5.4 ± 2.0) ml/s vs.(8.0 ± 3.2) ml/s],the symptom total score of IPSS was significantly higher than that in control group [(25.8 ± 4.1) scores vs.(22.6 ±5.0) scores],there were statistical differences (P ＜0.01).The maximum bladder capacity,compliance,incipient micturition desire volume in experimental group were significantly lower than those in control group,there were statistical differences (P ＜ 0.01).Conclusions The influence of DCP on the function of the bladder in BPH patients is significant.Urodynamic detection can provide objective basis for the selection of therapeutic methods,suitable to be operated and forecast the postoperative effect.It has an important reference value in DCP complicated with BPH patients.

BACKGROUND: Spleen is correlated with mitochondrion. The "spleen governs movement and transformation of food and liquids" in traditional Chinese medicine refers to not only the digestion and absorption of food in gastrointestinal tract, but also the process of biological oxidation and energy production of mitochondrion.OBJECTIVE: To analyze the effects of Si-Jun-Zi decoction (SJZD), a typical prescription for invigorating spleen and replenishing qi, on repairing the mitochondrial damage of cells of liver, myocardium, gastric mucosa and skeletal muscle in rats with spleen asthenia.DESIGN: A randomized controlled observation.SETTINGS: Second Department of Internal Medicine, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine;Guangzhou University of Traditional Chinese Medicine.MATERIALS: The experiments were carried out in the internal medicine laboratory, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and the testing center of Guangzhou University of Traditional Chinese Medicine from June to December in 2004. Forty SD rats were provided by the animal center of Guangzhou University of Traditional Chinese Medicine. Xiao Cheng-Qi decoction consisted of officinal magnolia bark, immature bitter orange and rhubarb according to the ratio of 3:3:2; SJZD consisted of radix codonopsitis pilosulae, largehead atractylodes rhizome, India bread and liquorice root according to the ratio of 2:2:2:1, and it was provided by the Department of Pharmacy, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,and made into 100% decoction.METHODS: After raised for 1 week, the SD rats were divided randomlyinto 4 groups: normal control group, spleen asthenia group, natural convalescence group and SJZD-treated group, and the rats in the latter three groups were made into models of long-term spleen asthenia. Rats in the normal control group were fed with normal chow, intragastric administered with saline (3 mL), once every other day for 34 weeks. Rats in the spleen asthenia group were intragastricly administered with Xiao Cheng-Qi decoction (3 mL) and fed every other day for 34 weeks, the rats in the natural convalescence group were fed with normal chow for 8 weeks after being treated as those in the spleen asthenia group for 26 weeks, and those in the SJZD-treated group were treated as those in the spleen asthenia group for 26 weeks, and then intragastricly administered with SJZD (4 mL, once a day) and fed with normal chow for 8 weeks. At the end of the 34th week,the rats were decapitated under anesthesia, and the skeletal muscle, liver,gastric mucosa and myocardium were taken out rapidly. The protein amounts in mitochondrial suspension were detected with the biuret method,the content of mitochondria in I g tissue was calculated according to the tissue mass, and the mitochondrial ultrastructures were observed under transmission electron microscope.MAIN OUTCOME MEASURES: The contents and ultrastructures of mitochondria in skeletal muscle, liver, gastric mucosa and myocardium were observed.RESULTS: All the 40 rats were involved in the analysis of results without deletion. ① At the end of the 34th week, the mitochondrial contents of skeletal muscle, liver, myocardium and gastric mucosa were all significantly lower in the spleen asthenia group than in the normal control group (P＜ 0.01), and markedly higher in the natural convalescence group than in the spleen asthenia group (P ＜ 0.05-0.01). The mitochondrial contents of the tissues were the highest in the SJZD-treated group, which were significantly higher than those in the spleen asthenia group and natural convalescence group (P ＜ 0.05-0.01), as well as the normal control group (P＜ 0.01). ② Comparison of mitochondrial ultrastructures in skeletal muscle,liver, gastric mucosa and myocardium at the end of the 34th week: In the spleen asthenia group, the mitochondria of myocardial cells were seriously swollen, the compact substance of hepatocellular mitochondria were decreased or disappeared and the crest disrupted; the mitochondria of skeletal muscle were shrunk and decreased, mitochondrial membranes were disorganized and crest disappeared, mitochondrial membranes were disorganized and crest disappeared; For gastric parietal cell of spleen asthenia,the amount of mitochondria reduced, inner structure confused, mitochondrial crestae of gastric chief cell was broken. In the natural convalescence group, the changes of the mitochondrial morphology were slight. The mitochondrial morphology in the SJZD group was close to those in the normal control group.CONCLUSION: SJZD has the effects of increasing the contents of mitochondria in skeletal muscle, liver, myocardium and gastric mucosa and repairing the damaged structure of mitochondria because of spleen asthenia.

Objective To evaluate the clinical results of self-designed double-pivot extracorporeal reduction device in internal fixation with percutaneous pedicle screws for thoracolumbar fractures.Methods From January 2014 to May 2015,a total of 41 patients with thoracolumbar fracture without neurological symptoms underwent minimally invasive fixation with percutaneous pedicle screws.Of them,22 were treated with our self-designed double-pivot extracorporeal reduction device and the other 20 with common single-pivot extracorporeal reduction device.The 2 groups were compared in terms of pre-and postoperative kyphotic angles,correction rates and anterior,middle and posterior heights of injured vertebrae to evaluate the therapeutic effects of the self-designed double-pivot extracorporeal reduction device.Results The patients were followed up for 6 to 18 months (average,12.3 months).No iatrogenic impairment of nerve root,postoperative infection,or implant failure happened.Compared with preoperation,significant improvements were observed in all the patients regarding cobb's angle,anterior,middle and posterior heights of the fractured vertebral body (P ＜ 0.05).Compared with the single-pivot group,the double-pivot group were significantly superior in the kyphotic angle,correction rate,and anterior and middle heights of the injured vertebrae(P ＜ 0.05),but there was no significant difference between the 2 groups in the recovery of posterior height of the fractured vertebral body (P ＞ 0.05).Conclusion Compared with the single-pivot reduction device,the self-designed double-pivot reduction device may be preferable in percutaneous pedicle screw fixation for thoracolumbar fractures.

Breast cancer is the leading cause of malignancy-related mortality in women worldwide. The more accurate prediction of lymph node metastasis and evaluation of personalized prognosis of breast cancer patients could provide evidence and reference for individualized comprehensive treatment and clinical decision-making. Nomogram is statistical calculation model developed to generate individualized prediction of a certain clinical event through the factors associated with it. Currently breast cancer related nomogram models is most commonly used in the prediction of non-sentinel lymph node status in patients with sentinel lymph node-positive breast cancer, sentinel lymph node metastasis in clinical node-negative breast cancer and prognosis evaluation of breast cancer. This article reviewed the recent advances in breast cancer related nomograms according to the above mentioned three aspects, and evaluated respectively the predictive factors, accuracy, characteristics and clinical application potential.