[Objective]To investigate the value of double plates in the anterior approach for the treatment of jumping multilevel CSM.[Method]From July 2003 to July 2004,21 cases of jumping multilevel CSM and 7 cases of CSM were operated with single level discectomy/anterior corpectomy and self-iliac bone graft and fixation by double plates.During the 6,9,12 month follow-up,bone fusion were assessed and neurological function、complications were recorded.[Result]All patients were followed up for 16~32 months(24 months on average).Based on JOA evaluation,the average improving rate was 88.5%.And 82.1% fusion was achieved at 6 months,the fusion rate reached 89.3% and 93% at 9 and 12 months accordingly.There were 6 cases with complications in the donor site of grafting.Indications of this approach:the compressing pathology was located anterior to the spinal cord.This included central,broad-based disc herniations and large bridging osteophytes at or adjacent to the level of the disc space.And it was especially indicated for patients with jumping multilevel CSM who did not have a lordotic spine.Complications:complications occurring with this approach could be related to injuries to the soft tissue during dissection or to the neurological elements.In addition,postoperative fusion or hardware failure could occur.[Conclusion]Single level discectomy/anterior corpectomy and self-iliac bone graft and fixation by double plates is an effective treatment to the jumping multilevel CSM.It allows restoration of the spinal canal and neural foramen to normal dimensions to decompress the spinal cord.To the cases of jumping multilevel CSM that have a kyphotic deformity,it allows anterior decompression and reconstruction of the spine to help restore a lordotic curvature.

Objective To evaluate the effects of sevoflurane anesthesia on the sleep architecture of rats.Methods Sixteen pathogen-free healthy male Sprague-Dawley rats,aged 10-12 weeks,weighing 300-350 g,were divided into 2 groups (n=8 each) using a random number table:control group (group C) and sevoflurane group (group S).Each rat was implanted with a transmitter for recording electromyogram and electroencephalogram via telemetry.The rats were exposed to 2.4％ sevoflurane and pure oxygen 1.5 L/min for 5.5 h followed by 0.5 h washout with pure oxygen in group S,and the rats were exposed to pure oxygen 1.5 L/min for 6 h in group C.Then the rats were taken into the sleep monitoring box,and the 24 h after anesthesia was divided into 4 time periods according to the circadian rhythm:L1 (14:00-20:00),D1 (20:00-02:00),D2 (02:00-08:00) and L2 (08:00-14:00).The total time spent on wakefulness,on non-rapid eye movement (NREM) sleep and on REM sleep,the number of wakefulness,NREM sleep and REM sleep,and the time spent on wakefulness,on NREM sleep and on REM sleep during each time period were recorded using Version 3.0 Neurosore software.Results Compared with group C,the total time spent on wakefulness was significantly shortened,the total time spent on REM sleep was prolonged,the number of NREM sleep was increased,the time spent on REM sleep in L1 and D1 time periods was prolonged,the time spent on wakefulness in D2 time period was shortened,the time spent on NREM sleep was prolonged (P＜0.05),and no significant change was found in the total time spent on NREM sleep or the number of REM sleep and wakefulness in group S (P＞0.05).Conclusion Sevoflurane anesthesia can change the stability of sleep architecture,increase REM sleep and reduce wakefulness in rats.

With the development of economy, the incidence of diabetes is keeping on rising. It has been a larger chief offender endangering human health. Glucose monitoring in time, accurately and continuously can provide the basis for the adjustment of diet, exercise and drug treatment project, and can control disease at the level of satisfaction degree. Noninvasive measurement of glucose avoids blood collection with high frequency, alleviates pain caused by blood sampling, and prevents infection. It comes with hope for the diabetic. In this article, we compare the kinds of techniques, introduce the theory, the problems of polarization rotation, the solving methods and the advantages, thus providing references for the noninvasive measurement of glucose.
Blood Glucose ; analysis ; Blood Glucose Self-Monitoring ; methods ; trends ; Diabetes Mellitus ; blood ; Humans ; Optical Rotation

Objective To study the correlation between the risk factors of coronary slow flow phenomenon ( CSF) and the level of plasma D-dimer in patients with ACS ( acute coronary syndrome) after emergency percutaneous coronary intervention ( PCI) .Methods A total of 297 patients with ACS after PCI were enrolled for retrospective analysis.All patients were divided into CSF group and control group in the light of corrected thrombolysis in myocardial infarction (TIMI) frame count method (cTFC).Multivariate analysis for evaluating clinical predictors of CSF was carried out using Logistic regression test and Pearson analysis to find the correlation between plasma D-dimer and cTFC.The predictive value of D-dimer level in the occurrence of coronary slow flow was determined by using receiver operating characteristic ( POC) curve analysis.Results CSF was observed in 59 cases (19.8%).The plasma D-dimer was significantly higher in the coronary slow flow group compared with the control group ( P <0.05 ) .Multivariate regression analysis and Logistic regression test showed that the level of plasma D-dimer ( OR =1.276, 95%CI:1.132-3.224, P=0.012), thrombus score (OR =1.108, 95%CI: 1.085-2.103, P =0.018) and target lesion length of culprit vessel ( OR =1.436, 95%CI: 0.635-1.382, P =0.037 ) were the risk factors of CSF.Correlation analysis showed that plasma D-dimer were positively associated with CSF. Receiver operating characteristic ( ROC ) curve analysis showed that D-dimer cutoff point at 515.3 ng/ml had a good judgment significance ( AUC 0.783, OR =1.502, 95%CI: 1.324-2.531, P =0.005). Conclusions The increased D-dimer level is a risk factor and plays an important role in the ACS patients with the CSF phenomenon, thereby predicting no-reflow phenomenon after primary PCI in these patients.

Objective To observe the changes of serum levels of inflammatory cytokines in the elder patients with clopidogrel resistance (CLR) after coronary stenting. Methods A total of 93 patients with unstable angina pectoris received coronary stenting were enrolled, and peripheral blood samples were taken before and 24 hours, 1 week and 1 month after surgery. The platelet aggregation (PAG) induced by adenosine diphosphate (ADP) were detected, and all patients were divided into CLR group (n=33) and normal response group (n=60) according to PAG response. At the same time, the levels of C-reactive protein (CRP), soluble fragment of CD40 ligand (sCD40L) and P-selectin were detected by enzyme-linked immunosorbent assay. Results The incidences of CLR were 35. 5% (33/93), 26. 9%(25/93) and 20. 4%(19/93) respectively 24 hours, 1 week and 1 month after surgery. The levels of CRP C(8. 8 ± 2. 5) mg/L at 24 hours, (5. 3 ± 2. 5) mg/L at 1 week], P-selectin [(73. 8±34)×10~(-3) ng/L at 24 hours, (70. 5±31. 6)×10~(-3) ng/L at 1 week, (66. 4±22. 3) ×10~(-3) ng/L at 1 month] and sCD40L C(7. 7 ±2. 3)×10~(-3) ng/L at 24 hours] after surgery in CLR group showed significant differences comparing with pre-surgery and normal response group (all P< 0.05). The CLR at 30 days after coronary stenting was significantly correlated with the level of P-selectin (r=1.334) and smoking (r= 1.053). Conclusions The levels of CRP, P-selectin and sCD40L in some elder patients after coronary stenting are increased and may be correlated with CLR. The levels of P-selectin and smoking are the predictors for CLR.

Objective To observe the effect of a triptolide-eluting stent(TES)on neointimal hyperplasia in response to vascular injury,inflammation and safety to prevent restenosis after angioplasty.Method Twelve pigs were randomly divided into three groups and received either a bare metal stent(BMS),a sirolimus-eluting stent (SES)or a TES.Each pig was treated with antiplatelet drugs after angioplasty.Biochemistry,vascular morphometry,histopathology and immunohistochemistry were analyzed at 12 weeks after angioplasty.Results The injury scores of the blood vessel were similar in all three groups.There were no differences in minimal lumen diameter or lumen area between the TES[(5.13 ±0.46)mm2;(2.65 ± 0.21)mm]and SES[(5.01±0.54)mm2;(2.65±0.25)mm]groups,but they were significantly(P＜0.01)larger than those in the BMS group[(3.76±0.61)mm2;(2.15 ±0.18)mm].The neointimal area in the TES group was smaller than that in the BMS group,but was similar to that in the SES group.The expression of VEGF,ICAM-1 and α-actinin were significantly lower in the TES group than in the BMS group.In all groups,the proliferation on both edges of the stents was insignificant.No toxicity was found in the TES group.Conclusions TES inhibits neointimal proliferation and the expression of inflammatory factors in pigs.In this study,TES safely and effectively prevented restenosis for 12 weeks.

PurposeTo determine the feasibility and accuracy of dual source CT (DSCT) in assessing myocardial delayed-enhancement and left ventricular wall thickness of hypertrophic cardiomyopathy (HCM) in comparison with cardiac magnetic resonance (CMR).Materials and MethodsEighty patients with HCM confirmed by clinical diagnosis were enrolled in the study. DSCT images and CMR images were acquired at the arterial and lag phases. According to 17-segment model provided by American Heart Association, the left ventricular wall thickness and location of delayed-enhancement were verified, and the correlation of these two methods were analyzed in terms of the diagnosis of myocardial delayed enhancement (MDE).Results1360 myocardial segments for 80 patients were assessed. The left ventricular wall thickness determined by DSCT was significantly correlated with MR results (r=0.88,P<0.01). DSCT and MDE showed substantial agreement on per-patient (n=74,Kappa=0.751,P<0.05) and per-segment (n=1238, Kappa=0.746,P<0.01) levels. For dense myocardial delayed enhancement, CT findings were significantly correlated with those of CMR (r=0.89, P<0.01), but CT scan slightly underestimated the lesion scope of fibrosis. Bland-Altman analysis showed that CT and MRI were different in measuring the lesion volume of myocardial delayed enhancement (mean standard deviation was 2.71%).ConclusionThe cardiac CT examination provides comprehensive information in coronary artery and myocardial assessment, and MDE-DSCT is also effective in the diagnosis of myocardial fibrosis in HCM since it can be used in assessing myocardial fibrosis.

Objective To provide new experimental evidences associated with the mechanisms of inhaled anesthetics, the effects of sevoflurane on the electric activities of inhibitory interneurons in basal forebrain area (BF) were observed.Methods C57BL/6 mice, aged 2-3 weeks, were used and BF sections were cut for whole patch-clamp recording.Artificial cerebrospinal fluid containing sevoflurane was given and action potential, inhibitory postsynaptic potential were recorded.Results Sevoflurane could increase the frequency of firing rate of inhibitory interneurons in basal forebrain area (P<0.001), which could increase the frequency of action potential caused by depolarization current (P<0.05), and increase the frequency of spontaneous inhibitory postsynaptic currents of pyramidal neurons (P<0.05), while AP-depended miniature inhibitory postsynaptic currents were not significantly changed.Conclusion The basal forebrain inhibitory interneurons are involved in the anesthetic effect of sevoflurane.

Objective To evaluate the clinical effects of two different revascularization approaches,one via percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and the other via coronary artery bypass graft (CABG),on short-and long-term prognosis in elderly patients with diabetes and multi-vessel coronary artery disease.Methods A retrospective analysis was conducted on 254 elderly patients with diabetes and multi-vessel coronary artery disease.Based on the revascularization approach,patients were divided into the PCI group (n=93) and the CABG group (n =161).The incidence of major cardiovascular events (MACE) were observed during hospitalization and 1-year after follow-up.Results All-cause mortality and the incidence of non-fatal myocardial infarction were higher in the CABG group than in the PCI group during hospitalization [4.9％ (8 cases) vs.1.1％ (1 cases),5.6％ (9 cases) vs.2.2％ (2 cases),each P＜0.05],while there was no significant difference in the incidence of MACE between the two groups1-year after follow-up (P＞ 0.05).The incidence of cerebrovascular events was lower in the PCI group than in the CABG group [2.2 ％ (2 cases) vs.6.2％ (10 cases),P＜0.05],while the rate of revascularization was higher in thePCI group than in the CABG group [6.5％ (6 cases) vs.1.9％ (3 cases),P＜0.05].Cox regression analysis showed that diabetes (OR =1.65,95％ CI:1.013-1.926,P =0.024) and left ventricular ejection fraction (OR =1.30,95 ％ CI:1.018-1.652,P =0.027) were independent risk factors for revascularization and cerebrovascular events.Conclusions MACEs during hospitalization are fewer in elderly patients with diabetes and multi-vessel coronary artery heart disease who received PCI than in those who received CABG.PCI has a similar mid-and long-term effect as CABG,bur PCI has a higher revascularization rate and lower risk of MACEs than CABG.

Objective : To investigate the influencing factors for depression and anxiety in patients with dysphagia after stroke. Methods: From May 2017 to June 2018,patients with post-stroke dysphagia in the Department of Rehabilitation Medicine of Zhejiang Hospital were recruited to collect their height,weight,education level,serum nutritional indicators and feeding patterns. Self-Rating Anxiety Scale and Self-Rating Depression Scale were employed to assess the incidence of anxiety and depression. Multivariate logistic regression model was used to analyze the influencing factors for depression and anxiety. Results : Among 96 patients enrolled,43 suffered from anxiety and depression,with the incidence of 44.79%. The results of multivariate logistic regression analysis showed that normal albumin（OR=0.208,95%CI：0.054-0.800）was a protective factor for anxiety,while indwelling gastric tube（OR=5.789,95%CI：1.654-20.260）was a risk factor. Normal transferrin（OR=0.189,95%CI：0.042-0.860）was a protective factor for depression,while indwelling gastric tube（OR=13.977,95%CI：1.472-132.667）was a risk factor. Conclusion Normal albumin and transferrin are the protective factors for anxiety and depression in patients with dysphagia after stroke,and indwelling gastric tube is the risk factor for anxiety or depression.