BACKGROUND: The early symptoms of amyotrophic lateral sclerosis (ASL) are usually located at a certain part of the body, and are similar to the clinical manifestations of cervical spondylotic myelopathy (CSM). However, their treatment and prognosis differ greatly. Therefore, multiple-part electromyography and electroneurography possess an important value of reference, particularly electromyography of thoracic paraspinal muscles can be used as an objective parameter for differentiation between ASL and CSM.OBJECTIVE: To investigate the electrophysiological changes in ASL and CSM.DESIGN: A retrospective clinical analysis.SETTING: Neurological Department of Second Hospital Affiliated to Jiangxi Medical College.PARTICIPANTS: Totally 30 inpatients and outpatients with ASL and 30 patients with CSM were selected from the Neurological Department of the Second Hospital Affiliated to Jiangxi Medical College between December 2001 and November 2004.METHODS: Totally 30 inpatients and outpatients with ASL as well as 30 inpatients and outpatients with CSM were subjected to routine electromyographic and electroneurographic examination. Routine electromyography examining three limb muscles + sternocleidomastoid + thoracic paraspinal muscles intended to observe the spontaneous potential at resting stage, time limit and wave-amplitude of motor unit potential, and recruit-ment phase during energetic contraction. Electroneurography was used to detect motsr conduction velocity and sensory conduction velocity,as well as the terminal latency and wave-amplitude of motor evoked potential.limb muscles, sternocleidomastoid and thoracic paraspinal muscles in paASL and SCM.RESULTS: Data of all the 60 patients entered the final statistical analysis.in patients with ALS and CSM, and were more severe in the former. The abnormality rate of spontaneous potential of thoracic paraspinal muscles reached 93.3% (28/30) as compared to 3.3% (1/30) in patients with CSM (P ＜ 0.001). The average time limit and abnormal increment of wave amplitude of motor unit potential were significantly different in patients with conduction velocity: The decrease rate of motor evoked potential amplitude of complex muscles was obviously higher in ASL than in CSM (75.6% and 86.7%, ~=7.25, P ＜ 0.01). So was the decrease rate of motor conduction sory nerve conduction velocity: It was not affected either in ASL or CSM.ALS and CSM, but the abnormality rate of spontaneous potential of thorography indicates that nerve conduction velocity was not affected in both playing decreased conduction velocity and wave amplitude than those with CSM.

Objective To investigate the clinical outcomes of three kinds oi internal fixations via posterior approach for treating adjacent two-segment thoracic and lumbar vertebral fractures.Methods A retrospective analysis was done on data of 34 patients with adjacent two-segment thoracic and lumbar vertebral fractures treated between 2003 and 2010.The treatments included three different pedicle screw fixations via posterior approach,ie,fixation with four verlebrae and four screws (Group Ⅰ,n ＝ 14),fixation with four vertebrae and six screws ( Group Ⅱ,n ＝ 11 ),fixation with four vertebrae and eight screws ( Group Ⅲ,n ＝ 9).The changes of spinal Cobb' s angle before and after operation and at the last final follow-up were statistically analyzed.Oswestry disability index (ODI) score,Denis pain scale and Denis work scale at the final follow-up were evaluated.Also,the recovery of neurological function was observed.Results The duration of follow-up was average 24 months (range,10-48 months).The neurological function of all the patients recovered to some degree.Two patients had pedicle screw breakage and one had spontaneous fusion of the collaprsed vertebra in Group Ⅰ.The Cobb' s angles of the three groups were decreased immediately after operation,but all obtained some degree of enhancement at the final follow-up.In Group Ⅰ,the mean Cobb's angle was (7.5 ±3.0)° postoperatively and then improved to ( 13.7 ±5.1 )°at the final follow-up,with correction loss of (6.2 ±2.1)°.In Group Ⅱ,the average Cobb's angle was( 1.4 ± 1.5) ° postoperatively and later increased to (4.5 ± 2.4)° at the final follow-up,with correction loss of (3.1 ± 1.1 )°.In Group Ⅲ,the mean Cobb' s angle was ( 0.0 ± 1.1 )° postoperatively but was increased to ( 1.3 ± 1.2 )° at the last follow -up,with correction loss of ( 1.3 ± 0.0 1 )°.The three groups showed statistical difference regarding the correction loss of Cobb' s angle ( P ＜ 0.05 ).Group Ⅱ and Group Ⅲ showed no significant differences in aspects of ODI score and Denis work and pain scale at the final follow-up,but the differences were significant when Group Ⅰ was compared with Group Ⅱ and Group Ⅲ (P ＜ 0.05 ).Conclusions The posterior transvertebral pedicle screw fixation with 4 vertebrae and 8 screws for adjacent two-segment thoracic and lumbar vertebral fractures is beneficial to gaining well reduction and fixation,maintaining deformity correction,preserving motion segment and releasing pain.The operation,a simple and convenient technique,has the prospect of clinical application.

Objective To investigate effect of applying nursing flowchart in the post-anesthesia care unit(PACU).Method The nursing flowchart in PACU are as follous,including a ventilator connection,monitoring instrument connection,handover of pipeline and skin and training for PACU nurses.Results After application of the nursing flowchart,the nursing time for postoperative patients was reduced from 7.0 min to 4.0 min.No nursing risks and adverse events occurred.Conclusion Application of nursing flowchart in PACU can improve the quality of nursing and enhance patients safety.

Objective To survey the employment intention of medical students in different universities in China.Methods A total of 1354 fourth-year or above medical students from 6 medical universities in China were selected for survey by random cluster sampling.A self-designed questionnaire was used to investigate the basic information of students and their employment intention.Results Overall 46.5％ (620/1333) of all students choose cities in economically-developed region as their desired working sites.45.5 ％ (363/797) of students studying in 4 Shanghai medical universities and 34.5％ (185/536) in other 2 non-Shanghai universities would first choose their original cities as working sites,respectively.81.3％ (1078/1326) of students preferred working in large public hospital,especially for those studying for higher degrees (88.0％,581/660).51％ of undergraduates expected 4000 RMB as monthly pay for graduation.Male students (54.6％,332/608) expected more income than female (47.9％,335/700),graduates (57.9％,377/651) expected higher payment than undergraduates (44.1％,290/657).Conclusion The survey shows that medical students in China mainly prefer cities and large public hospitals as working sites for their career development.

Objective To investigate the effect of the operational treatment for periampullary carcinoma.Methods The data of 53 operative patients were retrospectively analyzed. Among the 24radical operations, PD was performed in 23 cases ,PPPD in 1 ;the palliative operation was performed in 29 cases. Results Among the 24 radical operaions, the overall mortality was 8.3% (2/24), no operational death. The postoperative morbidity was 15 cases,including 5 cases of pancreatic fistula. Median length of hospital stay was 26 days. Conclusion Continual improvement of operative technique and sufficient perioperative management were the keys to increasing the effect of the operational treatment.

Objective To investigate the relationship between serum homocysteine (Hcy)and N -terminal brain natriuretic peptide (NT -proBNP)and the severity of coronary artery disease in elderly patients with coronary heart disease (CHD).Methods 129 cases of inpatient with concurrent coronary angiography whose age was over 60 years old were selected as the research object.Serum Hcy and NT proBNP level were detected,and parallel coronary angiography were administrated.Angiography was normal in 24 cases (CONTROL group),while 28 cases were stable angina pectoris(SAP group),non ST segment elevation acute coronary artery comprehensive syndrome group (NSTEACS group)had 47 cases,acute ST segment elevation myocardial infarction group had 30 cases(AMI group).was used to The severity of coronary artery lesions were assessed by Gensini score and the relationship be-tween serum Hcy and NT proBNP levels and coronary angiography in the diagnosis of coronary artery disease severity were analyzed.Results AMI group,the mean serum Hcy and NT proBNP levels[(18.13 ±8.26)μmol/L,(450.45 ± 230.45)pg/mL]were significantly higher than those of NSTEACS group [(16.96 ±9.04)μmol/L,(300.96 ± 170.94)pg/mL],SAP group[(14.35 ±5.31)μmol/L,(130.35 ±85.31)pg/mL]and control group[(10.19 ± 3.18)μmol/L,(65.19 ±40.18)pg/mL](t =5.73、3.64;t =5.53、3.23;t =4.96、3.46;P <0.05).In NSTEACS group,average of Hcy and NT proBNP levels were significantly higher than those of SAP group and control group (t =5.06,3.54;t =4.79,3.25;P <0.05).In SAP group,the average of Hcy and NT proBNP levels were higher than those in the control group (t =5.89,4.23;P <0.05).The levels of serum Hcy and NT -proBNP in patients with cor-onary artery stenosis,double vessel disease and single vessel disease were(16.13 ±7.26)mol/L,(7.29 ±14.35)mol/L, (12.67 ±6.48)pg/mL,(210.45 ±416.45)pg/mL and (160.71 ±140.57)pg/mL,the difference was statistically significant (F =140.25,F =13.15;P <0.05,P <0.01).The levels of serum Hcy and NT -proBNP were signifi-cantly correlated with Gensini score (r =0.342,P <0.05;r =0.962,P <0.01).Conclusion Correlation between serum Hcy,NT -proBNP levels in elderly patients with coronary heart disease and the severity of coronary artery disease and stenosis count is positive.Determining the levels of serum Hcy and NT -proBNP in patients with coronary heart disease and the assessment of the severity of the disease has important clinical significance.

Objective To investigate the role of sLOX?1 and leptin in metabolic syndrome ,glucose and lipid metabolism. Methods 58 patients with metabolic syndrome were included in the study ,with other 35 normal controls as control group. Fasting venous blood samples were collected. ELISA method was used to detect serum sLOX?1 and leptin levels. The related biochemical indicators were tested. Results The sLOX?1 and leptin levels in the metabolic syndrome group were significantly higher than those in the control group(P < 0.01). The levels of sLOX?1 and leptin were further compared between different genders. The differences were not statistically significant (P > 0.05). sLOX?1 and leptin levels were positively correlated. They were positively correlated with WAIST,TG,SBP,DBP,and negatively correlated with HDL?C. Leptin and age,FPG also had positive correlation,but sLOX?1 was not correlated with age and FPG. Conclusion sLOX?1 may be able to predict endothelial damage in patients with metabolic syndrome in an early stage. Combined with leptin ,the endothelial dysfunction could be reflected more accurately. They may be the important factors for early diagnosis and risk assessment of metabolic syndrome.

Objective:To observe effects of Huanglian Jiedu Decoction on expression of insulin receptor substrate 1(IRS-1)and the level of tyrosine phosphorylation in skeletal muscles to explore the molecular mechanism in improving insulin resistance.Methods:Wistar system insulin resistance model rats were developed with injection of small dose of streptozotocin into the caudal vein plus feeding by forage with high sugar and high lipids,and they were treated with Huanglian Jiedu Decoction for 10 weeks.Then blood sugar and serum insulin level were determined,and the changes of IRS-1 protein expression and tyrosine phosphorylation level in the skeletal muscles of the rat with insulin resistence after treatment of Huanglian Jiedu Decoction were detected with immuno- precipitation and Western Blot methods.Results:After treatment with Huanlian Jiedu Decoction,IRS-1 expression and IRS-1 tyrosine phosphorylation level in the muscular tissue increased as compared with those of the model group.Conclusion Huanglian Jiedu Decoction improves IRS-1 protein expression and tyrosine phosphorylation level in the skeletal muscle tissue of the rats with insulin resistance,which is possibly one of the mechanisms of decreasing blood sugar and improving sensitivity of insulin in tissues.