[Objective]To detect the predictors of residual low back pain (LBP) after laminectomy.[Method]From 1996 to 2000,69 cases (31 males and 38 females) of degenerative lumbar stenosis who had underwent laminectomy treatment and with at least 5 years' follow-up documents were involved in this study.LBP were evaluated by the Japan Orthopedic Association (JOA) Scoring System (3 points) pre- and post operation.The relationship between the patients' outcomes and all these clinical and radiographic parameters were analyzed by software package SPSS 13.0.[Result]Twenty-two cases were classified as residual LBP group(group 1) and 47 cases as no-residual LBP group(group 2),binary logistic regression analysis indicated that the predictors of residual LBP were preoperative lumbar lordosis angle、ROM and the number of decompressed laminae.The forward comparison revealed that the lumbar lordosis (22.27??3.12?) and ROM (22.91??2.31?) in group 2 were lower than the lordosis angle (37.23??2.19?) and ROM (31.66??1.52?) in group 1,but the number of decompressed laminae of group 2 (2.77?0.19 ) were higher than that in group 1(1.70?0.10 ) significantly,the P values were 0.000、0.002 and 0.000 respectively.[Conclusion]Residual LBP may attribute to the decrease of compensation ability to the postoperative instable tendency on a more flat and inflexible lumbar spine especially for multi-laminectomy,so that more attention should be paid to these kind of patients to avoid the development of refractory residual LBP.

The importance of cytotoxic T-lymphocyte(CTL)against malaria parasite in pre-erythrocytic stage has been presented in relevant researches. In order to investigate whether one CTL epitope(YLNKIQNSL)involved in a chimeric pre-erythrocytic stage vaccine candidate of Plasmodium falciparum which was expressed and purified in the laboratory can stimulate in vivo CTL response,HLA-A*0201 transgenic mice were immunized with this vaccine candidate. Enzyme-linked immunosorbent spot(ELISPOT)assay was performed on the splenocytes from the immunized transgenic mice. Positive result indicated that this CTL epitope can be in vivo processed and correctly presented.

Objective To study the treatment of abdominal compartment syndrome(ACS) secondary to fulminant acute pancreatitis (FAP).Method A retrospective study was conducted from Jan.2009 to Dec.2011 to analyze the therapeutic results of 18 patients with ACS secondary to FAP.Results Three out of 7 patients who received non-operative therapy died (mortality rate 42.9％).Three out of 11 patients treated with early surgery died (mortality rate 27.3％),which was significantly better than those patients treated conservatively.Conclusion A reduction in intra-abdominal pressure improved the function of the viscera in the treatment of ACS secondary to FAP.The decompressive effects of early surgery was efficacious,and it reduced the mortality rate.

Objective To evaluate the procedure and the therapeutic efficacy of duodenumpreserving pancreatic head resection (DPPHR) in treating benign lesions in the head of the pancreas.Methods From February 2003 to August 2011,DPPHR was performed in 21 patients with benign lesions in the head of the pancreas.Thirteen patients were male and eight were female.Age ranged from 30 to 48 years,and the lesions ranged from 2.0 cm to 5.6 cm in diameter.Posterior superior pancreaticoduodenal artery was conserved in all patients.Results There was no hospital death.Pancreatic fistula was the main and the most often morbidity,occurring in 33.3％.After operation all patients with preoperative abdominal pain were completely pain free.Preoperative hypoglycemia in 2 patients turned to eugycemia.There was no recurrences report during following up.Concl~ions DPPHR was safe and effective in treating benign lesion in the head of pancreas.It was important in preserving blood supply to the duodenum by posterior superior pancreaticoduodenal artery.

Objective To study the spinal neurocyte apoptosis and the changes of p53 in chronic fluorosis rats,and the improvement after drinking no fluoride water.Methods One hundred twenty Wistar rats were divided into 4 groups by random number table method according to body mass,30 rats in one group fed with high concentration NaF water (200 mg/L) to make fluorosis model and classified as high fluoride group;other 30 rats were fed with distilled water as control group;another 30 rats were fed with high concentration NaF water (200 mg/L) for 12 weeks,then fed with distilled water for 12 weeks and classified as defluorination group;the rest 30 rats were classified as defluorination control group.The content of fluoride in urine was tested after the 4th,8th,and 12th weeks.Then the content of fluoride in urine of defluorination group and defluorination control group was tested.The high fluoride group rats and control group rats were killed after 12th week.Defluorination group rats and defluorination control group rats were killed after 24th week.Their spinal cord was collected.The expression of p53 protein in spinal cord was detected by immunohistochemistry and Westem blotting.Apoptosis of the neurocyte was quantitatively analyzed by flow cytometry (FCM).Results By FCM,apoptosis of neurocyte was increased in both high fluorosis group rats and defluorination group rats compared with those in control group rats [(3.36 ± 0.71)％ vs.(0.78 ± 0.65)％;(3.47 ± 0.56)％ vs.(0.83 ± 0.64)％,t =14.680,17.003,all P ＜ 0.01)],but no difference was found between these two groups [(3.47 ± 0.56)％ vs.(3.36 ± 0.71)％,P ＞ 0.05)].Immunohistochemistry and Western blotting revealed that p53 expression in spinal cord of high fluorosis group rats was increased compared with those in control group rats (422.69 ± 12.35 vs.177.82 ± 14.16;253.37 ± 10.42 vs.87.14 ± 7.39,t =77.212,72.988,all P ＜ 0.01).And p53 expression in spinal cord of defluorination group rats was increased compared with those in control group rats (418.75 ± 11.84 vs.163.47 ± 8.57;248.29 ± 10.23 vs.98.74 ± 11.52,t =95.663,53.167,all P＜ 0.01).But the differences were not statistically significant (418.75 ± 11.84 vs.422.69 ± 12.35;248.29 ± 10.23 vs.253.37 ± 10.42,t =1.261,1.906,all P ＞ 0.05).Conclusions There is apoptosis of neurocytes in the spinal cord of chronic fluorosis rats;overexpression of p53 probably plays an important role in the mechanism of damage induced by excessive fluorine.Apoptosis can not be recovered after defluorination for a short time,and persistent overexpression of p53 may be one of the reasons that apoptosis of neurocytes in the spinal cord can not decrease.

Objective To compare the effectiveness,indications and side effect between microplasma technology (MPT) and 2940 nm Er ∶ YAG laser for treatment of burn scar.Methods 265 patients with hypertrophic scar were treated with MPT (MPT group,N=136) and Er ∶ YAG laser (Er ∶ YAG laser group,N=129).The patients were treated 2-6 times.Results The significant response rate was 73.52 ％ and 44.95 ％ in MPT group and Er ∶ YAG laser group; the cure rate was 28.67 ％ and 15.50 ％ in MPT group and Er ∶ YAG group,respectively.There was no statistically significant difference between two groups (P＞0.05).For moderate burn scar patients (93 cases),the significant response rate was 62.79 ％ and 10.00 ％ in MPT group and Er ∶ YAG laser group,respectively.There was significant difference between two groups (P＜0.05).Conclusions MPT and Er ∶ YAG laser has been proven to be effective and safe for the treatment of burn scar.The effectiveness of MPT is superior to Er ∶ YAG laser in treatment of moderate burn scar.

Objective To study the causes of hematoma-induced spinal cord injury after surgical treatment of fluorosis cervical canal stenosis (FCCS) so as to conclude the methods for early diagnosis and treatment.Methods A retrospective review was conducted on 329 cases of FCCS undergone expansive laminoplasty (ELOP) between 2006 and 2009.Eighteen out of the 329 cases presented with neural deterioration in postoperative 2 weeks,including l 1 males and 7 females at age of 45-73 years (mean 56.9 years).MRI scan at postoperative 1-5 days confirmed that the injury cause was hematoma formation (incidence of 5.47％).Once the definite diagnosis was made,immediate local puncture decompression,immobilization in the prone position as well as a timely second surgical probe and spinal decompression were performed.Results Nerve symptom of the 18 cases obtained different degree of recovery.Japanese Orthopedic Association (JOA) score promoted from preoperative (7.44 ± 1.25) points to (12.6 ± 2.1)points at 12 months after second operation.Scatter plot between time of definite diagnosis and improvement value in JOA score before and after the second operation was drawn so as to establish linear equation (Y =6.240 7-0.777 8X(F =9.89,P ＜0.01).As a result,the two variables presented a negative linear relationship,which suggested a better outcome after early treatment than delayed treatment.Conclusions Hematoma compression is the main cause of spinal cord injury following operation for FCCS patients.Strict hematosis and alternate lateral clinostatism after operation were effective prevention methods.Besides,early diagnosis and timely treatment are critically important.

OBJECTIVE To analyze the homology of carbapenem-resistant Klebsiella pneumoniae(KPN),offering help for clinical therapy and nosocomial infection control.METHODS The antimicrobial-resistant phenotype of forty carbapenem-resistant K.pneumoniae strains was analyzed by the WHONET 5.4 soft and the resistant genotypes were determined by plasmid profile analysis and pulse-field gel electrophoresis(PFGE).RESULTS Analyzing antimicrobial-resistant phenotype to usual eighteen clinical drugs,the main drug resistant profiles were pan-resistant and only sensitive to tobramycin among the eight antimicrobial-resistant profiles(72.5%).Additionally,the main strains were type Ⅰ and type Ⅱ among the five strains analyzed by plasmid profile(82.5%).When analyzed by PFGE,five types were identified and among these strains type Ⅰ was predominant in 34 strains(85.0%).CONCLUSIONS The strains used in this study exhibit higher homology.Therefore,clinical departments and nosocomial infection departments should pay more attention to these strains to avoid outbreak.

OBJECTIVE To understand the drug resistance genes in Klebsiella pneumoniae (KPN) isolate resistance to 18 kinds of antibacterials which included imipenem and meropenem. METHODS We detected 36 kinds of drug resistance genes for the strain of KPN by PCR method,included the beta-lactamases genes,blaTEM,blaSHV,blaLEN,blaOKP,(blaCTX-M-1,2 and 9) groups,(blaOXA-1,2 and 10) groups,CARB,PER,VEB and GES; the genes of metallo-beta-lactamases genes,IMP,VIM and KPC; the AmpC genes,DHA,ACT,MOX and LAT; the aminoglycosides resistant genes,aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6')-Ⅰb,aac(6')-Ⅱ,ant(2″)-Ⅰ and ant(3″)-Ⅰ; the quinolones resistant gene qnr; the TMP resistant genes,dfrA1 and dfrA17; the disinfectant-sulfanilamide resistantgene,qacE△1-sul1;the integron genes,intⅠ-1,intⅠ-2 and intⅠ-3; and the transposon genes,tnpA and merA.RESULTS We found 9 kinds of drug resistance genes in this KPN isolate. They were the beta-lactamases genes,blaTEM and blaSHV; the metallo-beta-lactamasesgene blaKPC-2; the aminoglycosides resistant genes,aac(3)-Ⅱ and ant(3″)-Ⅰ; the quinolones resistant gene qnr; the TMP resistant gene dfrA17; the disinfectant-sulfanilamide resistant gene qacE△1-sul1 and the integron genes intⅠ-1. CONCLUSIONS We discovere multiple drug resistant genes (some in the chromosome,some are plasmid-mediated) in this isolate. We also find the infrequent plasmid-mediated drug resistant gene blaKPC-2. We think it's concerned with the pan-resistant and the multi-drug resistant genes in this KPN,and we must pay highly attention to this isolate in clinic.

BACKGROUND:Some scholars have found that cervical vertebral body bone trabecula was reduced,became thin,even perforated in old patients with osteoporosis.Whether this change will induce cervical vertebral body deformation,and what relationship to the onset of cervical syndromeOBJECTIVE:To study the relation of cervical spondylotic myelopathy and osteoporosis by measuring and comparing.METHODS:A totaI of 40 subjects with normal lumbar vertebra density and without cervical spondylosis were enrolled as control group,averagely 32 5 years.A total of 30 patients with cervical spondylosis served as cervical spondylosis group,averagely 43.6 years.Totally 46 patients with cervical spondylosis and osteoporosis served as combined with osteoporosis group,averagely 58.6 years.116 subjects underwent radiograph Height and sagittal diameter of the vertebral body ratio of height to sagittal diameter of the vertebral body.and ratio of sagittal diameter of cervical canal/vertebra body were measured.RESULTS AND CONCLUSION:Compared with the control group.vertebral height was decreased.and sagittal diameter became longer(P＜0.05),and the ratio of sagittal diameter of cervical canal/vertebra body became smaller(P＜0.05)in the combined with osteoporosis group.Vertebral body deformation was characterized by decreased vertebral height and prolonged sagittal diameter became flat.Results suggested that osteoporosis induced cervical vertebral deformation,correlation between osteoporosis and cervical spondylosis,which may be a factor for cervical spondylosis development.