Objective To investigate the diagnosis,treatment and prevention strategies of pharyngostoma and esophagostoma caused by anterior cervical spine surgery.Methods A retrospective analysis were performed in 17 cases of anterior cervical operation complicated with pharyngeal and esophageal fistula from 1999 March to 2010 June,including 11 male cases and 6 female cases,aged from 7 to 67 years with the mean age of 44.23 years.16 cases (94％) got inflammation of anterior cervical surgery incision and throat pain.2 cases (11％) accompanied by high fever,whose body temperature was as high as 39.2° and incision particles or liquid flew after eating.17 cases underwent upper gastrointestinal radiography,and regular oral methylene blue.Barium overflew from fistula in 2 cases (11％) after upper gastrointestinal tract barium meal angiography,while methylene blue overflew from incision in 7 cases (41％) after oral methylene blue.Through X-ray examination,gas fistula before vertebral was visible in 14 cases (82％).A diagnosis can be made by outflow through fistula after barium esophagography or oral administration of methylene blue.For unknown but highly suspected pharyngeal and esophageal injury,operation can be confirmed if no improvement of symptoms was found after fasting,nasogastric or parenteral nutrition,and ant-infection treatment for 1 week.Results All of 17 patients underwent surgical treatment.During operation,fistula dot or small irregular shape can be seen in 8 cases;long stripe in 3 cases;boundary not clear or irregular in 2 cases;adhesion around the fistula of anterior cervical fascia,similar to tear in 1 case;two fistula in 1 case;fistula located in pharynx posterior wall or esophageal which was not clear or fistula of unknown reason in 2 cases (fascia might be not at the same side of incision or fascia was small and already closed).Pharynx posterior wall and esophageal fistula was found in 3 cases during surgical exploration,which was immediate sutured and placed with drainage tube.After 7 to 14 days,if flow was less than 30 ml,and no bacterial growth was found in 3 consecutive drainage fluids,we pull out the tube.Patients who underwent nasal feeding for 2 to 3 weeks,and then took liquid diets complained nothing,and cured after 1 month.12 cases underwent debridement,stitching fistula,irrigation and drainage tube placement instantly.The wash pipe was removed after 12 to 21 days and 3 consecutive drainage fluids showed no bacterial growth.Then 2 to 3 days later the drainage pipe was pull out.Two to three months later these patients healed.2 cases firstly underwent debridement and suture or part suture,and then the incision was opened and filled with nitrofurazonium gauze tamponade.Gradually pull out the filling gauze and change the dressing of wound.If the residual cavity was large or the drainage was pus,flush the wound with physiological saline once a day,then three times a week,and finally once a week.These patients healed after 6 to 12 months.Pharyngostoma or esophagostoma of all patients was found timely,and active surgical treatment was performed,so no obvious complications was found postoperatively.All 17 patients recovered and resumed diet after 1 to 12 months postoperatively.Conclusion Pharyngeal and esophageal fistula is a rare but severe complication after anterior cervical surgery,which seriously affect the effect of operation and even lead to death.Early diagnosis and active intervention can obtain satisfactory curative effect.

Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Female ; Femur ; blood supply ; Humans ; Male ; Middle Aged ; Moxibustion ; Osteonecrosis ; therapy

ObjectiveTo observe the clinical value of serum prealbumin in patients with chronic schistosome.Methodsone hundred and twenty six patients with chronic schistosome in the Gastroenterology Department and 40 healthy people in the Physical Examination Center of the First Hospital of Wuhan were enrolledin the study.Serum prealbumin(PA) and albumin(ALB) in healthy controls and patients with chronic schistosome before therapy and 1 st,2 nd,4 th weeks after therapy were detected and analyzed.ResultsBefore therapy,PA and ALB [(223.9 ± 43.2)mg/L, (41.5 ± 5.8)g/L] of patient group were lower than that of the control group [(314.5 ± 53.6)mg/L,(47.2 ± 6.9)g/L,t =4.527,2.786,respectively,all P＜ 0.05].After therapy,PAs of patient group at the 1 st,2 nd,4 th weeks [(245.8 ± 41.7),(258.3 ± 47.2),(282.9 ± 49.3)mg/L] were higher than that before the therapy (t =3.092,3.789,4.230,all P ＜ 0.05).ALB of patient group at the 1 st,2 nd,4 th weeks [(41.1 ± 4.7),(41.4 ± 5.2),(44.8 ± 4.5)g/L] were not significantly different compaired to that before therapy(t =0.123,0.119,0.156,all P ＞ 0.05).ConclusionsPrealbumin could quickly and sensitively respond to the changes of liver function.It could be used in the judgment of curative effect and prognosis of patients with schistosome.

Alternaria zinniae was a plant fungal pathogen isolated from a world-wide weed Xanthium occidentale,which could cause some weeds of Asteraceae disease. It was found that the fungus made disease spot on the leaf through producing secondary metabolite—phytotoxin. The toxin-producing capability of the fungus was studied. The optimal cultural conditions for producing phytotoxin were temperature 25℃,pH 6.5,cultured period 9~11d,rotating speed 110r/min,darkness and enough dissolved O_2,crude toxin was obtained through large scale fermentation. Analysis on the influence of time,temperature,lightness for storing on the stability of phytotoxin of Alternaria zinniae showed that the phytotoxin had the potential to develop as a herbicide originating from microorganism.

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

Objective To investigate the management and outcome of cerebrospinal fluid leakage(CSFL)complicating anterior cervical surgery.Methods1052patients were performed anterior cervical surgery between October1997and October2002.Of 1052cases,926cases were of cervical spondylotic myelopathy(CSM),and126of ossification of posterior longitudinal ligament (OPLL).11patients suffered from cerebrospinal fluid leakage during operation.There were8males and3females aging from46to72years(average,58years).In the group of CSM,there were2cases of CSFL(0.22%)occurred in resection of osteophyte of the posterior vertebral edge,who were serious CSM of C 4,5 and C 5,6 with severe anterior compression by osseous mass to spinal cord showed on MRI.In the group of OPLL,there were9cases of CSFL(7.14%)occurred in resection of the ossified posterior longitudinal ligament accompanied with severe spinal canal stenosis and anterior compression to spinal cord on radiological imagings,4of them were con-tinuous OPLL from C 2 to C 6 combined with herniation of cervical disc,3segmental,and2mixed.Results The defect area of spinal dura were(0.6～2.0)cm?(1.0～1.5)cm.The cerebrospinal fluid was blocked with fascia and absorbable gelatin sponge during the operation.If CSFL was persistent more than3days after oper-ation,expectant treatment was performed.After the operation,no CSFL occurred in8of 11patients,and the other3cases with postoperative CSFL were cured5,14and17days by dressing change,blocking the wound with gelatin sponge,and suturing of the wound respectively.All patients were followed up for 10to62months(mean,26months).No cerebrospinal fluid cyst and infection occurred.There were no significant negative effects of CSFL on the recovery of neuromuscular function.Conclusion CSFL following cervical anterior surgery can be cured by blocking up leakage of spinal dura during operation,however,conventional conservative treatment including of dressing change,antibiotics administration,horizontal position with low pillow are necessary after operation.

Acupuncture Therapy ; Adult ; Female ; Humans ; Laryngitis ; therapy

BACKGROUND:Due to the emergence of drug-resistant tuberculosis and mismanagement in tuberculosis patients,the incidence of delayed healing or recurrent after spinal tuberculosis surgery is gradualy increasing,especialy in strongly predisposal children.Therefore,exploring the risk factors of delayed healing orpost-operative recurrence in pediatric patients after spinal tuberculosis surgery,wil have significance in the prevention and treatment of tuberculosis.OBJECTIVE:To analyze the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis,and evaluate the efficacy of individualized re-operation.METHODS:From June 1998 to June 2013,clinical data of 145 pediatric patients with spinal tuberculosis were reviewed retrospectively,and some cases of delayed healing or post-operative recurrence in spinal tuberculosis were compared with other without delayed healing or post-operative recurrence.The patient's age,gender,nutritional condition,lesion debridement,history of chemotherapy and internal fixation,complicated spinal lesion,scope of lesions,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications were analyzed by Logistic regression analysis.The risk factors of delayed healing or post-operative recurrence were analyzed.After re-operation,erythrocyte sedimentation rate,C-reactive protein and imaging studies were detected.RESULTS AND CONCLUSION:After surgery,29 cases appeared delayed healing or post-operative recurrence and 12 of them received re-operation.The incidence of delayed healing or post-operative recurrence in pediatric spinal tuberculosis was 20％and the re-operation rate was 8.3％.Logistic regression analysis showed that,nutritional condition,history of chemotherapy,lesion debridement,and scope of lesions were significantly correlated with delayed healing or post-operative recurrence (P＜0.05).While patient's age,gender,history of internal fixation,complicated spinal lesion,preoperative erythrocyte sedimentation rate ＞60 mm/h,and postoperative complications had no correlation with the delayed healing or post-operative recurrence (P ＞0.05).Individualized re-operation can achieve good outcomes.Experimental findings indicate that,the risk factors of delayed healing or post-operative recurrence in pediatric spinal tuberculosis are very complex,enhancing the nutrition,complete debridement of lesions,and receiving chemotherapy can effectively decrease the incidence.According to the initial surgery and patient's conditions,individualized re-operation is the key to the success.

Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.

BACKGROUND:There are no systematic and coherent studies on the mitochondrial apoptotic pathway of fluoride-induced osteoblast apoptosis, and the specific pathways to induce apoptosis in osteoblasts by fluorine are stil unclear. OBJECTIVE:To explore the possible pathways of apoptosis in osteoblasts induced by fluoride and its molecular characteristics. METHODS:A fluorosis model of human osteosarcoma cel line Saos-2 was establishedin vitro. After in vitro culture, the cels were treated with sodium fluoride at different concentrations (0, 5, 10, 20, 40, 80 mg/L). Flow cytometry was used to inspect the mitochondrial membrane potential at 24 hours after intervention; 84 apoptosis-related genes were detected by PCR Array; parts of the differentialy expressed genes were verified by western blot method. RESULTS AND CONCLUSION: When the concentrations of sodium fluoride were 20, 40 and 80 mg/L, the mitochondrial membrane potentials in osteoblasts were 27.0%, 28.8%, 38.6%, respectively (alP < 0.05). PCR array found 13 genes upregulated and 15 genes down-regulated. Immunoblotting results showed Bim, Caspase 9, Caspase 14, BCL2, BAX expressions enhanced with increasing doses of sodium fluoride; Caspase 3 expression was decreased at the concentration of 5 mg/L, but increased gradualy at over 10 mg/L. Caspase 7 expression had no significant difference. The expression of Caspase 10 decreased with the increasing doses of sodium fluoride. These findings indicate that fluoride may induce apoptosis in osteoblasts through the mitochondrial pathway (including the endoplasmic reticulum stress pathway) and death receptor pathway.