Objectives: To reveal the possible role and mechanism of disc-facet angle in the occurrence and progress of Hirayama disease by analyzing the correlation of clinical appearance and the variation of disc-facet angle in Hirayama disease. Methods: 45 patients with Hirayama disease treated in the orthopedic de-partment of Peking University Third Hospital from October 2006 to January 2012 were reviewed. There were 44 males(97.8%) and 1 female(2.2%) with an average age of 19.33±3.89(range 13-37) years old. The onset age was 16.33±2.73 (range 10-27) years old and the duration of history was 35.64±23.24 (range 1 to 120) months. The disc-facet angle of C3-T1 was measured on PACS system. An extension line was made along the upper edge of objective vertebral body on the CT scan sagittal reconstruction image. An extension line was made along the joint surface of upper articular process of objective vertebra on the sagittal plane which crossed the midpoint of the facets. The blunt angle between two lines was the disc-facet angle. The cases were divided into unilateral affect and bilateral affected group according to history, spinal cord function and spinal cord lesion level. The correlation of above data and the variation of disc-facet angle were analyzed. Results: The duration of history in unilateral affected patients was significantly shorter than that of bilateral affected patients (P<0.05). The duration of history in sequential onset patients was significantly shorter than that of simultaneous onset in bilateral affected patients (P<0.05). The JOA score 17 and Chinese score 40 in unilateral affected patients were higher than those of bilateral affected patients. The C3-C7 disc-facet angle of affected side was bigger than that of normal side in unilateral affected patients, and C5, C6 had statistically significant difference (P<0.05). The spinal cord lesion level was mainly at C5 and C6 in unilateral affected group. The disc-facet angle had no difference on both sides in bilateral affected patients but the figures at C4 and C5 level were bigger than that of normal side in unilateral affected patients. The spinal cord lesion level was mainly at C4 and C5 in bilateral affected group. The stability of upper cervical spine segments was even worse in unilateral affected group and resulting in higher level of spinal cord lesion comparing with bi-lateral affected group. Conclusions: The disc-facet angle of C4, C5 is bigger in bilateral affected patients and may be correlated with higher level spinal cord lesion and more severe clinical symptoms. The C5, C6 disc-facet angle of affected side is significantly bigger than that of normal side in unilateral affected patients. This may be the key factor of spinal cord lesion mainly at C5 and C6 level on the same side.

Objectives: To study the morphological difference of luscka joints between Hirayama disease patients and non-Hirayama disease patients on CT scan and to provide a new possible mechanism of Hirayama disease. Methods: 32 patients(all males) with a mean age of 19.4±4.1(range 16-37 years) and with Hirayama disease were treated in our hospital from October 2006 to January 2012, the mean course of disease was 31.7±23.7 months(range, 1-120 months). 32 patients(all males) with a mean of age was 19.1±4.3 (range, 12-26 years) suffering from acute neck pain and having no Hirayama disease were reviewed as control. Both groups showed no age related difference. From the cervical CT coronal plane reconstruction images which passing through the transverse foramen center of C3-C7 in GE-PACS system, the following data were measured in both sides: ①The width of the uncinate process base: the distance between inner and outer margin of the uncinate process at the upper edge of the vertebral body. ②The height of the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. ③The distance between two uncinate processes: the distance between the tips of the bilateral uncinate processes. ④The inclination angle of the uncinate process: the angle between the uncinate process and the upper edge of the vertebral body. ⑤The inclination angle of the inferior endplate: the angle between the uncinate process:the vertical distance from the top of the uncinate process to the upper edge of the vertebral body. Results:There were no significant side-related differences on the width of the uncinate process base, the height of the uncinate process, the distance of the uncinate process, the inclination angle of the uncinate process and the inclination angle of the inferior endplate at the same segment from C3 to C7 in Hirayama disease patients(P>0.05). However, differences were found on the height of the uncinate process and the distance between two uncinate processes of C3-C7 (P<0.05), C6 and C4 had the highest and lowest height of the uncinate process as C6>C5>C7>C3>C4. The distance of the uncinate process gradually increased from C3 to C7. There were no significant differences on the width of the uncinate process base, the inclination angle of the uncinate pro-cess and the inclination angle of inferior endplate(except for C3) of C3-C7(P>0.05). Then, using the mean value of the left and right sides as the width of the base of uncinate process, the height of uncinate process, and calculating the sum of inclination angle of the uncinate process, the sum of inclination angle of inferior endplate of the upper vertebra and the difference between the sums (the sum of inclination angle of uncinate process - the sum of inclination angle of inferior endplate of the upper vertebra), then calculating the mean value and standard deviation. Compared with the non-Hirayama disease patients, there were no significant dif-ferences on the uncinate process base, the distance of the uncinate process and the sum of inclination angle of the uncinate process at the same segment of Hirayama disease patients (P>0.05), while the height of the uncinate process and the sum of inclination angle of uncinate process of Hirayama disease patients were sig-nificantly smaller than those of the control group, respectively(P<0.05), and the differences between the sums were larger than those of the control group (P<0.05). Conclusions: Hirayama disease patients may possess a dysplasia in the luscka joint, manifesting the nonuniform development of the uncinate indicators. Lower unci-nate process and smaller inclination angle of inferior endplate of the upper vertebra are common, The conse-quential cervical instability may play a significantly important role in the pathogenesis and progress of Hi-rayama disease.

[abstract] Objective To study the health education on diabetes nurse diabetes management mode at the core of application in the patients with follow-up effect. Methods Our hospital endocrinology in October 2015,participate in blood sugar management company research project(namely,doctors,nurses and patients ofthree Eonline and offline (O2O) integration management system).The project is the specialist education nurses,doctors and patients of organic whole,to form a closed-loop management.Use of the project with mobile tablet (PAD),SMS platform on the first base into a group of patients with type 2 diabetes insulin for 5 minutes on education and baseline data collection,and in the next 15 weeks of diabetes health education nurses via text message and phone tracking in the form of blood sugar and insulin dose data,at the same time for more than three months of education,guidance and management,to help patients with initial foundation of insulin self management knowledge and skills,promote the blood glucose control is at target. Results In 12 weeks of the completion of this project and follow-up,425 patients of FPG success rate is 82.6%. Conclusion Nurse diabetes health education as the core of diabetes management model is feasible in patients with type 2 diabetes, the effect is good,that greatly arouse the subjective initiative of patients;Improve the patients′self-management ability,improving according to the medical behavior;Improved treatment adherence to standard prompt patients FPG.