Objective: To discuss the influence of posterior thoracic and lumbar titanium internal fixation system on magnetic resonance image (MRI). Methods: Twelve patients who received thoracic-lumbar posterior titanium internal fixation system were subjected to MRI scanning. The artifact characteristics of titanium internal fixator and its influence on the spinal canal structure were analyzed. Results: The artifact size was 2-3 times that of the internal fixator. The details in the spinal canal and spinal cord were clearly displayed on the sagittal T1 and T2 weighted images and axial T1 weighted image. The link rod had small artifact and had influence on the images of adjacent lamina and facet, but had little influence on the observations after operation. The pedicle screw in the right position had considerable artifact, which influenced the images of lateral spinal canal, foramina, nerve root, and posterolateral herniated disc. Conclusion: Turbo spin echo sequence should be chosen for MRI scanning in patients implanted with posterior thoracic and lumbar titanium internal fixation system, with the echo time minimized. When reading the MRI images, the influence of titanium fixation system on the postoperative MRI should be considered in order to obtain the correct information of the patients.

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.

The paper aims to elucidate and establish a new mathematic model: the total quantum statistical moment standard similarity (TQSMSS) on the base of the original total quantum statistical moment model and to illustrate the application of the model to medical theoretical research. The model was established combined with the statistical moment principle and the normal distribution probability density function properties, then validated and illustrated by the pharmacokinetics of three ingredients in Buyanghuanwu decoction and of three data analytical method for them, and by analysis of chromatographic fingerprint for various extracts with different solubility parameter solvents dissolving the Buyanghanwu-decoction extract. The established model consists of four mainly parameters: (1) total quantum statistical moment similarity as ST, an overlapped area by two normal distribution probability density curves in conversion of the two TQSM parameters; (2) total variability as DT, a confidence limit of standard normal accumulation probability which is equal to the absolute difference value between the two normal accumulation probabilities within integration of their curve nodical; (3) total variable probability as 1-Ss, standard normal distribution probability within interval of D(T); (4) total variable probability (1-beta)alpha and (5) stable confident probability beta(1-alpha): the correct probability to make positive and negative conclusions under confident coefficient alpha. With the model, we had analyzed the TQSMS similarities of pharmacokinetics of three ingredients in Buyanghuanwu decoction and of three data analytical methods for them were at range of 0.3852-0.9875 that illuminated different pharmacokinetic behaviors of each other; and the TQSMS similarities (ST) of chromatographic fingerprint for various extracts with different solubility parameter solvents dissolving Buyanghuanwu-decoction-extract were at range of 0.6842-0.999 2 that showed different constituents with various solvent extracts. The TQSMSS can characterize the sample similarity, by which we can quantitate the correct probability with the test of power under to make positive and negative conclusions no matter the samples come from same population under confident coefficient a or not, by which we can realize an analysis at both macroscopic and microcosmic levels, as an important similar analytical method for medical theoretical research.

ObjectiveTo study central venous oxygen saturation (ScyO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison.MethodsSelection New Zealand pure line of rabbit 32 only,simple randonly divided into 4 groups,groups A and B for the observation group,groups C and D as control group,groups of eight only.A,B,C,D four groups respectively by ScvO2 ≤70％,ScvO2 ≤75％,hemoglobin (Hb)≥8g/dl,blood loss for the whole blood volume≥30％ as transfusion trigger.From right femoral artery bloodletting 10 minute inside,made the MAP to about (40 ± 5 )mmHg,and maintained the blood pressure 60 minutes,established controlled hemorrhagic shock rabbits of animal model.And then started to resuscitate,with colloid and crystalloid infusion according to the proportion 1∶2,infusion rate of about 10 ～ 15ml/( kg · h),according to the blood pressure and heart rate,and proper adjustment according to the different requirements of each group conducted a blood transfusion.Monitoring based value,shock,shock treatment 30 minutes,60 minutes,120 minutes,180 minutes all time points,and various indexes of blood loss,blood transfusions,crystalloid and colloid fluid volume and so on.ResultsIn shock treatment observation group A late blood pressure,pH,BE,HCO3-,O2ER etc compared with the other three groups had obvious statistical differences ( P ＜ 0.05 ),group B with C and D two groups at the same time points each monitoring were no significant differences ( P ＞0.05 ).The volume of transfusion group C was most,compared with the other three groups were significant difference ( P ＜ 0.05 ),group D of blood transfusions than A,B two groups (P ＜ 0.05 ),groups A and B infused colloid fluid,crystal fluid volume than groups C and D ( P ＜ 0.05 ),each group blood lossed without significant difference.ConclusionScvO2 for controlled hemorrhagic shock rabbit resuscitation monitoring can guide controlled hemorrhagic shock rabbit of blood transfusions,according to ScvO2 ≤75％ transfusion with traditional according to Hb or blood loss transfusion trigger comparison,can achieve the same resuscitation effect,and can more accurately and individualized guide transfusion,reduce unnecessary blood transfusions,save resources.

OBJECTIVETo investigate the mid-term outcome of operation for thoracolumbar tuberculosis. METHODS : Twenty-eight patiens with thoracolumbar tuberculosis underwent one stage anterior debridement,interbody fusion with bone graft and posterior pedicle screw internal fixation treatment from July 2006 to July 2011. There were 17 males and 11 females. Total 17 patients had nerve injuries ,including 6 cases of grade B, 5 cases of grade C, 6 cases of grade D according to Frankel classification. The poisoning symptoms of tuberculosis and recovery of spinal function were observed. The bone fusion and recovery of [umbar function were evaluated.

RESULTSAll the patients were followed up ,and the duration ranged from 39 to 85 months (mean 57 months). The clinical symptoms were controlled gradually, and the thoracolumbar back pain was alleviated after operation. Among the 17 patients with complications of nerve injuries, 3 patients were improved from preoperative grade B to postoperative grade D, 3 patients were improved from preoperative grade B to postopertive E, 5 patients with preoperative grade C and 6 patients with preoperative D were almostly recovered to normal after operation. According to JOA scoring system for curative effect evaluation, the excellent and good rate at the 3rd month, the 1st year, the 3rd year and the 5th year after operation were 67.86% ,82.14% ,85.71% ,89.29% and 91.30% respectively. The results at the 6th month and the 1st year had no statistical differences compared to the results at the 3rd month (P > 0.05); but the results at the 3rd year and the 5th year were better than that at 3 months after operation (P < 0.05); and the results between 3 yesrs and 5 years after operation had no statistical differences (P < O.05). The degeneration of adjacent segments were evaluated according to the California University (Universith of California at Los Angeles , UCLA) score. The degeneration rate was 53.57% (15/28) at the 3rd year after surgery, which was better than that before surgery. Twenty-three patients were followed up for 5 years ,and the degeneration rate was 86.96% (20/23) ,which was better than those of before surgery and 3 years after surgery.

CONCLUSIONThe surgical treatment for thoracolumbar spinal tuberculosis can achieve the thorough debridement, reconstruction of spinal stability, recovery of lumbar function and promote the functional recovery of the spinal cord, which is an effective method of treatment. However, the mid term follow-up showed that more severe degenerative changes were found in the postoperative adjacent segment.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; physiopathology ; surgery

Objective： This study was designed to investigate the relationship between p16 protein expression and gastric carcinogenesis,depth of invasion, lymph node metastasis, and evaluate the role of deletion and mutation of p16 gene in exon 2 in gastric carcinoma. Methods： p16 protein expression in gastric carcinoma and precancerous lesion was examined by streptavidin-peroxidase conjugated(S-P) method; The deletion and mutation of p16 gene were examined respectively by polymerase chain reaction(PCR) and polymerase chain reaction single-strand conformation polymorphism analysis(PCR-SSCP) in gastric carcinoma. Results： ① The positive rates of p16 protein expression were 96.25％ (77/80) in normal gastric mucosa, 92.00％ (45/50) in dysplastic gastric mucosa, and 47.54％ (58/122) in gastric carcinoma. The positive rate of p16 protein expression in gastric carcinoma was significantly lower than that in normal gastric mucosa and in dysplastic gastric mucosa (P<0.05). ② The positive rate of p16 protein expression in mucoid carcinoma (10.00％ ,1/10) was significantly lower than that of poorly differentiated carcinoma (51.22％ ,21/41), undifferentiated carcinoma (57.69％ ,15/26), and signet ring cell carcinoma (62.50％ ,10/16) (P< 0.05). ③ The positive rates of p16 protein in 30 cases paired primary and lymph node metastatic gastric carcinoma were 46.67 ％ (14/30) in primary gastric carcinoma,16.67％ (5/30) in lymph node metastatic gastric carcinoma. The positive rate of lymph node metastatic carcinoma was significantly lower than that of primary carcinoma(P<0.05). ④ Evaluation of mutation and deletion of p16 gene： There was no mutation of p16 gene in exon 2, but there were 5 cases displayed deletion of p16 gene in exon 2 in the 25 primary gastric carcinoma. Conclusions： ① The expression loss of p16 protein is related to carcinogenesis, histopathological subtypes,and lymph metastasis of gastric carcinoma. ② The mutation of p16 gene in exon 2 may not be involved in gastric carcinogenesis. But the deletion of p16 gene in exon 2 might be involved in gastric carcinogenesis.

This study aims to save cost of sampling for estimating the area under the amlodipine plasma concentration versus time curve in 24 hours (AUC(0-24 h)). Limited sampling strategy (LSS) models was developed and validated by mutiple regression model within 4 or fewer amlodipine concentration values. Absolute prediction error (APE), root of mean square error (RMSE) and visual predict check were used as criterion. The results of Jackknife validation showed that fifteen (9.4%) of the 160 LSS based on regression analysis were not within an APE of 15% by using one concentration-time point. 156 (97.5%), 159 (99.4%) and 160 (100%) of the 160 LSS model were capable of predicting within an APE 15% by using 2, 3, 4 points, separately. Limited sampling strategies have been developed and validated for estimating AUC(0-24 h) of amlodipine. The present study indicated that the implemention of both 5 mg and 10 mg dosage could enable accurate predictions of AUC(0-24 h) by the same LSS model. This study shows that 12, 4, 24, 2 h after administration are key sampling time points. The combination of (12, 4), (12, 4, 24) or (12, 4, 24, 2 h) might be chosen as sampling hours for predicting AUC(0-24 h) in practical application according to requirement.

ObjectiveTo analyze the disc working zone of intervertebral foramens (ⅣF) for percutaneous posterolateral approach to the lumbar disc with dissection and measurement of adult cadaveric spine speciments.MethodsTwenty-five lumbar IVFs of cadaveric spines(age:45-65 years; body height:150-176 cm) were studied.The heights of the intervertebral space at the most posterior margin (h) and the angles between the nerve root and the plane of the disc (β) at the sagittal plane and the distance from the nerve root to posterolateral margin of disc(d) were measured.The distances from nerve root to the lateral edge of articular process at the plane of the inferior endplate of the upper vertebra (a1) and the plane of the superior endplate of the vertebra below(a2) were measured.We also measured the distance between the nerve root and the dura at two planes of the vertebra endplate(b1,b2) after removing the lamina and articular processes.ResultsThe disc in the ⅣF is contained in the trapezoid shaped zone at the sagittal plane or the coronal plane.The parameters of two trapezoids are displayed:h is (7.0±1.1) mm; β is 77.6°±8.4°; d is (3.4±2.3)mm; a1 is (9.4±2.2) mm; a2 is (10.8±4.6) mm; b1 is (9.9±2.7) mm; and b2 is (17.7±2.1) mm.All values increase as the level goes down except the value of β,which decreases.ConclusionThe disc working zone of ⅣF is a complicated three-dimensional structure changed from the Kambin's triangle,which could be simulated by construction of two trapezoid on sagittal and coronal planes.The anatomic study of the structure is able to help the clinical transforaminal managements of the lumbar disc.For example,the dimension of working cannula could be figured out by the height of the intervertebral space.The angle of the needle inserted is affected by the distance from nerve root to the disc in this structure.

Objective：To study the toxicity mechanism(s) of ifosfamide(Ifo) in suspending cultured rat hepatocytes.Methods：Hepatocytes of adult rat were isolated using two-step perfusion method and cultured suspendingly. Cell viability,intracellular enzyme leakage, contents of sulfhydryl groups and MDA contents of hepatocytes were examined 3 hours after ifosfamide was administered at 5,10,20 mmol/L. Surface and ultrastructure of hepatocytes were also observed. Results：Cell viability and TSH,NPSH,PSH contents of hepatocytes significantly declined, and LDH,AST activities in media increased due to the leakage of intracellular enzymes. The decrease in PSH content was ascribed to depletion of TSH. The higher the dose was, the more serious these changes became. However, MDA contents of the hepatocytes were not found increased at any ifo dose groups. In pathological examination, “bulla" formation was found on the surface of the hepatocytes, deformation，swelling even vacuolation of mitochondria and dilation of rough，smooth endoplasmic reticulum were also observed. Conclusions：Ifo has toxic effect on suspending cultured rat hepatocytes. The decrease in sulfhydryl groups contributes to the hepatotoxicity induced by Ifo.

Objective To evaluate the effect of ropivacaine combined with low-dose naloxone or sufentanilropivacaine mixture on brachial plexus block carried under the guidance of ultrasound.Methods A total of 100 patients of our hospital undergoing upper limb surgery was randomly divided into four groups with 25 patients in each group.Four groups are patients receiving 20 mL of 0.375％ mesylate ropivacaine (Group D),20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil (Group S),20 mL of 0.375％ mesylate ropivacaine + 100 ng naloxone (Group N) and 20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil +100 ng naloxone (Group N+S).All patients underwent interscalene brachial plexus block under ultrasound guidance.The sensory block,motor block and other adverse reactions were observed and recorded at 5min,6,12,18,24 h.Results The sensory and motor block time of group D was (435.5 ± 77.9) min and (350.2 ± 69.8) min,group S (831.7 ± 52.0)min and (675.8 ± 48.1)min,group N (933.0 ± 117.1) min and (499.0 ± 40.5) min,group N+S (919.3 ± 59.0) min and (534.8 ± 56.6)min.The sensory block time of group N and group N + S were significantly longer than that of group D and S (P ＜0.05).The sensory and motor block time of group D were obviously shorter than that of other groups (P ＜ 0.05).There were no significant difference in the onset time of sensory and motor block in all groups.Conclusion Low dose of naloxone combined with ropivacaine or sufentanil-ropivacaine mixture can increase the duration of sensory block on brachial plexus.