Objective To compare iso-osmolar iodixanol and low-osmolar iohexol for the incidence of contrast- induced nephropathy(CIN) in patients with chronic congestive heart failure undergoing coronary interventional therapy. Methods The study included 220 consecutive patients with chronic congestive heart failure and undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) bewteen Janurary 2015 and May 2016. Study participants were divided into two groups by random digits table:iso-osmolar group (110 patients) and low-osmolar group (110 patients). The patients in iso-osmolar group were given iodixanol, and the patients in low-osmolar group were given iohexol. Serum creatinine (SCr), glomerular filtration rate (GFR) and cystatin C (CysC) were detected before the procedure and on the first, third day after the procedure. Then, the incidence of contrast-induced nephropathy (CIN) in two groups within 72 h of the procedure were observed and compared. Results The levels of SCr, GFR, CysC before operation had no significant differences (P>0.05). The levels of SCr in two groups on the first day after operation were increased, but there was no significant difference between two groups (P>0.05). On the first day after operation, the level of GFR in iso-osmolar group was higher than that in low-osmolar group, the level of CysC in iso-osmolar group was lower than that in low-osmolar group, and there were significant differences (P<0.05). On the third day after operation, the level of GFR in iso-osmolar group was higher than that in low-osmolar group, the level of CysC in iso-osmolar group was lower than that in low-osmolar group, and there were significant differences (P<0.01). The overall incidence of CIN was 20.9%(46/220). The incidence of CIN in low-osmolar group was 29.1%(32/110), in iso-osmolar group was 12.7%(14/110), and there was significant difference (P<0.05). Conclusions In chronic congestive heart failure patients undergoing coronary interventional therapy, the iso-osmolar contrast iodixanol is associated with a lower incidence of CIN compared with low-osmolar iohexol.

Objective: To observe the clinical efficacy of combined needle-embedding and SSRIs for depressive sleep disorder. Method: Upon admission, 71 depression cases were randomized into needle-embedding group of 24 cases, using combined needle-embedding and SSRIs, acupuncture group of 21 cases, using combined acupuncture and SSRIs, and medication group of 26 cases, using SSRIs alone. After 1, 2, 4 and 6 weeks of treatment, the HAMD sleep scores were compared. Result: The HAMD sleep scores in the needle-embedding and acupuncture group were remarkably superior to the medication group and there was significant statistical difference after 1, 2 and 4 weeks of treatment (P<0.01). However, there was no statistical difference after 6 weeks of treatment. Conclusion: SSRIs can improve HAMD sleep scores. The combined needle-embedding or acupuncture with SSRIs can work faster and better than medication alone. There was no statistical difference between needle-embedding and acupuncture group, however, needle-embedding can reduce the treatment frequencies and therefore has more active clinical meaning.

Objective: To evaluate the clinical and radiological outcomes,and the complications of staged minimally invasive surgery for adult degenerative scoliosis, comparing with that of the conventional open surgery. Methods: From Jun 2013 to Jun 2017, a total of 42 cases of degenerative scoliosis underwent surgical treatment. Among which, 23 cases underwent staged minimally invasive surgery(MIS group) and 19 cases underwent posterior open surgery(open group). The intra-operative bleeding, and operation time were recorded.The clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for low back pain and leg pain.The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (Sagittal Vertical Axis (SVA), Pelvic Incidence (PI)-Lumbar Lordosis (LL), Pelvic Tilt (PT)). The occurrence of complications was recorded. Results: The baseline demographic features of both groups (gender, age, medical comorbidity, etc.) were similar.The mean follow-up period for both groups was more than 2 years.The intraoperative bleeding in the MIS group 405.7±144.8 ml was significantly lower than that in the open group (2 005.3±728.4 ml, t=10.31, P<0.001); The total operation time 414.3±63.0 min of MIS group was significantly longer than that of the open group (304.2±51.8 min, t=6.10, P<0.001), but the operating time of each stage was shorter than the open group. The VAS score for back pain and leg pain,the ODI scores were significantly improved after surgery for both group, there was no significant difference between the two groups, but the low back pain and function in MIS group were better than the open group. The parameters of the coronal and sagittal deformity were significantly improved in both groups, correction of coronal deformity in MIS groupwassignificantly superior to the open group (F=12.02, P=0.001), there was no significant difference in sagittal balance correction between the two groups. The overall complication rate (63.2%) was slightly higher in the open group than in the MIS group (34.8%) without significant difference(χ²=3.36, P=0.07). The incidence of major complications in the open group was significantly higher than that in the MIS group (P=0.014). Conclusion Staged minimally invasive surgery can significantly relieve the patient's pain, improve functionand the coronal and sagittal balance of the patient, the early clinical and radiological outcomes were comparable to the open surgery; Minimally invasive surgery may significantly reduce the amount of bleeding and major complications. Minimally invasive surgery is safe and effective for carefully selected patients with degenerative scoliosis.However, the long-term outcomes of minimally invasive surgery remains to be followed up.

Objective To explore the outcomes and complications of 111 patients with pituitary neoplasms after neuroendoscopic endonasal transsphenoidal surgeries.Methods A retrospective review of clinical and radiographic data of 111 patients (113 procedures),admitted to our hospital from June 2010 to July 2014,was performed.The resection rate,clinical cured rate and complications in pituitary neoplasms of different Knosp classifications were compared.Results Gross total resection (GTR) rate for pituitary neoplasms according to Knosp classification was 97.4％ in grade 0,85.7％ in grade 1,88.7％ in grade 2,51.9％ in grade 3 and 0％ in grade 4,with significant differences (P＜0.05);GTR rate in pituitary neoplasms of grade 3 and 4 was significantly lower than that in pituitary neoplasms of grade 1 and 2 (P＜0.05).Clinical cured rate of the prolactin adenomas of different Knosp grades was significantly different,and that of grade 0 was statistically higher than that of grade 1-4 (P＜0.05).Clinical cured rate of growth hormone adenoma,adeno-corticotrophic stimulating hormone adenoma and mixed-functional adenomas of different grades showed no significant differences (P＞0.05).Chief complaints were improved in 75.0％-91.7％ non-functioning adenomas.Postoperative severe complications included 3 patients (2.7％) with cerebrospinal fluid rhinorrhea,4 (3.5％) intracranial hematoma,1 (0.9％);postoperative mild complications included 3 (2.7％) epistaxis,14 (12.4％) transient diabete insipidus,1 (0.9％) permanent diabetes insipidus and 3 (2.7％) hyponatremia.Mortality was observed in one patient with intracranial hematoma.Conclusions Neurendoscope provides a superior view of the sellar region,and improves the extent of resection of pituitary adenoma especially for those with cavernous sinus invasion;however,blind pursuit of GTR for tumor with Knosp classification greater than grade 3 will increase the risk of severe complications.Safety should always be the priority for a procedure with a long learning curve like neuroendoscopic surgery.Remission of residue tumor can be addressed by subsequent radiotherapy/stereotactic surgery.

BACKGROUNDThe purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion (iPLIF) in patients with lumbar disc herniation and Modic endplate changes. Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes (LDH-MC).

METHODSNinety-one patients with single-segment LDH-MC were recruited. All patients experienced low back pain as well as radicular leg pain, and low back pain was more severe than leg pain. Forty-seven patients were treated with discectomy and 44 were treated with iPLIF. The outcomes of both low back pain and radicular leg pain using visual analogue scale (VAS) as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association (JOA) score were assessed before and 18 months after surgery, respectively.

RESULTSBoth low back and leg pain were significantly improved 18 months after simple discectomy and iPLIF. Compared to patients undergoing simple discectomy, low back pain was significantly reduced in patients undergoing iPLIF, but there was no significant difference in leg pain between two groups. Solid fusion was achieved in all patients who underwent iPLIF.

CONCLUSIONSIn patients with LDH-MC, iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy. Simple discectomy can relieve radicular leg pain as efficient as iPLIF. Accordingly, iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

Adult ; Diskectomy ; standards ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Low Back Pain ; surgery ; Lumbar Vertebrae ; surgery ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; standards