BACKGROUND: Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently. The stability of pedicle screw fixation system can be evaluated from the perspective of biomechanics and finite element method is more and more popular in analyzing stress of pedicle screw fixation of vertebral body for researchers. OBJECTIVE: To analyze the stress and displacement changes of human lumbar spine in bending movement from the biomechanical point of view when unilateral and bilateral pedicle screws are fixed, providing theoretical reference for practical clinical application. METHODS: Three-dimensional models were established based on CT data of the volunteers. The volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Abaqus software was used to simulate the actual stress conditions. Finite element analysis of lumbar spine flexion was performed during unilateral and bilateral pedicle screw fixation. The stress and displacement of lumbar vertebra, disc and pedicle screw were observed under two fixation methods. RESULTS AND CONCLUSION: (1) Under bilateral fixation, the stress on the left screw was 22.2 MPa, and the stress on the right screw was 21.14 MPa, which was far less than the stress of the screw under unilateral fixation (79.19 MPa). The stress of intervertebral disc in unilateral fixation was 87% larger than that in bilateral fixation; the stress of vertebral body in bilateral fixation was 72% smaller than that in unilateral fixation. (2) From the perspective of displacement, the displacement of screw, lumbar disc and centrum under bilateral fixation were 53%, 55% and 62% smaller than that under unilateral fixation, respectively. (3) Therefore, from the mechanical point of view, bilateral pedicle screw fixation has less stress level, which is friendlier to the human body than unilateral fixation and thus more conducive to the recovery of patients.

Objective To analyze the DSA manifestations of arteriovenous fistulae in hepatic cancer and to discuss the appropriate method for obstructing the fistulae in order to improve the therapeutic results for hepatic cancer associated with arteriovenous fistulae. Methods The imaging findings in 183 patients of hepatic cancer with urteriovenous fistulae, which were. selected from 637 patients with liver cancer, were retrospectively analyzed. For cases with mild arteriovenous fistulae (n = 89) the tumor-feeding arteries were embolized after iodized oil embolization procedure, while for cases with moderate and severe aneriovenous fistulae (n = 94) the abnormal shunts were obstructed before performing chemoembolization of the tumor in order to ensure that the effective infusion of the drug into the lesion and the sufficient deposit of iodized oil in the tumor could be obtained. Results The tumor-feeding arteries were successfully embolized in all 89 patients with mild arteriovenous fistulae. Of 94 cases with moderate and severe arteriovenous fistulae,excellent deposit of iodized oil was seen in 64 (68.1%), incomplete embolization in 13 (14.83%), poor oil deposit due to over-embolization in 11 (11.7%) and failure to block the fistulae as the fistulae were too large or too diffuse in 6 (6.4%). No serious complications occurred. Conclusion The arteriovenous fistulae accompanied with hepatic cancer can be effectively obstructed in most patients, with resultant clinical improvement of the patients' condition. This therapeutic technique is safe and reliable.

Objective To investigate the protective effect of extracellular ATP on motoneurons of spinal anterior horn from spinal root avulsion induced cell injurey. Methods Thirty-six Wister rats were randomized into 2 groups: single root avulsion and root avulsion with ATP. The left C5-C8 nerve roots were avulsed, the experiment group was gioven extracellular ATP (2 mg/kg) 0.4 ml by intraperitoneal injection and control group physiological saline water was gioven 0.4ml as the same method, all one time daily, contin-ue injection ATP or saline water 2 weeks. At 2,4 and 6 week postoperatively, C5-C8 spinal cord was har-vested after the rats were executed. The change of nitric oxide synthase (NOS) and neurofilament protein (NF-200) were observed after histochemistrical examination. Results At 2、4 and 6 week postoperatively, the survival of motorneurons in the spinal anterior was 80.48%, 73.55% and 53.43% in experiment group, was 68.90%、63.58% and 37.72% in control group;compare experiment group with control group, the le-don-induced motomeurons death in the spinal anterior bern was decreased by 11.58%、9.78% and 15.71% respectively (P < 0.01) ; the activity changes of NOS expression rate was 17.85% ,40.20% and 18.03% in experiment group, was 25.53%,53.88% and 25.58% in control group, compare experiment group with con-trol group, the activity changes of NOS expression rate was decreased by 7.68% (P < 0.01), 13.68% and 7.55% (P < 0.05) respectively. The motoneurons expressed NF-200 in the experiment group was larger than the control group, there was significant difference was found between the control group and the experiment group. Conclusion ATP might play certain protective role in survival of motoneurous after spinal root avulsion.

Objective To study the state, feature and risk factors of bacterial infection in patients with liver cirrhosis, find out the influence of infection on prognosis, and provide scientific basis for its prevention and treatment. Methods Three hundred and twenty-three patients with liver cirrhosis were analyzed. The number of the patients with infection, the location of infection, clinical feature as well as the kind of pathogenic bacteria were analyzed. Unconditional Logistic regression analysis was used to assess the risk factors of bacterial infection. Results The overall infection rate was 39.94% (129/323),of which community acquired infection rate and nosocomial infection rate were 22.60% (73/323) and 17.34%(56/323) respectively. The most common location of infection in turn were respiratory tract,gastrointestinal tract, urinary tract,biliary tract and abdominal cavity. The main pathogenic bacteria was Gram-negative bacillus, most of which had drug resistance for cefquinome and quinolones. The risk factors related with bacterial infection included liver cancer, Child-Pugh class B and C grade of liver function, gastrointestinal tract bleeding, diabetes mellitus,invasive operations and the length of staying in hospital. Conclusions The incidence rate of infection in patients with liver cirrhosis is higher. Multiple factors are likely to affect the incidence rate of infection in patients with liver cirrhosis.

We describe a 58-years-old man with a primary nasopharyngeal carcinoma accompanying erythroderma. His first symptoms were systemic scattered erythema and itching for six months. Lower right cervical lymphadenectasis was found by physical examination. A neoplasm in nasopharynx could be seen with nasal endoscope. The pathology of the neoplasm was non-keratinizing carcinoma. This case illustrates that "erythroderma" could be a paraneoplastic effect of nasopharyngeal carcinoma.
Carcinoma ; Dermatitis, Exfoliative ; complications ; Humans ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; complications ; Paraneoplastic Endocrine Syndromes ; complications

Objective:To analyze the genetic test results and ultrasonographic markers of 41 fetuses with short femurs and their relationship.Methods:This study retrospectively analyzed 41 fetuses who were diagnosed with short femurs by ultrasound during 19-37 gestational weeks and underwent prenatal genetic examination at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2019. According to the results of genetic examination, these cases were divided into three groups after excluding three cases of variants of unknown significance: genetically normal group, chromosome variation (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) group, and gene mutation (including pathogenic or likely pathogenic gene mutations) group. According to the head circumference (HC), abdominal circumference (AC) and femur length (FL), Z FL, FL/HC, FL/AC, ΔZ H-F and ΔZ H+A-2F for each fetus were calculated. One-way ANOVA and LSD- t test were used for statistical analysis. Results:(1) Among the 41 fetuses with short femurs, there were 28 in the genetically normal group, five in the chromosome variation group, three with chromosome variations of unknown significance and five in the gene mutation group. (2) In the genetically normal, chromosome variation and gene mutation groups, Z FL values were -2.78±0.77, -4.36±0.69 and -4.69±0.70; FL/HC ratios were 0.178±0.011, 0.170±0.010 and 0.131±0.022; FL/AC ratios were 0.197±0.013, 0.186±0.011 and 0.151±0.017; ΔZ H-F values were 2.49±1.09, 3.53±1.28 and 8.17±1.30; ΔZ H+A-2F values were 4.44±2.00, 6.78±2.20 and 14.28±1.26, respectively. The differences in Z FL values between the genetically normal group and the chromosome variation group as well as the gene mutation group were statistically significant (both P<0.05); so were the differences in FL/HC, FL/AC and ΔZ H-F values between the gene mutation group and the genetically normal group as well as the chromosome variation group (all P<0.05) and in any pairwise comparison of ΔZ H+A-2F among the three groups (all P<0.05). Conclusions:The genetic etiology of fetal short femurs is mainly related to chromosomal variations (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) and gene mutation. In fetuses with chromosome variation and gene mutation, the degree of the femoral development delay relative to the development of HC and AC is worse than that in the normal genetic results group.

The clinical data of 186 patients with acute gout attack during upper gastrointestinal bleeding were analyzed retrospectively.The ratio of male to female was 1.7∶1, smokers and alcohol drinkers accounted for 66.1% ( 123/186 ) and 62.4% ( 116/186 ) of patients were had underlying diseases.All patients had different degree of joint painful and fever , the blood uric acid levels were higher.Gastroscopic examinations were performed in 166 patients , of whom 88 cases received endoscopic intervention.The symptoms of gout were improved after treatment with dexamethasone and celecoxib ; and the medication did not induce or increase gastrointestinal bleeding.

This report presented a case of 62-year-old woman who was admitted to our hospital for cirrosis, but she had a variety of clinical manifestations,such as abdominal distension,diarrhea,ascites, hepatosplenomegaly,anemia, palpitation, flushing, low blood pressure, arrhythmia and so on. Upper gastrointestinal endoscopy showed thicken mucosa at gastric fundus. Colonoscopy revealed nodular, pseudopolypoid. Ascitic fluid test suggested a transudate. Endoscopic abnormal mucosa biopsy showed chronic inflammation. Many mast cells were seen in bone marrow and liver biopsies,and liver tissue immunophenotype was CD117, and CD68. Thus the patient's diagnosis was systemic mastocytosis. It is rare that a patient only has the gastrointestinal tract symptoms complicated with ascites without skin lesion. The goal for treatment was to reduce hypersecretion of mast cells.

Objective To evaluate the efficacy and safety of long pulsed Nd:YAG laser in the treatment of onychomycosis.Methods Thirty-five patients with onychomycosis were treated by long pulsed Nd:YAG laser with a wavelength of 1064 nm,power of 30-40 J/cm2,pulse width of 35 milliseconds,diameter of light spot of 4 mm.One treatment session included 4 times of irradiation at an interval of 2 minutes.Patients were treated once a week for 4 weeks followed by once a month for 6 months.Clinical and mycological efficacy was evaluated 9 months after the beginning of treatment.Side effects were recorded and analyzed.Nails were divided into various groups according to causative fungal species,clinical phenotypes,and distribution of affected nails.Data were processed by using SPSS 17.0 software.Chi-square test was performed to compare the response and recurrence rate between these groups.Results A total of 79 nails were treated by long pulsed Nd:YAG laser in this study.At 9 months after the first treatment,clinical response was observed in 67.1％ of these nails,mycological response in 73.4％,and recurrence in 19.0％.The Trichophyton rubrum group showed a better clinical (x2 =10.913,P ＜ 0.05) and mycological response (x2=13.532,P ＜ 0.05),but a lower recurrence/reinfection rate (x2 =10.980,P ＜ 0.05) compared with the other-species group.No significant difference was observed between the Trichophyton rubrum group and Candida albicans group in the clinical and mycological response rate or recurrence/reinfection rate.The clinical response in the distal lateral subungual onychomycosis (DLSO) group was significantly poorer than that in the white superficial onychomycosis (WSO) group (x2 =11.935,P ＜ 0.05),but better than that in the proximal subungual onychomycosis (PSO)/total dystrophic onychomycosis (TDO) group (x2 =17.515,P ＜ 0.05).Increased clinical response rate was observed in the second-fifth finger nail group compared with the thumb nail/second-fifth toe nail group (x2 =13.437,P ＜ 0.05)and hallux nail group (x2 =10.595,P＜ 0.05),while no statistical difference was observed in clinical response rate between the hallux nail group and thumb nail/second-fifth toe nail group (x2 =3.030,P＞ 0.05),or in mycological response rate or recurrence/reinfection rate among the second-fifth finger nail group,thumb nail/second-fifth toe nail group and hallux nail group.There was no obvious adverse reaction but pain during the treatment.Conclusions Long pulsed Nd:YAG laser appears to be an effective and safe approach to the treatment of onychomycosis,and the treatment outcome is affected by clinical types,location,and causative fungal species of onychomycosis.

Aim:To characterize the immune response to YCP, a polysaccharide (PS) isolated from marine filamentous fungus Phoma herbarum YS4108. Methods:YCP was coupled to bovine serum albumin (BSA) to construct three neoglycoproteins which are different in their degrees of substitution (DSs; ≈ 3, ≈ 6, or ≈ 10 mol of BSA carrier/mol of YCP hapten, respectively), and their immunogenicities were evaluated in mice following subcutaneous immunization,respectively. IgG subclasses against the PS and the carrier protein were measured in addition to the total IgG and IgM antibodies for YCP induced by the neoglycoproteins. Results: While unconjugated PS was weakly immunogenic, theneoglycoprotein induced vigorous primary IgM and booster IgG responses to PS and the carrier protein. Interestingly,the IgG subclass distribution was different between PS and the carrier protein; for PS, the IgG response was predominant of IgG2a subclass with approximately low levels of IgG2b and IgG1, while the response to the carrier protein was mainly of the IgG1 subclass with relatively low levels of IgG2a and IgG2b, and the lowest of IgG3. Conclusion:YCP has the potential to elicit preferentially IgG2a as the dominant isotype antibody in mice.