Objective To explore the clinical effects of treating osteonecrosis of femoral head(ONFH) by stages with self designed Chinese medicine formula. Methods 106 ONFH patients in Shantou municipal TCM hospital from July 2010 to July 2013 were recruited and divided randomly into a control group and a treatment group, 53 patients in each. The treatment group was treated with self-designed Chinese medicine formula with the functions of strengthening spleen and promoting blood circulation in the early stage, and self-designed Chinese medicine formula with the functions of supplementing kidney and promoting blood circulation in the middle stage of disease, one dosage daily. The control group was treated with Xianliang Gubao capsule (3 granules per time, twice daily) and lovastatin capsule (10-20 mg per time). Both groups were treated for two therapeutic courses of 8-12 weeks. X-ray and hemorheology indexes were observed after the treatment. Results The total effects was 90.6%(48/53) and 73.6%(39/53) in the treatment group and the control group respectively, with significant difference(χ2=6.731,P<0.05);Whole blood viscosity, PV, HCT, Arbe, ESR, FIB were obviously improved in the treatment group after the treatment, [after the treatment: whole blood viscosity high cut(3.42±0.72)mPa?S, middle cut(4.21±0.30)mPa?S, low cut(8.36±0.12)mPa?S, PV(1.39±0.16)mPa?S, HCT(38.34±2.37)%, Arbe(5.47±0.33), ESR(27.35±2.16)mm/h, FIB(3.83±0.47)g/L], [before the treatment:whole blood viscosity high cut(3.97±0.21)mPa?S, middle cut (4.71±0.24)mPa?S, low cut (9.58±0.31)mPa?S, PV(2.01±0.13)mPa?S, HCT(41.29±1.01)%, Arbe(6.51±0.21),ESR(14.62±0.92)mm/h, FIB(4.94±0.26)g/L, P<0.05]. After the treatment, the treatment group was obviously improved in such indexes as whole blood viscosity high cut(3.76±0.08)mPa?S, middle cut(4.47±0.16)mPa?S, low cut (8.99±0.07)mPa?S, PV(1.72±0.14)mPa?S, HCT(40.46±1.06)%, Arbe(6.11±0.38), ESR(24.98±1.42)mm/h and FIB(4.33±0.57)g/L than the control group(P<0.01 or 0.05). Conclusion Self-designed Chinese medicine formula stage-therapy had better results in treating ONFH than Xianling Gubao capsule and lovastatin.

Objective To explore the related factors of local reccurrence to rectal cancer after Dixon operation. Methods 100 patients with rectal cancer were used Dixon treatment. Then the tumor cells in the intestine and peritoneal fluid were qualitatively and quantitatively analyzed by flow cytometry during operation. The patients were followed up 2 years to understand the local recurrence. Results In 100 patients,8 cases were found in local recurrence after 2 years. 6 cases of recurrence were in the anastomotic site. Conclusion The local recurrence was related to Dukes stage,tumor distance from the anus,much margin of tumor length,tumor differentiation,intestine and abdominal shed close tumor cells,and it was worthy of attention.

Objective:To study the characteristics of intestinal tract pathological injury of rats in hypobaric hypoxia at different high altitude.Methods:30 male SD rats were randomly divided into 5 groups:Plain group (n=6),High-altitude (HA) 5000 m for 10 day group(n=6),HA 5000 m for 21day group(n=6),HA 6500 m for 10day group(n=6),HA 6500 m for 21day group (n=6).Rats were raised normally either in plain or simulated high altitude environment,at the corresponding time point,rats were euthanized,small intestines were harvested,fixed tissues were processed routinely into paraffin and sections were stained routinely with hematoxylin and eosin.Morphologic parameters were measured by optical microscope and then the pathological injury score were evaluated.Results:The pathological injury scores ofjejunnm and ileum in the high altitude group were significantly higher than that of the plain group (P＜0.01),the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 5000 m for 21 day group than that of the HA 5000 m for 10 day group,but significant lower than that of the HA 6500 m for 21 day group,the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 6500 m for 10 day group than that of the HA 5000 m for 10 day group(P＜0.01,P＜0.05).The pathological injury scores of colon were significantly higher in the groups of the high altitude than the plain group except for the HA 5000 m for 10 day group (P＜0.01,P＜0.05).The pathological injury scores of jejunum had significant different with that of the colon in the HA 5000 m for 21 day group (P＜0.05);the pathological injury scores of both jejunum and ileum had significant different with that of the colon in the HA 6500 m for 21 day group(P＜0.05,P＜0.01).Conclusions:The injuries of the intestinal mucosa became serious with the with rising altitude and the stayed time,the intestinal injuries were more serious than that of colon at same situation,however there were no significant different between jejunum and ileum,the injuries of colon happened later than intestine,and they correlated with the stay time in the high altitude,which indicated that intestinal injury should be pay more attention in the early time of entering the hypobaric hypoxia environment of the high altitude.

Objective To evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2011 to June 2016,Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty.There were 21 patients finally enrolled in this study,which consisted of 11 male and 10 female aging from 55-69,mean(61.48±4.29).The preoperative patients all had severe symptoms of spinal compression.Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender,age,preoperative and postoperative follow-up.The length,width and thickness of OPLL were measured by CT scan and two-dimensional reconstruction of cervical spine during preoperative and follow-up,and the average progress rate was calculated.The relationship between OPLL size before surgery and OPLL progress rate after surgery was analyzed.Results A total of 21 patients were included in this study,with an average age of 61.48±4.29 years-old.The mean follow-up time was 3.36± 1.92 years.The JOA score of cervical spine was 11.81 ± 1.75 before operationand 14.43± 1.69 at the last follow-up time (t=3.8,P＜0.01).The progression rate of OPLL length,width and thickness was 3.54± 2.89 mm/year,0.49± 0.52 mm/year and 0.34± 0.21 mm/year,respectively.Compared with the width and thickness,the average progress speed of the length was statistically significant (t=3.6,P=0.003;t=3.8,P=0.002).The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1,P=0.559).Linear regression showed that OPLL length progression speed (mm) =0.05×preoperative length + 1.23,R2=0.26 and P=0.02.Theprogression rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness.The progression rates of local,segmental,continuous,and mixed OPLL were 3.02±0.26 mm,2.97±0.65 mm,3.65± 1.14 mm,and 3.82± 1.27 mm per year.Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved during a short-term follow up.CT imaging follow-up showed there was progression of OPLL in length,width and thickness,and the progression rate of length was faster than width and thickness.However,there was no significant difference between the progression of rostral and caudal of OPLL.In addition,short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of segmental and limited OPLL.

Objective To investigate the mechanisms of sacroiliac joint pain after lumbar fusion surgery and to present the clinical outcomes after a combining intra-and peri-articular injection.Methods Totally 20 male and 15 female patients (48-75 years old) from January 2013 to December 2016 were retrospectively included in the present study.The patients were all with sustained low back and hip pain after prior posterior lumbar interbody fusion surgery.Nine cases were diagnosed with lumbar disc herniation,22 cases with lumbar stenosis,and 4 cases with degenerative lumbar spondylolisthesis.Ten cases were performed with single level fusion,16 cases with two level fusion,9 cases with 3 or more level fusion.Autogenous iliac bone graft was not applied in any of those patients.The pain of the patients was confirmed from the sacroiliac joint through specific symptoms and signs.They were divided into two groups and were treated with either standard intra-articular injection (17 cases) or a combine of intra-and peri-articular sacroiliac injection (18 cases).Peri-articular injection was conducted at 1 cm above the inferior margin of the sacroiliac joint.Recover ratios of visual analogue scale (VAS) and Oswestry disability index (ODI) at 2 weeks post-operatively were recorded and were compared between the two groups.Results No statistical difference was found in gender,fusion location,fusion levels,pre-operative VAS and ODI score between the two groups (P ＞ 0.05).The combination of intra-and peri-articular sacroiliac injection showed significantly better results than the single intra-articular injection in VAS score immediately after injection (t=2.159,P=0.038),VAS score at 2 weeks after injection and ODI score at 2 weeks after the injection (t=2.705,P=0.011;t=2.156,P=0.039,respectively).Conclusion Both intra-and extra-sacroiliac joint diseases may lead to sacroiliac joint pain after lumbar fusion surgery.A single intra-articular sacroiliac injection could not provide optimistic outcomes.Further extra-articular injection is required at approximate 1 cm above the inferior margin of the sacroiliac joint.The technique combining intra-and peri-articular injection could guarantee improved early clinical outcomes.

Objective To investigate the values of serum thymidine kinase 1 (TK1) and soluble NKG2D (natural killer cell group 2D) ligand (soluble major histocompatibility complex class Ⅰ-related chain A,sMICA) in predicting the prognosis of colorectal cancer patients undergoing radical resection.Methods 45 patients and 45 healthy subjects were included.Perioperative serum TK1 and NKG2D ligand levels were measured in 45 patient and 45 healthy controls.Patients were divided into high TK1 group and low TK1 group,and high sMICA group and low sMICA group according to the ROC.Results Perioperative TK1 were (4.42 ± 1.42) and (2.98 ± 0.54) pmol/L,sMICA were (135 ± 79) and (100 ± 81)pg/ml,which were significantly higher than those in healthy controls (P =0.000).The postoperative TKI and sMICA levels decreased significandy (P =0.000 and 0.042).The 3 and 5 years cumulative survival rates in the high TK1 group were 84％ and 34％,compared with that of 90％ and 75％in the low TK1 group (P =0.023).The 3 year and 5 year cumulative survival rates in high sMICA group were 61％ and 31％,compared with 71％ and 52％ in low sMICA group (P =0.148).Conclusion Patients serum thymidine kinase levels were negatively corelated with the prognosis of colorectal cancer after radical resection.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Methods: From March 2020 to March 2023, 100 inpatients with DS were classified into groups A, B, C, and D based on the CARDS classification system. Preoperative radiological data were analyzed to measure the severity of central canal stenosis, facet joint arthropathy, intervertebral disc herniation, and spinal epidural lipomatosis, osteophyte formation, range of motion (ROM), and computed tomography value of the vertebral bodies. The radiological characteristics and clinical contraindications for OLIF were compared among the groups. Results: Of the 100 patients, 51% had clinical contraindications for OLIF, which included 85%, 25%, 62.5%, and 20% of patients in groups A, B, C, and D, respectively. Compared with group B, group A demonstrated greater severity of central canal stenosis, whereas group C showed a higher degree of facet joint arthropathy. More patients in groups A and C had severe central canal stenosis. Regarding the ROM results, group A had segmental stiffness, whereas group D presented relatively unstable slip segments. Conclusions Patients with different DS subtypes have varied radiological characteristics. Groups B and D are suitable candidates for OLIF. Most patients in group A are unsuitable for OLIF because of bony hyperplasia, severe spinal stenosis, and segmental stiffness.

Objective:To investigate the clinical efficacy and safety of intravenous thrombolysis with different doses of alteplase in the treatment of acute cerebral infarction in older adult patients.Methods:A total of 65 older adult patients with acute cerebral infarction (onset within 4.5 hours, age ≥ 75 years) who underwent intravenous thrombolysis in Wenzhou Central Hospital from February 2021 to February 2022 were included in this study. They were randomly assigned to undergo intravenous thrombolysis with either low dose alteplase (0.6 mg/kg, low dose group, n = 32) or standard dose alteplase (0.9 mg/kg, standard dose group, n = 33). The National Institutes of Health Neurological Stroke Scale score before and 24 and 48 hours after treatment, modified Rankin scale score before and 7, 14 and 90 days after treatment, serum C-reactive protein (CRP), neuron-specific enolase (NSE) and tumor necrosis factor-α (TNF-α) levels before and 24 hours after treatment, 24-hour incidence of intracranial hemorrhage, 24-hour incidence of symptomatic intracranial hemorrhage, and 90-day mortality were compared between the two groups. Results:Compared with before treatment, the National Institutes of Health Neurological Stroke Scale scores in each group were significantly decreased at 24 and 48 hours after treatment (low dose group, t24 h = 6.78, t48 h = 7.86; standard dose group: t24 h = 8.09, t48 h = 10.13, all P < 0.001). Compared with before treatment, the modified Rankin scale score in each group was significantly decreased at 7, 14 and 90 days after treatment (low-dose group: t7 d = 5.19, t14 d = 8.47, t90 d = 9.85; standard dose group: t7 d = 6.83, t14 d = 7.74, t90 d = 13.66, all P < 0.001). At 24 hours after treatment, serum levels of CRP, NSE, TNF-α in each group were significantly decreased (low-dose group: tCRP = 5.13 , tNSE = 4.22, tTNF-α = 34.29; standard dose group: tCRP = 4.87, tNSE = 5.53, tTNF-α = 31.98, all P < 0.001). At each time point after treatment, there were no significant differences in these indices between the two groups (all P > 0.05). The 24-hour incidence of intracranial hemorrhage in the low dose group was significantly lower than that in the standard dose group ( χ2 = 4.58, P = 0.032). There were no significant differences in incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (all P > 0.05). Conclusion:Intravenous thrombolysis with low dose alteplase (0.6 mg/kg) for the treatment of acute cerebral infarction in older adult patients exhibits equivalent clinical efficacy to that with standard dose alteplase (0.9 mg/kg), and the former is much safer than the latter.