Objective To explore the curative effect of prealbumin (PA) in the hand-foot-and-mouth dis-ease and analysis its value in monitoring and prognosing this disease. Method Detect levels of serum PA of 390 ca-ses of children before, after and during the treatment and compare the changes during the treatment. Then observe the prognosis. Results There are significant difference of PV levels between cases of different prognosis (P < 0.05). Conclusion The PV levels of children of hand-foot-and-mouth disease will change significantly after effective treat- ment. There are clinical significance in observing and prognosing the hand-foot-and-mouth disease by detecting the se-rum PV levels.

Objective To evaluate the therapeutic effect of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation for the treatment of lower thoracic disc herniation.Methods From June 2000 to June 2010,36 cases of lower thoracic disc herniation were treated with method of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation,including 23 males and 13 females,with an average of 42 years old(range,22-61 years old).The courses of disease were from 21 days to 69 months,with an average of 22 months.The lesion locations were T10-11 for 12 cases,T11-12 for 15 cases and T12L1 for 9 cases.Each of the patients underwent X-ray and MR examination,31 of them underwent CT scanning.Twenty-five cases were central protrusion type,7 cases were para-central protrusion type,4 cases were lateral protrusionstype.The clinical results were evaluated by Otanni scored system.Results The operative time was 135-220 min,with average of 155 min.The blood loss was 350-800 ml,with average of 460 ml.All patients were successfully operated without neurological symptoms aggravation and accidents.Cerebrospinal fluid leakage occurred in 12 cases,which was treated by continuous suture or dura patch repair.Two cases with giant disc herniation suffered from muscle strength decrease of lower limbs after surgery,which gradually recovered after drug treatment of hormones,dehydration,high-pressure oxygen and nerve nutrients.Postoperative X-ray examinations showed that there were no internal fixation loosening.The followed-up period was 14 days to 48 months,mean 4 months.According to Otani scored system,there were excellent results in 12 cases,good results in 18 cases and poor results in 1 case.The clinical satisfaction rate was 83.3%.Conclusion Posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation is a safe and effective surgical procedure for the treatment of lower thoracic disc herniation.

Objective: To investigate the clinical efficacy of two different anterior cervical surgeries in treatment of multi-segmental cervical spondylosis. Methods: A total of 86 patients with multi-segmental cervical spondylosis were treated by anterior cervical surgery procedure. Among them, 62 and 24 cases were involved in three and four gap, respectively. Each patient underwent the surgery of long or segmented anterior cervical decompression and fixation. Preoperative and postoperative cervical curvature change, internal if xation stability, fusion rate and nerve function were evaluated. Results: All patients were successfully completed the operation, segmented surgery showed better cervical lordosis recovery, but there were no significant difference between long and segmented anterior cervical surgery in blood loss and recovery of neurological function (P>0.05). Conclusion: The segmented anterior cervical surgery has advantages in the treatment of multi-segmental cervical spondylosis.

Objective To compare the minimum 5?year follow?up outcomes of surgical management by posterior only, anterior only and combined posterior and anterior approaches for lumbar tuberculosis in adults, evaluate the mid?term follow?up results of the surgery for the treatment of lumbar tuberculosis and explore its advantages and indications. Methods From Jun 2004 to Jan 2010, 311 adult patients with lumbar tuberculosis were treated surgically. The clinical data of 137 cases that met the enrolled criteria and had integrity following?up data was analyzed retrospectively. It included the patients who had the surgical indication of the posterior only surgery but underwent the anterior only or the combined posterior and anterior ap?proaches before 2008. There were 83 cases of male and 54 cases of female. The age ranged from 20 to 75 years, with a mean of 65.6 years. Among these patients, 63 cases were treated with single?stage posterior debridement, interbody fusion and instru?mentation (the posterior group); 42 cases were treated with posterior instrumentation, and anterior debridement and bone graft in a single or two?stage procedures (the combined group) and 32 cases were treated with anterior debridement and strut graft?ing with instrumentation (the anterior group). Trauma index (the operation time, blood loss, the length of hospital stay, compli?cations);imaging parameters (Segment kyphotic angle, corrective rate, loss angle, bone fusion time) and the quality?of?life indi?cators (Oswestry Disability Index、Frankle grade、visual analogue scale、Macnab score) were compared among three groups. Re?sults The mean operation time, mean blood loss and the complications rate were (207.9 ± 30.9) min, (409.5 ± 107.9) ml and 12.95%in the posterior group;(270.7±32.0) min, (649.0±120.0) ml and 30.95%in the anterior group;(349.7±38.9) min, (840.0± 168.7) ml and 25%in the combined group. The operation time, blood loss and the complications rate of the posterior group were less than the anterior group and the combined group, and the difference was significant;The combined group consumed the longest operation time, associated with the most intraoperative blood loss, the highest complication rate and the longest hospital stay among the three groups, and the difference was significant. The correction rate of kyphosis achieved of the anterior group ( 52%± 5.45%) was significantly inferior to the posterior group (74%±5.04%) and the combined group (69%±7.95%), while the loss of cor?rection in the anterior group (2.5°) was higher than both the posterior group (0.8°) and the combined group (1.1°), and the differ?ence was significant. The average follow?up was(6.5±1.96)years (range, 5-11). The mean bone fusion time of the posterior group, the anterior group and the combined group were (6.0±1.5) months, (6.2±1.3) months and (6.5±1.6) months respectively, and there was no statistic difference. After the surgery, the quality of life was improved obviously in all patients. At the time of the latest fol?low?up, the improvement rate of the ODI,VAS and the excellent and good rate according to the Macnab score were 80.6%±2.1%, 81.7%± 1.6%and 95.24%in the posterior group;79.8%± 1.5%, 79.7%± 2.0%and 92.95%in the anterior group;81.3%± 1.1%, 79.9%±0.8%and 90.63%in the combined group. There was no significant difference among the groups in the improvement rates of the ODI, VAS, Frankel grade and the excellent and good rate of the Macnab score. Conclusion The Mid?term follow?up of the different surgical procedures for the treatment of the lumbar tuberculosis in adults were basically satisfactory. Compared with the traditional surgery, the posterior?only surgery is a safe, minimally invasive and effective method in the management of monoseg?ment lumbar tuberculosis in adults.

Objective To explore the changes on BDNF mRNA in transected spinal cord and associated motor cortex and skeleton muscle following cord injury in rats.Methods 20 adult Sprague Dawleys rats were performed spinal cord transected operation at T11 level,then rats in each group(n=5) were sacrificed on 1,3,7 and 14 days post operation respectively.Other 5 rats were used as normal control without operation.The tissues from the rostral,caudal segments near injury site,cerebral cortex and linea obliqua tibiae were harvested.Total RNA was extracted with Trizol reagent separately.The BDNF mRNA expression in each group was detected by RT-PCR.Results(1)BDNF positive bands were seen in the tissues of the rostral,caudal segments near injury site,cerebral cortex and linea obliqua tibiae.Moreover,BDNF level in cerebral cortex is more than in the spinal cord at normal control(P

ObjectiveTo explore the clinical effects of cold therapy in treatment of inflammatory hemorrhoids.MethodsSixty patients were separated into two groups according to the visiting sequence with 30 cases each.The treatment group accepted cold therapy,meanwhile the control group took the tablets diosmin and accepted hot compress with 50％ magnesium sulfate.ResultsThe symptoms evaluation score was ( 10.5 ± 1.3 ) scores and (6.4 ± 1.2) scores before and after treatment in treatment group,while ( 10.3 ±1.4) scores and(9.4 ± 1.3) scores in control group,there was no significant difference before treatment between two groups (P＞ 0.05 ),but there was significant difference after treatment between two groups (P＜0.05).After 3 days treatment,cure rate was 60.0％(18/30),eifficient rate was 90.0％(27/30) in treatment group,while 10.0％ (3/30),53.3％ ( 16/30 ) in control group,there were significant differences between two groups(P＜ 0.05).ConclusionCold therapy is good for inflammatory hemorrhoids.

Objective To discuss the operative strategies for cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis.Methods Retrospectively analyzed 21 cases of cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic kyphosis,who underwent surgeries from January,2007 to August,2014.Twenty males and 1 female were included.Mean age was (48.6±7.5) years (range,36-65 years).The preoperative American Spine Injury Association (ASIA) classification distribution:2 cases of Grade A,6 cases of Grade B,7 cases of Grade C,5 cases of Grade D,and 1 case of of Grade E.The investigative surgical methods including posterior cervical open reduction,internal fixation and bone graft fusion;posterior cervical open reduction/decompression,internal fixation and bone graft fusion;or combined posterior and anterior cervical decompression,bone graft fusion and instrumentation.The operative time and blood loss were recorded,the clinical therapeutic effect was evaluated by visual analogue scale (VAS) score,ASIA grade improvement,cervical curvature (the angle between a line drawn parallel to the inferior endplate of C2 and a line drawn parallel to the inferior endplate of C7 in the lateral plane of an X-ray image) and radiological assessment (including bone graft fusion condition and internal fixation position).Results One case died from severe pulmonary infection and respiratory failure at the 45th day after operation.All the other 20 patients obtained complete follow-up with a mean time of (39.4±8.76) months (range,25-59 months).7 cases received posterior cervical open reduction,internal fixation and bone graft fusion,average operative time was (92.1±5.4) minutes and average blood loss was (96.1+23.7) ml.9 cases received the posterior cervical open reduction and decompression,internal fixation and bone graft fusion,mean operation time was (121.4± 14.0) minutes and blood loss was (250.0±38.9) ml.3 cases experienced combined posterior and anterior cervical decompression,bone graft fusion and fixation,average operative time was (222.4± 14.9) minutes and average blood loss was (354.3+46.7) ml.Mean of VAS scores at the 3th month postoperatively was 2.76±0.46,significantly lower than the preoperatively VAS scores (8.95±0.36).Mean of VAS scores at the 24th month postoperatively was 1.77±0.39,significantly lower than those at the 3th month postoperatively.The neurological function of spinal cord achieved significant improvement after operations and continued recovered gradually in the subsequent follow up.ASIA Classification distribution at the 24th month postoperatively was:0 case of Grade A,0 case of Grade B,3 cases of Grade C,8 cases of Grade D,9 case of Grade E.Mean of the cervical curvature after operation was-7.1°± 1.9°,significantly higher than preoperatively(-13.4°±3.3°) and did not have any loss of Cobb's angles at 24th month after operation.All the surviving cases achieved solid bone graft fusion.Mean bone graft fusion time was 5.8 months (range,4-9 months).There was no internal fixation loose,fracture and dislocation occurred during follow up.Conclusion All procedures can significantly relieve the painful symptoms,effectively restore the normal cervical alignment and stability,and remarkably improve the neural function of the patients suffering cervical spine fracture combined with ankylosing spondylitis and the deformity of cervicothoracic junction kyphosis.

ObjectiveTo find out the risk factors causing iatrogenic spinal cord injury (ISCI) so as to provide theoretical support for reducing the spinal cord injury during spinal operation. Methods A retrospective study was done on 120 patients undergone cervical or thoracic spinal( C1-T12 ) surgery at Xiangya Hospital of Central South University from January 2002 to January 2009. The patients were randomly divided into injury group (n = 34) and control group (n = 86) and the univariate analysis was used to analyze 30 factors including clinical factors, iconography factors, operation and pathology factors as well as possible protective factors. Then, the factors with statistical difference were analyzed by using the multi-factor unconditioned Logistic analysis.Results The univariate comparison between the two groups showed statistical difference ( P ＜ 0. 05 ) in nine factors including combined hypertension, combined diabetes mellitus, preoperative ASIA grade, spinal canal stenosis rate, ratio of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2WI high signal, bleeding amount during operation, intraspinal prominence adhesion to dura mate of spinal cord as well as intraoperative use of methylprednisolone. The multi-factor Logistic regression analysis revealed that ASIA grade, value of spinal cord area/efficient area of vertebral canal, spinal cord MRI T2W1 high signal and bleeding amount in operation had positive correlation with ISCI. Use of methylprednisolone during operation had negative correlation with ISCI. ConclusionsCombined diabetes mellitus, ASIA grade, spinal cord MRI T2W1 high signal, ratio of spinal cord/vertebral canal area and bleeding amount in operation are the risk factors for ISCI. Use of large dose methylprednisolone exerts preventive effect on ISCI.

OBJECTIVETo study different effects of Herba Lycopodii (HL) Alcohol Extracted Granule combined methylprednisolone on behavioral changes, brain derived neurotrophic factor (BDNF) expression levels, and N-methyl-D-aspartate (NMDA) receptor levels in rats with spinal cord injury (SCI).

METHODSMale adult SD rats were randomly divided into five groups, i.e., the sham-operation group, the model group, the HL treatment group, the methylprednisolone treatment group, the HL + methylprednisolone treatment group. Rats in the HL treatment group were intragastrically administered with HL at the daily dose of 50 mg/kg for 5 successive days. Rats in the methylprednisolone treatment group were intramuscularly injected with 50 mg/kg methylprednisolone within 8 h after spinal cord contusion, and then the dose of methylprednisolone was reduced for 10 mg/kg for 5 successive days. Rats in the HL + methylprednisolone treatment group received the two methods used for the aforesaid two groups. Basso Beattie and Bresnahan (BBB) score (for hindlimb motor functions) were assessed at day 0, 3, 7, and 28 after operation. At day 13 after SCI, injured spinal T8-10 was taken from 8 rats of each group and stored in liquid nitrogen. The N-methyl-D-aspartate (NMDA) receptor affinity (Kd) and the maximal binding capacity (Bmax) were determined using [3H]MK-801 radioactive ligand assay. Rats' injured spinal cords were taken for immunohistochemical assay at day 28 after SCI. Expression levels of BDNF in the ventral and dorsal horn of the spinal cord were observed.

RESULTSCompared with the sham-operation group, the number of BDNF positive neurons in the ventral and dorsal horn of the spinal cord increased in the model group, Bmax increased (470 ± 34), Kd decreased, and BBB scores decreased at day 3 -28 (all P <0. 05). Compared with the SCI model group, the number of BDNF positive neurons and Kd increased, BBB scores at day 3 -28 increased (P <0. 05) in each medicated group. Bmax was (660 ± 15) in the methylprednisolone treatment group, (646 ± 25) in the HL treatment group, and (510 ± 21) in the HL +methylprednisolone treatment group (P <0. 05). Compared with the methylprednisolone treatment group, the number of BDNF positive neurons and Kd increased, BBB scores at day 7 -28 increased, and Bmax decreased in the HL treatment group and the HL + methylprednisolone treatment group (all P <0. 05). Compard with the HL treatment group, the number of BDNF positive neurons and Kd increased, and Bmax decreased (all P < 0.05).

CONCLUSIONSHL could effectively improve motor functions of handlimbs, increase expression levels of BDNF in the spinal cord, and lessen secondary injury by affecting spinal levels of NMDA receptors. It showed certain therapeutic and protective roles in treating SCI. Its effect was better than that of methylprednisolone with synergism.

Animals ; Brain-Derived Neurotrophic Factor ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Ethanol ; Male ; Methylprednisolone ; pharmacology ; therapeutic use ; Models, Animal ; N-Methylaspartate ; metabolism ; Neurons ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; Spinal Cord Injuries ; drug therapy ; metabolism

Objective To investigate the clinical features of Menkes disease(MD)caused by ATP7A gene mutation.Methods Clinical data of one MD patient was retrospectively analyzed,and the literature on the MD cases was reviewed.Results The patient was a 7-month-old male.The initial symptoms were epilepsy,feeding difficulties and psychomotor retardation,followed by distinctive facial appearance,hair abnormality,pectus excavatum and hypotonia.Biochemical tests revealed reduced serum ceruloplasmin and copper.Brain MRI showed diffuse cerebral atrophy,cerebral dysplasia and subdural effusion.Genetic testing showed that there was a new hemizygous mutation c.2916+2(IVS14)T＞C in the ATP7A gene splicing site on the X chromosome,which verified that the mother was a heterozygous carrier with a normal phenotype.Conclusions MD often starts in infancy and childhood.MD may involve multi-system such as the nervous system and connective tissues,and should be diagnosed with genetic testing.