BACKGROUND: The curative effect is satisfactory for adult patients with spasticity of lower limbs treated with selective posterior rhizotomy and peripheral nerve micro diminution. But how to improve the strength of relevant muscle is the key factor to accelerate recovery of motor function during rehabilitation training.OBJECTIVE: To observe the effect of muscle stimulating instrument on the recovery of muscle strength and the improvement of motor function of adults with spasticity of lower limbs during rehabilitation training.DESIGN: Case analysis.SETTING: Department of Neurosurgery, China-Japan Friendship Hospital of Beijing Ministry of Public Health.PARTICIPANTS: Totally 49 adults with spasticity of lower limbs were selected from Department of Neurosurgery, China-Japan Friendship Hospital of Beijing Ministry of Public Health from January 2000 to May 2002.There were 37 males and 12 females aged from 19-48 years. Totally 21patients treated with muscle stimulating instrument were determined as treatment group and other 28 patients were determined as control group during rehabilitation training.METHODS: One day after operation, conventional rehabilitation training was performed on patients in the treatment group and the control group.Patients in the treatment group were also treated with muscle stimulating instrument three times a day with each for 30 minutes for totally 7 days as a course. There was a three-day interval between treating courses and the rehabilitative time lasted for 6 months. Before rehabilitation training, indexes of patients in the two groups, such as ankle extension, knee flexion and muscle strength of thigh adductor, were recorded and the improvement of muscle strength after 3 and 6 months was followed up.MAIN OUTCOME MEASURES: Average strength of relevant muscle before and after 3-month and 6-month rehabilitation training.RESULTS:Totally 49 patients entered the final analysis.①After 3-month and 6-month treatment, indexes of ankle extension, knee flexion and muscle strength of thigh adductor were increased at various degrees.②During 3-month and 6-month treatment,indexes of ankle extension,knee flexion and muscle strength of thigh adductor in the treatment group were obviously higher than those in the control group [3-month treatment:(4.2±0.8), (3.7±0.7) degrees; (4.3±0.7), (3.8±0.7) degrees; (4.0±0.7), (3.5±0.5)degrees; 6-month treatment: (4.5±0.6), (3.9±0.7) degrees; (4.6±0.7), (4.0±0.5)degrees; (4.4±0.7), (4.0±0.6) degrees, (P ＜ 0.05 or P ＜ 0.01)].CONCLUSION: The combination of rehabilitation training and muscle stimulating instrument can accelerate the recovery of muscle strength and motor function in adults with spasticity of lower limbs after microsurgical treatment.

Objective:To observe the efficacy of contact lenses on a wide range of corneal epithelial shedding. Methods:The information has collected a wide range of corneal epithelium of thirty-six patients admitted to our hospital in the January 2010-December 2010, tracking observed in patients with epithelial wear contact lenses after the healing. Results:The patients wear contact lens immediate relief of symptoms with eye pain, foreign body sensation. Patients with continuous wear contact lenses after five to seven days, including twenty-eight patients with corneal epithelial fully restored, the remaining eight cases without contact lens continue to use eye drops of one to two days corneal epithelial fully restored in the ointment;thirty-six patients were followed up in three to six months, not fall off again. Conclusion:Therefore, use contact lenses to treat corneal epithelial shedding, the patients suffered less pain, treatment is easy to operate, low cost, the treatment effect is significant.

ObjectiveTo evaluate the effect of de-splanchnic circulation of the stomach (DSCS) on ultramicrostructure of gastric mucosa and submucosal microcirculation in prehepatic portal hypertensive canine models.MethodsTwelve prehepatic portal hypertensive canine models were established by half constriction and silk line chronic embolization of the portal vein. The esophageal varices and collateral circulation were observed by venography after 4 weeks.Dogs with established model were divided into pericardial devascularization group and DSCS group randomly.Esophageal variceal pressure (VP) was measured when the abdoman was open immediately before the abdoman was closed and 4 weeks after the operation respectively. The liver function was also tested preoperatively and 4 weeks postoperatively. The ultrastructure of gastric mucosa and submucosal microcirculation was observed by transmission electron microscope.ResultsThe VP decreased significantly from (22. 1 ± 0.9 ) cm H2O to (17. 8 ± 0. 4) cm H2O after DSCS ( P ＜ 0. 01 ).There were no obvious different changes in the liver function preoperatively and postoperatively ( P ＞ 0. 05 ) in pericardial devascularization group. The microvillus of gastric epithelium cells were interrupted and fell off and that microvillus significantly reduced. Moreover, it was also shown that the basal lamina of submucosal veinule endothelial cells were uneven thick and discontinuous and that red blood cells could be obviously gathered in the endothelial cells interspace. While there were less severe damages in the gastric musosa epithelia and submucosal venule endothelial cells in DSCS group.ConclusionsDSCS procedure can significantly decrease espophageal variceal pressure and improve the ultramicrostructure of gastric mucosa and submucosal microcirculation in canine models with prehepatic portal hypertension.

Purpose To evaluate the correlation among diffusion weighted imaging (DWI), tumor Cellularity and hypoxia-inducible factor-1α (HIF-1α) for the high and low grade astrocytoma. Materials and Methods DWI was applied with 33 patients with astrocytoma confirmed by pathology, and ADC value was measured. Tumor Cellularity was measured using Scion Image 4.0.3.2. The expression of HIF-1α was tested using immunohistochemisty. Results Mean ADC value was higher in the low grade astrocytoma than that in the high grade astrocytoma (t=7.300, P<0.001). The tumor Cellularity was higher in the high grade astrocytoma than that in the low grade astrocytoma (t=-3.845, P<0.01). HIF-1αexpression could be demonstrated in the low grade [(20.08±10.01)%] and high grade [(47.91±19.03)%] astrocytoma. The negative correlation was demonstrated between ADC value and HIF-1αand tumor Cellularity (r=-0.756,-0.617;P<0.001). The positive correlation was demonstrated between HIF-1αand tumor Cellularity (r=0.622, P<0.001). Conclusion ADC value can be used to discriminate the low and high grade astrocytoma, and the role of HIF-1αshould be further to study with enlarged sample.

Objective To observe the positional relationship of lumbar nerve roots and its main adjacent structures with CT data, and to conduct 3D construction and measurement,so as to provide anatomical basis for percutaneous lumbar diskectomy(PLD).Methods CT serial tomography dataset of 30 healthy adults' lumbosacral portions were imported into Mimics 17.0 software to segment related structures and obtain the layers of different structures.The structures were 3D reconstructed and virtually demonstrated.The lumbar nerve roots and their main surrounding structures were observed and measured.Results The minimum distances between the lumbar nerve roots and the superior articular processes increased gradually from L3 to L4 intervertebral disc layer to L5 to S1 intervertebral disc layer.The 3D model clearly displayed the morphology and spatial relationship of the lumbar nerve roots and their adjacent structures in lumbosacral portion.The lower the lumbar intervertebral discs were,the thicker they were.The distances from the middle point of the back of lumbar intervertebral disc to the end of the superior spinous process of lumbar vertebra increased at first and decreased then,and the distance in L3 to L4 intervertebral disc layer was the farthest.Conclusion The relationship between lumbar nerve roots and superior articular processes,the intervertebral disc thickness variance and the change of the distances from lumbar intervertebral disc to the end of the superior spinous process have been analyzed in this study,and the clinic basis has been laid for percutaneous lumbar diskectomy.

Objective To investigate the clinical efficacy of enhanced recovery after surgery (ERAS) in the radical gastrectomy for gastric cancer.Methods The clinical data of 140 patients undergoing radical gastrectomy for gastric cancer at the Affiliated Hospital of Qingdao University from April 2011 to June 2013 were prospectively analyzed.A double-blind,randomized,controlled study was performed in the 140 patients,and all of them were divided into the ERAS group (patients undergoing perioperative management according to enhanced recovery rehabilitation program) and the control group (patients undergoing perioperative management) based on a random numble table.The inflammatory markers,nutritional index and postoperative recovery of patients were observed.Patients of the ERAS group were followed up by telephone interview within the first 24 hours after discharge,and by outpatient examination since the second week after discharge.The follow-up was ended at postoperative day 30.Patients of the control group were reexamined at the third week after discharge.The measurement data with normal distribution was presented as x ± s.The comparison between groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact probability.Results Eighty patients were screened for eligibility,and were allocated into the ERAS group (40 patients) and the control group (40 patients).The total protein in serum (TP),albumin (Alb),prealbumin,TNF-α,IL-6,c-reactive protein,resting energy expenditure (REE),glycemic index,insulin index and Insulin resistance index in the 2 groups showed a range of variations at postoperative day 1,3,and 5,and these were (61 ±5)g/L,(34 ±3)g/L,(160 ± 18)g/L,(12.3 ±2.3)mmol/L,(101 ±34)ng/L,(43 ± 11)g/L,(1 336 ± 105)kal/d,(7.6 ±0.8)mmol/L,(16.8 ±3.5)mU/L and 5.7 ±1.3 in the ERAS group at postoperative day 1,and (58 ± 4) g/L,(31 ± 4) g/L,(147 ± 18) g/L,(15.3 ± 2.2) mmol/L,(122 ±37)ng/L,(56 ±27) g/L,(1 450 ± 164)kal/d,(9.3 ± 1.4) mmol/L,(30.5 ±6.8) mU/L and 12.5 ±3.2 in the control group,respectively,showing a significant difference between the 2 groups (F =31.63,8.03,67.36,147.04,9.63,6.84,16.10,54.85,104.51,139.47,P ＜0.05).The duration of fever,time to flatus,duration of hospital stay,hospital expenses,numeric rating scale and quality of life (QOL) were (2.9 ±0.9) days,(2.9 ± 0.6) days,(7.6 ± 2.1) days,(28 495 ± 4 722) yuan,1.4 ± 1.0 and 15.4 ± 0.9 in the ERAS group after operation,and (3.8 ±0.6)days,(3.5 ±0.7)days,(8.9 ±2.6)days,(35 318 ±7 610)yuan,2.4 ± 1.1 and 14.4 ± 1.2 in the control group,respectively,with a significant difference between the 2 groups (t =-0.91,-3.66,-2.85,-4.82,-4.20,3.92,P ＜0.05).Two patients were complicated with respiratory diseases,1 patient received reoperation and 1 was readmitted to the hospital at postoperative day 30 in the ERAS group.Three patients had respiratory diseases,1 received reoperation and 2 were readmitted to the hospital at postoperative day 30 in the control group,with no significant difference between the 2 groups (P ＞ 0.05).Conclusions ERAS is safe and feasible for the perioperative treatment of patients with gastric cancer,meanwhile it could reduce the surgical stress,shorten the duration of hospital stay and improve QOL and postoperative complications,ERAS might take effects by reducing insulin resistance and decreasing REE.Registry This study was registered with the Chinese Clinical Trial Registry with the registry number of ChiCTR-TRC-10001611.

Objective To evaluate the status of lymph node micrometastases in "non-metastatic" No11P lymph nodes as judged by conventional pathology in the lower third of gastric cancer. Methods In this study 43 No11P lymph nodes harvested from 43 patients which was histologically free of metastasis were examined by consecutive sections and TRAP( telomeric repeat amplification protocol)-ELISA (enzyme linked immunosorbent assay). The data were statistically analyzed according to the clinicopathological features of the patients. Results Micrometastasis was discovered in 4 lymph nodes from 4 patients by consecutive sections. The micrometastatic rate of the conventional pathologic non-metastatic No11P lymph nodes was 9%. The micrometastatic rate of the conventional pathologic non-metastasis No11P lymph nodes detected by TRAP-ELISA was 44%, including 4 lymph nodes observed by consecutive sections It revealed that lymph nodes micrometastases were correlated with the size of the tumor( x2 = 8. 488, P < 0. 05 )、and tumor stage (x2 = 12. 022,P < 0. 05 ). It also showed that the micrometastatic rate increased proportionally to tumor infiltration depth(x2 =6. 473, P <0. 05), not correlated with patients' demographic features, general type and histological differentiation of the tumor. Conclusions There was a high rate of micrometastasis in No11P lymph nodes. This lymph nodes micrometastasis was correlated with the size of the tumor, invasion depth of primary tumor and patients' clinical stage.

Objective:To investigate the complications of spastic cerebral palsy with selective posterior rhizotomy (SPR).Methods:In the study, 2 593 patients who had undergone SPR from January 2000 to September 2012 were followed-up for at least one year .The complications were classified .Results:Peri-operative complications:pulmonary system complications including bronchial spasm (5 cases, 0.19%) and aspiration pneumonia (4 cases, 0.15%);digestive system complications including abdominal bloa-ting (145 cases, 5.6%) and colic (80 cases, 3.1%);urinary system complications including tempora-ry bladder dysfunction (54 cases, 2.1%) and urinary tract infection (6 cases, 0.23%); peripheral nervous system complications including lower extremity weakness ( 327 cases, 12.6%) and lower extremity sensory disturbances ( 140 cases, 5.4%); central nervous system complications including headache (112 cases, 4.3%) and epileptic seizures (4 cases, 0.15%).None spinal or intracranial in-fection, intraspinal hematoma or intracranial hemorrhage were identified .General surgery complications including back pain (1 382 cases, 53.3%), delay wound healing caused by infection (5 cases, 0.19%) and cerebrospinal fluid leakage (8 cases, 0.31%).Long-term follow-up complications inclu-ding lower limb decreased exercise capacity ( incidence: 7.33%) and lower extremity sensory distur-bance (incidence:5.59%).Urination occurred in only one case and defecation function disturbance with no sexual dysfunction was identified .The incidences of scoliosis , thoracic kyphosis , spondylolisthe-sis and long-term back pain were 7.23%(31/429), 4.2%(18/429), 10.49%(45/429) and 9.72%respectively .Conclusion:SPR is one of the effective and safe surgical treatments for spastic cerebral pal-sy.Valid methods should be applied to reduce the incidence of postoperative complications , such as choosing the appropriate patients , meticulously operating in the surgery , assistance of electrophysiological guidance , reinforcing perioperative management and regular rehabilitation training after operation .

OBJECTIVE:To compare therapeutic efficacy and safety of different chemotherapy regimens in the treatment of small cell esophageal cancer. METHODS:In retrospective analysis,58 patients with small cell esophageal cancer were divided into group A(18 cases),B(26 cases)and C(14 cases)according to chemotherapy regimens. Group A was given Cisplatin injection 75 mg/m2 intravenously,d1-3+Paclitaxel injection 175 mg/m2,d1-3. Group B was given Cisplatin injection 30 mg/m2 intravenously,d1-3+Et-oposide injection 100 mg/m2,d1-3. Group C was given Vinorelbine tartrate injection 25 mg/m2 intravenously,d1-3+Gemcitabine hydro-chloride for injection 1000 mg/m2,d1-3. A treatment course of 3 groups lasted for 21 d,and they all received 2 cycles of treatment. Clinical efficacies,1,2,3-year survival rate and the incidence of Ⅲ-Ⅳ degree toxic reaction(cough,fever,expectoration,short-ness of breath,fatigue,chest pain,bone marrow suppression,gastrointestinal reactions) were compared among 3 groups. RE-SULTS:Total response rate and 1,2,3-year survival rate were in descending order:group C>group B>group A;the incidence of Ⅲ-Ⅳ degree cough,fever,expectoration,shortness of breath,fatigue,chest pain were in ascending order:group C0.05). CONCLUSIONS:Therapeutic efficacy and 1,2,3-year survival rate of vinorelbine combined with gemcitabine are significantly higher than those of cisplatin combined with paclitaxel or etoposide with better safety.

Objective To evaluate the implementation of the national essential medicine system in Shaanxi Province.Methods Using a standardized methodology (2008 Edition) developed by the World Health Organization(WHO) and Health Action International(HAD,data on the prices and availability of 38 essential medicines were collected from 120 primary,secondary and tertiary public hospitals in ten cities of Shaanxi Province from March to May 2012.Results The availability of essential medicines is generally low at public hospitals in Shaanxi province,as the average availability of originator brands is but 5.9％,and that of generics of the lowest prices is but 23.9％,while this availability at tertiary hospitals is higher than hospitals of lower levels.The procurement prices of originator drugs within essential medicines are distinctly higher than the international reference prices for the originator brands,and slightly higher for the lowest priced generics.The procurement prices at primary care hospitals are slightly lower than that of other hospitals.Retail prices of essential medicine are not significantly different among regions of different income levels.Affordability of originator brands is poor,while that of their generic equivalents is good.Conclusion The government is recommended to adjust the national essential medicine list,expand the variety of essential medicine moderately,improve the medicine pricing mechanism,and deepen public hospitals reform.