Objective To evaluate the efficacy of plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc in patients with cervical intervertebral disc herniation.Methods Fifty-six patients suffering from cervical intervertebral disc herniation with headache,dizziness,and pain in the neck and in the shoulder were randomly divided into 2 groups ( n =28 each):collagenase injection out of disc group (group C) and plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc group (group R).All operations were carried out under CT guidance.Results At the sixth month of follow up after treatment,the remission rates of headache,dizziness and pain in the neck and in the shoulder were 86％,79％,and 93％ in group C and 96％,93％,and 100％ in group R,.respectively,with significant difference between the two groups ( P ＜ 0.05 ) Conclusion The efficacy of plasma radiofrequency ablation at low temperature in disc combined with collagenase injection out of disc is much better than collagenase single in patients with cervical intervertebral disc herniation.

Objective To evaluate the potential high risk factors of femoral head necrosis after femoral neck surgery in adult patients. Methods From January 2009 to October 2014,390 patients with femoral neck fractures in our hospital were treated with multiple hollow compression screws. All patients were followed up for 12 to 60 months. Then retrospectively analyzed the incidence rates of femoral head nec-rosis and the clinical data about age,gender,fracture side,Garden index,fracture shift condition,internal medicine complications,whether to do lower limb preoperative traction,restoration method,postoperative load time and whether take out hollow compression screw internal fixa-tion,so as to explore the higher risk factors for femoral head necrosis. Results Among the 390 cases,352 cases got followed up. There were 45 cases of them ended with nonunionand 49 cases ended with femoral head necrosis. The univariate regression analysis results showed that the age,fracture shift condition,internal medicine complications,postoperative load time and Garden index,whether take out internal fixation were risk factors for femoral head necrosis (P<0. 05). The multi-factor results showed that aged from 40 to 60 years old,transfered fracture, seriously complications,time of loading less than 3 mouths,Ⅲ and Ⅳ Garden index,take out internal fixation were the high risk factors for femoral head necrosis (P<0. 05). Conclusion Patients who aged from 40 to 60 years old and having transfered fracture,seriously complica-tion,early weight bearing,high Garden index and internal fixation take-out would increase the risk of femoral head necrosis.

OBJECTIVE To discuss how to strengthen detail management to control hospital infection in operating room. METHODS The consciousness of controlling hospital infection,detail management as the key,integration of daily supervision examination with periodic inspection test and assessment,perfecting the detail management mechanism of hospital infection,and executing operation rules strictly were carried out. RESULTS The knowledge of hospital infection in staff members was improved,working efficiency raised,nursing level increased obviously,and the sterile operation infection rate dropped down. CONCLUSIONS Strengthening detail management is good for hospital infection control in operating room.

Objective To compare the severity of periopemtive myocardial injury caused by live donorliver transplantation (LDLT) performed under sevoflurane and pmpofol combined anesthesia in adult patients. Methods Forty ASA Ⅱ-Ⅳ patients(liver function Child-Pugh grade B or C)aged 40-67 yr weighing 47-95 kgundergoing right lobe LDLT were randomly divided into 2 groups(n=20 each):sevoflurane combined anesthesiagroup (group S) and propofol combined anesthesia group(group P).Anesthesia was maintained with 1.6%-3.0% sevoflurane in group S or PCI of pmpofol(Cp 2-4μg/ml)in group P combined with sufentanil infusion at 0.5- 1.0 μg·kg-1·h-1 and intermittent iv boluses of cisatracurium in both groups.MAP,HR,CVP,MPAP,PCWP, CO and mixed venous O2 saturation(S(v)O2)were recorded before skin incision at 5 and 30 min of anhepatic phaseand 5 and 30 min of ncohepatic phase and the end of operation:Blood samples were taken from central vein beforeskin incision(T0,baseline)at 30 min of anhepatic phase(T1),30 min of neohepatic phase(T2),the end ofsurgery (T3) and 24,48,72 h after operation (T4,5,6) for determination of serum concentrations of cardiactroponin I (cTnI) and creatine kinase MB(CK-MB).Postoperative adverse effects were recorded.Results Thetwo groups were comparable with respect to 8ex ratio(M/F),age,body weight,duration of operation,duration ofanhepatic phase,blood loss,dopamine and nitroglycerin consumption.There was no significant difference in MAP, HR,CVP,MPAP,PCWP,CO and S(v)O2 between the two groups.The serum concentrations of cTnI and CK-MB were significantly increased at T2-5 as compared with the baseline value at T0 in both groups. There was no significant difference in serum concentrations of cTnI and CK-MB and in the incidence of myocardial ischemia and arrythmia between the two groups. Conclusion Sevoflurane and propofol combined anesthesia have similar effects on myocardial injury caused by LDLT in adult patients.

Objective To discuss the degenerative factors, the spinal segment distribution, and the mechanism in hyperextension injury of cervical spine. Method Eighty-nine patients with hyperextension injury of cervical spine were retrospectively analyzed by observing the degenerativelesion, the spinal cord segment with high signal in T2WI, and the location of facial trauma. Results Fifty-eight cases showed the disc hemiation which was the most common lesion, followed by 8 cases showing the calcification of the posterior longitudinal ligament. Besides, 7 cases presented the developmental stenosis of spinal canal, and also, 6 cases showed disc hemiation combined with the yellow ligament hypertrophy. The intervertebral level of the spinal cord with high signal in T2WI were distributed as follows:4 cases were at C2/3, of which onesuffered the forehead trauma; 12 cases were at C3/ 4, of which 10 had the forehead trauma, and one had the zygomatic trauma; 12 cases were at C4/5, of which 5 had the forehead trauma, one had both the zygomatic and the forehead trauma, and one had both the forehead and with the lower jaw trauma; 11 cases were at CS/6,of which 3 had the forehead trauma, 3 had the zygomatic trauma, and 2 had the lower jaw trauma. The location of the spinal cord with single high signal in T2WI did not correspond with the intervertebral disc level in 4 cases. For 10 cases the high signal in T2WI was found at two discontinuous segments. For 2 cases the 1 high signal in T2WI was found at over two segments. For 6 cases the high signal in T2WI was found at over three segments. Conclusions Disc hemiation is the most common underlyding factor in cervical hyperextension injury. The spinal level with high signal in T2WI was correlative to the impacted facial site. The shear force at the inflection point with or without the anterior-posterior compression force accounted for the cervical hyperextension injury.

Performance appraisal is an important means for keeping hospitals on correct tracks for their medical services and their public interest nature,in addition to its importance in enhancing internal performance management within public hospitals.Since 2006,Shanghai Shenkang Hospital Development conducted performance appraisal for directors of 23 public hospitals in Shanghai.This paper highlights the importance of performance appraisal for these directors,and its significance in keeping the correct director of hospital operation.

The performance evaluation is an effective method to guide the public hospitals behavior and pro-mote their sustainable development.The introduction of disease severity could make the performance evaluation sys-tem more scientific and reasonable, and encourage the hospitals to improve their technical skills and services ability. Based on the Shanghai diagnosis related groups system, a case-mix index ( CMI) was introduced and a severity score of disease was developed after the relative weight ( RW) adjustment to evaluate different types of disease severity in hospitals.The results have shown that CMI effectively reflects the patients'disease severity and the intensity of treat-ment in those hospitals taken into consideration.Therefore, the scientific indicators should be selected and the evalu-ation system should be improved thereby establishing an effective monitoring and dynamic adjustment mechanism and further developing the diagnosis related group application.

Based on the Australian AR-DRGs, this research gathered the diagnosis related information on the first page of medical records and accomplished the computerization of data collection and analysis through the data-base of Shanghai Shenkang Hospital Development Center.According to the clinical practices, the DRGs model has been adjusted to complete the localization and a severity-based-DRGs model and grouping tool have been established for the municipal hospitals in Shanghai.

Objective To evaluate the role of hippocampal mammalian target of rapamycin (mTOR) signaling pathway in inflammatory pain in rats.Methods Sixty adult male Sprague-Dawley rats,weighing 180-240 g,were randomly divided into 4 groups (n=6 each) by using a random number table:control group (group C),inflammatory pain group (group IP),dimethyl sulfoxide (DMSO) group and rapamycin (inhibitor of mTOR) group (group R).Inflammatory pain was produced by injection of honey bee venom 50 μl into the plantar surface of the left hindpaw.While the equal volume of normal saline was given instead in group C.In group D,2％ DMSO was injected through a gastric tube into stomach 1 ml per day lasting for 3 days,and inflammatory pain was produced at 1 h after the last injection on 3rd day.In group R,rapamycin 10 mg/kg (in 2％ DMSO) was injected through a gastric tube into stomach 1 ml per day lasting for 3 days,and inflammatory pain was produced at 1 h after the last injection on 3rd day.At 2 h after the model was established,the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured.Rats were sacrificed after measurement of pain threshold,and hippocampal tissues were obtained for detection of the expression of mTOR,phosphorylated mTOR (p-mTOR),ribosomal S6 kinase (S6K) and phosphorylated S6K (p-S6K).Results Compared to group C,the MWT was significantly decreased,TWL was shortened,the expression of p-mTOR and p-S6K was up-regulated,and no significant change was found in the expression of mTOR and S6K in IP and DMSO groups,and no significant change was found in group R in the MWT,TWL and expression of p-mTOR,mTOR,p-S6K and S6K.Compared to group IP,no significant change was found in group DMSO in the MWT,TWL and expression of p-mTOR,mTOR,p-S6K and S6K,and the MWT was significantly increased,TWL was prolonged,the expression of p-mTOR and p-S6K was down-regulated,and no significant change was found in the expression of mTOR and S6K in group R.Conclusion Hippocampal mTOR signaling pathways are involved in the development of inflammatory pain in rats.

ObjectiveTo investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.MethodsThree male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years(range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.ResultsTwo cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.ConclusionAscending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated.