0.05),but the duration of the peaking period, the time for improving one grade, the time for reaching 2 grade, and the hospitalization was significantly shorter in patients treated with steroid than without steroid(P0.05). (3) The major side effects included Cushing's reaction and the infection of the upper respiratory tract.Conclusion Steroids can quicken the recovery of GBS, and shortened average hospitalization in patients with GBS, but steroid doesn't alter the incidence rate of the sequel and the severity of the disability at 1 year in the course.It has no side reaction to use steroid reasonably.

Objective To investigate the clinical features of myasthenia gravis (MG) in elderly people. Methods Elderly patients among all MG patients observed from February 1977 to February 2003 were respectively reviewed. Results Of 3010 MG patients,232(7.7%) were identified with the onset of the disease after or at the age of 60,and males were more than females with the ratio of 1.3∶1. The first and most commonly seen symptom in the elderly people after MG onset were ocular manifestation,occurring in 79.3%. Bulbar symptoms(12.9%) such as dysarthria and swallowing difficulties were the following symptoms. The systemic form (62.9%) were significantly more than ocular form (37.1%). There were less MG patients with autoimmunity diseases such as thyroid diseases associated with MG than that with the other senile diseases,and the myasthenia crisis were even less in the elderly patients with MG. However,it was found that more MG patients with thymoma than with other thymus abnormality. Conclusions The elderly MG patients had its distinctive clinical features. It is beneficial for diagnosing and treating the MG patients in the elderly people by understanding these clinical features.

Objective To describe the clinical features and genetic susceptibility of the familial myasthenia gravis (FMG) patients. Methods The clinical data of 47 FMG patients and 2953 sporadic myasthenia gravis (SMG) patients from 1977 to 2003 were analyzed retrospectively, and 15 FMG patients, 36 SMG patients and 47 healthy controls were investigated for human leukocyte antigen (HLA)-DQA1 genotyping by polymerase chain reaction-sequence specific primers. Results FMG was an autoimmune disorder disease and immunosuppressive therapy was as highly effective in FMG as in SMG. In all patients, 11(23.4%) cases improved significantly, 14(29.8%) cases relieved with only 5 mg prednidone, and 20(42.6%) cases relieved completely. Most FMG occurred in siblings and familial members within 2 generations, and no sexual difference was found. These suggested it should be atypical Mendel’s rules. Onset and clinical features of patients within the same family often had little difference. As compared with the SMG patients, the frequence of DQA1 *0301 allele was higher in FMG patients, especially in the ocular form, and the differences had statistical significance(40.0% vs 19.4%, P

Objective To improve the diagnosis and treatment of liver trauma. Methods We retrospectively analyzed different therapeutic means on liver trauma including 79 cases with operative treatment and 27 cases with nonoperative treatment. Results In nonoperative treatment group, 25 cases were cured, 2 cases died. In operative treatment group, 73 cases were cured, 6 cases died. Cure rate was 92.5%(98/106), mortality was 7.5%(8/106). 5 cases died of major blood vessels rupture, 3 cases died on multiple organ function failure. Postoperative complications included 3 cases of subphrenic infection, 10 cases of hepatic abscess, 8 cases of pleural hydrops, 7 cases of incisional infection. Conclutions Type I of liver trauma can be treated by nonoperation, type Ⅱ～Ⅳ of blunt liver trauma can be treated by nonoperation on the condition of intensive monitoring. Type Ⅱ～ Ⅵ of liver trauma should be operated on emergently in case of massive intraabdominal bleeding and combined organ injury.

Objective To evaluate the long-term outcomes of immunosuppressive agents used for myasthenia gravis(MG) patients with disease onset after or at 60. Methods Long-term outcome was evaluated in 99 cases with following-up longer than 1 year. Remission, pharmacological remission, and marked improvement were considered as good results or good long-term outcome. Results All good results were recorded in 79 MG patients (79.8%) receiving immunosuppressive treatments. 48 patients had been treated with glucocorticoids (GC) alone, of them, 35(72.9%) achieved good results. 8 of them having a complete remission for 18 to 67 months (averaging (54.8?19.8) months). 16 patients got pharmacological remission for 7 to 37 months (averaging (15.7?8.0) months). MG patients in different gender had different responses to GC. The good long-term outcome was found in 83.3% (25/30) males and only 55.6% (10/18) in females with GC therapy. There was a rate statistically higher in male than in female patients (P

Objective To explore the clinicopathological characteristics of early gastric cancer (EGC),surgical treatment, and prognosis in elderly patients. Methods The clinicopathological and follow-up data in 83 elderly patients with EGC treated by gastrectomy from 1989. 8-2004. 8 were studied retrospectively. Results All of 83 patients were resectable, and there was no operative death nor surgical complications. The 5-, 10-, and 15- year survival rate was 98%,95%,and 92%, respectively. Sixty-one cases (74%) were mucosal cancer without lymph node metastasis, 22 cases were submucosal cancer with node metastasis in 4 cases. 7 cases were multiple primary carcinoma. Conclusions Local resection and partial gastrectomy are not suitable for multiple primary carcionoma in elderly patieats with EGC. Subtotal gastrectomy, and total gastrectomy should be the procedure of choice when foci were scattered about. Lymph node metastasis,multiple primary cancer foci and invasion of submucosal layer are all among factors impacting postoperative prognosis.

Objective To discuss the effectiveness and safety of Ommaya sar implantation through neuronavigation in treatment of intracranial cysts. Methods Twenty-eight patients with intracranial cysts (cystic glioma, cystic metastases, radioactive encephalopathy cystic necrosis), admitted to our hospital from January 2007 to December 2014, were chosen in our study; these patients accepted Ommaya sar implantation through neuronavigation. The clinical data, disease courses, CT scan results, operation efficacies and postoperative complications of these patients were retrospectively analyzed. Results In the 8 patients with cystic gliomas, improvement of clinical symptoms and activity of daily living was noted in 6 patients; imaging re-check indicated focus shrink<50%in 6 patients, enjoying an effective rate of 75%. In the 12 patients with cystic metastases, the improvement of clinical symptoms and activity of daily living was noted in 9 patients; imaging re-check indicated focus shrink<50% in 9 patients, enjoying an effective rate of 75%. In the 8 patients with radioactive encephalopathy cystic necrosis, the improvement of clinical symptoms and activity of daily living was noted in 7 patients;imaging re-check indicated focus shrink<50%in 7 patients, enjoying an effective rate of 87.5%. No antidromic intracranial infection was noted in these 28 patients. Conclusion Implantation of Ommaya sar through neuronavigation is an effective treatment in intracranial cysts, enjoying minimally invasiveness.

BACKGROUND: A number of clinical trials addressing olfactory ensheathing cells for the treatment of chronic spinal cord injury have been conducted in the world, but the efficacy and safety are still controversial. OBJECTIVE: To evaluate the safety and efficacy of olfactory ensheathing cell transplantation for chronic spinal cord injury, and to further compare its short-and long-term efficacy. METHODS: PubMed, Cochrane Library, EMBASE, CNKI and WanFang databases were searched at July 23, 2018 for retrieval of clinical trials addressing olfactory ensheathing cells in the treatment of chronic spinal cord injury. Types and cases of adverse events during the safety trial should be recorded in detail. In the enrolled studies, American Spinal Injury Association scale was used to assess the motor, light touch, and pinprick scores of spinal cord injury patients before and after cell transplantation. The follow-up time was recorded. Systematic evaluation of efficacy data was performed using Review Manager 5.3. RESULTS AND CONCLUSION: Both short-and long-term follow-up data showed that the neurological function of patients was significantly improved after olfactory ensheathing cell transplantation (P < 0.05) , and the results were homogeneous (I2 < 50％ and P> 0.1). However, the long-term efficacy was not as good as the short-term efficacy, which may be related to chronic rejection and olfactory ensheathing cell survival. The overall adverse event rate was 8.99％, and no complications associated with olfactory ensheathing cells occurred. These findings show that olfactory ensheathing cell transplantation is effective and safe in the treatment of chronic spinal cord injury, but it is still necessary to explore more minimally invasive approaches to reduce surgical complications. In addition, a large number of high-quality experiments and clinical trials are warranted to confirm factors affecting the long-term efficacy of olfactory ensheathing cell transplantation.

Objective To explore the effect of Four Flavor Elimination Decoction on treatment of brain metastases.Methods Sixty patients with brain metastases,admitted to our hospital from January 2015 to January 2017,were selected.According to the willing of the patients,they were divided into observation group and control group (n=30).The patients from control group were given conventional medicines,and the patients from observation group were supplemented with Four Flavor Elimination Decoction on the basis of control group.The clinical efficacy of the two groups after treatment,and scores of Kamofsky performance status scale (KPS) and changes of T lymphocyte subsets and tumor markers before treatment and on 7th,14th,21th and 28th d of treatment were observed.Results The total effective rate of the observation group after treatment was 100％,which was significantly higher than that of the control group (50％,P＜0.05).KPS scores of the observation group were significantly higher than those of the control group on 21st and 28th d of treatment (P＜0.05).The levels of CD3+,CD4+ and CD8+ in the observation group were significantly higher than those of the control group after treatment (P＜0.05).The levels of carcino-embryonic antigen,carbohydrate antigen (CA)50 and CA125 in the observation group were significantly lower than those of the control group (P＜0.05).Conclusion Four Flavor Elimination Decoction is efficient in treatment of brain metastases,which can improve quality of life and immune indexes,and is worth of clinical application.

Objective:To investigate the role of TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation in unstable pelvic fracture surgery.Methods:Twelve patients with unstable pelvic fractures, 7 males and 5 females, aged 39.41±12.56 years (range 25-60 years), admitted from January 2020 to January 2021, were retrospectively analyzed. The duration between injury and surgery was 9.67±5.81 d (range 4-24 d). The following are the causes of injury, namely traffic injury in 6 cases, fall from height injury in 4 cases, crush injury in 2 cases. Tile type of pelvic fractures were 3 cases of type B (2 cases of type B2, 1 case of type B3), 9 cases of type C (4 cases of type C1, 3 cases of type C2, 2 cases of type C3). Sacral fractures with Denis division were 5 cases of zone I, 7 cases of zone II. Seven patients were repositioned by intraoperative traction on the injured side of the limb and maintained by fixation with a Starr frame. Two cases were repositioned by intraoperative longitudinal bone traction on each lower limb for fracture displacement. The other 3 B-type fractures were repositioned by inserting Schanz nails into the anterior inferior iliac spine bilaterally. Then, the fractures were maintained with external pelvic fixators. The fractures were assessed by O-arm fluoroscopy. Hollow screws were placed with the aid of orthopedic robotic guidance, and the screw positions were verified by O-arm fluoroscopy again after the nail placement. The duration of each screw placement and operation were recorded. The quality of fracture repositioning, hip function and postoperative complications were observed at the follow-up.Results:All patients were followed up for 8.17±1.99 months (range, 6-12 months). There were 27 screws inserted in 12 patients, with a single screw insertion duration of 19.9±1.8 min (range, 9-31 min). In all patients, one O-arm fluoroscopy was performed in each row after closed reduction and after completion of nail placement. The operative duration was 257.78±80.63 min (range, 160-450 min). The O-arm fluoroscopy after nail placement verified that 23 screws were placed in a satisfactory position at one time, with satisfactory rate of 85% (23/27) for the first nail placement. Two patients with preoperative grade II sacral plexus nerve injury recovered to grade I in one case and grade II in one case. However, the numbness was reduced after operation. No further aggravation of nerve injury occurred after surgery. The quality of fracture repositioning was evaluated according to the Matta score, including excellent in 9 cases, good in 2 cases, and acceptable in 1 case, with an excellent rate of 92% (11/12). At the last follow-up, the Majeed pelvic fracture quantitative assessment system scored 85.75±5.82 (range, 74-96). There were 8 cases in excellent and 4 cases in good. Twelve patients had one-stage wound healing. No complications, such as incision infection, nerve injury, loosening and breaking of the internal fixation occurred during the follow-up.Conclusion:TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation for unstable pelvic fractures has some advantages, including safety, precision, convenient nail placement, and less fluoroscopic radiation.