Objective To explore the causes and preventive measures of missed diagnosis of motor system's fiactures following traumatic brain injury.Methods Retrospective analysis was performed on 52 patients suffering from severe traumatic brain injury and motor system's fractures from January 1995 to December 2009. Statistical analysis was performed to demonstrate the relation between doctors' seniority and the missed diagnosis on fracture, and different results between the patients with missed diagnosis and correct diagnosis were compared. Results 56 fractures, including fractures spinal in 18, pelvic fractures in 11 and fractures of the extremities in 23, were noted in 52 patients. The doctors' seniority was closely correlated to the missed diagnosis rate; the residents had a significantly higher missed diagnosis rate than the attending physicians (P＜0.05). Patients with fractures of the extremities showed obviously low efficacy than those with correct diagnosis (P＜0.05). Conclusion strict and regulated medical examinations and timely X-ray photographs or CT examination can help to make correct diagnosis; choosing the proper operation time on the fractures can effectively reduce the morbidity rate.

OBJECTIVE To explore the value of spiral CT in detecting narrow level of obstructive sleep apnea hypopnea syndrome(OSAHS) through investigating measured parameters of upper airway. METHODS The upper airway levels from the roof of nasopharynx to the inferior border of cricoid cartilage were scanned with spiral CT in 127 OSAHS patients and 52 controls.The coronal and sagittal diameter and the cross sectional areas of palate,uvula,tongue, epiglottis level were measured using image handling workstation.The measured values of each level were divided by the measured values of the cricoid cartilage level,and get relative values.The relative values of the OSAHS patients and controls were compared. RESULTS The relative values of posterior soft palate and uvula region,lingual region and epiglottis regions were statistically different.The difference also existed between genders.The relative values of 46 controls and 17 OSAHS patients were in the normal range. Among 127 OSAHS,the relative values of 110 cases with OSAHS(86.6%) were below the normal range in every region,while in control group,the relative values were found below the normal range in only 6 persons (11.2%).CONCLUSION The relative values of each regions is useful to judge the narrow level of upper airway in OSAHS patients.

Objective To observe the therapeutic efficacy of eight nape needle therapy in treating mild cognitive impairment (MCI) after cerebral stroke. Method By following a randomized controlled trial design, 200 eligible patients were randomized into an eight nape needle group and a medication group by the random number table, with 100 cases in each group. The patients all received basic medications, while the eight nape needle group was additionally intervened by acupuncture at the eight nape acupoints including Fengchi (GB20), Fengfu (GV16), Dazhui (GV14) and Xiangsihua points (Extra), and the medication group additionally received oral administration of nimodipine. The intervention lasted eight weeks, followed by a three-month follow-up. Before and after treatment, the two groups of patients were evaluated by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Barthel Index (BI). Result Respectively at four-week and eight-week treatment and the follow-up, the scores of MMSE, MoCA and BI showed improvements compared with the corresponding baseline (P<0.01, P<0.05);compared with the medication group, the eight nape needle group was superior to the medication group comparing the MMSE score at each time point after treatment (P<0.01, P<0.05); there were no significant differences in the MoCA and BI scores between the two groups at four-week treatment (P>0.05), but the differences were significant at eight-week treatment and the follow-up (P<0.01). Conclusion Eight nape needle therapy can effectively improve the cognitive function in patients with MCI after cerebral stroke.

The clinical application of orbital magnetic resonance (MR) T2-mapping imaging in detecting the disease activity of Graves' ophthalmopathy (GO),and the predictive values of therapy response to intravenous glucocorticoid (ivGC) were investigated.Approved by the local institutional review board (IRB),106 consecutive patients with GO were included in this prospective study.All subjects were divided into two groups according to the patients' clinical activity score (CAS):the CAS positive group (CAS ≥3) or the CAS negative group (CAS ＜3).T2 relaxation time of extraocular muscles (T2RT;ms) and the areas of four extra-ocular muscles (AEOMs;mm2) were measured by 3D T2-mapping MR sequence before and after methylprednisolone treatment,so as the CAS and some ophthalmic examinations including visual acuity,intra-ocular pressure,eyeball movement,diplopia and proptosis.In addition,24 healthy volunteers were recruited as the control group.The mean T2RT and AEOMs in CAS positive group were higher than those in CAS negative group.Both CAS positive and negative groups had significantly higher mean T2RT and AEOMs than the control group (P＜0.01).There was a positive correlation between T2RT and AEOMs values in GO patients,both of them had a positive correlation with CAS and the ophthalmic examinations.It was concluded that to evaluate the activity of GO,CAS was mostly related to inflammation symptoms of ocular surface,more than that,T2RT and AEOMs were also related to abnormal findings of the ophthalmic examinations including high ocular pressure,impaired eyeball movement,diplopia and proptosis.T2RT and AEOMs can reflex the inflammation state of ocular muscles better.CAS combined with 3D T2-mapping MR imaging could improve the sensitivity of detection of active GO so as the prediction and evaluation of the response to methylprednisolone treatment.

Objective:To investigate clinical efficacy of composite subcutaneous pedicled flaps in repairing full-thickness nasal alar defects.Methods:Clinical data were collected from 11 patients with basal cell carcinoma of nasal ala in Department of Dermatologic Surgery, the Third People′s Hospital of Hangzhou from August 2019 to September 2020, and analyzed retrospectively. There were 6 females and 5 males, aged 70 years in average (range, 56-87 years) . After tumor resection, full-thickness nasal alar defects were formed, a flap was designed along the inner side of the cheek and turned by 180 degrees to repair the nasal mucosal lining; then, a subcutaneous pedicled flap was designed along the ipsilateral nasolabial fold to repair the outer secondary defects and postoperative defects.Results:The mean diameter of postoperative defects was 1.8 cm (range, 1.5-2.5 cm) , and the mean diameter of the nasal lining was 0.9 cm (range, 0.6-1.5 cm) . Seven days after the operation, stitches were removed, wounds healed without complications, and all flaps survived with a satisfactory appearance. The follow-up period ranged from 1 to 13 months (average, 6 months). After scar maturation, all patients were satisfied with the aesthetic outcome. No tumor recurrence was observed during the follow-up period.Conclusion:The composite subcutaneous pedicled flap is safe and effective for the repair of full-thickness nasal alar defects, and has advantages of a well-hidden donor site, good color match, and stage-I operation for reconstruction.

OBJECTIVETo access the efficacy of posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury using CYL-pedicle screw.

METHODSFrom September 2007 to December 2009, 74 cases who underwent posterior short-segment fixation for single level thoracolumbar burst fractures (Denis burst fracture type A, B, C) without spinal injury were analyzed retrospectively. There were 53 male and 21 female, mean age was (39 ± 15) years. Neither of them treated with direct decompression, grafting or fusion. Changes in the anterior vertebral height ratio, vertebral wedge angle, Cobb angle, regional angle were measured preoperatively, postoperatively, before implant removal, and at final follow-up to find the statistic difference. Pain status and work status were evaluated using Denis criterion. The incidence of incision infection, screw breakage, iatrogenic spinal injury were recorded as well.

RESULTSThe time of follow-up was (20 ± 11) months, no significant change was noted in anterior vertebral height ratio and vertebral wedge angle (P > 0.05). A significant loss was noted in Cobb angle and regional angle, which were 9.8° ± 5.1° and 9.1° ± 4.8° respectively (t = 2.48 and 3.41, P < 0.05). Comparing with the patients with Cobb angle > 20°, the patients with Cobb angle ≤ 20° had better pain scale rate (χ(2) = 4.16, P = 0.04) and work scale rate (χ(2) = 24.34, P < 0.01). There were incision infection in 1 case, screw breakage in 1, screw loose in 1, and no iatrogenic spinal injury.

CONCLUSIONSCYL-pedicle screw could be successfully used in posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury based on radiographic and clinic outcomes.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; Young Adult

OBJECTIVETo explore the effects of Huoxiang Zhengqi liquid (HXZQ) on enteric mucosal immune responses in mice with Bacillus dysenteriae and Salmonella typhimurium induced diarrhea (BSD).

METHODMice were randomly divided into four groups with 10 mice in each group: control group (control), BSD group, Huoxiang Zhengqi liquid treated BSD groups at high dosage and low dosage (HXZQ high, HXZQ low). HXZQ was administrated from the day of diarrhea induction at dosage of 5.21 g kg(-1) and 0.52 g kg (-1) respectively. Peyer's patch and periphery lymphocytes were prepared for flow cytometry, and level of TNF-alpha in periphery and enteric tissue homogenate were determined with ELISA. Student's t-test was used for statistics.

RESULTMice in BSD group started showing continuous diarrhea at the day of induction till the fourth day when the mice were sacrificed. Diarrhea in the mice of HXZQ high and low groups lasted for 36 and 54 h respectively. There were more CD4+ and CD8+ cells in periphery, less CD4+ cells in peyer's patch in BSD mice comparing to normal mice. In peyer's patch, there were more CD8+ cells in mice in HXZQ high and low groups and more CD4+ in mice in HXZQ high group. Higher level TNF-alpha in periphery and intestinal tissue homogenate in BSD group were observed. Mice in HXZQ high group showed the decreased level TNF-alpha in periphery and enteric tissue homogenate.

CONCLUSIONThe immune regulation on peyer's patch CD4+ and CD8+ cells and suppression on TNF-alpha level in enteric homogenate might partially explain the effect of HXZQ on improvement of BSD.

Animals ; CD4-CD8 Ratio ; Colon ; immunology ; metabolism ; pathology ; Diarrhea ; immunology ; metabolism ; microbiology ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacology ; Dysentery, Bacillary ; immunology ; metabolism ; microbiology ; Immunity, Mucosal ; drug effects ; Intestinal Mucosa ; immunology ; pathology ; Male ; Mice ; Mice, Inbred BALB C ; Peyer's Patches ; drug effects ; immunology ; pathology ; Plants, Medicinal ; chemistry ; Random Allocation ; Salmonella Infections ; immunology ; metabolism ; microbiology ; Salmonella typhimurium ; immunology ; Shigella dysenteriae ; immunology ; T-Lymphocyte Subsets ; drug effects ; immunology ; pathology ; Tumor Necrosis Factor-alpha ; blood ; metabolism

OBJECTIVETo identify the activin A receptor type II-like 1 gene (ACVRL1) mutations in a Chinese family with hereditary hemorrhagic telangiectasia (HHT2).

METHODSThe exons 3, 7 and 8 of ACVRL1 gene of the proband and her five family members were amplified by polymerase chain reaction (PCR), and the PCR products were sequenced.

RESULTSThe proband had obvious telangiectasis of gastric mucosa, and small arteriovenous fistula in the right kidney. All the patients in the HHT2 family had iterative epistaxis or bleeding in other sites, and had telangiectasis of nasal mucosa, tunica mucosa oris and finger tips. ACVRL1 gene analysis confirmed that there is frameshift mutation caused by deletion of G145 in exon 3 in the 4 patients, but the mutation is absent in 2 members without HHT2.

CONCLUSIONThe HHT2 family is caused by a 145delG mutation of ACVRL1 gene, resulting in frameshift and a new stop codon at codon 53.

Activin Receptors, Type II ; genetics ; Exons ; genetics ; Female ; Frameshift Mutation ; genetics ; Humans ; Male ; Mutation ; Polymerase Chain Reaction ; Telangiectasia, Hereditary Hemorrhagic ; genetics ; pathology

AIM:To investigate the role of autophagy in inhibition of human lung cancer PC 9 cell proliferation by ursolic acid(UA)as well as the underlying mechanism.METHODS:MTT assay and Trypan blue exclusion test were performed to analyze the effect of UA on the proliferation of PC 9 cells.The PC9 cells were treated with UA,and autophagy was observed under fluorescence microscope through acridine orange staining.The expression of autophagy-associated pro-teins LC3 and ATG5 in the PC9 cells were detected by Western blot.The effect of UA,3-methyladenine(3-MA)3-MA or their combination on the cell viability was measured by MTT assay.RESULTS:The viability of PC9 cells was significantly inhibited by UA(P<0.05 or P<0.01).The number of bright red fluorescence positive cells was significantly increased after treatment with UA.The protein expression of LC3-II and ATG5 was significantly up-regulated compared with control group(P<0.01).Furthermore,combination of UA and 3-MA resulted in a substantial decrease in cell viability compared with using UA alone(P<0.01).CONCLUSION: UA inhibits the proliferation and induces the autophagy of the PC 9 cells,in which autophagy plays a protective role.The inhibition of autophagy significantly promotes the death of the PC 9 cells induced by UA.

We reported a technical report of traumatic lower cervical spondylolisthesisca used by bilateral pedicle fracture, without neurological compression. The patient was treated with the minimally invasive technique of percutaneous pedicle screw fixation. Fracture healing and normal cervical motion were confirmed by plain films and physical examinations on the 18-monthpostoperatively. The technique of percutaneous pedicle screw fixation might be an alternative strategy for the treatment of traumatic lower cervical spondylolisthesis with pedicle fracture.
Cervical Vertebrae ; Female ; Fracture Healing ; Humans ; Physical Examination ; Spondylolisthesis*