[Objective]To study the relationship between trauma and the lumbar disc degeneration and to detect the expression of the fibronectin splicing variants in the degenerated lumbar intervertebral disc,and study the expression of EDA.[Method]The human lumbar intervertebral disc tissues were collected to extract total RNA which was then amplified by RT-PCR technique.[Result]EDA~+ Fn of normal lumbar intervertebral disc were not expressed,whereas EDA~+ Fn of degenerated lumbar intervertebral disc were expressed abundantly.The defference between different groups has statistical significance.[Conclusion]EDA~+ Fn has very strongly expression in the lumbar degenerated intervertebral disc,and the trauma is one of prerequisite factors in the disc degenerated process probablely.

0.05).2)a.There was no severe side effects related to cement in 20dogs,and no pulmonary embolic necrosis was found in autopsy.Cement leakage was frequent which occupied the spinal canal no mo re than 1/4of the median sagittal dia meter without major neurological complication.The epidural leaks we re related to the vertebral morpholo gy.b.The average peak temperatures were 70.5℃at the core,53.5℃at the in terface,40.8℃at the anterior corte x,and 40.5℃in the spinal canal.The temperature above 50℃lasted for 2.9minutes at the core,and 1.3minutes at the interface.In pathological examination,necrosis of osteocytes was found focally at t he periphery of the cement,and resid ual bone in this area showed signs of acti ve remodeling.3)The procedure was technically successful in all pa-tients,with an average injection am ount of 6.3ml cement per vertebral body.No clinically significant com-plications were noted.The 3slight e pidural leaks,1slight neural foram ina leak,and 5paravertebral leaks detected with CT had no clinical importance.Partial or complete pain relief was achieved in all patients as-sociated with improved mobility,an d 1patient experienced transitory worsening of pain followed by significant pain relief.Patients with vertebra l haemangioma or compression fractu res were discharged in 1-4days(average,1.6days)after the procedure.Of the 26patien ts,22were followed up from 6to 24mon ths(average,13.5months),partial or complete pain relief were sustained in 21cases,the other one experienced relapse of pain following partial pain relief,which was related to the deterioration of the metastases.Con-clusion Minimal invasive PVP is a valuable alternative in the treatment of painfu l vertebral haemangioma,osteoporotic vertebral fractures,and osteolytic metastases or myelom a,providing acute pain relief and ea rly mobilization in appropriate patien ts.[

Objective Short-segment pedicle instrumentation for thoracolumbar burst fracture was known to have a relatively high incidence of failure and correction loss, intracorporeal gap secondary to reduction being probable causes. The purpose of this study was to evaluate the intracorporeal gap after reduction and the biomechanical effect of vertebroplasty on thoracolumbar burst fractures. Methods Six fresh adult thoracolumbar specimens were collected, and 10 segmental specimens (T11-L1, L2-L4, T12-L2) were processed. Burst fracture was created using free-drop test. Then the fractures were reduced and augmented with injectable self-setting calcium phosphate cement. The intracorporeal gap and bone mineral density(BMD) were measured using spiral CT and dual energy X-ray absorptiometry(DEXA) before fracture, after reduction and after vertebroplasty respectively. The stiffness in middle vertebrae and above discs were measured under flexion, extension, lateral flexion and torsion stress before fracture and after augmentation. The ultimate strength against compression was tested in the augmented vertebrae and the integral vertebrae below it. Results Burst fractures were created in eight of ten specimens. 1) There was no evident intracorporeal gap before fracture, which appeared after reduction with average volume of 5.25 cm3 (13.9% of total corporal volume), and it decreased to normal level after vertebroplasty. 2) The BMD was normal in all specimens before fracture, which decreased significantly after fracture reduction, and it was significantly higher after vertebroplasty than that before fracture or after reduction. 3) There was no significant difference of stiffness in vertebrae before fractures and after augmentation. The mean value of ultimate strength against compression in the augmented vertebrae decreased slightly but not significantly in contrast to the vertebrae below it. In contrast to the value before fracture, the stiffness of above discs decreased significantly under flexion and extension stress but not significantly under lateral flexion stress after augmentation, while the stiffness of the specimen decreased significantly under torsion stress. Conclusion 1) Posterior reduction in thoracolumbar burst fracture can not reestablish intact corporeal structure, which may be an important cause of postoperative implant failure and correction loss. 2) Vertebroplasty with injectable self-setting calcium phosphate cement is helpful to reestablish intact corporeal structure, and restore stiffness and strength of the injured corpora nearly to its initial value.

Objective To investigate the clinical results of percutaneous vertebroplasty(PVP) for symptomatic vertebral hemangioma. Methods Eleven patients(2 males and 9 females) suffered from symptomatic vertebral hemangioma(11 thoracic segment levels and 3 lumbar segment levels) were treated with PVP under DSA or CT guidance. The main goal of this procedure was to relieve hemangioma related pain. All patients were examined with CT scan after intervention and were followed up from 3 to 34 months (average, 15.2 months). Results The procedure was technically successful in all patients, with an average injection amount of 6.3 ml cement per vertebral body. No clinically significant complications were found. There was no epidural leakage, and the 2 paravertebral leakages detected with CT had no clinical importance. Partial or complete pain relief was achieved in all patients associated with improved mobility, and 1 patient experienced transitory worsening of pain followed by significant pain relief. Patients were discharged in 1-4 days (average, 1.5 days) after the procedure. Pain relief was sustained in all patients at the last following-up. Conclusion PVP is a valuable minimal invasive alternative procedure in treatment of symptomatic vertebral hemangioma and provides satisfactory pain relief with less complications.

Objective To analyze the clinical results of percutaneous vertebr oplasty (PVP) for osteolytic spinal tumor. Methods Forty patients with osteolyt ic vertebral metastases or myeloma were selected from Feb. 2000 to Jun. 2003 to undergo percutaneous vertebroplasty. All patients complained of back pain. Among them, 6 cases had radiculopathy, and 1 had paraplegia. Based on CT or MR scanni ng, the posterior vertebral wall was involved in 21 cases. 42 PVP was performed on 59 segment levels under fluoroscopic or CT guidance, including 1 at cervical spine, 29 at thoracic spine, 27 at lumbar spine and 2 at sacrum, and biopsy was performed in 28 cases simultaneously. CT scanning was conducted after interventi on to assess the lesion filling and cement leakage, and all patients were asked to remain lying on bed for 4 hours prior to axial loading. In combination with P VP, radiotherapy, chemotherapy, medicament were administered before or after the intervention. Results The procedure was technically successful in all patients with an average injection amount of 6.5 ml cement per vertebral body. Partial or complete pain relief was achieved in 39 cases, associated with improved mobilit y in 38 cases, the symptoms of patients with radiculopathy and paraplegia were u nchanged. Two cases with severe multiple vertebral destruction underwent PVP at one segment, neither of them experienced improved mobility. In one case, the sev erity of pain was unchanged, while the other experienced partial pain relief for 48 hours. Leakages were detected with CT at 21 levels of 17 cases. 2 of 7 epidu ral leakage produced transitory radicular pain, which were relieved in 6 h and 8 h respectively. 2 with intervertebral foraminal venous leakage, 8 with paravert ebral leakage, and 6 with intra-disc leakage had no clinical symptoms. 37 cases were followed up from 2 to 32 months (average, 8.5 months). Exclusive of poor re sults in 2 patients, pain relief was sustained in 29 cases, and 6 patients exper ienced relapse of pain following partial pain relief, which was related to the d eterioration of tumors. Conclusion PVP of osteolytic spinal tumors is a minimal invasive procedure that provides immediate and stable pain relief with improved mobility. It can be combined with radiotherapy or chemotherapy.

Objective To investigate the effectiveness of TACE in combination with percutaneous microwave coagulation therapy(PMCT) in treatment of hepatocellular carcinoma.Methods 82 cases of hepatocellular carcinoma confirmed by pathology were randomly divided into 2 groups by odd or even hospitalization number.A total of 40 patients were enrolled in the TACE only group(group A) and 42 patients were enrolled in the synthetic therapy group(group B,underwent treatment by TACE in combination with PMCT).Results The survival rates in 1,2 and 3 years were 70%,54% and 20%,respectively,with a median survival of 1.72 years in group A,and 88%,76% and 51%,respectively,with a median survival of 2.1 years in group B.The survival rates in group B were significantly higher than that in group A(P

Objective To investigate the interventional therapy for the complication in the treatment of advanced primary hepatocellular carcinoma.Methods 62 cases of primary hepatocellular carcinoma confirmed by pathology,imagings and AFP,were randomly divided into 2 groups according to odd or even hospitalization number.32 patients were enrolled in the TACE group(control group)and 30 patients were enrolled in the combination therapy group(TACE + other kinds of therapy).Patients in the combination therapy group underwent the TACE procedure adding with another kind of therapy for treating the complication such as arterial,venous,portal vein cancer embolism,or the inferior vena cava tumor embolisms and may further include ablation of residual cancer,jaundice,hepatic abscess or biloma.Results 1,2,3-years survival rates and median survival rates of the control group and combination therapy group were 68%,50%,19% and 87%,75%,48%;1.5 years and 2 years,respectively.Survival rate and duration in the combination therapy group was significantly greater than those of control group(P

Objective To establish a UPLC-MS/MS method for the determination of dexmedetomidine in human plasma and investigate the effect of obstructive jaundice on pharmacokinetics of dexmedetomidine in vivo. Methods Samples were obtained by liquid-liquid extraction. Agilent Eclipse Plus C₁₈ column was used for chromatograph with methanol and 0.1% formic acid-water solution as mobile phase. Flow rate was 0.2 ml/min. The column temperature was 35 ℃, and the MS detection was selected in MRM mode. Results The calibration curves of dexmedetomidine showed good linearity in the ranges of 0.01−10.00 ng/ml. The results of intra and inter-day precisions were both within 15%. The recovery rate was 85.5%−93.1%. Matrix effect was 91.2%−95.6%. Samples remained stable during analysis. Compared with the control group, c_max、AUC_(0−t)、AUC_(0−∞) and V_z of dexmedetomidine in the patients with obstructive jaundice were increased by 63.4%, 78.9, 66.4%, 82.5%, respectively (P<0.01). CLz was decreased by 42.1%. Conclusion This method is accurate, sensitive and reproducible. It is suitable for dexmedetomidine assay in human plasma. The elimination rate of dexmedetomidine is slower in obstructive jaundice.

OBJECTIVETo determine the prevalence of loss to follow-up (PLF) and risk factors among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients from 1989 to 2012 in Baoshan city, Yunnan province.

METHODSThe epidemic and follow-up databases of HIV/AIDS patients by the end of 2012 were downloaded from "the history card downloading site" of HIV/AIDS database in China Information System for Disease Control and Prevention and obtained the related data of patients from 1989 to 2012 who had local residence in Baoshan city. These data included demographic characteristics (genders, age at the time of HIV testing positive, and occupation, marital status, and education levels, et al), transmission routes, and disease staging, antiretroviral therapy (ART), and sources of samples, the first CD4(+)T cell counts, and status of follow-up, et al. Descriptive epidemiological study was used to describe the general characteristics of loss to follow-up. Multivariable Cox regression was used for determining risk factors associated with loss to follow-up.

RESULTSA total of 3 295 eligible HIV/AIDS patients from 1989 to 2012 were included. The accumulative study person-year was 11 416.59 years, 222 HIV/AIDS patients were lost to follow-up, and the PLF was 0.019 4/ person years (py). The highest PLF was 0.052 8/py in 2008, the lowest was 0.006 2/py in 2012. The lost patients included 56.76% (126/222) males and 43.24% (96/222) females, the PLFs were 0.020 4/py, 0.018 3/py, respectively. Baoshan city, other cities in Yunnan province, and other provinces, foreign nationality as the family register reached 53.60% (119/222) , 28.83% (64/222) , and 5.86% (13/222) , 11.71% (26/222) , respectively, and their PLFs were 0.012 5/py, 0.046 3/py, and 0.053 6/py, 0.095 6/py, respectively. Receiving ART and not receiving ART occupied 6.76% (15/222) , 93.24% (207/222) , respectively, and the PLFs were 0.001 9/py, 0.0588/py. AIDS and HIV staging standed at 8.11% (18/222) , 91.89% (204/222) , respectively, and the PLFs were 0.003 3, 0.034 5/py. The first CD4(+)T cell counts < 200, 200-350, and > 350 cells /ml accounted for 4.95% (11/222) , 73.87% (164/222) , 21.17% (47/222) , respectively, and the PLFs were 0.004 8/py, 0.024 0/py, 0.020 3/py. The results of multivariable Cox regression showed the risks of loss to follow-up (RLFs) of family register as other cities in Yunnan province (HR = 3.11, 95%CI:2.28-4.25) , other provinces (HR = 2.55, 95%CI:1.42-4.56) , and foreign nationality (HR = 2.12, 95%CI:1.35-3.33) higher than that of Baoshan city, respectively. The RLFs of not receiving ART (HR = 20.83, 95%CI:11.74-36.96) and HIV staging (HR = 3.61, 95%CI:1.82-7.16) were higher than those of receiving ART and AIDS staging, respectively, moreover, the RFLs of the first CD4(+)T cell counts between 200-350 cells/ml (HR = 0.35, 95%CI:0.15-0.82) and the first CD4(+)T cell counts > 350 cells/ml (HR = 0.29, 95%CI:0.12-0.72) were less than that of first CD4(+)T cell counts < 200 cells /ml, respectively. The RLF of transmission route as injecting drug (HR = 0.60, 95%CI:0.41-0.88) was less than that of heterosexual contact.

CONCLUSIONOverall, the prevalence of loss to follow-up among HIV/AIDS patients shows a downward trend, moreover, patients of outsiders, heterosexual contact, HIV staging, baseline CD4(+)T cell counts < 200 cells/ml are at higher risk of loss to follow-up.

Acquired Immunodeficiency Syndrome ; epidemiology ; China ; epidemiology ; Continuity of Patient Care ; statistics & numerical data ; trends ; Female ; Follow-Up Studies ; HIV Infections ; epidemiology ; Humans ; Lymphocyte Count ; Male ; Prevalence ; Risk Factors

Objective To evaluate the efficacy of mobile endospine system for sequested lumbar disc herniation.Methods From May 2007 to December 2009,31 patients of sequested lumbar disc herniation were treated with mobile endospine system,including 17 men and 14 women with a mean age of 46 years (32-59 years).Patients complained severe leg and low back pain with disability.According to MRI,the sequested nucleus herniated from the disc of L2-3 in 1 case,L3-4 in 1,L4-5 in 16 and L5S1 in 13;and the direction of herniation was caudal in 24 cases,cephalic in 6 and indistinguishable in 1.The patients were followed up for 12 months (range,6-24 months) ,and the results were evaluated according to Macnab scale.Results The procedure was technically successful in all the patients:the sequested nucleus was completely extracted.The protruded disc was treated with discectomy in 30 cases,and the nearly intact disc was left untouched in one patient.Among the 24 cases with caudal herniation,sequested nucleus situated ventrally beneath the dural theca and the transitional nerve root in 15 cases,between the nerve root and dural theca in 5,and dorsally on the nerve root and dural theca in 4.All the 6 cephalic herniation situated beneath the dural theca,1 of them reached the level of pedicle,and 2 herniated into the intervertebral canal.The sequested disc presented as indistinguishable signal on MRI included nucleus,annulus and cartilage endplate,and situated dorsally around the dural theca.The mean operative time was 50 min (range,40-70 min) with a mean blood loss of 80 ml (range,30-200 ml).There was no complication of nerve injury.Only too much facet was resected in 2 patients without clinical symptom.The results were excellent in 21 cases and good in 10 cases,and all of them were satisfied with this procedure.Conclusion The working canal and visual field of mobile endospine system is movable,so the sequested nucleus can be extracted completely with good results.