Objective To explore the risk factors in the prognosis of patients with severe multiple trauma related factors.Methods Ninety-three patients with severe multiple trauma(ISS score≥16 points) were selected as our subjects,who all hospitalized in the second hospital affiliated to Dalian medical University.Among of which,38 cases' ISS score was 16-25,and 55 cases' ISS score was higher and equal to 25.Clinical data and general information were recorded.ISS score,APACHE Ⅱ score and 6 h lactate clearance rate score were measured.Results Twenty-seven dead among these 93 cases and the mortality was 29.03％.There were significant differences in terms of ISS score,APACHE Ⅱ score,lactate level when entering ICU,6 h lactate level and 6 h lactate clearance rate between death patients (27 cases) and survival patients (66 cases) (t =9.846,9.812,7.112,7.012,9.831 ; P ＜ 0.001).In multiple organ dysfunction syndrome (MODS) patients,the mortality of ISS score:16-25 group was different from that of ISS score≥25 (15.78％ (6/38) vs.35.18％ (21/93),x2 =21.52,P ＜0.001).Among the 93 cases of severe multiple trauma,35 cases with MODS(37.6％ (35/93)),and 20 cases of which were dead(57.1％ (20/35)).There was statistic difference between MODS group(35 cases) and non-MODS(58 cases) in term of mortality(37.6％ (35/93) vs.12.1％ (7/58) ;x2 =21.52,P ＜ 0.001).Multivariate logistic regression analysis showed that the ISS score,APACHE Ⅱ score,6 h lactate clearance rate and MODS were independently prognostic correlation factors (P ＜ 0.05).Operating characteristic curve (ROC) showed that AUC of ISS score was 0.735 (95 ％ CI 0.629-0.842),of APACHE Ⅱ score was 0.888 (95％ CI 0.821 =0.956),of 6 h lactate clearance rate score was 0.951 (95％ CI 0.906 -0.997).Conclusion The factors of ISS score,APPCHE Ⅱ assessment,6 h lactate clearance rate,the occurrence of MODS are independent prognostic factors.

BACKGROUND:When peri-implantitis occurs, the levels of interleukin-17 in the peri-implant sulcular fluid and soft tissues are significantly increased, and there is a positive correlation with the depth of the peri-implant probing. However, because of the dual effects of bone absorption and protection, the function of interleukin-17 in peri-implantitis remains controversial, which should be further studied. OBJECTIVE:To retrospectively analyze the correlation between peri-implantitis and interleukin-17. METHODS: The first author searched Wanfang, CNKI and Medline databases from 1991 to 2014 by using key words of “dental implants, peri-implantitis, periodontitis, Th17 cels, interleukin-17, cytokines” in Chinese or English. The functions of bone destruction and protection of interleukin-17 in peri-implantitis were reviewed, and interleukin-17 expression and correlation with the peri-implantitis were detected. RESULTS AND CONCLUSION:According to the inclusion and exclusion criteria, 46 articles from 241 articles are selected. The results show that, noninvasive detection of the variation of interleukin-17 levels in peri-implant sulcular fluid or blood is conducive to the monitoring of early diagnosis and treatment of peri-implantitis. At present, most researches show the relationship between interleukin-17 and peri-implantitis, and there is a positive correlation between interleukin-17 and peri-implant probing depth. But other researches suggest that interleukin-17 acts as protector for bones, and there is no statistic significance in the level of interleukin-17 receptor gene in chronic peri-odontitis and healthy subjects. Therefore, the correlation between peri-implantitis and interleukin-17 remains to be further studied.

Objective To explore the effects of traditional Chinese medicine (TCM) five-tone therapy in combination with constitutional types of Chinese medicine based dietary intervention on patients with irritable bowel syndrome (IBS). Methods By convenience sampling, a study was conducted among 68 patients with IBS. The patients were divided into the control group and the intervention group by random digital table method, and each group consisted of 34 patients. Patients in two groups were both treated with conventional drug and routine nursing care, but patients in the intervention group were provided TCM five-tone therapy in combination with constitutional types of Chinese medicine based dietary intervention for 3 months. Patients in two groups were assessed by Chinese Medicine Constitution Questionnaire (CMCQ), Symptom Check List-90 (SCL-90), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) before treatment and after 12-week treatment. Results After TCM five-tone therapy in combination with constitutional types of Chinese medicine based dietary intervention, the number of IBS patients with pathological constitution types decreased in two groups, the number of patients with gentleness constitution increased to 8 and 25 separately in the control group and intervention group (P<0.05). After intervention, the scores of SAS and SDS in the intervention group were (40.73±8.27)points and (41.16±8.75)points respectively, which were lower than(48.36±7.53)points and(50.03±9.23)points of the control group, and the difference was statistically significant (P< 0.05). The intervention group scored lower than the control group in SCL-90, and the scores had significant differences between two groups (P<0.05). Conclusions TCM five-tone therapy in combination with constitutional types of Chinese medicine based dietary intervention may be more effective in adjusting pathological constitution to gentleness constitution of patients with IBS, alleviating their depression and anxiety and improving their physiological symptoms.

Objective To study the effects of traditional Chinese medicine (TCM) five-tone therapy on nursing care of patients with irritable bowel syndrome (IBS).Methods By convenience sampling,a study was conducted among 100 patients with IBS.The patients were randomly divided into the control group and the intervention group,each group consisted of 50 patients.Patients in two groups were both treated with conventional drug and routine nursing care,but patients in the intervention group were intervened by TCM five-tone therapy for 3 months.Clinical efficiency of patients in two groups were assessed by Symptoms Check List-90 (SCL-90),Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD)before treatment and after 12-week treatment.Results The clinical efficiency in the control group and intervention group were 60％ (30/50) and 84％ (42/50) after intervention (P＜0.05).The scores of HAMA and HAMD after TCM five-tone therapy intervened were (5.24±1.15)points and (5.21±1.63) points,which were lower than the control group (8.32±1.42)points and (7.64±1.96) points (P＜0.05).The intervention group was scored lower than the control group in SCL-90 (P＜0.05).Conclusions TCM five-tone therapy may be more effective in decreasing the depression and anxiety of patients with IBS and alleviating their abdominal symptoms.

OBJECTIVETo investigate the clinical features, surgical transcranial approaches and outcomes of giant pituitary adenomas.

METHODSA series of 112 consecutive cases of giant pituitary adenomas underwent microsurgery through transcranial approaches at People' s Liberation Army General Hospital were retrospectively analyzed. Of the 112 patients, 58 were male and 54 were female, with age ranging from 3 to 72 years(mean age 44. 3 years). There were 91 non-functioning adenomas and 21 hormone-secreting adenomas. The maximum tumor diameter varied from 4. 0 to 7. 2 cm, with mean diameter of 4. 8 cm. Unilateral subfrontal approach was chosen in 16 cases, pterional approach in 41 cases, anterior interhemispheric approach in 34 cases, transcallosal-interforniceal approach in 6 cases, transcortical- transventricular approach in 5 cases, combined approach in 6 cases and other approaches in 4 cases. Postoperative MRI and endocrine function were re-examined routinely to evaluate the therapeutic efficacy. Staged operation through transsphenoidal approach or adjuvant treatments including medical and radiation therapies were administered in patients with hormone-secreting adenomas when hormonal excess persisted after surgery and in patients with non-functioning adenomas who had postoperative MRI evidence of residual tumor.

RESULTSTotal removal of the lesion was achieved in 57 cases (50. 9%) , 26 patients (23. 2%) underwent subtotal resection, and 29 patients (25. 9%) underwent partial removal. Postoperative mortality occurred in 3 patients (2. 7%). Major surgical morbidity occurred in 38 patients (33. 9%). Vision was preserved or improved in 98 patients (87. 5%). The postsurgical follow-up period varied from 3 to 64 months (mean 19. 5 months) . Nineteen of the 21 patients with hormone-secreting adenomas were considered to be in hormonal remission, and 87. 2% of the cases were capable of normal work and life and 8 patients suffered recurrence during the followed-up period.

CONCLUSIONSSelection of appropriate transcranial approaches is the key to successful microsurgery for giant pituitary adenomas according to the morphological characteristics presented in image examinations and clinical symptoms. Staged transsphenoidal operation and/or adjuvant therapies including medical and radiation therapies offer the best chances to control the residual tumors after the maximal surgical removal of giant adenomas through transcranial approaches.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Microsurgery ; methods ; Middle Aged ; Neurosurgical Procedures ; methods ; Pituitary Neoplasms ; surgery ; Postoperative Period ; Retrospective Studies ; Young Adult

Adenocarcinoma, Mucinous ; pathology ; Adult ; Breast ; metabolism ; pathology ; Breast Neoplasms ; metabolism ; pathology ; Carcinoma ; metabolism ; pathology ; Female ; Humans ; Keratins ; metabolism ; Metaplasia ; Mucin-1 ; metabolism ; S100 Proteins ; metabolism

Attention deficit hyperactivity disorder (ADHD) has been associated with an elevated risk for obesity but this seems to be paradoxical to the fact that many youths with ADHD have symptoms of hyperactivity. People diagnosed with ADHD tend to have a high risk of developing undesirable diet habits and consequently have health related problems. However, less attention has been paid to obesity in ADHD while many efforts have been devoted to the prevention of childhood obesity in mentally normal people. Hence the purpose of this study was to explore the nutritional status and life habits of children and adolescents with ADHD (n = 76) based on degree of obesity by utilizing the Korean National Health and Nutrition Examination Survey (KNHANES) data from 2005–2013. As results the levels of blood pressure, total triglycerides and the fat intake relative to total energy intake in overweight ADHD group were higher than those in normal weight group. Interestingly, overweight ADHD subjects consumed significantly less amount of iron compared to normal weight ADHD subjects and the level of serum ferritin was lower in the overweight ADHD group (59.0 ng/mL) than in the normal weight ADHD group (47.9 ng/mL). After adjusting total energy intake, total vegetable consumption was 14.3% lower in overweight group compared to the consumption in normal weight group. These results indicate a plausible relationship of iron status and obesity in ADHD subjects but this relationship may not be specific to ADHD. A future study with case-control design is necessary to investigate the association of obesity, nutrient intake, and cognitive/mental status of ADHD.
Adolescent* ; Attention Deficit Disorder with Hyperactivity* ; Blood Pressure ; Case-Control Studies ; Child* ; Energy Intake ; Ferritins ; Food Habits ; Humans ; Iron ; Nutrition Surveys ; Nutritional Status* ; Obesity ; Overweight ; Pediatric Obesity ; Triglycerides ; Vegetables

Objective To evaluate the reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation and therapeutic strategy choice of intracranial tumors.Methods MRI scan,including regular MRI,MRA,MRV and DTI,were performed in 87 case.Then tumor themselves as well as tumor-associated structures were reconstructed and fused through iPlan 2.6 software.Based on the reconstructed images,therapeutic strategy were established,preoperative and intraoperative imags were compared.Results The digital reconstruction were successfully finished in all cases.Meanwhile,digital images,originally radiological images and actual images matched well.No approach-associated complication were met in our series.Among tumors in the convexity,the relationship of the reflux veins and the tumors were divided into three types:anterior(12 cases),posterior(19 cases) and overriding(3 cases).All of the relationships were seen in the preoperative fusion image,and the veins were all effectively protected during operation.The tumor-associated arteries could be pushed or wraped by the tumors,and the three-dimensional fusion image could provided their virtually aberrant pathway as well as their relationship with tumor.During microsurgical managment of tumors in the deep brain parenchyma,safe approach were found with the help of comprehensive understanding of the tumors and their adjacent structures.Conclusion Three-dimensional digital fusion anatomy can vividly and accurately display full rang of information about the tumor,and facilitate tumor treatment safely.

The data of 30 patients simulated before surgery were analyzed using Dextroscope operation planning system in Department of Neuresurgery,General Hospital of Chinese PLA between August 2004 and September 2005,including 2 patients with basilar artery aneurysm,1 with posterior cerebral artery aneurysm,3 with ophthalmic aneurysm,2 with middle cerebral artery aneurysms,1 with anterior cerebral artery aneurysm,7 atlas-occipital malformation,4 meningioma,5 schwannomas,and 5 deep gliomas. The primary CT and MRI data of 30 patients were input to the workstation of Dextroscope system for 3D reconstruction,reunion,segmentation and simulation the entire process of the operation. The relationship of the cranial nerves,vessels and skull base bone with lesions during operations were similar with that of the preoperative simulation on the workstation. The time of clipping aneurysms was reduced from (37.60±13.43) minutes to (23.51±7.62) minutes following application of Dextroscope system,and time of resections of odontoid processes was shortened from 81 minutes to 50 minutes. The ratios of complications were decreased and the patients' Karnofsky scales were 88.7 scores 3 months after operation. Dextroscope operation planning system can help doctors to analyze the patients' image data on a 3-D view and video outlook. The system can raise a precise and detailed operation plan before operation based on the simulation of the operation process,to well know the difficulty and shorten operation duration.

BACKGROUND:There is evidence that internal fixation through an anterior or posterior approach for treatment of severe kyphotic deformity in spinal tuberculosis exhibits good curative effects. However, few prospective, long-term fol ow-up case control studies are reported. OBJECTIVE:To investigate the efficacy and safety of cobalt al oy pedicle screw implantation for treatment of severe kyphotic deformity in spinal tuberculosis. METHODS/DESIGN:This is a prospective, single-center, self-control, open-label trial, which wil be performed at the Affiliated Hospital of Hebei University, China. Eighty-four patients with severe kyphotic deformity in spinal tuberculosis wil be included according to the diagnosis criteria. Among 52 patients with tuberculosis of the thoracic spine, 28 wil undergo surgery through a posterior approach, and 24 through an anterior approach. According to the Frankel Grade classification, grade C, D and E spinal cord function wil be assessed in 8, 31 and 13 patients, respectively. Surgery through a posterior and anterior approach wil be respectively performed in half of 32 patients with tuberculosis of the lumbar spine. Grade C, D and E spinal cord function wil be assessed in 7, 14 and 11 patients, respectively. The primary outcome measure of this study wil be the Cobb angle at the thoracic spine segments before and 2 years after surgery, which wil be used to evaluate the angle of the spine curvature at the thoracic segments. The secondary outcome measures wil be X-ray scan or MRI findings before and 2 years after surgery, which wil be used to evaluate vertebral fusion after internal fixation;and Frankel Grade before and 2 years after surgery, which wil be used to evaluate recovery of spinal cord function after injury. Other outcome measures wil include multiple logistic regression analysis results of the factors that influence patient's curative effects and the incidence of adverse events 2 years after surgery. The trial protocol has been approved by the Ethics Committee, Affiliated Hospital of Hebei University, China and wil be performed in strict accordance with the Declaration of Helsinki, formulated by the World Medical Association. Signed informed consent regarding the trial protocol wil be obtained from each participant. DISCUSSION:This study is to validate that cobalt al oy pedicle screw implantation shows precise curative effects in the treatment of severe kyphotic deformity in spinal tuberculosis and to analyze through what approach, posterior or anterior, internal fixation wil be more beneficial to surgery performance. The outcomes of this study wil provide objective long-term fol ow-up evidence for internal fixation treatment of severe kyphotic deformity in spinal tuberculosis in the clinic.