The present of atlanto-axial pedicle screw fixation through posterior approach provide a new remedy for treating instability of pillow and cervical. A lot of researches have reported feasibility of atlanto-axial pedicle screw fixation, the results showed that it had advantages of easily exposure, less blood loss, shorter operative time, especially in treating as remedy fixation for atlanto-axial joint screw, atlas lateral mass screws and pedicle screw caused by injuries of tumor,inflammation and trauma. If not done properly, it can cause serious complications, such as iatrogenic fracture,injuries of vertebral artery and cervical spinal cord. Therefore,the safty and effectiveness of atlanto-axial pedicle screw fixation may be focus of research.
Atlanto-Axial Joint ; surgery ; Bone Screws ; utilization ; Cervical Atlas ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; trends ; Humans ; Spinal Fractures ; surgery

Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) ＜ 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P ＜ 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1.8) mmol/L and (5.7 ± 0.3) mmol/L in the Sleeve + DJB group,and (9.9 ± 1.2) mmol/L,(6.9 ± 0.8) mmol/L,(6.6 ± 2.2) mmol/L and (5.6 ± 0.8) mmol/L,with no significant difference between the 2 groups (F =1.670,2.932,0.444,0.158,P ＞ 0.05).The levels of HbAle before operation and at postoperative months 1,3,6 were 7.4％± 1.4％,6.5％ ±0.6％,5.7％±0.5％,5.9％ ±0.6％ in the Sleeve + DJB group,and 7.7％± 2.0％,6.8％ ± 1.3％,5.7％±0.8％,5.6％ ± 1.1％ in the RYGB group,with no significant difference between the 2 groups (F =0.055,0.125,0.005,0.286,P ＞ 0.05).The remission rates of T2DM of the Sleeve + DJB group and the RYGB group were 14/15 and 74.1％ (20/27) at postoperative month 6,with no significant difference between the 2 groups (x2 =2.320,P ＞ 0.05).The decrease rate of BMI of the Sleeve + DJB group and the RYGB group were 18.2％±9.5％ and 21.2％ ± 4.9％,with no significant difference between the 2 groups (t =0.982,P ＞0.05).The numbers of patients with postoperative anaemia,avitaminosis and diarrhea were 0,0,2 in the Sleeve + DJB group and 3,2,6 in the RYGB group,with no significant difference between the 2 groups (x2=1.795,1.167,0.908,P ＞0.05).The BMIs of all the patients were above 19 kg/m2.Conclusion The effects and incidence of postoperative complications of Sleeve + DJB for the treatment of T2DM are comparable to those of RYGB.Sleeve + DJB has less interference on the nutritional condition of patients compared with RYGB.

AIM: To study the bioequivalence of domestic and imported Metoprolol Tartrate Tablets in Chinese healthy volunteers.METHODS: According to the rule published by SFDA,the serum concentration of 20 selected volunteers among 18 to 40 years old was determined by HPLC-fluorescence detection after giving domestic and imported Metoprolol Tartrate Tablets 0.1g,and the pharmacokinetic parameters were calculated by DAS software.RESULTS: The method of HPLC-fluorescence detection to study the pharmakokinetics of Metoprolol Tartrate was sensitive,reliable,accurate and reasonable.The main pharmakokinetics parameters of domestic and imported Metoprolol Tartrate Tablets were T_(max):(1.11)?(0.36 h) and(1.39)?(0.65 h) respectively;C_(max):(269.20)?(87.15)(?g?L~(-1)) and(262.03)?(75.52)(?g?L~(-1)) respectively;AUC_(0-12h):(1088.91)?(510.52)(?g?L~(-1)?h) and(1098.29)?5(55.14)(?g?L~(-1)?h) respectively.The relative bioavailability of domestic Metoprolol Tartrate Tablets was(100.09)%.CONCLUSION: The domestic and imported Metoprolol Tartrate Tablets was bioequivalents.

Objective To investigate the clinical therapeutic effect of Chaishi fever particles on patients with epidemic encephalitis B and to study the machanism of anti-inflammatory.Methods One hundred and twenty one patients with epidemic encephalitis B admitted to the Second Clinical Medical College of Henan University of Chinese Medicine from January 2014 to May 2017 were enrolled, and they were divided into a routine treatment group (60 cases) and a traditional Chinese medicine (TCM) treatment group (61 cases) by random number table. The patients in routine treatment group were given symptomatic support and comprehensive treatment for 15 days, while those in the TCM treatment group were given as that of routine group with the addition of Chaishi fever particles 8 g, 4 times every day, orally taken for consecutive 15 days. The levels of tumor necrosis factor-α (TNF-α), interleukin (IL-1β, IL-10) in the serum of two groups were determined by enzyme-linked immunosorbent assay (ELISA), and the clinical therapeutic effect, complications and sequelae in two groups after treatment were observed.Results Compared with the routine treatment group, after treatment the time of body temperature recovering normal (days: 5.8±1.2 vs. 7.5±1.7), the coma time (days: 5.5±1.3 vs. 6.8±1.6), the remission time of convulsion (days: 5.2±1.4 vs. 6.5±1.5), and the length of stay in hospital (days: 22.6±1.9 vs. 25.2±1.8 ) were significantly shorter in TCM treatment group (P < 0.05). After treatment, the levels of serum tumor TNF-α and IL-1β were decreased, IL-10 was increased in both groups, moreover, compared with the routine treatment group, the changes were more obvious in TCM treatment group [TNF-α (μg/L): 11.4±3.6 vs. 14.6±3.5, IL-1β (μg/L): 22.3±6.2 vs. 26.2±5.6, IL-10 (μg/L): 225.2±19.2 vs. 186.2±21.5, allP < 0.05]. In addition, compared with the routine treatment group, the total effective rate was higher [98.3% (60/61) vs. 90.0% (54/60),P < 0.05], and the incidence of sequelae was lower [1.64% (1/61) vs. 13.3% (8/60),P < 0.05] in TCM treatment group.Conclusion The Chaishi fever particles can effectively treat the patients with epidemic encephalitis B and the action is related to the inhibition of inflammatory reaction.

Objective To evaluate the effect of CT temporal subtraction(TS) for detection of lung nodules.Methods 80 cases of CT images (current and previous CT images) and corresponding CT TS images were presented, which included 30 cases with nodules(75 nodules) and 50 controls.4 observers, including 2 radiologists and 2 residents, indicated their confidence level regarding the presence of a new emerging or larger or solid component than before,which first used standard CT images, then with the addition of CT TS images.Receiver operating characteristic(ROC) curve analysis was used to evaluate the observers'' performance.Results The mean value of the area under the ROC curve (AUC) were 0.860 and 0.925 for four observers without and with TS images,respectively(P<0.01).Average sensitivity for detection of lung nodules was improved from 77.3%(58/75) to 89.3%(67/75) by using CT TS images.Conclusion The use of CT TS images can significantly improve radiologists'' performance for detection of lung nodules,especially when a small size solid or subsolid nodule presents near the pulmonary hilum.CT TS is more helpful for residents.

Objective To investigate the association between rs1013940 in SLC5A7 and Tourette Syndrome ( TS) in Chinese Han population.Methods Polymorphism was genotyped in 401 TS nuclear fam-ilies trios from china by real-time fluorescent quantitive PCR.Transmission disequilibrium test ( TDT) and Haplotype relative risk ( HRR ) were used to analyze the association between the genetic distrbution of rs1013940 and TS and the results were verified by haplotype-based haplotype relative risk( HHRR) .Results No transmission disequilibrium was found between rs1013940 in SLC5A7 and TS by TDT and HRR( TDT:χ2=0.268, P=0.657, OR=0.728,95%CI=0.366-1.451;HRR:χ2=0.111, P=0.739, OR=0.959,95%CI=0.762-1.466) .HHRR also indicated the same result ( HHRR:χ2=0.276, P=0.599, OR=1.082,95%CI=0.806-1.453) .Conclusion The result reveals that there is no significant association between rs1013940 in SLC5A7 and TS in Chinese Han population.However,the results need to be further validated in different populations.

Objective To investigate the utility of bedside electromyography (EMG) in diagnosis and management of critical illness patients with suspected neuromuscular diseases.Methods Bedside EMG was performed in 34 critical illness patients with weakness and respiratory involvement,including segmental motor nerve conduction studies,sensory nerve conduction studies,F waves,concentric needle EMG and repetitive nerve stimulation.The clinical manifestations and clinical utility of bedside EMG in critical illness patients with suspected neuromuscular diseases were analyzed. Results EMG was normal in 5 patients.Low-frequency repetitive nerve stimulation showed decrement response of compound muscle action potential (CMAP) in 4 of 8 patients.Motor nerve conduction studies showed CMAP amplitude decreased in 73.3％(22/30) patients,and demyelinating changes was detected in 20.0％ (6/30)patients.F-wave persistence was 0 in 55.0％ (11/20) patients.Amplitude of sensory nerve action potential decreased in 28.6％ (6/21)patients.Bedside EMG could help to confirm or exclude diagnoses and guide the management in 82.4％(28/34) patients,confirm the diagnoses of peripheral neuropathy but have no effect on management in 11.8％ (4/34) patients,and bedside EMG was inconclusive in 2 patients.Conclusions Bedside EMG is useful for the diagnosis and management of critical ill with suspected neuromuscular diseases,while motor nerve conduction studies and repetitive nerve stimulation are more valuable.Individualized protocol for EMG studies should be made on the basis of clinical problem.

OBJECTIVETo evaluate the clinical effectiveness of Yiqi Huoxue Tongyang Xiezhuo Recipe (YHTXR, capable of supplementing qi, activating blood, warming yang, and discharge turbidity) in treating coronary atherosclerotic heart disease (CAHD). and chronic heart failure (CHF) with carotid plaque patients, and to explore new ways of Chinese medicine (CM).

METHODSTotally 69 CAHD-CHF patients of qi deficiency phlegm stasis syndrome (QDPSS) with carotid plaque were recruited in this study using parallel cohort method. They were assigned to the treatment group (35 cases) and the control group (34 cases). Patients in the control group received routine treatment of Western medicine, while those in the treatment group were additionally treated with YHTXR (twice daily). The therapeutic course for all was three months. Cardiac function levels, echocardiography, carotid plaque, blood lipids and safety indicators were observed before and after treatment.

RESULTSAfter treatment the improvement of cardiac function levels was better in the treatment group than in the control group (P < 0.05). Decreased LDL-C levels were higher in the treatment group than in the control group (P < 0.01). There was statistical difference in left ventricular ejection fraction (LVEF), carotid intima-media thickness (IMT), LDL-C, TC, TG in the treatment group between before and after treatment (P < 0.05). LDL-C and TG also decreased in the control group after treatment (P <0.05). There was no significant difference in the left ventricular ejection fraction, carotid IMT, or TC in the control group between before and after treatment (P > 0.05). There was no significant difference in stroke volume, left ventricular end-diastolic diameter, the area of carotid artery plaque, or HDL-C in the two groups between before and after treatment (P > 0.05).

CONCLUSIONSYHTXR could effectively improve cardiac functions of CAHD-CHF patients of QDPSS with carotid plaque, reduce blood lipids and IMT. It had no significant adverse reactions for elderly patients in short term.

Carotid Intima-Media Thickness ; Coronary Disease ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Heart ; Heart Failure ; drug therapy ; Humans ; Lipids ; Plaque, Atherosclerotic ; drug therapy ; Qi ; Ventricular Function, Left

Objective To investigate the effects of HINT1 on the growth of and apoptosis in malignant melanoma in nude mouse models established by subcutaneous xenotransplantation of human melanoma A375 cells. Methods Three groups of nude mice were subcutaneously inoculated with A375 cells transfected with pcDNA 3.1/myc-His (-) A-HINT1 (HINT1-A375), A375 cells transfected with pcDNA 3.1/myc-His (-) A empty vector (neo-A375), and untransfected A375 cells, respectively. Then, the growth of transplanted tumors was observed and tumor formation rate was calculated. Thirty-three days after the inoculation, mice were killed and tumor tissue was obtained followed by the examination of tumor weight and volume. Histopathology was performed to observe the morphological features of tumor cells and in situ end labeling technique (TUNEL)was carried out to assess the apoptosis in transplanted tumor cells. Results The tumor formation rate was consistently 100% in the three groups. The transplanted tumor in HINT1 group grew more slowly than that in the other two groups, and significant difference was observed as early as day 18 (P ＜ 0.01 ). Lower tumor weight and volume were noted in the HINT1 group compared with the neo group and A375 cell group (0.04 ±0.00 g vs. 0.23 ± 0.00 g and 0.29 ± 0.03 g, 0.06 ± 0.04 cm3 vs. 0.34 ± 0.15 cm3 and 0.43 ± 0.19 cm3 respectively, all P ＜ 0.01 ). Histopathology revealed smaller tumor nests, slight atypia of tumor cells with no obvious pathologic mitoses or necrosis in HINT1 group in comparison with the other two groups. Immunohistochemistry and TUNEL revealed that the percentage of apoptotic cells in HINT1 group was statistically higher than that in the neo group and A375 cell group (12.87% ± 1.18% vs. 3.22% ± 0.49% and 3.00% ± 0.53%, both P ＜0.01 ). Conclusion High expression of HINTl could inhibit the growth of and promote the apoptosis in malignant melanoma in nude mice subcutaneous xenotransplantation models, suggesting that HINT1 gene might be responsible for tumor suppression in human malignant melanoma.

Objective To elucidate the function of phosphatidylinositol 3-kinase (PI3K)-protein kinase B (AKT) signaling pathway underlying the regulation of Na+-I-symporter (NIS) and the influence of different levels of iodine on PI3K-AKT signaling pathway in lactating breast cells.Methods The primary cultured mammary gland cells were divided into three groups:①control group [0 μmol/L LY294002 + 0 μg/L insulin-like growth factor Ⅰ (IGF-Ⅰ)];②stimulation group (50 μg/L IGF-Ⅰ);③inhibition group (40 μmo]/L LY294002 + 50 μg/L IGF-Ⅰ).In addition,the cells were treated with different iodine contents (0,5,50,1 000,3 000 μg/L) for low iodine groups 1 and 2,iodine group,high iodine groups 1 and 2,and IGF-Ⅰ (50 μg/L) was used to stimulate PI3K-AKT signaling pathway.The expressions of AKT and NIS mRNA and protein were determined by real-time quantitative PCR and Western blotting,respectively.Results The expression of AKT mRNA (1.497 ± 0.550) in stimulation group was higher than that in inhibition group (0.777 ± 0.108,P ＜ 0.05),while the expression of NIS mRNA and protein in stimulation group (0.783 ± 0.187,0.618 ± 0.103) was lower than those in inhibition group (2.430 ± 1.423,1.417 ± 0.250,all P ＜ 0.05).With the iodine concentration increasing,except high iodine group 1 (1.090 ± 0.356),the expression of AKT mRNA in low iodine groups 1 and 2,iodine group,high iodine group 2 (1.758 ± 0.893,1.320 ± 0.538,1.003 ± 0.006,0.745 ± 0.307) tended to decline;total AKT protein (0.640 ± 0.106,0.601 ± 0.081,0.583 ± 0.089,0.555 ± 0.097,0.532 ± 0.023) and NIS mRNA (2.259 ± 0.682,1.823 ± 0.332,1.409 ± 0.366,1.321 ± 0.405,1.150 ± 0.454) tended to decline in low iodine groups 1 and 2,iodine group,high iodine groups 1 and 2;except low iodine group 2 (0.484 ± 0.179),NIS protein expression tended to decline (0.556 ± 0.199,0.502 ± 0.179,0.455 ± 0.126,0.435 ± 0.138);however,except low iodine group 2 (0.076 ± 0.045),the p-AKT protein expressions (0.078 ± 0.049,0.079 ± 0.040,0.085 ± 0.055,0.095 ± 0.051) were on the rise.Conclusion PI3K-AKT signaling pathway may play an inhibition role in the expression of NIS in lactating breast cells.