Objective Patients with previous failed scoliosis surgery were managed by revision surgery,the reasons, methods and results of revision surgery were evaluated and analyzed. Methods Thir-ty-six patients with previous failed scoliosis surgery underwent revision surgery between June 1996 and Au-gust 2002. There were 15 males and 21 females with an average age of 16.8 years. The patients had 1.57 operations on average (1 for 27 cases, 2 for 8 cases and 3 for 1 case). The reasons for revision surgery were failure of previous instrumentation (6 cases), deterioration of the deformity (18 cases), and unsatisfactory re-sults with previous surgery (12 cases). Thorough radiographic evaluations including plain X-ray, CT scan and MRI were taken for each patient pre-operatively. The preoperative average Cobb angle for scoliosis was 76.2?(52?-108?)?Of 36 patients, there were 11 with kyphosis and the preoperative average Cobb angle was 53?(36?-79?). The involved spines in the deformity were 10.1 on average (8-13 levels). The surgical proce-dures included removal of previous instrumentation in 21 cases, staged trans-thoracic anterior release in 5 cases with rigid curve, and osteotomy passing through articular joints and laminae on previous fusion mass in 18 cases. All patients underwent trans-pedicular fixation and fusion as well. The clinical and radiographic results were evaluated post-operatively. Results All patients underwent surgery safely. The average opera-tive time was 3.8 hours (2.8-5.1 h) and the average blood loss was 817 ml(630-1 800 ml). There were no serious complications such as neurological injury. The average correction was 48? (22?-64?, 56%) for scolio-sis, and 47? (17?-52?, 72%) for kyphosis respectively. All patients were followed up at least 12 months (12-76 months). There was no loss of correction found during follow up and all patients achieved solid fu-sion. At the last follow up, 33 patients (91.7%) were satisfied with the results of revision surgery. Conclusion Revision surgery for failed scoliosis surgery is challenging because of technical difficulties for the procedure and higher risk for neurological injury. Extreme caution must be taken for each patient during pre-operative examination and evaluation. If appropriate surgical procedure including staged anterior re-lease, posterior osteotomy and trans-pedicular fixation is properly selected according individual deformity, the satisfactory results can be achieved.

Humans ; Nasal Cavity ; Paranasal Sinuses

Adolescent ; Cyanosis ; complications ; Heart Septal Defects, Atrial ; complications ; Humans ; Male ; Pulmonary Wedge Pressure

Female ; Humans ; Hypoparathyroidism ; blood ; diagnosis ; drug therapy ; Infant ; Infant, Newborn ; Male ; Parathyroid Hormone ; blood ; Retrospective Studies ; Vitamin D ; therapeutic use

OBJECTIVETo analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.

METHODSThis was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.

RESULTSThe ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.

CONCLUSIONWhether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.

Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Prognosis ; Radius Fractures ; surgery ; Retrospective Studies ; Ulna Fractures ; surgery

Adult ; Choristoma ; Humans ; Male ; Mediastinal Cyst ; Neck ; pathology ; Thymus Gland ; pathology

To evaluate the efficacy and safety of acupuncture combined with traction therapy for lumbar disc herniation, providing the basis for future research strategies. Randomized control trials. (RCT) of acupuncture combined with traction therapy for lumber disc herniation at home and abroad from 2000 to 2013 were searched, analysis and evaluation of literature and strength of evidence were based on the principles and methods of Evidence-based Medicine. The total effective rate and curative rate were considered as primary outcome measures; pain improvement, quality of life, relapse rate and adverse effects were considered as secondary outcome measures. Seventeen RCTs were identified, Meta-analysis showed that (1) total effective rate and curative rate: acupuncture combined with traction therapy was better than single therapy (acupuncture or traction); (2) pain improvement: acupuncture combined with traction therapy was better than traction therapy; (3) relapse rate: current evidence could not support the conclusion that acupuncture combined with traction therapy was better than traction therapy. Acupuncture combined with traction therapy for lumbar disc herniation was effective. However, the included studies were with high risk of bias, important outcome measures such as quality of life, relapse rate and adverse effects were not found in most of the studies. Current evidence has not yet been able to fully reflect acupuncture combined with traction therapy for lumbar disc herniation is better than single therapy, so more RCTs of higher quality are needed to further confirm its efficacy and safety.
Acupuncture Therapy ; methods ; Combined Modality Therapy ; Humans ; Intervertebral Disc Displacement ; therapy ; Traction ; methods

Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery (male 43 cases,female 37 cases,aged 24-79 years,ASA gradeⅠorⅡ)were included for the trial.After endotracheal extubation and on arri-val in the post-anaesthesia care unit (PACU),the levels of pain on numerical rating scale (NRS)were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50 μg fentanyl was administrated after 5 min if NRS rated in 4-10.The pupillary diameter (PD),systolic blood pressure (SBP)and heart rate (HR)were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5 minutes with NRS 0-3 to 4-10,after 5 minutes with NRS 4-10 to 0-3,in 10 minutes with NRS 4-10 which were marked respectively with ΔPD,ΔSBP and ΔHR.With the variation of NRS as a criterion,the reactivity of ΔHR,ΔSBP and ΔPD responding to NRS varia-tion were assessed by analysing the receiver operating characteristic curve (ROC),the area under the receiver operating characteristic curve (AUC)was calculated.Results The patients' ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD 0.904 (95% CI 0.822-0.987 ), AUCΔSBP 0.65 1(95%CI 0.5 10-0.781)and AUCΔHR 0.588(95%CI 0.444-0.733)respectively.Value of AUCΔPD was larger than that of AUCΔSBP and AUCΔHR respectively (P < 0.05 ).Importantly, operating characteristic curve (ROC)analysis showed that the diagnostic cutoff value of ΔPD was 41.3% with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value of ΔSBP was 10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demon-strated that the accuracy of ΔPD was higher than ΔSBP and ΔHR responding to pain/analgesia evalu-ation.ΔPD was a valuable index for assessment of postoperative pain.

BACKGROUND: Sepsis and secondary multiple organ failure in critically ill patients are the major cause of death, but the pathogenesis of sepsis is not clear, especially the dysfunction of the immune system. In this paper, we review the response and regulation of the immune system and the functions of a variety of inflammatory mediators in sepsis. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles using the keywords "sepsis", "immune response", and "inflammatory mediator" up to October 2010. Additional papers were identified by a manual search of the references from the key articles. RESULTS: This systematic review was conducted of: 1) the immune response; 2) immune regulation; 3) inflammatory mediators; 4) high-mobility group box 1 protein; 5) the complement system; and 6) the autonomic nervous system. There are no therapeutic approaches available for sepsis that target inflammatory response; the mortality of sepsis has not been significantly reduced. CONCLUSIONS: Sepsis is complex and dynamic, and it has a group of heterogeneous syndromes. Since different patients with sepsis have different etiology, susceptibility, and responses, treatment should be prescribed individually.

CD127 is the interleukin7 receptor ?(IL7R?),it regulates the specific respond of T lymphocytes to IL7.CD127 plays an indispensable role in the development of thymocytes into T lymphocytes,the survival and homeostatic proliferation of memory T cells.There are only two phases of the life period of T cells that do not express CD127:immature CD4+8+double positive(DP)thymocytes and activated T cells.Recently,it was found that CD127 play an important role as the specific marker of memory T cells and regulator T cells.The role and mechanism of CD127 in the life period of T cells were discussed herein.