Parkinson's disease was primarily considered to be a movement disorder affecting only the extrapyramidal system. Although the non-motor symptoms such as neuropsychiatric symptoms, dysautonomia, sleep disturbances and olfactory dysfunction, etc., were also common, they were often misdiagnosed or neglected. This paper would review the manifestation, relevant factors, pathogenesis and treatment of non-motor symptoms of Parkinson's disease.

[Objective] To evaluate the feasibilitiy,methods and therapeautical effects of the posterior circumferential fusion (PCF) combined with short -segmental pedicle screw system fixation for the treatment of lumbar spondylolisthesis(LSL). [Method] From October 2002 to March 2006, 44 cases of LSL were treated with decompression for spine canal stenosis, circumferential fusion and short-segmental pedicle screw system fixation. There were 15 male and 29 female, average age was 48. 6 (ranged, 31~68) years. The diagnoses of LSL and stenosis were confirmed by X-ray and CT. According to Newman classification, 15 of them were the degenerative type and 29 were isthmic type. According to Meryerding classification of LSL, 17 patients had degree I, 24 patients had degree Ⅱ and 3 patients had degree Ⅲ spondylolisthesis. The levels of LSL was between L4 and L5,in 18 patients and between L5 and S1 in 26 cases.[Result]The follow-up period was 18~36 months , averaged 26 months.Seventeen patients with degree Ⅰ spondylolisthesis were all reduced anatomically after surgery. Twenty-four patients with degree Ⅱ spondylolisthesis were reduced anatomically except for 6 patients with Ⅰ degree residual spondylolisthesis. 3 patients with degree Ⅲ spoadylolisthesis were reduced anatomically except for 2 spatients with Ⅰ degree residual spondylolishesis. The effect was evaluated according to Hou Shuxun's evaluation standard, the results were excellent in 28 cases, good in 13 cases, and fair in 3 cases. The excellent and good rate was 93.2%. No complication such as interfixation failure and nerve pedicle injury or cauda equine injury were found. All cases got bony union in 3 to 10 months (mean 4.2 months) postoperatively. All patients had normal disc height and no loss of spondylolisthesis reduction. [Conclusion] The PCF combined with short-segmental pedicle screw system fixation is reasonable options in treating the LSL. It can improve the fusion rate of the spine and maintain good intervertebral space and good lordosis of the lumbar spine. The satisfactory clinical result is relied on the completely understanding of the characteristics of PCF and short-segmental pedicle screw fixation.

[Objective]To investigate the best internal fixation methods of upper segment complicated femoral fractures(USCFF).[Method]Fifty-two cases(54 limbs) with USCFF were treated.In all patients open fracture reduction with use of internal fixation were done.Intramedullary interlocking nails(IIN) were used to treat 32 cases(34 limbs) of adult's USCFF and 130? plate were used to treat 20 cases of children's USCFF.Thirty-six limbs of them were closed fractures,and 18 limbs were opene.Measures of auto-ilium transplant(5 limbs),homolegous allograft bone transplant(10 limbs)were also taken.[Result]Fifty-two patients were followed-up from 9 to 40 months with an average of 16 months.Infection,fracture nonunions,malunion and femoral head necrosis complications were not found.The average period of union of adult and children fractures was respectively 6.8 months and 6.5 months.The long term effect was evaluated according to Ma Yuanzhang's evaluation standard,94.4 percent showed excellent function of joints and limbs.[Conclusion]Appropriate selection of internal fixation according to the age of patients and satisfactory fracture reduction are key points to improve outcome of USCFF.IIN in treating fiacture of adult and 130? plate in treating fracture of children are more ideal selections.

[Objective]To discuss the feasibility and efficacy of the treatment of low subtrochanteric femoral fracture(LSFF) by using general interlocking intramedullary nail(GIIN).[Method]Between March.2000 and January.2006,47 cases(38 males,9 females) of LSFF were treated with limited incision and 6IIN.The mean age of the patients were 41.2 years(range 25 to 78 years).29 of them were injured in a traffic accident,7 in falling,6 in crush by a heavy object and 5 in pedestrain injury.According to Seinsheimer classification,11 cases were type IA,10 cases were type lB,19 cases were type ⅢB,and 7 cases were type Ⅳ(8 combined with other fractures)6 of these were open fractures(4 cases of Gustilo-Anderson type Ⅰ and 2 cases of type Ⅱ).The procedure included following step: all patients were treated with limited open reduction.The pyriform sinus entry point were localized with retrograde reamed;then,intramedullary nail was performed through the anterograde approach after limited reamed.All fractures were fixed statically.The operation time were from 50 minutes to 130 minutes(averaging 90 minutes).[Result]All the cases,were followed up for 11 to 34 months,with an average time of 33 months.The alignment of fracture was good.The bone union time were 2.5～6 months,the average 3.9 months.Fracture union rate was 100%.The functional evaluation was done by Sanders traumatic hip rating scale.of the 47 cases,31 were excellent,14 good and 11 fair.The excellent and good rate was 95.7%.There were no infection,implant breakage,limb shortening and varus deformity.[Conclusion]In treatment of LSFF,the GIIN is worth to recommend because it is simple for use,no need of X-ray monitoring during the operation,reliable,high union rate,rare complications,and good effects.Reasonable application of GIIN,better fracture reduction and early active functional rehabilitation(earlier activities and later weight bearing) are the keys to obtain a good clinical result.

Objective To investigate the relationship between the infarction area and the changes of serum fibrotic indexes in acute myocardial infarction (AMI) patients.Medthods Serum procollagen type Ⅲ (PCⅢ),collagen IV(IV?C) and laminin (LN) were measured in 42 AMI patients with successful recanalization,22 AMI patients with unsuccessful recanalization and 37 healthy controls.Michelle's method was used to calculate infarction area and correlative analysis was made between indexes and infarction area.Results Serum PCⅢ,IV.C and LN were significantly increased in AMI patients with unsuccessful recanalization as compared with the other two groups,which were positively correlated with the infarction area.However,there was no statistical significance between the indexes in the other two groups and infarction area.Conclusion Serum PCⅢ,IV.C and LN can be serum fibrotic indexes in AMI patients,which can reflect the infarction area indirectly.

Objective To discuss the selection and application of internal fixators in the treatment of aged patients suffering from femoral condyle fracture. Methods 82 aged patients with femoral condyle fracture were treated from February 1995 to June 2002. According to AO/ASIF classifcation,26 cases were classified as type A,17 cases type B, and 39 cases type C. They were treated with internal fixation by 95?angle plate (19 cases), T type plate(5 cases), AO condyle supporting plate (11 cases), dynamic condylar screw (DCS) (23 cases) and Green Seligsen Henry (GSH) (24 cases). Measures of auto ilium transplant or homologous allograft bone transplant (28 cases) were also taken. Results All the cases were followed up for an average of 14.6 months. Merchan grading method was applied to evaluate their knee joint functions. The total excellent and good rate was 90.2%. Conclusions Aged patients with femoral condyle fracture should be treated specially. The fixation should be chosen according to their fracture type so as to ensure fine clinical results. The goal of the operation is to keep the integrity of articular surface of the femoral condyle and to acquire secure internal fixation.

Objective:To explore the clinical effect of mild hypothermia combined with puncture aspiration operation on the hypertensive intracerebral hemorrhage and its effect on the serum TNF-α,IL-6 and CRP levels.Methods:112 cases of patients with hypertensive intracerebral hemorrhage admitted in our hospital from February 2015 to August 2016 were selected as the research objectives and randomly divides into 2 groups with 56 cases in each group.Both groups were treated with minimally puncture aspiration,and mild hypothermia was performed in the observation group additionally,the clinical effect,complication,short-term prognosis,serum TNF-α,IL-6,CRP levels at different time points before and after operation were compared between two groups.Results:The overall effective rate of observation group was 92.86％,which was significantly higher than of the control group(76.79％.P＜0.05).The incidence of MODS and complications were 0％ and 26.79％ respectively,which were significantly lower than those of the control group(P＜0.05).The serum TNF-α,IL-6,CRP levels of observation group were significantly decreased on the 3rd and 7th day postoperation,which were significantly lower than those before operation (P＜0.01).The serum TNF-α,IL-6,CRP levels of control group on the 3rd day postoperation were similar to those before operation (P＞0.05),but the serum TNF-α,IL-6,CRP levels on the 7th day postoperation were significantly decreased (P＜0.01).The serum TNF-α,IL-6,CRP levels on the 3rd,7th day postoperation were significantly lower than those of the control group at same time points (P＜0.01).The favorable prognosis of observation group was 80.36％,which was significantly higher than that of the control group (62.50％,P＜0.05).Conclusion:Mild hypothermia combined with puncture aspiration operation could effectively reduce the neurological deficits,inhibit the inflammatory response and decrease the mortality.

Objective In this study,we elucidated the role of high mobility group box chromosomal protein 1 (HMGB1) in collagen-induced arthritis (CIA) rat and the antagonist role of ethyl pyruvate by using a rat model of CIA as the research object by comparing the expression of HMGB1 in normal control group,CIA model group and ethyl pyruvate group.Methods Thirty-six rats were randomly divided into 3 groups (n=12):normal control group,CIA group and ethyl pyruvate group.Then the 6 rats were dissected at the 6th,9th week respectively.Thc expression of HMGB1 was analyzed by immunohistochemistry and Pathology-image analysis software in the cytoplasma.The expression of HMGB1 mRNA with real time-polymerse chain reaction (PCR) was evaluate,and the HMGB1 expression of each group were compared with t-test.Results The immunohistochemical results of HMGB1 showed that the expression intensity in the normal control group,CIA model group and ethyl pyruvate group was 2.1±0.6,7.3±1.2,6.0±1.2 respectively at the 6th week; and 2.2±0.7,12.4±4.5,5.5±1.0 at the 9th week respectively.The HMGB1 mRNA real time-PCR results had shown that the relative quantification of the normal control group and CIA model group were 1,2.865,2.602respectively at the 6th week and 1.005,4.694,1.729 at the 9th week.At those two points, the HMGB1 expressions of HMGB1 antagonist group were significantly higher than those of the normal controls (P＜0.05).In addition,there was statistical significant difference(P＜0.05) in the HMGB1 expression when compared with the placebo group.Furthermore, when the degree of HMGB1 expression among the three groups was compared,the HMGB1 antagonist group was decreased significantly (P＜0.05).Conclusion The results has demonstrated that HMGB1 could induce inflammation in the synovial tissue of CIA rats,and has provided the rationale that HMBG 1 could be the target of treating rheumatoid arthritis (RA).The results of this study have shown that ethyl pyruvate could antagonize the effect of HMGB1.This finding may provide a new therapeutic target for the treatment of RA.

Objective To investigate the effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome (ARDS) combined with critical illness-related corticosteroid insufficiency (CIRCI).Methods All early ARDS patients combined with CIRCI were screened by an adrenal corticotrophic hormone (ACTH) test and randomly divided into treatment group (hydrocortisone 100 mg intravenous,3 times/day,consecutively for 7 days,n =12 ) and control group (equivalent normal saline,n =14 ).General clinical data,changes of arterial blood gas,hemodynamics and respiratory mechanics were observed and recorded at admission and at 7 days after treatment.Ventilator-free and shock-free days,ICU stay within 28 days after admission were recorded and 28-day mortality was used as judge prognosis index.Results CIRCI rate in 45 early ARDS patients was 57.8％ ( 26 patients),and the shock rate was markedly higher in ARDS patients with CIRCI than patients without CIRCI (46.2％ vs 5/19 ).There were no significant differences in baseline parameters,oxygenation and illness severity between the treatment and control groups,except for markedly lower lactic level in the treatment group [ 2.7 ( 1.2,3.9 ) mmol/L vs 4.6 ( 2.5,6.3 ) mmol/L,P ＜ O.05].After 7 days of treatment,PaO2/FiO2 markedly increased,while heart rate obviously decreased in the both groups.Compared with the control group,survival time of patients was significantly longer and shock rate of the patients was markedly lower in treatment group within 28 days (5/12 vs 10/14,P ＜ 0.05).The 28-day mortality,which were adjusted by baseline arterial lactic,was lower in the treatment group (2.6/12 ) than in the control group (5.8/14) while with no significant difference ( P ＞ 0.05 ).There was no significant difference in complication incidence between the two groups.Conclusion Stress dose glucocorticoid could reduce shock incidence and prolong survival time,and has a tendency of lower 28-day mortality in early ARDS patients combined with CIRCI.

Objective To investigate the clinical results of extracorporeal membrane oxygenation (ECMO) technique during the peri-operative heart transplantation. Methods The clinical data of heart transplantations supported by the ECMO were retrospectively analyzed, including during the bridge to transplant, working as routine bypass in the operation room, and supporting the heart failure after surgery. Results Three 3 cases were supported with ECMO to extend the waiting time: 2cases died of multi organ failure during the waiting, and the third one received the heart transplant and the ECMO was successfully removed. Totally 12 cases of heart transplantation received the modified open style ECMO techniques replacing the routine bypass. The ECMO was removed after assistance for (38 ± 14) h. All the recipients except one death recovered well without right ventricular failure or obvious tricuspid regurgitation which was common after heart transplantation. Ten cases received ECMO support for the heart failure after the transplant. The initial application time ranged from 2 h to 2 days and lasted 43～176 h. One died of infection and two died of multi organ failure nothing to do with ECMO application and other 7 discharged with NYHA Ⅰ/Ⅱ cardiac function. Conclusion Early use of ECMO could safely bridge the heart failure patients to the transplant. Replacing the routine with ECMO techniques in the heart transplantation could get good myocardial protection results even with long cold ischemic time and improve the cardiac function recovery. For the heart failure patients after the surgery the ECMO could afford good support effect.