Antineoplastic Agents, Hormonal ; therapeutic use ; Bone Neoplasms ; secondary ; Breast Neoplasms ; chemistry ; drug therapy ; pathology ; Disease Progression ; Female ; Humans ; Menopause ; Neoplasm Recurrence, Local ; Receptors, Estrogen ; analysis ; Receptors, Progesterone ; analysis ; Tamoxifen ; therapeutic use

BACKGROUND:Systemic lupus erythematosus is a kind of heterogeneous disease, and the difference of clinical features may also be the risk factors of osteonecrosis besides of treatment with glucocorticoids according to the literature. However, it remains controversial on the risk factors of osteonecrosis in systemic lupus erythematosus patients.
OBJECTIVE:To systematical y review the major risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus.
METHODS:The CNKI database, CBMdisc database and Wanfang database were retrieved for the published case-control study literatures on the risk factors of osteonecrosis in the Chinese patients with systemic lupus erythematosus. The literatures met the inclusion and exclusion criteria were included, and a Meta-analysis was conducted by RevMan 5.0 and Stata software. Then, the pooled odd ratio and 95%confidence interval of each risk factor were calculated.
RESULTS AND CONCLUSION:Ten case-control study literatures were included involving 332 cases in the case group and 986 cases in the control group. The pooled odd ratio and 95%confidence interval of each risk factor of osteonecrosis in the Chinese patients with systemic lupus erythematosus were as fol ows:Raynaud’s
phenomenon 3.28(1.69-6.38), dental ulcer 2.95(2.13-4.09), renal involvement 1.21(0.83-1.74), vasculitis 5.64(2.84-11.21), hyperlipidemia 5.11(3.10-8.42), anti-phospholipid antibody 2.32(1.49-3.61) and joints involvement
2.02(1.33-3.07). It has been clear that the glucocorticoids is an independent risk factor of osteonecrosis in the patients with systemic lupus erythematosus. However, it is not the one and only risk factor. The fol owing risk factors of
vasculitis, hyperlipidemia, Raynaud’s phenomenon, dental ulcer, positive anti-phospholipid antibody and joints involvement are the risk factors of osteonecrosis in the patients with systemic lupus erythematosus.

Objective To evaluate the association between bradycardia and neurological sequel in patients with restoration of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) during targeted body temperature management (TTM).Methods Forty-three unconscious patients with ROSC after CPR were treated with TTP.The patients were cooled with therapeutic hypothermia to body temperature target range (32-34°C) after cardiac arrest and divided into bradycardia and control groups depending on the lowest heart rate less than 50 beats/min and more than or equal to 50 beats/min respcetively at that time.The bispectral index (BIS) and the neuron-specific enolase (NSE) values were respectively recorded at the following intervals,0h (h0)、24h (h24)、48h (h48)、72h (h72) after ICU admission.Neurological outcome was defined according to the Pittsburgh cerebral performance category (CPC) at 3 months after ICU discharge.Results Compared with the control group,during TTM the bispectral index levels were significantly higher in the bradycardia group at h0,h48,h72 after admission,(h0 bradycardia group 73.0 ± 12.3;control group 58.0 ± 18.6,P ＜0.01)、(h48 bradycardia group 71.4 ± 21.2;control group 46.3 ± 18.9,P ＜ 0.01)、(h72 bradycardia group 78.6 ± 24.6;control group 51.8 ± 24.1,P =0.01).The neuron-specific enolase level in bradycardia group was significantly lower than that in control group on day3 (118.8 ± 118.8 ng/mL vs.248.3 ± 191.9 ng/mL,P =0.02).The level of CPC in the bradycardia group was significantly higher than that in the control group (P =0.046).Conclusions Patients with bradycardia during TTM had favorable neurological outcome,which could provide evidence for clinical treatment and prognostic evaluation of the patients.

Objective To investigate the characteristics and the diagnostic value of the tissue strain imaging in constrictive pericarditis(CP).Methods Twenty-six patients and thirty controls underwent comprehensive echocardiography with apical four chamber tissue Doppler imaging and strain imaging.Peak strain of the middle segments of the inter-ventricle septum and left ventricular lateral wall was recorded.The peak strain difference and strain ratio between the two segments were calculated.Results In patients with CP peak strain of the left ventricle lateral wall was significantly lower than that of the septum[(-5.60?3.46)% vs(-14.14?4.11)%,P

Objective To evaluate the prognostic value of the neuron-specific enolase ( NSE ) and bispectral index ( BIS) in patient with mild therapeutic hypothermia ( MTH) after cardiopulmonary resuscitation ( CPR ) .Methods Forty-six patients with restoration of spontaneous circulation ( ROSC ) after CPR were treated with MTH.The BIS values were recorded and the serum NSE was measured at the following times:24 h, 48 h, and 72 hours after ICU admission.Neurological outcome was classified according to the Pittsburgh cerebral performance category ( CPC 1 to 5) at 3 months after ICU discharge.Results Fourteen patients had a good neurological outcome with CPC score 1-3, and thirty-two patients had a poor neurological outcome with CPC 4-5 at 3 month.Compared with good outcome group, the NSE values were significantly higher in the poor outcome group on day 2 and day 3 after admission [48 h: (90.1 ±42.7) ng/mL vs.(33.2 ±17.5) ng/mL;72 h: (95.4 ±37.0) ng/mL vs. (29.2 ±17.0) ng/mL, P<0.05].NSE increased markedly in the poor neurological outcome group at 48h and 72h, and decreased significantly in the good group at the same time [△NSE 24 h-48 h: (37.3 ±28.7) ng/mL vs.(-10.7 ±12.1) ng/mL; △NSE 48 h-72h: (5.3 ±13.2) ng/mL vs.(-4.0 ±4.5 ng/mL), P<0.05].Over the 72 h of monitoring, the mean BIS values were lower in the poor outcome group compared to the good outcome group at 48 h [ (39.2 ±24.1) vs.(78.0 ±12.4); 72 h: (45.7 ±26.4) vs.(89.0 ±7.3), P<0.05].Conclusions The values of NSE and BIS were effective prognostic indicators for the neurological outcome of patients with MTH after CPR.

Objective To set the criteria of mild spinal tuberculosis and investigate the ettect of standard chemotherapy regimen for further establishing the clinical classification of spinal tuberculosis and standardizing management.Methods According to the criterion,a total of 89 patients with mild spinal tuberculosis were enrolled for outpatient conservative management and follow-up.Ambulant treatments were carried out in all patients,including nutrition support and standard chemotherapy regimen.The regimen was consisting of four first-line antituberculosis drugs (rifampicin,isoniazid,ethambutol and pyrazinamide).All patients were followed up one month later,then every 3 months for the following 12 months,and subsequently at intervals of half a year.The clinical manifestations,kyphosis progression,neurological status,erythrocyte sedimentation rate and liver function were analyzed.Results A mean of 30.62± 13.20 (range,18-46) months' follow-up was achieved in 85 patients,whose tuberculosis lesions were cured completely.Another 4 patients,who were diagnosed with drug-resistant tuberculosis later,had underwent surgery for progressive bone destruction and no response to chemotherapy.The mean visual analogue scale score and Cobb's angle was 5.6± 1.6 and 6.25°±3.11° before chemotherapy,and 2.1 ± 1.1 and 12.36° ±6.31 °at the last follow-up time,respectively.Signals of vertebral body and intervertebral disc returned to normal in 6 patients,while solid bony fusion of adjacent segment was achieved in 79 patients.Asymptomatic mild kyphosis was observed in 69 patients.2 patients with sinus before treatment all healed.No neurological deficit was found.Conculusion For patients early diagnosed with mild spinal tuberuclosis,standard chemotherapy regimen could work safely and effectively for healing the tuberculous lesion,avoiding surgery as well as preventing kyphosis,vertebral instability and neurological deficit.Mild spinal tuberculosis that was early diagnosed could be considered as a subtype of spinal tuberculosis.

Objective This study aimed to estimate the impact of the threshold of Autocapture algorithm on the pacemaker's service life.Methods Seventy-four patients implanted with VVI pacemaker were retrospectively evaluated.Among them,48 were implanted with pacemaker of autocapture function.Diagnostic data were retrieved from device memory.Pacemaker's service life was estimated according to the working flow and voltage.Results (1) The average working voltage of the control group and the observation group was (2.8 ± 0.4) V and (1.1 ± 0.4)V respectively.The difference was statistically significant;(2) The battery life in the observation group was (12.59 ± 0.55) a,significantly longer than that in the control group (6.74 ± 1.12) a,with an 86.8％ increase of the device's estimated service life (P＜0.05).Conclusion The Autocapture function results in a significant service life of cardiac pacemaker and represents valuable clinical technology.

Objective To discuss the application value and improvement of principle of multi-echelon medical care in emergent rescue of the injured in Chinese Wenchuau earthquake. Methods The author analyzed and evaluated the medical rescue that was done at disaster site, in the front line hospital and higher level hospitals during earthquake. Results A total of 4 689 patients were treated at disaster site, including 413 patients with severe injury, of whom 3 died. Different kinds of operations including debridement were performed at disaster site, with infection incidence of open wound was nearly 80%. In the front hne hospital, 1 400 patients were treated, with 200 operations done. Of all, 110 patients with severe trauma were treated emergenfly, with an amputation rate of 3.0% and postoperative infection incidence of 66.8%. In the station hospitals, 125 patients received definite surgeries, with 1-5 surgeries per injury site. There was no postoperative cross infection, amputation or death. Conclusions The multi-echelon medical care is the basic mode for medical rescue of large number of patients in natural disaster rescue. First aid at disaster site should be performed as early as possible. Transportation is crucial for successful rescue and an improved patient grading system can help increase the efficiency of rescue. The front line hospitals should mainly provide life support, debridement and fixation of simple fracture, while the specific treatment and definite surgery should be carried out in the station hospitals.

Objective To study the efficacy and safety of four surgical techniques of tuberculosis of lumbosacral junction retrospectively. Methods Between Jul 2001 and Jan 2013, 79 patients with lumbosacral spinal tuberculosis underwent surgery. Antituberculous chemotherapy and nutrition support prior to surgery were used for at least two weeks. 45 patients underwent single stage radical debridement, fusion and anterior instrumentation (A group). 18 patients underwent combined anterior and posterior spinal surgery (AP group), 10 patients underwent transpedicular drainage, posterior instrumentation, and fusion (P group), and 6 patients underwent anterior radical debridement (D group). All the patients were treated by antituberculous chemotherapy for 18 months and followed regularly. The operation duration, blood loss, clinical status, ESR, VAS, ODI, roentgenogram and 3D?CT were concerned to estimate the progress of tuberculosis. Radiographs were analyzed before surgery, immediately after surgery, and at the final follow?up examination to assess the result of anterior fusion and maintenance of correction. Results There was no inju?ry of blood vessel, ureter or cauda equina during surgery. The mean follow?up period was 23 months (range 18-42 months). No obvious loss of deformity correction was observed. There was no recurrence, no tuberculous peritonitis, and no incidence of im?potence or retrograde ejaculation in any of these patients. The average operating duration(min) were 144.31 ± 23.18, 444.72 ± 141.63, 351.50 ± 85.25, 90.00 ± 29.66, respectively; The average blood loss(ml)were 266.67 ± 104.45, 988.99 ± 488.26, 890.00 ± 306.23, 200.00±104.88, respectively; The average Pre?op VAS were 4.71±1.79, 5.22±1.48, 3.30±1.64, 2.50±1.52, respectively;The average last follow?up VAS were 0.89±0.68, 0.90±0.74, 1.00±0.63, respectively; The average Pre?op ODI(%)were 29.64± 7.85, 32.17±7.59, 28.20±4.26, 20.67±4.63, respectively; The average last follow?up ODI(%)were 5.09±3.59, 4.78±3.78, 4.80± 3.39, 4.00 ± 1.18, respectively; The average Pre?op lumbosacral angle(°)were 20.61 ± 4.92, 23.78 ± 5.84, 25.10 ± 4.28, 21.67 ± 4.27, respectively; The average Post?op lumbosacral angle were 27.17±3.66, 30.56±5.31, 32.10±4.01, 24.83±2.32, respectively;The average last follow?up lumbosacral angle were 23.89 ± 3.12, 27.00 ± 5.46, 29.00 ± 4.85, 23.33 ± 2.50, respectively. Conclu?sion Single stage anterior interbody fusion with anterior instrumentation worked effectively to stabilize lumbosacral junction (less invasive, short surgical duration, no injury of posterior column). Anterior interbody fusion combined with posterior instrumentation was recommended for patients with extensive bone defect and low iliocava junction.

Objective To analyse the phenotypes of the drug?resistant tuberculosis, and investigate the outcomes of the individualize surgery and chemotherapy for these patients. Methods From January 2009 to June 2012, we retrospectively ana?lyzed 49 patients with drug?resistant tuberculosis spondylitis admitted in Southwest Hospital. 33 were initial cases and 16 were re?curring cases. All the 49 patients received individualized open operation or CT?guided percutaneous drainage and local chemother?apy depending on the characteristics of the focus. Individualized chemotherapy regimens were tailored for all patients according to the drug?resistant spectrum and all patients were followed up successfully at least 24 months. All the clinical data were collected and analyzed by statistical methods. Results Among the 49 patients, 14 were monoresistance tuberculosis, 11 were polyresis?tance tuberculosis, and 24 cases were multi?drug resistant tuberculosis. Frequence of the drug?restistance from high to low was Iso?niazid, Rifampicin, Streptomycin, Levofloxacin, Dipasic/Rifapentine, Ethambutol, Protionamide, Capreomycin, Paza?aminosalicy?late, and Amikacin. 43 patients received open operation and 6 patients received CT?guided percutaneous drainage and local che?motherapy. Time of the percutaneous drainage was (48±11) days (39-60 days), and all patients received Individualized chemother?apy with an average of (29.5±2.5) months (24-36 months) postoperatively. At the last follow?up, all patients had remarkable pain remission, 44 patients with paraplegia got slight or remarkable recovery and 17 patients with kyphosis got significant correction. Conclusion The main drug?resistant spectrums are Isoniazid、Rifampicin、Streptomycin、Levofloxacin. The individualized sur?gery combined with individualized chemotherapy made according to the drug?resistance is a feasible treatment for the drug?resis?tant tuberculosis especially the multi?drug resistant tuberculosis.