Based on clues from the China CNKI database, 52 articles on Y in-Chen-Hao (YCH) decoction in the treatment of jaundice were screened. All modified YCH decoctions were taken. The ExcellPivotTable report and SPSS 19.0 factor analysis were used in the study of compatibility rules of YCH decoctions in the treatment of jaun-dice. The results showed that the prescription was mainly composed of heat-clearing drugs, water-dampness remov-ing drugs, drastic purgative drugs, which were combined with blood-activation and stasis-removing, qi-regulating drugs.

A 12-year-old boy was admitted for complaint of progressive urination disorder for over 2 years. Physical examination found dysesthesia in the perineal region and disappearance of anal reflex with anal relaxation and a spinal cleft in the sacrococcygeal region. Lumbosacral magnetic resonance imaging MRI showed a low-set of the spinal cord, tethered cord, spina bifida of sacral vertebrae, and meningocele combined with lipoma inside and outside of the spinal canal. Ultrasonography displayed a significantly increased residual urine volume. The diagnosis of tethered-cord syndrome resulting from mixed lipoma was thus established. During the microsurgery, the adhesions between the spinal cord, coccygeal nerve and lipoma were released with a laser scalpel, and the lipoma inside and outside of the spinal canal was excised, after which the dural defect was repaired. The patient recovered smoothly, and the urinary function was normal at the follow-up 6 months after the surgery. Spinal cord lipoma can be classified into 2 types based on the integrity of the dura mater, and in this case, a combined dural defect was found. A definite diagnosis can be derived from the clinical manifestations and MRI findings. Microsurgery remains the currently only effective treatment, and a favorable prognosis can be expected after an early surgical intervention, especially before the functional lesion of the spinal cord. The integrity of the local dura mater considerably affects the outcome of the treatment, and dural defect often leads to surgical difficulty and poor results. The key to a successful operation lies in a full release of the adhesion and avoidance of injury to the conus medullaris and cauda equina. A reoperation in case of recurrence should be carefully evaluated for its benefits.
Child ; Humans ; Lipoma ; complications ; surgery ; Male ; Microsurgery ; Neural Tube Defects ; etiology ; surgery ; Spinal Cord Neoplasms ; complications ; surgery ; Treatment Outcome

OBJECTIVETo explore the surgical approaches, microsurgical techniques and therapeutic effect of modified cistern magna reconstruction for treating of syringomyelia with Chiari malformations.

METHODSThe clinical data of 35 patients with syringomyelia complicated by Chiari malformations were retrospectively reviewed, and the patients' chief complaints, presenting symptoms, neurological and radiographic findings, surgical approaches, outcomes, and complications were analyzed.

RESULTSThe radiographs revealed type I Chiari in 18 and type II Chiari malformations in these patients. Surgical treatment resulted in symptomatic improvements in 29 patients, and 6 patients showed no obvious changes in the symptoms after the surgery; 3 patients received subarachnoid shunting for syringomyelia. During the follow-up for a mean of 2 years, 32 patients showed obvious clinical improvement, and magnetic resonance imaging demonstrated complete spontaneous resolution of syringobulbia in 25 patients.

CONCLUSIONModified cistern magna reconstruction relieves brainstem compression and restores the pulsatile flow of the cerebrospinal fluid at the cervicomedullary junction. Cerebellar tonsil reduction is performed chiefly by electric coagulation and cauterization combined with subpial resection, and the integrity of the pia mater should be maintained as much as possible to avoid potential adhesion and recurrence. The median foramens and Luschka of the fourth ventricle have to be opened to recover normal CSF circulation. Arachnoidal suspension and placement of a patulous dural graft are also important. Modified reconstruction of the cistern magna can be a good option for treatment of syringomyelia complicated by Chiari malformations.

Adolescent ; Adult ; Arnold-Chiari Malformation ; complications ; surgery ; Cisterna Magna ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syringomyelia ; complications ; surgery ; Young Adult

Objective: To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment. Methods: Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C_2-7 sagittal vertical axis(SVA) and T₁ slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor. Results: Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C_2-7Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C_2-7SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T₁ slope changed from -10.6°±16.4° to 7.1°±14.9° postoperatively. The average postoperative C_2-7 Cobb angle, Cobb angle of kyphosis region, KI, C_2-7 SVA and T₁ slope changed significantly compared with preoperation (F=12.700-218.200, all P<0.01). The average postoperative JOA, VAS and NDI scores improved significantly compared with preoperation (F=225.500, 217.900, 131.200, all P<0.01). Conclusion For severe cervical kyphosis, anterior correction is a safe and effective technique, sufficient decompression will be achieved.

Objective To compare the efficiency of nomogram and different machine learning algo-rithms for constructing the dental caries predictive models for middle-aged and elderly people.Methods The multi-stage stratified random sampling method was used to select 510 middle-aged and elderly people from Nanning City,Guigang City and Chongzuo City as the research subjects for conducting the questionnaire sur-vey and oral cavity examination.The univariate analysis and Lasso regression were used to screen the related variables,and the multivariate logistic regression analysis was used to determine the final independent influen-cing factors.Based on the salient features,the nomogram predictive model was established,and the seven ma-chine learning algorithms,including linear discriminant analysis (LDA),partial least squares (PLS),range Doppler algorithm (RDA),generalized linear models (GLM),random forest (RF),support vector machine (SVM) kernel function (SVM-Radial),and SVM linear kernel function (SVM-Linear),were used to construct the seven kinds of dental caries risk predictive models.The area under the receiver operating characteristic (ROC) curve (AUC) was adopted to evaluate the predictive performance of various models and the predictive performance of models constructed using different variable screening methods.Results The detection rate of dental caries in middle-aged and elderly people was 71.18％.After feature screening,the five predictive factors were ultimately retained,which were the age (OR=0.945,95％CI:0.917-0.973),brushing frequency (OR=0.688,95％CI:0.475-0.997),whether having teeth cleaning in the past one year (OR=0.303,95％CI:0.103-0.890),number of remaining teeth (OR=1.062,95％CI:1.038-1.087) and oral health assess-ment tool (OHAT) score (OR=1.363,95％CI:1.234-1.505).The results of comparison of various models showed that the predictive model constructed by the RF algorithm performed the best,the median of AUC was 0.747,followed by the nomogram,and the median of AUC was 0.733.The median of AUCs in the predic-tion model constructed by single factor+Lasso+multivariate logistic (Lasso+logistic) screening independent variables were higher than those constructed by RF algorithm screening independent variables.ConclusionBased on Lasso+logistic screening variables,RF provide more reliable predictive efficiency in predicting dental caries in middle-aged and elderly people than nomogram and the other machine learning algorithms.

Circadian rhythm refers to the 24-hour periodic changes in behavior, physiology, and molecular processes in the human body. Disruptions to the circadian rhythm not only affect mental health but are also associated with various metabolic disorders, including the regulation of bone and muscle metabolism. Research has shown that work-related musculoskeletal disorders (WMSDs) are influenced not only by workload but also by circadian rhythm factors, such as shift work. This review examined the relationships between circadian rhythm-related antecedents, outcomes, and WMSDs, exploring their shared metabolic markers and mechanisms. It provided a systematic overview of the intrinsic connection between circadian rhythm disruptions and WMSDs. While current studies highlight the impact of circadian rhythm disturbances on musculoskeletal disorders, further investigation is required to address the confounding factors involved. Future research should integrate chronobiology with both subjective and objective data to explore the pathway from environmental factors to intermediate phenotypes to diseases, ultimately providing a more comprehensive understanding of the network mechanisms underlying WMSDs.