Objective To discuss the value of thoracolumbar injury classification and severity score (TLICS) and load-sharing scores in guiding selection of the indications of combined anteroposterior surgery for thoracolumbar fractures. Methods A total of 216 patients with thoracolumbar fractures treated surgically from January 2006 to January 2008 were involved in the study. Combined anterior and posterior surgery was carried out in 48 patients including 32 males and 16 females (at average age of 39 years, range 18-55 years). Segments involved T11 in two patients, T12 in eight, L1 in 20 and L2 in 18. According to the classification of Magerl, there were 20 patients with type B1 fractures, 15 with type B2, four with type C1 and nine with type C2. Neurologic status based on ASIA classification was at grade A in five patients, grade B in 16, grade C in 16, grade D in nine and grade E in two. All patients were operated in lateral position at one stage within 14 days after injury, with posterior laminectomy and pedicle fixation, anterior corpectomy, reduction and strut graft. Forty-five patients were followed up for 14-38 months. Plain X-ray radiographs and reconstruction CT were taken to observe the bone healing. Local kyphosis and vertebral canal were also measured. All the patients were evaluated with TLICS and load-sharing scores. Results Lumbar physical lordosis was reconstructed, with no evident correction loss,pseudoarthrosis or implant failure noted during follow-up. The patients treated with combined surgery had TLICS score ≥5 points, load-sharing scores ≥7 points and were combined with posterior ligamentous complex injury, so the fracture could not be sufficiently decompressed and reconstructed with single anterior or posterior surgery. Of all, 45 patients were followed up for 14-38 months (mean 25 months), which showed that all the combined surgeries were performed successfully, with bone fusion and neurological status improved for at least one ASIA grade. No complications like implant breakage, loosening, titanium mesh displacement or subsidence were observed. Conclusions LICS is basically helpful for guiding selection of combined surgery, but does not well evaluate the canal compromise, to which the load-sharing scores can supplement. These two evaluation systems should be applied together. The anteroposterior surgery can be recommended when the patients are with TLICS≥5 points, load-sharing score ≥7 points and combined with ligament complex injury.

Objective To analyze the diagnosis and prognosis value of abdominal CT scans in patients with acute pancreatitis complications.Methods 151 cases with acute pancreatitis were selected.The relationship between abdominal CT performances and the common complications and death in patients was analyzed.The prognosis of patients with different Balthazar CT severity index (CTSI) grade was compared.Results The complication rate of patients with CT signs of fatty liver, pleural effusion, liver gap effusion, adrenal gland involvement (AGI), penirenal space involvement (PSI) and gastric bare area involvement (GBAI) was significantly higher than that of patients with negative CT findings above (P<0.05).With CTSI grading increasing, the patient''s fasting time, heating time, hospital stay, recovery time of blood amylase were extended, and the incidence of pseudo cyst, transit surgery, organ failure and death was gradually increasing (P<0.05).Conclusion Severe fatty liver, AGI, GBAI, PSI and liver gap effusion are risk factors for acute complications and death in patients with pancreatitis.

Objective To investigate condition of single drug or multiple drug resistance and sensitivities of different combinations of antibiotics in Helicobacter pylori (H.pylori) infected patients of different ages in Jiaxing City,Zhejiang Province.Methods From January 2007 to December 2011,a total of 6280 patients underwent gastroendoscopy examination were enrolled,the average age of them was 50.8 years old.Among them,129 cases were less than 20 years old,1802 cases were between 20 and 40,3016 cases were between 40 and 60,and 1333 cases were over 60.The mucosa of gastric antrum was collected for H.pylori culture.Drug sensitivity of isolated H.pylori strains was tested with metronidazole,amoxicillin and gentamycin,furazolidone,clarithromycin and levofloxacin.x2 test was performed for the comparison of drug resistance among different age groups.Results Among 6280 specimens,H.pylori culture of 2311 cases was positive (positive rate 36.80％).The positive rate of patients aged between 40 and 60 was the highest (38.43％,1159/3016),and that of patients over 60 was the lowest (33.76％,450/1333).The drug resistance rate of metronidazole in patients between 20 and 40 years reached 98.02％ (644/657) and was the highest.The drug resistance rate of clarithromycin in patents over 60 years old was the highest,which was 22.67％(102/450).The drug resistance rates of the levofloxacin,furazolidone,amoxicillin and gentamicin were low of all ages.Mixed resistance of two antibiotic appeared in 586 strains,mixed resistance rate of metronidazole and clarithromycin was the highest (259 strains,15.23 ％).Mixed resistance of three drugs appeared in 49 strains,mixed resistance rate of metronidazole,clarithromycin and levofloxacin was the highest (32 strains,12.88％).A total of 1691 strains were sensitive to the combination of amoxicillin and gentamycin,the sensitive was rate 99.41％.The sensitive rate of the combination of amoxicillin and furazolidone,gentamycin and furazolidone was both 94.24％.Conclusions Metronidazole presented high drug resistance of all ages,and should not be chosen.The combination use of amoxicillin and gentamicin is the ideal antibiotic combination for different ages.The combination of gentamycin and furazolidone is recommended for patients who are allergic to penicillin.

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

Objective To explore and evaluate the clinical significance of pressure-controlled discography in diagnosis of discogenic low back pain.Methods From July 2008 to October 2009,pressurecontrolled discography under C-arm guidance was taken in 52 patients with suspected discogenic low back pain,including 83 degenerative discs and 52 good discs.Based on the pressure of discography inducing pain,the discs were divided into 4 groups:pressure ≤ 30 psi,30 psi＜pressure ≤50 psi,50 psi＜pressure≤70psi,and pressure＞70 psi.By using SPSS 11.0 statistical software,the correlation of pressure of discography and morphologic representation was analyzed.Results Among 83 degenerative discs,positive discography was detected in 46 discs.During discography,the pressure of positive degenerative discs was (36.5±15.7)psi; the pressure of negative degenerative discs was (50.5±26.2) psi,and the normal discs’ pressure was (98.6±3.7) psi.A significant difference could be found between the mentioned three groups.Among different pressure groups,the positive rate were analyzed by x2 test,and a significant difference was found as well.But no significant difference was found between the group of less than 30 psi and group of 30 to 50 psi.According to Adams’ morphological classification of discography,the pressure of disc varied from 30 to 50 psi in grade Ⅲ,while less than 30 psi in grade Ⅳ.There was a significant difference of discography pressure between discography positive grade Ⅲ and grade Ⅳ.Conclusion The pressure-controlled discography is valuable for clinical diagnosis of discogenic low back pain.The morphological classification of discs could indicate the degree of the disruption of annular fibrosus.

Objective To study the onset,treatment,prognosis and possible causes of transient quadriplegia shortly after anterior cervical compression and fixation (within four hours postoperatively) in three patients with cervical spondylotic myelopathy who could function well for limbs after anesthesia awakening from the operation. Methods A retrospective study was carried out on medical data of three patients including two males and one females,at age of 41-61 years.Anterior cervical corpectomy,titanium mesh bone fusion and titanic plate fixation were performed under general anesthesia.The decompression segment was C5 in one patient,C6 in one and C5 plus C6/7intervertebral disc in one respectively.Paralysis occurred between 30 minutes and 4 hours postoperatively.Two patients were with complete paralysis and one with incomplete. All the patients received dehydration,neurotrophic drugs and high-dose methylprednisolone therapy immediately after paralysis. Meanwhile,emergent cervical MRI was performed,which showed spinal cord swelling,without obvious spinal cord compression by hematoma.Results The paralysis was alleviated completely in two patients within two hours after early medication without additional surgical compression.The other one patient was recovered incompletely at 24 hours after medicationand then underwent posterior cervical laminoplasty,when tremendous pressure was released from cervical spinal cord.But the spinal function had significant recovery after surgical compression and won complete recovery one week later. Conclusions Besides spinal cord ischemia-reperfusion injury,the transient paralysis after anterior cervical surgery may be associated with cervical spinal cord swelling and limited anterior decompression space.Early diagnosis and early intervention of paralysis may save the spinal cord function and attain a satisfactory prognosis.

Objective To evaluate the effect of en bloc open-door laminectomy and pedicle screw fixation for extremely severe cervical ossification of posterior longitudinal ligament (OPLL).Methods From January 2007 to December 2011,16 cases of serious cervical OPLL were treated,in which there were 13 males and 3 females,aged from 45 to 74 years (average,56.5 years).Spinal cord functional deterioration was related to minor activities of the neck,such as sneeze,cough or hyperextension of the neck,in 15 cases.One case suffered from aggravating neurological symptoms without a definite precipitating factor.The average preoperative Japanese Orthopaedic Score (JOA) was 7.1 ±1.8.Preoperative CT scans displayed the average stenotic rate (thickness of OPLL/sagittal diameter of the spinal canal) was 83.7％.All the patients received en bloc laminectomy and pedicle screw fixation of the cervical spine.Results All the patients were followed up for 3 months to 4 years (average,24.4±10 months).The JOA scores at 2 weeks,3 months,and the last follow-up postoperatively were 13.2±1.7,13.5 ±1.6 and 14.1 ±1.5,respectively; the improvement rates were 61.6％,64.6％ and 70.7％,respectively.The operative time ranged from 80 to 150 minutes (average,130 minutes),and blood loss ranged from 150 to 600 ml (range,300 ml).One case of postoperative wound hematoma,1 case of cerebrospinal fluid leakage and 3 cases of trapezius muscle pain occurred in this group.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury and internal fixation failure,were noticed.Conclusion Owing to the minimum interference to the cervical spinal cord,stabilization of the decompressed segments and maintenance of cervical lordosis,en bloc open-door laminectomy and pedicle screw fixation is suitable for extremely severe cervical OPLL.

OBJECTIVETo study the effect of electro-acupuncture (EA) at points along Foot Yangming Channel on metabolite of ulcerative colitis (UC) rats' cerebral cortex and to identify key metabolites by referring to Pi/Wei-brain related theory in Chinese medicine (CM).

METHODSThe UC rat model was set up by dextran sulfate sodium (DSS) method. Male SD rats were randomly divided into the model group and the EA group, 13 in each group. Another 13 rats were recruited as the blank control group. Rats in the blank control group and the model group received no EA. EA was performed at Zusanli (ST36), Shangjuxu (ST37), and Tianshu (ST25) for 5 days by using disperse-dense wave. Then all rats were sacrificed. Their recto-colon and the ileocecal junction were pathomorphologically observed by light microscope and transmission electron microscope (TEM). Cerebral cortexes were extracted. Water-soluble and lipid-soluble brain tissue metabolites were respectively extracted for metabolic research using 1H nuclear magnetic resonance (1H-NMR).

RESULTSEA could obviously improve the general condition of UC model rats, decrease the value of DAI, reduce the infiltration of inflammatory cells in the intestinal tract, stabilize structures such as mitochondria, endoplasmic reticulum and so on (P <0.05). 1HNMR analysis showed that in the model group, contents of glutamic acid, cholesterol, very low density lipoproein (VLDL) in the pallium obviously decreased, while alanine and low density lipoprotein (LDL) significantly increased. After EA, levels of lactic acid, glutamic acid, total cholesterol (TC), and VLDL all increased, and levels of alanine and LDL decreased. All indices were approximate to those of the blank control group.

CONCLUSIONEA at Foot Yangming channel was found to have some effect on metabolites in the brain tissue of UC model rats, which had specific metabonomic material basis and mechanism based on the Pi/Wei-brain related theory.

Acupuncture Points ; Animals ; Cerebral Cortex ; metabolism ; Colitis, Ulcerative ; Electroacupuncture ; Lipids ; Male ; Rats, Sprague-Dawley

OBJECTIVETo observe the clinical effect of Chinese medicine for nourishing yin and clearing heat therapy (CM therapy) in treating nasopharyngeal carcinoma (NPC) patients with yin deficiency-induced inner heat syndrome, and suffered from acute radiation oral mucositis.

METHODSSixty patients with NPC fitting to the inclusion criteria and undergoing initial dose radiotherapy were assigned to two groups. The 31 patients in the treatment group received CM therapy, and the 29 in the control group were treated with standard Western medical therapy. The condition of oral mucosa and epidermal growth factor (EGF) content in saliva of patients during the therapeutic period were observed, meanwhile the quality of life (QOL) of patients was estimated with the quality of life questionnaire-core 30 (QLQ-C30) issued by European Organization for Research and Treatment of Cancer (EORTC).

RESULTSAcute radiation oral mucositis occurred in all patients, but the severity in the treatment group was milder than that in the control group (P < 0.01). Salivary EGF content decreased along with the increasing radiation dosage, it decreased significantly when 40 Gy radiated and down to the minimum when 70 Gy radiated, but the decrement in the treatment group was less than that in the control group (P < 0.01). Comparison of QOL by QLQ-C30 scale showed that after radiotherapy the global health status in the treatment group was superior to the control group (P < 0.01).

CONCLUSIONChinese medicine for nourishing yin and clearing heat therapy could actually postpone the occurrence of acute radiation oral mucositis, lessen the adverse reaction of radiotherapy and improve patient's QOL, show a favorable effect in prevention and treatment, and has definite application value for clinical spreading.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Phytotherapy ; Quality of Life ; Radiotherapy ; adverse effects ; Stomatitis ; drug therapy ; etiology ; prevention & control ; Yin Deficiency ; drug therapy ; Young Adult

OBJECTIVETo investigate the therapeutic effect of island flap pedicled with lateral tarsal artery for forefoot skin defect.

METHODSFrom March 2007 to January 2009, 12 cases with forefoot skin defects were treated by reversed island flap pedicled with lateral tarsal artery.

RESULTSAll the flaps survived completely with a followed-up period of 8-22 months, 13 months in average. The flaps and skin grafts had soft texture and a similar color as the surrounding skin. The flaps had a suitable thickness with deep pain sensation. Shallow touch and pain sensation recovered in the skin graft and within 1-2 cm of the flap edge, which was graded as S1-S2. There was no problem in shoes-wearing and walking. No flap ulcer happened.

CONCLUSIONIsland flap pedicled with lateral tarsal artery is suitable for forefoot skin defect, leaving less morbidity to donor site.

Adult ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply