Objective:To explore the clinical efficacy and surgical indications of Y type osteotomy in the treatment of post-tuberculous thoracolumbar severe angular kyphosis.Methods:From March 2012 to June 2018, 36 patients with post-tuberculous thoracolumbar severe angular kyphosis were treated with Y type osteotomy, including 22 males and 14 females, aged 23.6±5.7 years (range, 7-57 years). The parietal vertebrae of kyphosis were located in the upper thoracic vertebra in 3 cases, the thoracic vertebra in 11 cases, the thoracolumbar segment in 17 cases, and the lumbar vertebra in 5 cases. The Cobb angle of kyphosis before the operation was 92.8°±23.3° (range, 60°-147°). The visual analogue scale (VAS), American Spinal Injury Association (ASIA) neurological function grade, and Kirkaldy-Willis function score were used to evaluate the clinical effect. The imaging evaluation indexes were interbody kyphosis angle and spinal bone fusion.Results:The operation was successful in all the 36 patients. The operation time was 210 ±25.9 min (range, 180-270 min), the intraoperative blood loss was 520 ±110 ml (range, 400-800 ml), and the postoperative follow-up time was 26.38±1.75 months (range, 22-30 months). The postoperative kyphosis Cobb angle was corrected to 16.5°±7.7° (range, 5°-35°), which was significantly improved compared with that before operation( t=25.438, P<0.01), and the correction rate was 82.2%. At the last follow-up, the kyphosis angle was 16.5°±7.1° (range, 6°-32°), which was not significantly different from that after the operation. The preoperative VAS score was 7.3±1.8 (range, 3-9), and the postoperative VAS score was 2.4±0.8 (range, 1-3), while the improvement rate was 67.1%. At the last follow-up, it was 1.1±0.6 (range, 0-2), and the improvement rate was 85.0%. According to the Kirkaldy-Willis functional score, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases at the last follow-up, with an excellent and good rate of 91.7%. Before the operation, 9 cases were accompanied by neurological dysfunction (ASIA grade: grade C in 2 cases, grade D in 7 cases). At the last follow-up, all the 9 patients recovered to grade E. During the operation, the electrophysiological nerve monitoring was abnormal in 2 patients, and the awakening test was negative in 1 case. In another patient, neuroelectrophysiological monitoring after posterior column osteotomy showed a decrease in bilateral sensory and motor function. There was no compression around the spinal cord in the osteotomy area, so the operating bed was gradually folded and partially restored to kyphosis and temporarily fixed with double rods. Neuroelectrophysiological monitoring suggested the recovery of nerve function. The awakening test showed that the nerve function of both lower limbs recovered close to the preoperative state, and further osteotomy and internal fixation was performed 2 weeks later. The nerve function of both lower limbs returned to normal after 3 months. After the operation, one patient's muscle strength of the lower limbs decreased from grade 5 to grade 3, and the sensory function was normal. After symptomatic support treatment such as neurotrophic drugs, it returned to normal 2 weeks later. 1 case developed delayed neurological dysfunction 1 year after the operation. Neurotrophic drugs and rehabilitation treatment improved it. The sinus of the incision was formed in one case 3 months after the operation and healed after debridement and suture. Conclusion:Y typeosteotomyis a safe and effective method for patients with post-tuberculous thoracolumbar severe angular kyphosis. Compared with traditional osteotomy, anterior support bone grafting can be avoided, and spinal shortening can be reduced.

Objective To study the survival situations,care skill,social support and demand condition of senile people with home care.Methods Many methods were used such as self-designed questionnaire,social support scale,interview and so on.Cluster sampling was used and totals of 202 hone caregivers of senile people from eight communities,old town of Hangzhou city were selected and were investigated with questionnaire in their homes and interviewed by face to face,then,the status of survival and care of home care-givers was analysed.Results Children(52.5％ ) and spouses( 12.5％ ) were main caregivers,65.8％ caregivers provided 24 hours care,10.4％ caregivers believed that the seriously effect of care work was sleeping,25.2％ caregivers believed that they could not treated with senile person' s unusual mental well.The male score of social support was (29.02 ±5.51 ) and female was(27.50 ± 5.37 ),and the difference was statistically significant (t =1.906,P ＜0.05 ).Conclusions Community nurse and health manager should pay attention and assessment on the caregivers'needs and wishes,and provide feasible and appropriate social support service for caregivers.

OBJECTIVESTo study on the changes of intracellular calcium and magnesium in cirrhosis and its clinical significance.

METHODSThe calcium and magnesium were determined in serum (SCa, SMg), platelets (PCa, PMg), mononuclear cells (MNCCa, MNCMg), polymorphonuclear cells (PMNCa, PMNMg) and erythrocytes (RCa, RMg) of 50 patients with uncompensative cirrhosis (group A) and of 35 patients with compensative cirrhosis (group B). 35 health persons were the control group.

RESULTSThe SCa and SMg of group A were lower significantly than those of both group B and control group. The MNCCa, PMNCa, RCa, PMg, MNCMg, PMNMg, RMg of group A [(4.76+/-1.91) micromol/10(9), (7.56+/-2.88) micromol/10(9), (0.66+/-0.13) mmol/L, (5.53+/-2.25) micromol/10(11), (6.64+/-3.53) micromol/10(9), (10.12+/-4.32) micromol/10(9), (2.02+/-0.76) mmol/L] and those of group B [(5.34+/-2.41) micromol/10(9), (8.32+/-2.34) micromol/10(9), (0.67+/-0.11) mmol/L, (5.55+/-2.67) micromol/10(11), (6.56+/-3.44) micromol/10(9), (10.95+/-4.45) micromol/10(9), (2.21+/-0.74) mmol/L] were lower significantly than those of control group [(6.86+/-2.02) micromol/10(9), (9.89+/-3.23) micromol/10(9), (0.72+/-0.10) mmol/L, (7.43+/-2.78) micromol/10(11), (8.68+/-4.1) micromol/10(9), (13.96+/-5.76) micromol/10(9), (2.74+/-0.92) mmol/L]; t (group A vs. control group)=4.88, 3.48, 2.31, 3.45, 2.46, 3.52, 4.00, 0.01, 0.01, 0.05, 0.01, 0.02, 0.01, 0.01; t (group B vs. control group)=2.87, 2.34, 2.00, 2.89, 2.33, 2.45, 2.65, 0.01, 0.05, 0.05, 0.01, 0.05, 0.02, 0.02. The PCa of the patients with hepatic encephalopathy was higher, the SMg, PMg, MNCMg, PMNMg and RMg were lower than those of the patients without hepatic encephalopathy significantly. The SCa, SMg, PMg, MNCMg, PMNMg and RMg of the patients in Child stage C were lower significantly than those of the patients in Child stage B. There were no significant differences of PCa, MNCCa, PMNCa and RCa between Child stage C and Child stage B. There were no significant differences of SCa, MNCCa, PMNCa and RCa between the patients with and without hepatic encephalopathy. The ratios of PCa/SCa, MNCCa/SCa and PMNCa/SCa of the patients with decreased SMg were lower than those of control group. The SMg, MNCMg, PMNMg and RMg were correlated directly with the level of serum albumin.

CONCLUSIONThere are calcium and magnesium deficiencies in the patients with uncompensative cirrhosis and compensative cirrhosis, this deficiency aggravates with the severity of the disease. There is relative increase of intracellular calcium. The magnesium deficiency may be one of the reasons for both hepatic encephalopathy and relative increase of intracellular calcium.

Adult ; Blood Cells ; chemistry ; Calcium ; blood ; Female ; Humans ; Liver Cirrhosis ; blood ; Magnesium ; blood ; Male ; Middle Aged

OBJECTIVETo observe the urinary S-phenylmercapturic acid (S-PMA) variation in the benzene dynamic exposed rat models and benzene exposed workers, and study the feasibility of use of urinary S-PMA as the biomarker in benzene exposed.

METHODSIn an animal model study, forty-eight adult Wistar rats were randomly divided into 4 groups: the control group, low-dose group, middle-dose group and high-dose group. The exposed groups were dynamically exposed for 28 days (4 periods) by benzene and the concentration was monitored. The urine was immediately collected after every exposure period and detected by the liquid chromatographic/mass spectrometry methods. In a cohort study, eighty benzene exposed workers in a ship-yard in Guangzhou were selected as the exposed subjects while forty healthy officers in the same shipyard who were not occupationally exposed to benzene were treated as the control. The urine was collected after work shift. The urinary S-PMA and the benzene in the workplace was treated as the rat model.

RESULTSIn the animal model study, the urinary S-PMA increased along with the environment benzene in every period and had significantly difference in the different exposed groups (P < 0.01 or P < 0.05), but did not change along with the exposed time course (P > 0.05). In the cohort study, the urinary S-PMA in the high-dose group [(27.2 +/- 7.9)microg/L] was significantly higher than the low-dose group [(13.6 +/- 3.4)microg/L] (P < 0.01). Otherwise, the background of urinary S-PMA was lower than 5microg/L in both workers and rat models.

CONCLUSIONThe urinary S-PMA can be proposed as a sensitive biomarker of occupational benzene exposure.

Acetylcysteine ; analogs & derivatives ; urine ; Adult ; Animals ; Benzene ; administration & dosage ; toxicity ; Environmental Exposure ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Rats ; Rats, Wistar ; Young Adult

To explore a simple and effective method to determinate the volume of CD34(+) cells in the peripheral blood of donors received drug mobilization for stem cell transplantation by using flow cytometry, the mobilized peripheral blood from donors and 100 micro l fresh whole blood were labeled with monoclonal antibodies Anti-CD34-PE and Anti-CD45-FITC, after lying the red blood cells, and assessed with flow cytometer FL2 (log) vs SSC (log) and FL1 (log) vs SSC (log) were mainly used for analysis windows. The results showed that a level of CD34(+) cells in whole nucleated cells as low as 0.05% - 0.1% can be detected effectively using this method when 10(5) nucleated cells were counted. At day 5 or day 6, the level of CD34(+) cells in most samples of patients reached a peak volume, some of samples and the levels were more than one percent in. It was concluded that CD34(+) cells can be effectively determined by using this method. According to the relative rate of CD34(+) cells, the time to harvest the stem cells in blood can be determined.
Antigens, CD34 ; blood ; Blood Donors ; Flow Cytometry ; methods ; Hematopoietic Stem Cells ; cytology ; Humans

Adult ; Female ; Humans ; Prednisone ; therapeutic use ; Sarcoidosis ; diagnosis ; Takayasu Arteritis ; diagnosis

Objective To discuss the clinical efficacy and surgical indications of one-stage posterior debridement,Smith-Petersen osteotomy(SPO), compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis. Methods All of 32 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one-stage posterior debridement,SPO, compressive fusion and instrumentation from March 2010 to October 2016,including 23 males and 9 females,aged 2 to 77 years old,average(39.2±17.8)years.All patients were treated by preoperative quadruple anti-tuberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months.Preoperative and postoperative changes in clinical symptoms,nervous func-tion,the situation of the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)with strict follow-up,as well as other re-lated complications were observed.The spinal fusion rate and fusion situation,changing of the physiological curvature,as well as loosening or breaking of the internal fixation device were detected through regular imaging examination.Results The surgery du-ration time was 90-150 min,average(120±19.6)min,and the blood loss was 150-600 ml,average(320±88.9)ml.Postoperative follow-up time was 1 to 3 years,average 2.3 years.The symptoms of tuberculosis poisoning in all patients were obviously relieved and the nutritional status was improved gradually. The visual analogue scale(VAS) improvement rate was about 92%. The VAS score in the preoperative and the last follow-up was statistically significant.All patients'ESR and CRP returned to normal levels at the last follow-up.The Kirkaldy-Willis function score showed that the total fine rate was 93.75%.9 patients with spinal neurologi-cal impairment were postoperative improved significantly.Except 1 patient's Asia grade improved from the B to C,others returned to normal condition.30 cases recovered.Pleural effusion was observed in 3 cases treated with closed thoracic drainage and antibi-otics.The drainage tube was removed after 5-7 d.Incision fistula were observed in 1 patient at 1 month after discharge and recov-ered after debridement and drugs adjustment.Internal fixation loosening was found in 1 elderly patient after 6 months after surgery which was treated with hyperextended brace and anti-osteoporosis drugs.No tuberculosis recurrence was found.Conclusion One-stage posterior debridement, SPO, compressive fusion and instrumentation is a simple, effective and safety surgical approach, which has great application value for surgical treatment of patients with thoracolumbar spinal tuberculosis.

Objective To evaluate the health related quality of life (HRQoL) and to explore the influencing factors related to the prevalence of the essential hypertension,diabetes,coronary heart disease (CHD) and stroke in middle-aged and elderly people from rural communities.Methods A total of 5345 individuals were chosen from a 2010 Health Survey in Fangshan,Beijing.Self-designed questionnaire was applied to collect the information on general health-related behaviors,chronic conditions,self-rated health,blood pressure and HRQoL with the EuroQoL questionnaire (EQ-5D) were measured.Probit regression model was used to identify the influencing factors on HRQoL,adjusting age,marriage status,education level,smoking,alcohol intake,physical activity and control of blood pressure.Population Attributable Risk Proportion (PARP) for estimating the influence of chronic disease on HRQoL was also calculated.Results The average EQ-5D index was 0.923 ±0.145,with 72.1％ of the overall respondents in the status of having chronic diseases.Participants with chronic diseases had significantly lower EQ-5D index (0.907 ± 0.155 ) than those without (0.963 ±0.105 ) (t =15.082,P＜ 0.001 ).Significant relations were found between a lower HRQoL and chronic diseases.Relative risk (RR) and 95％ confidence interval (95％ CI) of poor HRQoL in populations with hypertension,diabetes,CHD and stroke were 1.686 (95％CI: 1.519-1.871),1.725 (95％CI:1.502-1.981 ),1.869 (95％CI: 1.663-2.099),and 1.759 (95％CI: 1.474-2.089) respectively.The most influential disease appeared to be stroke in male (RR=1.929,95％CI: 1.462-2.546),whereas CHD in female individuals (RR=1.926,95％CI: 1.671-2.220).Rates of PARP (PAR％) for poor HRQoL in chronic disease subgroups were as follow: hypertension 31.05％,CHD 23.39％,diabetes 4.84％ and stroke 4.44％,respectively.Conclusion This study suggested that stroke,at individual level,was the major influential factor to HRQoL.However,hypertension remained the leading preventable influential factor to HRQoL at the population level.

Objective: To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance. Methods: The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method. Results: Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000). Conclusion Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance.

The name"Lonicerae Japonicae Flos"was first published in Materia Medica from Steep Mountainsides of the Southern Song Dynasty.After the Song Dynasty,the name was gradually used by later generations and became the proper name of medicinal ma-terials.The origin of the varieties of LJF is complicated in ancient times.Since the 2005 edition of the Chinese Pharmacopoeia has stip-ulated that L.japonica Thunb.is the only source of LJF,and medicinal parts are buds or flowers with initial bloom.It is mostly used for raw products,and the processing accessories are mainly wine.Shandong and Henan are the genuine producing area,and the quality of flower buds harvested at the first crop is better.Based on current research results combined with modern research results and re-source cultivation situation,the application and development of the classic prescriptions containing LJF(Simiao Yong'an Soup,Wuwei Disinfectant Drink and Tuoli Disinfection San)in the Catalogue of Ancient Classic Recipes(The First Batch)is suggested to use raw ma-terials from Shandong,Henan,and other genuine producing areas with L.japonica Thunb.being the origin,and the buds harvested from the first crop during the second white to big white period were preferred for medicinal use.Based on the clinical application litera-ture of famous classical prescriptions and bibliometric methods,the common dosage and average dosage of LJF in the three prescriptions were obtained,which could be used as the reference dosage of LJF in the development and utilization of famous classical prescriptions.