Objective To investigate the efficacy of modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction for severe thoracolumbar fractures.Methods A retrospective case-control study was made on 44 cases of severe thoracolumbar fractures treated from January 2009 to June 2014.There were 34 males and 10 females, with age range of 20-68 years (mean, 37.9 years).The injured vertebrae included T11/12 in one case, T12-L1 in 10, L1/2 in 21, L2/3 in nine and L3/4 in three.Injury type was all AO type B2.According to the American Spinal Injury Association (ASIA), neurological deficit was Grade A in three cases, Grade B in five, Grade C in 22, and Grade D in 14.Load sharing score (LSC) was 7-9 points (mean, 8.1 points), while the thoracolumbar injury classification and severity score (TLICS) was 7-9 points (mean, 8.2 points).According to the difference of surgical procedures, all cases were divided into traditional group (21 cases) and improved group (23 cases).The patients in traditional group were treated by 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction, and those in improved group were treated by modified 270°spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction.Between-group differences were compared with regard to operation time, intraoperative blood loss, postoperative drainage, allogeneic blood transfusion, pain visual analogue scale (VAS) at postoperative 72 hours, Cobb angle, anterior vertebral height, spinal canal compromise, Denis score, work state, neurological function, bone graft fusion and complications.Results Duration of follow-up was (32.4±15.8)months (range, 12-60 months).No wound infection or deterioration of neurological function was found after operation.Operation time was (2.4±0.5)hours in traditional group, less than (2.8±0.6)hours in improved group (P<0.05), while there were no significant differences in intraoperative bleeding, postoperative draining and blood transfusion between the two groups (P>0.05).VAS was (3.2±0.9)points in traditional group and (3.3±0.9)points in improved group at postoperative 72 hours (P>0.05).Cobb angle, anterior vertebral height and spinal canal compromise in both groups obtained well recovery and maintained after operation (P<0.05), but the recovery of spinal canal compromise was better in improved group than traditional group [(2.1±1.8)% vs.(11.8±6.1)%] (P<0.05).Denis score and work state were similar between the two groups (P>0.05).At the last follow-up, ASIA Grade A was noted in three cases, Grade C in two, Grade D in 23, and Grade E in 16.Bone union was achieved in all cases, with no implant loosening or breakage observed.Thirteen cases in traditional group were found with residual bone fragments in the spinal canal after surgery, and two of them received revision surgery.Conclusions Either modified or traditional 270° spinal canal decompression combined with one-stage pedicle screw fixation and vertebral reconstruction can attain satisfactory clinical results in treatment of severe thoracolumbar fractures.However, the modified 270°spinal canal decompression can achieve more thorough decompression without reducing stability of the spine.

OBJECTIVETo evaluate the therapeutic effect of clarithromycin combined with tanshinone in the treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in patients with nasopharyngeal carcinoma (NPC).

METHODSA total of 255 NPC patients with rhinosinusal and laryngeal radiation injury following radiotherapy were randomized into 3 groups for treatment with clarithromycin (group A, n=69), tanshinone (group B, n=69), and clarithromycin + tanshinone (group C, n=69), and the clinical outcomes of the patients were evaluated.

RESULTSIn all the 3 groups the patients responded favorably to the treatments and showed obvious improvements (P<0.05). The therapeutic effects were similar between groups A and B (P>0.05), but the patients in group C showed the most obvious improvements (P<0.05).

CONCLUSIONSClarithromycin combined with tanshinone can be an effective regimen for treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in NPC patients.

Adult ; Aged ; Carcinoma ; Clarithromycin ; therapeutic use ; Combined Modality Therapy ; Diterpenes, Abietane ; therapeutic use ; Female ; Humans ; Larynx ; pathology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Nose ; pathology ; Paranasal Sinuses ; pathology ; Pharynx ; pathology ; Radiation Injuries ; drug therapy ; Young Adult

OBJECTIVESTo summarize the experience in the treatment of 112 cases of complex bone nonunion from 1982 to 1999 in our department and introduce the technique of external skeletal fixation.

METHODSThe two fragment ends of all cases were fixed under pressure with half-ring sulcated external skeletal fixator. Those cases complicated by bone defect or limb shortening were operated on with epiphysiotomy to restore the length of the limb in the period of compressive fixation or after the occurrence of bone union according to the condition of complicated infection and the length of the limb shortened.

RESULTSThe nonunion of the 112 cases was united eventually. The infection in 34 cases was eradicated. Bone union in cases without infection took 3 approximately 7 months (average 5.2 months) and in cases with infection took 5 approximately 11 months (average 5.5 months). The length of the limb in 11 cases with bone defect was restored in the same period of compressive external fixation and another 8 cases achieved after bone union. The length between the injured and healthy limbs was balanced.

CONCLUSIONSWhen external skeletal fixation is employed to treat those troublesome cases of bone nonunion, the pins for fixation are inserted in sites far from the lesions and the non-united fragment ends are exposed only in the area without scars. Consequently, there is little interference with the blood circulation and the osteogenic potency of the fragment ends. The sclerotic bone tissue is not excised, the marrow cavity is not chased to be open and the fragment ends are only moderately modified. As a result, the stability of fixation is increased and further shortening of the limb avoided. External skeletal fixation using small pins with cross penetration results in plastic fixation and promotes bone healing. Bone lengthening with epiphysiotomy can restore the balance of the limbs.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Fracture Fixation ; Fracture Healing ; Fractures, Ununited ; Humans ; Male ; Middle Aged

Objective To explore the feasibility of serum Klotho level in the elderly donors to predict the renal graft function in the recipients. Methods Clinical data of 16 elderly donors and 27 recipients undergoing renal transplantation were collected. The general status of the recipients was observed. The levels of serum Klotho and serum creatinine (Scr) in the elderly donors were measured on the day of renal transplantation. The Scr levels in the recipients were measured at postoperative 1, 3 and 12 months respectively. The estimated glomerular filtration rate (eGFR) was calculated. The correlation between the serum Klotho level of the donors and postoperative graft function of the recipients was analyzed. Results The cold ischemia time during renal transplantation was (649±245) min. The incidence rate of delayed graft function (DGF) was 26%. The incidence rate of acute rejection was 7%. In the elderly donors, the serum Klotho level was 537 (245-793) pg/mL and the Scr level was (164±62) μmol/L. At postoperative 1, 3 and 12 months, the Scr levels in the recipients were (136±47), (132±43) and (133±46) μmol/L, respectively. The corresponding eGFR was (52±20), (52±19) and (53±21) mL/(min?1.73m²), respectively. The serum Klotho level in the elderly donors was negatively correlated with the renal graft function at postoperative 1 month in the recipients (P < 0.05). The sensitivity and specificity of serum Klotho level in predicting the renal graft insufficiency at postoperative 1 month were 0.909 and 0.769. Conclusions The preoperative serum Klotho level in the elderly donors have predictive value for renal graft function in the recipients at postoperative 1 month.

Epilepsy is a recurrent neurological disease with synchronous abnormal high discharge of neurons in the brain. The pathogenesis of this disease is extremely complex， which is closely related to neurotransmitter regulation， oxidative stress response， inflammatory factors， neuroglial cell， and abnormal gene expression. Western medicine mainly uses phenobarbital， phenytoin sodium， carbamazepine， and other drugs， but long-term use also produces certain toxic and side effects. Traditional Chinese medicine （TCM） believes that the pathogenesis of epilepsy is related to wind， fire， phlegm， and blood stasis， which leads to dysfunction of viscera， disorder of Qi movement， and finally uncontrolled spirit. In recent years， TCM has achieved certain curative effects on the treatment of epilepsy. As a high-frequency antiepileptic drug， Acori Tatarinowii Rhizoma has the effects of opening orifices and eliminating phlegm， awakening spirit and benefiting intelligence， and removing dampness and opening stomach， which has been widely used in clinic. In this paper， the pathogenesis of epilepsy and the pharmacological mechanism of Acori Tatarinowii Rhizoma extract and chemical components in the treatment of epilepsy were expounded by referring to relevant pharmacological studies and animal experiments. It was found that Acori Tatarinowii Rhizoma played a role in regulating the neurotransmitter level， antioxidant stress response， scavenging oxygen free radicals， regulating the expression of c-fos gene， reducing the level of inflammatory mediators， resisting neuronal apoptosis， and regulating the neuroglial cells and the permeability of blood-brain barrier. This paper summarizes the positive effects of Acori Tatarinowii Rhizoma on the treatment of epilepsy， and provides a scientific basis for the popularization and application of Acori Tatarinowii Rhizoma in the prevention and treatment of epilepsy.