ObjectiveTo study the changes of related hormone levels using hormone replacement therapy in patients with perimenopausal syndrome,and its clinical significance.Methods Eighty-five patients with perimenopausal syndrome received continuous sequential estrogen and progesterone treatment.Daily oral conjugated estrogen 0.625 mg,28 days as one cycle.In each cycle the 19-28th d combined with medroxyprogesterone acetate 4 mg,once a day,a total of 3 cycles.Observed the changes of hormone levels before and after treatment.ResultsThe levels of estradiol and progesterone were obviously increased after treatment compared with those before treatment [ (83.6 ± 1.9) ng/L vs.(10.0 ± 1.1 ) rng/L,(0.32 ± 0.10)μ g/L vs.(0.22 ± 0.20) μ g/L,P ＜ 0.05 ],and follicles stimulating hormone,luteinizing hormone,total cholesterol and triglyceride were obviously decreased [ (40.8 ± 11.0) U/L vs. (57.1 ± 10.8) U/L, (24.9 ±13.6) U/L vs.(46.2 ± 13.8) U/L,(4.6 ±0.9) mmol/L vs.(6.1 ± 1.0) mmol/L,(1.1 ±0.2) mmol/L vs.( 1.6 ± 0.1 ) mmol/L,P ＜ 0.05 ].Body mass index was no obviously different[ (23.9 ± 1.9) kg/m2 vs.(22.5 ± 2.2)kg/m2,P ＞ 0.05 ].ConclusionApplication of hormone replacement in treatment of perimenopausal syndrome is safe.

Objective To investigate the effect of Lokomat gait training rehabilitation robot on joint motion and lower limb function in hemiplegic patients after stroke.Methods Forty hemiplegic patients after stroke were randomized equally into a robotic group and a control group (20 cases in each group).The robotic group received robotic rehabilitation therapy in addition to routine rehabilitation training,while the control group was only given instructions for routine rehabilitation training.All the patients were assessed at the beginning of the training and at the end of 4,8 and 10 weeks of treatment.The Fugl-Meyer Assessment of lower extremities (FMA),range of motion (ROM) in hip and knee,force and tone of bilateral hip/knee flexors and extensors were used to evaluate stepping function before training,and after 4,8 and 10 weeks of treatment.Results There was no significant difference between the 2 groups with regard to FMA scores,the ROM in hip and knee,as well as force and tone of bilateral hip/ knee flexors and extensors (P ＞ 0.05).After treatment,the robotic group was significantly improved with all the evaluation indexes when compared to its baseline values (P ＜ 0.05).It was also shown that the robotic group improved to a significantly greater extent than the control group (P ＜ 0.05).Pearson's correlation analysis demonstrated a positive relationship between the ROM of knee or hip and lower limb function (P ＜ 0.05).Conclusions The Lokomat gait training rehabilitation robot can improve the lower extremities functions,as indicated by increase of ROM and muscle strength as well as decrease in muscle spasticity in hemiplegic patients after stroke.

Objective To investigate the serum levels of Th1 and Th2 cytokines and explore its roles in development and clinical features in the elderly patients with eczema. Methods The serum levels of interleukin-2(IL-2),interleukin 4(IL-4),interleukin-10(IL-10),interleukin-12(IL-12) and tumor necrosis factor alpha (TNF-α) were derected in 50 elderly patients with eczema and 34 healthy elderly as control by enzyme-linked immunosorbent assay (ELISA). The above cytokines were compared between acute and chronic,generalized and localized eczema. Results The serum levels of IL-2 [(16.03±0.47)vs.(15.72±0.33) μg/L],IL-4[(14.04±0.56) vs.(13.56±0.16) μg/L],IL-10 [(33.01±5.40) vs.(29.49± 1.07) μg/L],IL-12 [(39.32± 3.54) vs.(37.93± 1.17) μg/L]and TNF-α [(27.33±0.72) vs.(26.38±0.48) μg/L] were higher in elderly eczema than in control (t/t'=3.55,5.74,4.49,2.58,6.69,all P＜0.05).The serum levels of all cytokines tested in acute eczema(t/t'=3.59,4.68,3.35,2.00,6.44,all P＜0.05),the levels of IL2,IL-4,IL-10 and TNF-α t'=2.46,5.50,3.83,3.10,P＜0.05,but not IL-12 (t'=1.77,P＜0.05) inchronic elderly eczema were increased as compared with control ( P ＜0.05).No significant difference was found in cytokines levels between acute and chronic eczema (P＞0.05)as well as between generalized and localized eczema(t=0.18,5.74,4.49,0.91,0.25,1.11,P＞0.05). Conclusions Changes of Th1 and Th2 cytokines may play some role in the pathogenesis of elderly eczema,but not characterized by clinical types of eczema.

Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.

Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum (MERS) in children.Methods Four patients of MERS, who were diagnosed and treated in the First Hospital of Jilin University during 2013-2014, were collected retrospectively.Their clinical, laboratory, radiologic data and the related literatures were reviewed.Results Four patients onsetted as gastrointestinal symptom (3 cases) or respiratory (1 case) symptom, in accompany with disturbance of consciousness (3 cases of drowsiness, 1 case of lethargy), convulsions (4 cases), headache (1 case) as the main symptoms.Abnormal neurological signs included positive cervical resistance (3 cases), positive bilateral Babinski sign (3 cases), bilateral chemosis (2 cases).Laboratory test showed the average blood sodium was 131.6 mmol/L, while the cerebrospinal fluid test only showed abnormality in 1 case.In etiology examination, 2 cases showed human rotavirus antigen positive, and Mycoplasma pneumoniae antibody was found positive in 2 cases.Cranial MRI showed reversible lesion in the splenium of corpus callosum (patchy iso-or hypo-intensity on T1 WI and apparent diffusion coefficient, hyper-intensity on T2WI, FLAIR and DWI, clear boundary).After active treatment, clinical symptoms disappeared within 1 week, and cranial MRI lesions disappeared within 2 weeks.Conclusion The clinical presentations of MERS, which is a clinical-radiological syndrome, are sudden onset and mild, with characteristic changes in brain MRI and good prognosis.

BACKGROUND:Traditional internal fixation for thoracolumbar vertebral fractures easily causes poor vertebral reduction, and postoperative vertebral height loss easily appears.
OBJECTIVE:To analyze the feasibility of lateral-position pedicle screw placement in spinal surgeryvia combined anterior-posterior approaches.
METHODS: A total of 36 cases undergoing spinal surgical operation in the Baoji City Chinese Medicine Hospital from February 2013 to October 2014 were enroled in this study. The patients were divided into two groups according to the method of repair. 18 patients in the control group received prone-position pedicle screw placement, and 18 patients in the experimental group received lateral-position pedicle screw placementvia combined anterior-posterior approaches. Postoperative CT and X-ray examinations compared the adverse rate of screw placement and the rate of nerve root injury between the two groups. Operation time, length of stay, time of beginning movement, intraoperative blood loss and American Spinal Injury Association impairment scale score were compared between the two groups.
RESULTS AND CONCLUSION:Significant differences in the adverse rate of screw placement and the rate of nerve root injury were detected between the two groups (P < 0.05), and the adverse rate of screw placement and the rate of nerve root injury were better in the experimental group than in the control group. Operation time, length of stay, and time of beginning movement were significantly better in the experimental group than in the control group (P < 0.05). Intraoperative blood loss was significantly lower in the experimental group than in the control group (P < 0.05). American Spinal Injury Association impairment scale scores were significantly higher in the experimental group than in the control group (P < 0.05). These findings confirm that lateral-position pedicle screw placementvia combined anterior-posterior approaches in spinal surgery can reduce intraoperative trauma, shorten the length of hospital stay, and promote functional recovery of spinal cord.

Objective To explore the optimal exercise way of improving the risk indicators of electrocardiogram (ECG) during exercise.Methods Twenty-four healthy male subjects aged between 40 and 49 years old were divided randomly into a control group (n=9),a low amount exercise group of 1200 kcal/wk (n=7) and a high amount exercise group of 2000 kcal/wk (n=8).The intensity of the exercise groups was 65％～ 80％VO2max training in the standard 400 m track for 12 weeks.The accelerometer and polar watch were worn to monitor the exercise process.During the exercise,the exercise amount was controlled using the distance and duration while the intensity was controlled using target heart rate.The subjects took part in the graded exercise test before and after the exercise intervention.Twelve lead electrocardiograms were used to measure the indicators of ST segment depression and corrected QT interval dispersion (QTcd) during the exercise.Results The exercise intervention did not result in significant change in ST segment depression,while the QTcd indicator in both the exercise groups decreased significantly after the intervention (P＜0.05).Moreover,the decrease of QTcd indicator in the low amount exercise group was significantly higher than that of the control group (P＜0.05),while the decrease of QTcd indicator in high volume group was higher than that of the control group (P＜0.01).No significant differences were found in the ST segment depression among the 3 different groups.Conclusion The Twelve-weeks exercise interventions with intensity of 65％ ～ 80％ VO2max and exercise amount of 1200 kcal/wk and 2000 kcal/wk have no effect on the ST segment depression during the exercise.However,they can result in significant decrease in the QTcd of ECG during exercise,reducing the risk of exercise-induced myocardial ischemia.

Objectives:To evaluate if the administration of an enteral diet supplemented with glutamine,arginine and ? 3 fatty acids modulate the inflammatory and immune responses and the outcome after surgery. Methods:A prospective,randomized,double blind and clinical trial was performed.Eighty eight patients with gastrointestinal cancer were randomly divided itnto two groups.One group was given an isocaloric and isonitrogenous standard diet and the other was fed with the supplemented diet with glutamine, arginine and ? 3 fatty acids.Feedings were started within 48 hour after operation, and continued until day 8.All variables were measured before operation and on postoperative day 1,4 and 8.Blood was drawn at different time points to assess albumin, prealbumin and transferring.Immune responses was determined by phagocytosis ability,respiratory burst of polymorphonuclear cells, total lymphocytes, lymphocyte subsets, nitric oxide,cytokine concentration,immunoglobins,and inflammatory responses by plasma levels of C reactive protein and prostaglandin E 2. Results:Tolerance of both formula diets was excellent.There were significant differences in the immunological and inflammatory responses between the two groups.In supplemented group,the serum concentrations of IgA,IgG,IgM,phagocytosis and respiratory burst after surgery were higher and C reactive protein level was lower( P

Cardiopulmonary exercise test and electrocardiogram exercise test were performed in 68 patients with suspected coronary artery disease,the diagnostic value of two tests was compared with coronary angiography results as the gold standard.The results show that the sensitivity,specificity,positive predictive value and negative predictive value of electrocardiogram exercise test for coronary heart disease were 51.28％,68.97％,68.97％ and 51.28％ respectively; those for ratio of O2 pulse peak in cardiopulmonary exercise test were 51.28％,75.86％,74.07％ and 53.66％ respectively.It suggests that the results of cardiopulmonary exercise test may have the same value as electrocardiogram exercise test in diagnosis of coronary artery disease.

Objective To investigate the spinal stability reconstruction and related complications after total spondylectomy for thoracolumbar tumors. Methods From January 1997 to December 2009, 34 cases with thoracolumbar tumors treated with total spondylectomy, including 20 males and 14 females with an average age of 43 years. The tumors were located in thoracic vertebra in 27 cases and lumbar vertebra in 7, including 6 spinal metastases and 28 primary tumors. The total spondylectomy was piecemeal in 23 cases and en bloc in 11. The reconstruction methods included posterior short-segment fixation in 19 cases, multi-segmental fixation in 13, anterior intervertebral fixation in 2, titanium mesh with auto-bone graft in 20 cases, titanium mesh with bone cement in 7, bone cement filling in 2, auto-bone strut graft in 2, titanium mesh with strengthened rings in 1, artificial vertebral body replacement in 2, posterior massive bone bridging graft in 8 and bone particles graft in 26. Results The mean follow-up time was 43 months. Seven patients died, 5 suffered recurrence. Poor grafted bone fusion was found in 5 cases. The intervertebral sagittal Cobb angle of adjacent vertebra was ??after operation, 9.3?at the end of follow-up or before revision operation. The average lost angle was 14.1?for cases with multi-segmental fixation, and 21.5?with short-segment fixation. Complications included internal fixation broken (5) and loosening (2), titanium mesh subsidence (6) and displacement (3). There were 5 revision surgeries. Conclusion There are relative more complications about spinal stability reconstruction after total spondylectomy. To achieve temporary stiff fixation and long-term fusion, the posterior multi-segment fixation and massive bone bridging graft combined with the anterior artificial vertebral body replacement are effective.