目的探讨980nm半导体激光经皮椎间盘减压术(PLDD)治疗腰椎间盘突出症的疗效。方法286例患者局麻后在C型臂X射线机透视下确定病变椎间盘平面,以每个椎间盘600～800J激光能量行PLDD。参照Choy评分法评价疗效。结果经1年以上随访,0～2分者(优)188例(65.8%),;3～5分者(良)41例(4.1%),6～10分者57例(20%);无椎间盘炎及其他并发症发生。结论PLDD能有效缓解椎间盘源性疼痛。

The key point of development of emergency medicine is professional training. What we need are "emergency physicians who have well-knit theory and comprehensive technique" but "the internal physicians who could do some resuscitation". This is the goal of emergency medical education. To realize the goal, we need to improve our condition of training-bases, the curriculum,the academic level of trainer and training method. Besides, we should balance the effectivness and safety of training. We believe that the "four steps" course should be the most important and most effective method of emergency medical training.

OBJECTIVE:To review the current situation and the trend of development of drugs for chronic hepatic diseases,so as to provide the information for rational use of these drugs METHODS:By using the methods of sequences of total sales volumn and DDDs,the main drugs for chronic hepatic diseases used in 8 hospitals of Xinxiang during the period 2001～2003 were analysed RESULTS & CONCLUSION:The total sales volumn and DDDs of the liver-protective drugs always occupied the front row of drugs for chronic hepatic diseases,and the use of compound glycyrrihizin(Stronger Neo-Minophagen C) is rapidly increasing

BACKGROUND:Functional recovery after joint arthroplasty is an important indicator to evaluate the effect and prognosis of total knee arthroplasty, and is affected by patients and many kinds of outside factors. OBJECTIVE:To investigate the influencing factors of functional recovery of knee in patients with knee osteoarthritis after total knee arthroplasty. METHODS:Clinical data of 76 osteoarthritis patients undergoing total knee arthroplasty in the Dongying People’s Hospital from August 2007 to August 2013 were retrospectively analyzed. Hospital for Special Surgery knee score, knee pain Visual Analogue Score, range of motion and posterior slop angle of tibial plateau were compared before and 6 months after surgery. Changes in anterior condylar offset were recorded before and after femoral prosthesis arthroplasty. SPSS 21.0 software was used to analyze the influential factors for Hospital for Special Surgery knee scores after arthroplasty. RESULTS AND CONCLUSION:(1) Hospital for Special Surgery knee score, knee pain Visual Analogue Score, and range of motion were significantly higher 6 months after arthroplasty than that before arthroplasty (P<0.05). (2) Pearson correlation analysis demonstrated that preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative range of motion, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were positively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). Body mass index and inversion deformity angle were negatively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). (3) Multiple linear regression analysis showed body mass index was negatively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). Preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score and preoperative posterior slop angle of tibial plateau were positively correlated with postoperative Hospital for Special Surgery knee score (P<0.05). (4) These results indicated that total knee arthroplasty significantly improved knee joint function. Body mass index, preoperative Hospital for Special Surgery knee score, preoperative knee pain Visual Analogue Score, preoperative posterior slop angle of tibial plateau and preoperative and postoperative anterior condylar offset changes were correlated with the recovery of joint function after total knee arthroplasty.

Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.

Objective To explore the value of diffused optical tomography(DOT)with ultrasonography (US)in differential diagnosis of breast benign from malignant neoplasms.Methods One hundred ard twenty-three breast neoplasms from 113 patients were checked use the optical tomography image ultrasonography(OPTIMUS).The diagnosis results of the system were compared with pathological study.Two-dimensional ultrasound features in breast neoplasms were digitalizated,and HBT and SO_2 were detected by DOT.At last,synthesis diagnostic index(SDI)was obtained by both US and DOT.Statistic process was carried out in sensitivity,specificity,and the rate of accuracy respectively by US,DOT and OPTIMUS system.Results Among breast neoplasms of 123 mass studied pathologically,78 of them were benign and the rest were malignant.HBT in benign lesions(153.02±105.78)was significantly less than malignant lesions(232.95±78.22),SO_2 in benign lesions(1.0332±0.1641)was significantly elevated compared with malignant lesions(0.8794±0.1814),SDI in benign lesions(147.26±53.76)was significantly less than malignant lesions(243.98±57.27),significant differences were found between the two groups(P＜0.05).The sensitivity of differential diagnosis of breast neoplasms by the OPTIMUS system was 93.33%,the specificity was 83.33%,and the rate of accuracy was 86.99%.Conclusions OPTIMUS can improve the specificity and the rate of early diagnosis.

Objective To investigate the role of oxidative stress in type 2 diabetes patients with macrovascular complications. Methods Serum levels of 8-hydroxy-deoxygnan osine (8-OHdG) and hemoglobin Alc (HbAlc) in 32 cases of type 2 diabetic patients with macrovascular complications and 46 cases of patients without complications were determined. 8-OHdG was detected by enzyme linked immu-nosorbent assay (ELISA). Results The level of 8-OHdG (2.93±1.37) ng/mL in type 2 diabetic patients with macrovascular complica-tions was higher than those without complications, whose 8-OHdG level was (2.67±1.30)ng/mL, but the difference was not significant(P>0.05). Compared with all kinds of macrovascular complications in patients, the 8-OHdG levels were increased, but the difference were not significant (P>0.05). Compared with patients without complications, the duration and age of the patients with macrovascular compli-cations also increased significantly (P<0.05), but the HbAlc levels were not statistical difference between them (P>0.05). Spearman regression analysis showed that 8-OHdG level was positively correlated with the duration (r=0.33, P<0.05), while the age and HbAlc level had no obvious correlation (P>0.05). Conclusion The role of oxidative stress may not be the important reason in type 2 diabetes with macrovascular complications, but the duration and age of the patients may be closely related with the disease.

OBJECTIVE:To observe the hepatoprotective effect of compound glycyrrhizin in treating patients with multidrug resistant pulmonary tuberculosis(MDR-TB).METHODS:A total of 68 MDR-TB cases were enrolled:36(treatment group) were randomly assigned to receive additional glycyrrhizin,and 32(control group) to receive additional glucurolactone and legalon,the hepatoprotective effects and side effects between 2 groups were compared before and after treatment.RESULTS:The total effective rates of the treatment group and the control group were 94.4% and 62.5%,respectively 1month after hepatoprotective treatment,and significant difference was noted between 2 groups(P0.05).CONCLUSION:Compound glycyrrhizin has a reliable hepatoprotective efficacy and few adverse drug reactions in treating MDR-TB patients complicating with lesion of liver function.

Objective To compare the torque resistance effect with different types of reconstruction of the distal radioulnar joint (DRUJ) dislocation,in order to explore biomechanical basis for clinical practice.Methods Six adult cadaver forearm were used,including 4 males and 2 females.The average death age was 64.9 years (range,36-78 years).Three were right side,3 were left side.The DRUJ dislocation model was made after the standardized resection of the palmar and dorsal DRUJ ligament.Clinic reconstruction methods of the DRUJ include trans-bone tunnel renconstruction (intra-articular reconstruction) and Looptie up reconstruction (extra-articular reconstruction).The mechanical properties as follows:torque velocity:5°/min,maximum torque angulation:90°,maximum torsion force:1 N· mm.Each limb was detected for the torque mechanic under four conditions:normal,DRUJ dislocation,intra-articular reconstruction and extra-articular reconstruction.Results Each limb was inspected for intact mechanic baseline and without the visual damage to the bone.The average pronation torque resistance on normal condition was (0.44±0.10) N·mm,(0.37±0.09) N·mm on DRUJ dislocation group,(0.45±0.09) N-mm on intra-articular reconstruction group,and (0.42±0.09) N·nun on extra-articular reconstruction group.Pronation torque resistance of DRUJ dislocation group was apparently lower than the normal group (t=2.043,P=-0.047).The pronation torque resistance reconstruction group had no significant difference with normal group.The average supination torque resistance on normal condition was (0.56±0.16) N·mm,while on DRUJ dislocation group was (0.42±0.11) N-mm,on intra-articular reconstruction group was (0.54±0.16) N·mm,on extra-articular reconstruction group was (0.51±0.13) N·mm.There were no apparent differences among four groups.Conclusion Both internal and external reconstruction could recover the rotation stability and normalize the torque resistance,without statistical difference.

Objective:To explore the correlation between ascending aortic elasticity and coronary blood flow reserve (CFR)in patients with hypertension.Methods:A total of 60 patients with essential hypertension were regarded as hypertension group,another 50 normotensive subjects were enrolled as normal control group during the same period. Ascending aortic dilation (D),stiffness (β)and CFR were measured and calculated by tissue Doppler ultrasound,then compared between two groups.Pearson correlation analysis was used to analyze the correlation amongβ,D and CFR.Results:Compared with normal control group,there were significant reductions in D [(3.59±0.30)10-6 cm2/d vs.(2.88±0.77)10-6 cm2/d]and CFR [(3.23±1.16)vs.(2.02±0.63)],and significant rise inβ[(3.54 ±1.52)vs.(5.46±1.98)]in hypertension group,P<0.05 or<0.01. Pearson correlation analysis indicated thatβwas significant inversely correlated with CFR (r=-0.413,P=0.005),while D was significant positively correla- ted with CFR (r=0.384,P=0.003 ).Conclusion:Reduced ascending aortic elasticity is significantly correlated with coronary blood flow reserve.