OBJECTIVE:To investigate the clinical efficacy of Zhuanggu huoxue recipe for necrosis of femoral head in patients with osteoporotic femoral neck fracture. METHODS:305 patients with osteoporotic femoral neck fracture randomized into therapy group and control group. Both groups were given internal fixation therapy and continuous traction treatment for skin. Therapy group were given Zhuanggu huoxue decoction (p.o. b.i.d) for 12 weeks. Control group were given ossotide and puerarin. At 1st month,2nd month,4th month,6th month,12th month,18th month after operation,roentgenograms of bone in femoral lateral position were taken to observe the fracture healing and the occurrence of femoral head necrosis. At 4th month,6th month,8th month after radiotherapy,MRI of double lateral hip was taken to observe the occurrence of femoral head necrosis. RESULTS:The rate of femoral head necrosis and nonunion of fracture in therapy group were all lower than in control group (P

OBJECTIVE: We investigated the development of the studying of bone marrow mesenchymal stem cells (MSCs) and elucidated the feasibility of gene therapy for Parkinson's disease. DATA SOURCES: Using the key terms "mesenchymal stem cells, Parkinson disease, gene transfer", we searched the MEDLINE database for the articles published in English from January 2000 to December 2005. Meanwhile, Wanfang database was retrieved for the relevant articles published during the same period, with the keywords of "Parkinson's disease, gene therapy, gene transfer, mesenchymal stem cells" in Chinese. STUDY SELECTION: All articles were selected firstly and those were relevant to gene therapy of Parkinson disease, differentiation of MSCs into nerve stem cells, or the therapy of MSCs transplantation for Parkinson disease. DATA EXTRACTION: A total of 158 articles including 32 Chinese and 126 English were collected, finally 30 articles of them were included. DATA SYNTHESIS: Parkinson disease is a very normal disorder of central nerve systematic degeneration, which pathological change is the damage of dopamine neuron in substantia nigra. Nowadays the systematic study of Parkinson disease indicates that transplantation of MSCs has a potential prospective application. Due to the autospecific superiority, MSCs become an engineering cell of Parkinson disease therapy. In recent years there are a lot of researches on genetic modification about MSCs that involved in gene therapy as an ideal target cell. MSCs can improve the dopamine synthesis and decrease the death of dopaminergic neuron. Target gene encoding enzymes in the route of dopamine synthesis, such as Tyrosine Hydroxylase, Aromatic L-Aminoacid Decarboxylase and neural protective molecule including neurotrophic factor and anti-apoptosis protein, is in the state of animal experiments, which provide great space for treating neurodegenerative disease-Parkinson disease. CONCLUSION: As MSCs are the plentiful sources of engineering cells, which have an extensive prospective application, it has potential clinical value in treating Parkinson disease, especially in gene therapy of Parkinson's disease.

0.05).Internal fixation could make the adjacent segment rigidity degrade and stress raise significanly(P

Science and technology innovation is an important quality of young talents in the new period requirements and training objectives,as well as hospital's driving force and source of the future sustainable development.Under the innovation-driven strategy,characterized by cultivating young talents of science and technology innovation,with the efforts to develop and improve young talents cultivation way,our hospital aim to accelerate the development of young talent as soon as possible.By setting up a hospital's fund,we gradually formed a stable funding system including the four directions of clinical,nursing,management,education.With the development purposes of young researchers as the main body,adhere to improve the quality of hospital funds is the key,we aim at forming a reasonable fund scale.Through the top level design,strict process management,implementation of opening argument and a series of strong measures to ensure project quality,we promote youth science and technology innovation talents effectively.

BACKGROUND:Recently, the number of elder patients with femoral neck fracture increased. It is controversial if patients aged over 75 years should receive total hip replacement or hemiarthroplasty. To select a reasonable surgical manner is of great significance for increasing surgical safety, improving hip joint function, elevating quality of life, decreasing postoperative complications, and reducing revision rate.
OBJECTIVE:To retrospectively analyze data of patients aged over 75 years after hip replacement, to compare the advantages and disadvantages, and to find a precise indication.
METHODS:Case data of 171 patients undergoing total hip replacement (observation group) (n=51) or hemiarthroplasty (control group) (n=120) were included. Their differences were compared using basic diseases, operation time, bleeding amount, postoperative complications, postoperative hospitalization day, Harris score at 1 week and 3 months after operation.
RESULTS AND CONCLUSION:Patients in both groups were fol owed up for 3 to 39 months (averagely 23 months). No significant difference in basic diseases, average age, postoperative complications, postoperative hospitalization day, and Harris score at 1 week was detected between the two groups (P>0.05). Harris score and excellent and good rate at 3 months were better in the total hip replacement group than that in the hemiarthroplasty group (P<0.05). Results indicated that strict choice of indication achieved good short-period efficiency in two groups. Thus, hip function of elder patients was early recovered. Quality of life was obviously elevated. The recovery of hip function was relatively better at 3 months in observation group. The incidence of postoperative complications did not increase obviously. These results suggested that besides sufficient preparation, total hip replacement should be the first choice for elder patients.

BACKGROUND: The number of dementia patients ceaselessly increases with the extension of the life expectancy and the ageing of the population; hence the survival rate of patients with post-stroke dementia(PSD) has become an important issue of public health. Although it is generally believed that dementia could shorten human life expectancy, there is rare report regarding the impact of PSD on the survival rate of the patients in developing countries.OBJECTIVE: To investigate the impacts of ischemic dementia on the survival rate of the patients to explore the risk factors that would affect the survival rate of patients after cerebral infarction(CI).DESIGN: A prospective randomized controlled study based on patients.SETTING: The second department of neurology of a field surgery institute in a military university hospital of Chinese PLA.PARTICIPANTS: Totally 619 cases of acute CI including 313 males and 306 females aged between 55 and 85 years old[mean of (70. 3 ±9.5) years old] were selected form the Department of Neurology of the Daping Hospital of the Third Military Medical University of Chinese PLA between 1st May 1998 and 28th December 1999.INTERVENTIONS: Data including human factor, vascular factor and CI characters of 619 cases of ischemic cerebral stroke were collected and they also received neuropsychological test. Dementia was diagnosed in CI patients at admission and 3 months after CI according to DSM-Ⅳ criteria. Two-year follow up was conducted for the analysis of survival rate in PSD patients and survival-correlated predicting factors.and survival rate in CI patientsRESULTS: Totally 146 total patients(23.6% ) were diagnosed as PSD at 3 month after CI, of which 39 cases were pre-stroke dementia and 107 cases were CI-correlated dementia. The survival rate of PSD patients was 49.3%after(19.4 ±8.3) months of follow-up. The survival rate of patients with CI-correlated dementia was 53.7% while the non-dementia patients was 92.0% after(21.3 ± 9.1 ) months of follow-up. There was significant correlation between PSD and survival rate as indicated by multifactor analysis ( RR = 4. 91, 95% CI = 3.85 - 13.49) . The rest predicting factors included age(RR=1. 12, 95% CI=1.06-1.18), BarthelIndex(BI, RR=1.63,95% CI=1.15-2.31), auricular fibrillation(AF, RR=1.47, 95%CI = 1.17 - 1.85) and CI history( RR = 2. 81, 95% CI = 1.53 - 5.16).CONCLUSION: Dementia could reduce the survival rate of CI patients and it could be set as a predicting factor for post-infarction survival rate.

Objective To evaluate the curative effects and complications of synthetic dural substitute (Neuro-Patch) in the surgical treatment of Chiari type I malformation (CMI) complicated with syringomyelia (SM). Methods .Forty patients suffered from CMI with SM were given foramen magnum decompression and duraplasty between June 2002 and June 2004. The duraplasty was performed using either synthetic dural substitute (Neuro-Patch Group, n=20) or autologous fascia lata (Autologous Group, n= 20). Results .Symptoms were improved in 17 patients in both of groups (85.0%) at 6 months postoperatively, and no deterioration of symptoms was seen. Postoperative pyrexia occurred in 12 patients in the Neuro-Patch Group (60.0%) and 9 patients in the Autologous Group (45.0%), without significant differences (?2=0.902,P=0.342). No statistically significant differences were observed between the Neuro-Patch Group and the Autologous Group in the operating time (3.6?0.7 h vs. 3.4?0.4 h; t=1.109,P=0.274), the time to the onset of postoperative pyrexia (7.3?3.4 d vs. 9.4?2.5 d;t=-1.560,P=0.135), the length of duration of postoperative pyrexia (range, 1~19 d vs. 1~8 d, median, 4.5 d vs. 2 d;z=-1.643,P=0.100), the drainage time (1.3?0.5 d vs. 1.2?0.4 d; t=0.230, P=0.820), the drainage volume (range, 15~300 ml vs. 20~250 ml, median, 80 ml vs. 37.5 ml; z=-1.359,P=0.174), the duration of antibiotic administration (15.8?4.8 d vs. 13.7?1.5 d;t=1.260,P=0.223), and the assessment outcomes of curative effects. The length of duration of hormone requirement was longer in the Neuro-Patch Group (12.8?4.1 d) than in the Autologous Group (7.8?3.1 d) (t=3.055, P=0.007). On MRI examinations at 6 postoperative months, no posterior cranial fossa effusion was detected in both of groups. Follow-up checkups for 9 months ~ 2 years in the 40 patients showed delayed infectious granuloma on the wound in 1 patient in the Autologous Group, which was cured by debridement. Conclusions .The Neuro-Patch is a reliable dural substitute for repairing of dural defects in the treatment of CMI associated with syringomyelia.

Objective To discuss the diagnosis and treatment of brain abscesses. Methods A total of 20 patients with brain abscesses from January 1996 to June 2004 were studied.All the patients received a CT scanning,and 8 patients were given an MRI examination(two of them underwent a magnetic resonance spectroscopy).An administration of ceftriaxone in combination with metronidazole was given for 1~9 weeks(mean,3.7 weeks).Surgery was conducted in 8 patients under the guidance of CT scanning or B-ultrasonography,including 3 cases of abscess resection and 5 cases of aspiration and drainage. Results One patient died of ventricle involvement,16 patients were cured without after-effects,and 3 patients were improved but the hemiplegia was left behind.No surgery-related deaths were encountered in the 8 surgical cases.Among 8 patients who complicated with diabetes mellitus,tuberculosis,HIV infection,or kidney transplantation,4 patients were cured;all the remaining 12 patients without co-morbidities were cured.Among 9 patients with lesions closely near the ventricle,5 were cured,while the rest of 11 patients with superficial abscesses were all cured.All the 5 patients with multiple abscesses were cured,and 11 out of 15 patients with solitary lesion were cured. Conclusions Most brain abscesses can be cured by early diagnosis and early drug administration.The magnetic resonance is an important means for early diagnosis,and the stereotactic operation is a favorable surgical treatment.

Objective To evaluate the effect of surgical treatment of hypertensive intracerebral hemorrhage (HICH) through a straight incision and keyhole minimally invasive craniotomy. Methods According to the location of the hematoma revealed by preoperative CT scans, a straight skin incision was made 4～5 cm in length, and then a keyhole craniotomy 2 cm in diameter was performed. The underlying cortex was incised the hematoma was exposed and removed under microscope. Results The hematomas were thoroughly cleared in 17 cases. The clearance rate was 90% in 18 cases and 80% in 4 cases. Re-hemorrhage occurred in 2 cases after operation. A total of 35 cases was followed for 0.5～3 years (mean, 2.1 years). The quality of life was assessed by activity of daily living (ADL) classification, which revealed 9 cases of grade 1, 12 cases of grade 2, 9 cases of grade 3, 4 cases of grade 4, and 1 case of grade 5 at the 6th postoperative month. The mortality of this series was 10.3% (4/39). Conclusions Straight incision keyhole minimally invasive craniotomy is a rapid, effective, and safe technique for the removal of hypertensive cerebral hemorrhage. The method herein provides an effective decompression of hematoma, with low recurrence rate and good prognosis compared with conventional surgery.

Objective The purpose of this study was to evaluate the outcome of surgical treatment for spinal cord tumors. Methods We retrospectively analyzed a series of 660 patients with 676 intra-spinal tumors who were treated surgically from February 1993 to December 2007. The tumors located at the cervical level in 231 patients,thoracic in 202,lumbar in 159,sacral in 9,cervico-thoracic in 16,thoracico-lumbar in 42,and lumbar-sacral in 17. Totally 699 operations were performed,including posterior bilateral laminectomy approach in 599,unilateral laminotomy in 71 and laminoplasty in 6 cases.Besides,23 additional operations via lateral or ventral-lateral were performed for resection of extra-spinal component of dumbbell shaped tumors. Results In this series,Schwannomas and meningiomas were the most common extramedullary tumors accounting for 76.5% of the cases [517/676,rate of total resection: 92.3% (477/517)]. The intra-medullary tumors accounted for 23.5% (159/676),in which astrocytomas and ependymomas were the most often observed [rate of total resection: 67.3% (107/159)]. The peri-operative mortality was 1.7% (11/660). The motor and sensory functions were found to be improved after operation in 77.8% (357/459) and 79.2% (397/501) respectively. The sphincter function was improved in 72.4% (215/297). The rate of pain relief was 93.3% (361/387). The follow-up periods ranged from 0.5 to 15.1 years in 582 patients with an average of 5.9 years;during the period,87.8% (499/568) of the patients had an ASIA impairment scale E neurological function. Conclusions Intra-spinal tumors locate mostly in the subdural-extramedullary space,with a majority are Schwannomas and meningiomas. The widespread application and availability of MRI investigation provide the physician with accurate localization of the lesion thereafter ensure a minimally invasive surgical treatment strategy keeping the stability of the spine while removing the tumors with an satisfactory outcome.