BACKGROUND:Whether lumbar spondylolisthesis needs to be treated with reduction remains controversial.OBJECTIVE:To investigate the clinical effectiveness of pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the patients aged more than 70 years old.METHODS:The clinical data of 30 patients with degenerative spondylolisthesis aged over 70 years old undergoing pedicle screw fixation combined with posterior lumbar interbody fusion were analyzed retrospectively.The Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were compared and analyzed before and after surgery.RESULTS AND CONCLUSION:(1) Among 30 patients,12 were male and 18 female,the average age was (75.1±6.7) years old,and all were followed up for more than 12 months.(2) The postoperative Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were significantly improved compared with baseline (P ＜ 0.05).According to the Japan Orthopedics Association scores,3 cases were cured,24 were significantly effective,and 3 effective.(3) Graft fusion was achieved at all patients,the average fusion time was (5.13±0.65) months.(4) The average operation time was (225.6±23.4) minutes,the average intraoperative blood loss was (470±45.5) mL,and the average follow-up time was (25.8±3.5) months.(5) Six patients presented complications (20％),including one case of dural tear,two cases of paralytic intestinal obstruction,and three transient lower extremity nerve symptoms.(6) These results indicate that if the associated disorders are strictly controlled,pedicle screw fixation combined with posterior lumbar interbody fusion can achieve good surgical results in the treatment of degenerative spondylolisthesis in the elderly.

Objective To evaluate the olfactory functions in patients with Parkinson's disease (PD) with a smell identification test developed for the Chinese population and to examine possible factors contributing to PD patients' olfactory performance.Methods Fifty-five patients with idiopathic and nondementia PD and 55 demographically matched healthy controls (HC) were recruited and their olfactory identification tested using the Chinese Smell Identification Test developed by the Institute of Psychology at Chinese Academy of Sciences.Results Olfactory identification score was significantly lower (t =-6.827,P＜0.01) in the PD group (19.3 ±5.4) as compared with the HC group (26.5 ±5.7).Of all PD patients,63.6％ scored over 1 SD below the age norm.In particular,of those with Hoehn-Yahr ratings between 2 to 3,77.8％ scored over 1 SD below the age norm.Receiver operating characteristic (ROC) curve analysis indicated that a cut-off score of 22.5 on the Chinese Smell Identification Test distinguished between PD patients and HC with a sensitivity of 74.6％ and specificity of 70.9％.Within the PD group,age,education,Hoehn-Yahr rating and Mini-Mental State Examination score were not found to correlate with olfactory performance (all P ＞ 0.05).Conclusion PD patients in China show significant impairment of olfactory identification,which is effectively captured by the Chinese Smell Identification Test.

[ ABSTRACT] AIM: To observe the effects of TNF-α/nuclear factor-κB( NF-κB) /matrix metalloproteinase-2 (MMP-2) pathway on the expression of MMP-2 in the mice with viral myocarditis.METHODS: Six-week-old inbred male mice were randomly assigned to control and myocarditis group.The mice in myocarditis group and control group were intra-peritoneally inoculated with 0.1 mL 10-5.69 TCID50 /mL coxsackievirus B3 and vehicle (PBS), respectively.Ten mice were sacrificed at the 4th and 10th days after injection.The blood and heart specimens were harvested.The serum content of TNF-αwas measured by ELISA.The myocardial levels of MMP-2, NF-κB p65 and IκBαwere determined by Western blot.RESULTS: Compared with control group, the protein expression of MMP-2 and NF-κB p65 in the myocardium and the serum content of TNF-αwere significantly increased in myocarditis group (P <0.05).The protein expression of IκBαwas lower in myocarditis group than that in control group (P <0.05).CONCLUSION: TNF-α, NF-κB p65 and MMP-2 were higher in the mice with acute viral myocarditis.The increased expression of them might be involved in the pathogene-sis of viral myocarditis.

Toll-like receptors (TLRs) family may play important roles in inflammatory bowel disease. This study examined the expression of TLR2, TLR4 and TLR9 in the colonic tissues of patients with ulcerative colitis (UC) and explored their roles in the pathogenesis of UC. Colonic biopsies were taken from the colon of 30 patients with mild or moderate UC (at active phase) and 10 healthy controls during colonoscopy. TLR2, TLR4 and TLR9 protein expression levels were immunohistochemically detected. The mRNA expression levels of TLR2, TLR4 and TLR9 were assessed by reverse transcription polymerase chain reaction (RT-PCR). The disease activity index (DAI), colonoscopic and histologic grades and fecal microbial flora were determined. Histological examination showed that the intestinal mucous membrane of UC patients underwent acute inflammation changes. Immunohistochemistry exhibited that the expression levels of TLR2, TLR4 and TLR9 in colon epithelia and inflammatory cells were higher in UC patients than in control group (P<0.01). The mRNA expression levels of TLR2, TLR4 and TLR9 were increased in UC patients but were not detected in the normal controls. Expression levels of TLR2, TLR4 and TLR9 were positively correlated, and bore close correlation with DAI, colonoscopic and histologic grades and fecal microbial flora. An important mechanism of UC might be that abnormal activation of mucosal immunity by intestinal dysbacteriosis caused dysregulation of TLRS that mediates innate immunity.

Objective To evaluate the efficacy and safety of acute ureteroscopy for the treatment of ureterie stones during middle and late pregnancy.Methods From June 1998 to March 2005,17 pregnant women(mean age,27 years;age range,21-35 years)with ureteric stones were treated by ureteroscopy when the fetus was at 20-36 weeks of gestation(mean,29 weeks).All the cases presented with urgent symptoms such as recurrent renal colic(11 cases),fever(4)or acute obstructive anuria(2).Among 17 cases,the stones(between 6 mm?7 mm and 13 mm?21 mm)were located in the upper(8 cases),middle(5)or lower ureter(4);and on the left side(5 eases),on the right(10)and on both(2)of the lower ureter. Mild hydronephrosis were observed in 6 cases and moderate hydronephrosis in 11,Of the 17 cases,14 under- went ureteroscopic pneumatic lithotripsy;in 1 case the calculi were pushed to the renal pelvis;and 2 cases were treated by Double-J catheter drainage.Results All the urgent symptoms in 17 cases were relieved after treatment.The stone-free rate of initial treatment was 82.4%(14 of 17).Three cases with residual stones were treated by Douhle-J catheters,which were replaced every 3 months until the calculi were re- moved.No abortion,premature delivery or complications such as ureter perforation occurred.Mild renal colic occurred in 1 case after insertion of Douhle-J catheter,and it was relieved 3d later;gross hematuria occurred in l case and disappeared 6 d later without treatment.All 17 patients had normal delivery and gave birth to healthy children.Conclusions Ureteroscopy is a safe and reliable method for the treatment of ureteric calculi during middle and late pregnancy.

Macrophages( Mφ)play an important role in the regulation of immune reaction. Different kinds of cellular microenvironment influence the phenotypes and function of Mφ and induce different immunological effect. Researches showed that there was a strong correlation between the dysfunction of Mφ and development of ulcerative colitis( UC ). Targeted regulation on immunological activity of Mφ may improve the clinical manifestations and pathological changes in UC. Regulation of the activity and migration of Mφ through changing microenvironment might be one of the potential mechanisms of moxibustion in treating UC. Progress in research on immunological effect of Mφ in UC was summarized in this review article.

OBJECTIVETo explore the value of ultrasono-portography using SonoVue in selective portal vein embolization (SPVE).

METHODSTwenty-eight patients with malignant liver tumors underwent percutaneous ultrasound-guided SPVE. The procedure was performed under color Doppler ultrasound guidance in 11 cases (conventional group) and under guidance with ultrasono-portography using SonoVue in 17 cases (contrast group). Contrast-enhanced CT was performed 2-4 weeks after SPVE to evaluate the effect of embolization.

RESULTSThe procedure of SPVE was aborted in 3 cases in which ultrasono-portography showed contraindications. Postoperative contrast-enhanced CT showed ectopic embolization in 2 cases in the conventional group, and none of the cases in the contrast group showed ectopic embolization.

CONCLUSIONUltrasono-portography using SonoVue can provide important assistance for SPVE.

Carcinoma, Hepatocellular ; pathology ; therapy ; Embolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; pathology ; therapy ; Male ; Middle Aged ; Portal Vein ; Portography ; methods ; Ultrasonography, Doppler, Color

OBJECTIVEPostoperative pain is a common problem in male circumcision. We investigated the effect of nanometer silver dressing (Shenzhen AGT Pharm. Co. Ltd.) in relieving pain following male circumcision.

METHODSSixty patients undergoing circumcision in the outpatient department were randomized into an experimental and a control group, the incision covered with nanometer silver dressing in the former and with vaseline dressing in the latter. None of the patients received any analgesics or other pain-killing therapies after surgery. The postoperative pain intensity was accessed using the modified numeric pain intensity assessment scale at 1, 2, 3, 5 and 7 days after the operation, and statistical analyses were performed using SPSS 12.0 software.

RESULTSThe patients averaged (31.13 +/- 13.94) years in age, and had no significant differences in age and body mass index (BMI) between the two groups. At 1, 2, 3 and 5 days, postoperative pain intensity was significantly lower in the experimental than in the control group (P > 0.05). Multiple regression analysis revealed that postoperative pain score was not correlated with patients' age, BMI and types of disease, but with the types of dressing.

CONCLUSIONNanometer silver dressing can significantly alleviate postoperative pain of circumcision, and is particularly applicable to such moist parts as the perineum, genitals, and urethra.

Adolescent ; Adult ; Bandages ; Circumcision, Male ; Humans ; Male ; Middle Aged ; Nanostructures ; therapeutic use ; Pain Measurement ; Pain, Postoperative ; therapy ; Silver ; pharmacology ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the alterations in coagulation in patients during conditioning with modified busulfan plus cyclophosphamide (BU/CY) +/- antithymocyte globulin (ATG) regimen before allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to assess the effect of ATG on coagulation system.

METHODSThirty-five patients with various hematological malignancies undergoing allo-HSCT were assessed. Of them, 19 patients with HLA-matched sibling donors (group A) were conditioned with modified BU/CY regimen, 16 with HLA-mismatched family members or HLA-matched unrelated donors (group B) were conditioned with modified BU/CY + ATG regimen. Blood samples were collected before the beginning of conditioning till d + 1 after allo-HSCT. The following parameters were measured: prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), antithrombin (AT), D-Dimer, fibrin degradation product (FDP), platelet (BPC), liver enzymes and bilirubin. FVIII: C, FIX: C, FXI: C and FXII: C in prolonged APTT blood samples were also determined. Clinical hemorrhagic symptoms were monitored.

RESULTSDuring conditioning, temporary lengthening of APTT, persistent rising in Fg and declining of BPC were observed in the two groups. Alterations of Fg and BPC were more significant in group B than in group A. Transient D-Dimer increase occurred only in group B on administration of ATG. Among intrinsic pathway coagulation factors, FXII: C and FXI: C were commonly decreased while APTT prolonged. No difference between the two groups was found with regard to PT, FDP, AT and liver parameters which remained in normal ranges. Most of patients in the two groups did not have overt bleeding manifestations.

CONCLUSIONSModified BU/CY +/- ATG conditioning regimen can induce subclinical alterations in coagulation. The regimen containing ATG has more significant effect on coagulation parameters.

Adolescent ; Adult ; Antilymphocyte Serum ; therapeutic use ; Blood Coagulation ; drug effects ; Child ; Cyclophosphamide ; therapeutic use ; Female ; Hematologic Neoplasms ; physiopathology ; surgery ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time ; Transplantation Conditioning ; Young Adult

Objective To find out whether the levels of serum creatinine and urea,creatinine clearance rate and GFR estimated by using different equations correlate with the exact measurement of GFR with ~(99m)Tc-DTPA in elderly patients with chronic kidney disease.Methods Renal function was determined by using ~(99m)Tc-DTPA technique in 83 elderly patients aged 65—96 years.Blood and urine tests were done at the same time.Estimated clearance was determined by using the equations of Cockcroft-Gauh,MDRD(modification of diet in renal disease)predigestion and MDRD seventh,and the correlation coefficients between the above parameters and ~(99m)Tc-GFR were determined.Veracity for the diagnosis of renal dysfunction was calculated by using receiver operating characteristic(ROC) curves.Results Cockcroft-Gault formula(r=0.833),MDRD predigestion formula(r=0.811), MDRD seventh formula(r=0.803),creatinine(r=-0.672),Ccr(r=0.632),urea(r=-0.612), and albumin(r=0.444)were correlated significantly with ~(99m)Tc-GFR in this sequence.If GFR 30, 40,50,60ml/min were defined respectively as renal impairment thresholds and areas under the curve (AUC)were compared,the best parameter for estimation of GFR was the Cockcroft-Gault formula. Then MDRD predigestion formula and MDRD seventh formula,creatinine and Ccr were less accurate in all different renal dysfunction thresholds.Conclusions The Cockcroft-Gault equation seems to be the best formula available for GFR estimation,the two equations of MDRD are the second,creatinine is the third,Ccr and urea are the last.