Objective To compare the clinical effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of multi-segment anterior decompression and fusion for cervical spondylotic myelopathy.Methods From March 2010 to September 2013,92 patients with multi-segment cervical spondylotic myelopathy were treated with anterior decompression and fusion.52 patients were treated with common cage plus titanium plate fixation,while 40 patients were treated with ROI-C self-locking fusion cage.Clinic data including clinical preoperative condition,operation time,intraoperative blood loss,intervertebral space height,Cobb angle of cervical spine,bone graft fusion rate,complications,and JOA score and VAS score were compared.Results Follow-up visit was conducted for all cases,with the time of 12-48 months (22 months on the average).The neurologic symptoms of patients in two groups were relieved obviously after postoperative 1 week,including chest and abdomen constriction feeling,finger pain,finger and lower limb activities.Intervertebral space height of cage +titanium plate group and ROI-C fusion cage group increased to 79.06±6.67 mm and 78.80±6.85 mm respectively after postoperative 3 months from preoperative 47.15±6.96 mm and 46.95±7.14 mm;the Cobb angle increased to 9.29°±12.90° and 8.57°±13.00° respectively after postoperative 3 months from preoperative 4.27°±11.15° and 2.80°±10.81°.In ROI-C group,the operation time,intraoperative blood loss and postoperative complications were significantly lower than those in cage+titanium plate group.The differences of two groups have statistical significance.In the last follow-up visit,JOA score of ROI-C group increased to 15.15±0.91 from preoperative 9.32±1.74,with the improvement rate of 75.82％±13.28％;JOA score of cage + titanium plate group increased to 15.29± 1.07 from preoperative 9.11 ± 1.23,with the improvement rate of 77.91％± 14.14％.The differences of two groups in the improvement rate have no statistical significance.Conclusion Curative effects of ROI-C self-locking fusion cage and common cage+titanium plate fixation on treatment of muhi-segment anterior decompression and fusion for cervical spondylotic myelopathy are similar,while ROI-C self-locking fusion cage has such advantages as short operation time,less blood loss,little injury and low complication incidence.

Objective: To study the relationship between bone morphogenetic proteins(BMPs),BMP receptor type IA (BMPR IA) and the oncogenesis of squamous cell carcinoma in oral epithelia. Methods: Expression of BMP 2/4,BMPR IA was immunohistochemistry analyzed in the specimens obtained from buccal mucosa, including 18 cases of normal mucosa(NB), 24 cases of chronic inflammation(NCI) and 58 cases of oral squamous cell carcinoma(SCC). Result: Weak staining of BMP 2/4 and BMPR IA was observed in normal and chronic inflammation samples,while stroug staining was found in 52 out of 58 cases of oral SCC. No significant difference was found among the heighly,intermediately and poorly differentiated SCC groups.Conclusion: BMP 2/4,BMP IA might be involved in oncogenesis and development of squamous cell carcinoma of oral epithelium.

Objective To develop an all-in-one multifunctional thoracolumbar fixation rescue vest for land and water rescue of thoracolumbar injury and investigate its application effect.Methods According to the thoracolumbar physiological curve,type Ⅰ thoracolumbar fixation rescue vest with keel and inflatable airbag and type Ⅱ thoracolumbar fixation rescue vest with additional lifesaving balloon and inflatable cylinder were developed using thermoplastic polyurethane (TPU)-nylon composites and polycarbonate (PC) as the main materials.Clinical application of type Ⅰ thoracolumbar fixation rescue vest in 532 cases of thoracolumbar injury was discussed.Type Ⅱ thoracolumbar fixation rescue vest were tested at marine rescue and related parameters measured were automatic inflation time,buoyancy force,floating time,floating condition and victims' face orientation.Clinical outcome was quantified by the MacNab standard,and VAS for pain was recorded.Results According to the MacNab standard,excellent outcome was achieved for all cases.VAS improved from 8.2 points to 2 points after the bracing was applied,showing 100％ improvements.The brace into the water showed automatic inflation time of 3-5 seconds and maximum buoyancy force of 100 kg,and ensured a 90 kg dummy of floating over 96 hours.At marine rescue,the wounded in braced condition showed face upward with 24-hour buoyancy loss ≤5％ and freedom of movement.Conclusions The multifunctional thoracolumbar fixation rescue vest provides dual immobilization and ensures marine rescue for its automatic inflation device.This invention provides the feasibility to remove,transport and evacuate the thoracolumbar fracture patients in cabin.

BACKGROUND:The diagnosis of osteoporosis depends upon the bone mineral density T-score of ≤ -2.5 standard deviation or brittle fractures. Bone mineral density measurement combined with vertebral fracture assessment might prevent the missed diagnosis of osteoporosis due to bone mineral density evaluation alone, and improve the diagnosis rate of osteoporosis.
OBJECTIVE:To evaluate the effect of bone mineral density measurements combined with vertebral fracture assessment for the diagnosis of osteoporosis.
METHODS:Bone mineral density measurements of proximal femur and vertebral fracture assessment for lateral thoraco-lumbar images were consecutively done for 217 postmenopausal women who aged ≥ 50 years. The rate of osteoporosis diagnosed with bone mineral density T score was compared with that diagnosed with bone mineral density combined with vertebral fracture assessment. The effects of bone mineral density on the vertebral fracture were analyzed.
RESULTS AND CONCLUSION:92 (42.4%) patients had bone mineral density T score ≤ -2.5, which met the threshold for diagnosis of osteoporosis. 102 (47.0%) patients had osteopanic (-1>T>-2.5) and 23 (10.6%) had normal range of bone mineral density. 158 patients had no vertebral fractures and 59 (27.2%) patients had 101 vertebral fractures. The vertebral fracture rate was 21.6%in the patients with bone mineral density T> -2.5 and 34.8%in the patients with bone mineral density T ≤ -2.5, with significant differences (P<0.05). Bone mineral density in combination with vertebral fracture assessment for the diagnosis rate of osteoporosis was up to 54.8%, which was significantly higher than the rate diagnosed with only bone mineral density (12.4%;P=0.01). Bone mineral density measurement combined with vertebral fracture assessment improves the diagnosis of osteoporosis for postmenopausal women.

Objective: To explore the relationship between serum sodium level and early prognosis in patients with acute ST-elevation myocardial infarction (STEMI). Methods: A total of 7461 STEMI patients within 12h of onset who matched the diagnostic standard of European society of cardiology and American college of cardiology were retrospectively studied. According to serum sodium levels within 24h of admission, the patients were categorized into 3 groups: Serum sodium≥135 mmol/L group, Serum sodium 130-134 mmol/L group and Serum sodium<130 mmol/L group. The baseline condition, 30-day mortality with other adverse events and the effect of neuroendocriology inhibitor treatment were compared among 3 groups; their relationships to serum sodium level were analyzed. Results: Serum sodium<130 mmol/L group had the higher 7-day and 30-day mortality than the other 2 groups, both P<0.001; compared with Serum sodium≥135 mmol/L group, Serum sodium<130 mmol/L group presented the higher occurrence rates of 30-day cardiac shock, heart failure (HF) and life-threatening arrhythmia, P<0.001. With adjusted affecting factors of age, diuretic and reperfusion treatments, serum sodium<130 mmol/L was still related to 7-day and 30-day mortality (OR=1.69 and OR=1.57). Both single and multivariable analysis indicated that serum sodium<130 mmol/L was related to cardiac shock (OR=1.75 and OR=1.64), HF (OR=1.42 and OR=1.30) and life-threatening arrhythmia (OR=1.53 and OR=1.34). In all 3 groups, the patients using ACE inhibitor, β-blocker or both medications had reduced 30-day mortality than those without such medication, allP<0.001; the reduction was more obvious in Serum sodium<130 mmol/L group than the other 2 groups,P<0.001. Conclusion: Serum sodium level<130 mmol/L within 24h of admission was the risk factor for the early stage main adverse events as mortality, cardiac shock, HF and life-threatening arrhythmia in acute STEMI patients.

Objective To evaluate the reliability of axial view of patella with the knee joint flexed at 60 and 90 degrees on imaging diagnosis of patellar subluxation with DR (digital radiography). Methods 60 cases confirmed patella subluxation were reviewed retrospectively. In addition to routine anteroposterior and lateral DR views, axial DR views of patella with the knee flexed at 60 degrees and 90 degrees were taken meanwhile. Results Of the 60 cases, 45 failed to provide any patellar problems, while the other 15 cases revealed suspicious imaging view of patella subluxation in their normal AP and lateral DR views. In the axial DR views of patella with the knee flexed at 60 degrees and 90 degrees, 50, 4 and 6 cases revealed subluxation, suspicious subluxation and normal alignment of patella. Conclusion Axial DR view of patella with the knee joint flexed at 60 and 90 degrees could provide helpful roentgenographic information in determining the existence of patella subluxation.

OBJECTIVE: To evaluate the short-term efficacy and investigate the factors of specific immunotherapy (SIT) efficacy of allergic rhinitis. METHOD: Fifty-seven patients with allergic rhinitis to dermatophagoides pteronysinus were included to receive SIT. Pair t-test was used to compare the symptom scores, visual analogue scores (VAS) and medication scores in patients before SIT and into maintain treatment statement to evaluate the clinical efficacy. T-test and Spearman correlation analysis were used to analyze the correlation between gender, age,reaction condition of skin prick test (SPT) and serum sIgE and the efficacy of SIT. RESULT: SIT was able to significantly reduce the symptom scores, VAS and medication scores. But the correlation between gender, age, SPT, and sIgE and theefficacy of SIT were not significant. CONCLUSION SIT is effective in the short-term treatment of AR. Further research is needed to investigate the factors that impact the efficacy of SIT.
Animals ; Humans ; Immunoglobulin E ; blood ; Immunotherapy ; Pyroglyphidae ; Rhinitis, Allergic ; therapy ; Skin Tests

BACKGROUND: Skin defect is commonly repaired by autologous skin graft, but in which, it is required healthy skin provider and it probably results in scarring deformity to various extents. The successful construction and clinical application of tissue-engineered skin (TE skin) mark the major breakthrough in treatment of skin defect.OBJECTIVE: To analyze the relationship between operation method and healing rate, through repair of skin defect with TE skin, to provide experimental evidence on clinical application of TE skin.DESIGN: Randomized controlled observation was designed.SETTING: Department of Oral and Maxillofacial Surgery, Teaching-Research Room of Histology and Pathology and Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University of Chinese PLAMATERIALS: The experiment was performed in Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University, in which 6 healthy York pigs were employed, of clean grade,aged varied from 2.5 to 3 months. 3 groups were randomized, named TE whole-layer group, TE dermal and auto-epidermal group and auto-graft group, 2 pigs in each group. 8 wounds were prepared in each pig, round in shape and 50 mm in diameter, 16 wounds in each group, totally 48wounds.METHODS: ①Preparation of TE whole layer and TE true skin. ② In TE whole-layer group: The whole layer of skin was cut off from fat layeralong the drawn line. When bleeding stopped thoroughly and the wound was covered with wet physiological saline gauze, TE whole-layer skin was collected and windowing was done on the skin for drainage. Physiological saline was used to rinsed away the culture solution on the surface of TE skin, and then, the cuticular layer was upward-covered the wound, avoiding gas vacuole between cuticular layer and wound. Single-layer oleic gauze, physiological saline gauze, aseptic dry gauze and elastic sponge cushion were covered successively, about 3-5 mm in thickness each layer. After routine dressing, elastic bandage was wrapped with compression terminally. ③ TE dermal and auto-epidermal group: The whole- layer skin was cut off with same method. Thin split-thickness skin (TIS) 0.1-0.2 mm was collected with drum dermanuring machine and soaked in physiological saline. The same method was used to collect the managed TE true skin and cover it on the wound, covering immediately on autoTTS. The rest management was same as TE whole-layer group. ④ Autograft group: The whole-layer skin was cut off and the fat tissue was removed, afterwards, it was re-grafted on the auto-wound, covered with various layers of dressing and bandaged with compression. ⑤ The survival case was determined if it was discovered no infection, necrosis and scaling of grafted skin, less than 3 mm in diameter when the wound was opened for changing fresh dressing each time, otherwise, the failed case was recorded. The survival rate in each group was analyzed statistically in 4 weeks after operation.MAIN OUTCOME MEASURES: Survival situation of grafted skin in 4weeks after operation in each group.RESULTS: In 4 weeks after operation, the survival rate of grafted skin was 75% in TE whole-layer group was 87% in TE dermal and auto-epidermal group and was 94% in auto-graft group. The results were similar basically in comparison among 3 groups (x2=-2.34, P ＞ 0.05).CONCLUSION: The effect of TE skin graft on repair of skin defect is near to that of auto-epidermal graft, testifying that the repair of skin defect with TE skin is feasible.

Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose>10 mmol/L) and known diagnosis of diabetes mellitus (DM) ,these patients were divided into four groups, Ⅰ :no DM and normal glucose group (control group) ; Ⅱ : DM but normal glucose group; Ⅲ : no DM and hyperglycemia group; and Ⅳ: DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group Ⅲ 17. 1% vs group I 8.6%, group Ⅳ 18.6% vs group Ⅰ 8. 6%, P<0.001) and also an increased incidence of MACE (group Ⅲ36. 3% vs group Ⅰ 21.6%, group Ⅳ 38. 8% vs group Ⅰ 21.6%, P<0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group Ⅱ 11.6% vs group Ⅰ 8. 6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold(OR 1.51,95% CI 1.22-1.87,P<0.001) and 1.83 fold(OR 1.83,95% CI 1.40-2. 39, P<0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05,95% CI 1.04-1.07,P<0.001), but DM without hyperglycemia was not so (OR 1.11,95% CI 0. 87-1.42, P =0. 412). Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia isv not associated with the short-term mortality.

Objective To discuss the influence of anatomical variations of the cystic duct on preoperative diagnosis and operational scheme for cholecystectomy. Methods A 47-year-old woman was admitted to our hospital with diagnosis of cholecystolithiasis. Ultrasonography suggested minimal intra- and extrahepatic ductal dilatation. Laboratory tests showed that serum levels of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were 189 IU/L, 366 IU/L and 144 IU/L, respectively. In order to make a certain diagnosis, the patient received both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Results MRCP showed the bile duct slightly dilated with a shuttle shape figure and a lower signal with a strip form in it. MRCP could not confirm the quality of this signal and was doubtful of choledochus diaphragma. Subsequently, ERCP was applied to demonstrate that the cystic duct was collateral with the common hepatic duct when arriving into its left side and converged into the bile duct with a lower position, which was the reason for why MRCP misjudged the formation of choledochus diaphragma in the bile duct. Finally, the patient underwent open cholecystectomy. Conclusion There are some kinds of variations in the cystic duct including course, appearance and location of confluence. Combing MRCP with ERCP can significantly elevate the diagnostic accuracy of the cystic duct before operation, especially in those patients with doubtful diagnosis upon admission. To avoid biliary injury as much as possible, open cholecystectomy is superior to the laparoscopic cholecystectomy (LC)with regard to the patients suffering from cholecystolithiasis complicated with variation of the cystic duct.