Objective To explore the etiopathogenisis of fungal infections induced by systemic lupus erythematosus (SLE). Methods One hundred and forty-seven SLE patients with fungal infections during 2004-2013 were assigned as experimental group and the same number of SLE patients without infections were randomly selected as control group. Clinical and laboratory documents of these patients were comparatively analyzed. Results The fungal infections in SLE patients affected oral mucosa , lower respiratory tract and skin , and the pathogenic bacteria were mainly candida albicans. The wide application of glucocorticoid, immunosuppressants and antibiotics pushed the rise of incidence of fungal infections in SLE patients significantly. Conclusions The patients′ use of glucocorticoid , immunosuppressants and antibiotics attributes to a higher risk of fungal infections , especially infections by candida albicans. Fungus infection may raise the level of C4.

Objective To make a preliminary investigation and summary of the technique and efficacy of the novel intracranial stent, Enterprise, together with hydro-detachable coils for the treatment of very small intracranial wide-necked aneurysms (diameter<3 nun and body-to-neck ratio<1.5). Methods Six cases with very small intracranial wide-necked aneurysms were treated with Enterprise stents and hydro-detachable coils. In 5 cases the Enterprise stent was implanted to cover the neck of the aneurysm, which was followed by the introduction of a microcatheter into the aneurysmal sac through the stent mesh to stuff hydro-detachable coils in order to fill the aneurysmal sac. In the remaining case, the microcatheter was placed into the aneurysmal sac before the Enterprise stent was inserted to embolize the aneurysm. Postoperative follow-up was conducted for 3-6 months. Results The operation was successfully completed in all 6 patients, with the implanted stents being in right place. The parent arteries remained patency in all patients. No complications occurred. Complete occlusion of aneurysmal cavity was obtained in four cases, and the occlusion degree of the aneurysmal cavity above 95% was seen in 2 cases. After the procedure, all the patients recovered well. Neither rebleeding nor symptoms related to thrombosis occurred during a clinic follow-up of 3-6 months. Conclusion Endovasculur embolization with Enterprise stent together with hydro-detachable coils is a safe and effective method for the treatment of very small intracranial wide-necked aneurysms. However, its long-term effect needs to be further observed.

Objective To investigate the influence of hyperbaric oxygen treatment (HBOT) on blood pressure (BP) and the incidence of rebleeding in patients with hypertensive intracranial hemorrhage (HICH)Methods One hundred and twenty patients with HICH were treated for 60 min with 100% oxygen at 2.0 absolute atmospheres (ATA) daily when the condition was stable and BP was controlled ideally. Blood pressure was measured before the patients were sent into the HBO chamber and remeasured following completion of each HBOT session and 1 hour later. Rebleeding was monitored during and after each HBO session . Results HBOT caused a significant elevation of systolic BP in 25.83% (31/120) patients and a significant decrease in 16.67% (20/120) patients (P ＜0. 05 ),whereas the rest 57.5% (69/120) patients had no significant changes,when the BP was measured right after the HBOT session. The mean diastolic BP increased in 69 (57. 50% ) patients and decreased in 4. 17%(5/120) patients (P ＜ 0. 05 ), whereas we found no significant changes in the rest 46 (38. 33% ) patients. No differences were found in the comparison of BP before and 1 hour after the HBOT session and no one suffered from rebleeding during and after HBOT session. Conclusions HBOT may cause temporal blood pressure changes in most patients with HICH, however, it will not cause an increasing incidence of rebleeding if the patient's condition is stable and the blood pressure has been well controlled.

BACKGROUND:Artificial total disc replacement is one treatment of low back pain in recent years, but the report on the effect of disc replacement on lumbar sagittal plane is rare. OBJECTIVE:To analyze the effect of lumbar disc replacement on lumbar lordosis. METHODS:Retrospective analysis of radiographic data of 17 patients who underwent lumbar disc replacement for single segment degenerative disc disease was carried out. Data measurement included preoperative and postoperative lumbar lordosis, diseased segmental lordosis and lumbar intervertebral angle. RESULTS AND CONCLUSION:Al the 17 patients were fol owed-up for more than 12 months. Lumbar disc replacement was performed at L4-5 segment in three cases and L5-S1 segment in 14 cases. The average diseased segmental lordosis and lumbar lordosis were increased significantly after replacement when compared with those before replacement (P<0.05);the lumbar intervertebral angle was increased after replacement when compared with that before replacement, but the difference was not significant. The results indicate that lumbar disc replacement for the treatment of single segment degenerative disc disease can increase the lumbar lordosis and diseased segmental lordosis, which can help to improve the lumbar sagittal balance. The postoperative lumbar intervertebral angle has no correlation with the implant angle of the prosthesis on the replace segment.

BACKGROUND:Transforaminal endoscopic discectomy needs to dissociate the ligamentum flavum, and if
combined with the continuous dilator and working channel, it can keep the intact ligamentum flavum no matter how smal the incision may be (even 3-5 mm).
OBJECTIVE:To present the technique of interlaminar endoscopic lumbar discectomy with ligamentum flavum splitting.
METHODS:We performed operations on 16 male and 14 female patients by interlaminar endoscopic lumbar
discectomy with ligamentum flavum splitting. The average age of the patients in the study was (48±15) years. The chief complaint before surgery was radiculopathy confined to one leg. The anatomic operative level was L 3-4 in
one case, L 4-5 in 13 cases and L 5-S 1 in 16 cases. The ruptured disc migrated superiorly in four cases and
inferiorly in seven cases, and intraoperative electromyo-graphic monitoring was performed in al surgeries. The
ligamentum flavum was split, and after withdrawing the working channel, the ligamentum flavum could reset itself. RESULTS AND CONCLUSION:The total operation time was 20-40 minutes, and the fol ow-up period was
(149±108) days. There were no abnormal signals on the intraoperative electromyography in any cases, and the reported symptoms were immediately improved in al patients after the operation. Fol ow-up magneticresonance imaging showed a disappearance of the ruptured disc without defect in the ligamentum flavum. There were no operation-associated complications in al the patients. Interlaminar endoscopic lumbar discectomy with
ligamentum flavum splitting is a feasible approach.

Objective To analyze differences in gene expression profile of pituitary tissue in cervical spondylosis of vertebral artery type(CSA)model rats and explore the mechanism of adrenal gland's regulation of CSA.Methods Ten SPF male Wistar rats were randomly divided into model group and blank group.The CSA model was established by compound modeling method.The total RNA was extracted from the pituitary;the gene expression profile was detected by whole gene chip,ontology(GO),and signal pathway analysis.Results Compared with the normal group,the differential genes'expression profile analysis showed that the total number of the differential genes was 321(fold change︱ ＞ 2,P＜0.05),with 203 up-regulated genes and 118 down-regulated genes.A total of 1 294 genes rich in GO function were involved in the regulation of intercellular signal activity and nerve cell function;the stress response to external stimuli;and the regulation of coagulation function,angiogenesis, endometrial system,and cell cycle;There were 145 signal transducers,including adipocytokine signaling pathway, TGF-β signal transduction,AMPK signaling pathway,PPAR signal pathway,Wnt signaling pathway,and MAPK signal transduction pathway.Conclusion The pituitary regulates CSA mainly through the inflammatory stimulation,immune regulation,regulation of vertebral artery function,and endometrial system.

BACKGROUNDCervicothoracic junction spinal tuberculosis (CJST) in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children.

METHODSTen pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months.

RESULTSThe patients were followed-up for an average of 26 months (range, 15-32 months). There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° (range, 30-52°) before the operation to 18° (range, 12-26°) post-operation. Neurological function was improved in all patients.

CONCLUSIONSCombined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.

Bone Transplantation ; Cervical Vertebrae ; surgery ; Child, Preschool ; Debridement ; Decompression, Surgical ; Female ; Follow-Up Studies ; Humans ; Male ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

BACKGROUND: Nicotine, which is a known central nervous system stimulant, appears to be the neuroprotective factor of Parkinson disease(PD). It has been reported that PD patients' symptoms such as trembling,rigor, hypokinesia are ameliorated during smoking, but its mechanism still keeps unclear.OBJECTIVE: To observe the effects of nicotine on gene expression levels of dopamine D1 and D2 receptors (D1R,D2R)in striatum of rats and analyze the possible mechanism of behavioral changes of rats induced by nicotine.DESIGN:Randomized and controlled experiment.SETTING:Institute of Neurology, Xiangya Hospital, Central South University.MATERIALS :Twenty-four SD rats aged at 10 weeks were chosen,weighing 180-200 g. Nicotine (Sigma),revert AidTM M-Mulv reverse transcriptase (MBI Fermentas,USA), polymerase chain reaction (RCR,Beckman),densitometric scanning imaging system (Stratagene Eagle Eye Ⅱ ,USA).METHODS :This experiment was carried out in the Laboratory of Institute of Neurology, Xiangya Hospital,Central South University from July 2001 to July 2002. These rats were divided into two groups: control group (n=12)and nicotine group(n=12). The level of D1 and D2 receptors on striatum of rats was estimated at the timepoint of thirty-minute after chronic nicotine administration (4 mg/kg per day s.c.), and the behavioral activities were also recorded at the same timepoint for thirty minutes. The functional behavioral activities recorded included: rearing up repeatedly, moving about, provoking, climbing, grooming, yawning, rotating, smelling and vomiting. At the fourteenth day, all rats were killed after thirty minutes of nicotine injection,the brains were dissected out and the region of striatum was separated immediately. Total RNA was extracted from striatum by RNeasy Total RNA Kit. PCR amplification was performed at special condition. For semi-quantitative analysis, 10 μ L of PCR products for each was examined by electrophoresis on 12 g/L agarose gel containing 0.5 mg/L ethidium bromide,and absorbance (A value) was quantitated by using densitometric scanning imaging system, thuse D1R,D2R mRNA expression were determined. Differences between means were analyzed with two-tailed student's t test.MAIN OUTCOME MEASURFS: Changes of locomotor activities and the gene mRNA expression levels of D1 R and D2R in the regions of striatum in rats.RESULTS: Totally 24 SD rats were involved in the final results.① Locomotor activities of rats become more active after 3-day nicotine administration and reach the top during 7-14 days.②The A value of total RNA ratio of A260/A280 ＞1.8, and the total RNA had no degradation with 12 g/L agarose gels electrophoresis. ③As expected, PCR amplification product lengths of D1R, D2R,βA were 350 bp, 399 bp, 218 bp respectively. A significant increase of 23% of D1R mRNA expression in the region of striatum detected in the nicotine group compared with that of control group (98.63±1.13 and 65.29±1.45 seperately,P ＜ 0.01), no difference was detected on the level of D2R mRNA expression in the same regions above (76.73±1.45 and 78.21±1.69 respectively ,P ＞ 0.05 ).CONCLUSION: Nicotine may induce changes of locomotor activities of rats by up-regulating D1R mRNA expression in striatum.

Lomatogonium rotatum (L.) Fries, Gentianopsis barbata (Froel) Ma, and Gentianella acuta (Michx.) Hulten, the three kinds of Digeda-species Mongolian medicinal materials belonging to the family Gentianaceae, bad been widely used for the treatment of liver diseases. To analyze comparatively the content of swertiamarin and swertisin among these three kinds of Digeda-species Mongolian medicinal materials. HPLC method was applied for qualitative and quantitative analysis of swertiamarin and swertisin. The Phenomenex C18 (4.6 mm x 250 mm, 5 μm) was used, chromatographic methanol and water as mobile phase, the flow rate was 1.5 mL x min(-1) with UV detected at 237 nm, column oven temperature was 25 degrees C. Results showed that the contents of swertiamarin and swertisin were closely related the different species and producing areas. The content range of swertiamarin in L. rotatum from different habitats was 1.73% - 2.72%, 0.43% - 0.96% for the swertisin content; the content of swertiamarin in G. barbata from Alxa Left Banner was 0.38%, and the content of swertiamarin and swertisin in G. barbata from the others habitats and G. Acuta from different habitats were all detected qualitatively. The contents of swertiamarin and swertisin among these medicinal plants showed a significant difference due to the different species and producing areas. As a consequence, these medicinal plants should not be put together for clinical applications.
Apigenin ; analysis ; Chromatography, High Pressure Liquid ; Gentianaceae ; chemistry ; classification ; Gentianella ; chemistry ; classification ; Iridoid Glucosides ; analysis ; Medicine, Mongolian Traditional ; Mongolia ; Plant Extracts ; analysis ; Pyrones ; analysis

Objective To investigate the association between serum uric acid (SUA) and early clinical outcome among patients with acute stroke.Methods A total of 3231 acute stroke patients were included in the present study.Data on demographic characteristics,life style risk factors,history of disease,admission SUA and clinical outcome at discharge were collected for all participants.Poor clinical outcome was defined as neurologic deficiency (NIHSS≥10) at discharge or death during hospitalization.Results Increased SUA level was associated with decreased risk of poor outcome among ischemic stroke patients.After adjustment for multivariate,the odds ratio (95％ confidence interval) of poor outcome for every increased unit was 0.856 (0.795-0.898) among ischemie stroke patients.Logistic analysis was conducted according to quintile of SUA level,after adjustment for multi-variates,the odds ratio (95％ confidence interval) of poor clinical outcome appeared to be associated with SUA of 197-241 μmol/L,242-285 μmol/L,286-346 lμmol/L and ≥347 μmol/L,but were 0.552 (0.354-0.861),0.417 (0.263-0.661),0.390 (0.241-0.630) and 0.352(0.213-0.581),respectively in those acute ischemic stroke patients,when compared to those with SUA＜ 197 μmol/L.Among acute hemorrhagic stroke patients,after adjustment for multivariate,the odds ratio (95％ confidence interval) of poor outcome for every increased unit was not significant among hemorrhagic stroke patients.According to the quintile of SUA level,when compared to those with SUA＜ 150 μmol/L,the odds ratio(95％ confidence interval) of poor clinical outcomes associated with SUA of 150-185 μmol/L,186-230 μmol/L,231-297 μtmol/L and ≥298 μmol/L,were also not significant among those hemorrhagic stroke patients.Conclusion Elevated SUA seemed to be an independent predictor for short-term good clinical outcome among acute isehemic stroke patients.