Objective To employ intraoperative discography to determine the injured intervertebral disc segments that can not be identified on the preoperative MRI in patients with cervical spinal cord injury without fracture and dislocation for confirming the responsible segments needing surgical decompression and fusion.Methods The study involved 85 patients with cervical spinal cord injury without fracture and dislocation treated from January 2007 to December 2011,among which sixteen patients had not been identified with the responsible segments by preoperative MRI.The average preoperative Japanese Orthopedic Association (JOA) score was (9.1 ± 1.8) points.There was no obvious fracture or dislocation of the cervical spine on preoperative X-ray film,CT and MRI,but all patients displayed high intense signal in cervical spinal cord on MRI T2 weighted imaging.Besides,MRI revealed hemorrhagic swelling of anterior cervical soft tissue in nine patients and cervical intervertebral disk hernia in all patients.Annulus fibrosus rupture of cervical intervertebral disc with contrast leakage in intraoperative discography of suspected injury segments in all patients under direction of C-arm X-ray machine was set as the injury criterion.The patients with pure ruptured discs received cervical discectomy,interbody fusion and titanium plate fixation.The patients associated with multilevel cervical intervertebral disc hernia or ossification of posterior longitudinal ligament underwent anterior cervical corpectomy,bone graft with titanium cageand titanium plate fixation of ruptured discs.Results Nineteen injured discs were identified eventually by discography,including 2 discs at C3/4,4 at C4/5,8 at C5/6 and 5 at C6/7.Moreover,anterior annulus fibrosus rupture with intact anterior longitudinal ligament was found in 11 patients.The follow-up lasted for (24.4 ± 10.0) months.JOA scores were (13.3 ± 1.5) points and (14.5 ± 1.6) points at two weeks and three months after operation,and (15.1 ± 1.5) points at the last follow-up,indicating a relevant improvement rate of 53％,68％ and 76％ respectively.Mean operation time was 110 minutes and blood loss was 120 ml.Three patients had pain on shoulder and back and one patient had hoarse voice,but all the patients were relieved in two weeks after conservative treatments.No serious complications,such as deep infection,deterioration of neurological dysfunction,vertebral artery injury or internal fixation failure were noticed intra-or post-operatively.Conclusion For the intradiscal rupture that is hard to be determined by the conventional imaging methods,intraoperative discography can be used as an auxiliary method of imaging diagnosis in early surgical determination of responsible segments for cervical spinal cord injury without fracture and dislocation.

AIM: To analyze the reasons of low vision and blindness in elderly patients and the application of optical aids in rehabilitation.METHODS: Totally 87 elderly patients which had 74 cases of low vision,13 cases of blind,including 53 males and 34 females.Routine internal and external eye examinations should be performed,and special removal examinations should be performed if necessary.Both refractive correction,and try with far and near optical aids,check after wearing a typoscope distant and near vision,distant vision ≥0.05 out the blindness,distant vision ≥0.3 out the disability.Near vision ≥ 0.5 was valid,<0.5 was invalid.RESULTS: Among 87 elderly patients with low vision,high myopia was the leading cause of blindness,followed by macular degeneration,cataracts,glaucoma and diabetic retinopathy.The visual acuity after refractive correction increased ≥ 2 lines in 62 cases (71%),visual acuity was not correct or corrected for ≤ 1 of 25 cases (29%).With aids,far visual was ≥0.3 of the 70 cases (80%),≥0.05 in 10 cases (11%),<0.05 in 7 cases (8%),residue removal rate of 92%.With reading glasses near and near visual acuity was >0.5 effective in 60 cases (69%),<0.5 ineffective in 27 cases (31%).Typoscope was often used in 58 cases,not often used 18 cases,11 cases rarely used or give up.CONCLUSION: High myopia is the leading cause of low vision and blindness in the elderly,followed by macular degeneration.The application of visual aids is still reliable and economical and effective treatment method,patients should be encouraged to use visual aids to improve the utilization rate of aids,so as to improve the quality of life of patients.

Objective To examine plasma levels of protease C1 inhibitor (SERPING1) in adult patients with latent autoimmune diabetes (LADA), and their clinical significance thereof. Methods The levels of SERPING1 were detected and compared between LADA, type 1 diabetes (T1DM), type 2 diabetes (T2DM) and healthy control groups. The correlation between plasma levels of SERPING1 and other clinical indicators such as age, disease course, glycosylated hemoglobin (HbA1c), fasting blood glucose (FPG), 2 h postprandial plasma glucose (2 hPG), fasting c-peptide (FCP) and 2 h postprandi-al C peptide (2 hCP) was analyzed. Multi-factor regression analysis and receiver operating characteristic (ROC) were used to evaluate the predictive effect of SERPING1 in LADA at the early stage. Results The level of SERPING1 was significantly higher in LADA group than that of T2DM group and control group (P < 0.05). There was a negative correlation between SERPING1 and FCP, and a positive correlation between SERPING1 and HbA1c, FPG and 2 hPG (P<0.05). There were no significant correlation between SERPING1 and age, disease course and 2 hCP. FCP was analyzed by regression equation (P<0.05), and which was the main influence factor of the plasma level of SERPING1. The area under the ROC curve (AUC) of SERPING1 was 0.613 (P<0.05), 95%CI 0.514-0.712. The optimal cut-point of SERPING1 for early prediction of LADA was 289.71 mg/L, and the sensitivity and specificity were 69%and 48%respectively. Conclusion SERPING1 combined with other indicators will be useful for identifying LADA from T2DM at the early stage.

OBJECTIVETo explore the working mechanism and age-related change of the conflict processing system of the frontal cortex.

METHODSFifteen normal elderly people and 15 youth were performed a modified Eriksen flanker paradigm, while event-related potential (ERPs), which include 32 systerm electroencephalography, reaction time and correct rate were recorded.

RESULTSThe elderly group showed a distinct effect of reaction time and effect of conflict in the respond level compared with the youth group. The elderly group had a longer time window of N380 and same amplitude as the youth group. Low resolution brain electromagnetic tomography (LORETA) showed the bilateral temporal lobe and the dorsolateral prefrontal cortex (especially right) were activated in the youth group, while the left temporal lobe, the left dorsolateral prefrontal cortex and left medial frontal gyrus were activated in the elderly group.

CONCLUSIONWhen conflict stimuli existed in the response level, old people showed frontal interference control hypofunction. N380 reflected the activation of the left dorsolateral prefrontal cortex and the left temporal lobe during response selection and executive control processing in older people.

Adolescent ; Aged ; Aging ; Electroencephalography ; Evoked Potentials ; Frontal Lobe ; physiology ; Humans ; Prefrontal Cortex ; physiology ; Reaction Time ; Temporal Lobe ; physiology

A female patient aged 61 years was diag-nosed with metastatic liver cancer from colorectal cancer. Com-puted tomography (CT) scanning showed that the mass was located at the confluence of 3 hepatic venous trunks and had a diameter of 7 cm. The patient's standard liver volume was 1087 ml, and the volume in the right lobe was 634 mL and the right posterior lobe was 279 ml. We attempted to resect the left and caudate lobes with the middle hepatic vein (MHV) and to reconstruct tributaries of the MHV from segment V using a cryo-preserved autologous iliac artery. The operation time was 280 minutes and blood loss was 300 mL, and no postoperative com-plications were observed. The length of hospital stay was six days. Two weeks after the operation, imaging examinations by ultrasound and CT indicated that the graft vessel was patent. Three months after the operation, ultrasound examination demonstrated that the bypass was blocked, while no atrophy in hepatic segment V was detected, which indicated that communi-cating branches between the hepatic veins of segment V and the right hepatic veins had formed. Hepatectomy combined with hepatic venous reconstruction is safe and feasible for hepatoma at the confluence of three hepatic venous trunks.

The roles of NF-kappaB (NF-kappaB) expression, Bax activity and cytochrome C (Cyt C) release, apoptosis of islet cells induced by high concentration glucose were explored in vitro. Pancreatic islet cells, which were isolated from Kunming mice, were cultured with different concentrations of glucose in DMEM, and divided into the following groups: G1, G2, G3, G4, G5, and G6 groups, corresponding to the glucose concentrations of 5.6, 7.8, 11.1, 16.7, 22.5, and 27.6 mmol/L, respectively. After culture for 120 h, insulin secretion was evaluated by radioimmunoassay, and the NF-kappaB expression was detected by immunocytochemistry. Bax activity and Cyt C release were measured by immunofluorescence, and apoptosis was examined by Hoechst33342 assay. The results showed that in G1, G2 and G3 groups, insulin secretion was enhanced with the increase of glucose concentration, and the NF-kappaB expression was also increased (P<0.05), but Bax activity, Cyt C release and apoptosis rate showed no significant difference among them. However, in G4, G5, and G6 groups, apoptosis rate of islet cells, NF-kappaB expression, Bax activity, and Cyt C release were all significantly increased, and insulin secretion was impaired as compared with G1, G2, and G3 groups (P<0.05). It was concluded that the exposure of islet cells to high glucose could induce islet cells apoptosis as well as impaired insulin secretion. The NF-kappaB signaling pathway and mitochondria pathway in islet cells might play some roles in the progressive loss of islet cells in diabetes. The inhibition of the NF-kappaB expression could be an effective strategy for protecting pancreatic islet cells.

Objective To explore the condition of cortistatin (CST)expression in human renal tissue and the changes in the level of CST in IgA nephropathy (IgAN)of different degrees.Methods Ten tumor adjacent normal renal tissue samples were collected.The mRNA and protein expressions of CST in human renal tissue were detected by reverse transcription-polymerase chain reaction (RT-PCR)and Western blotting,respectively.Immunohistochemisty (IHC)was performed to locate the expression of CST in renal tissue.According to the grading system of Lee et al,IgAN was divided into three groups:grade Ⅰ -Ⅱ (group A),grade Ⅲ -Ⅳ (group B),and grade Ⅴ (group C),and ten renal biopsy tissue samples were collected for each group.IHC was performed to detect the change in the level of CST in normal and IgAN renal tissue of different degrees.The effect of clinical indices on the level of CST in IgAN renal tissue was assessed by multiple linear regression analysis.Results RT-PCR and Western blotting showed that CST was expressed in renal tissue and IHC showed that CST was expressed on renal tubular epithelial cells.In IgAN,the higher the pathological grade was, the higher the expression of CST in renal tubules was.Multiple linear regression analysis showed that the pathological grade was associated with the expression of CST in renal tissue (r =0.875,P <0.01).Conclusion CST may participate in the inflammatory reaction of IgAN pathological injury and exert anti-inflammation effects.

Objective To investigate the long-term effects and risk factors of arterial polyvinyl alcohol resin (PVA) embolization for ⅢB and IV non-small cell lung cancer(NSCLC) patient.Methods 126 patients with 1 B or V NSCLC were performed the perfusion with 5-FU,THP,DDP by PVA grain embolization under fluoroscopic control.All patients were followed up.Kaplan-Meier was used to calculate the survival rate and the median survival time,and Cox regression model was adopted to analyze related risk factors which affected curative effect.Results The median survival time was( 11.78 ± 3.24) months and 1 -,2-year survival rate was 39.1 ％,25.59％ in 126 patients with NSCLC.Cox model analysis showed that of the tumor staging,tumor size,location and combination chemotherapy were all independent risk factors of prognosis (all P ＜ 0.01 ).Conclusion Arterial embolization of PVA for treatment of NSCLC is effective.Tumor size,stage,location and combination chemotherapy are associated with prognosis of NSCLC.

Objective To investigate the clinical value of fast track surgery (FTS) in donor in liver transplantation.Methods The clinical data of 214 donors for liver transplantation at the Renji Hospital of Shanghai Jiaotong University from January 2006 to November 2011 were retrospectively analyzed.All donors were divided into FTS group and conventional group.From January 2006 to May 2009,73 donors who received conventional perioperative management were in the conventional group,and 141 donors who received FTS from May 2009 to November 2011 were in the FTS group.The recovery of the donors in the 2 groups was compared.All data were analyzed using the chi-square test or t test.Results The operation time,time to out-of-bed activity,time to postoperative exsufflation,time to bowel movement,and duration of postoperative hospital stay were (178 ±37) minutes,(1.6 ± 1.0) days,(2.9 ± 1.6) days,(3.1 ± 1.5) days and (5.9 ± 1.9) days in the FTS group,which were significantly shorter than (167 ± 33) minutes,(3.6 ± 1.4) days,(4.6 ± 2.3) days,(4.5 ± 1.4) days and (7.6 ± 1.5) days in the conventional group (t =2.115,77.138,6.504,6.913,6.970,P ＜ 0.05).The hospital costs of the FTS group and the conventional group were (1.8 ±0.6) × 104 yuan and (2.2 ±0.4) x 104 yuan,respectively,with a significant difference between the 2 groups (t =73.038,P ＜ 0.05).The volumes of operative blood loss of the FTS group and the conventional group were (130 ± 47)ml and (138 ± 46)ml,with no significant difference between the 2 groups (t =1.251,P ＞ 0.05).The rate of satisfaction of the donors in the FTS group and conventional group were 98.6％ (139/141) and 89.2％ (74/83),respectively,with a significant difference between the 2 groups (x2 =9.94,P ＜ 0.05).Conclusion FTS is safe,economical and can reduce stress,decrease hospital costs and promote early recovery of donors in liver transplantation.

Adult ; Empyema, Pleural ; complications ; etiology ; Humans ; Male ; Neck Injuries ; complications ; Tracheoesophageal Fistula ; complications ; etiology