Objective To study the relationship between endothel in-1 in plasma and TCD in patients with brain injury.Methods We measured dynamically the level of ET-1 in plasma on 33 adult brain injured patients. Cerebral vasospasm was detected by transcranal Doppler sonography (TCD).Results 1.During 6-8 days, 13-15 days after injury,there was a significantly positive correlation between the level of ET-1 in plasma and cerebral vasospasm (r=0.533,P=0.002;r=0.423,P=0.02),especially during 6-8 days after injury. The increase of the level of ET-1 in plasma paralleled paroled with the time of cerebral vasospasm developed. 2.During 6-8 days after injury, the level of ET-1 in plasma of patients with cerebral vasospasm was obviously higher than those without cerebral vasospasm obviously (P

The treatment of spondylolysis is a rest, curtailment of activity and a back support. But in the case of increasing the back pain and disability, the surgical procedure is necessary such as the removal of posterior part of spine, posterior fusion of spine and anterior fusion of spine for lower back pain. If the patient had a radiating pian and positive neurological finding. the laminectomy is necessary. The another surgical procedure is the intertransverse fusion. In any way, after spine fusion, the motinn of spine is inevitably limited. Recently I had an experience of bone grafting between the transverse precess and lamina by the paraspinal sacrospinal mnscle splitting approach and semilunal transverse skin insion. The purpose of my experiences is the control of lumbago withont the lumbar motion limitation. The cases that I reported here are no any radiating pain and neurologically no any spinal nerve root irritation sign. I think, on the patient side, our method will be good idea for the chronic lower back pain without a radiating pain when the fusion becomes sucessful because of none of intervertebral fusion, non-cast immobilization and easily consealed surgical scar.
Back Pain ; Bone Transplantation ; Cicatrix ; Humans ; Immobilization ; Laminectomy ; Low Back Pain ; Methods ; Skin ; Spinal Nerve Roots ; Spine ; Spondylolysis

[Objective] To explore the change of biomechanics about human tendon with"?"irradiated which was universal used by domestic and foreign.[Methods]Twenty-four upper limb tendon of human with the same length were divided into two groups,group A(12):nonirradiated group,group B(12):2.5 Mrad gamma irradiated group.Material properties and structural properties were determined with WDW-3020 electron universal testing machine.[Results]The mean length of the tendon was 99.15% of control,the elongation to failure was 93.46%,the linear stiffness was 95.27%,the energy to maximum force was 93.60%,the maximum stress was 84.88%,the strain to failure was 85.82%,the linear modulus was 90.40%,the strain energy density to maximum was 66.73%.Difference was noted after compared hetween group A and B(P

Objective To measure normal range of CD4 from Chinese adults in Shanghai area by flow cytometry. Methods CD4 and CD8 value were measured through flow cytometry in adult blood specimens from various age and gender group. Results There were no difference in CD4 value among different sex and age groups, with the mean value being 726.99?255.21. However, CD8 and CD4/CD8 ratio vary significantly among different groups. The mean value of CD8 was 539.58?134.07, while the mean value of CD4/CD8 1.49?0.57. Conclusions The mean value of CD4 in Shanghai adults is about 100/mm 3 lower than that in American.

Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.

BACKGROUND: Studies have showed that transforming growth factor-β1 (TGF-β1) could yield to the collagen synthesis and adhesion formation of tendon cells at the process of healing. OBJECTIVE: To investigate the preventive effect of TGF-β1 neutralizing antibody on the collagen production and adhesion formation of flexor tendon. DESIGN, TIME AND SETTING: Randomized grouping observational experiments were performed in the Experimental Animal Center of Tongji Medical College between September 2005 and June 2006. MATERIALS: New Zealand white rabbits aged 2-5 months, weighing 3.5-4.5 kg. TGF was offered by Santa Cruz Biotechnology, USA. METHODS: Sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes were obtained from rabbit flexor tendons. Cells were divided into two groups at random. In the experiment group, each cell culture was supplemented with 1 μg/L of TGF-β at increasing dose (0.1, 0.5, 1.0 mg/L) of TGF-β1 neutralizing antibody. No reagents were given in the control group. Collagen Ⅰ production was measured by enzyme-linked immunoabsorbent assay. Eighty-four adult New Zealand white rabbit forepaws underwent sharp transection of middle toe flexor digitorum profundus, followed by immediate repair. Thirty-six adult New Zealand white rabbit were divided into three groups randomly (n=12), injecting with the saline, 1.0 mg/L TGF-β1 neutralizing antibody and 2.0 mg/L TGF-β1 neutralizing antibody into tendon sheath respectively. Tendons were harvested at 4 and 8 weeks to conduct adhesion detection, biomechanical testing, histological evaluation and scanning electron microscopy observation. The remaining 48 New Zealand white rabbits were divided into two groups randomly (n=24), undergoing the saline and 1,0 mg/L TGF-β1 neutralizing antibody injection in tendon sheath respectively. Tendons were harvested at an increasing time interval (1, 2, 4, 8 weeks) and analyzed by in situ hybridization to determine the mRNA expression of TGF-β1 and collagen Ⅰ. MAIN OUTCOME MEASURES: Collagen production and adhesion of rabbit tendon cells. RESULTS: ELISA exhibited that TGF-β1 increased collagen Ⅰ production and the addition of neutralizing antibody significantly reduced TGF-β-induced collagen Ⅰ production in all cell cultures. The effect between antibody and collagen Ⅰ was dose dependent. At 4 and 8 weeks after operation, the gliding excursion ratio of the tendon was shortened and the simulated active flexion ratio were less in saline group compared with 1.0 and 2.0 mg/L TGF-β1 groups (P < 0.05). The tendon anastomosis breaking strength was shown no significant differences among 3 groups (P > 0.05). Scanning electron microscopy and histological observation showed that collagen fibers arranged irregularly in saline group, but arranged regularly in 1.0 and 2.0 mg/L TGF-β1 groups at 4 and 8 weeks after operation. The in situ hybridization examination revealed that TGF-β1 and collagen Ⅰ mRNA expression in 1.0 mg/L TGF-β1 group was lower than that in saline group at each time (P < 0.05). CONCLUSION: TGF-β1 neutralizing antibody can inhibit the function of the TGF-β1 effectively following the flexor tendon injury and repair, and can prevent adhesion formation.

Objective To investigate the effect of dexmedetomidine on the cerebral injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Forty ASA Ⅱ or Ⅲ patients of both sexes,aged 43-64 yr,scheduled for elective cardiac valve replacement,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was injected intravenously over 15 min before induction of anesthesia,followed by infusion at 0.2μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were obtained from the radial artery and jugular bulb for blood gas analysis before CPB,immediatelv after declamping of the ascending aorta,at the end of CPB and at 6 h after operation (T1-4).The arteriovenous blood O2 difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated.The plasma concentrations of S-100β and neuron-specific enolase (NSE) in the blood samples obtained from the jugular bulb were measured at T1-4 and 24 h after operation.Results Compared with group C,the jugular venous oxygen saturation was significantly increased and Da-jvO2 and CERO were decreased at T2,3,and the plasma concentrations of S100β and NSE were decreased at T2-4 in group D (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the cerebral O2 metabolic rate and reduce the cerebral injury in patients undergoing cardiac valve replacement under CPB.

ObjectiveTo evaluate left ventricular (LV) function and dyssynchrony in patients with dilated cardiomyopathy (DCM) and complete left bundle branch block (CLBBB) by three-dimensional speckle tracking imaging(3D STI).Methods3D STI was performed and analyzed using TomTec 4-D LV analysis 3.0 software in 37 DCM patients with CLBBB and 25 healthy volunteers.The global 3D,longitudinal,circumferential,radial strains were measured.LV dyssynchrony was evaluated by the standard deviation of time to peak from 3D strain of 16 segments related to the heart cycle(3D-SDI).ResultsIn control group,uniformity in the average value of 3D strain was observed between apical,mid-ventricular and basal levels (P ＞ 0.05).Global 3D,longitudinal,radial and circumferential strains had excellent correlations with LV ejection fraction ( r =- 0.92,- 0.84,- 0.78 and 0.81,respectively,P ＜0.01).Compared with control group,global 3D,longitudinal,radial and circumferential strains were significantly lower in DCM patients ( P ＜0.01 for all).3D-SDI in DCM patients with CLBBB was significantly longer than that of volunteers ( P ＜0.01).3D-SDI increased with worsening LV systolic function regardless of QRS duration (P ＜0.05).ConclusionsWhen image quality is optimal,3D STI represents a promising novel technique for assessment of global LV function and dyssynchrony.

Objective:To explore influence of psychological persuasion and drug intervention on anxiety and depres‐sion in patients with myocardial bridge .Methods:A total of 126 patients ,who were confirmed as had myocardial bridge by coronary angiography (CAG) ,were divided into routine treatment group (n=62) and psychological intervention group (n=64 ,received psychological persuasion ,flupentixol melitracen tablet and sertraline therapy based on routine treatment ) . Another 40 cases with normal CAG results were enrolled as normal control group ,three groups received anxiety and depres‐sion assessment using Zung self‐rating anxiety scale (SAS) and self‐rating depression scale (SDS) before and after interven‐tion ,and the results were compared among three groups .Results:Before intervention ,there were no significant difference in SAS and SDS standardized scores between routine treatment group and psychological intervention group (P>0.05) ,but they were significantly higher than those of normal control group [SAS:(50.38 ± 7.10) scores ,(49.78 ± 7.42) scores vs . (25.70 ± 3.80) scores ,SDS:(48.5 ± 7.43) scores ,(47.67 ± 8.12) scores vs .(26.47 ± 4.10) scores , P<0.01 all] .After intervention ,SAS and SDS standardized scores of psychological intervention group significantly reduced compared with be‐fore intervention (P<0.01) ,and they were significantly lower than those of routine treatment group [SAS:(40.84 ± 6.23) scores vs .(50.88 ± 8.63) scores ,SDS:(39.82 ± 5.84) scores vs .(50.69 ± 8.48) scores] ,P<0.01 all .Conclusion:Psychological persuasion combined drug intervention could significantly reduce or relieve anxiety and depression in patients with myocardial bridge .

Interventional therapy is an important treatment for biliary stenosis.The treatment methods are different ac cording to the different causes.Conventional interventional therapy include biliary drainage,balloon dilatation and stent implantation.There are some new treatment methods such as radiofrequency catheter ablation and biliary stent loaded with 125I seeds.The applications of interventional therapy in biliary stenosis were reviewed in this article.