[Objective]To investigate the efficacy of treatment of C_(1～C) instability with 3D-fixation techniques.[Method]From July 2002 to July 2005,thirteen patients were treated with atlantal lateral mass screw associating with axoid pedicle screw;twelve patients were treated with axoid transarticular screw associating with posterior atlantal arch hook;sixteen patients were treated with Vertex and nine patients with Summit among them.[Result]There were 26 lateral mass screws,26 axoid transarticular screws,24 atlantoaxial transarticular screws and 24 posterior atlantal arch hooks were applied in the 25 patients.All patients were followed up.The follow up duration time was ranging from 10 to 36 months with the mean time of 16.7 months.No spinal injury and vertical artery injury was found. The postoperative JOA score was ranging from 13.6 to 15.9 with the mean score of 14.8 and the improvement rate of 89.5%.All fractures of odontoid process and all bone grafts had solid bone union.No failure and loosening of internal instrument was found.[Conclusion]The two 3D-fixation techniques are effective and reliable.

BACKGROUND: Brain trauma can stimulate the proliferation of neural stem cells (NSCs) to some extent, while progesterone can ameliorate the learning and memory function following brain trauma, which can also promote the neurofunctional recovery after brain trauma by stimulating the proliferation of NSCs.OBJECTIVE: To observe the effects of progesterone on the proliferation of NSCs after diffuse brain injury (DBI).DESIGN: Randomized control animal experiment.SETTING: Xinxiang Medical College.MATERIALS: Forty-eight healthy male SD rats at 4-5 months with the body mass of 280-330 g were selected.METHODS: The experiment was conducted in Xinxiang Medical College from September 2004 to January 2005. Forty-eight rat models of Marmarou DBI were selected and randomly divided into 4 groups with 12 rats in each group: ①Sham-operation group: rats were cut open the scalp and then sutured.②Brain trauma group: rats were made into animal models of brain trauma.③Dimethyl sulphoxide (DMSO) group: rats were given intraperitoneal injection of DMSO at the same volume as progesterone group at one hour after brain trauma and then the same administration was performed daily. ④Progesterone group: rats were intraperitoneally injected with 4 mg/kg progesterone at one hour after brain trauma and then the same administration was performed daily. Rats were executed respectively at 3 and 6 days after sham operation or brain trauma operation, and hematoxylin-eosin staining was conducted to observe the morphological changes of cortical neurons in brain. The expressions of nestin in dentate gyrus and hippocampus were detected with immunohistochemical staining.MAIN OUTCOME MEASURES: Observation of histomorphological changes of neurons and detection of the expressions of nestin in hippocampus and dentate gyrus.RESULTS: ①There was no injury in cortical neurons in the sham-operation group, while obvious neuronal injury and loss in cortex of rats were found in the 3-day and 6-day brain trauma groups, and the neuronal injury was significantly severer in brain trauma than in 3-day and 6-day progesterone groups. ②The expressions of nestin in hippocampal CA4 region or dentate gyrus of sham-operation group were in low level or little, and the expression of nestin could be seen occasionally in hippocampal CA4 region. The expressions of nestin in hippocampal CA4 region and dentate gyrus of the brain trauma group significantly increased (P ＜ 0.05), while those in the progesterone group increased more than the brain trauma group remarkably (P ＜ O.05).③There were no differences in neuronal injury and nestin expression between braintrauma group and DMSO group(P ＞ 0.05).CONCLUCION: Progesterone for brain trauma may be related with its promoting effects on the proliferation of NSCs.

OBJECTIVETo investigate the risk factor of cholecystitis after radical gastrectomy for gastric cancer.

METHODSClinicpathological data of 553 gastric cancer patients with normal gallbladders undergoing radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital between March 2013 and March 2015 were analyzed retrospectively. Univariate and multivariate analysis were applied to evaluate factors influencing the cholecystitis after radical gastrectomy using log-rank and logistic regression model.

RESULTSThere were 360 males and 193 females with a median age of 60 years. All patients were followed up from 6 months to 2 years. The incidence of cholecystitis after radical gastrectomy for gastric cancer was 33.1%(183/553), while incidence of cholecystolithiasis was 4.9%(27/553). In addition, the cholecystitis incidence of patients with No.12 lymph node cleaning was 39.6%(89/225), while with No.8a lymph node cleaning was 38.0%(151/397), with No.5 lymph node cleaning was 38.0%(68/179), with No.7 lymph node cleaning was 34.4%(138/402), with No.9 lymph node cleaning was 34.7%(136/392). Univariate log-rank test indicated that the lymphadenectomy of No.8a(χ(2)=15.530, P=0.000), No.12 group(χ(2)=7.157, P=0.007) and surgical methods (χ(2)=7.427, P=0.024) were significantly associated with cholecystitis after radical gastrectomy. Multivariate analysis showed that the lymphadenectomy of No.8a was independent factor of cholecystitis after radical gastrectomy (OR=2.016, 95% CI:1.244 to 3.267, P=0.004).

CONCLUSIONSVagal nerve trunk and sympathetic ganglion should be protected carefully during No.8a lymphadenectomy in radical gastrectomy for gastric cancer, in order to reduce the incidence of postoperative cholecystitis.

Cholecystitis ; epidemiology ; Female ; Gastrectomy ; adverse effects ; Humans ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; surgery

OBJECTIVE：To investigate the effects of curcumin on bone metabolism balance in ovariectomized osteoporosis model rats ，and to investigate its potential mechanism. METHODS ：Totally female Wistar rats were randomly divided into blank group（group A ），model group （group B ），estradiol group [group C （positive control ），estradiol valerate 50 μg（/ kg·d）]， curcumin low-dose ，medium-dose and high-dose groups [group D-F ，55，110，165 μg（/ kg·d）]，with 15 rats in each group. Except for group A ，other rats were ovariectomized to establish osteoporosis model. After modeling ，group A and B were given normal saline intrgastrically ，and administration groups were given relevant medicine intrgastrically 30 mL/kg，once a day ，for consecutive 12 weeks. The contents of serum bone metabolism markers [BALP ，CBF-α1，CTX-Ⅰ，PINP and OC] were determined by ELISA. The bone mineral density （BMD）and trabecular structure indexes [relative bone volume fraction （BV/TV），trabecular number （Tb.N），trabecular thickness （Tb.Th），connectivity density （Conn. D ），trabecular separation （Tb.Sp）and structure model index （SMI）] were determined by micro CT imaging system. The mRNA and protein expression of OPG and RANKL in hypothalamus and femur were determined by RT-PCR and Western blotting assay. RESULTS ：Compared with group A ，the contents of serum bone metabolism markers ，BMD，BV/TV，Tb.N，Tb.Th，Conn.D，mRNA and protein expression of OPG were decreased significantly in group B ，while Tb.Sp ，SMI，mRNA and protein expression of RANKL were increased significantly @qq.com （P＜0.05）. Compared with group B ，the contents of serum bone metabolism markers ，BMD，BV/TV，Tb.N，Tb.Th，Conn.D，mRNA and protein expression of OPG were increased significantly in administration groups ；Tb.Sp，SMI，mRNA and protein expression of RANKL were decreased significantly ，in a dose-dependent manner among curcumin groups （P＜0.05 or P＜0.01）. CONCLUSIONS ：Curcumin can improve the level of bone metabolism，increase BMD ，improve the trabecular microstructure and inhibit bone absorption in ovariectomized osteoporosis model rats. Its mechanism may be related to the regulation of OPG/RANKL signaling pathway.