Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

BACKGROUNDIt has been known that different degrees of hypoxia can produce different effects on tumor. The study is to investigate the effect of hypoxia on the infiltration and migration of lung adenocarcinoma cells.

METHODSLung adenocarcinoma cells were exposed to normoxic (air, 5%O₂), hypoxic (1%O₂, 5%CO₂, 94%N₂) or anoxic (95%N₂, 5%CO₂) condition for 48 hours. The migration ability of the cells was assayed by wound healing methods. The infiltration ability was assayed by HABM-HEM model. The cells exposed to hypoxia were planted subcutaneously in nude mice, and the growth of cells and the rate of metastasis to lymph node or lung were observed. The levels of matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of metalloproteinase II (TIMP-2) in culture media were assayed by ELISA.

RESULTSComparing with normoxia group, the infiltration, migration and metastasis of hypoxia group were increased significantly (P < 0.05) , as well as the level of MMP-2 (P < 0.01), and the TIMP-2 level was remarkably decreased (P < 0.05) . In anoxia group, the levels of MMP-2 and TIMP-2 were both significantly decreased (P < 0.01).

CONCLUSIONSModerate hypoxia can up-regulate the expression of MMP-2, down-regulate the expression of TIMP-2, and increase the infiltration and migration of lung cancer cells. But serious hypoxia can decrease the expression of MMP-2 and TIMP-2, and inhibit the proliferation, infiltration and migration of lung cancer cells.

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.

To investigate the protective effect of genistein on endotoxin-induced acute lung injury in rats, and explore the underlying mechanisms, 32 male Sprague-Dawley rats were randomly divided into 4 experimental groups: saline control, genistein alone, lipopolysaccaride alone, and genistein pretreatment. Each treatment group consisted of eight animals. Animals were observed for 6 h after LPS challenge, and the wet/dry (W/D) weight ratio of the lung and bronchoalveolar lavage fluid(BALF) protein content were used as a measure of lung injury. Neutrophil recruitment and activation were evaluated by BALF cellularity and myeloperoxidase (MPO) activity. RT-PCR analysis was performed in lung tissue to assess gene expression of ICAM-1. The histopathological changes were also observed using the HE staining of lung tissue. Our results showed that lung injury parameters, including the wet/dry weight ratio and protein content in BALF, were significantly higher in the LPS alone group than in the saline control group (P＜0.01). In the LPS alone group, a larger number of neutrophils and greater MPO activity in cell-free BAL and lung homogenates were observed when compared with the saline control group (P＜0.01). There was a significant increase in lung ICAM-1 mRNA in response to LPS challenge (P＜ 0. 01, group L versus group S).Genistein pretreatment significantly attenuated LPS-induced changes in these indices. LPS caused extensive lung damage, which was also lessened after genistein pretreatment. All above-mentioned parameters in the genistein alone group were not significantly different from those of the saline control group. It is concluded that genistein pretreatment attenuated LPS-induced lung injury in rats.This beneficial effect of genistein may involves, in part, an inhibition of neutrophilic recruitment and activity, possibly through an inhibition of lung ICAM-1 expression.

Objective:To study the role of autophagy-associated gene regulation FK506 binding protein 1A (FKBP1A) in the regulation of head and neck squamous cell carcinoma (HNSCC).Methods:TCGA was used to analyze the gene expression difference between HNSCC and normal tissues, and the DAVID was employed to perform functional annotation of differently expressed autophagy-associated genes enrichment in HNSCC. Univariate and multivariate Cox regression analysis was used to find genes that were meaningful for the prognosis of HNSCC patients in TCGA; the Gene Expression Comprehensive Database (GEO) was employed to verify the prognosis of the screened gene; the prognosis of HNSCC patients was analyzed by Kaplan-Meier Plotter.Results:Compared with the normal tissues samples, a total of 38 genes significantly changed in HNSCC tissues. These differential genes were mainly distributed in autophagy-associated pathways in biological processes (BP), cellular components (CC) and molecular functions (MF) in GO analysis. Univariate and multivariate Cox regression analysis found that 18 autophagy-associated genes were significantly correlated with the prognosis of HNSCC patients in the TCGA database. Among them, the high-risk genes were verified in the GEO database, and found that FKBP1A was closely related to the prognosis of HNSCC patients. Immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) assays showed that the expression of FKBP1A in patients with HNSCC was higher than that of the corresponding adjacent tissues, and was closely related to the stage of HNSCC.Conclusions:This study used integrated bioinformatics methods to study the role of autophagy-associated genes in the occurrence and development of HNSCC. Moreover, the screened biomarker, FKBP1A, is closely related to the prognosis of HNSCC, and provide the theoretical basis for the pathogenesis and potential treatment of HNSCC.

Objective To compare the efficacy of sound therapy and conventional medical treatment in the treatment of chronic tinnitus.Methods CNKI,Wanfang database,Weipu database (VIP),Chinese biomedical literature database (CBM),Pubmed,Embase,OVID,SciVerse ScienceDirect and Cochrane library were used.The data were retrieved up to May 2017,and the relevant literature was screened according to the inclusion and emission standards.The quality of the literatures were analyzed and the data was extracted.Meta analysis was carried out by using Revman 5.2 software with total effective rate,tinnitus handicap inventory(THI) value and visual analogue scale(VAS) value.Results A total of 16 articles (1 594 patients) were included in the literature,including 14 articles in Chinese and 2 articles in English.The total effective rate in the sound therapy group were 86.42 ％ (by patients) and 80.50％ (by ears),while in conventional medical treatment group were 60.62％ (by patients),and 48.10％ (by ear),respectively[P＜0.01 (by patients),P＜0.01 (by ear)].The changes of THI value were analyzed before and after treatment,the difference was statistically significant(P＜0.01).The changes of VAS value were analyzed before and after treatment,the difference was statistically significant (P＜0.05).Conclusion Compared with conventional medical treatment,sound therapy can significantly improve the clinical efficacy of tinnitus treatment and reduce the symptoms in tinnitus patients.

OBJECTIVE To analyze the clinical manifestation,diagnosis and treatment of cervical lymph node tuberculosis.METHODS The clinical data of 100 patients with cervical lymph node tuberculosis admitted in our hospital from 2007 to 2015 were retrospectively analyzed.RESULTS Most of the patients with cervical lymph node tuberculosis presented with cervical mass alone,only 8 cases associated with fever,night sweats,fatigue and other systemic symptoms of poisoning.Ninety five patients were diagnosed by postoperative pathological examination,while 15 patients were diagnosed with fine needle aspiration preoperatively.Ninety five patients received surgical treatment with postoperative systemic anti-tuberculosis treatment for 6 months,the remaining 5 patients given standard antituberculosis treatment.All of the patients got satisfactory results.There were three operative methods:simple cervical lymph node resection(31 cases),cervical lymph node dissection(53 cases),and abscess incision debridement(ll cases).All patients had no recurrence.CONCLUSION The clinical manifestation of cervical lymph node tuberculosis are complicated,the positive rate of fine needle aspiration biopsy is low.Postoperative pathological examination can help to further confirm the diagnosis.Surgical treatment combined with postoperative systemic standard anti-tuberculosis therapy can be used to cervical lymph node tuberculosis.

Objective:To investigate the clinical effect of low molecular weight heparin sodium combined with antivenin in the treatment of severe and critical bite by Trimeresurus stejnegeri.Methods:The clinical data of 48 patients with severe or critical bite by Trimeresurus stejnegeri admitted to emergency department of Southeast Hospital Affiliated to Xiamen University from March 2017 to May 2019 were retrospectively analyzed. On the basis of early treatment of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, the patients were divided into heparin treatment group and non-heparin treatment group according to whether the low molecular heparin sodium was used or not. The patients in the two groups were compared in terms of gender, age, clinical classification, swelling degree of injured limbs, change of coagulation function index, bleeding of skin, mucous membrane or digestive tract, blood transfusion, local symptoms of bite, length of hospital stay and prognosis.Results:There was no significant difference in terms of gender, age, clinical classification or swelling degree of injured limbs between the two groups. On the 3rd day of treatment, the platelet count (PLT) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [×10 9/L: 210.0 (160.0, 252.0) vs. 136.0 (104.0, 198.5), P < 0.05]. However, there was no significant difference in the four coagulation test results between the two groups. On the 6th day of treatment, the plasma thrombin time (TT) in the heparin treatment group was significantly shorter than that on the 3rd day of treatment [s: 30.3 (20.4, 37.0) vs. 34.7 (24.0, 73.4), P < 0.05], and the fibrinogen (FIB) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [g/L: 0.60 (0.31, 1.07) vs. 0.20 (0.14, 0.60), P < 0.01]. The incidence of bleeding in the heparin treatment group was significantly lower than that in the non-heparin treatment group [21.7% (5/23) vs. 64.0% (16/25), P < 0.01]; 11 patients in the heparin treatment group and 18 patients in the non-heparin treatment group received blood transfusion and prothrombin complex supplement respectively. There was no significant difference in the length of hospital stay between the heparin group and non-heparin treatment group (days: 6.91±1.92 vs. 7.48±2.27, P > 0.05). The patients in both groups were followed up for 1 week to 1 month after treatment, and no death or local necrosis of skin and soft tissue was found. Conclusions:For the patients with severe and critical bite by Trimeresurus stejnegeri, on the basis of injection of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, early application of low molecular weight heparin sodium anticoagulation and other comprehensive treatment is helpful to improve limb swelling and inflammation, reduce blood transfusion, promote the recovery of coagulation function, and shorten the length of hospitalization.

OBJECTIVETo evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction.

METHODSThere were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores.

RESULTSAll the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05).

CONCLUSIONSThe n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.

Adolescent ; Adult ; Aged ; Durapatite ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Nanostructures ; Nylons ; Spinal Diseases ; surgery ; Spinal Fusion ; instrumentation ; methods ; Treatment Outcome ; Young Adult