Objective To investigate the difference of short-term clinical efficacy between decompressive laminectomy into In-Space and simple decompressive laminectomy for treatment of lumbar spinal stenosis with vertebral instability.Methods Thirty-three patients with lumbar spinal stenosis with vertebral instability admired from May 2009 to July 2010,were divided into two groups by random number table.Group A of 16 cases was treated with laminectomy decompression and placement In-Space,group B of 17 cases was treated with laminectomy decompression.Lumbar anteroposterior,lateral and flexion-extension X-ray films,preoperatively,and the follow-up were used to measure anterior and posterior disc height,foraminal height,segmental lordotic angle at surgical level.Using Oswestry disability index (ODI) and the visual analogue scale (VAS) to evaluate the clinical efficacy.Results All patients were followed up for (13.20 ± 2.91 ) months (range 6 to 21 months).The anterior disc height after operation of group A was slightly decreased compared with the preoperative(P＞ 0.05 ),the posterior disc height at 1 day after operation and foraminal height after operation of group A were significantly increased compared with the preoperative (P＜ 0.05).The anterior and posterior disc height,foraminal height of group B at 1 day,1 month,3 months after operation were no significantly different compared with the preoperative (P ＞ 0.05 ),at 6 months after operation and the end of follow-up were significantly decreased compared with the preoperative or 1 day after operation (P ＜ 0.05 ).Activity of lumbar vertebra by preoperative 9.86° ± 1.90° decreased to the end of followup 5.60° ± 2.02°in group A,while activity of lumbar vertebra by preoperative 9.89° ± 2.00°increased to the end of follow-up 10.76° ± 3.14° in group B.At the end of follow-up,lumbar back pain VAS,ODI score [ (2.02 ± 1.98 ),( 20.18 ± 18.80) scores ] of group A were significantly lower than those of group B [ (4.15 ±2.36),(30.39 ± 16.62 ) scores ],the differences were statistically significant (P ＜ 0.05 ).No patient suffered In-Space loosening,fracture and emerge.Conclusion The operation of In-Space can maintain spinal mobility and stability as well as avoiding lumbar vertebral instability,and its short-term efficacy is satisfactory.

Objective To investigate the genotypes and encoding resistance genes differences of Acinetobacter baumannii and analyze their interrelations with multi-drug resistance.Methods A total of 77strains Acinetobacter baumannii were collected random from the second Xiangya Hospital during September 2008 to September 2009.The K-B method which was WHO recommended was adopted to Acinetobacter baumannii drug sensitivity test to 15 kinds of antibiotics to establish susceptibility spectrum.At the same time,random amplified polymorphic DNA(RAPD)technique was used to establish DNA fingerprinting.The genes of β-lactamase(TEM-1,IMP,OXA-23,OXA-24,AmpC),aminoglycoside-modifying enzymes[aac(3')-Ⅰ ,aac(6')-Ⅰ ,ant(3")-Ⅰ]and 16S rRNA methylase(armA,rmtA,rmtB)were detected by PCR and sequenced,and find the relationship between the gene encoding and multi-drug resistance.In addition,we compared the rates of resistance genes of Acinetobacter baumannii and the relations with the genotype and the multi-resistance.Results Thirty-one sensitive strains and 46 multi-drug resistance strains(10 Pan-drug resistances)were isolated.Seventeen types from A to Q were separated using RAPD technique.E genotype widely popular in the ICU was the advantage type in multi-drug resistance strains,and the rate was 47.1%.While the various types scattered in sensitive strains.The positive rates of TEM-1,IMP,OXA-23,OXA-24,AmpC,aac(3')-Ⅰ ,aac(6')-Ⅰ ,ant(3")-Ⅰ ,armA in the multi-drug resistance strains and the sensitive strains were 95.7%,39.1%,84.8% ,54.3%,87.0%,89.1%,84.8%,45.7%,63.0% and 58.1%,9.7%,32.3%,48.4%,48.4%,29.0%,45.2%,12.9%,9.7%,respectively,and there was significant difference except for OXA-24 using the X2 test(P ＜ 0.05).All isolates were negative for rmtA gene and rmtB gene.Drug susceptibility analysis showed that the resistant rate was significantly higher of the strains carrying resistant genes than that of the resistance negative strains.When the strains were resistant to gentamicin and amikacin,the rate of three aminoglycoside genes positive was 34.8%.The trains containing all the measured β-lactamase genes were all resistant strains.Conclusion Compared with the sensitive Acinetobacter baumannii strains,a broad resistance spectrum and a high drug resistance rate were showed in multidrug resistance strains isolated from clinic,which harboring many kinds of β-lactamase genes and aminoglycosides genes with a high separation rate,and the same clone of multiple drug-resistant strains may be transmitted in and among wards.

Objective To investigate the prevalence of 16S rRNA methylase gene armA and to analyze their effect on the drug resistance in multi drug-resistant strains of Acinetobacter baumannii . Methods A total of 72 Acinetobacter baumannii isolates were collected from the Second Xiangya Hospital from Jan. 2008 to Dec. 2008. The size of inhibitory zone of these strains to gentamycin, tobramycin and amikacin were determinate using Kirby-Bauer( K-B) method. The 16S rRNA methylase genes armA were detected by PCR. PCR products were purified and sequenced. Then we used randomly amplified polymorphic DNA method (RAPD) genotyping technology for the establishment of DNA fingerprinting. In addition, we compared drug sensitivity test with RAPD technology. Results Twenty isolates of 72 strains were armA positive and the resistance rates of the strains with armA gene to gentamycin, tobramycin, amikacin were 90.0% , 90.0% and 90. 0% , respectivily. armA positive stains were divided into 7 types using RAPD technology. A genotype was the advantage type. Conclusion The study showed that 16S rRNA methylases gene armA was prevalent in Acinetobacter baumannii which could lead to resistant to almost all aminoglycosides at a high level. And the main form of armA gene prevalence in our hospital was the spread of the same clone strain inside and outside of clinic department.

Objective:To explore the correlations of TNF-α-238 site gene polymorphism and the onset of Ankylosing Spondylitis(AS)in Hunan Han population.Methods:100 AS samples (including serum and whole blood) were collected from the Department of Immunology and Rheumatology of the Second Xiangya hospital from May 2008 to Jan 2009 and 90 samples of normal people were collected as control group.We detected the TNF-α-238 gene polymorphism of these subjects by using PCR-RFLP technique.The TNF-α level in the serum samples were measured by ELISA and HLA-B27 antigen was detected by flow cytometry (FCM).Then all of the data was analyzed by SPSS13.0 software.Results:There were 95 cases with the TNF-α-238 G/G genotype in 100 AS patients,5 cases with the G/A genotype.While in the control group,TNF-α-238 G/G genotype and G/A genotype were 88 cases and 2 cases respectively.There was no TNF-α-238 A/A genotype in both groups.The allele frequencies of G in AS group was higher than in the control group(98.9% vs.97.5%),while the allele frequencies of A in AS group was lower than in the control group(1.1% vs.2.5%).However,there were no significant difference both A allele frequencies and G allele frequencies (P＞0.05).In addition,the average TNF-α level in AS group was higher than in the control group significantly (10.16±1.19 pg/ml vs.5.64±1.18 pg/ml).And the average TNF-α level in AS patients with the genotype of G/A was higher than that of with the G/G genotype (13.49±1.27 pg/ml vs.9.44±1.29 pg/ml).There was a very large difference of the positive ratio of HLA-B27 between two groups (χ~2=114.975,P=0.000).After gene analysis of HLA-B27and TNF-α-238,the odds ratio(OR)was higher in both G/G genotype and HLA-B27 positive than HLA-B27 lonely.Conclusion:There is probably no relationship between the gene polymorphism of TNF-α-238 site and the onset of AS but the G/G genotype of TNF-α-238 may increase the sicken risk of AS in Hunan population.

Objective To explore the value of serum circulating immune complex C 1q(CIC-C1q),comple-ment C3and C4in the diagnosis and treatment of patients with rheumatoid arthritis(RA).Methods From June 2014 to June 2016,60 cases of rheumatoid arthritis treated in Luoyang Central Hospital Affiliated to Zhengzhou University were selected as the observation group.Meanwhile,60 cases who under went healthy physical examination were chosen as control group.The levels of CIC-C1q,C3and C4in serum of two groups were detected by C1q solid-phase ELISA and immunoturbidimetry respectively,and the differences were com-pared.Results The level of CIC-C1q in the observation group was significantly higher than that in the control group,the level of C4was lower than control group,and there was statistical significance in the differences (P<0.05).But there was no statistical difference between the two groups of the C3level(P>0.05).The level of CIC-C1q was ascending in control group,quiescent phase RA group and active phase RA group,the statisti-cal significance was existed(P<0.05).The level of C4was successively decrease in the three groups,and there was a statistically significant difference(P<0.05).There was no significant difference in the level of C3the three groups(P> 0.05).Conclusion The detection of CIC-C1q and C4has a good application value in the treatment evaluation for patients with RA.

OBJECTIVE:To study the chemical constituents in ethanol extract from the stem of Miao medicine Rubus multibracteatus. METHODS:The ethanol extract from the stem of Miao medicine R. multibracteatus was isolated and purified by silica gel column,preparative liquid chromatography and Sephadex LH-20 gel column,etc. The structure of compounds were analyzed and identified according to physicochemical properties and spectrum data(MS,hydrogen spectrum and carbon spectrum). RESULTS:Ten compounds were isolated from the ethanol extract of R. multibracteatus stem,i.e. 5,4′-dihydroxy-8-(3,3-dimethylally)-2″, 2″-dimethylpyrano [5,6∶6,7] isoflavone(1),3-hydroxy-1-(4′-hydroxy-3′-methoxyphenyl)propan-1-one(2),3β-hydroxysitost-5-en-7-one (3),Lupeol(4),Coniferaldehyde(5),E-p-hydroxy-coumaric acid(6),Genistein(7),1-O-p-coumaroylglycerol(8),Scopoletin(9), and Kaempferol(10). CONCLUSIONS:Compound 1-9 are isolated from the plants of R. multibracteatus for the first time,and Compound 2,5,8 are isolated from the plants of Rubus L. for the first time. The study lays the foundation for further development and utilization of R. multibracteatus.

With accelerated aging process of the population, femoral intertrochanteric fractures have gradually become another major social health problem in China. Internal fixation is still the gold standard treatment for the fractures. Fracture reduction is the first step of the treatment and also the first element that affects the treatment efficacy. It is still controversial in clinical practice how to evaluate the quality of fracture reduction during internal fixation of the fractures. This article systematically expounds and analyzes the 7 systems of judging criteria for the reduction of intertrochanteric fractures from the aspects of fracture alignment, fracture apposition, difference in judgment criteria, and difference in imaging methods, in order to provide a reference for reaching consensus and improving curative effects.

Objective:To compare the efficacy of high density grid mapping catheter (HD-Grid) and circular mapping catheter in the ablation of paroxysmal atrial fibrillation.Methods:Patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation in Xingtai People′s Hospital from March 2020 to March 2021 were randomly divided into the HD-Grid group and the circular mapping catheter group. The baseline data, operation time, X-ray exposure time, pulmonary vein isolation time, recovery of pulmonary vein conduction, the number of recovery sites, and perioperative complications were compared between the two groups. The patients were followed up at 1, 3, 6 and 12 months after operation, and a continuous electrocardiogram was performed to evaluate recurrence of atrial fibrillation.Results:Sixty patients were enrolled in the study with 30 cases in each group, including 33 males and 27 females with an average age of 63.0 (57.0, 70.3) years. There were no significant differences in age, gender ratio, comorbidity proportion, CHADS 2-VASC score, history of atrial fibrillation, B-type natriuretic peptide level, and left atrial diameter between the two groups (all P>0.05). The operation time of the HD-Grid group was longer than that of the circular mapping catheter group ((136.6±7.7) minutes vs. (127.5±7.7) minutes, P<0.001). During the observation period, 8 cases (26.67%) with pulmonary venous conduction recovery were identified in the HD-Grid group, which was higher than that in the circular mapping catheter group (2 cases(6.67%)) ( P=0.038). Eighteen (60.00%) pulmonary vein reconnection sites were identified in the HD-Grid group, which were more than that in the circular mapping catheter group (2 sites(6.67%), P=0.013). There was no significant difference in X-ray exposure time and pulmonary vein isolation time between the two groups (both P>0.05). There was no significant difference in the proportion of patients taking anticoagulant drugs and antiarrhythmic drugs during the perioperative period between the two groups (both P>0.05). No serious complications such as cardiac tamponade, phrenic nerve injury, pulmonary embolism, cerebral infarction and death occurred in both groups. During the follow-up period, 1 patient (3.33%) in the HD-Grid group had recurrence of atrial fibrillation, while 5 patients (16.67%) in the circular mapping catheter group had recurrence of atrial fibrillation, but there was no significant difference between the two groups ( P=0.197). Conclusions:HD-Grid for radiofrequency ablation of paroxysmal atrial fibrillation improves the identification rate of pulmonary vein potentials and pulmonary vein reconnection sites, and it may reduce the recurrence rate of atrial fibrillation. Although the operation time was prolonged, it would not increase the risk of perioperative complications.

Objective:To investigate the correlation between CHA 2DS 2-VASC score and the recurrence risk of paroxysmal atrial fibrillation after radiofrequency ablation. Methods:It was a retrospective cohort study. A total of 150 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in Xingtai People′s Hospital from January 2017 to January 2021 were consecutively included in the study. According to the preoperative CHA 2DS 2-VASC score, patients were divided into high score group (≥3 points, n=90) and low score group (<3 points, n=60). Baseline clinical data was collected. All patients underwent circumferential pulmonary vein isolation, and those with atrial flutter before ablation also underwent tricuspid isthmus isolation. Holter and electrocardiogram examinations were performed at 3, 6 months and 1 year after ablation to evaluate whether there was recurrence of atrial fibrillation. Univariate and multivariate Cox regression was used to analyze the risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Results:Among 150 patients 90 were males and 60 were females with a mean age of (64.0±3.6) years. There were no significant differences in age, sex, and proportion of hypertension, diabetes, chronic heart failure and stroke or transient ischemic attack (TIA), medication of antiarrhythmic and anticoagulant drugs between the two groups (all P>0.05). The longest duration of atrial fibrillation in the high score group was significantly longer than that in the low score group (26.0±6.1) hours vs. (10.0±2.1) hours, P<0.05). There were no patients with cardiac tamponade, atrial esophageal fistula and severe vascular puncture complications in the two groups. During the follow-up period, the recurrence rate in the high score group was significantly higher than that in the low score group (16.7% (15/90) vs. 8.3% (5/60), P<0.05). Multivariate Cox regression analysis showed that CHA 2DS 2-VASC score≥3 was an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation ( HR=3.84, 95% CI: 1.87-7.89, P=0.02). Conclusion:CHA 2DS 2-VASC score≥3 is an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation.

Objective:To investigate the risk factors of atrial fibrillation (AF) in patients with typical atrial flutter after radiofrequency ablation.Methods:This study was a case-control study. The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed. Patients were followed up every 3-6 months for a period of 2 years, and AF occurred in 30 patients (25.0%). The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results:The mean age of patients was (62.0±6.5) years and 64(53.3%) were males. No patients in the two groups had complications such as cardiac tamponade, pulmonary embolism and cerebral infarction after radiofrequency ablation. Compared with non-AF patients, patients in AF group had older age and higher CHA 2DS 2-VASC score ( P<0.001). Multivariate regression analysis showed that age ( HR=1.09, 95% CI:1.01-1.17) and CHA 2DS 2-VASC score ( HR=3.84, 95% CI:1.87-7.89) were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter. Conclusion:After radiofrequency ablation of typical atrial flutter, nearly 25% of patients will relapse into AF, old age and higher CHA 2DS 2-VASC score increase the risk of AF recurrent.