Objective To study the diffusion tensor imaging (DTI)features in acute cervical spinal cord injury (CSCI)and evaluate its clinical value.Methods Eight patients with acute CSCI (within 72 hours after onset)were performed conventional MRI and fast DTI scans (112 seconds)and diffusion tensor tractography (DTT)at 3.0T Siemens Trio Tim system.Meanwhile,the fractional anisotropy (FA) values and apparent diffusion coefficient (ADC)values were calculated separately in the site of lesions,the upper and lower sections to the lesions.Then the data were analyzed by paired-samples t test analysis with SPSS 13.0 software.Results Cervical spinal cord injury occurred likely in the sites of C5-C6 (account for 4/8)and C4-C5 (account for 3/8).All MRI and DTI images were satisfied for clinical diagnosis.The FA value and ADC value of injury lesions were markedly lower than that of the normal cord.Accordingly,the injury lesions on FA map and ADC map presented low signals.There were no significant differences of FA values and ADC values between the upper and lower sections to the lesions.DTT could help in displaying the disruption of spinal fiber tract in lancination case and distortion fibers in closed cervical spinal cord injury.Conclusion Fast DTI sequence at 3.0 Tesla may obtain the qualified spinal cord images.By calculation of FA values and ADC values in CSCI patients,DTI may play an important role in detecting the changes of anisotropy and water diffusion caused by myelin sheath injury and cytotoxic edema and vasogenic edema respectively.

Emodin is an effective active ingredient extracted from Chinese herbal medicine, which has the function of antimicrobial, anti-inflammatory, antioxidant and scavenging oxygen free radicals, inhibiting platelet aggregation, improving microcirculation, protecting various organs and tissues as well as a wide range of anti-tumor effect. Primary biliary gallbladder is a common malignant tumor resection rate and lack of effective adjuvant treatment. It has been confirmed that emodin has broad spectrum antitumor effect, whereas, whether it has curative effect in the treatment of gallbladder carcinoma there is no reliable clinical trials confirmed that its resistance to gallbladder carcinoma function needs further experimental research. In this review, we report the research progress of emodin anti-gallbladder carcinoma.
Animals ; Antineoplastic Agents ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Emodin ; therapeutic use ; Gallbladder ; drug effects ; Gallbladder Neoplasms ; drug therapy ; Humans

OBJECTIVETo identify the affect of chronic low back pain on multifidus muscle atrophy and fatty infiltration.

METHODSFrom March 2010 to August 2013, a retrospective study were carried out in the department of orthopedics of patients with low back pain. Finally 31 cases were selected to this study including 19 males and 12 females with an average age of 36.4 years ranging from 23 to 55 years. The main symptoms of these patients were repeated back pain. Duration was more than 1 year. X-ray, CT, MRI showed no obvious abnormalities. The changes of net cross-sectional area of multifidus and T2 signal ratio of the same patient were measured at different time by MRI. VAS and Oswestry disability scores were recorded in two MRI examination. Correlation between these change of multifidus net area and T2 signal ratio in two times measurement and duration of low back pain, VAS, Oswestry disability scores were analyzed to find the affection of low back pain on paraspinal multifidus muscle.

RESULTSThe net multifidus cross-sectional area in same case by the second follow-up MRI is significantly smaller than that of the first follow-up, T2 signal ratio at second was significantly higher than that of the first (P < 0.05). The net cross sectional area of multifidus muscles reduced rate were positively correlated with VAS scores, duration and of Oswestry disabilitry scores (P < 0.001). The rate of increase in T2 signal ratio was not correlated with VAS scores,duration and the Oswestry disability scores (P > 0.05).

CONCLUSIONChronic low back pain is one of the most important reasons of paraspinal multifidus muscle atrophy and fatty. The duration, VAS and Oswestry disability scores of chronic low back pain were positively correlated with the multifidus muscle atrophy.

Adult ; Chronic Disease ; Female ; Humans ; Low Back Pain ; complications ; Male ; Middle Aged ; Muscular Atrophy ; diagnostic imaging ; etiology ; Paraspinal Muscles ; diagnostic imaging ; Radiography ; Retrospective Studies ; Young Adult

OBJECTIVETo review the literature on the clinical progress in cauda equina syndrome (CES), including the epidemic history, pathogenesis, diagnosis, treatment policy and prognosis. Data sources All reports on CES in the literature were searched in PubMed, Ovid, Springer, Elsevier, and the Chinese Biomedical Literature Disk using the key terms "cauda equina syndrome", "diagnosis", "treatment", "prognosis" and "evidence-based medicine". Study selection Original milestone articles and critical reviews written by major pioneer investigators about the cauda equina syndrome were selected.

RESULTSCES is rare, both atraumatically and traumatically. Males and females are equally affected. The incidence of CES is variable, depending on the etiology of the syndrome. The most common cause of CES is herniation of a lumbar intervertebral disc. CES symptoms may have sudden onset and evolve rapidly or sometimes chronic ally. Each type of CES has different typical signs and symptoms. Low back pain may be the most significant symptoms, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction. MRI is usually the preferred investigation approach. Patients who have had CES are difficult to return to a normal status.

CONCLUSIONSThe diagnosis of CES is primarily based on a careful history inquiry and clinical examination, assisted by elective radiologic investigations. Early diagnosis and early surgical decompression are crucial for a favorable outcome in most CES cases.

Evidence-Based Medicine ; methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Polyradiculopathy ; diagnosis ; etiology ; pathology

OBJECTIVETo investigate the changes in the plasma levels of endotoxin in severe burn patients during administration of antibiotics.

METHODSFifty severe burn patients with burn area larger than 30% TBSA were enrolled in the study, and they were respectively treated with Netilmicin (A group), Cefoperazone (B group), Ceftazidime (C group) and Imipenem/Cilastatin (D group). Venous blood samples were harvested for determination of endotoxins levels before treatment and 1, 2, 3, 5, 7 post-treatment day (PTD).

RESULTSThe plasma levels of endotoxin were elevated in different degrees in A, B and C groups. The plasma levels of endotoxin in B group were higher on 1, 2 PTD than on 3, 5, 7 PTD, and they were also higher than that in D group (P < 0.05). The plasma levels of endotoxin in C group reached the peak on 5 PTD [(0.398 +/- 0.172) EU/mL], which were higher than that before treatment [(0.251 +/- 0.142) EU/mL, P < 0.05] and other groups (P < 0.05). The plasma levels of endotoxin in D group were lower on 1, 2 PTD than that before treatment (P < 0.05).

CONCLUSIONDifferent amounts of endotoxins can be released after treatment with antibiotics in severe burn patients. Attention should be paid to the effect of antibiotics on the levels of endotoxin in practice.

Adolescent ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Burns ; blood ; drug therapy ; Endotoxemia ; etiology ; Endotoxins ; blood ; Female ; Humans ; Male ; Middle Aged ; Plasma ; Young Adult

OBJECTIVETo investigate the prevention and treatment of hepatitis B virus (HBV) reinfection and recurrence after orthotopic liver transplantation (OLT) for HBV related end-stage liver disease.

METHODSThe clinical data of 316 patients undergoing allograft orthotopic liver transplantation who lived more than 6 months and had HBV infection preoperative with complete data from March 2001 to March 2007 at the First Affiliated Hospital of Sun Yat-sen University. According to the HBV prevention strategy, these patients were divided into two groups: group with pure lamivudine (LAM) (n = 106) and group with lamivudine plus intramuscular injection of low dose anti-hepatis B immunoglobulin (HBIG) (n = 210).

RESULTSMean follow-up was 33.6 months. The rate of HBsAg negative conversion 1 week after OLT of the LAM group was 82.1% (87/106), significantly lower than that of LAM + HBIG group [91.0% (191/210), P < 0.05]. The rates of HBV reinfection, HBV recurrence, and YMDD mutation of the lamivudine group was 17.0% (18/106), 11.3% (12/106) and 8.5% (9/106) respectively, all significantly higher than those of LAM + HBIG group [6.2% (13/210), 3.8% (8/210) and 2.4% (5/210) respectively, P < 0.05 respectively]. All patients with HBV reinfection or HBV recurrence were treated with Adefovir, Entecavir or increased dose of HBIG and achieved better curative effect.

CONCLUSIONSThe therapy with high dose of HBIG combining with adefovir or entecavir is better for patients who have HBV reinfection. Patients with HBV recurrence after OLT should be administrated reasonable liver aid, immunity regulation and anti-hepatic fibrosis to obtain better transplant liver histological results and normal transplant liver function.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Hepatitis B ; drug therapy ; prevention & control ; Hepatitis B virus ; immunology ; Humans ; Immunoglobulins ; administration & dosage ; therapeutic use ; Lamivudine ; administration & dosage ; therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Secondary Prevention ; Young Adult

OBJECTIVETo investigate and summarize the experience in clinical presentation, diagnosis and treatment of portal vein thrombosis after orthotopic liver transplantation (OLT).

METHODSThe clinical data of 402 patients who underwent OLT from January 2003 to February 2007 were reviewed. A retrospective study was performed on etiology, prognosis and treatment in 9 cases of portal vein thrombosis after OLT.

RESULTSAll of the 9 cases received anticoagulant and antiaggregation therapy, within whom one underwent percutaneous transluminal angioplasty and stent placement, one underwent retransplantation after failure of thrombolysis therapy, and one received surgical embolectomy. Six patients died of multiple organ failure on 9th, 30th, 34th, 40th, 48th, 6 2nd days, respectively, while 3 patients survived.

CONCLUSIONSThe major risk factors of portal vein thrombosis after OLT were pathological changes in portal vein, abnormal blood stream dynamics, hypercoagulable status and improper surgical technique. Prophylactic intervention to patients with high risk factors, early diagnosis and aggressive comprehensive therapy on portal vein thrombosis patients are essential to improve prognosis.

Adult ; Female ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Portal Vein ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Prognosis ; Retrospective Studies ; Venous Thrombosis ; diagnosis ; etiology ; therapy

OBJECTIVETo investigate the drug resistance of pathogenic bacteria of nosocomial infections in the surgical intensive care unit.

METHODSThe drug resistance of pathogenic bacteria of nosocomial infections in the SICU in our hospital from January 2001 to December 2004 were analyzed.

RESULTSThe average nosocomial infections rate was 11.3%. The major sites of nosocomial infections were respiratory tract (30.9%), abdominal cavity (29.0%), bloodstream (9.7%) and biliary ducts (7.2%). The most common pathogens were pseudomonas aeruginosa (11.6%), methicillin-resistant coagulase negative staphylococci (11.1%) and candida albicans (9.7%). ESBLs-producing strains accounted for 66.2% and 58.5% of escherichia coli and klebsiella spp. respectively. Methicillin-resistant staphylococcus aureus accounted for 94.7% and methicillin-resistant coagulase negative staphylococci accounted for 88.2% in staphylococcus aureus and coagulase negative staphylococci. Carbapenems were the most powerful antibiotics against enterobacteriaceae. The non-fermenters were high resistant to antimicrobial agents. Vancomycin was the most potent antimicrobial against gram positive cocci. Amphotericin B was the most active antibiotic against fungi.

CONCLUSIONSMost strains of pathogens were antibiotic resistant in SICU. The main pathogenic bacteria of each infection site were different. So it is essential to establish nosocomial infections surveillance system in order to prevent, control and treat nosocomial infections effectively.

Bacterial Infections ; microbiology ; prevention & control ; Cross Infection ; microbiology ; prevention & control ; Drug Resistance, Bacterial ; Humans ; Intensive Care Units ; Microbial Sensitivity Tests

OBJECTIVETo investigate the safety and feasibility of steroids minimization immunosuppressive regimen in liver transplantation.

METHODSOne hundred and sixteen patients in line with the selecting criteria from January 2005 to June 2008 were divided into three groups according to the withdrawal of steroids: 40 cases in 3 months withdrawal group, 40 cases in 7 d withdrawal group and the other 36 cases in 24 h withdrawal group. The difference of recipients' survival, infection, acute rejection and steroids resistant acute rejection, wound healing, recurrence of HBV and hepatocellular cell (HCC), new on-set of diabetes, hyperlipidemia and hypertension between the three groups were compared.

RESULTSThe difference of recipients' survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipidemia between the three groups were not significant (P > 0.05), the incidence of wound un-healing and hypertension in 24 h withdrawal group was significantly lower than that in the other 2 groups (P < 0.05), the incidence of infection and new on-set diabetes in 24 h withdrawal group and 7 d withdrawal group was significantly lower than that in 3 months withdrawal group (P < 0.05).

CONCLUSIONSteroids minimization immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications without increasing the risk of rejection.

Adult ; Female ; Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppression ; methods ; Immunosuppressive Agents ; administration & dosage ; therapeutic use ; Liver Transplantation ; Male ; Middle Aged ; Postoperative Care ; Prognosis ; Retrospective Studies ; Steroids ; administration & dosage ; therapeutic use ; Young Adult

OBJECTIVETo assess the indication, surgical and post-operative complications of the multivisceral transplantation.

METHODSThe post-transplant complications of 8 patients who underwent multivisceral transplantation between May 2004 and May 2010 were analyzed. There were 7 male and 1 female, aged from 28 to 65 years. Five patients who suffered from non-resectable advanced upper abdominal malignancy experienced the liver, stomach, spleen, pancreas, duodenum, omentum and variable amounts of the colon resection, and then underwent standard multivisceral transplantation (included liver, stomach, pancreaticoduodenal and small bowel). After underwent hepatectomy while retaining the native pancreas and entire gastrointestinal, three recipients with end-stage liver cirrhosis and type 2 insulin-dependent diabetes mellitus (IDDM) was performed combined en bloc liver/pancreaticoduodenal transplantation.

RESULTSSince the third day post-operation, all recipients no longer needed exogenous insulin and had normal blood glucose concentrations. Two weeks after transplantation, their liver function almost became normal. For the 5 recipients who suffered abdominal malignancy, the longest survival period was 326 days. Cause of death are recurrent tumor (n = 2), multiple organ failure (n = 3). All the 5 patients experienced infection. For 3 patients suffered cirrhosis and IDDM, the longest survival was over 18 month. Excepting the case 8 died of graft versus host disease, all were still living without apparently post-transplant complication.

CONCLUSIONSMultivisceral transplantation is an alternative in the treatment of the patients with benign massive abdominal pathologies. Careful patient selection and technical modification are crucial to improve the outcome of these patients.

Abdomen ; surgery ; Adult ; Aged ; Duodenum ; transplantation ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Organ Transplantation ; Pancreas Transplantation ; Retrospective Studies