Child ; Chronic Disease ; Cough ; diagnosis ; etiology ; therapy ; Humans ; Practice Guidelines as Topic

Objective:To evaluate the six-degree setup errors of tumors of cervical vertebra, thoracic vertebra and lumbar vertebra by image guided radiotherapy. Methods:From May 2013 to June 2014, 30 patients with spinal malignant tumors(10 patients of cervical vertebra, thoracic vertebra and lumbar verte-bra respectively) were treated with Elekata Synergy accelerator(Elekta company,Sweden). Six-degree set up errors were corrected using HexaPODTM evoRT bed under image of on board cone beam computed tomography ( CBCT) guided. All the patients received kilovoltage CBCT before receiving radiotherapy and after correction. The acquired images were co-registered with planning CT with bone window. The data of 838 CT images were analyzed and the errors of translational directions X ( lateral ) , Y ( lngitudi-nal),Z(vertical)and rotational directions RX(pitch), RY(roll), RZ(yaw) were recorded. The data were compared by t-test using SPSS 13. 0. Results:The absolute translational setup errors in X, Y and Z axes of cervical vertebra before correction were (1. 71 ± 0. 10) mm, (1. 81 ± 0. 11) mm and (1. 94 ± 0. 09) mm respectively:(3. 17 ± 0. 19) mm, (4. 26 ± 0. 28) mm and (2. 18 ± 0. 12) mm for thoracic vertebra, and (2. 69 ± 0. 24) mm, (3. 33 ± 0. 26) mm and (2. 86 ± 0. 21) mm for lumbar vertebra. The residual setup errors in X, Y and Z axes of cervical vertebra were (0. 5 ± 2. 4) mm,(0. 01 ± 2. 4) mm and (2. 4 ± 1. 4) mm, respectively after correction;(1. 17 ± 0. 11) mm,(0. 26 ± 0. 30) mm and (0. 08 ± 0. 12) mm for thoracic vertebra and (1. 09 ± 0. 24) mm,(2. 03 ± 1. 26) mm and (0. 06 ± 0. 51) mm for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three translational directions of cervical vertebra and thoracic vertebra, only Z (t= -3. 518,P<0. 001) for lumbar vertebra. The absolute rotational setup errors in RX,RY and RZ axes of cervical vertebra before correction were 0 . 67 ° ± 0 . 04 ° ,1 . 06 ° ± 0 . 06 ° and 0 . 78 ° ± 0 . 05 ° respec-tively. 0. 62° ± 0. 05°, 0. 75° ± 0. 06°, and 0. 84° ± 0. 06° for thoracic vertebra, 0. 59° ± 0. 06°, 0. 80° ± 0. 07°, and 0. 73° ± 0. 06°for lumbar vertebra. The rotational directions RX, RY and RZ axes of cervical vertebra were 0 . 27 ° ± 0 . 14 ° , 1 . 20 ° ± 0 . 04 ° and 0 . 28 ° ± 0 . 05 ° respectively;0 . 02 ° ± 0 . 20 ° , 0. 05° ± 0. 26°and 0. 64° ± 0. 16°for thoracic vertebra and 0. 09° ± 0. 26°, 0. 50° ± 0. 05°,and 0. 03° ± 0. 16°for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed signifi-cant difference in three rotational directions of cervical vertebra and lumbar vertebra, only RY(t=7. 106, P<0. 001)for thoracic vertebra. All the patients acquired pain relief and there was no radiation-induced toxicity detected clinically during a median follow-up of 6 months. Conclusion:Six-degree set up errors of spine tumors were corrected effectively with HexaPODTM evoRT bed under CBCT image guided and its feasibility in day-to-day clinical practice has been demonstrated.

Objective To introduce distal clavicle excision plus suture anchor to treat Craig Ⅴ distal clavicle fracture.Methods From November, 2005 to August, 2007, 25 patients with Craig Ⅴ distal clavicle fracture were treated with distal clavicle excision plus suture anchor.They were 18 men and 7 women,with a median age of 42.6 years.They were followed up periodically by radiological examination.At the final follow-up, their shoulder functions were evaluated by University of California-Los Angeles (UCLA) scoring system and Constant scoring system, and the pain was evaluated according to visual analog scale (VAS).Results All the patients obtained a median follow-up of 13.6 months (8 to 24) .The height of distal clavicle in all patients reached anatomical reduction.Their average UCLA score was 33.5 (28 to 35), and average Constant score was 90.6 (79 to 100) .Their mean VAS score was 1.2 (0 to 4) .Their average forward flexion and elevation was 156.4° ( 145° to 170°), and external rotation was 45.6° (40° to 60°) .The rate of top quality was 88.0% (22/25).Conclusion Distal clavicle excision plus suture anchor is an effective method to treat Craig Ⅴ distal clavicle fracture which results from serious trauma.

OBJECTIVETo explore the effect of curcumin on TGF-β2 regulated peroxisome proliferater activated receptor y (PPAR-γ)/platelet derived growth factor β (PDGF-β) signaling pathway in lung fibroblasts of mice.

METHODSC57BL/6 mouse lung fibroblasts were in vitro cultured with TGF-β2, curcumin, or TGF-β2 plus curcumin. The cell proliferation was detected by cell growth counting in the blank control group, low, middle, and high dose curcumin groups (5, 25, 50 μmol/L), the TGF-β2 (10 ng/mL) group, TGF-β2 (10 ng/mL) plus curcumin (5, 25, 50 μmol/L) groups. mRNA expressions of PPAR-γ, platelet-derived growth factor receptor β (PDGFR-β), fibroblast growth factor R1 (FGFR1) were detected using reverse transcription PCR. Protein levels of PPAR-γ and collagen-1 were detected using Western blot and ELISA in the blank control group, the TGF-β2 group, the TGF-β2 (10 ng/mL) plus curcumin 50 μmol/L group.

RESULTSCompared with the blank control group, curcumin 50 μmol/L showed the most significant inhibition on cell proliferation at 48 h and 72 h. Compared with the TGF-β2 group, TGF-β2 (10 ng/mL) plus curcumin 50 mol/L also showed the most significant inhibition on cell proliferation at 48 h and 72 h. Compared with the blank control group, mRNA expressions of PPAR-γ and PDGF-β, as well as protein expression of PPAR-γ increased, the collagen-1 expression also increased in the TGF-β2 group (P < 0.05). Compared with the TGF-β2 group, mRNA expressions of PPAR-γ obviously increased in the TGF-β2 (10 ng/mL) plus curcumin 25 μmol/L group and the TGF-β2 (10 ng/mL) plus curcumin 50 μmol/L group, higher than that in the TGF-β2 (10 ng/mL) plus curcumin 5 [μmol/L group (P < 0.05). mRNA expressions of PPAR-γ was higher in the TGF-β2 (10 ng/mL) plus curcumin 50 μmol/L group than in the TGF-β2 (10 ng/mL) plus curcumin 25 μmol/L group (P < 0.05). mRNA expressions of PDGF-β was lower in TGF-β2 (10 ng/mL) plus curcumin groups than in the TGF-β2 group (P < 0.05). Besides, PDGF-β mRNA expressions were lower in the TGF-β2 (10 ng/mL) plus curcumin 50 μmol/L group than in the TGF-β2 (10 ng/mL) plus curcumin 5 μmol/L group and the TGF-β2 (10 ng/mL) plus curcumin 25 μmol/L group (P < 0.05). There was no statistical difference in FGFR1 mRNA expressions between the TGF-β2 group and 3 TGF-β2 plus curcumin groups (P > 0.05). Compared with the TGF-β2 group, PPAR-γ protein expressions increased and collagen-1 protein expressions decreased in the TGF-β2 (10 ng/mL) plus curcumin 50 μLmol/L group (P < 0.05, P < 0.01).

CONCLUSIONSCurcumin not only could inhibit TGF-β2 induced proliferation of lung fibroblasts, but also could inhibit the synthesis of collagens. These might be associated with up-regulating PPAR-γ expressions and down-regulating PDGF-β expressions. Therefore, curcumin might inhibit the occurrence and developing of lung fibrosis through blocking PPAR-γ/PDGF-β signaling pathway.

Animals ; Cell Proliferation ; Collagen ; Curcumin ; pharmacology ; Fibroblasts ; metabolism ; Lung ; drug effects ; metabolism ; Mice ; Mice, Inbred C57BL ; PPAR gamma ; metabolism ; RNA, Messenger ; Receptor, Platelet-Derived Growth Factor beta ; metabolism ; Signal Transduction ; Transforming Growth Factor beta ; Transforming Growth Factor beta2 ; metabolism

ObjectiveTo evaluate the efficacy and feasibility of extraperitoneal approach (EPA) for the resection of primary retroperitoneal tumors (PRT). MethodsForty six cases undergoing resection of PRT were analyzed retrospectively, of which, 26 cases were through transabdominal approach (TAA group) and 20 through EPA. ResultsThe postoperative complications in EPA group was lower than in TAA group (2/20 vs. 11/26, P

Objective To investigate the variations of glomerular function in rabbits with partial unilateral ureteral obstruction (PUUO). Methods Thirty healty adult Japanese White Rabbits were randomly divided into the control group (6 rabbits) and the obstruction group (24 rabbits). The right PUUO model was established according to Cheng′s method. According to the PUUO duration, they were eaqually divided into four subgroups:the 7 day PUUO group, the 14 d PUUO group, the 28 d PUUO group and the 56 d PUUO group. The dynamic renal imaging was performed on all rabbits, and the glomerular filtration rate (GFR) was also calculated. The correlation between the renal function and PUUO duration was analyzed , and functional variations in the healthy kidneys were observed. Results (1)To the control group, no significant difference in the renal function was found between the left and the right kidneys (t = -0.145, P = 0.894). However, to the PUUO group, the right renal GFRs were significantly lower than the left renal GFRs (P < 0.05). (2) To the right renal GFR, significant difference was observed between the 7 day PUUO group and the control group (t = 5.066, P = 0.001),but not among the 7 day PUUO group, the 14 day PUUO group, the 28 day and the 56 day PUUO group (P > 0.05), (3)No significant differences were found in the left renal GFRs among the five groups. Conclusions The function of PUUO kidneys is characterized by an obvious decrease in the early stage, followed with a steady state. The basic function of the opposite healthy kidney does not present the compensation phenomenon.

BACKGROUND: Progress of lung infection after kidney transplantation is rapid, and the adjustment of immunosuppressive drugs is critical, which related to the prognosis of pneumonia and the maintenance of renal function. Therefore, an accurate diagnosis for the pneumonitis post-kidney transplantation is of great significance for choosing the appropriate treatment scheme. OBJECTIVE: To summarize the diagnosis and treatment of pulmonary infection at different periods after kidney transplantation, and then to explore the proper treatment scheme. METHODS: A retrospective analysis of 178 cases of pulmonary infection at different periods after kidney transplantation was performed. According to the progress of patients with lung inflammation, the lung infection was divided into three phases: early, advanced, and phases, and then given different immunosuppressive treatments combined with glucocorticoids; for those with unclear pathogens, given broad-spectrum antibiotics, antiviral, anti-fungal and other drugs, and targeted anti-infective treatment was underwent once pathogen was confirmed. RESULTS AND CONCLUSION: (1) There were 178 patients with pulmonary infection after kidney transplantation, 90 cases occurred at postoperative 1-6 months (78 cases at postoperative 2-4 months), 16 cases occurred at postoperative 6-12 months, 14 cases occurred at postoperative 12-24 months, 12 cases occurred at postoperative 24-36 months, and 46 cases occurred at postoperative more than 36 months. (2) The clinical symptoms of pulmonary infection at the early stage were not obvious, fever was the earliest or primary symptom, and sometimes it was the only symptom. In some cases, the patients appeared with dry cough, expectoration with white mucous sputum, and the amount of sputum increased if infected with mixed bacteria or fungus. But the pulmonary signs are unobvious, and the main imageology feature of lung tissues showed interstitial inflammation. (3) Totally 173 patients were cured, the recovery rate reached to 97.2% and the curative efficacy was satisfactory. (4) Among five patients who dead from pulmonary infection, three were died from acute respiratory failure, and two were for multiple organ failure. Three patients presented with acute rejection to transplant kidney and were cured, and six patients suffered impaired renal function. (5) These results suggest that there is potential risk for pulmonary infection after renal transplantation and it develops rapidly. Based on the situation of pulmonary infection, the physicians can adjust the dose of immunosuppressor and hormone in time, so as to improve the immunosuppressive state and clarify the pathogen for pulmonary infection, then corresponding treatment for anti-infection will be offered, which is beneficial to increase the recovery rate of pulmonary infection and improve the stability of transplanted renal functions.

OBJECTIVETo compare the effects of different kind of methods in the management of hydrofluoric acid burn in early postburn stage in rabbits.

METHODSThirty-three rabbits were inflicted with burn by 55% of hydrofluoric acid covering 5% TBSA, and were randomly divided into 3 groups, i.e. A (n = 13, with 5 ml.kg(-1).h(-1)of isotonic saline intravenous infusion), B (n = 10, with isotonic saline and 50 g/L of calcium gluconate infusion in dose of 20 mg/kg at different time points), and C (n = 10, with the same treatment as B group, and with excision of burn wound at 0.5 post burn hour) groups. The serum levels of fluorine and calcium were determined before and after various postburn hours, and the mortality rate was statistically analyzed.

RESULTS(1) The serum level of fluorine in A (8.37 +/- 2.62 mg/L) and B (8.59 +/- 2.25 mg/L) groups reached the peak value at 1 postburn hour (PBH), which was 107 times higher than that before the burn injury. The serum level of fluorine in B group was significantly lower than that in A group at 24 PBH (P < 0.05), while that in C group declined to (6.20 +/- 0.23) mg/L, which was obviously lower than that in A and B groups (P < 0.01). (2) The serum calcium level declined after burns, reaching the lowest level at 8 to 12 PBH. and began to increase at 24 PBH. Compared with normal calcium value, the serum level of calcium in A, B and C groups declined to as much as 46%, 32% and 26%, respectively. Statistically significant difference was found between C and B groups (P < 0.01). (3) The mortality rate in the three groups within 72 PBH were 30.8%, 12.5% and 0.0%, respectively.

CONCLUSIONEarly removal of burn area and calcium supplementation could help quickly decrease blood fluorine, reverse the fatal hypocalcemia and the multiple systemic toxic injury in rabbits inflicted with hydrofluoric acid injury.

Animals ; Burns, Chemical ; drug therapy ; surgery ; Calcium ; blood ; Calcium Gluconate ; therapeutic use ; Disease Models, Animal ; Elective Surgical Procedures ; Fluorine ; blood ; Hydrofluoric Acid ; adverse effects ; Rabbits ; Random Allocation ; Skin Transplantation ; Wound Healing

BACKGROUND: Posterior internal fixation is one of the most common methods for thoracolumbar fractures. There is a lack of systematic evaluation about the efficacy of injured vertebra pedicle screw fixation(IVPSF)versus short-segment pedicle instrumentation (SSPI) for thoracolumbar fracture. OBJECTIVE: To compare the clinical outcomes of IVPSF and SSPI for single thoracolumbar fracture through a METHODS: A computer-based on-line research of PubMed, Medline, Embase, Cochrane Library, CNKI, and WanFang databases was performed for the studies regarding IVPSF versus SSPI for thoracolumbar fracture from 1990 to 2016. meta-analysis. The randomized controlled trials and cohort studies were collected based on the strict criteria of inclusion and exclusion. A meta-analysis was conducted on Revman5.3 sofeware. RESULTS AND CONCLUSION: (1) Eleven articles were enrolled, including 5 English and 6 Chinese ones, involving 689 patients (328 cases for IVPSF and 361 cases for SSPI). (2) The meta-analysis indicated that the operation time, blood loss and mean hospital stay showed no significant differences between two groups. IVPSF showed more effective than SSPI in the kyphotic angle correction and anterior vertebral height recovery at postoperation and 1-5 years of follow-up. Moreover, the incidence of postoperative fixation failure in IVPSF was lower than that in SSPI. (3) These findings suggest that IVPSF that reduces the postoperative fixation failure rate for thoracolumbar fractures provides better kyphosis correction and restoration of anterior vertebral height at post-operation and 1-5 years of follow-up.

BACKGROUNDThe subtemporal transtentoral approach has been reported for nearly two decades; however it was not well used due to some limitations in dealing with large and giant petroclival meningiomas. The clinical outcome and merit of the modified subtemporal transpetrosal apex approach in large and giant petroclival meningiomas, as well as the choices, the improvements and the therapy strategies of the microsurgical approach in such patients were evaluated in this study.

METHODSTotally 25 cases of large and giant petroclival meningiomas undergone the modified subtemporal transpetrosal apex approach between April 2004 and January 2010 were enrolled in this study. The choice and improvement of the approach, the basis of anatomy and related research, the effect of accessory equipment, the exposure of tumor and the changes of neurofunction pre- and post-operation were all reviewed retrospectively. The operation outcomes and complications in this approach were also compared with those in the transpetrous presigmoid approach done in 14 cases in the same period.

RESULTSAll 25 cases underwent the modified subtemporal transpetrosal apex approach under electrophysiologic monitoring of cranial nerves and brain stem function. Trochlear nerve was partly wrapped in 14 cases, totally wrapped but can be explored in the initial segment of the cerebellum tentorium in 8 cases, totally wrapped and could not be seen until tumor was partly removed in 3 cases. The cerebellum tentorium was cut along the temporal bone from the anterior part of the apex to the mastoid part of superior petrous sinus in 6 cases, from the posterior part of the apex to the mastoid part of superior petrous sinus in 19 cases. Gross tumor resection was accomplished in 17 (68%) patients, subtotal resection in 7 (28%) patients, and partial resection in 1 (4%) patient. The most common postoperative complication was new neurological deficits or aggravations of preexisting deficit (64%). Follow-up ranged from 3 to 69 months. Compared with the transpetrous presigmoid approach done in 14 cases in the same period, the modified subtemporal transpetrosal apex approach showed obvious advantages such as simplicity in manipulating, microinvasiveness, less time-consuming, less complication, higher rate of tumor resection though the rates of gross tumor resection might be of no significant difference.

CONCLUSIONSModified subtemporal transpetrosal apex approach has obvious advantages compared with the transpetrous presigmoid approach. Some complications need to be solved by practice and modification of the approach as well as the accumulation of the experiences.

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Meningioma ; pathology ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Young Adult