OBJECTIVE:To evaluate the economic effects of different doses of methylprednisolone treatment regimes on traumatic reaction in patients with cervical spondylotic myelopathy after anterior decompressive operation.METHODS:56cervical spondylotic myelopathy cases who have been subjected to anterior decompressive operation were chosen to be the sub-jects.The56cases were divided into3groups and treated with different dosage of methylprednisolone,the initial dose for group A(18cases,low dose group)was80mg;the initial dose for group B(21cases,medium dose group)was600mg and that for group C(17cases,large dose group)was1000mg,the improvement of clinical symptom of each group was observed re-spectively and the cost-effectivenesses of the three groups were compared.RESULTS:The costs of the A,B,C groups were990.00,1339.10and1886.70yuan respectively;the effectiveness rates(E)of the A,B,C groups were5.56%,14.29%and35.29%respectively;The costs for each unit of obvious effectiveness(C/E)of the A,B,C groups were178.06,93.71and53.46yuan respectively;On the basis of group A,the needed costs of group B and C were39.99and30.16yuan respectively for each obvious effectiveness unit increase(?C/?E).CONCLUSION:Compared with group A and B,the effectiveness rates of group C had a bigger increase while the needed cost for each unit of obvious effectiveness was the lowest,therefore,the dose regimen of group C is more rational.

AIM: To study the feasibility, security a nd validity of the intrapericardial injection with a trans-diaphragmatic approach in chronic heart failure rats and its value in the study of gene therapy for hea rt diseases, and further investigate whether adeno-associated virual gene transf er of sarcoplasmic reticulum Ca 2+-ATPase (SERCA2a) gene can improve ven tricular function in chronic heart failure (HF) rats. METHODS: An animal model of heart failure was obtained by creati ng descending aortic constriction in rats. Recombinant adeno-associated virus, c arrying enhanced green fluorescent protein (EGFP) gene and recombinant adeno-ass ociated virus carrying SERCA2a gene, were respectively injected into pericardium of heart failure rats in different groups (group HF+EGFP and group HF+SERCA2a) by intrapericardial injection with a trans-diaphragmatic approach. After 30 days , hemodynamic parameters were measured and analyzed. Cryosection was analyzed by fluorescence microscopy to examine the expression of green fluorescent protein, and Western blotting was performed to detect the expression of SERCA2a. RESULTS: Green fluorescence was detected in cryosection of the h earts in all rats in group HF+EGFP and the expression of green fluorescent prote in was ubiquitously. The expression of SERCA2a in all rats in group HF+SERCA2a w as more than those in group HF and group HF+EGFP. And overexpression of SERCA2a improved the systolic and diastolic function of heart failure rats significantly and the hemodynamic parameters were similar with those of the controls. CONCLUSION: The intrapericardial injection with a trans-diaphrag matic approach suggests a simple, safe, efficient and cheap technique for the ge ne therapy of chronic heart failure. Gene thransfer of SERCA2a may be a new appr oach for the treatment of chronic heart failure.

We reviewed medical data of 22 patients receiving intravenous thrombolysis therapy for acute isehemic stroke and evaluated our efforts of promoting intravenous thrombolysis for acute ischemic stroke.The mean in-hospital delay was 107 minutes.The most common reason was waiting for the results of laboratory tests.Only 6 cases received a standard dose of recombinant tissue plasminogen activator (rtPA) at 0.9 mg/kg.Only one patient had asymptomatic intracranial hemorrhage.No symptomatic hemorrhage occurred.Intravenous thrombolysis for ischemic stroke had excellent safety profile.Intravenous thrombolysis for ischemic stroke should be promoted under the guidance of standardized protocol according to the national guideline.

Objective To discuss a new procedure to treat Pilon fractures with combined by the using of external fixation and arthroscopy. Methods The external fixation was used to keep the broken bone in line, and the facet of the ankle joint was made smooth under the arthroscope. Several lag screws were put to fix the fracture. 31 cases, 21 male and 10 female, were treated from Nov. 2002 to Mar. 2004 with this technique. There were 22 cases of type B, and 9 type C1,C2 according to AO classification. Results The follow ups ranged from 4 to 12 months, averaging 7.3 months. No nonunion or infection was found. The average bone healing time was 3.7 months. Conclusion The combined use of arthroscopy and external fixation to treat Pilon fracture is an efficient procedure, for it can provide stable fixation, cause limited incision or trauma, and allow early recovery exercises of the ankle joint.

Objective To investigate rheumatic disease manifestations in patients with myelodysplastic syndromes and explore possible causes.Methods Nine myelodysplastic syndromes(MDS)inpatients with rheumatic disease manifestations were reviewed retrospectively.Results Nine patients with the diagnosis of MDS had active rheumatic disease manifestations with various degree of hypergammaglobulinemia and positive autoantibodies.Two patients had rheumatoid arthritis(RA)and RA+anti-phospholipid syndrome(APS),four systemic lupus erythematosus(SLE)and SLE+polymyositis(PM),one patients had adult onset Still's disease, one with acute arthritis and cutaneous vassulitis,one had lupus-like manifestations including polyserositis,al- buminuria,hypocomplementemia and positive Commb's test.Conclusion The rheumatic disease manifesta- tions in patients with myelodysplastic syndromes are characterized by various active rheumatic disease manifes- tation.Immunological abnormalities and ineffective hematopoiesis are persistent.Immunologic abnormalities in MDS such as impaired function of T and B cells,hypergammaglobulinemia,positive autoantibodies,may be the causes of various rheumatic manifestations.We suggest that there is a significant association between myeludys- plastic syndrome and rheumatic diseases.

Humans ; Occupational Health ; Protective Devices ; utilization ; Welding

Cardiac Pacing, Artificial ; Electrodes, Implanted ; Female ; Humans ; Middle Aged ; Postoperative Complications ; etiology ; Subclavian Artery ; injuries ; Treatment Outcome

BACKGROUND: Carbonated hydroxyapatite cement (CHC) s a new kind of biomaterial for bone defect, which is made of powder and fluid, and can be mixed to be pasty to repair various bone defects.OBJECTIVE: To observe the improvement of vertebrae height and pain in patients with osteoporosis vertebral compression fracture (VCF) after vertebroplasty by using a new kind of bone graft biomaterial, taking CHC as the filling material to reinforce the vertebral body.DESIGN: A contrast observation trial taking patients as subjects.SETTING: Department of Orthopaedics, General Hospital of Chinese PLA.PARTICIPANTS: Totally 34 patients with thoracic or lumbar osteoporosis VCF who received the treatment in the Department of Orthopaedics, General Hospital of Chinese PLA between October 2000 and August 2003. Inclusive criteria: ①Definite diagnosis by CT; ② Informed consents were obtained from the patients. Exclusive criteria: The patients with osteoporosis vertebral compression fractures who suffered vertebral posterior wall fracture. There were 6 males and 28 females, and they were aged (72±13)years; Among the patients, 27 were diagnosed as postmenopausal osteoporosis, 1 as cortical hormone-induced osteoporosis and 6 male patients weresenile osteoporosis.METHODS: ①All the patients were randomly divided into two groups: Experimental group (n =23) and control group (n=11). All the patients were performed percutaneous operation with local anesthenia. All cases were performed percutaneous operation under local anesthesia. Under the C-arm monitored, one side pedicle puncture was performed to enter the anterior column of the involved VCF. Patients of the experimental group were filled with CHC. Patients of control group were filled with polymethyl Methacrylate (PMMA) with the same way. ② Referred to McGill-Melzack scoring. Among the scale 0-100 mm (0 was no pain, 100 was acute pain), the value indicated the painful intensity and mental assault degree. ＜ 30 scores indicated good, 30-40 basically satisfied and ≥ 50 poor .③ Referred to the method from Lee et al, the preoperative height (A1) and postoperative height (A2) of compression fracture position of VCF were measured according to the lateral X-ray film. At the same time, the upper vertebral height (A3) and the inferior vertebral height (A4) were measured at the same position. The original height (A) of the involved vertebra was calculated as (A)= (A3+A4)/2,and the preoperative vertebral compression rate =(A-A1 )/A, the postoperative vertebral compression rate =(A-A2)/A, the restoring rate = (the preoperative vertebral compression rate-the postoperative vertebral compression rate)/the preoperative vertebral compression rate. ④ The wounds of the patients were observed after operation. The levels of blood routine, serum calcium and serum phosphorus were detected before, one day and one week after operation. MAIN OUTCOME MEASURES: ① Preoperative and postoperative VAS scoring. ② The vertebral compression rate and restoring rate. ③ Wounds were observed after operation. The blood routine, the serum calcium and serum phosphorus were detected before, one day and one week after operation.RESULTS: Totally 34 patients were involved in the result analysis. ①The preoperative visual analogue scale (VAS) score of experimental group were (91.5±21.7) points, and the postoperative ones were (44.5±27.2) points. The difference of VAS score reduced gradually along with the postoperative time. There was no difference of VAS score between experimental group and the control group 4 weeks after operation. ② The biocompatibility of CHC in the vertebral body was fine. The vertebral compression rate of experimental group was recovered from (43.1±21.4)％ preoperatively to (27.3± 18.5)％ postoperatively. The rate of restored heights was (27.3±18.5)％. ③ All patients obtained Ⅰ stage wound healing, and none of them had infection, inflammatory secretion and nervous symptom. There were no differences in blood routine test, serum calcium, serum phosphorus between patients in two groups. One case filled by PMMA and two cases filled by CHC presented leakage, and none had nervous symptom.CONCLUSION: As the filling materials for vertebropalsty, CHC can restore the vertebral heights and relieve pain safely and effectively, however, its efficacy to relieve pain is not significant as PMMA in the short term.

Objective To observe the anti-tumor action of Chang'aishu and its influence on the expression of the Ki67 and PCNA. Methods Forty Balb/c mice with CT-26 colorectal cancer were randomly divided into four groups, including the control group (normal saline, 0.6 mL), the chemotherapy group (Xeloda 205.5 mg/kg), the high dose group (Chang'aishu 51.38 g/kg) and the low dose group (Chang'aishu 17.13 g/kg). Each group of mice was treated with intragastric administration every two days. After 15 days, the anti-tumor rate was calculated and the expression of Ki67 and PCNA were analyzed by immunohistochemistry. Results Compared with the control group, inhibitive rate of the chemotherapy group, the high dose group and the low dose group was 43.35%, 29.48% and 13.30%, respectively. Compared with the control group, the treatment group showed statistical significant difference in Ki67 and PCNA (P<0.05, P<0.01). Conclusion Chang'aishu had inhibition effect on the growth of colorectal cancer, which may be related to down-regulating the expression of Ki67 and PCNA.