[Objective]To discuss the pathological typing of posterior longitudinal ligament(PLL) in cervical spondylotic myelopathy.[Method]Data of pathological typing and resection methods of PLL were reviewed in 87 patients with cervical spondylotic myelopathy.[Result]The degeneration of the posterior longitudinal ligament(DPLL) was divided into single-DPLL(n=34,39.1%) and proliferation-DPLL(n=53,60.9%) by the results of resecton and pathological studies.The proliferation-DPLL was subdivided into hyperplasy-DPLL(n=26,29.9%),accretion-DPLL(n=12,13.8%)and ossification-DPLL(n=15,17.2%).[Conclusion]The posterior longitudinal ligament can thoroughly be resected in cervical spondylotic myelopathy combined with single-DPLL or with hyperplasy-DPLL.In cervical spondylotic myelopathy combined with accretion-DPLL or ossification-DPLL,complete decompression can be obtained by isolating the accretion and the ossification-chondrification of DPLL.

[Objective]To study the effects of titanium cable system used as a treatment alternative for comminuted patella fractures.[Method]Fifty-seven cases of comminuted patella fractures were treated from November 2004 to August 2007.The patients were divided into three groups:the group of titanium cables,AO modified tension band and nickel titanium-patella catcher respectively,according to the choice of internal fixation.The operation time,the amount of blood loss,the first knee exercise time after operation,length of hospitalisation,medical expenses,time off for employees,complication and long-term knee function were studied.All the data were analyzed and compared by statistical ways.[Result]The 57 patients were followed up for 11 to 48months(means,22.4 m).Patients who were fixed with titanium cables could start most early extending and flexing the knee(5.6 d after operation),but most expense in medical usages(9500 RMB).The good or excellence rate was 95.1% in patients treated with titanium cables cerclage,which was better than that of the other two groups.[Conclusion]Titanium cables cerclage can cure comminuted patella fractures.The method had advantage of better long-term curative effect and less complication,and so on.It's worthy to be recommended for the therapy of comminuted patella fracture.

Seventeen cases of malignant melanoma (MM) were observed with transmission electron microscopy in order to clarify the significance of abberant melanosomes in its diagnosis.30 cases of nevus were also studied to serve as control.It was found that aberrant melanosomes were present in 14 cases of MM including 2 cases of amelanotic MM and absent in 2 cases of pigmented MM and one case of amelanotic MM.In addition,aberrant melanosomes were found in 4 cases of congenital nevus.The findings suggest that the significance of aberrant melanosomes in the diagnosis of MM has been overemphasized.It is believed that the diagnosis of MM must be judged comprehensively on all the ultrastructural changes under transmission electron microscope.

Fifteen cases of malignant melanoma,17 cases of acquired nevus,18 cases of congenital small nevus,and 3 cases of congenital giant nevus were labeled with anti-human prolifera-tive cell antibody Ki-67 with ABC labeling method.It was found that 13 out of the 15 cases of malignant melanoma were positive and the positive rate of the tumor cells was ranged between 2% to 33%.After culture,the positive rate of the melanoma cells was 88%.But all the 3.types of melanocytic nevi were negative.The findings suggest that the labeling of anti-human proliferative cell antibody Ki-67 is a sensitive and specific method to identify melanocytic tumors and it is not sensitive enough to differentiate the minor changes of the 3 types of nevi.

There are controversies concerning whether congential small nevus(CSN)is liable to undergo malignant degeneration and whether it should be resected promptly.The signif-icane of CSN in the pathogenesis of malignant melanoma(MM)was assessed with microspec-trophotometric determination of DNA quantity,the detection of the gene product of N-ras,p21 protein,with ABC technique,ultrastructural study of MM tissue with electron microscopy,and analysis of clinical data of MM.The findings were as follows:(1)The DNA content increased sequentially in order of acquired nevus(AN),CSN,congenital giant nevus(CGN)and MM,and the difference was statistically significant among the 4 groups(P

Objective To systematically assess the efficacy of memantine on moderate to severe Alzheimer's disease (AD).Methods With the evaluation method of the Cochrane system,searches were made in the Cochrane Library,MEDLINE,Embase,Forest Laboratories,CNKI,Wanfang Data,and VIP Data up to February 2013 for double blind,randomized,and placebo-controlled trials (RCTs) evaluating the efficacy of memantine for moderate to severe AD.A meta-analysis of included clinical trials was conducted using the Revman 5.2 software to evaluate the efficacy of memantine on overall clinical status,cognitive function activities of daily living,and behavioral and psychological disturbances.Results A total of 8 RCTs were included (2 527 patients with moderate to severe AD).Results of the meta-analysis showed that,for patients with moderate to severe AD,memantine had better efficacy than placebo on overall clinical status,cognitive function,and activities of daily living (MD=-0.24,95％CI:0.340.15;SMD=-0.26,95％CI:-0.340.18;SMD=-0.13,95％CI:-0.21-0.05),but there was no significant difference in efficacy on behavioral and psychological function between memantine and placebo (P =0.08).Analysis of subgroups showed that memantine had better efficacy than placebo on cognitive function in moderate AD patients (SMD =-0.22,95％CI:-0.37 0.06) and on overall clinical status,cognitive function,and activities of daily living in severe AD patients (MD-0.29,95％CI:-0.40 0.18;SMD=-0.31,95％CI:0.46-0.15;SMD=-0.16,95％ CI:-0.25 0.06;MD=-3.13,95％ CI:-4.88-1.39;respectively).Conclusions Memantine has efficacy on overall clinical status,cognitive function and activities of daily living in patients with moderate to severe AD,especially in patients with severe AD.

ObjectiveTo investigate the feasibility of Legacy pedicle screw system plus minimally invasive technique in treatment of Tile type C pelvic fracture and evaluate its therapeutic effects.MethodsFrom January 2008 to March 2010, 12 patients with closed Tile type C pelvic fractures were treated with Legacy pedicle screw system plus minimally invasive technique.There were seven males and five females, at age range of 21-60 years (average 39.6 years).All patients had sacrum fractures of the posterior pelvic rings.The anterior pelvic ring fractures included unilateral ischiadic ramus fractures in four patients and bilateral ischiadic ramus fractures in eight.Three patients were combined with shock.The anterior pelvic rings were fixed with minimally invasive reconstruction plates and the posterior pelvic rings fixed with minimally invasive technique plus Legacy pedicle screw system.ResultsThe operation lasted for average 90 minutes (range, 80-110 minutes) , with average intraoperative blood loss of 105 ml (range, 80-150 ml).All patients were followed up for average 18 months (range, 6-32 months), which showed that all patients got satisfactory reductions and that the fractures were healed at one stage, with average period of 11.5 weeks (range, 9-13 weeks).There occurred no infections, failures of internal fixations or nerve injuries.According to improved Lindahl standard of pelvic injury function assessment, the result was excellent in 10 patients and good in two, with average score of 78.6 points.Conclusions Under master of the surgical indications, Legacy pedicle screw system plus minimally invasive technique takes advantages of minor trauma, less intraoperative fluoroscopy, short operation time, good curative resuhs and few complications in treatment of Tile type C pelvic fractures by fixation of the posterior pelvic rings and reconstruction of the anterior pelvic rings.

Objective To investigate the relationship between activation of gliacytes , mitogen-activated protein kinase (p38MAPK) and neuronal apoptosis after microinjecting aggregated Aβ25-35 into hippocampus.Methods The model was established by using stereotaxic technique to inject 10μg aggregated Aβ25-35 into dorsal hippocampus in rats .The rats were grouped as the control , vehicle and model groups .Immunohistochemistry and Western blotting were used for detection of activation of microglia(MG), atrocytes (AS) and expression of p-p38MAPK in the hippocampus.ELISA was used to evaluate the level of TNF-αand IL-1β.The survival neurons were observed by Nissl staining and the apoptotic neurons were identified by tunnel staining .Results Expression of ox-42, GFAP, p-p38MAPK were up-regulated in hippocampus, as well as TNF-α、IL-1β, which reached a highest value on the 7th day after injection of Aβ25-35.However, the number of neuron with Nissl positive decreased gradually , and the tunnel positive neurons increased highly and reached a peak value on the 7th day.There were significant differences between the control and vehicle group ( P <0.01). Conclusion Apoptosis of the neuron caused by Aβ25-35 injection may result from activation of gliacytes , p38 MAPK and increase of TNF-αand IL-1βlevel.

Many pathogenic genes have been identified in early-onset Parkinson′s disease, but the early-onset Parkinson′s disease with 22q11.2 deletion has not been reported in Chinese. A case of early-onset Parkinson′s disease with 22q11.2 deletion was confirmed by whole-exome sequencing-based copy number variation detection in Fujian Medical University Union Hospital. This article reports its clinical characteristics and discusses its pathogenesis, diagnosis and treatment management.

Objective To analyze the methods and effects for treating unstable posterior pelvic ring fracture combined with sacral nerve injury and further identify the relationships among the diagnostic methods,surgical approaches and clinical outcomes.Methods A total of 38 patients with posterior pelvic ring fracture combined with sacral plexus injury treated from January 2000 to January 2010 were enrolled in the study.There were 20 males and 18 females at an average age of 35 years (range,10 to 59 years).The causes of fractures included traffic injury in 20 patients,fall injury in 12,weighty object impingement injury in five,and stabbing injury in one.Classification of posterior pelvic ring fractures included fracture and dislocation of sacroiliac joints in eight patients,fracture of ilium wing in two and sacrum fracture in 28.According to the Denis typing of sacrum fractures,there was one patient with type Ⅰ fracture,14 with type Ⅱ fracture and 13 with type Ⅲ fracture.All 38 patients presented the decrease or loss of skin sensation around the lower extremities,perineal region and crissum.Simultaneously,30 patients suffered motor dysfunction of the lower extremities,while 20 patients had bladder and anus sphincter dysfunction or sexual disorder.Thirteen patients were suspected of sacral plexus avulsion and four of them were confirmed by myelography or MRI examination.All patients had at least one associated injury.The average ISS was 21.9 points ( range,9 to 47 points).Therapeutic methods were fracture reduction and fixation in the absence of nerve decompression for eight patients and nerve decompression for 30 patients including 26 patients being also managed by fracture reduction and fixation.Operation time ranged from 6 days to 6 months.The clinical outcomes were evaluated according to the British Medical Research Council (BMRC) evaluation criteria of sensation and movement function.Results Thirty-four patients were followed up for average 4.9 years ( range,1 to 10 years),during which their pelvis obtained stable recovery.The neurological outcome was excellent in two patients,good in four and unchanged in two in the nondecompression group and was excellent in 16 patients,good in nine and unchanged in one in the decompression group,with the decompression group superior to the non-decompression group ( P ＜ O.05 ).Conclusions For unstable posterior pelvic ring fracture combined with sacral nerve injury,nerve decompression and release combined with internal fixation can better improve the sacral nerve function and obtain good pelvic ring stability and is worth of clinical application.