[Objective] To evaluate the efficacy and short-term results of selective expansive open-door laminoplasty(ELAP).[Method] From June 2005-June 2006,a total of 102 pataents with cervical spondylotic myelopathy(CSM)were enrolled in this study.Forty-four patients underwent ELAP.Fifty-eight patients undergoing conventional C3~7 ELAP served as controls.The clinical results and radiological examinations of both groups were evaluated at 12 month after surgery.[Result]There was no significant difference in recovery rate of Japanese Orthopaedic Association(JOA)scores.The incidence of axial symptoms in the selective ELAP group was significantly lower than those in the C3~7 ELAP group(P

Objective To investigate the value of clinical parameters in predicting the initiation of renal replacement therapy(RRT) in acute kidney injury (AKI) patients with cardiorenal syndrome (CRS).Methods A total of 75 AKI patients hospitalized with CRS were enrolled.All patients received pharmacologic therapy on the beginning 3 days.The patients whose heart function improved were divided into control group (n=39),and the patients whose heart function worsened were divided into RRT group (n=36).Clinical and laboratory data on the first day and the fourth day were collected and analyzed.The factors on the first day were labeled asⅠ ,and those on the fourth day were labeled asⅡ. The ratio of some parameters calculated were labeled asⅡ/Ⅰ .Area under curve (AUC) of receiver operating characteristic curve (ROC) of these factors was used to evaluate the sensitivity and specificity in predicting the initiation of RRT.Results The patients in RRT group had significantly higher levels of BNP-Ⅱ,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ (P ＜ 0.01),and lower levels of 24 hours urine volume-Ⅰ and 24 hours urine volume-Ⅱ (P ＜ 0.01).From ROC curve analysis,the AUC of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,creatinine Ⅱ / Ⅰ,BNP-Ⅱ levels and BNP Ⅱ/Ⅰ to predict RRT were 0.736,0.875,0.747,0.779 and 0.894 respectively.When the cutoff values of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,BNP-Ⅱ levels,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ were 905 ml (sensitivity 75％,specificity 94.9％),1450 ml (sensitivity 75％,specificity 100％),3360 ng/L (sensitivity 72.2％,specificity 100％),1.37 (sensitivity 75％,specificity 100％) and 1.25 (sensitivity 72.2％,specificity 94.4％) respectively,the value of the parameters to predict RRT was high.Conclusions The 24 hours urine volume,BNP levels after treatment and the dynamic changes of BNP levels and creatinine levels can be used as predictors of the initiation of RRT in the AKI patients with CRS.

Objective To analyze factors associated with long-term survival of acute leukemia(AL). Methods Clinical data is analyzed in 27 leukemia cases who had at least 5 years free survival (EFS). Combined intensive chemotherapy was administered under the principle of individualization to induce remission.Regular consolidation treatment after remission was strictly continued.Long-term follow up Was kept on,with the therapeutic regimen modified accordingly.Results Complete remission(CR) was achieved in 112 of 143(78.3%)AL patients and 27(18.9%)of them had survived more than 5 years.Conclusion The long-term survival of AL patients is related to the type of AL,leukemia cell burden,extramedullary leukemia, individual treatment,time required to achieve CR,continuous intensive chemotherapy and the regular postremission treatment.

Objective To analyze on the efficacy and toxicity of MAAE (MIT ,Ara-C,AMSA,VP16)regimens on treating refractory and relapsed acute leukemia in adult patients. Methods MAAE (MIT, Ara-C,AMSA, VP16) regimen, which consisted of MIT 10mg/d (d1～3), intravenousdrop, Ara-C 200mg/d (d1～7),intravenousdrop, AMSA 75 mg/d (d1～3), intravenousdrop VP16 100 mg/d(d1～4), intravenousdrop were used to treat 25 cases of adults with refractory and relapsed acute leukemia (AL). G-CSF 5 μg/kg were used every day when WBC＜0.5×109/L. Results In the 25 cases with refractory and relapsed acute leukemia, 14 cases (56 %) reached complete remission, 5 patients(20 %) reached partial remission, the total effective rate was 76 %. Conclusion MAAE regimen was a very effective alternative treatment for CR induction in adult patients with refractory and relapsed AL and low toxicity.

Objective To investigate the clinical and imaging features in patients with vertebrobasilar dolichoectasia (VBD) through a comparative study in patients with ischemic stroke with or without VBD.Methods The patients with acute cerebral infarction were divided into either a VBD group or a non-VBD group according to magnetic resonance angiography.The VBD group was further divided into an anterior circulation infarction subgroup and a posterior circulation infarction subgroup.The cardiovascular risk factors,the diameter of basiar artery (BA),bifurcation height,and horizontal displacement were compared in all groups.Results A total of 269 patients with acute cerebral infarction were included,28 had VBD,accounting for 10.41％ of the patients with acute cerebral infarction during the same period.The proportion of male patients (78.6％ vs.66.8％ ;x2 =4.392,P =0.036),age (70.38 ± 10.58 years vs.62.86 ± 12.20 years; t =2.870,P =0.009),and the proportion of hypertension (89.3％ vs.47.7％ ; x2 =17.367,P =0.000) in the VBD group were significantly higher than those in the non-VBD group.The multivariate logistic regression analysis showed that the advanced age (odds ratio [OR] 1.248,95％ confidence interval [CI] 1.137-1.371; P=0.000),hyperglycemia (OR 1.599,95％ CI 1.181-2.164; P =0.002),hypertension (OR 1.251,95％ CI 1.020-1.534; P =0.032) and increased triglyceride level (OR 1.876,95％ CT 1.021-3.445; P =0.043) were the independent risk factors for VBD,while female gender (OR 0.133,95％ CI 0.024-0.735; P =0.021) was the independent protective factor for VBD.Of the 28 cerebral infarction patients with VBD,9 had anterior circulation infarction and 19 had posterior circulation infarction.There were significant differences in BA diameter ([5.40 ± 0.49] cm vs.[6.00 ± 0.77] cm; t =2.046,P =0.041),and the proportions of high score in bifurcation height (x2 =6.768,P =0.037) and horizontal displacement (x2 =5.241,P =0.042) between the 2 groups (all P ＜0.05).The multivafiate logistic regression analysis showed that the BA bifurcation height was an independent risk factor for posterior circulation infarction (OR 1.347,95％ CI 1.069-2.457; P =0.038) in patients with VBD.Conclusions VBD accounted for 10.41％ of the patients with acute cerebral infarction during the same period.Advanced age,hyperglycemia,hypertension and increased triglyceride level were the independent risk factors for VBD.Female gender was the independent protective factors for VBD,and the BA bifurcation height was an independent risk factor for VBD occurring posterior circulation infarction.

Effect of clinical intervention on human body is multistage and multifaceted, involving physiology, psychology, social function and the surrounding resources, etc. Therefore, the range of clinical outcome assessment includes patient, his or her family and care giver. The evaluation of clinical intervention mainly focuses on its effectiveness, safety and health economics. Effects of clinical interventions are measured by comparisons of the outcome of intervention and control groups. Different effect measures come from different comparisons.

Abstract: There are two stages for selecting the clinical intervention outcome variables. One is crude collection and the other is precise collection. The selection methods include brainstorming method, Delphi method, Gordon method, systematic review, systematic analysis method, mathematic model method and so on. Each method has some advantages or disadvantages. When selecting the clinical intervention outcome variables, researchers should make sure the research aim, the representative and the sensitivity of the variables, and select all kinds of recommended methods comprehensively, then decide which method should be used.

Child ; Critical Care ; Humans ; Intensive Care Units, Pediatric ; Medical Records ; Severity of Illness Index

BACKGROUND:Previous studies have shown that continuous administration of 1×107 of bone marrow mesenchymal stem cel s can induce immune tolerance in rats undergoing kidney transplantation, but it is not yet found clinical y that curcumin exerts an on immunomodulatory effect on kidney transplantation.
OBJECTIVE:To investigate the effects of different concentrations of curcumin on bone marrow mesenchymal stem cel s-induced immune tolerance in rats after kidney transplantation.
METHODS:Rat model of kidney transplantation was made, and rat models were randomly divided into four groups:transplantation group with no treatment;bone marrow mesenchymal stem cel s group (cel group) injected with 1×107/kg bone marrow mesenchymal stem cel s via the left iliac vein (before peritoneal suture) and tail vein (from the 2nd day) for 10 days;bone marrow mesenchymal stem cel s+low/high dosage of curcumin groups (low/high dosage curcumin groups) injected intragastrical y with 2 or 10 mg/kg curcumin combined with injection of bone marrow mesenchymal stem cel s for 10 days. Transforming growth factor-β1 protein expression in the kidney tissues was examined by immunohistochemical staining. The concentrations of interleukin-2 and interleukin-6 in serum were detected by ELISA assay.
RESULTS AND CONCLUSION:After kidney transplantation, the protein expression of transforming growth factor-β1 in renal tubular epithelial cel s and renal interstitial cel s as wel as the concentrations of interleukin-2and interleukin-6 in serum were significantly higher in the transplantation group than the other groups (P<0.05). Compared with the cel transplantation group, the protein expression of transforming growth factor-β1 as wel as the concentrations of interleukin-2 and interleukin-6 reduced significantly in the low/high dosage curcumin groups (P<0.05). These findings indicate that simultaneous administration of curcumin and bone marrow mesenchymal stem cel s can effectively inhibit immune rejection reaction and improve renal function in rats after kidney transplantation.

Objective To understand the drug resistance situation of 84 strains of Acinetobacter Baumannii (ABA) isolated from the lower respiratory tract samples in ICU patients to provide a basis for the rational use of antibacterial drugs in clinic .Methods Eighty-four strains of ABA were retrospectively analyzed .The VITEK2-Compact automatic microbiological analyzer was adopted to conduct the bacterial identification and drug susceptibility test .The software Whonet5 .6 was used for conducting the statistical analysis .Results Eighty-four strains of ABA had strong drug-resistance . The resistance rate of nitrofurantoin was highest (100 .00% ) ,followed by cefotetan (98 .81% ) and aztreonam(80 .95% ) .The resistance rate of beta lactam antibacterial drugs was>75 .00% ,and which to imipenem was 76 .19% .The sensitive rate of 13 kinds of common antibacterial drugs was < 30 .00% . MDR ,XDR and PDR strains were 67 strains ,64 strains and 26 strains respectively ,which accounted for 79 .76% ,76 .19% and 30 . 95% respectively .The non-sensitivity rates of multi-drug resistant strains either to MDR or XDR was >90 .00% in non sensitive rate of common antimicrobial agents .Conclusion ABA is the major pathogen .The laboratory should strengthen the analysis and drug sensitivity monitoring of ABA resistant strains in ICU .At the same time ,ICU should strengthen the disinfection and isolation to avoid the outbreak of nosocomial infections .