[Objective]To assess the efficacy of one-stage anterior radical debridement,decompression,and fusion with anterior and/or posterior spinal instrumentation in the treatment of multisegments spinal tuberculosis.[Method]From 2001 and 2005,a total of 15 patients included thoracic,thoracolumbar and lumbar spinal tuberculosis underwent anterior debridement,allograft bone fusion,and stabilization with anterior and posterior instrumentation.The mini-invasive technique including thoracoscope and X-tube were applied in the later 8 cases.[Result]An average of 2.1 years' follow-up was achieved in 16 patients.The overall fusion rate was 100% in the dynamic lateral views.There was no graft problems.The kyphosis angles that were corrected postoperatively averaged 19.9?.All patients' neurological function were improved except that there was no change in 1 patient with Frankel grade B preoperatively.[Conclusion]Reconstructing the stability of spine is very important for the treatment of spinal tuberculosis.The application of internal instrument and allograft,choosing appropriate surgery can greatly improve the clinical results.Mini-invasive technique reduced blood lost and made the operation easier.

BACKGROUND: Nowadays, it is reported that vessel structural abnormity is the main morphological basis of vertigo due to vertebrobasilar arterial insufficiency abroad, but the report of vascular structural abnormality in vertebrobasilar arterial insufficiency is rare at home.OBJECTIVE: To observe the manifestation and clinical significance of vessel structural abnormity tested by digital substraction angiography (DSA)in patients with vertigo induced by vertebrobasilar arterial insufficiency.DESIGN: Case analysis.SETTING: Department of Neurology, Wuxi Second Hospital (Wuxi Municipal Second People's Hospital) Affiliated to Nanjing Medical University and Department of Neurology, Huaihua Hospital Affiliated to Nanhua University.PARTICIPANTS: A total of 57 patients, who were diagnosed as having episodic vertigo with or without nausea or vomiting, and hospitalized in the Department of Neurology, Huaihua Hospital Affiliated to Nanhua University from August 2003 to May 2004 and Wuxi Second Hospital (Wuxi Municipal Second People's Hospital) Affiliated to Nanjing Medical University between October 2004 and May 2005, were enrolled.METHODS: Fifty-seven patients with vertigo induced by vertebrobasilar arterial insufficiency hospitalized in the recent two years were treated with digital subtraction radiography in aortic arch and aortocranial angiography:Applying retrograde angiography of femoral artery puncture, Optiray nonionic contrast agent with syringe pattern to perform aortic arch angiography. Digital subtraction machine displayed bilateral carotid artery, vertebral artery, ranged from carotid artery to siphon of carotid artery from multiple angles. Measurement and evaluation were conducted by 2 doctors from department of neurology.MAIN OUTCOME MEASURES: Type, distribution and proportion of vesselstructural abnormity of aortic arch, carotid artery and vertebrobasilar system.RESULTS: Of the 57 patients, 1 patient was dropped out, because the left vertebral artery (LVA) could not be entered. A large area cerebral infarction was occurred in another patients during aortic arch angiography was performed, and the operation was stopped. Totally 55 patients were involved in the result analysis. It was found that 71%(39/55) of patients had vessel structural abnormity in cervical part and intracalvarium, 11%(6/55)of patients with simple anterior circulation lesion, 60% (33/55) of patients with posterior circulation lesion, of which 9 cases (16%) with compound lesion of anterior circulation abnormity. Two or above vessels in 24 cases (24/55,44%) were involved. Vertebral artery complicated with other angiostegnosis was the most common, and there was no vessel structural abnormity in other 16 cases (16/55,29%).CONCLUSION: Various types of vessel structural abnormity are the main etiological factors of vertigo induced by vertebrobasilar arterial insufficiency. Gold standard of diagnosing vertigo due to vertebrobasilar arterial insufficiency is DSA.

Objective To investigate the effect of safflower yellow pigment on plasma D-dimer (D-D) and β-human chorionic gonadotropin (β-HCG) in ectopic pregnancy patients.Methods 96 patients with conservative treatment of ectopic pregnancy from April 2014 to April 2016 in our hospital were divided into control group and experimental group according to the method of drawing lots.The control group was treated with routine therapy, the experimental group was treated with safflower yellow pigment based on the control group.Pelvic mass disappearance time, D-D, β-HCG, vascular endothelial growth factor, carbohydrate antigen 125 and safety of the two groups were compared.Results The total effective rate of the experimental group(97.91%) was higher than that of the control group(83.33%),the difference was statistically significant (P<0.05) .The time of disappearance of pelvic mass in the experimental group was shorter than that in the control group (P<0.05); the levels of VEGF and CA125 in the experimental group were lower than those in the control group ( P<0.05 ) .There was no difference in safety between the two groups. Conclusion Conventional therapy plus safflower yellow pigment can promote the absorption of pelvic mass and reduce the levels of plasma D-D and β-HCG in the conservative treatment of ectopic pregnancy.

Objective To summarize clinical data of 33 patients with off-pumb coronary artery bypass grafting(OPCABG) procedure and analyze the benefit and curative effects of OPCABG procedure. Methods From February 2002 to June 2005,33 patients with cardiac function in class Ⅱ-Ⅲ (NYHA) and left ventricular ejection fraction(LVEF) was 34%-68%,and all of them underwent coronary artery bypass grafting(CABG) surgery without cardiopulmonary bypass. Results After operation,There was no death, the cardiac function improved in various degree. Preoperative angina disappeared. Conclusion OPCABG procedure is a safe, available, effective method for coronary artery disease.

Objective To assess the efficacy and clinical resuhs of thoracic endovascular aortic repair (TEVAR) in Stanford type B aortic dissection,and to explore the therapentic strategy and prevention of complication.Methods Fifty-eight patients with Stanford type B aortic dissection underwent TEVAR were enrolled,and were followed up regularly.Results The technical feasibility and success with deployment proximal to the entry tear was 100.0％(58/58),requiring partial coverage of the left subclavian artery in 20 patients and total coverage in 4 patients,and 2 patients used chimney stents.Hospital mortality was 5.2％ (3/58).Type Ⅰ endoleak was found in 11 patients (19.0％,11/58).In 55 survival patients,48 patients occurred thrombosis in pseudocoele and 2 patients' endoleak disappeared.Seven patients' endoleak appeared blood flow.Forty-eight patients(87.3 ％,48/55) were followed up for 3-68 months.Two patients died,and 2 patients' endoleak disappeared,with total suberization in pseudocoele.Other 5 patients' endoleak relieved,with partial suberization in pseudocoele.One patient had new intimal tear at the distal end of the stent-graft and required a second stent implantation.Conclusion TEVAR is safe and effective for the treatment of Stanford type B aortic dissection.

Objective To analyze the effect of EVAR in the treatment of octogenarian patients with abdomi-nal aortic aneurysm.Methods 16 octogenarian patients aged over 80 years who treated with EVAR were collected. Mean age was (87.0 ±6.2)years and included 11 cases in male,2 cases in emergency.All the cases were infrarenal abdominal aortic aneurysm and 11 cases (69%)were the complex aortic anatomy.According to ASA classification, 11 cases (69%)were class Ⅲ and 5 cases (31%)were class Ⅳ.All patients were followed up with CT for 1 month to 3 years.We evaluated technical success rate,perioperative complications and the application characteristics of EVAR in the treatment of octogenarian patients with abdominal aortic aneurysm were analyzed.Results All the patients were operated with EVAR,the success rate was 100%,12 Endurant endografts and 4 Talent endografts were used.Mean operation time was (92 ±25)min and mean hospital stay length was (17 ±9.5)days.1 patient died with heart failure in 3 days after operation.1 patient died due to the Ⅰ endoleak and 4 patients died due to other fators. Conclusion For the octogenarian abdominal aortic aneurysm patients,EVAR is the preferred treatment with accepta-ble procedural success and perioperative morbidity.Those patients have characteristics in the physiological function and anatomy,so we should take measures to prevent the complications.The medium and long -term results suggest that EVAR may be of limited in some patients who are aged over 80 years.

Objective To summarize the experience of surgical treatment of venous drug-induced infective endocarditis(IE). Methods The 17 cases of drug-induced IE were found to have valvular vegetations,16 patients had involvement of tricuspid valve, 1 mitral valve associated with ventrieular septal defect. Preoperative blood culture was positive in 8 patients. The operations included tricuspid valve repair (6 cases),tricuspid valve replacement(8 cases), mitral valve replacement and VSD closure(1 cases). Results All patients were alive and discharges. After follow-up of 6 months to 6 years, 1 case had severd tricuspid alve regurgitation, 1 had haemoptysis because of incorrect anticoagulation. Conclusions This study indicated surgical intervention is effective treatment of venous drug-induced infective endocarditis.

Objective To assess the value of combined detection of enterovirus nucleic acid and antibody in early etiological diagnosis for hand-foot-and-mouth disease ( HFMD).Methods A case-control study was conducted.A total of 1 066 cases of children clinically diagnosed with HFMD from Hangzhou Children′s Hospital were involved into the research group from January to June 2014, consisting of 401 common cases and 665 severe cases; Throat swabs and serum samples from these children underwent combined detection for EV71/CA16/EV of enterovirus nucleic acid by fluorescence quantitative RT-PCR and for EV71/CA16-IgM by ELISA.All data were analyzed with SPSS 16.0.Results The total positive rate of enterovirus nucleic acid EV71/CA16/EV by fluorescence quantitative RT-PCR in the 1 066 cases of children clinically diagnosed with HFMD was 75.52%( 805/1 066 ) ( 95%CI: 72.80%-78.05%).But the total positive rate of combined detection was 91.46%( 975/1 066 ) ( 95%CI:89%.58-93.04%).The total positive rate of combined detection is higher than that of RT-PCR test(χ2 =98.338,P=0.000).The positive rate of EV71 type of combined detection was 64.63%(689/1 066)(95%CI:61.67%-67.49%),which is 15.38%higher than that of RT-PCR test 49.25%(525/1 066)(95%CI:46.21%-52.29%)(χ2 =51.453, P=0.000).In 665 severe cases of HFMD, the total positive rate of combined detection was 96.69%(643/665)(95%CI:94.95%-97.87%), which is higher than that of RT-PCR test 79.25%(527/665)(95%CI:75.92%-82.22%)(χ2 =95.607, P =0.000).In the severe cases, the positive rate of EV71 type of combined detection was 87.52%( 582/665 ) ( 95%CI:84.71%-89.89%) , which is 18.95% higher than that of RT-PCR test 68.57%(456/665) (95%CI:64.87%-72.06%) (χ2 =69.665, P=0.000).In the fatal cases, the positive rate of EV71 type of combined detection was 95.92%(94/98) (95%CI:89.28%-98.68%).Conclusions The combined detection of enterovirus nucleic acid and specific IgM antibody can significantly increase the positive rate of HFMD, especially for severe cases.The combine detection increases both the total positive rate and EV71 positive rate.Thus it has a high potential for becoming a new guidelines for laboratory diagnosis of HFMD.

Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Rickets ; prevention & control ; Vitamin D ; therapeutic use

Objective To investigate the organ protective effects and the timing of continuous blood purification (CBP) in the treatment of severe sepsis. Methods A double-blind randomized controlled trial was conducted. Seventy-four patients with severe sepsis aged between 35 years and 80 years with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores over 20 admitted to Department of Critical Care Medicine of the First Hospital of Wuhan from January 2013 to January 2015 were enrolled. They were divided into control group (n = 37) and treatment group (n = 37) by random number table method. All patients in these two groups received conventional therapy following the guidelines for management of severe sepsis in 2012. In addition the patients in treatment group received continuous veno-venous hemofiltration (CVVH). The critical score, liver and kidney function indexes, etc., levels of pro-inflammatory cytokines in plasma and ultra filtrate before and 24, 48, and 72 hours after treatment, and the clinical picture 2 weeks after treatment in two groups were observed. Results APACHE Ⅱ scores, multiple organ dysfunction syndrome (MODS) scores, Murray scores of acute lung injury, and systemic inflammatory response syndrome (SIRS) scores of the patients of the above two groups were gradually declined after the treatment. The levels of white blood cell count (WBC), procalcitonin (PCT), lactate (Lac), tumor necrosis factor-α (TNF-α), interleukins (IL-6 and IL-8), and endotoxin gradually lowered. Levels of blood urea nitrogen (BUN), serum creatinine (SCr), alanine transaminase (ALT) and the oxygenation index (PaO2/FiO2) showed a tendency of lowering. There were statistically significant differences in scores of critical illness, WBC, PCT, Lac, pro-inflammatory cytokine, liver and kidney function indexes, etc. between treatment group and control group 48 hours after treatment (APACHE Ⅱ score: 15.5±4.7 vs. 20.3±5.3, MODS score: 4.6±1.4 vs. 7.3±2.2, Murray score: 1.4±0.5 vs. 1.7±0.6, SIRS score: 2.9±0.8 vs. 3.7±1.0, WBC (×109/L): 1.1±0.5 vs. 1.6±0.5, PCT (μg/L): 26.7±12.0 vs. 32.4±14.1, Lac (mmol/L): 7.6±2.2 vs. 9.3±2.8, TNF-α (μg/L): 96.3±17.4 vs. 153.4±24.2, IL-6 (μg/L): 146.8±20.6 vs. 213.8±29.2, IL-8 (μg/L): 287.1±43.6 vs. 354.5±56.2, endotoxin (kEU/L): 1.4±0.5 vs. 2.6±0.8, BUN (mmol/L): 8.7±3.6 vs. 18.5±6.4, SCr (μmol/L): 143±39 vs. 197±42, ALT (U/L): 141±27 vs. 183±34, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 150.3±45.4 vs. 124.7±32.1, all P < 0.05], and the difference was significant up to 72 hours. In the treatment group, TNF-α, IL-6, IL-8, and endotoxin could be decreased in the filtrate 24 hours and 48 hours after treatment and they correlated with the lowering tendency of their plasma levels. Compared with the control group, CVVH based on conventional treatment of severe sepsis could significantly reduce the incidence of MODS (10.8% vs. 29.7%, χ2 = 4.423, P = 0.038) and mortality (5.4% vs. 13.5%, χ2 = 4.674, P = 0.032), and remarkably shortened the duration of mechanical ventilation (days: 3.1±0.6 vs. 5.3±1.7, t = 2.103, P = 0.045), and the length of intensive care unit (ICU) stay (days: 8.5±1.7 vs. 13.2±2.4, t = 2.245, P = 0.042). Conclusion Early CBP can decrease the level of pro-inflammatory cytokines, prevent MODS, and remarkably improve the prognosis of patients with severe sepsis.