BACKGROUND:As a traditional treatment for multilevel cervical myelopathy,nterior long-segmental decompression has the shortcomings of great operative trauma,high difficulty,low fusion rate,etc.,which can affect the postoperative efficacy.OBJ ECTIVE:To evaluate the clinical effects of three different anterior surgeries on multilevel cervical myelopathy.DESIGN:A comparative observation.SETTING:Department of Orthopaedics,Changzheog Hospital,the Second Military Medical University of Chinese PLA.PARTICIPANTS:Thirty-six patients with multilevel cervical myelopathy of 3 consecutive segments,who were surgically treated,were selected from the Department of Orthopaedics,Changzheng Hospital,the Second Military Medical University of Chinese PLA from June 1999 to June 2003,including 25 males and 11 females,35-62 years of age,the disease course ranged from 3 to 26 months. According to the clinical manifestations and imaging esults,they were diagnosed as multilevel cervical myelopathy,and they were not suffering from consecutive ossification of posterior longitudinal ligament and ossification of ligamenta flava. Informed contents were obtained from all the patients and their relatives.METHODS:All the patients were grafted with utologous bone. Autologous ilium or cancellous bone excluding vertebral body was filled into titan net or Cage,which were made of titan and characterized by high intensity,tolerance to decay,good biocompatibility,etc. According to the operative manner,the patients were divided into 3 groups:① two-level corpectomy with fusion group(long-segmental decompression group,n =11):There were 4 cases grafted with long-titan net,and 7 cases grafted with autologous iliac bone. Sub-total two-level corpectomy with fusion was performed. ②segmental decompression group(n =16):including 12 cases of titan net+cage graft,4 cases of autologous bone+cage graft. One-level decompression and sub-total single corpectomy with fusion were performed. ③three-level decompression group(n =9):Only discectomy without corpectomy was performed. After complete decompression,3cages were used to fill artificial bone or grafted with autologous bone.MAIN OUTCOME MEASURES:Cervical anteroposterior and lateral radiographies,flexion and extension radiograph were reexamined within 1 week and at 3,6 and 12 months postoperatively. The neurological function was assessed using the Japanese Orthopaedic Association(JOA) scoring method preoperatively and 3 months postoperatively. The total score was 17 points,the higher the score,the better the neurological function. The duration of operation,perioperative bleeding amount,length of stay,cost of hospitalization,graft fusion at 3 months postoperatively,improved JOA score at 3 months postoperatively were recorded in the three groups. The occurrence of postoperative complications was observed by means of return visit.RESULTS:All the 36 patients with multilevel cervical myelopathy were involved in the analysis of results. The mean duration of operation,mean perioperative bleeding amount and mean length of stay in the segmental-decompression group and three-level decompression group were obviously fewer or shorter than those in the long-segmental decompression group(P ＜ 0.05),and the average cost of hospitalization was obviously higher than that in the long-segmental decompression group(P ＜ 0.05). The postoperative improved JOA score and graft fusion rate were close among the groups(P ＞ 0.05).CONCLUSION:Segmental anterior cervical decompression is a recommendable technique for multilevel cervical myelopathy by comprehensively considering the fusion rate,recovery of neurological function,duration of operation,perioperative bleeding and length of stay.

10.3969/j.issn.2095-4344.2013.25.008

Objective Few prospective data are currently available on acute gastrointestinal hemorrhage (AGIH) as a complication in acute kidney injury (AKI).The aim of the present study was to find out clinical characteristics,incidence,etiology,risk factors,and outcome of AGIH in patients with AKI.Methods We performed a prospective study on an inceptione cohprt of 512 patients admitted for AKI in our hospital.Data on clinical risk factors for bleeding,frequency of occurrence of AGIH,in-hospital mortality were collected,and independent predictors of AGIH were identified.Results A total of 53 patients had AGIH as a complication of AKI,and 45 were upper AGIH.Fifteen patients had clinically severe bleeding.Independent baseline predictors of AGIH were severity of illness,cardiac failure,mechanical ventilation,low platelet count,chronic hepatic disease,liever cirrhosis,severe AKI.Inhospital mortality was 52.8％ in patients with AGIH,and 22.2％ in the other patients.AGIH was significantly associated with an increase in hospital mortality.Conclusions AGIH are frequent complications of AKI.In this clinical condition,AGIH is more often due to upper gastrointestinal bleeding and is associated with a significantly increased risk of death.Both renal and extrarenal risk factors are related to the occurrence of AGIH.

Objective To compare the effect of active compression-decompression cardiopulmonary resuscitation(ACD-CPR) with standard- cardiopulmonary resuscitation(S-CPR) on ventricular function in a canine ventricular fibrillation model. Methods Ventricular fibrillation was induced in anesthetized and instrumented canine. Twenty-four dogs were randomly assigned to either ACD-CPR group or S-CPR group.After 4 minutes of untreated VF,two-dimension echocardiography was used to evaluate the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction (LVEF) of every canine of the two groups when they were undergoing cardiopulmonary resuscitation. Results During ventricular fibrillation, both ACD-CPR group and S-CPR group showed decreased LVEDV compared with pre-ventricular fibrillation, but not statistically significant( P ＞0.05).LVEDV was increased in ACD-CPR group compared with S-CPR group, but not statistically significant (P＞ 0. 05). Both ACD-CPR group and S-CPR group showed significantly increased LVESV compared with pre-ventricular fibrillation,of which the difference was statistically significant ( P ＜0. 001). Both ACD-CPRgroup and S-CPR group showed significantly decreased LVEF compared with pre-ventricular fibrillation,of which the difference was statistically significant (P ＜0. 001). LVEF was increased in ACD-CPR group compared with S-CPR group,of which the difference was statistically significant ( P = 0.019). Conclusions Compared with S-CPR,ACD-CPR resulted in higher LVEF.

Adenoma ; metabolism ; pathology ; surgery ; Aged ; Diagnosis, Differential ; Endodermal Sinus Tumor ; pathology ; Female ; Humans ; Immunohistochemistry ; Neprilysin ; metabolism ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Sex Cord-Gonadal Stromal Tumors ; pathology ; Stromal Cells ; metabolism ; pathology ; Vimentin ; metabolism

OBJECTIVE:To reduce the disputes between pharmacists and patients and to provide references for the improvement of relationships between pharmacists and patients. METHODS: The characteristics of emergency dispensary work and the reasons that accountable for the disputes between pharmacists and patients in the emergency dispensary were analyzed, and aimed at which, some countermeasures were put forward. RESULTS & CONCLUSION: Pharmacists should change their thoughts and attach importance to the cultivation of their language arts so as to improve their capability of dealing with the disputes between pharmacists and patients.

Objective To clarify the effective location of propofol in central nervous system (CNS) by detection of the c-jun expression after propofol-induced anesthesia in rats. Methods Wistar rats were randomly divided into 6 groups: normal control (C), low-dose propofol group (50 mg/kg, P 1), middle-dose propofol group (100 mg/kg, P 2), high-dose propofol group (150 mg/kg, P 3), stimulation with tail broken group (S 1), and propofol + stimulation with tail broken group (S 2). The expressions of nucleoprotein JUN in the CNS were detected by immunohistochemisty. Results Rather weakly stained nucleoprotein JUN positive neurons were observed in the supraoptic nucleus, lateral septal nucleus, and lateral habenular nucleus in the control group. In groups P 1, P 2, and P 3, the expressions of nucleoprotein JUN were increased significantly as compared with those in the control group. The expressions were mainly located in the accumbent nucleus, lateral septal nucleus, periventricular hypothalamic nucleus, ventral lateral geniculalaten nucleus, dorsal lateral geniculate nucleus, supraoptic nucleus, suprachiasmatic nucleus, anteroventral preoptic nucleus, nucleus of the solitary tract, supramammillary nucleus, basolateral amygdaloid nucleus, paraventricular thalamic nucleus, lateral habenula nucleus, and islands of Calleja. The expressed positive neuron number was positively correlated with the doses of propofol. Conclusion Propofol anesthesia has the determined sites of action in rat CNS.

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.

AIM: To explore the effects of processing on components group of Semen Raphani. METHODS: By comparing HPLC maps of Semen Raphani samples prepared with different methods and computing similarity,(analysis) the change law of the components group. RESULTS: The mechanism of inhibiting the enzyme by processing Semen Raphani was found and C3 was able to produce new compounds A209,B221. CONCLUSION: Processing Semen Raphani can change the components group through influencing the decoction process,eventually produce different clinical effects.

Objective To evaluate the effects of Wuqinxi bear play on TCM symptoms and health status in patients with chronic atrophic gastritis of Qi deficiency of spleen and stomach.Methods A total of 60 patients with chronic atrophic gastritis admitted to the Department of Gastroenterology in our hospital were selected.Using random number table method,the patients were divided into the intervention group and the control group with 30 cases in each group.The intervention group adopted bear play for exercise,and the control group was treated with routine treatment and nursing.The scores of TCM symptoms and SF-36,and reports of endoscope were compared between two groups.Results The scores of TCM symptoms in the intervention group were decreased after 2 and 4 weeks' of intervention.The score of each factor in SF-36 was increased and results of endoscope report were improved after 12 weeks' intervention.The differences were statistically significant(P＜0.05).Conclusion Bear play can effectively alleviate symptoms of chronic atrophic gastritis of Qi deficiency of spleen and stomach,and improve patents' quality of life.