Objective To analyse the relationship between lumbar discectomy outcomes and herniated type and annular integrity. Methods Two hundred and sixty patients who underwent conventional posterior discectomy for lumbar herniated disc were reviewed and followed-up for 6-14 years, with an average of 8.5 years. The criteria of enrolled patients include: all of the cases with low lumbar disc herniation at a single level, laterally protruded disc(one side sciatica) without spinal canal stenosis. Four categories of intraoperative findings were found basing on the defect size of annular and extruded fragments, and postoperative outcomes was compared statistically. Results The patients with larger disc fragments and minimal annular defects had the better outcomes and lowest incidence of recurrence after surgery. On the contrary, small fragments with massive annular defects did worse by comparison. Conclusion The outcomes of lumbar discectomy have close relationship with herniation type and annular integrity. Patients with mild clinical symptoms, small and broad-based disc herniations should be exempted from open discectomy. If open discectomy unavoidable, annular integrity and bony stability should be preserved as much as possible.

Degeneration of the lumbar facet joints is considered to be one of the main causes of low back pain,which severely impact the life quality of people.This article sums up the research advancement of the lumbar facet joints degeneration of domestic and foreign scholars in recent years,and summarizes the characteristics of the X-ray,CT and MRI and clinical significance of the degeneration of articular process,of which the characteristic of MRI was rarely reported domesticly.The purpose is to provide ideas and references for domestic scholars aiming to further clinical research of related fields in the future.

Objective To study the multi-slice spiral CT (MSCT) perfusion imaging in evaluating the changes of blood supply of hepatocellular carcinoma( HCC ) before and after transcatheter hepatic arterial chemoembolization (TACE). Methods Before and after TACE, MSCT perfusion was performed in 17 patients with HCC. The perfusion indexes such as hepatic blood flow (HBF), hepatic blood volume(HBV),mean transit time (MTT),hepatic arterial fracture (HAF),permeability surface (PS), hepatic artery perfusion (HAP), portal venous perfusion (PVP) were calculated. The hemodynamic changes of HCC after TACE were evaluated according to perfusion parameters. Results After TACE, HBF,HBV and HAP found in MTT and PS before and after TACE (P > 0.05). Conclusion The parameters of MSCT perfusion imaging( HBF, HBV and HAP) can effectively evaluate the hemodynamic changes of HCC after TACE, and has important value in chnical application.

Objective To investigate the clinical value of modified BI?RADS classification by using the coronal plane of automatic breast volume scaner. Methods The total of 201 BI?RADS 3~5 classification of breast masses were retrospectively analyzed. All masses underwent conventional ultrasound and ABVS examination. Using BI? RADS classification standard terms to describe various information of breast masses, and record the coronal image of the masses on the complete interface echo, convergence sign, angle, burr, which classified BI?RADS ultimately. Results The coronal plane of convergence sign, complete interface echo, angulation and burr were significantly different between benign and malignant tumors (P<0.0001). The sensitivity of ABVS convergent sign in diagnosing breast malignant tumors was 68.2%, specificity was 93.4% and accuracy was 82%. The conventional ultrasound combined with the coronal feature of ABVS modified by BI?RADS classification showed that 3 kinds of malignant rate reduced from 8.5%to 3.2%. The rate of malignant 4a decreased from 25.2%to 12.1%and the rate of malignant 5 increased from 94.2% to 98%. Conclusion The convergence sign of ABVS can be used as a significant independent predictor of breast malignant tumors;ultrasound combined with ABVS is helpful to improve the accuracy of ultrasound BI?RADS classification.

Clinical pharmacology is a cross subject of clinical medicine sciences and basic pharmacology.Only by making a lot of efforts to teach clearly,newly and lively,can we increase the students'interest and improve the teaching quality.

Objective To evaluate the middle and short-term effects of integrative cognitive training on mild cognitive impairments(MCI).Methods All the participants with MCI aged over 70 years were selected from one sub-district of Putuo District,Shanghai and divided into cognitive intervention group (n=46) and control group (n=35).The integrative cognitive training was conducted in 24 sessions for 12 weeks.All subjects were assessed by Neuropsychological Test Battery for Elderly (NTBE) and by a questionnaire of Shanghai Health Survey for the Elderly (VER2006)at baseline,follow-up and one-year follow up phases.Results At baseline phase,semantic relations test in NTBE was better (t=2.13,P=0.037),verbal fluency test (vegetables) in NTBE was worse(t =-2.25,P=0.038) in intervention group than in control group,while there were no significant differences in scores of other neuropsychological tests between intervention group and control group(all P＞0.05).At follow up phase,16 subscales in reasoning test of NTBE were improved (t=-2.70,P=0.010)and 2 subscales were declined in cognitive intervention group(all P＜0.05).9 subscales in semantic relations test of NTBE (t=-2.27,P=0.013) were improved and 5 subscales were declined in control group (all P＜ 0.05).Comparison between groups at one year follow-up showed that 5 subscales in reasoning test of NTBE (F=16.80,P=0.000) were better in intervention group than in control group(all P＜0.05).General linear model (GLM) with repeated measures at three time points showed that 4 subscales in reasoning test of NTBE had a time-by group interaction (F=5.16,P=0.01).Conclusions Integrative cognitive training can improve cognitive function in patients with mild cognitive impairments,and the validity of reasoning ability can sustain one year.

Objective To investigate the relationship between stent thrombosis and obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients after coronary artery stent implantation (CASI). Methods One hundred and seventeen patients were rolled after CASI, of which 29 suffering from OSAHS were enrolled into the research group, 88 patients without OSAHS were enrolled into the control group. The incidence rate of stent thrombosis between the above two groups was analyzed. Results Three patients suffered stent thrombosis in the research group, with the incidence rate of 10.3%,which was significantly higher than that in the control group, with the incidence rate of 1.10%(P = 0.047). Conclusions After CASI, patients with OSAHS had higher risk of stent thrombosis compared with patients without OSAHS. OSHAS should be considered as a risk factor for stent thrombosis.

Objective To investigate the expression of apoptosis-related proteins in rat cerebral cortex following traumatic brain injuries(TBI)and discuss the role of oxygen free radical-mitochondria signal pathway in Edaravone treating TBI.Methods A total of 180 male adult Sprague-Dawley rats were randomly divided into TBI group,Edaravone treatment group and control group.Each group was divided into six subgroups at 1,3,6,24,48 and 72 hours after TBI.Edaravone treatment group was injected with Edaravone(10 mg/kg)and the other two groups injected with the same volume of 0.9%normal saline.The pathological change in the rat cortex following TBI was observed with HE staining.At different time points,the expressions of Cytc,Bcl-2 and Bax in rat cortex as well as cell apoptosis and MDA change were observed by means of immunohistechemistry,TUNEL and TAB.Results HE staining showed scattered degenerated and necrotic neurous in cerebral cortex six hours after neuron injury,which peaked at 24 hours.Compared with control group,intermediate product MDA of free radical was increased six hours after TBI and peaked at 48 hours in Edaravone treatment group,which was lower than TBI group especially at 24,48 and 72 hours(P＜0.05).Compared with control group,the immunity reaction of Cytc positive cells inereased at six hours and peaked at 24 hours in TBI group,with statistical difference at 3,6,24,48 and 72 hours(P＜0.05).Compared with TBI group,the immunity reaction of Cyte positive cells was decreased obviously at 24,48 and 72 hours in Edaravone treatment group.Hyperexcitability of Bcl-2 after TBI reached peak at 3 hours and decreased gradually.But the expression of Bax was increased gradually after TBI and peaked at 48 hours,when Bax/Bcl-2 reached peak too.Folowing TBI,TUNEL positive cells increased gradually and reached peak at 48 hours,with mainly type Ⅰ TUNEL cells before 24 hours and typeⅡTUNEL cells after 24 hours.Conclusions There exist necrosis and apoptosis of nerve cells in cortex after TBI,especially apoptosis.Oxygen free radical mitochondria is one of the signal transduction pathways of nerve cell apoptosis following TBI.Edaravone exerts certain therapeutic effect on TBI.

BACKGROUND: The metal implant internal fixation exhibits good effect for femoral neck fractures of young patients, but few studies report the metal implant treatment for femoral neck fracture in the aged patients. OBJECTIVE: To compare different implant treatments for osteoporotic hip fractures in senile patients. METHODS: A total of 237 aged patients with osteoporotic hip fracture, aged from 60 to 96 years old, were recruited from the hospital between January 1998 and December 2008. There were 32 cases treated by cannulated screw internal fixation, 23 cases by anatomical plate internal fixation, 41 cases by dynamic hip screw internal fixation, 111 cases by bipolar femoral head replacement, and 30 cases by total hip replacement. Comparison of the incidence of complications and the recovery of hip function were performed in each group. RESULTS AND CONCLUSION: Cannulated screws, anatomical plates, dynamic hip screw internal fixation showed a higher complication rate significantly than bipolar femoral head replacement and total hip arthroplasty (P < 0.01); the good and excellent effect rate in cannulated screw, femoral end plate, and dynamic hip screw fixation was significantly lower than that in bipolar femoral head replacement and total hip arthroplasty (P < 0.001, P < 0.01). The results suggested that artificial joint replacement (bipolar femoral head replacement or total hip replacement) is the optimal choice for aged osteoporotic femoral neck fracture, cannulated screw fixation is suitable for Garden I, dynamic hip screw fixation and proximal femoral anatomical plate fixation fit for intertrochanteric fractures of Jensen-Evans I-Ⅱ; Jensen-Evans Ⅱ-Ⅲ osteoporotic intertrochanteric fractures joint replacement is the ideal choice.