Erythropoiesis ; physiology ; Humans ; Mitochondria ; physiology ; Mitochondrial Degradation

Objective To summarize the clinical features and diagnostic flow of cervical spondylosis with proximal upper extremity amyotrophy;and further analyze the clinical effect of cervical anterior decompression and fusion on cervical spondylosis with proximal upper extremity amyotrophy.Methods Twenty-two cases of cervical spondylosis with proximal upper extremity amyotrophy were analyzed retrospectively from June 2006 to December 2013.Seventeen males and 5 females with an average age of (55.73 ± 8.64) years (38 to 68 years) were included.The mean preoperative course of disease was (19.2 ± 21.86) months (1-72 months).Clinical symptoms,imaging findings and electrophysiological findings were analyzed.The muscular strength recovery of atrophic muscles was evaluated by Manual Muscle Testing (MMT).The clinical improvement rate was evaluated by the Japanese Orthopedic Association (JOA) score,and the clinical satisfaction was assessed at followed up.Results The muscles involved in patients of cervical spondylosis with proximal upper extremity amyotrophy are mainly the deltoid muscle,biceps and scapula levator muscle.Most cases of imaging findings showed multi-segmental degeneration,of which C4,5,C5,6 segments were most common.Neuroelectrophysiological examination showed that affected muscles experienced obvious denervation and decreased action potential.The average follow-up time was (44.14 ± 20.51) months (14 to 102 months).At the last follow-up,the JOA score (16.29 ±0.59) in 17 cases was higher than preoperative (15.12 ± 0.93),the difference was statistically significant (F=51.814,P=0.000),and the average improvement rate was 73.3％.MMT assessment showed that 19 patients (86.4％) in this group had muscle strength recovery for more than 1 grade at the last follow-up.The average clinical satisfaction was 83.7％.Conclusion The clinical diagnosis of cervical spondylosis with proximal upper extremity amyotrophy requires a combination of clinical symptoms,imaging findings and neurophysiological examination results for comprehensive judgment.Anterior cervical decompression and fusion in the treatment of cervical spondylosis with proximal upper extremity amyotrophy patients can achieve good clinical results.

Objective To observe brain functional activity of patients with arrhythmia after radiofrequency ablation with amplitude of low-frequency fluctuation (ALFF).Methods Twenty-six patients with anxiety disorder after radiofrequency catheter ablation (RFCA) were included as RFCA group.Age and sex matched twenty-six healthy volunteers were included as control group.The difference of ALFF between the two groups was analyzed by two-sample t test.Partial correlation between extracted values from dysfunctional brain regions and hamilton anxiety scale (HAMA) scores were investigated.Results Compared with control group,ALFF of left middle temporal gyrus,right putamen,left amygdala significantly increased,and left dorsolateral prefrontal cortex (DLPFC),right praecuneus,left middle frontal gyrus and right middle occipital gyus significantly decreased in RFCA group (Alphasim correction,P＜0.01).ALFF values of left DLPFC were negatively correlated with HAMA scores (r=-0.872,P=0.013).Conclusion The brain activity of RFCA patients in resting state is abnormal.ALFF can provide more evidences for the pathogenesis of the disease.

Objective To observe the safety and effectiveness of inductive chemotheray with lobaplatin plus 5-Fu (LF regimen) and concurrent chemoradiotherapy with lobaplatin for local-regionally advanced nasopharyngeal carcinoma (NPC) patients,and investigate the appropriate lobaplatin dose for the concurrent chemoradiotherapy.Methods Newly diagnosed local-regionally advanced NPC patients signed informed consent.The inductive chemotherapy was lobaplatin 30 mg/m2 + 5-Fu 4 g/m2 civ 120 h for 2 cycles every 21 days,then concurrent lobaplatin chemoradiotherapy was conducted.The initial lobaplatin dose for concurrent chemoradiotherapy was 50 mg/m2 with at least 3 cases in every dose level.If 2 of 3 patients presented dose-limiting toxicity (DLT),5 mg/m2 dose decreased for the next level until maximal tolerant dose (MTD) reached.The tumor response was evaluated after inductive chemotherapy,at the end of the chemoradiotherapy,3 months after chemoradiotherapy and 6 months after chemoradiotherapy.Results From Dec 2011 to Apr 2012,11 patients were enrolled in this study.After 2 courses of inductive chemoradiotherapy,CR,PR and SD were observed in 1,8 and 2 patients,respectively.At the end of the chemoradiotherapy and 3 months after chemoradiotherapy,CR and PR were observed in 10 and 1 patients,respectively.Six months after the chemoradiotherapy,all patients were CR.For the patients(3 in each arm) received 50 mg/m2 or 45 mg/m2 lobapaltin concurrent chemoradiotherapy,2 patients in each arm presented DLT.For the 5 patients received 40 mg/m2 lobapaltin concurrent chemoradiotherapy,no patients presented DLT.40 mg/m2 was suggested as the MTD.Inhibition of platelet was the major DLT.Conclusion Inductive chemotherapy with LF regimen and concurrent chemoradiotherapy with lobaplatin is safe and effective for local-regionally advanced NPC patients and the MTD of lobaplatin for the concurrent chemoradiotherapy is 40 mg/m2.Further clinical trial with large sample is expected.

Objective To evaluate safety and efficacy of EUS-FNA for occupying pancreatic lesions.Methods Data of 62 patients with occupying pancreatic lesions,who underwent EUS-FNA between June 2011 and June 2014,were analyzed for completion and complications,with surgery and clinical follow-up as the golden standard.Accuracy,sensitivity and specificity of EUS-FNA were calculated.Results A total of 62 patients with pancreatic lesions successfully underwent EUS-FNA and median puncture number was 4.2(3 to 8).Success rate of puncture was 100％ and sampling satisfaction rate was 90.3％ (56/62).No complications such as fever,infection,bleeding,perforation,severe pancreatitis or death were found.With the final diagnosis as the golden standard(39 malignant lesions and 23 benign lesions),overall diagnostic accuracy of EUS-FNA was 88.7％(55/62).The cytology diagnostic accuracy was 69.4％ (43/62),significantly higher than that of the tissue pathology of 30.6％ (19/62,P＜0.01).Sensitivity and specificity of the procedure were 87.2％(34/39) and 91.3％(21/23) respectively.Conclusion EUS-FNA is an effective and safe procedure in diagnosis of occupying pancreatic lesions.

Objective To compare the discrepancy between the new (2012) and the old (1992) Atlanta classification criteria for defining severity, organ failure and local complications in patients with acute pancreatitis (AP).Methods Demographic, clinical and laboratory data of 2 305 consecutive AP patients with onset less than 3 days, were collected between January 2005 to December 2013 in the First Affiliated Hospital of Nanchang University.Severity, organ failure and pancreatic local complications were respectively classified by the old Atlanta classification and the new revised Atlanta classification.Multi-factor scoring system and single serum marker were recorded and calculated using the acute pancreatitis database.Results In 2 305 patients with AP, there were 301 cases (13.1％) diagnosed with acute respiratory failure, 136 cases (5.9％) with shock, 105 cases (4.6％) with acute renal failure, 296 cases (12.8％) with gastrointestinal bleeding, based on the old Atlanta classification criteria.According to the severity, 900 cases (39.0％) were classified as mild acute pancreatitis (MAP), 1 405 cases (61.0％) as severe acute pancreatitis (SAP).However, based on the new Atlanta classification criteria, there were 686 cases (29.8％) with acute respiratory failure, 129 cases (5.6％) with acute renal failure, 107 cases (4.6％) with circulatory failure.Consequently, 998 cases (43.3％) were classified as MAP, 937 cases (40.7％) as moderately severe acute pancreatitis (MSAP), 370 cases (16.1％) as SAP.The incidence of respiratory failure was lower than that of the old standard.In SAP patients by new criteria, the discharge rate in critical condition and mortality were not only higher than those in MSAP patients (17.0％ vs 4.1％, 4.1％ vs 1.5％, respectively , all P ＜ 0.001), but also higher than those in SAP patients by the old classification (17.0％ vs 7.2％ ,4.1％ vs 2.1％, all P ＜ 0.001).Conclusions The diagnostic criteria of organ failure are different between the new and old Atlanta classification.The SAP patients classified by the new standard have worse outcome than those by the old standard.More attention needs to be paid to critical patients stratified by the new standard.

Objective To evaluate postprandial pharmacokinetics and bioequivalence of two preparations of cefdinir capsules in Chinese healthy volunteers. Methods In a two-way cross-over study, 24 healthy male volunteers were divided into two groups randomly and a single dose of cefdinir capsules of test and reference preparation were administered orally, respectively.The concentration in plasma was determined by LC-MS/MS. Pharmacokinetic parameters and bioequivalence were calculated and evaluated by DAS. Results The main pharmacokinetic parameters of test and reference were as follows: AUCt (4.35±1.09) μg??h??mL-1 and (4.12±1.22) μg??h??mL-1, AUC0-∞(4.53±1.12) and (4.53±1.73) μg??h??mL-1, t1/2 (1.74±0.29) h and (2.13±1.65) h, tmax(4.44±0.86) h and (4.54 ±1.16) h, Cmax(900±250) ng??mL-1 and (876±269) ng??mL-1 . Conclusion The test and reference preparation of cefdinir capsules are bioequivalent.

Objective To investigate the effects of early hemofiltration combined with traditional Chinese medicine on nasal feeding on severe acute pancreatitis (SAP) patients. Methods Seventy four patients were divided into traditional Chinese medicine group (group A, 35 cases) and traditional Chinese medicine+hemofiltration group (group B, 39 cases). In group A, patients were given a serious of procedure including fasting, gastrointestinal decompression, fluid resuscitation, inhi-bition of pancreatic secretion, antibiotic prophylaxis, parenteral nutrition and traditional Chinese medicine on nasal feeding;In group B, patients received continuous veno-venous hemofiltration treatment(also called Continuous Renal Replacement Therapy,CRRT) in addition to the procedures receiving by group A. On admission and the first, 3rd, 7th days post-treatment, the scores of acute physiology and chronic health evaluation (APACHEⅡ), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) levels were recorded. Length of hospital stay, local and systematic complications, surgical inter-vention, mortality and hospitalization expenses were compared between two groups. Results On admission, no statistical significance was seen in the hematocrit, white blood cell count, lactic acid dehydrogenase, blood urea nitrogen, blood glu-cose, APACHEⅡscore, Ranson’s score and classification of etiology between these two groups (P>0.05). But APACHEⅡ, TNF-α, IL-6, IL-8 were decreased significantly in group B than in group A, after the first, 3rd, 7th days post-treatment (P＜0.05). Compared with group A, the length of hospital stay, local complications, systemic complications, surgical interven-tion, mortality and hospitalization expense were lower in group B. Conclusion Traditional Chinese medicine on nasal feed-ing combined with early hemofiltration could effectively reduce complications, incidence of organ dysfunction and could im-prove the prognosis of SAP patients.

Objective To investigate the risk factors and treatment strategy in treating adjacent segment diseases (ASD) after anterior cervical decompression and fusion.Methods Fourteen patients with ASD after anterior cervical decompression and fusion from December 2005 to August 2012 were analyzed.The overall curvature of the cervical spine,local curvature of surgical segments,and the distances between the plate and the upper and lower intervertebral space were measured and analyzed.10 males and 4 females,age at initial surgery was 36 to 68 years old,the mean was 52.0±11.0 years old.The secondary surgery was taken,according to the number of involved segments and other factors.Anterior decompression and fusion and internal fixation was taken to patients who segment number ≤2 without severe ossification of posterior longitudinal ligament or ossification of the ligamentum flava; posterior decompression and laminoplasty was conducted in patients whose segment number ≥3,but not accompanied with significant kyphosis,instability and serious ossification of the ligamentum flava; and posterior laminectomy and fusion was performed in patients with significant kyphosis,instability and not suitable for anterior decompression due to technical reasons,as well as patients with serious ossification of the ligamentum flava.Results The average time of occurrence of ASD after the initial surgery was 9.3±4.4 years,and the average age of reoperation was 61.3±12.4 years old.The overall curvature of the cervical spine,surgical segment local curvature after the initial surgical procedure were 12.4°± 10.8 o,1.5o±6.8o,respectively; and the distances between the plate and the upper and lower interyertebral space were:0.9± 1.8 mm,3.8±3.2 mm.The secondary surgeries were taken as follows:9 cases anterior decompression and fusion and internal fixation,3 cases posterior decompression and laminoplasty,and 2 cases posterior laminectomy and fusion.All 14 patients were followed up 30.4± 17.8 months,and the average improvement rate of Japanese Orthopaedic Association scores at the last follow up was 73.9％±9.7％.Conclusion The smaller distance between the plate and neighboring intervertebral space,and poorer local curvature of surgical segments might be the risk factors for ASD after anterior cervicad decompression and fusion.The appropriate secondary surgery was taken after comprehensive analysis of the number of adjacent segments,compression factors,cervical curvature and other factors.

Objective To evaluate efficacy and safety of ursodeoxycholic acid(UDCA)for preven-tion of obstruction of biliary plastic stent.Methods A total of 88 patients with plastic biliary stents at our hospital were divided into UDCA group and the control group.Stents were collected 3 months after the opera-tion for argile biliare in the stent.The contents of APF,calcium bilirubin and calcium carbonate were ana-lyzed by biochemistry,and bacterium culture was conducted.Results The obstruction rate of UDCA group (n=43)and control group(n=45)were 8. 9% and 58. 1% respectively with significant differences(P<0. 05).There were significant differences in the protein level of APF between the UDCA group(17. 29 ± 9. 52)μm/L and the control group(10. 39 ±2. 17)μm/L(P<0. 05).Calcium bilirubin[(13. 90 ±3. 80) vs.(30. 92 ±7. 07)]and calcium carbonate[(12. 60 ±5. 69)vs.(16. 52 ±4. 11)]were less than those of the control group (P<0. 05 ).Only one type of bacterium was found,and Escherichia coli were cultured in 40. 0% samples,a lower incidence compared with the control(72. 1%).Conclusion UDCA would lessen biofilm and smooth stent surface by promoting secretion of endogenous bile acid and increasing APF,and keep the biliary patency.