Objective To evaluate retrospectively whether posterior longitudinal ligament(PLL)adhere to dura mater in the patients with cervical spondylotie myelopathy(CSM)or not before the anterior cervical operation.Methods From December 2005 to January 2007,of 18 patients with CSM the adhesion between PLL and dura mater was found in the anterior cervical operation.The patients included of 11 males and 7 females,with mean age of 65.4 years (range 55-72 years).All the patients were measured by CT and MRI before operation.There were 12 cases of dual-segmental cervical intervertebral disc herniation,6 of tri-segmental disc herniation.The former cases were treated with one level corpectomy and titanium mesh or iliac grafting and cervical anterior plate,and the latter with an additional cervical cage in the intervertebralspace.The floatation method was used to deal with the adhesion.The fitness between the two radiological methods was analyzed by matched-pairs Kappa eoemcient test.Results The nerve functions of all the patients were improved after anterior cervieal decompression.The mean score of JOA was increased from 9.6 of pre-operation to 12.1 of post-operation.There were 4 cases with injury in dura mater,which healed after appropriate dealing with the leakage of cerebrospinal fluid.None of lacerated dura was directly repaired during the operation.The condition of the coarse touch and bur between intervertebral disc and dura mater were found in CT transverse scanning.The thickening of the PLL and the unsymmetrical space between inferior and superior subdural cavity was found in MRI.The coefficient test proved that the difference of the CT and MRI was significant in finding the adhesion.Conclusion MRI iS better than CT in finding the adhesion between the PLL and dura mater in CSM before operation,besides the floatation method should be good to deal with the adhesion.

Objective To determine the serum level of advanced glycosylation end products (AGEs) of uremia and its expression in the vascular wall and peritoneum of dialysis patient, meanwhile to explore its possible significance. Methods Using the ELISA method to determine the serum level of AGEs of uremia; using immunohistochemical method to examine the expression of AGEs in the vascular wall of uremia patients undergoing hemodialysis and the expression of AGEs and laminin in the peritoneum of uremic patients undergoing peritoneal dialysis. Results The AGEs level of uremic patients was obviously higher than that in the normal. No kind of dialysis could clear it well. AGEs accumulated obviously in the vassular wall of hemodialysis patients. After CAPD the expression of AGEs and laminin in the peritoneum was significantly strong. There was an obviously positive correlation between AGEs and laminin, so between these two and the time of peritoneal dialysis. Conclusions The high serum level of AGEs and its accumulation in the vascular wall may relate with the high incidence of cardic diseases of the uremia. Accumulation of AGEs and laminin in the peritoneum of patients undergoing peritoneal dialysis may be one of the reasons causing peritoneum sclerosis and dysultrafiltration

[Objective]To evaluate the restoration of the cervical curvature after segmental anterior cervical decompression.[Method]Thirty-seven patients(male 31,female 6,mean age 57.8)with cervical spondylotic myelopathy were treated by segmentai anterior decompression,JOA(17 scores)was used to evaluate the improvement of nerve function of the patients.The measurement of the lordosis was according to the Harrion posterior tangent angle which is presented on the tangent of posterior vertebral body margins of C2 and C7 in the cervical spine.E-film software was used to measure the tangent angles which were obtained by pre operation and post operation.All patients were divided into two groups in terms of the fifteen degree of lordosis of the cervical spine before the operation.[Result]All of the cases were obtained the improvement of the nerve function of the extremities.The mean JOA scores was 10.6 in pre-operation,and was 12.8 in post-operation(P

DSS group,although without statistical significance.JOA score of two groups before and after surgery without statistical significance.[Conclusion]Developmental spinal stenosis is pathology found,which influences course of ossification of cervical posterior longitudinal ligament.The principal factor is trauma,which induces ossification of cervical posterior longitudinal ligament.Decompressed from a posterior approach is a reasonable treatment way.

Objective To approach the treatment principle of lumbar spondylolisthesis with spina bifida occulta. Methods Twenty-six patients(male19,female 7,average 23.2 years old)with spondylolisthesis and spina bifida occulta were analyzed retrospectively.All cases were evaluated by radiological examinations including X-rays,computed tomography,magnetic resonance image.Based on the radiological results,the degeneration of intervertebual disc were varied by Ⅰ~Ⅴ types.Meyerdin’s score was used to evaluate the severe slip of the body of spondylolysis.At same time spina bifida occulta was divided into 4 models as follows,type A meant that the semi-lamina of sacrum was hypoplasia and still linked with spinous process;type B meant that the both sides of the lamina of sacrum was hypoplasia and the spinous process was free;type C meant that the lamina of sacrum was absent;type D meant that the spina bifida occulta was companied by other deformities such as the round formation of the end-plate of sacrum,the deformity of the transverse process of L5. Results The modality of the operations included 9 cases in single-vertabra fixation,13 cases in single-segment fixation,4 cases in two-segment fixation.All patients had been follow-up for 6~37 months(average 11.2 months).The effect of treatment was also obtained(8 in excellent,13 in good,5 in fair). Conclusions As for how to do with spondylolisthesis with spina bifida occulta(SBO),the type of SBO,degeneration scores of the disc and the degree of the slip of spondylolysis should be taken into consideration.

Objective To investigate the role of Toll like receptor 4/nuclear factor-κB (TLR4/NF-κB) signal pathway on myocardial dysfunction after cardiac arrest-cardiopulmonary resuscitation (CA-CPR) in animal model. Methods Twenty-six pigs were randomly divided into sham group (n = 6), CA-CPR 12 hours group (n = 10) and CA-CPR 24 hours group (n = 10). The model of CA-CPR was reproduced by endocardial electrical stimulation for 8 minutes followed by CPR, and the pigs in sham group were only given anesthesia and tracheal intubation. The changes in hemodynamics including mean arterial pressure (MAP) and cardiac output (CO), as well as morphology and ultrastructure of myocardial cells were observed before and after CPR. The levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme linked immunosorbent assay (ELISA), and protein and mRNA expressions of TLR4/NF-κB in the myocardium were determined by Western Blot and real-time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR), respectively. Results Hemodynamic disturbance and myocardial serious injury were observed in CA-CPR groups. Compared with sham group, the levels of serum TNF-α were markedly increased 0.5 hour after return of spontaneous circulation (ROSC) in CA-CPR 12 hours and 24 hours groups (pg/L: 62.49±6.66, 48.39±2.37 vs. 10.75±0.74, both P < 0.05), and peaked at 2 hours (pg/L: 70.93±5.51, 66.03±2.60 vs. 10.87±0.91, both P < 0.05) followed by a gradual decline. The levels of serum IL-6 at 0.5 hours after ROSC in CA-CPR 12 hours and 24 hours groups were markedly higher than those of sham group (pg/L: 14.42±1.99, 11.23±1.12 vs. 8.75±0.74, both P < 0.05), and peaked at 12 hours (pg/L: 36.50±2.91, 38.15±1.26 vs. 8.88±0.62, both P < 0.05) followed by a gradual decline. The protein expressions of TLR4 and NF-κB in the myocardium were significantly increased in CA-CPR 12 hours and 24 hours groups as compared with sham group [TLR4 protein (gray value): 0.11±0.03, 0.24±0.05 vs. 0.05±0.02; NF-κB protein (gray value): 0.27±0.04, 0.24±0.03 vs. 0.09±0.02, all P < 0.05]. The mRNA levels of TLR4 in CA-CPR 12 hours and 24 hours groups were increased by approximately (9.93±1.07) folds and (9.21±1.27) folds of sham group respectively, and NF-κB mRNA expressions were increased by (4.44±0.96) folds and (6.09±0.81) folds of sham group respectively (all P < 0.01). Conclusion Activation of TLR4/NF-κB signal pathway may be one of the main pathological mechanisms of post resuscitation myocardial injury in a porcine model of CA-CPR.

ObjectiveTo examine whether Shenfu injection (SFI) reduces post-resuscitation myocardial dysfunction in a pig model by modulating expression imbalance of transcription factors of regulatory T cell, namely GATA-3 and T-bet.Methods Thirty pigs were randomly divided into sham group (n = 6) and cardiopulmonary resuscitation (CPR) group (n = 24) according to the random number table method, and the pigs in the CPR group were randomly subdivided into normal saline (NS) group, epinephrine (EP) group, and SFI group (n = 8 per group). After 8minutes of untreated ventricular fibrillation (VF) followed by 2 minutes of CPR, animals in three groups respectively received central venous injection of either 20 mL SFI (1.0 mL/kg, SFI group), EP (0.02 mg/kg, EP group) or NS (NS group). Blood samples were obtained before VF and 0.5, 2, 6 hours after restoration of spontaneous circulation (ROSC), and the parameters of hemodynamics and oxygen metabolism were determined. Surviving pigs were sacrificed at 24 hours after ROSC, the pathological changes in myocardium were observed, the levels of interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) andγ-interferon (IFN-γ) were measured by enzyme linked immunosorbent assay (ELISA), and expressions of protein and mRNA of GATA-3 and T-bet were determined by Western Blot and quantitative real-time polymerase chain reaction (RT-qPCR), respectively.Results Six pigs of three resuscitation groups were successfully resuscitated. The CPR time, number of defibrillation, defibrillation energy, and ROSC time were significantly decreased in the EP and SFI groups compared with those in the NS group. Compared with the sham group, the parameters of left ventricular systolic function and oxygen metabolism were significantly decreased, myofibril organelles were extensively damaged, and progressive and severe deterioration of the myocardium was found, and mitochondrial structure was not recognizable in the NS group; the level of IL-4 in myocardium were markedly decreased, while that of TNF-α, IFN-γand IFN-γ/ IL-4 [reflecting helper T cell 1/2 (Th1/Th2)] were significantly increased. Protein and mRNA expressions of GATA-3 were markedly reduced in the myocardium of pigs in the NS group compared with that of the sham group at 24 hours after ROSC, while T-bet was significantly increased. Compared with the NS group, animals treated with SFI had minimal myocardial intracellular damage, with decreased heart rate (HR, bpm: 90.33±3.79 vs. 106.83±5.36) and increased mean arterial pressure (MAP), cardiac output (CO), oxygen delivery (DO2), and oxygen consumption (VO2) at 6 hours after ROSC [MAP (mmHg, 1 mmHg = 0.133 kPa): 107.67±1.96 vs. 86.83±1.85, CO (L/min): 2.47±0.08 vs. 2.09±0.04, DO2 (mL/min): 364.31±4.21 vs. 272.33±3.29, VO2 (mL/min): 95.00±2.22 vs. 82.50±2.28, allP<0.05]. Compared with the NS groups at 24 hours after ROSC, level of IL-4 was markedly increased in myocardial cells (ng/L: 33.80±3.06 vs. 16.15±1.34,P< 0.05), while the levels of TNF-α, IFN-γ and IFN-γ/IL-4 were lowered significantly [TNF-α (ng/L): 18.16±0.71 vs. 29.64±1.89, IFN-γ (ng/L): 373.75±18.36 vs. 512.86±27.86, IFN-γ/IL-4: 16.15±1.34 vs. 33.80±3.06, allP< 0.05], and myocardial T-bet protein and mRNA expressions were reduced [T-bet protein (gray value): 0.41±0.07 vs. 0.59±0.11, T-bet mRNA (2-ΔΔCt): 4.37±0.21 vs. 7.57±0.55, bothP< 0.05], furthermore, myocardial GATA-3 protein and mRNA expressions were significantly up-regulated in SFI group [GATA-3 protein (gray value): 0.25±0.07 vs. 0.16±0.07, GATA-3 mRNA (2-ΔΔCt): 0.63±0.07 vs. 0.34±0.05, bothP< 0.05]. The parameters in SFI group were significantly improved compared with those of the EP group.ConclusionsMyocardial immune dysfunction is induced by Th1/Th2 imbalance following myocardial injury subsequent to CPR in pigs. SFI can attenuate myocardial injury and regulate myocardial immune disorders, protect post-resuscitation myocardial injury by modulating expression imbalance of transcription factors GATA-3 and T-bet.

Objective To find out the changes of the soft tissue profile in Guangdong women with Angle's I teeth uncovered by lips after extraction of 4 first bicuspid teeth and to evaluate its significance. Methods Fifteen cases of adult Guangdong women with Angle's I teeth uncovered by lips were enrolled in this retrospective study. The X-ray film of lateral cephalometry was used to analyze the soft tissue profile in pre- and post- corrective tooth extraction. The paired t-test was statistically applied for comparison between the changes of lip tissue in pre- and post- correction. Results The changes occurred obviously in the angles of nose vs. lip and upper vs. lower lips, angle Z, and the length, thickness, esthetical plane distance and convex distance of upper and lower lips, but not in the angles of face and facial convex, basic angle of upper vs. lower lips and chin thickness. Conclusilons The facial dislocation and figure of these women have been positively improved after extraction of 4 first bicuspid teeth in spite of the larger thickness of lips than before correction, the just partly shortened distance between lips and the upper and front teeth still exposed and uncovered by lips to some extent. Further improvement depends on functional exercise of lip muscles.

objective To evaluate the diagnostic efficiency of magnetic resonance imaging(MRI)for rheumatoid arthritis(RA).Methods The major international databases was searched by computer and Other methods to collect control studies about MRI for the diagnosis of RA,the searching deadline was December 2009.Data were screened and extracted by inclusion criteria.Meta-disc software Was used for statistics,including sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio(OR)and heterogeneity analysis.Results Twelve random control tests were included.Meta-analysis indicated that sensitivities of vities of synovitis,bone-erosion and tendenosynovitis were 81%~100%,48%～100%and 67%～96%while specificities of them were 64%～89%,16%~100%and 21%-74%respectively for RA patients(≤2vears).Sensitivities of synovitis and bone-erosion were 91%and 84%while specificities of them were 70%and 81%for RA Datients (>2 years).Conclusion Synovitis shown by MRI is helpful for the diagnosis of earlv and med-to-late RA.Diagnostic values of bone-erosion and tendonosynovitis demonstrated by MRI for earlv RA were not clear.The sample size of the included studies is small and some studies lack of control groupsput the conclusion of this meta-analysis liable for bias.We suggest that better designed and larger sample clinical studies are necessary.

Objective To construct three-dimensional finite element model of lumbar spondylolysis,then to verify its validity by comparison of biomechanics in vitro.Method According to the radiological data of a patient with lumbar spondylolysis,the bone and intervertebral disc of L4-S1 were reconstructed by Simpleware software.The lumbar attaching ligaments and articular capsule were added into simulating model by Ansys software.The three-dimensional finite element model of lumbar spondylolysis was finally simulated successfully,and validated by lumbar spondylolysis biomechanical experiment in vitro.Results The reconstruction of digital model contained the bones of lumbar spine which include vertebral cortical bone,cancellous bone,facet joint,pedicle,lamina,transverse process and spinous process,as well as the annulus fibrosus,nucleus pulposus,superior and inferior end-plates.Besides,anterior and posterior longitudinal ligaments,flavum ligament,supraspinal and interspinal ligaments and articular capsule of facet joint are also attached.The model consisted of 281,261 nodes and 661,150 elements.Imitation of spondylolysis is well done in this model.The validity of the model was verified by comparison of the results of biomechanics in vitro which involved in the trends under loading of stress/strain of L4 inferior facet process,L5 superior and inferior facet process,S1 superior facet process and the trends of stress/strain of lateral and medial L4 inferior facet process.Conclusions Three-dimensional model of lumbar spondylolysis is reconstructed using finite element analysis,and can be further used in the research in biomechanics of lumbar spondylolysis.