Objective To analyze the results of one-stage combined anteroposterior surgery in lateral position for serious thoracolumbar fracture dislocation. Methods A retrospective review was performed for surgically treated thoracolumbar fractures from October 1998 to September 2005. Of all the 192 patients, the 34 serious cases were treated with one-stage combined anteroposterior surgery. There were 25 males and 9 females, 34.2 years old on the average (ranging from 18 to 56 years). Segments involved: T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 8 cases, L3 in 5 cases, L4 in 2 cases and L4,5 in 1 case. According to the Classification of Magerl, there were 12 cases of type A3, 2 cases of B1, 2 cases of B2, 12 cases of C1, 4 cases of C2 and 2 cases of C3. During the operation the patients were in lateral position. Laminectomy and pedical screw insertion were performed posteriorly first; anterior corpectomy, reduction and strut graft were accomplished through an additional anterior approach. The final fixation was finished by clapping the strut graft with pedical screw system. Operative notes, preoperative and postoperative neurological status, ASIA scales, radiographs, CT scans, and follow-up records were reviewed. Results All these surgeries were performed successfully without any neurological deterioration. 32 of 34 patients were followed-up for 6 to 60 months (13 months on average). Neurological status improved at least 1 ASIA grade in 24 patients with preoperative incomplete paraplegia. 6 patients complained intercostals nerve injury symptom which alleviated with conservative treatment. During follow-up, lumbar physical lordosis was reconstructed and no evident correction loss, pseudoarthrosis or implant failure was noted. Conclusion One-stage combined anteroposterior surgery can be accomplished in a lateral position. It was proved to be an effective treatment for serious thoracolumbar fracture dislocation.

Objective To analyze the results and indications of anterior, posterior or combined surgery for thoracolumbar burst fractures. Methods A retrospective review of surgically managed thoracolumbar burst fractures from 1998 to 2003 was performed. There were 76 males and 13 females, and the age of the patients were from 17 to 51 years with an average of 36.8 years. The fractures were located at T11 in 10, T12 in 21, L1 in 29, L2 in 18 and L3 in 11. According to Magerl classification, type A fractures were 68, and type C were 21. Of the 89 patients, 41 received posterior surgeries, 40 anterior surgeries, and 8 combined anterior and posterior surgeries. Operative notes, preoperative and postoperative neurological status, radiographs, CT scans, and follow-up records were reviewed. Results All of the 89 cases had successful surgery. Seventy-eight patients were followed-up for 6 to 48 months (average 12 months). Neurological status improved at least 1 ASIA grade in all of the 65 patients who had preoperative incomplete paraplegia. In the posterior surgeries, pedicle screws broken in 2 cases, deep infection in 1 case which was cured after debridement. The correction of anterior vertebral body height and Cobb's angle averaged 9.4 mm and 14.8? postoperatively, and the correction loss averaged 0.5 mm and 7.5? respectively at 6 months after surgery. And the correction loss was most evident at the above disc spaces, then the below disc spaces. In the anterior surgeries, leakage of cerebrospinal fluid in 2 cases which cured with dressing change, the other cured after debridement, implant removal and posterior fixation. The spinal canal was enlarged, and the spine recovered normal curvature. No evident correction loss, pseudoarthrosis or implant failure was noted at follow-up. Conclusion The choice of anterior, posterior or combined surgery for thoracolumbar burst fractures depends on neurological status and column stability. The vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.

Objective To explore the effects of nutritional intervention on body composition,blood biochemical parameters and blood pressure of overweight adults with metabolic syndrome.Methods Forty overweight adults with metabolic syndrome (body mass index (BMI) ＞ 28.0 kg/m2,waist circunference ≥85 cm(for male)or ≥80 cm(for female))participated in this investigation.Changes of serum lipid profiles,blood glucose,blood pressure and other indicators were compaired before and after 2-months'intervention.SPSS 18.0 Software was used for data analysis.Results After two rnonths' nutritional intervention,body weight,body fat,BMI,visceral fat area and waist hip ratio were significantly improved(t =17.02,11.07,5.11,10.35,9.58 ; P ＜ 0.05).The glutamic-pyruvic transaminase,glutamic-oxalacetic transaminease,cholesterol,triacylglycerol,fasting blood-glucose,systolic blood pressure and diastolic blood pressure were also significantly improved after nutrition intervention(t =2.87,2.91,3.33,2.24,2.56,5.74,6.99 ;P ＜ 0.05).Conclusion Nutrition intervention may contribute to improved levels of blood pressure,blood glucose and serum lipid profiles of obesity individuals through body weight and body fat control and lead to reduced insulin resistance caused by obesity.

Objective To investigate the relationship between apolipoprotein E (ApoE) ε4,ε2 alleles and intrauterine growth.Methods ApoE genotypes of 1418 people born in Peking Union Medical College Hospital were analyzed,allele frequencies were calculated and their parameters at birth were collected.To compare ApoE ε4,ε2 alleles with parameters at birth through single factor analysis and Logistic regression analysis.Results The alleLic frequencies of e2,83 and 84 were 8.11%,83.39% and 8.50% in the group.The results of single factor analysis showed that there was significant difference between the distribution of ponderal index (PI) in the ApoE ε2 allele group(χ2=4.87 ,P=0.027).While there was no significant difference between the distribution of head circumference at birth,placental weight and gestational age in the ApoE ε2 allele group.ApoE ε2 allele showed negative correlation with small PI in the logistic regression analysis(χ2=5.077 ,P=0.024),after adjusted for gender,age,head circumference at birth,placental weight,gestational age,parity and maternal age at delivery.No association between ApoE ε4 allele and parameters at birth was found.Conclusions ApoE ε2 allele may have protective effect on PI.No association was found between ApoE ε4 allele and intrauterine growth.

Objective:To study the clinical significance of early detection of soluble growth stimulating gene 2 protein (sST2) and prealbumin (PAB) in patients with chronic pulmonary heart disease (CPHD) complicated with refractory heart failure.Methods:From September 2017 to June 2019, 112 CPHD patients complicated with refractory heart failure were admitted to Hengshui People's Hospital. The selected patients met the revised guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2013 revision) and the cardiac function grade Ⅲ-Ⅳ according to the grading criteria of the New York Cardiology Society. Cardiogenic shock, severe liver and kidney dysfunction, malignant tumors, anemia, and autoimmune diseases were excluded. Patients were divided into the high PAB group (≥200 mg/L) and the low PAB group (<200 mg/L) according to the PAB level on admission. The pulmonary artery systolic blood pressure (PASP), pulmonary artery mean pressure (MPAP), and left ventricular ejection fraction (LVEF) were observed in the two groups before and after the treatment. PAB, total bilirubin (TBIL), hypersensitive C reactive protein (hs-CPR), N-terminal B type brain natriuretic peptide (NT-proBNP) and sST2 levels were detected. Measurement data were expressed in terms of mean ± standard deviation, the counting data were compared using χ 2 test. Correlation analysis was conducted using Spearman correlation test. Results:There were 40 cases in the high PAB group and 72 cases in the low PAB group. There were no statistically significant differences in general data between the high PAB and low PAB groups ( P>0.05). Hospitalization time was significantly different between the two groups ( P<0.05). Before the treatment, there were no significant differences in PASP, MPAP, NT-proBNP and LVEF between the two groups ( P>0.05). High sST2 was significantly different between the two groups ( P<0.05). After the treatment, PASP, MPAP, NT-proBNP and sST2 were decreased in both groups, and the improvement was more obvious in the high PAB group than in the low PAB group, with statistical significance ( P<0.05). Before the treatment, the levels of TBIL and hs-CPR were not statistically different between the high PAB and low PAB groups ( P>0.05). However, the levels of TBIL and hs-CPR were beyond the normal range. After the treatment, TBIL and hs-CPR were decreased in both groups, and there was statistically significant difference between the two groups ( P<0.05). Spearman correlation analysis showed that PAB was negatively correlated with sST2 ( r=-0.778, P=0.001). There was a positive correlation between cardiac function and sST2 ( r=0.569, P=0.034), hospitalization time ( r=0.572, P=0.033) in patients with refractory heart failure. The higher the sST2 of CPHD with refractory heart failure, the longer the patient hospitalization time, and the more serious the heart failure was. The area under the combined ROC curve of PAB and sST2 was 0.756. CPHD patients with refractory heart failure had the greatest predictive value. Conclusion:The combined test of sST2 and PAB can evaluate the condition and outcome of CPHD patients with refractory heart failure, and guide the clinic.

The effect of PubMed on the development of biomedical journals and the role of its Linkout function in extending the effect of journals were analyzed , followed by a description of the technologies and methods for the full-text seamless link of journal Websites and PubMed using its Linkout function with Biomedical and Environmental Sciences as an example .

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures),three with axis fracture and dislocation,one with dens fractures plus nonunion,two with C2,3 fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation,the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22-26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1-2 after operation.Results A total of 64 cervical pedicle screws were implanted in all 15 patients,with no vertebral artery injury,spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12-36 months,which showed bony fusion,with no looseness or breakage of the screws.Neurologic impairment was improved in all patients,with no complications associated with the cervical pedicle screw.Conclusions Cervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.

BACKGROUND: To discuss the basic theory of traditional Chinese medicine (TCM) related to stem cell for a try to offer a new combining site +for the modernization research of the basic theory of TCM.METHODS: Comparatively analyzing the characteristic of stem cells and the essence theory in TCM.RESULTS: Stem cells have the capacity for both self-renewal and differentiation and can produce the daughter cells with the same phenotype and genotype as themselves. Stem cells have the plasticity that a stem cell may differentiate into cells other than the lineages to which it is committed, and therefore, is also termed transdifferentiation. So it is of great value for stem cell application in tissue engineering, curing tissue-damaged diseases and as the vector for transgene therapy. We compared the character of stem cells with essence theory, an elementary and important part of the basic theory of TCM, and found that stem cells are related greatly to essence,according to its two origin, congenital essence and acquired essence, and four kinds of functions of essence, which are controlling reproduction,controlling growth and development, manufacturing marrow and transforming blood; nourishing and moistening the zangfu-organs. Furthermore, stem cells especially have direct connected with the congenital essence which is stored in the kidneys. Congenital essence is the reproductive essence accepted from parents. Sperm and ovum merge to be oosperm, that is just the totipotent stem cell. The connotative meanings of congenital essence include all germ plasm and the special developing message of a genus in the oosperm. Genital stem cells are in charge of the function of controlling reproduction of congenital essence. Growth and development function is related to the proliferation and differentiation of adult stem cells controlled by gene. Manufacturing marrow function has relation with bone marrow stem cells and neural stem cells (NSC) in medullary cavity in which contains bone marrow, spinal cord and brain. Dominating bones function of the kidneys is related to mesenchymal stem cells (MSC), and hematopoietic stem cells (HSC) execute the function of producing blood completely.CONCLUSION: We consider that stem cells have a close relation with the congenital essence, and we put forward a new viewpoint in this research that stem cells have the same properties of congenital essence, and they are existence formation of congenital essence in cell level.

Objective To observe the clinical efficacy of pricking anti-Ashi points with fire needles in treating acute lumbar sprain.Method Seventy-six patients with acute lumbar sprain were randomized into a treatment group and a control group, 38 cases in each group. The treatment group was intervened by pricking anti-Ashi points with fire needles, while the control group was by warm needling. The Visual Analogue Scale (VAS) and Roland-Morris Dysfunction Questionnaire (RMDQ) were adopted to evaluate lumbar pain and dysfunction after 1-day and 5-day treatment, and the clinical efficacies were compared between the two groups.Result Respectively after the first treatment session and 5 treatment sessions, the VAS and RMDQ scores were significantly changed in both groups (P<0.01). Respectively after the first treatment session and 5 treatment sessions, the VAS and RMDQ scores in the treatment group were significantly different from that in the control group (P<0.05). The total effective rate and recovery rate were respectively 94.7% and 63.2% in the treatment group, versus 86.8% and 42.1% in the control group, and the differences were statistically significant (P<0.01).Conclusion Pricking anti-Ashi points with fire needles is an effective method in treating acute lumbar sprain, and it can produce a significant real-time analgesic effect.

The research data at home and abroad show that the overall burnout rate of clinical professional graduate students was high. They are vulnerable to burnout because of long duty hours, learn-ing pressure, intense and overloading work and especially the significantly reduced personal accomplish-ment in the situation of the contradiction between doctors and patients in our country. Burnout not only re-sults in psychological distress and physical symptoms, but also has negative effect on the quality of graduate medical education during residency training. Therefore, educators need to develop an active awareness of burnout and ought to perform interventions such as formulating the appropriate learning goals, improving the work efficiency, reducing work hours, positive psychological counseling and stress management training to prevent such occurrences.