Humans ; Internal Fixators ; Lumbar Vertebrae ; surgery ; Spinal Fusion ; instrumentation ; methods ; Spinal Stenosis ; surgery

Anticoagulants ; classification ; therapeutic use ; Child ; Humans ; Sepsis ; drug therapy ; physiopathology ; Treatment Outcome

Acute Disease ; Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Ivermectin ; analogs & derivatives ; poisoning ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Antiviral Agents ; therapeutic use ; Biomarkers ; blood ; Biopsy ; Diagnostic Imaging ; methods ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Hepatitis B, Chronic ; complications ; diagnosis ; pathology ; Humans ; Liver ; pathology ; Liver Cirrhosis ; diagnosis ; drug therapy ; pathology ; Reproducibility of Results

Objective Isoflurane preconditioning has been shown to protect against cerebral ischemia-reperfusion(I/R)injury.The purpose of this study was to investigate if isoflurane inhalation during reperfusion hasany protective effects.Methods Fourty-two SD rats weighing 318-365 g were randomly divided into 3 groups:sham group(n=6),control group(n=18)and isoflurane group(n=18).Control group and isoflurane groupwere further divided into 10,15 and 20 rain ischernia subgroups(subgroup A,B,C,n=6).In isoflurane group1.4% isoflurane in air was inhaled immediately after reperfusion was started for 30 min.Two days before theexperiment the animals were anesthetized with intraperitoneal chloral hydrate 300 mg?kg~(-1).Microdialysis catheterwas inserter into right hippocampns using stereotactic technique and fixed.BIS microelectrodes were placed in thebrain.Vertebral arteries were permanendy occluded by electric coagulation.Bilateral common carotid arteries wereexposed and atranmatic sutures were placed around them.Globol cerebral ischemia was produced by tighteningcarotid sutures and maintained for 10,15 or 20 min(subgroup A,B,C).Cerebral iscbemia was confirmed by lossof righting reflex,dilated pupils,loss of light reflex,BIS=0 and isoelectric potential on EEG.Carotid sutureswere then released for reperfusion.Isoflurane inhalation was started right after the beginning of reperfusion andmaintained for 30 min.Neurologlc outcome was assessed by motor performance according to Combs(0-10,0=severe dysfunction,10=no dysfunction)at 24 h,48 h and 72 h of reperfusion.Microdialysis samples werecollected before during and 0-15,15-30,30-45 and 45-60 min after ischemia for determination of glutamateconcentration.Three days after ischemia the animals were sacrificed and brains were removed for microscopicexamination of hippocampns CA1 region.The number of apoptotic(TUNEL positive)neurons were counted and thepercentage(the number of TUNEL positive neurons/the total number of neurons)was calculated.Results Theglutamate content in hippocampus was significantly lower in isoflurane group than in control group duringreperfusion(P

Objective Patients with previous failed scoliosis surgery were managed by revision surgery,the reasons, methods and results of revision surgery were evaluated and analyzed. Methods Thir-ty-six patients with previous failed scoliosis surgery underwent revision surgery between June 1996 and Au-gust 2002. There were 15 males and 21 females with an average age of 16.8 years. The patients had 1.57 operations on average (1 for 27 cases, 2 for 8 cases and 3 for 1 case). The reasons for revision surgery were failure of previous instrumentation (6 cases), deterioration of the deformity (18 cases), and unsatisfactory re-sults with previous surgery (12 cases). Thorough radiographic evaluations including plain X-ray, CT scan and MRI were taken for each patient pre-operatively. The preoperative average Cobb angle for scoliosis was 76.2?(52?-108?)?Of 36 patients, there were 11 with kyphosis and the preoperative average Cobb angle was 53?(36?-79?). The involved spines in the deformity were 10.1 on average (8-13 levels). The surgical proce-dures included removal of previous instrumentation in 21 cases, staged trans-thoracic anterior release in 5 cases with rigid curve, and osteotomy passing through articular joints and laminae on previous fusion mass in 18 cases. All patients underwent trans-pedicular fixation and fusion as well. The clinical and radiographic results were evaluated post-operatively. Results All patients underwent surgery safely. The average opera-tive time was 3.8 hours (2.8-5.1 h) and the average blood loss was 817 ml(630-1 800 ml). There were no serious complications such as neurological injury. The average correction was 48? (22?-64?, 56%) for scolio-sis, and 47? (17?-52?, 72%) for kyphosis respectively. All patients were followed up at least 12 months (12-76 months). There was no loss of correction found during follow up and all patients achieved solid fu-sion. At the last follow up, 33 patients (91.7%) were satisfied with the results of revision surgery. Conclusion Revision surgery for failed scoliosis surgery is challenging because of technical difficulties for the procedure and higher risk for neurological injury. Extreme caution must be taken for each patient during pre-operative examination and evaluation. If appropriate surgical procedure including staged anterior re-lease, posterior osteotomy and trans-pedicular fixation is properly selected according individual deformity, the satisfactory results can be achieved.

To study the clinical characteristics and surgical treatment of congenital scoliosis with diastematomyelia, four patients were found to have scoliosis with diastematomyelia by CT and MRI.The first step of surgery was to excise the osteal compartion in spinal cord, the second step was the posterior scoliosis correction and fusion after two weeks. All the patients had successful surgery. The body height of the patients increased 4 75cm and the Cobb angle deceased 43? in average. No complication was found in the nervous system. This method is very effective, and is worth popularizing its application.

Objective To observe the effects of hypoxia on the expression of connective tissue growth factor(CTGF)and matrix metalloproteinase 9(MMP-9)in lung fibroblasts at different time points.Methods Fibroblasts were cultured at hypoxic condition 0,1.5,3,6,12 h respectively.CTGF mRNA and MMP-9 mRNA level were detected in each group by reverse transcription-polymerase chain reaction(RT-PCR).The concen- tration of CTGF and MMP-9 protein in fibroblasts supernatant were determined using enzyme-linked im- munosorbent assay(ELISA).Results Hypoxia stimulated fibroblasts increased the level of CTGF mRNA with- in 1.5 h,and the levels remained at a plateau up to 6 h,and then decreased by 12 h.The level of MMP-9 mRNA increased significantly within 3 h,and the levels kept the trend for increasing.ELISA revealed that the levels of both CTGF and MMP-9 protein/cell in medium conditioned by fibroblasts exposed to hypoxia were maximal at 12 h.The level of MMP in the CTGF-Ab treated groups was significantly decreased compared to the untreated groups.Conclusions These findings suggest that hypoxia stimulates fibroblasts to release CTGF as a mitogen factor,which initiates the fibrosis cascade and airway remodeling by regulating the balance of extracellular ma- trix synthesis and degradation via MMP-9 which is secreted by fibroblast cells in response to CTGF.

Objective To compare the safety,effectiveness and predictability of laser in situ keratomileusis (LASIK) with fem- tosecond laser (IntraLase) and mechanical microkeratome (Moria M2,head 90?m).Design Prospective clinical study.Participant 148 patients (274 eyes) with high myopia received operation of LASIK.Method The patients were assigned to receiving LASIK with corneal flap creation by Intralase femtosecond laser (134 eyes of 76 patients) or Moria 90 keratome (140 eyes of 72 patients),both groups receiving eximer laser ablation with VISX Star S4.Followed-up examinations such as visual acuity,refraction,wavefront aberra- tion,etc.were scheduled for 1 day,1 week,1 month and 3 months postoperatively.Main Outcome Measures Visual acuity,refrac- tion,wavefront aberration,Schirmer test and tear film breakup time(BUT).Results At 3 months after operation,108 eyes (80.6%) of IntraLase group had UCVA better than or equal to BSCVA preoperatively,showing no statistically significant difference to microker- atome group (116 eyes,82.9%,P=0.642).The mean residual spheroequivalent of refraction of IntraLase group was -0.49?0.70D,show- ing no statistically significant difference to microkeratome group (-0.56?0.83D,P=0.448).The mean Schirmer test of Intralase group was 9.5?4.0mm,showing no statistically significant difference to microkeratome group (9.5?7.2mm,P=0.950).The mean BUT of IntraLase group was 7.9?4.3s,showing no statistically significant difference to microkeratome group (8.08?5.48s,P=0.869).The postoperative higher-order aberrations of the IntraLase group was 0.480?0.133?m,lower than that of microkeratome group (0.578?0.169?m,P=0.034). Conclusions Thin-flap LASIK with femtosecond laser and mechanical keratome flap creation are both safe,effective for the correction of high myopia,showing good predictability and stability.Femtosecond laser has slightly better clinical outcomes than microkeratome.

Objective To investigate the influencing factors for eye cyclotorsion and pupil centroid shift during LASIK.Design Non-controlled retrospective case series.Participant 131 patients (262 eyes) with myopia received bilateral LASIK.Methods Eye cy- clotorsion and pupil centroid shift were measured with Custom Vue~(TM) software during operation and compared with age,gender,right or left eye,flap-making method,spherical equivalent (SE),pupil diameter before and during operation.Main Outcome Measures The de- gree of eye cyclotorsion and distance of pupil centroid shift during LASIK.Results The mean eye cyclotorsion during LASIK was 3.07??2.07?(0?-8.6?).The mean pupil centroid shift was 0.33?0.14 mm (0.04-0.51 mm).The eye cyclotorsion was relevant to preoperative pupil size,difference of pupil size before and during operation,and preoperative SE (r=0.188,0.156,0.130,all P7.0 mm was higher than that of with pupil diameter≤7.0mm (3.35??2.17?,2.71??1.89?,P=-0.014).Pupil centroid shift was higher in fight eyes than that in left eyes (0.39?0.12 mm,0.28?0.13 mm,P=0.000).Conclu- sion Eye cyclotorsion and pupil centroid shift during LASIK can be measured with Custom Vue~(TM) system.The eye cyclotorsion may be influenced by the preoperative pupil size.The pupil centroid during LASIK was more significant in the right eyes than in the left eyes.