To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated. Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all <0.001).In the ultra-early stage after surgery,HCR was significantly higher in the KAES group(<0.001),whereas in the early and sub-early stage,HCR showed no significant differences(all >0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all >0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all >0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(=0.413). Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.
Basal Ganglia ; Humans ; Intracranial Hemorrhage, Hypertensive ; Retrospective Studies ; Treatment Outcome ; Urokinase-Type Plasminogen Activator

OBJECTIVETo study technique and clinical therapeutic effects of internal fixation with three-column plates for the treatment of complex tibial plateau fractures through antero-midline and postero-medial approaches.

METHODSFrom January 2010 to December 2012, 28 patients with complex tibial plateau fractures were treated with internal fixation using three-column plates through antero-midline and postero-medial approaches. There were 17 males and 11 females, with an average age of 45.3 years old (ranged, 28 to 64 years old). Twelve patients had injuries in the left side and 16 patients had injuries in the right side. According to Schatzker classification, 12 patients were type V, 16 patients were type VI. According to three-column classification, all the patients had injuries of lateral, medial and posterior columns. The mean interval from injury to operation was 9.4 days (ranged, 6 to 15 days). The main clinical symptoms were knee joint swelling, deformity and limitation of motion before operation. The X-ray and CT showed all patients had complex tibial plateau fractures, which involved in the lateral, medial and posterior columns. The therapeutic effects were evaluated by fracture healing time, hospital for special surgery knee score (HSS) at one year after operation. The indexes such as tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FfA) were compared between immediate postoperation and one year after operation.

RESULTSAll incisions primarily healed without postoperative complications such as infection and cutaneous necrosis. All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of 18.1 months. The bone union time ranged from 5 to 10 months (mean, 7.8 months) after operation. Knee joint swelling and pain disappeared after bony union, and joint function completely recovered. The results of hospital for special surgery knee score (HSS) was 27.81 ± 2.17 in pain, 19.52 ± 2.05 in function,15.82 ± 1.73 in passive range of motion, 8.51 ± 1.32 in muscle strength, 8.33 ± 1.08 in flexion deformity, 9.36 ± 0.52 in joint stability, and the total mean score was 89.35 ± 3.19. According to results of HSS, 20 patients got an excellent result, 5 good,2 fair and 1 poor. There were no significant differences in tibial plateau-tibial shaft angle (TPA), posterior slope angle (PA) and femoral-tibial angle (FTA) between immediate postoperation and one year after operation.

CONCLUSIONThree-column plate internal fixation for the treatment of complex tibial plateau fractures through antero-midline and posteromedial approaches is effective to achieve anatomic reduction,rigid internal fixation and early functional exercise.

Adult ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; physiopathology ; surgery

OBJECTIVETo introduce exponent curve model methods in the study of the hepatitis B vaccine antibody level.

METHODSAfter the China made vaccine of hepatitis B DNA recombinant yeast derived vaccine (YDV) had been carried out for 5 years, data on the anti-HBsAg's titer were used to construct an exponent curve model. When the vaccination program had been carried out for 8 years, the predicating results of the model were further tested by observed number.

RESULTSThe exponent curve model was Y = 165.67 exp (-0.019X) and the R(2) was 0.98. After 8 years, the practical observed number became 35 mIU/ml, and the predicating result of the model was 27 mIU/ml, 8 mIU/ml lower than the observed number. When the vaccine had been carried out for 12 years, the predicating results of the model became 10.74 mIU/ml, still higher than 10 mIU/ml but was still in the effective range.

CONCLUSIONAn exponent curve model could be constructed, as long as the data of the antibody's titer was in accordance with the tendency of exponent curve. The model could be used to predict the persistence lever of vaccine antibody under certain conditions. The results showed that after 8 years, the predicting results of the model were reliably lower than the observed number.

Follow-Up Studies ; Hepatitis B ; immunology ; prevention & control ; Hepatitis B Antibodies ; blood ; Hepatitis B Vaccines ; immunology ; Humans ; Models, Biological ; Saccharomyces cerevisiae ; genetics ; Vaccination ; Vaccines, DNA ; immunology ; Vaccines, Synthetic ; immunology

Objective To evaluate the effectiveness of biofeedback in preventing chronic daily headaches. Methods One hundred patients experiencing daily headaches were randomly divided into a biofeedback group ( n=50) and a drug therapy group (n=50). The patients in the drug therapy groupwere administered a predetermined course of medication. Those in the biofeedback group were given 30 minutes of biofeedback therapy twice a week for 8 weeks, followed by 10 months of intensive therapy once a month. The headache frequency, duration of headache at-tacks, days of using acute pain medication and any other adverse events were recorded 3, 6 and 12 months after the treatment. Results The patients in the biofeedback group had significantly less-frequent headaches, shorter headache attacks and fewer days of using acute pain medications. Conclusion Compared to drug therapy, biofeed-back can prevent chronic daily headachesmore safely and effectively.

Objective The immunotoxins generated by conjugating monoclonal antibody (mAb) and a certain toxin play an important and promising role in treating hematopoietic malignancies. However, most of the toxins used for the conjugation are toxic proteins, which are immunogenic in the patients. Norcantharidin (NCTD) is a small molecule toxin without immunogenicity, and thus has become a potential new drug for hematopoietic cancers. In this study, we prepared immunotoxin 2E8-NCTD by using the ZCH-4-2E8 cells produced in the laboratory of our hospital, and then detected its targeting effect against CD+19 lymphoid malignant Nalm-6 cells in vitro.Methods 2E8 mAb was obtained from mouse ascites and purified by gel chromatography. After its purity was checked by SDS-PAGE, immunotoxin 2E8-NCTD was generated by conjugating CD19 mAb with NCTD using activated ester method. The binding activity of the immunoconjugate to CD19 antigens on cell surface, and the expression levels of the CD19 antigens on Nalm-6 and K562 cells were determined by flow cytometry. The inhibitory effects of PBS, purified 2E8 mAb, NCTD, and immunotoxin 2E8-NCTD on the cell growth of either Nalm-6 or K562 cells were then compared.Results The purity of the 2E8 mAb was higher than 99% demonstrated by SDS-PAGE assay. 2E8 mAb was detected on the surface of 99.34% of the Nalm-6 cells, while on only 0.98% of the K562. The newly generated immunotoxin had a positive rate of 99.90% on the Nalm-6 with slightly reduced binding activity. Both 2E8-NCTD and NCTD significantly inhibited the growth of CD+19 Nalm-6 cells (P < 0. 001 ), while the purified 2E8 mAb did not show any significant influences on the growth of the same cell line ( P > 0.05 ). Meanwhile, no significant inhibitory effects on the CD-19 K562 cells were identified in the 2E8-NCTD, 2E8 mAb, or control groups, indicating a significant targeting effect of 2E8-NCTD against Nalm-6 cells.Conclusions The immunotoxin 2E8-NCTD can be synthesized by activated ester method. It has target killing effects on CD+19 Nalm-6 leukemia cells in vitro.

OBJECTIVETo investigate the expression of cyclooxygenase-2 (COX-2) in different prostate cancer (PCa) cell lines and its role in the acquisition of invasive and metastatic potentials of PCa.

METHODSWe detected the expressions of COX-2 in prostate cancer cell lines LNCaP, C4-2, IF11, IA8 and PC-3 with different metastatic potentials by Western blotting and RT-PCR, and analyzed their roles in the invasion and metastasis of different PCa cell lines.

RESULTSWestern blotting and RT-PCR showed that the expression of the COX-2 protein was high in PC-3, but absent in IF11, IA8, LNCaP and C4-2 (P < 0.05), and it was consistent with the expression of COX-2 mRNA.

CONCLUSIONCOX-2 expresses differently in PCa cell lines with different metastatic potentials. The overexpression of COX-2 may be associated with the high invasion and metastasis of PC-3, but not with the metastasis of other cell lines.

Cell Line, Tumor ; Cyclooxygenase 2 ; metabolism ; Humans ; Male ; Neoplasm Metastasis ; Prostatic Neoplasms ; metabolism ; pathology ; RNA, Messenger ; genetics

Objective To investigate the flexibility of both the covered stents specially designed for use in intracranial vasculature and the delivering system in passing through the bone tube and the physiological curves of the cranial internal carotid artery(CICA)to reach the targeted area,the performance (adherence)of the covered stents in occluding vascular wall diseases and the impact on the vascular branches of the covered segment.Methods The covered stents specially designed for use in intracranial vaseulature were used to treat 13 patients with CICA diseases using endovascular techniques.There were 4 huge pseudoaneurysms,4 giant aneurysms,3 small wide-necked aneurysms,1 giant pseudoaneurysm with concurrent internal carotid cavernous fistula(CCF),and 1 CCF.Prior to the detachment of the covered stents,balloon occlusion test(BOT)of the internal carotid artery on the diseased side and whole-brain digital subtraction angiography(DSA)were performed in all the patients.Three to 16 months following procedure,DSA and clinical follow-ups were performed.Results Thirteen patients all tolerated the BOT well with the DSA demonstrating well-opened anterior and posterior communicating arteries.The covered stents and the delivering systems all successfully passed CICA to reach the targeted diseased area,with the diseased segments of the internal carotid artery including C3—C4 in 4 cases,C4—C5 in 4 and C6—C7 in 5.Immediately following the detachment of the covered stents,DSA demonstrated that 7 aneurysms were completely occluded,4 aneurysms had slight endoleak,and 1 CCF had markedly-decreased blood flow through the fistula.In the patient with concurrent pseudoaneurysm and CCF,the pseudoaneurysm disappeared and the blood flow through the fistula was markedly-reduced immediately following the stenting procedure.Apart from one patient with aneurysmal subarachnoid hemorrhage who died due to extensive vascular spasm on the 9th day following the stenting procedure,all the other 12 patients had unobstructed stented vessels on the follow-up DSA images,with 2 demonstrating slight stenosis.In the 6 patients with post-procedure endoleak,DSA showed that the endoleak in 4 patients had disappeared,one endoleak disappeared following the second stenting,and one CCF remained low-flow fistula.There was no sequela related to the occlusion of branches in the covered arterial segment.Conclusion The covered stents specially designed for use in the intracranial vasculature and the delivering system are both flexible enough to pass the tortuous CICA to reach the intracranial diseased artery,and are effective in managing CICA diseases.Further follow-up is still needed to determine the long-term effect of the covered stents,and the adherence of the covered stents needs further investigation.

Objective To explore the problems of microsurgical treatment of multiple intracranial aneurysms with regard to the indications,surgical timing,operative approaches and the prevention of complications, and improve their diagnoses and treatments. Methods We retrospectively reviewed the data of 33 patients with multiple intracranial aneurysms admitted to our hospital from Jan.2000 to Dec.2008 and their clinical manifestations,imaging features and microsurgical treatments were summarized. Results In the 33 cases of multiple intracranial aneurysms,the male-to-female sex ratio was 1:1.75 and the average age at onset of symptoms was 56.52.Twenty-four patients showed good postoperative prognosis(Glasgow Outcome Scale IV-V) with 2 deaths.Conclusion Individual treatment should be adopted in the treatment of differently localized multiple intracranial aneurysms with different sizes and clinical classifications,and the utilization of temporary blockade and ultrasound during the operation can improve the therapeutic effects and reduce the postoperative complication rates.

OBJECTIVETo access the efficacy of posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury using CYL-pedicle screw.

METHODSFrom September 2007 to December 2009, 74 cases who underwent posterior short-segment fixation for single level thoracolumbar burst fractures (Denis burst fracture type A, B, C) without spinal injury were analyzed retrospectively. There were 53 male and 21 female, mean age was (39 ± 15) years. Neither of them treated with direct decompression, grafting or fusion. Changes in the anterior vertebral height ratio, vertebral wedge angle, Cobb angle, regional angle were measured preoperatively, postoperatively, before implant removal, and at final follow-up to find the statistic difference. Pain status and work status were evaluated using Denis criterion. The incidence of incision infection, screw breakage, iatrogenic spinal injury were recorded as well.

RESULTSThe time of follow-up was (20 ± 11) months, no significant change was noted in anterior vertebral height ratio and vertebral wedge angle (P > 0.05). A significant loss was noted in Cobb angle and regional angle, which were 9.8° ± 5.1° and 9.1° ± 4.8° respectively (t = 2.48 and 3.41, P < 0.05). Comparing with the patients with Cobb angle > 20°, the patients with Cobb angle ≤ 20° had better pain scale rate (χ(2) = 4.16, P = 0.04) and work scale rate (χ(2) = 24.34, P < 0.01). There were incision infection in 1 case, screw breakage in 1, screw loose in 1, and no iatrogenic spinal injury.

CONCLUSIONSCYL-pedicle screw could be successfully used in posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury based on radiographic and clinic outcomes.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; Young Adult

In the context of internationalization of education,the military graduate education concepts and models also come to change,and opportunities and challenges coexist.In this article,the challenges and problems of army medical college graduate education were mentioned and analyzed,and the exploration and attempt of graduate education in the process of international were summarized.