BACKGROUND: There has been increasing attention in the study of adolescent idiopathic scoliosis (ALS)and bone metabolism, which is accompanied by osteopenia and osteoporosis. Interleukin(IL) -6, a cytokine that strongly promotes bone resorption, participates in the regulation of bone metablism.OBJECTIVE: To explore the relationship between changes of bone mineral density(BMD) and serum IL-6 content in AIS.DESIGN: A controlled non-randomized concurrent study involving patients with AIS and and healthy volunteers.SETTING: The clinic and wards of the department of spinal surgery of a university-affiliated hospital.PARTICIPANTS: Thirty-six patients with AIS(6 males and 30 females aged 12 to 18 years) were treated in the Department of Spinal Surgery, Drum Tower Hospital, Medical College of Nanjing University from July to October 2003, who had a Cobb angle ranging from 34° - 109° and curvature of the thoracic spine. Thirty-six healthy adolescent volunteers(7 males and 29 females within the range of 13 - 18 years old) served as the control group.METHODS: The BMD was measured at L2- L4 and the proximal femur;(including the femoral neck, greater trochanter and Ward' s triangle) by dual-energy X-ray absorptiometry and serum IL-6 determined by enzyme-linked immunosorbent assay(ELISA).MAIN OUTCOME MEASURES: ① BMD of the lumbar spine and femur ② Comparison of serum IL-6 content of all the subjects.RESULTS: The BMD of AIS patients at L2- L4, femoral neck, greater trochanter and Ward' s triangle was 0.79±0. 12, 0.78±0. 12, 0.65± 0. 10, and 0. 69 ± 0. 13 g/cm2, respectively, all significantly lower than the corresponding measurements of the control group(1.09 ± 0. 11, 0.95 ± 0. 11,0. 78 ± 0. 10, and 0. 88 ± 0. 11 g/cm2, respectively, P ＜ 0. 001), whereas the serum IL-6 content in the patients was significantly higher than that in the control subjects ( P ＜ 0. 005). The changes of BMD at the lumbar spine and the three sites of femur were negatively correlated with serum IL-6 in AIS patients( P ＜ 0. 001 ), but not so in the control group( P ＞ 0.05).CONCLUSION: The BMD is decreased and serum IL-6 elevated in patients with AIS, and excessive secretion of IL-6 might be one of the important factors of osteopenia in AIS.

Objective To investigate the significance of monitoring P(c-a)CO2 (the gradients between transcutaneous PCO2 and arterial PCO2) in patients with septic shock.Method 31 patients with early septic shock were enrolled as the study group and 20 patients with stable hemodynamics as the control group from Fab.2013 to Sept.2014 in our Intensive Care Unit (ICU).The patients with septic shock were treated guided by early goal directed therapy (EGDT) within 6 hours since hospitalization.The differences of baseline P(c-a) CO2 levels and other index as arterial lactate (LAC) concentration between two groups and the variations of these indexes after EGDT in the study group were compared respectively.Results The baseline levels of P(c-a)CO2 and LAC in patients with septic shock were significantly higher than in patients of control group: (21.2 ± 10.1) mmHg vs.(7.5 ±4.6), P =0.000, and (4.0±2.4) mmol/ Lvs.(1.6 ± 0.5), P =0.000.The areas under receiver operator characteristic (ROC) curve (AUC) for baselineP(c-a)CO2 and LAC were 0.918 (95％ CI: 0.843-0.992) and 0.840 (95％ CI: 0.719-0.962) respectively.A threshold of 14.0 mmHg for P(c-a)CO2 and 2.1 mmol/L for LAC discriminated patients with septic shock from without shock with the same sensibility of 83.9％ and the same specificity of 90.0％, respectively.With regard to prognosis (Day 28), AUC for baseline P(c-a)CO2 and LAC were 0.739 (95％ CI: 0.562-0.917) and0.702 (95％ CI: 0.514-0.889) respectively.A threshold of 21.5 mmHg for P(c-a) CO2 and 3.9 mmol/L for LAC discriminated survivors from nonsurvivors with the same sensibility of 71.4％ and the same specificity of 70.6％ respectively.31 patients in the study group completed EGDT within 6 hours after the admission, 16 (51.6％) passed EGDT and 13 (81.3％) survived, 15 (48.4％) failed EGDT and 4 (26.7％) survived, and survival rates were significantly different, F =9.314, P =0.004.After EGDT, P(c-a) CO2 (18.8 ± 9.4) mmHg and LAC (3.3 ± 2.4) mmol/Lreduced significantly compared with the baselines, all P =0.000.AUC then for P(c-a) CO2 and LAC were 0.742 (95％ CI: 0.562-0.921) and 0.769 (95％ CI: 0.593-0.945), respectively.A threshold of 18.3 mmHg for P(c-a)CO2 and 3.1 mmol/L for LAC discriminated survivors from nonsurvivors with the same sensibility of 71.4％ and the specificity of 71.4％ and of 76.5％ respectively.P(c-a) CO2 and LAC of patients passed EGDT reduced significantly compared with those failed EGDT: (14.8 ± 7.5) mmHgvs.(23.6±9.6) mmHg (P=0.012)、 (2.5±1.5) mmol/L vs.(4.3±2.9) mmol/L (P=0.038), and so did with their baseline : (14.8±7.5) mmHgvs.(18.0±8.1) mmHg, (P=0.042)、 (2.5±1.5) mmol/Lvs.(3.2±1.8) mmol/L, P=0.043.In patients failed EGDT, P(c-a)CO2 and LAC changed little after EGDT, from (24.6 ± 9.2) to (23.6 ± 9.6) mmHg (P =0.238) and from (4.8 ± 2.5) mmol/L to (4.3 ± 2.9) mmol/L (P =0.629).When baseline levels were compared between patients passed EGDT with those failed EGDT, P(c-a) CO2 was (18.0 ±8.1) mmHg vs.(24.6 ± 9.2) mmHg (P =0.042), LAC was (3.2 ± 1.8) mmol/L vs.(4.8 ± 2.5) mmol/L (P =0.050).Conclusions P(c-a) CO2 ＞ 14.0 mmHg could play a role in recognizing early septic shock.EGDT was an effective therapy for the disease and P(c-a)CO2 level could reflect the efficacy of EGDT.P(c-a)CO2 ＞ 21.5mmHg before EGDT and P(c-a) CO2 ＞ 19.3 mmHg after EGDT both could predict the prognosis of patients with septic shock.All above correlated well with LAC and represented a new efficient technique to assess tissue microperfusion.

OBJECTIVETo introduce the imaging characteristics of moyamoya disease (MMD) using high-resolution magnetic resonance imaging (HR-MRI) and to discuss the role of HR-MRI in differentiating MMD from other intracranial artery diseases, especially intracranial atherosclerotic disease (ICAD).

DATA SOURCESThis review was based on the data in articles published between 2005 and 2015, which were obtained from PubMed. The keywords included HR-MRI, MMD, ICAD, and intracranial artery diseases.

STUDY SELECTIONArticles related to HR-MRI for MMD or other intracranial artery diseases were selected for review.

RESULTSThere are differences between the characteristic patterns of HR-MRI in MMD and ICAD. MMD is associated with inward remodeling, smaller outer diameters, concentric occlusive lesions and homogeneous signal intensity, while ICAD is more likely to be associated with outward remodeling, normal outer diameters, eccentric occlusive lesions, and heterogeneous signal intensity. Other intracranial artery diseases, such as dissection and vasculitis, also have distinctive characteristics in HR-MRI. HR-MRI may become a useful tool for the differential diagnosis of MMD in the future.

CONCLUSIONSHR-MRI of MMD provides a more in-depth understanding of MMD, and it is helpful in evaluating pathological changes in the vessel wall and in differentiating MMD from other intracranial artery steno-occlusive diseases, particularly ICAD.

Animals ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; methods ; Middle Cerebral Artery ; pathology ; Moyamoya Disease ; diagnosis

AIMTo investigate the role of the Chinese herbal medicine Xianhuayin on the reversal of 7,12-dimethylbenz[a]anthracene (DMBA)-induced premalignant mucosal lesions in the oral buccal pouch of golden hamsters.

METHODOLOGYThe animals were randomly divided into a non-diseased control group (n=5) and an experimental group including 50 animals in which the buccal mucosa had been painted with DMBA (0.5% in acetone) to generate an oral mucosa premalignant lesion. Animals in the experimental group were further divided into Xianhuayin-treated group (n=30), untreated premalignant lesion group (n=10) and normal saline (NS)-treated group (n=10). The cheek (buccal) pouch mucosa of the golden hamsters in each group was observed with light and electron microscopy eight weeks after intragastric administration with NS or Xianhuayin.

RESULTSIn the non-diseased control group, the buccal mucosa was keratinized and stratified squamous epithelium under a light microscope. In the untreated premalignant lesion group, variable degrees of epithelial dysplasia was observed. The irregular epithelial mucosa gradually became distinct in the Xianhuayin-treated group. Scanning electronic microscopic (SEM) analysis showed that surface of the cells exhibited honeycomb structures in the hamster of untreated-group. The cells were morphologically irregular, overlapped and loosened in the untreated premalignant lesion group. Most of the cell surface exhibited honeycomb structure in the Xianhuayin-treated group. Transmission electronic microscopic (TEM) analysis showed that buccal mucosal epithelial cells were morphologically regular in the non-diseased control group. Desmosomes and tonofibrils were reduced and the nucleus was morphologically irregular in the untreated premalignant lesion group. In the Xianhuayin-treated group, the widening intercellular gap was gradually reduced, desmosomes and the cells becoming morphologically regular. No significant difference was observed between the hamsters in NS-treated group and those in the untreated premalignant lesion group. Significant therapeutic efficacy was observed in the group receiving Xianhuayin.

CONCLUSIONXianhuayin is effective in the reversal of DMBA-induced premalignant lesions in the buccal pouch of golden hamsters.

9,10-Dimethyl-1,2-benzanthracene ; adverse effects ; Amomum ; Animals ; Anticarcinogenic Agents ; administration & dosage ; therapeutic use ; Carcinogens ; Carthamus tinctorius ; Cell Nucleus ; drug effects ; Cricetinae ; Desmosomes ; drug effects ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Epithelial Cells ; drug effects ; Epithelium ; drug effects ; Glycyrrhiza ; Hyperplasia ; Intercellular Junctions ; drug effects ; Intermediate Filaments ; drug effects ; Keratins ; Mesocricetus ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Mouth Mucosa ; drug effects ; pathology ; Mouth Neoplasms ; prevention & control ; Philodendron ; Poria ; Precancerous Conditions ; prevention & control ; Random Allocation ; Sodium Chloride

OBJECTIVETo analyze the postoperative short-term and long-term outcomes in the management of type I esophageal atresia, and to explore the ideal operative strategy.

METHODSClinical data of 22 patients with type I esophageal atresia treated from January 2005 to September 2012 were retrospectively reviewed. Of 22 patients, 6 patients gave up the treatment. Two underwent primary repair after birth. Of 14 patients undergoing cervical esophagostomy and gastrostomy, 8 patients received esophageal replacement. Postoperative short-term and long-term complications, nutritional state and neurodevelopment were studied on above 10 children with radical operations.

RESULTSOf 10 patients with radical operation, the short-term complications were hydrothorax in 1 case, anastomotic leakage in 4, dumping syndrome in 1, anastomotic stricture in 1. The long-term complications were esophageal stricture in 2 cases, and repeated respiratory infection in 3. These complications could be managed successfully. The postoperative follow-up duration ranged from 2 to 62 months. Two cases were lost during follow-up after 2 years. Weight-for-age was normal in 2 patients, mild malnutrition in 5 patients, and moderate malnutrition in 1 patients. Neurodevelopment is significantly delayed as compared to normal children.

CONCLUSIONSOperative strategy should be chosen according to the distance between proximal and distal esophagus in the treatment of type I esophageal atresia. The efficacy of radical operation is relative satisfactory in terms of short-term and long-term complications and the quality of life.

Child ; Esophageal Atresia ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Quality of Life ; Retrospective Studies

OBJECTIVETo establish a computer-aided three-dimensional visualization operation simulation system based on Mimics and Unigraphics NX software to provide reliable evidence for accurate preoperative surgical planning.

METHODSThe preoperative CT scans of 5 patients with intertrochanteric fractures were used for three-dimensional reconstruction of intertrochanteric fractures using Mimics software. Three-dimensional reconstruction of the surgical instruments was carried out using the modeling function of Unigraphics NX software, whose assembly function was used to visualize the simulates internal fixations of intertrochanteric fractures with dynamic hip screw (DHS) system. The operative procedures simulated by Unigraphics NX were analyzed preoperatively.

RESULTSThe virtual surgery procedures were clearly and vividly visualized in three dimensions. The fracture reduction and surgical effects could be predicted using this system.

CONCLUSIONSThis system of three-dimensional visualization of virtual surgery for intertrochanteric fractures has important values in surgical planning, risk assessment and clinical training, and can help improve the reliability and outcome of orthopedic surgery.

Bone Screws ; Computer Simulation ; Female ; Hip Fractures ; surgery ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Software ; Surgery, Computer-Assisted ; Tomography, X-Ray Computed ; User-Computer Interface

Objective To evaluate the prevalence of depression,anxiety and suicide behavior in patients suffering from tuberculosis in Hangzhou and to explore their relationship with medication adherence. Methods Demographic characteristics,self-rating anxiety scale (SAS),the center for epidemiological studies -depression (CESD),social support rating scale (SSRS),suicide behavior information and the morisky medication adherence scale (MMAS)were investigated in 973 tuberculosis patients who were selected by systematic random sampling.Results The means of SAS and CESD were 39.71 ±8.30 and 14.16 ±10.77 respectively,which were both higher than the norms(P<0.01).Totally 102 (10.48%)patients had anxiety and 333 (34.22%)were depressed.Out of 973 patients,60 (6.17%)reported suicide ideation after tuberculosis diagnosis.The prevalence of non -adherence was 20.55%,which was defined with MMAS score above one and more.The non -adherence group had higher anxiety,depression and suicide ideation prevalence than the adherence group (15.50%vs.9.18%,46.50%vs.30.66%,11.00%vs.4.92%respectively,P<0.01).The mean score of SSRS,subjective support,objective support and utilization of support in the non-adherence group were 30.71 ±5.15,4.61 ±2.07,19.74 ±4.55 and 6.34 ±1.93 respectively,which were 34.06 ±7.39,6.62 ± 2.27,20.67 ±5.27 and 6.77 ±2.23 in the adherence group respectively.SSRS and its three dimension scores were significantly lower in the non-adherence group than that in the adherence group (P<0.01).Conclusion These findings show a quite serious situation of psychological problems of tuberculosis patients in Hangzhou and suggest psychological intervention should be included in adherence intervention.

OBJECTIVE: To estimate the biological dose by the chromosome aberration analysis in a victim suffered in the radioactive source-loss accident in Nanjing City. METHODS: Peripheral blood sample of the victim was collected 6 days after radioactive exposure. Individual radioactive biological dose was estimated by identifying the aberration of the dicentrics plus centric rings in the metaphase chromosome of cells. The distribution of chromosome aberration was tested by the Poisson distribution. Impure Poisson distribution was used to estimate the radiation dose. RESULTS: Among the 353 cells observed at metaphase,75 aberration of dicentrics plus centric rings were found,43 cells had 1 aberration and 7 cells had 2 aberrations. Moreover,there were 3 multi-aberration cells with 3,4 and 11 aberrations respectively. The average individual radiation dose was estimated to be 1. 52 Gy,which was consistent with the clinical diagnosis as mild acute bone marrow radiation disease. The Poisson distribution u test revealed that the patient suffered from nonhomogeneous radiation.By the impure Poisson distribution test,the radiation exposure proportion of the whole body was estimated to be 55% and the average dose was 3. 02 Gy. CONCLUSION: The biological dose estimation was successfully performed,the results showed that this was a case of nonhomogeneous irradiation.

Buxrugulosides A-E, four lignan glycosides (1-4) and a protocatechuate derivative (5) featuring a rare (N, N-diethyl)methyl amino group at aromatic rings, were obtained from the aerial parts of Buxus rugulosa, which is famous for treating coronary heart disease. Their structures including absolute configurations were elucidated by HRMS, 1D and 2D NMR, and by comparing their CD data with previous reports. Compound 1 was a rare sesquilignan, and all of these compounds were the first example of lignans with (N, N-diethyl)methyl amino group.