Objective To examine the morphological changes in the cervical intervertebral foramen during axial rotation of cervical spine and explore its clinical significance for the diagnosis and treatment of cervical degenerative disease. Methods Ten healthy volunteers (5 male, 5 female) were subjected to transectional scan by multislice spiral computed tomography of cervical spine from the upper edge of C 3 vertebra to the lower edge of C 7 vertebra. On the 45 degree oblique reconstructions of C 3～4, C 4～5, C 5～6 and C 6～7 intervertebral foramina, four parameters were measured, including foraminal height, foraminal width (both superior and inferior), and cross-sectional area of the foramen. Statistic analyses were performed to examine the morphological changes in the cervical intervertebral foramen. Results It was found that the foraminal cross-sectional area was decreased on the side of rotation,and increased on the opposite side of rotation. Significant correlation was revealed between the variation rate of the C 3～4 intervertebral foramen cross-sectional area and the rotational degree between C 3 and C 4. Conclusion Morphologic changes were found in the cervical intervertebral foramen due to axial rotation. The correlation between the cross-sectional foraminal areas with the degrees of rotation of the vertebrae was statistically significant. The results of the test have the clinical significance on the prevention, diagnosis and treatment of the cervical degenerative diseases, especially of the radiculopathy.

Hepatic stem cells transplantation might be an important treatment strategy for patients with end stage liver diseases and related research has become a focus of recent studies.Hepatic stem cells of different sources have great therapeutic potential in clinical practice,but much research still need to be done before it can be used as a routine method in clinical practice. This review discusses the characteristics of hepatic stem cells and its role in liver regeneration after liver damage.

In order to gain the strain which has high growth vigor and whose biomass concentration satisfy further fermentation to produce arachidonic acid, we took the yield of microbes olein and arachidonic acid as evaluative index, adopted twice ultraviolet mutation, determined the time of ultraviolet irradiation by single factor expriment, and then the content of the arachidonic acid was measured by GC. The results of this experiment showed that the power of viltalight lamp was 20 W, exposure distance was 30 cm and exposure time was 80 s, lethality of spores of Mortierella isabellina was 76.4%. After twice ultraviolet mutation and repeatedly screen, a mutation of Mortierella isabellina Z80s2-109 whose arachidonic acid concentration in biomass were 3.77 times of the control strains was obtained and genetic stability.

Objective To observe the ultrasonographic features of local chest wall tumor recurrence after mastectomy for breast cancer and its clinical and histopathological characteristics. Methods The ultrasonographic features, clinical and histopathological characteristics of 27 patients with local chest wall tumor recurrence after mastectomy confirmed histopathologically were retrospectively reviewed. Results The disease-free intervals of twenty-seven patients ranged from 3 to 129 months [mean (31.9±31.4) months]. Most of the recurrence(18/27, 66.7%) occurred within 3 years after mastectomy. The clinical manifestations were:7 cases (7/27, 25.9%) with regional skin redness and swelling, red rash or ulceration on chest wall associated with or without palpable mass, 20 cases(20/27, 74.1%) with chest wall palpable masses without obvious skin change. On ultrasonography, 2 cases showed diffuse inifltrative type with ill-deifned inhomogeneous hypoechoic lesion and skin thickening. And twenty-ifve cases(43 lesions) showed mass type with a lesion size range of 5.4-114.7 mm [mean (24.4±21.6) mm]. Among them, 32 lesions were located near to the operation incision scar, 36 involved muscle layer, 38 were hypoechoic, 31 had irregular shape, 24 had indistinct margin, and 31 had blood lfow signal. In addition, calciifcation, halo, and taller-than-wide shape were absent in all 43 lesions. Conclusions The tumor recurrence often occurred within 3 years after mastectomy in high-risk patients. Ultrasonographic feature of chest wall recurrent lesion is of great value in the diagnosis.

Objective To build a normal value of serum sex hormone in the healthy children in favour of the diagnosis of children precocious puberty and the evaluation of the growth of the children.Method Serum of 462 healthy children(aged from 1 month to 14 years;205 females,257 males)was collected,and the level of testosterone(T) and 17-estradiol(E2).Results There were no significant deviation in the levels of E2 of deferent genders between 1-12 months,but the level of T in boys and girls were obviously different.The puberty of boys was la-ter than girls.There was no significant deviation in the level of E2 of the boys in different periods,but the levels of T in boys at different ages were obviously different.Conclusions With the improvement the detection methods,the normal values of the serum sex hormone in healthy children have been changing.It is helpful for diagnosis of children precocious puberty by rebuilding normal values of T and E2 .

Objective To evaluate the accuracy of bispectral index (BIS) in predicting outcomes in patients with cerebral hemorrhage.Methods A total of 103 patients of either sex with acute cerebral hemorrhage,aged 18-77 yr,with body mass index of 17-29 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing craniotomy for evacuation of hematoma,were enrolled in this prospective study.BIS electrodes were adhered to the forehead of patients,and the BIS value was continuously recorded for 20 min.The maximum BIS value (BISmax) and minimum BIS value (BISmin) were recorded,and the mean BIS value (BISmean) was calculated.The patients were divided into 2 groups according to Glasgow Outcome Scale (GOS) scores assessed at 6 months after surgery:good outcome group (GOS score≥ 3) and poor outcome group (GOS score 1 or 2).The receiver operating characteristic curve of BIS in predicting outcomes was plotted,and the area under the curve (AUC) and 95％ confidential interval (CI) were calculated.The best cut point and sensitivity and specificity were calculated according to the BIS value when Youden index reached the maximal value.Results The AUC (95％ CI) for BISmax in predicting outcomes was 0.903 (0.830-0.976),the best cut point 79,the sensitivity 84％,the specificity 86％,and Youden index 0.695.The AUC (95％ CI) tor BISmin in predicting outcomes was 0.841 (0.760-0.921),the best cut point 43,the sensitivity 86％,the specificity 71％,and Youden index 0.577.The AUC (95％ CI) for BISmean in predicting outcomes w() 0.883 (0.800-0.958),the best cut point 60,the sensitivity 90％,the specificity 76％,and Youden index 0 562.Conclusion BIS can accurately predict outcomes in patients with acute cerebral hemoorrhage,and BISmax provides the highest accuracy.

Objective To analyse the effective rate and adverse effect of only levetiracetam (LEV) versus LEV plus other drugs in the treatment of middle and old aged patients with partial seizures (PS) and secondary generalized tonic-clonic seizure (SGTCS).Methods The self-control study was used and 59 elderly patients with PS and SGTCS were treated with LEV single or plus drug (therapeutic dose was 1000-2000 mg/d,bid).The effective rate and the side effects of LEV were observed and compared between LEV single and plus drug or between the patients with only epilepsy versus epilepsy plus other diseases,respectively.Results The effective ratios at the end of 3,6,9and 12 months after LEV treatment were 76.2％,70.6％,64.3％ and 66.7％,respectively and there were no significant difference among above time points (x2=1.911,P＞0.05).A chi-square test showed that the differences in effective ratios were not statistically significant (P＞ 0.05) between single and combination of drugs (x2 =1.437) and between two groups of patients at the end of 12 months.Clinical effect of LEV showed no remarkable difference between different types of epilepsy at the end of 6 months (x2 =1.315,P＞0.05)and 12 months(x2 =2.700,P＞0.05).The control ratio of epileptic attack was higher in single LEV than in combination drugs (x2 =10.83,P＜0.05).The total side effects were 13.6％,including somnolence,weakness,anorexia,headache,irritability and forgetfulness.Conclusions The curative effects of levetiracetam single or in combination are definite,stable and continuous for PS and SGTCS,especially in combination with other diseases.

Objective To investigate the clinical effects of continuous 3-in-1 femoral nerve block with stimulating catheters for patient controlled regional anesthesia(PCRA) in elderly patients after unilateral total knee replacement (TKR)surgery.Methods Thirty ASA Ⅰ - Ⅱ elderly patients wererandomly divided into two groups: FB group and Ⅳ group.FB group received continuous 3-in-1 femoral nerve block for postoperative analgesia with 0.2% ropivacaine plus 0.1 μg/ml sufentanil continuous infusion at 5 ml/h plus PCA boluses (1.0 ml/15 min).Ⅳ group received continuous intravenous analgesia with 1 μg/ml sufentanil plus 0.04 mg/ml tropisetron hydrochloride at 2 ml/h plus PCA boluses (0.5 ml/15 min).All patients were maintained analgesia for 48 hours.Results In FB group, the visual analogue scale(VAS) scores were 1.3 ±1.1, 1.2 ± 1.0, 1.1±0.9, 1.1 ± 1.0,1.0±0.9 at 4, 8, 12, 24, 48 hours after surgery under rest status respectively and were 3.04±1.4,2.3±1.3 at 24, 48 hours after surgery in active function training.These parameters in Ⅳ group were 4.0±1.6, 3.5±1.6, 3.2±1.4, 3.0±1.3, 2.5±1.2, 4.7±1.5 and 3.3±1.5 respectively, which were significantly different compared with FB group (t=5.358, 4.707, 4.852, 3.784, 3.743, 3.254,1.932,all P<0.05 or P<0.01).The incidence of nausea was higher in IV group than in FB group(P = 0.0022).Postoperative satisfaction ratings was higher (χ2 =41.1 ,P<0.01) and the total morphine use for 48 hours after operation was less(uc=2.412, P<0.01) in FB group than in Ⅳ group.Conclusions After TKR surgery, the continuous 3-in-1 femoral nerve block with stimulating catheters is an effective method with better pain relief,fewer side effects and higher satisfaction ratings in the elderly.

Objective To investigate the expression of HPV-DNA and p16,Ki-67 proteins in intraepithelial lesion of cervix (CIN) so as to provide the aluable evidence for the early clinical diagnosis and genetic therapy of the CIN.Methods Hybrid capture2 was used to detect HPV DNA in 35 cases of CIN Ⅰ,44 cases of CIN Ⅱ,and 20 cases of CIN Ⅲ.Immunohistochemical MaxVision was used to research the expression of p16 and Ki-67 protein in CIN Ⅰ,CIN Ⅱ and CIN Ⅲ.The results were analyzed with clinicopathological factors.Results Positive expression rates of HPV-DNA were 31.4 ％ (11/35),63.6 ％ (28/44),85.0 ％ (17/20) in CIN Ⅰ,CIN Ⅱ and CIN Ⅲ,respectively.The expression rates of p16 in the three groups were 65.7 ％ (23/35),97.7 ％ (43/44),100.0 ％ (20/20),there were statistically significant difference (x2 =21.30,P =0.00).The expression rates of Ki-67 in the three groups were 77.1％ (27/35),79.5 ％ (35/44),95.0 ％ (19/20),there were no difference (x2 =3.00,P =0.22).Conclusions HPV infection is closely related to the occurrence and development of CIN.p16,Ki-67 can be used as objective marks in diagnosis of CIN.

Objective To investigate the management status of loaner surgical instruments,and evaluate the effect of plan-do-check-act cycle (PDCA)quality control on loaner surgical instrument management.Methods From July 2011 to June 2012,8 965 pieces of loaner surgical instruments before adopting PDCA quality control management was as control group;from July 2012 to June 2013,8 564 pieces of loaner surgical instruments adopting PDCA quality control was as ob-servation group.The defects of loaner surgical instruments during application process and effect of PDCA quality control on loaner surgical instrument management were analyzed.Results There were many problems in checking-tracking,cleaning quality and company personnel of loaner surgical instruments.The qualified rate of observation group was higher than that of control group(99.36% vs 96.27%)(χ2 =194.74,P <0.01).The main causes for unqualification of observation group were unqualified cleaning (n=21 ,38.18%)and incomplete function of instruments(n=8,14.55%);while the main causes for unqualification of control group were the loss of instruments(n=81,24.25%),lack of monitor and record (n=71, 21.26%),unqualified cleaning(n=55,16.47%)and the soaking of package(n=54,16.17%).Conclusion PDCA quality control is an effective method for loaner surgical instruments management,it is helpful for building long-term effective quali-ty control system for loaner surgical instruments,and make loaner surgical instrument management more scientific,system-atic,and standard.