Objective To investigate the anatomic relationship between the upper thoracic vertebrae and adjacent structures in anterior approach of upper thoracic spine, an anatomy study was conducted and its clinical significance was evaluated. Methods Twenty upper thoracic spine specimens of adult human cadaver were exposed, measured and studied for their anatomic landmarks. The origin, course of the recurrent laryngeal nerve, thoracic duct and blood vessels and their relationship were measured and analyzed. The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and compared. Results The right recurrent laryngeal nerve reaches the tracheo-esophageal groove at the level of C6-7 disc in 55% of the specimens and derives from vagus nerve at the level of T1,2. The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 75% of the specimens and among them, more than 50% up to T1 level. The left brachiocephalic vein is at T3 in 55% of the specimens; and the aortic arch is at T3-4 disc in 80% of the specimens. The anterior aspect of T3 can be easily exposed through a modified anterior approach to the upper thoracic vertebrae in only 45% of the specimens(9), compared with outside space of the brachiocephalic trunk(between the right brachiocephalic vein and the brachiocephalic trunk and left brachiocephalic vein) in 95% of the specimens (19). Conclusion Surgical approach through outside space of the brachiocephalic trunk is simple and adequate to expose the T3,4 vertebra body and can get more exposed space of 0.5-1 of the vertebra body than through inner space of the brachiocephalic trunk and can be utilized selectively during anterior upper thoracic spine surgery. Attention should be paid to avoid injury of vagus nerve in the middle, right recurrent laryngeal nerve on the right and thoracic duct on the left, respectively.

Objective To investigate the procedure of anterior thoracic corpectomy and the surgical outcomes of upper thoracic spine tumors by the right space of the ascending aorta and the right space of the brachiocephalic artery. Methods 12 patients underwent surgery between June 2000 and January 2006. There were 8 cases of primary tumors and 4 metastatic carcinomas, 4 cases of tumor in T3 and 6 cases in T4 and 3 cases in T3,4. The anterior modified transmanubrium approach was made. After the exposure of the tumor through the right space of the ascending aorta and the right space of the brachiocephalic artery, the involved vertebral body and contiguous discs were resected, the spinal cord was decompressed. Curettage was performed in 3 cases for other tumors, en bloc vertebrectomies were performed. As a body replacement, in case of benign disease autogenous bone graft harvested from the dorsal iliac crest was used, and for malignant bone tumors using bone cement. To secure the strut, anterior cervical titanium alloy plates were used until T5. Neurological status was graded according to Frankel grading system. Results 6 cases of bradycardia and hypotension or increasing airway resistance occurred intraoperatively. The mean follow-up period was 28.6 months (range 4-66 months). 3 patients with autogenous bone graft had bone union 6 months postoperatively. According to Frankel grading system, 1 patient improved from grade A preoperation to B postoperation, while another patient from B to C; of the 5 cases with grade C preoperation, 4 patients improved to D postoperation and 1 patient to E; 4 patients improved from D to E; 1 patient with grade E left unchanged. 3 patients died from general metastasis and failure 10-20 months postoperatively. One patient with giant cell tumor recurred 10 months postoperatively. Conclusion Clear exposure and satisfactory outcome can be obtained by the use of the right space of the ascending aorta and the right space of the brachiocephalic artery; it is especially indicated to the upper thoracic spine T3 and T4 tumors, where the spinal compression is located anteriorly.

Objective To evaluate the value of ultrasound-measured changes in diaphragmatic excursion (DE) in predicting successful weaning from mechanical ventilation during the spontaneous breathing trial (SBT).Methods Sixty-three patients of both sexes,who were mechanically ventilated for more than 24 h and screened for ascertained readiness to wean,aged 45-64 yr,were enrolled in the study.Bilateral DE was measured using ultrasound at 0,10 and 30 min of SBT.The patients who successfully completed 30 min of SBT were extubated.The patients were divided into either success group or failure group according to whether or not weaning was successful.Receiver operating characteristic (ROC) curves were used to evaluate the value of bilateral △DE30-10 in predicting successful weaning.Results There were 48 cases in success group and 15 cases in failure group.Bilateral △DE30-10 was significantly higher in failure group than in success group (P＜0.05).The area under the ROC curves of the right △DE30-10 in predicting successful weaning was 0.958,＜0.175 cm was used to predict successful weaning,and the sensitivity and specificity were 93.3％ and 87.5％,respectively.The area under the ROC curves of the left △DE30-10 in predicting successful weaning was 0.903,＜0.275 cm was used to predict successful weaning,and the sensitivity and specificity were 80.0％ and 89.6％,respectively.Conclusion The fight △DE30-10 measured using ultrasound can serve as an assistant index in predicting successful weaning from mechanical ventilation during SBT.

Adult ; Female ; Humans ; Male ; Mercury Poisoning ; diagnosis ; therapy ; Middle Aged

Humans ; Male ; Middle Aged ; Silicosis ; surgery

[ABSTRACT]AIM:Toinvestigatetheroleofcysteine-rich61(Cyr61/CNN1)inproliferationandmigrationof bone marrow mesenchymal stem cells ( BMSCs ) .METHODS: The lentiviral vector carrying CCN 1 ( Lenti-GFP-CCN1 ) was constructed and then transfected into the rat BMSCs .The cells were divided into non-transfection group , transfection group ( transfected with Lenti-GFP-CCN1 ) and negative control group ( Lenti-GFP ) .The fluorescence intensity of the transfected BMSCs was observed under inverted fluorescence microscope .The effects of CCN1 on the proliferation and mi-gration of BMSCs were detected by MTT assay and scratch wound healing assay .RESULTS:The proliferation of BMSCs transfected with Lenti-GFP CCN1 had no significant difference compared with negative control group and control group .The width/thickness ratio of migrated BMSCs in wound healing was significantly higher in Lenti-GFP-CCN1 group than that in negative control group and control group (P<0.05).CONCLUSION:Exogenous CCN1 promotes the migration of BMSCs.

Objective To realize the relationship between substance P(SP) and abnormal gastrointestinal tran- sit. Methods By radioimmunoassay, concentration of SP in sigmoid mucosa was determined in 12 healthy volun- teers, 15 slow and 10 fast transit patients. ResultsThe concentration was (27.68±15.42)μg/g, (24.07+5.76)μg/g and (28.61± 18.34)μg/g,respectively. They had no statistical difference. Conclusion There was no relationship be- tween concentration of SP in sigmoid mucosa and abnormal gastrointestinal transit.

This study was aimed to observe the effect ofZi-Bu Pi-Yin Recipe (ZBPYR) on the mRNA expressions of NMDA receptor subunits NR1, NR2A, NR2B in different brain regions of spleen-yin deficiency Alzheimer's Disease (AD) model rats. The levels of NR1, NR2A, NR2B mRNA expressions were detected by using RT-PCR method. The results showed that the levels of NR1, NR2A, NR2B mRNA expressions of AD group and spleen-yin deficiency AD group decreased significantly (P < 0.05). The levels of NR1, NR2A, NR2B mRNA expressions of ZBPYR treatment group increased significantly (P < 0.05). It was concluded that the expression levels of NMDAR mRNA in different brain regions of the ZBPYR treatment group increased significantly, which indicated that ZBPYR may up-regulate the protein expressions of NMDAR by increasing the expression levels of NMDAR mRNA, thereby to play the anti-dementia effect.

Objective To analyze the curative effects of different managements of different types of fracture of the first metacarpal basal body. Methods From October 1984 to October 2003, 142 patients with fracture of the first metacarpal basal body were treated with 5 different methods: manipulative reduction and fixation with abduction tooth arch, manipulative reduction and suspension traction, manipulative reduction and fixation with abduction frame, manipulative reduction and percutaneous internal fixation with Kirschner wire, as well as open reduction and internal fixation with Kirschner wire or screw. Results 80 patients were followed up. The therapeutic efficacy was excellent in 65 cases , good in 13 cases, poor in 2 cases. Conclusion Different types of fracture of the first metacarpal basal body can be treated satisfactorily if a suitable management is applied accordingly.

Objective To explore diagnosis and treatment of biliary hypoplasia with huge choledochal cyst in infants.Methods From Feb 2003 to Dec 2011,278 choledochal cyst cases were treated in our hospital.There were 3 infant cases of biliary hypoplasia with huge extrahepatic choledochal cyst diagnosed and treated during this period.All patients underwent cholangiogram demonstrating patent,but markedly diminutive extrahepatic biliary structures.After excision of the cyst,hepatic duct was injured in 1 case.The cyst wall was removed,a stent was put inside of hepatic duct,and Roux-en-Y hepaticojejunostomy was porformed.Results All three patients (ages from 1 month to two months) received the Roux-en-Y hepaticojejunostomy,none of our patients has developed stenosis and fistula of the Roux-en-Y hepaticojejunostomy.Intraoperative cholangiogram showed the huge choledochal cyst and diminutive intrahepatic ducts.All three cases were followed-up for 1-5 years,there was no jaundice and nor stones formation.Conclusions In cases of huge choledochal cyst when intraoperative cholangiogram demonstrates a diminutive biliary tree with huge choledochal cyst,great care is required during cyst excision in order not to injury the hepatic duct.Stent placement into hepatic duct helps bile flow at early stage after surgery.