Objective To explore the effects and safety of escitalopram on suicide-related symptoms for depression patients controlled with amitriptyline.Methods Depression patients with suicide-related symptoms were randomly grouped.The study group(n=35) were treated with escitalopram 10 mg/d to 20 mg/d and the control group(n=33) were done with amitriptyline 75 mg to 250 mg daily.Both groups with psychotherapy were carried out for 8 weeks' observation.The Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression-severity of illness (CGI-SI) were tested and suicide-related examined before and after 1,2,4,6 and 8 weeks'treatment.The Treatment Emergent Symptom Scale (TESS) was checked at 4th week to evaluate safety.Results In the study group,the incidence of wishing to die (97.1％),suicidal attempts (91.4％),suicidal ideations (88.6％),suicidal plans (80.0％),hopelessness (71.4％) and suicidal behavior (54.3％) was similar to the control group(97.0％,97.0％,90.9％,87.9％,72.7％ and 54.5％,respectively,x2 =0.00-0.94,P＞0.05).The incidence of suicide-related symptoms showed significantly lower after treatment than before (P＜0.01).At 1st week treatment,the incidences of hopelessness (37.1％),suicidal plans (45.7％) and suicidal ideations (48.6％)showed significantly lower in the study group than those in the control group(63.6％,72.7％ and 75.8％,respectively,x2 =4.77,5.12,5.32,P＜ 0.05).The study group showed significantly lower side-effects (11.4％) at 4th weeks' treatment than the control group(62.9％,x2 =21.95,P＜0.01).Conclusion The effects of escitalopram on suicide-related symptoms for depression patients is similar to amitriptyline but with faster effect and higher safety.

Objective To assess the effect of magnetic resonance imaging (MRI) on preoperative staging of endometrial carcinoma and depth of myometrial invasion. Methods Fifty-six patients with endometrial carcinoma were underwent conventional and contrast-enhanced MR scan. The results of pathology , MRI examinations of preoperative staging and depth of myometrial invasion were assessed and compared. Results The accurate rate of MRI diagnosis in preoperative staging diagnosis was 82.1% (46/56) and the consistency check as Kappa was 0.771 (P < 0.001). Conclusions MRI may be a good diagnostic tool with high sensitivity and specificity for assessing myometrial invasion and detecting tumour extension and should be considered as a routine part of the preoperative assessment in all patients with endometrial carcinoma.

BACKGROUND:Posterior lumbar interbody fusion can thoroughly decompress the central canal, which is the common surgical technique for the central type of lumbar disc herniation with intervertebral instability at low lumbar segment. However, due to the regular traction on dural sac and nerve root in the operation, lower limb radicular pain in the early stage is inevitable. OBJECTIVE:To evaluate the effect of local use of gelatin sponge containing prednisolone acetate around the nerve roots after posterior lumbar interbody fusion on lower limb radicular pain. METHED:Sixty-three cases of lumbar disc herniation with degenerative instability were devided into treatment group (n=21) and control group (n=42) based on the type of implants. Gelatin sponge containing prednisolone acetate was implanted into patients in the treatment group after posterior lumbar interbody fusion, while pure gelatin sponge was implanted into patients in the control group. RESULTS AND CONCLUSION:Compared with the control group, radicular pain in the treatment group was significantly relieved within 1 week after surgery. The visual analog scale score and Oswestry disability index score were similar between the two groups. There were three cases of radicular pain recurrence in the control group, but no incision infection and epidural hematoma after surgery in both two groups. In conclusion, local use of gelatin sponge containing prednisolone acetate around the nerve roots can significantly relieve lower limb radicular pain in the early stage after posterior lumbar interbody fusion in lumbar disc herniation, contributing to early rehabilitation exercise and patient satisfaction outcomes.

BACKGROUND:The infection after spinal internal fixation was its serious complications. A number of studies have shown that erythrocyte sedimentation rate and C-reactive protein are of great importance in judging infections. OBJECTIVE:To analyze the trend of change of erythrocyte sedimentation rate and C-reactive protein for patients without infection after the cervical fixation. METHODS:Total y 56 patients, who underwent cervical fixation from October 2013 to July 2014, were retrospectively analyzed, and then divided into anterior cervical group (n=29) and posterior cervical group (n=27). Patients in the anterior cervical group underwent anterior cervical decompression bone graft internal fixation. Patients in the posterior cervical group underwent posterior cervical unilateral open door decompression internal fixation. The peripheral blood was col ected before fixation and at the early morning of the 1, 3, 6, 9 days after fixation. Erythrocyte sedimentation rate and C-reactive protein values were determined. The fol ow-up of patients was more than one year. Signs of infection did not appear. RESULTS AND CONCLUSION:(1) General rule:After the cervical fixation, the erythrocyte sedimentation rate was increased significantly and reached a peak on postoperative day 6. The peak level gradual y decreased but has not returned to normal at the 9 postoperative days. The C-reactive protein increased significantly on the first postoperative day and reached a peak on postoperative day 3. The peak level rapidly decreased but has not returned to normal at the 9 postoperative days. The level of erythrocyte sedimentation rate of patients in the posterior cervical group was significantly higher than that in the anterior cervical group at 3, 6 and 9 days after internal fixation (P<0.05). There was no significant difference in the C-reactive protein between these two groups (P>0.05). (2) These results demonstrate that C-reactive protein is an important indicator of monitoring the inflammatory response of patients after cervical internal fixation, which was conductive to the judgment of early infection after internal fixation. The abnormal inflammatory indices of erythrocyte sedimentation rate and C-reactive protein do not suggest a presence of blade infection after internal fixation. C-reactive protein can reach the peak at 3 days after fixation. It is recommended to check blood at 2 and 3 days. If there is no apparent rebound, then the possibility of infection is smal . It may indicate the presence of infection if the inflammatory indices increased again or decreased slowly after the decrease.

Objective To evaluate the value of diffusion-weighted MRI ,time of flight MR angiography (TOF-MRA) and 3D dynamic contrast enhanced MR angiography (3D DCE-MRA) in the diagnosis of transient ischemic attacks(TIA). Methods 176 consecutive patients with TIA were undergone MRI, including FLAIR,DWI,TOF-MRA and 3D CE-MRA sequences. Results Of 176 cases,48.9% of patients were found having hyperacute ischemic lesions by DWI sequence and 18.2% of lesions could be detected by T2WI.TOF-MRA showed arterial stenosis and occlusion in 76 cases(43.2%),false positive rate and excessive diagnosis were happened in 20 cases.3D CE-MRA of brain showed arterial stenosis and occlusion in 69 cases(39.2%).3 cases with aneurysm and 2 cases with arteriovenous malformation were detected by two methods.3D CE-MRA of neck showed arterial stenosis and occlusion in 38 cases(21.6%).Conclusion DWI and MRA are helpful in detecting the hyperacute ischemic lesion and evaluating the arterial lesions in the patients with TIA.

To investigate the etiological and pathological characteristics of adolescent lumbocrural pain, the findings of X ray, CT and MRI and biopsy in 67 cases of adolescent (14～28 years old) and 97 of the adult and the aged were compared. The results showed that the incidence of back epiphysis loop fracture of lumbosacral vertebrae was 40.74% (12/27) and 22.50% (9/40) in the teenage (14～18) and the youth (19～28) respectively, and 3.85% (2/52) and 4.44% (2/47) in the adult(28～60) and the aged (over 60) respectively, showing that the differences were significant between the adolescent and the adult(P 0.05 ). It is indicated that back epiphysis loop fracture of lumbosacral vertebrae is the specific pathological feature of adolescent lumbocrural pain. Therefore, it should be regarded as an important cause of adolescent lumbocrural pain.

Objective To discuss the intervention effect of cognition therapy for perioperative patients of digestive tract with depression and/or anxiety symptoms.Methods 135 patients with digestive tract operation were randomly divided into intervention group and non-intervention group.The patients in intervention group accepted cognition therapy.The Mores of SDS and SAS,the curative effect and hospitalized time were compared among the two groups and the norlns of our country at last.Results (1)The scores of SDS and SAS in the two group patients in pre-operation were no difference(P＞0.05),but all were significantly higher than those of the norms of our country(P＜0.01).It indicated that patients have evident depression and/or anxiety symptoms pre-operation. (2)Compared with pre-operation,the scores of SDS and SAS in the intervention group patients showed significantly lower after operation(P＜0.01),which returned to the norms of our country(P＞0.05),and showed lower than those of the non-intervention group predominantly (P＜0.01).This indicated that cognition therapy can relieve the depression and/or anxiety symptoms of the perioperative patients.(3)Though the therapeutic effect of the two group are similar(P＞0.05),but the hospitalized fime decurated in the intervention group predominantly(P＜0.01).Conclusion The periopexative patients of digestive tract had obvious depression and/or anxiety symptoms.Cognition therapy could relieve the depression and/or anxiety sympmms of the perioperative patients,this was helpful for patients to recover early.

BACKGROUND: In lumbar spondylolisthesis patients with severe osteoporosis, screw is easily loose and pul s out during reposition, or loss of reduction and internal fixation failure easily occur after repair. Therefore, it is very important to elevate the intensity of pedicle screw fixation during repair. At present, few studies concern application of bone cement screw enhancement technology in lumbar spondylolisthesis patients with osteoporosis. OBJECTIVE: To investigate the clinical value of augmented pedicle screw with polymethylmethacrylate for lumbar spondylolisthesis accompanied with osteoporosis. METHODS: From June 2009 to June 2011, 27 patients suffering from lumbar spondylolisthesis accompanied with osteoporosis were included in this retrospective study. These patients received augmented pedicle screw with polymethylmethacrylate. The levels of disability and pain were evaluated by Oswestry Disability Index and visual analog scale. The internal fixation and fusion were evaluated by radiological findings. Al complications were recorded. RESULTS AND CONCLUSION: Al cases were fol owed up for 15-37 months. Oswestry Disability Index and visual analog scale scores were significantly better in final fol ow-up than that pre-treatment (P < 0.05). Imaging results revealed that bone cement tightly connected to bone interface. The position of screw and bone cement was good. Symptomatic bone cement leakage was not found. No fixation failure was detected during final fol ow-up. Al patients achieved interbody fusion. These results suggested that polymethylmethacrylate bone cement could increase the gripping force of the pedicle screw in osteoporotic vertebral body. It is safe and effective to treat spondylolisthesis accompanied with osteoporosis with augmented pedicle screws. Satisfactory fixation stability and interbody fusion can be obtained.

Objective:To investigate the evaluation of disease perception, treatment compliance and community follow-up services of community schizophrenia patients, family members and personnel in Shantou City, and to provide a reference basis for improving the quality of management treatment.Methods:With the method of stratified sampling qualitative research, a community sample of 17 198 patients with schizophrenia in seven districts or county in Shantou City were sampled from February to August 2019, with 2 towns being drawn from each district or county, and 10 patients, 10 family members and 3 personnel were selected in each town. The evaluation of disease perception, treatment compliance and community follow-up services were investigated and analyzed. Respondents were eventually included in 137 patients, 138 family members and 41 personnel.The interviewees were conducted with semi-structured interviews, the data were collected according to traditional methods, and the descriptive statistical analysis was carried out with SPSS 12.0.Results:(1)34.3% of patients and 32.6% of the family members were not fully aware of the disease.22.6% of the patients and 23.2% of the family members had a sense of ill shame. (2)26.3% of patients did not comply with treatment, 29.9% of patients had not insight, 53.3% of patients and 24.6% of family members on the side effects of drugs and addiction understood improperly, and, 35.0% of patients and 13.0% of the family had a misunderstanding of illness and using drugs. (3)29.2% of patients and 31.2% of their families were tired of taking long-term medication, 24.8% of patients and 21.0% of their families felt socially isolated, and, 17.5% felt unsupported and 18.8% of their families admitted that they did not care enough about patients. (4)31.4% of patients did not actively receive follow-up services, 37.2% of patients and 20.3% of family members did not cooperate with follow-up doctors, and, 21.2% of patients and 10.1% of family members were not satisfied with follow-up services. (5)The personnel of psychiatric care could basically grasp the conditions of patients in the jurisdiction and carried out follow-up services on a regular basis (90.2%), master emergency disposal methods (92.7%), and have carried out training (97.6%). However, the psychiatric practice of the personnel were lower than (58.5%) and most lying part-time (78.0%), the average length of service was 5.7±1.4 years. The personnel satisfaction with the community follow-up service was higher (95.1%), but most of them thought that the psychiatric care was more difficult (36.6%), and were dissatisfied with the multi-functional staff to undertake a number of public services (31.7%).Conclusion:The management treatment project of mental disorders services in Shantou City show initial results.The patients were satisfied with the community follow-up service, but the patients and their families still have low level of cognition, poor compliance, obvious negative emotions, and have concerns about drug treatment.It is necessary to strengthen the professionalization of personnel, to carry out early mental health education and rational emotional behavior training for patients and their families.

BACKGROUND:There are few studies on the effect of degeneration of paraspinal muscle on osteoporotic vertebral compression refractures treated by percutaneous vertebroplasty in postmenopausal women.This paper intends to reveal the relationship between them. OBJECTIVE:To investigate the relationship between degeneration of paraspinal muscle and osteoporotic vertebral compression refractures in postmenopausal women treated by percutaneous vertebroplasty. METHODS:The medical records of 81 postmenopausal female patients who were admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2018 to March 2021 for osteoporotic vertebral compression fracture and received percutaneous vertebroplasty were retrospectively analyzed.The patients were divided into an osteoporotic vertebral compression refracture group(n=39)and a control group(n=42)according to whether they had osteoporotic vertebral compression refracture after percutaneous vertebroplasty.General data,vertebral bone mineral density,paravertebral cross-sectional area and mean CT value(Hu)of the two groups were analyzed. RESULTS AND CONCLUSION:(1)Univariate analysis showed that there was no significant difference in age and mean CT value of psoas major between the two groups(P>0.05).The body mass index,vertebral bone mineral density,paravertebral cross-sectional area and the mean CT value of the posterior vertebral muscle group in the control group were significantly higher than those in the osteoporotic vertebral compression refracture group(P<0.05).(2)Multivariate logistic regression analysis showed that low vertebral bone mineral density(OR=0.004,95%CI:0.000-0.555,P<0.05)and low mean CT value of posterior vertebral muscle group(OR=0.940,95%CI:0.894-0.988,P<0.05)were independent risk factors for postmenopausal osteoporotic vertebral compression refracture.(3)It is indicated that degeneration of paraspinal muscle will increase the risk of osteoporotic vertebral compression refractures in patients treated by percutaneous vertebroplasty,especially in postmenopausal women with a low mean CT value of low posterior vertebral muscle group.