OBJECTIVE: To investigate the possible mechanism and fracture stability of subtypes of type B Hangman's fracture by using imaging observation. METHODS: Patients with type B Hangman's fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients' age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C _{2, 3} instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C ₂ vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability. RESULTS: A total of 86 cases of type B Hangman's fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups ( P>0.05). However, the incidence of spinal cord injury in POA group was the highest ( P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest ( P<0.05). The incidences of vertebral arch floating and C _{2, 3} instability in IAP group were the highest ( P<0.05). There were significant differences in SAFA and VBRA between groups ( P<0.05). There was no significant difference in SAFD between groups ( P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant ( P<0.05). There were 78 cases of unstable Hangman's fracture, including 2 cases of simple C _2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. CONCLUSION The mechanism of different subtypes of type B Hangman's fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C _{2, 3} intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
Humans ; Spinal Fractures/surgery* ; Male ; Female ; Cervical Vertebrae/diagnostic imaging* ; Middle Aged ; Adult ; Tomography, X-Ray Computed ; Aged ; Odontoid Process/injuries* ; Fracture Fixation, Internal/methods* ; Young Adult

[Objective]To explore the medicinal efficacy of Semen Sinapis Albae and its application value in gynecological diseases,hoping to provide reference for the treatment of modern gynecology diseases.[Methods]Through consulting ancient classics,literature and clinical consultation,it summarizes the medicinal efficacy of Semen Sinapis Albae and its wise application in the clinical treatment of gynecology in ancient and modern Chinese medicine.[Results]Semen Sinapis Albae can eliminate phlegm,"soothe five Zang-organs",enter the blood flow to remove blood stasis.Semen Sinapis Albae,with the acridity character,also can help ovulation.Meanwhile,the external application can promote transdermal absorption.In the clinical application of gynecology,it can help treat polycystic ovary syndrome(PCOS),eliminate phlegm and unblock collaterals to treat infertility,treat amenorrhea with its pungent,warming and dispersing properties,regulate dysmenorrhea with internal and external treatments,reduce swelling and dissolve lumps.[Conclusion]Semen Sinapis Albae can serve the purpose of elimination as a tonic and combination of elimination and tonic in clinical applications.Through flexible combination of prescription and addition and reduction,it can play a multiplier effect on the treatment of gynecological diseases.

Objective:To analyze the clinical effect of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular joint facilitation(NJF)technique in improving the enhancement of muscle tone after stroke.Methods:From October 2020 to October 22,a total of 114 patients with increased muscle tone at lower limb during the recovery period of stroke who admitted to Beijing Rehabilitation hospital were selected,and they were randomly divided into the observation group(57 cases)and the control group(57 cases)according to the random number table method.The control group received routine rehabilitation treatment.The observation group added low-frequency rTMS and NJF training on the basis of the routine rehabilitation treatment.The differences of clinical efficacy and various indicators of muscle tone of lower limb before and after treatment between two groups were compared,which included modified Ashwonh score(MAS)scale,functional ambulation category(FAC)scale of the motor of lower limb,Fugl-Meyer motor function scale-Lower limbs(FMA-L),clinical spasmodic index(CSI),modified Barthel index(MBI)of activity ability of daily life,integrated electromyogram(IEMG)and root mean square(RMS)of tibialis anterior muscle of lower limb in electromyogram.Results:After intervention,29 cases appeared significant effect,and 23 cases appeared valid result,and 5 cases appeared invalid result in the observation group,and 20 cases appeared significant effect,and 20 cases appeared valid result,and 17 cases appeared invalid result in the control group.The total effective rate of the observation group was 91.23%,which was significantly higher than 70.18%of the control group,and the difference was statistically significant(x2=8.111,P<0.05).Before intervention,there was no statistically significant difference in each indicator between the two groups(P>0.05).The MAS score,CSI score,IEMG and RMS of two groups after intervention were significantly lower than those before intervention,while the FAC score,FMA-L score and MBI score were significantly higher than those before intervention,and the differences were significant(t=3.377,4.398,5.554,P<0.05),respectively.At the same time,the MAS score,CSI score,IEMG and RMS of the observation group were significantly higher than those of the control group,and the differences were statistically significant(t=11.160,9.625,16.993,8.095,P<0.05),respectively.Conclusion:The combined application of low-frequency rTMS and NJF training can significantly improve the enhancement of muscle tone after stroke,and effectively reduce the muscle tone of lower limb,and improve the motor function of lower limb and the degree of spasticity,and improve the activity ability of daily life.

Objective:To investigate the changes of thickness and area of the ligamentum flavum after lateral lumbar interbody fusion (LLIF) for lumbar degenerative diseases.Methods:From 2019 to 2021, a total of 54 patients with lumbar degenerative diseases who underwent LLIF combined with percutaneous pedicle screw internal fixation were retrospectively analyzed. There were 9 males and 45 females, aged 59.46±6.91 years (range, 45-76 years), followed up for 14.69±6.87 months (range, 12-33 months). The disc height (DH), midsagittal canal diameter (CD), dural sac axial cross-sectional area (DCSA), ligamentum flavum area (LFA) and ligamentum flavum thickness (LFT) before and after surgery and at the last follow-up were evaluated and compared. Pearson correlation analysis was used to assess the relationship between the amount of change in the DCSA and LFA in the immediate postoperative period and at the last follow-up, as well as the correlation between the two and the amount of change in the DH. The data of patients at the last follow-up of 12 months after operation were extracted. Pearson correlation was used to evaluate the changes in DCSA and LFA at the last follow-up and the visual analogue scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI) at 1 year after surgery.Results:All patients were followed up for 14.69±6.87 months (range, 12-33 months). The differences in DH ( F=354.93, P<0.001), sagittal CD ( F=44.78, P<0.001) and DCSA ( F=130.97, P<0.001) before, immediately after surgery and at the last follow-up were statistically significant. The DH, sagittal CD, and DCSA immediate after surgery and last follow-up were higher than those before surgery ( P<0.05). The differences in LFA ( F=51.59, P<0.001) and bilateral LFT ( F=53.49, P<0.001; F=50.53, P<0.001) before and after surgery and at the last follow-up were statistically significant, and both LFA and bilateral LFT at immediate after surgery and last follow-up were smaller than those before surgery ( P<0.05). Pearson correlation analysis showed that the change of DH immediately after surgery was moderately correlated with the change of DCSA ( r=0.57, P<0.001), and was strongly correlated with the change of LFA ( r=0.65, P<0.001). The change of DH at the last follow-up was moderately correlated with the change of DCSA ( r=0.43, P<0.001), and was weakly correlated with the change of LFA ( r=0.25, P=0.042). The differences in VAS-leg ( F=199.51, P<0.001), VAS-low back ( F=233.90, P<0.001), and ODI ( F=199.17, P<0.001) were statistically significant in patients before operation, 3 months after operation and 12 months after operation. There was no correlation between the changes of DCSA and LFA at the last follow-up and the changes of VAS and ODI at 1 year after operation ( P>0.05). Conclusion:LFA and LFT decrease and DCSA increase in patients with lumbar degenerative diseases after LLIF. LFA and LFT gradually decrease with time, and VAS and ODI are significantly improved compared with those before surgery. The DH loss caused by a certain degree of cage subsidence after surgery does not affect the clinical efficacy. There is no correlation between the improvement of DCSA and LFA and the improvement of clinical symptoms.

Objective To investigate the efficacy of aripiprazole addition therapy on adiponectin and leptin in schizophrenia patients with olanzapine-induced weight gain. Methods Schizophrenia patients with clinically significant weight gain induced by olanzapine were randomly divided into two groups:treated with olanzapine+aripiprazole (5 mg/d, n=48) or olanzapine+placebo (n=46). The level of FBS, TG, TC, adiponectin, leptin, the body index (BMI) and the insu?lin resistance index (HOMA-IR) were measured before and 4, 8 and 12 weeks after treatment. Results Adiponectin in?creased and leptin as well as HOMA-IR decreased in olanzapine+aripiprazole group after 4, 8 and 12 weeks treatment (P<0.05). However, FBS, TG and TC decreased and BMI increased only after 8 and 12 weeks treatment(P<0.05). In olanzapine+placebo group, the dadiponectin decreased and leptin, HOMA-IR as well as BMI increased after 8 and 12 weeks treatment(P<0.05). In olanzapine + aripiprazole group the adiponectin, leptin and HOMA-IR of 4, 8 and 12 weeks and BMI of 8 and 12 weeks were different from olanzapine + placebo group(P<0.05). Conclusions In schizo?phrenia patients with olanzapine-induced weight gain, aripiprazole addition therapy can ameliorate the HOMA-IR and BMI probably through the regulation of adiponectin and leptin.

Aim To study the role of ubiquitin carboxyl terminal hydrolase L1 (UCH-L1)involved in the pro-tective effect of fluoxetine against monocrotaline-in-duced pulmonary arterial hypertension in rats.Meth-ods Monocrotaline (60 mg·kg -1 )was used to es-tablish pulmonary arterial hypertension in rats and low-dose (2 mg·kg -1 ·d -1 )or high-dose (10 mg·kg -1 ·d -1 )fluoxetine was applied to inhibit pulmonary ar-terial hypertension.The hemodynamics,morphology of pulmonary arterioles and lungs,UCH-L1 protein ex-pression and nuclear factor-κB (NF-κB)nuclear trans-location were observed.Results Monocrotaline not only increased pulmonary arterial pressure and promo-ted pulmonary arterial remodelling and lung inflamma-tion,but also down-regulated UCH-L1 protein expres-sion and increased NF-κB activity in lungs.Fluoxetine inhibited these changes in a dose-dependent manner. However,UCH-L1 protein expression of pulmonary ar-teries did not significantly change among different groups.Conclusion Fluoxetine inhibits monocrotal-ine-induced lung inflammation in rats,involved in NF-κB activity inhibited by up-regulated UCH-L1 protein expression.

Delayed cerebral vasospasm is a common complication of subarachnoid hemorrhage. Its study has become a topic of general interest in neurology. The article reviews the effects of neuropeptide Y, nitric oxide, endothelin-1,bilirubin oxidation product, Rho kinase, immuno- inflammation, and apoptosis from the pathogenesis of cerebral vasospasm.