Methods: Sixty-two patients (2014–2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed. Results: Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05). Conclusions Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.

Psychogenic non-epilepsy seizures (PNES) are defined as paroxysms with clinical symptoms similar to epilepsy without epileptiform discharges. It is often misdiagnosed as epilepsy. Misdiagnosis not only delays the time for patients with PNES to get correct diagnoses and treatments, but also may increase the risk of adverse effects from improper use of antiseizure medications. The diagnostic method of PNES is video electroencephalogram monitoring, but there is no consensus on the optimal duration of monitoring. At the same time, the use of diverse physiological signals, brain imaging, laboratory examination, and the application of machine learning provide new perceptions for the precise identification of PNES and epilepsy. This article reviewed the progress of precise differential diagnosis between PNES and epilepsy.

Objective:To investigate the role of Akt signaling pathway in the regulation of breast cancer bone metastasis induced pain behavior in rat.Methods:Model rats were randomly divided into three groups:Model group,Model+GSK690693 group and Model+ Saline group.On PID 13,14 and 21,Model+GSK690693 group rats were intrathecally injected with GSK690693,a specific inhibitor of Akt.Model+Saline group were injected with saline instead.The pain related behaviors were respectively recorded on PID 0,7,14 and 21.The expression ofp-Akt in DRG used for western bloting were examed on PID 21.Results:After the injection of Akt specific inhibitor GSK690693 by intrathecal,In the Model+GSK690693 group,the threshold value of mechanical contraction reflex was increased,the spontaneous pain behavior and the expression of p-Akt in DRG decreased.On PID 14 d and 21 d,the pain behavior of rats in Model+GSK690693 group was significantly different from that of Model+Saline group and Model group (P＜0.01);On PID 21 d,There was significant statistical significance (P＜0.01) on the expression of p-Akt and Model in the ipsilateral Model+GSK690693 of DRG group,which was statistically significant (P＜0.05) compared with the Model+Saline group.Conclusion:Intrathecal injection of Akt specific inhibitor GSK690693 inhibits rat pain related behaviors induced by bone metastasis in rat breast cancer.

Objective To investigate the potential risk factors of organ dysfunction and mortality in the early resuscitation of severe sepsis and septic shock patients.Methods Data were retrospectively analyzed from patients with severe sepsis and septic shock receiving non-cardiac operation and admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from January 1st,2013 to December 31st,2015.The patients were divided into the senior group (≥ 65 years old) and the younger group (＜ 65 years old),the high-procalcitonin (PCT) group (PCT ＞ 100 μg/L) and the control group (PCT ≤ 100 μg/L).The stage of early resuscitation was set to the first 6 hours.The diagnostic time and the incidence of acute respiratory distress syndrome (ARDS),acute kidney injury (AKI),and cardiac insufficiency were observed,which also included the usage of continuous renal replacement therapy (CRRT).The total fluid volume and the time of vasopressor usage during the first 6 hours of early goal-directed therapy (EGDT) were also recorded,which aslo included the 28-day mortality.Results 512patients with severe sepsis and septic shock receiving non-cardiac operation were treated according to the guidelines of Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:2012.EGDT was used during the early resuscitation.The incidence of ARDS,AKI,and cardiac insufficiency was 80.9％ (414/512),71.3％ (365/512),and 61.9％ (317/512) respectively.There were 205 senior patients and 307 younger,as well as 154in high-PCT group and 358 in control group.The 28-day mortality was 30.3％ (155 died).90.8％ of patients (376/414)combined with ARDS were diagnosed before EGDT.95.1％ of patients (347/365) combined with AKI were diagnosed before EGDT,among whom 14.0％ (51/365) were treated with CRRT.153 senior patients combined with cardiac insufficiency were diagnosed no longer than 12 hours after EGDT.Compared with the younger group,the incidences of ARDS and cardiac insufficiency were higher in the senior group [85.9％ (176/205) vs.77.5％ (238/307),82.9％(170/205) vs.32.9％ (147/307),both P ＜ 0.05],so were the time of vasopressor usage during EGDT (hours:5.81 ±0.28vs.5.68 ± 0.52,P ＜ 0.05) was prolonged markedly and the 28-day mortality [42.9％ (88/205) vs.21.8％ (67/307),P ＜0.05] was increased significantly.But the incidence of AKI and the total fluid volume during EGDT were not significantly different between the senior group and the younger group [incidence of AKI:74.1％ (152/205) vs.69.4％ (213/307),total fluid volume (mL):2 769 ± 1 589 vs.2 804± 1 611,both P ＞ 0.05].Compared with the control group,the incidence of ARDS was higher in the high-PCT group [86.4％ (133/154) vs.78.5％ (281/358),P ＜ 0.05].But the incidences of AKI and cardiac insufficiency were not significantly differentiated between the high-PCT group and the control group [77.9％ (120/154) vs.68.4％ (245/358),58.4％ (90/154) vs.63.4％ (227/358),both P ＞ 0.05].Multiple logistic regression analysis showed that the risk factors of increase in mortality in patients with severe sepsis and septic shock included old age [odds ratio (OR) =1.782,95％ confidence interval (95％CI) =1.173-2.708,P =0.007],ARDS (OR =1.786,95％CI =1.028-3.102,P =0.040),AKI (OR =1.878,95％CI =1.145-3.079,P =0.012),and cardiac insufficiency (OR =4.177,95％CI =2.505-6.966,P =0.000),except for gender (OR =1.112,95％CI =0.736-1.680,P =0.614).Conclusions In the senior postoperative patients with severe sepsis or septic shock,the incidence of ARDS and cardiac insufficiency,and the mortality were increased.The incidence of ARDS was correlated to the severity of infection.Old age,surgery,and EGDT could be the potential risk factors of cardiac insufficiency.

Objective To study the effects of nitroglycerin on leak point pressure of chronic complete spinal cord injury female rats. Methods Models of chronic complete spinal cord injury in female rats were established. Changes of leak point pressure were investigated following nitroglycerin 3 mg intraperitoneal injection. Results Leak point pressure decreased from (32.27±15.00) cmH2O to (23.29±9.46) cmH2O. Conclusion There was obvious descent of leak point pressure of chronic complete spinal cord injury female rats following nitroglycerin intraperitoneal injection.

Objective To study the effects of nitroglycerin on urethral sphincter of chronic complete spinal cord injury female rats in vitro. Methods 30 SD female rats with 3 months old were transected at T10 spinal cord. After 8 weeks, the 10 rats with BBB scores ≤5 were selected as experimental group, and other 10 normal rats as control group. The difference of tension in both proximal segment (urethral smooth muscle strips) and distal segment (external urethral sphincter muscle strips) were surveyed before and after nitroglycerin 0.5 mg administration in bath. Results The tension of distal segment in control group reduced from (640.50±91.79) mg to (597.50±92.61) mg, and from (485.50±68.94) mg to (459.90±69.51) mg in experimental group. The difference between proximal segment and distal segment were (222.30±12.14) mg and (42.00±7.86) mg before and after administration in control group, and were (223.00±15.78) mg and (25.60±5.17) mg in experimental group. Conclusion The administration of nitroglycerin 0.5 mg in bath can reduce the tension of both urethral smooth muscle and external urethral sphincter in both normal and spinal cord injured rats. The relaxative effect on external urethral sphincter muscle of normal rats exceed that of injured ones, but approximate on urethral smooth muscle.

Objective To investigate the neuronal nitric oxide synthase (nNOS) distribution in intramural striated sphincter of female rats. Methods 4 female Wistar rats were anesthetized with chloral hydrate. The whole bladder and urethra specimen were harvested, fixed in formalin and imbedded in paraffin wax. Longitudinal and transverse sections were developed with 2 urethra respectively. Routine HE staining and Mallory phosphotungstic acid-hematoxylin staining were used for observation of urethral microstructure. nNOS distribution in intramural striated sphincter was determined with immunohistochemical staining. Results The urethras of female Wistar rat were tubular structure about 1.5～2.0 cm long. From outside inward,the structure included circular striated muscle layer,circular smooth muscle layer,longitudinal smooth muscle layer,dense connective tissue and epithelium. The longitudinal sections showed intramural striated muscle predominates the middle and distal third,not the whole urethral length. The transverse sections showed intramural striated muscle is closed ring shape,about 5～10 layers uneven distributed with more layers in the posterior wall than in the front wall. Strong positive expression of nNOS immunoreactivity was found in some intramural striated muscle fiber. Conclusion nNOS expresses in some intramural striated muscle fiber, surggesting nitric oxide may play an important role on intramural striated sphincter.

Injection of botulinum toxin type A (BTX-A) seems to have a positive therapeutic effect in multiple urological conditions, including detrusor external sphincter dyssynergia, voiding dysfunction, painful pelvic floor, bladder overactivity, frequency-urgency syndrome, interstitial cystitis, benign prostatic hyperplasia, and be thought as a novel and promising treatment for a variety of lower urinary tract dysfunctions within the urological field. However, there is a long way to go to assess the clinical efficacy of this form by randomized, double blinded, placebo-controlled trials.

0.05).②The average scores of psychological abuse sub-scale scold and threaten dimension of the male students were higher than those of the female ones(P