Objective:To investigate the mid-term clinical efficacy and imaging changes of Waveflex semi-rigid internal fixation system combined with posterior lumbar interbody fusion (PLIF) in the treatment of double segmental lumbar degenerative diseases.Methods:The data of 51 patients with lumbar degenerative diseases who underwent surgery from September 2014 to September 2015 were retrospectively analyzed, including 29 males and 22 females, aged 65.5±5.6 years (range 58-73 years). Preoperative intervertebral space degeneration grade by University of California at Los Angeles (UCLA) and Pfirrmann intervertebral disc degeneration grade were recorded. 23 cases of primary responsible segments were treated with decompression, fixation and fusion, and adjacent secondary responsible or degenerative segments were treated with Waveflex semi-rigid internal fixation (combined group); 28 cases of double segments were treated with decompression, fixation and fusion (fusion group). Disc height index (DHI) and intervertebral foramina height (IFH) of the semi-rigid fixation segments, DHI and IFH of the upper adjacent intervertebral space, and horizontal displacement of the upper adjacent vertebral body (HD) were measured on lateral X-ray films of lumbar spine; In the fusion group, DHI and IFH adjacent to the upper vertebral space and HD adjacent to the upper vertebral body were measured. The efficacy was evaluated by short-form McGill Pain Questionnaire (SF-MPQ) and Oswestry disability index (ODI).Results:51 cases were followed up for 5.4±0.3 years (range 5.2-6.3 years). The low back and leg pain and function in the combined group and fusion group were significantly improved compared with those before operation. SF-MPQ and ODI at 3 months, 1 year, 5 years after operation were significantly different from those before operation ( P<0.05). In the combined group, the DHI of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 37.8%±7.6%, 37.9%±7.4%, 36.5%±6.9% and 36.0%±7.1% respectively ( P>0.05); The IFH of semi-rigid internal fixation segments before operation and 3 months, 1 year, 5 years after operation were 21.5±2.8, 21.4±2.8, 20.4±2.7, 19.4±2.4 mm respectively ( P<0.05); The DHI of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 37.1%±9.3%, 36.8%±9.1%, 35.2%±9.1%, 33.9%±8.8% respectively ( P>0.05); The IFH of the upper segment adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 21.9±3.0, 21.4±3.0, 20.4±2.9, 19.5±2.7 mm, respectively ( P<0.05). The HD of upper vertebral body adjacent to semi-rigid internal fixation before operation and 3 months, 1 year, 5 years after operation were 2.2±0.7, 2.3±0.5, 2.5±0.5, 2.8±0.5 mm respectively ( P<0.05). At the last follow-up, one case of semi-rigid titanium rod fracture, one case of screw loosening at semi-rigid internal fixation segment, three cases with unsatisfied numbness relief, and 2 cases of facet joint spontaneous fusion at semi-rigid fixation segment occurred in the combined group. Conclusion:Waveflex semi-rigid internal fixation can protect the degenerative lumbar intervertebral disc, and delay the degeneration of semi-rigid internal fixation segment and adjacent upper segment after interbody fusion, but long-term follow-up and study are needed.

Objective: To investigate the prognostic value of N-terminal B-type natriuretic peptide (NT-proBNP) on all-cause mortality in heart failure patients with preserved ejection fraction (HFpEF) at real world scenarios. Methods: Patients who met the diagnostic criteria of HFpEF in the China National Heart Failure Registration Study (CN-HF) were divided into death and survival groups. The demographic data, physical examination, results of the first echocardiography, laboratory results at admission, complications, drug use and clinical outcomes were obtained from CN-HF. The univariate Cox proportional hazard model was used to screen the variates that might predict prognosis, and then the covariates with statistical significance were included in the multivariate Cox regression model to analyze the predictive value of baseline NT-proBNP on all-cause death. Spearman correlation analysis was used to evaluate the relationship between NT-proBNP and estimated glomerular filtration rate (eGFR), so as to further explore the predictive value of the interaction between renal dysfunction and NT-proBNP on death. Since NT-proBNP did not obey the binary normal distribution, it was expressed by the natural logarithm of NT-proBNP (LnNT-proBNP). Results: A total of 1 846 HFpEF patients were enrolled in this study, with an average age of 71.5 years, 1 017 males(55.1%), median NT-proBNP 860 ng/L, and median eGFR 73.9 ml·min^-1·1.73m^-2. After a median follow-up of 34 months, 213 (11.5%) patients died. Patients in the death group were older, with higher NYHA classification Ⅲ-Ⅳ ratio, longer hospital stay, higher serum potassium and NT-proBNP level, prevalence of complications of diabetes mellitus, arrhythmia and atrial fibrillation, use of angiotensin receptor antagonist(ARB), mineralocorticoid receptor antagonists (MRA), diuretic and digoxin was significantly higher in death group than in survival group. Body mass index (BMI), diastolic blood pressure, left ventricular ejection fraction (LVEF), hemoglobin, serum cholesterol(TC), serum triglycerides (TG) and eGFR, and use of angiotensin converting enzyme inhibitors (ACEI), statins and aspirin were lower in death group than in survival group. Univariate Cox regression analysis showed that NT-proBNP was a predictor of all-cause death in HFpEF patients (HR=2.522, 95%CI 2.040-3.119, P<0.001). Multivariate Cox regression analysis showed that the elevated NT-proBNP remains as the independent predictor of all-cause death in patients with HFpEF (HR=1.230, 95%CI 1.049-1.442, P=0.011) after adjusting for age, BMI, diastolic blood pressure, LVEF, hemoglobin, serum potassium, serum sodium, TC, serum high-density lipoprotein cholesterol (HDL-C), TG, eGFR, atrial fibrillation, as well as the treatment of ACEI/ARB, MRA, diuretics and digoxin. Spearman correlation analysis showed that LnNT-proBNP was negatively correlated with eGFR (r=-0.361, P<0.001), but there was no interaction between NT-proBNP and renal dysfunction in predicting death in HFpEF patients (P>0.05). Conclusion The elevated level of NT-proBNP at admission is an independent predictor of all-cause mortality in HFpEF patients.

Objective: To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) in lymph node staging and resectability assessment of patients with non-small cell lung cancer (NSCLC). Methods: The clinical data of 154 patients with NSCLC who underwent EBUS-TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS-TBNA. EBUS-TBNA and CT were used for preoperative staging and resectability evaluation. Results: The sensitivity, specificity and accuracy of EBUS-TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively. The differences were statistically significant (P<0.05). The sensitivity, specificity and accuracy of EBUS-TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P<0.05). The staging of 62 patients was changed, 27 cases were up-regulated and 35 cases were down-regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS-TBNA showed excellent consistency with that of pathological results (Kappa=0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion EBUS-TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.

Objective To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS?TBNA) in lymph node staging and resectability assessment of patients with non?small cell lung cancer (NSCLC). Methods The clinical data of 154 patients with NSCLC who underwent EBUS?TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS?TBNA. EBUS?TBNA and CT were used for preoperative staging and resectability evaluation.Results The sensitivity, specificity and accuracy of EBUS?TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively.The differences were statistically significant (P＜0.05).The sensitivity, specificity and accuracy of EBUS?TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P＜0.05). The staging of 62 patients was changed, 27 cases were up?regulated and 35 cases were down?regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS?TBNA showed excellent consistency with that of pathological results ( Kappa＝0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion EBUS?TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.

Objective To evaluate the role of endobronchial ultrasound guided transbronchial needle aspiration (EBUS?TBNA) in lymph node staging and resectability assessment of patients with non?small cell lung cancer (NSCLC). Methods The clinical data of 154 patients with NSCLC who underwent EBUS?TBNA from March 2015 to December 2018 were collected. All accessible mediastinal and hilar lymph nodes were systematically explored and punctured using EBUS?TBNA. EBUS?TBNA and CT were used for preoperative staging and resectability evaluation.Results The sensitivity, specificity and accuracy of EBUS?TBNA were 94.2%, 100.0% and 96.0%, respectively, while those of CT were 89.9%, 31.8% and 72.0%, respectively.The differences were statistically significant (P＜0.05).The sensitivity, specificity and accuracy of EBUS?TBNA in lymph nodes with short diameter less than 15 mm were 92.4%, 100.0% and 96.0%, respectively, while those of CT were 80.7%, 34.8% and 60.1%, respectively, with statistical differences (P＜0.05). The staging of 62 patients was changed, 27 cases were up?regulated and 35 cases were down?regulated. Among them, 32 cases had been changed to resectable. The evaluating resectability of EBUS?TBNA showed excellent consistency with that of pathological results ( Kappa＝0.95). The sensitivity and specificity were 100.0% and 97.2%, respectively. Conclusion EBUS?TBNA can systemically evaluate the metastatic status of NSCLC patients and improve the accuracy of preoperative lymph node staging and resectability assessment.

Objective To observe the effect ofTanreqinginjection combined with routine medicines on the treatment of senile patients with bronchial pneumonia.Methods A total of 146 patients were randomly divided into 2 groups according to the random number table, each group 73 patients. Control group was treated with routine medicines and treatment group was added 20 mlTanreqing once a day. All treatments lasta total of 7 days. The Th17 and Treg cells were detected by cytometry analysis. The expression of IL-17, IL-10, IL-6, and TNF-α were detected by ELISA analysis. The clinical effect and adverse effect of the two groups were compared. Results After treatment, the clinical effective rate of control group was 79.5% (58/73), which was significantly lower than that of 91.8% (67/73) in treatment group (χ2=2.406,P=0.045). After treatment, Th17 cells was significantly lower in the treatment group than that in the control group (5.16% ± 1.24%vs. 8.22% ± 1.84%;t=2.564,P=0.017); but Treg cells was significantly higher in the treatment group than that in the control group (6.32% ± 1.79%vs. 4.32% ± 1.23%;t=2.552,P=0.021). The expression of IL-17 (11.43 ± 2.52 ng/mlvs. 14.15 ± 2.61 ng/ml,t=2.684), IL-6 (12.47 ± 2.16 ng/mlvs. 15.58 ± 3.12 ng/ml,t=2.564), and TNF-α (25.43 ± 4.27 ng/ml vs. 32.55 ± 6.14 ng/ml,t=2.594) was significantly lower in the treatment group than those in the control group. However, the expression of IL-10 (10.07 ± 2.13 ng/mlvs. 7.94 ± 1.83 ng/ml;t=2.673,P=0.023) was significantly higher in the treatment group than that in the control group. The temperature decreased time (4.57 ± 1.24 dvs.
3.25 ± 0.92 d,t=2.628), cough disappeared time (7.53 ± 2.13 dvs.6.14 ± 1.59 d,t=2.416), pulmonary rales disappeared time (6.81 ± 1.82 dvs.5.17 ± 1.06 d,t=2.537) was significantly lower in the treatment group than those in the control group.Conclusions TheTanreqing injection combined with routine western medicine could regulate Th17/Treg cells balance in the senile patients with bronchial pneumonia, and showed the significantly clinical effect.

Objective To measure and analyze Varian Clinac 21EX accelerator induced radioactivity,and to provide specific recommendations and ways of radiation protection for radiotherapy technicians.Methods To simulate the working environment of radiotherapy technician,and to detect induced radioactivity variation of Varian Clinac 21EX accelerator that induced by 15 MV X-rays under different conditions of beam field area,dose,time,distance and by high energy electron beam (12,16,20 MeV)at the different time.Results The induced radioactivity level was not influenced by different beam field area,and was increased with increasing dose (r =0.930,P ＜ 0.05),decreased with time increase (r =-0.84,P ＜ 0.05),decreased with distance increase(r =-0.975,P ＜ 0.05).The induced radioactivity attenuation levels of the different doses at the same time are different,and have the common characteristic that the induced radioactivity attenuation rate is faster in the initial times.The induced radioactivity levels of high energy electron beams were significantly lower than those of high-energy X-rays.Conclusions During radiotherapy positioning,it is necessary to take measures to protect against the induced radioactivity when high-energy rays with energy greater than 10 MeV will be used.The radiotherapy technician should take the different time and energy interval steps for the different ray type and energy and dose in order to meet the radiation protection principle of optimization.

OBJECTIVE: To analyze the clinical and genetic features of a patient with Treacher Collins syndrome (TCS), and identify the mutation in TCOF1 gene. METHOD: The medical history was taken, and general physical examinations and otological examinations were conducted in this patient. Genomic DNA was extracted from this patient and his parents and complete TCOF1 gene coding exons were amplified by specific PCR primers. Direct sequencing was carried out to identify the mutations. The raw data was analyzed with GeneTool software and molecular biological website. RESULT: We detected a heterozygous c. 1639 delAG mutation in exon 11 of TCOF1, which resulted in a truncated protein lacking normal function. This mutation is a novel mutation and the second case identified in exon 11 of in TCS. CONCLUSION TCS patient reported in this study has unique clinical phenotype. TCOF1 gene mutation is the specific risk factor.
DNA Primers ; Exons ; Genes, Regulator ; Genetic Testing ; Humans ; Mandibulofacial Dysostosis ; diagnosis ; genetics ; Mutation ; Nuclear Proteins ; genetics ; Phenotype ; Phosphoproteins ; genetics ; Syndrome

OBJECTIVE:To conduct pharmacognostical study of Caulopyhllum robustum Diels so as to offer evidences for exploiting and utilization of this herbal plant. METHODS:A pharmacognostical study of C.robustum was performed by carrying out identification of characteristics,microscopic identification and physicochemical identification. RESULTS:The pharmacognostical features of C.robustum have been established in our study. CONCLUSIONS:This study is suitable for the identification of the origin of C.robustum and it provides approach and evidence for the establishment of the quality standard and sustainable development of resources of C.robustum.

OBJECTIVE To monitor the Enterobacter cloacae resistance in our hospital patients.METHODS Disk susceptibility tests were performed for detection of E.cloacae resistance to 10 antibiotics,Detection of(extended)-spectrum ?-lactamases and AmpC ?-lactamase was conducted by three-dimensional extract test.RESULTS Seventy four strains of E.cloacae were isolated from our hospital patients,its had high resistant rate to 9 antibiotics(from(40.5%) to 91.8%),Among 74 strains of E.cloacae,10 isolates(13.5%) were considered as AmpC enzyme producing,31 strains(41.89%) were ESBLs-producing,6 strains(8.1%) were producing both of them.Total detection of AmpC(?-lactamase),or the production of ESBLs,or both of them were 47 strains(63.5%).Only imipenem was effective for all E.cloacae.CONCLUSIONS For the serious infection induced by E.cloacae producing AmpC ?-lactamase or(ESBLs),imipenem is first choice of treatment.