Volume 90  ·   Issue 35  ·  2010

Clinically, cervical spine diseases, lumbar spine diseases and even thoracic spine diseases exist at the same time, that is, multiple lesions of the spine exist at the same time, and cause nervous system damage at the same time. The clinical symptoms are very complicated, and it is difficult to judge the level of spinal lesion segments corresponding to clinical symptoms. It often leads to clinical misdiagnosis or misdiagnosis, and the treatment is delayed by shifting between various departments in hospitals. Even if the diagnosis is confirmed, it is often difficult to determine the surgical choice because of the difficulty of defining the main lesions.

Objective To investigate the mobility changes of adjacent segments after fusion retrospectively. Methods A total of 28 patients underwent standard anterior cervical arthrodesis. The kinematic changes occurred at segments adjacent to cervical arthrodesis through a coral bone graft and plating system. The mean follow-up period was 6. 3±1.6 years (3. 6 - 10. 5 ). Lateral radiographic views of cervical spine in flexion and extension were obtained at pre-operation and follow-up. Rotational motion at adjacent levels was quantified. Results Sagittal range of motion ( ROM ) at adjacent cranial level was 11.2°± 5.0° at pre-operation and 11.4°± 6.4°at follow-up. It was not statistically significant ( P ＞ 0. 01 ).At adjacent caudal level, ROM was 9. 8°±5. 3°, but 10. 2°±4. 6°at follow-up. But it was not statistically significant ( P ＞0. 01 ). During the follow-up, entire cervical motion ( C2-C7 ) decreased significantly from 46. 8°± 13.4° to 36. 8°± 9. 6° in single-level fusion group, but from 48.6°± 14. 6° to 39. 9°± 7. 2° in double-level fusion group. Conclusion The assumption of an iatrogenically elevated adjacent level mobility by cervical fusion is refuted by the present study.

Objective To study the clinical effect of anterior cervical approach surgery to removal posterior longitudinal ligament (PLL) with posterior longitudinal ligament hook pliers and posterior longitudinal ligament nip pliers. Methods To retrospectively analyzed anterior cervical approach surgery treatment 73 patients who were cervical spondylosis myelopathy. All patients removal PLL with self-make instrument, According to JOA grade to evaluate effect of operations. Results Full patients removal PLL were in succeed, in shape of extradural has renew ,the JOA grade were increase, ( 12. 8 ±3.2) vs (8. 3 ±1.9). Conclusions Removal PLL were increase effect of downright decompress in anterior cervical approachsurgery, Operations become safety agile and reduce the complications with self-make instrument.

Objective To evaluate the efficacies and features of treating Hangman's fracture by anterior cervical discectomy and fusion (ACDF). Methods Since June 2005 to December 2008, 36 cases with Hangman's fracture were analyzed with their clinical data including history, symptoms, signs,radiological findings and treatments. According to the classification system designed by Levine and Edwards depending on the radiological manifestations of Hangman's fractures, they were subdivided into type Ⅰ ( n =9) (conservative therapy), type Ⅱ (n = 17) and type ⅡA (n = 10). Conservative therapy was offered to type Ⅰ in 9 cases, while ACDF with cervical gear protection for 4 weeks after surgery was performed to type Ⅱ in 17 cases and type Ⅱ A in 10 cases. A combination of operation time, days of hospitalization,complications, neurological improvement and fusion rate was assessed. Results An average follow-up of 15months (range: 10 -36) was achieved. No vertebral redisplacement and angulation deformity occurred.Axial pain was relieved in each case. The preoperative neurological deficits in all patients got improvements. No spinal cord injury, vertebral artery injury or cerebrospinal fluid leakage ocurred. No complication related to internal fixator was found. Average operative time and hospitalization were similar to those of ACDF for lower cervical spine(98 minutes vs. 9 days). Fusion was achieved within 6 months in all cases. Conclusion ACDF at C2-C3 may be an effective and safe way to treat Hangman's fracture.

Objective To evaluate the efficacy and indication of pneumonectomy in patients with pulmonary tuberculosis. Methods From January 1992 to the end of 2008, 174 patients with pulmonary tuberculosis underwent pneumonectomy. According to the classification of pulmonary tuberculosis, there were tuberculous destroyed lungs ( n = 106 ), chronic fibro-cavernous pulmonary tuberculosis ( n = 27 ), cavernous pulmonary tuberculosis with aspergilloma ( n = 5 ), tuberculous tracheobronchial stenosis (n =16),pulmonary tuberculosis with encapsulated empyema (n = 5), tuberculous empyema with broncho pleural fistula ( n = 4) and massive hemoptysis (n = 11). Results The surgical approaches were pneumonectomy (n = 146 ), pleuropneumonectomy ( n = 21 ), chlorine pneumonectomy ( n = 3 ), pneumonectomy with thoracoplasty (n = 1 ) and pneumonectomy with tracheoplasty ( n = 3). The overall clinical cure rate was 93.0%, the rate of complications 11.5% and the operative mortality 2. 3%. There were 3 dead cases resulting from operations in six months. Conclusion Tuberculosis chemotherapy is an important modality for pulmonary tuberculosis, but surgical therapy remains essential for some patients. Pneumonectomy may increase the cure rates of severe pulmonary and multiple drug resistant tuberculosis.

Objective To outline the clinical features of Kennedy disease in Chinese patients. Methods The peripheral blood was collected from the male lower motor neuron disease patients of our inpatients and outpatients from July 2005 to September 2008. Then the genome DNA was extracted and the target gene amplified by polymerase chain reaction and sequenced. The clinical data of positive samples were analyzed and summarized. Results The number of expanded CAG repeats of 12 patients ranged from 43 to 57. And the number of CAG repeats was inversely correlated with the age of onset ( r = -0. 756, P＜0. 005 ). The first symptom of all of these patients was extremity weakness. The progression of disease was slow. One of the patients died from pneumonia. And the whole disease course lasted for 14 years. Conclusion As an adult onset degenerative disease with a slower clinical progression, Kennedy disease has its own characteristics of inheritance pattern and natural course. It can be accurately diagnosed by androgen receptor gene analysis.

Objective To discuss the clinical features and surgical tactics of neurogenic tumors external spinal canal. Methods The investigators retrospectively analyzed the clinical data of 56 cases with neurogenic tumors external spinal canal as confirmed by pathology at our department from January 2000 to June 2010. And the follow-up results were tracked. Among the patients, 51 cases underwent microsurgery and 5 cases routine retro-peritoneal operation. Results Fifty cases received total resection and 5 cases subtotal resection. Partial tumor removal was performed in 1 case with multiple Schwannoma only because nerve roots were densely distributed around the tumor. Postoperative complications included declining myodynamia (n=3), extremity pain ( n = 2 ), topical sensory disturbance ( n = 7 ), hoarseness ( n = 5 ), ipsilateral facioplegia & hypophasis (n = 1 ) and Horner's syndrome (n =2). Thirty-six cases had a follow-up period of 0. 5 year to 10 years. No in situ recurrence was found in 34 cases. Two cases with in situ recurrence were reoperated. There was no operative death. Conclusion The surgery of neurogenic tumors external spinal canal can improve the symptoms and quality of life for the patients. A better outcome is based on anatomic familiarity and skilled micromanipulation. The key aspects of tumor resection are a maximal protection of proximal important vessels and nerves and thorough tumor dissection.

Objective To compare the surgical outcomes for staging by laparoscopy and laparotomy in patients with endometrial cancer, evaluate the feasibility of laparoscopic surgical treatment of endometrial cancer, compare the difference between clinical and surgical staging of endometrial cancer and elucidate the advantages and feasibility of its surgical staging. Methods Fifty-six patients diagnosed pre-operatively as stage Ⅰ endometrial cancer were reviewed for surgery for staging. They were assigned into laparoscopic group ( n = 34 ) and laparotomic ( open ) group ( n = 22). The operative parameters including operating time, intraoperative blood loss, the number of lymph nodes removed, gastrointestinal recovery time, urinary catheterization time, complications and post-operative hospital stay were compared. Results The preoperative clinical characteristics before operation between two groups were similar. No significant differences were found in age and body mass index between two groups. As compared with the open group, the laparoscopic group had a longer operation time (213 min ±49 min vs 162 min ±30 min, P ＜0. 05), less hemoglobin change ( 12 g/L ±8 g/L vs 19 g/L ±8 g/L, P ＜0. 05), shorter hospital stay (6. 3 d ± 1.7 d vs 9.5 d ± 1.8 d, P ＜0. 01 ) and shorter gastrointestinal recovery time ( 1.8 d ±0. 6 d vs 2. 7 d ± 1.2 d, P ＜0. 01 ). While there was no significant difference between two groups in the number of lymph nodes removed,urinary catheterization time, costs and complications. The total coincidence was 57. 14% between clinical and surgical staging. Conclusion Laparoscopic staging surgery is both feasible and safe in the treatment of endometrial cancer. And the surgical staging truly reflects the extent of cancer invasion and it is thus necessary for early-stage endometrial cancer.

Objective To evaluate the efficacy of the endovascular inter-vention for transatlantic inter society consensus (TASC) type C and type D femoropopliteal artery disease. Methods We conducted a retrospective analysis on 95 cases (98 lower limbs) with TASC type C and type D femoropopliteal artery arteriosclerosis lesion treated by percutaneous transluminal angioplasty and/or primary stent implantation from January 2007 to April 2009. We used ankle brachial index (ABI), Fontaine stages, limb salvage percentage and primary patency to evaluate the efficacy of the endovascular intervention therapy. Results The technical success rate of the 98 limbs was 94.9%, the perioperation mortality was 4. 2% and the total amputation rate was 5. 1%. 81 cases(84 limbs) were followed-up for a mean time of ( 13 ± 7) months,whose average ABI in dorsalis pedis artery and posterior tibial artery were 0. 58 ±0.22 and 0. 60 ±0. 21 and increased 0. 14 ±0. 25 and 0.13 ±0.22 respectively than the ABI before intervention therapy. The statistical analysis showed a significant difference in ABI. The limbs of critical limb ischemia(CLI) were of 16. 4% in the follow-up period and of 73.5% before the intervention therapy. The statistical results showed a significant difference in the percentage of CLI. Conclusion Percutaneous endovascular intervention is an effective and minimally invasive method, and has a curative clinical efficacy to treat TASC type C and type D femoropopliteal artery disease.

Objective To evaluate the efficacy, radiographic changes and safety of the combination of recombinant human tumor necrosis factor-α receptor Ⅱ IgG Fc fusion protein (rhTNFR: Fc ) and methotrexate (MTX) in patients with rheumatoid arthritis (RA). Methods 30 RA patients were treated with rhTNFR: Fc (25 mg subcutaneously twice weekly) and oral MTX (up to 15 mg weekly) in an openlabel manner. Clinical response was assessed by American College of Rheumatology (ACR) criteria and Disease Activity Score in 28 joints (DAS28). Radiographs of hands and wrist were assessed by the modified Sharp score. Results At Week 24, ACR20, ACR50 and ACR70 responses were achieved by 90%,76. 67% and 46. 67% respectively. At Week 24, the mean DAS28 was 3.65 ± 1.26 versus 6. 41 ±0. 61 at baseline ( P ＜ 0. 001 ). And 20% patients achieved remission and 16. 67% patients had a low disease activity. At week 24, EULAR good and moderate responses were attained by 36. 67% and 60%respectively. Similarly, Health Assessment Questionnaire (HAQ) improved significantly, declining from 1.12 at baseline to 0. 36 at week 24 (P ＜0. 001 ). No radiographic progression ( based on change of total Sharp score) was found in 27 cases. Adverse events were mild. Conclusion rhTNFR: Fc in combination with MTX shows an excellent efficacy of reduced disease activity, improved function and slowed radiographic progression through 24 weeks. A combination therapy for 24 weeks can lead to disease remission and an inhibition of radiographic progression. Further study is warranted.

Objective To investigate the differential diagnostic value of NMO-IgG for neuromyelitis optica (NMO) versus multiple sclerosis (MS) and to analyze its possible clinical features related to NMOIgG. Methods Forty-one NMO patients and 44 MS patients in acute phase and 40 healthy controls were investigated. Serum NMO-lgG was tested by indirect immunofluorescence assay. The disability severity in NMO and MS patients was assessed by Expanded Disability Status Scale (EDSS). Clinical features and MRI imaging profiles were analyzed between NMO-IgG positive patients and negative ones. Results 70. 7% (29/41 ) NMO patients were NMO-IgG positive compared to 9. 1% (4/44) MS patients and all healthy controls were NMO-IgG negative (P ＜ 0. 01 ). The sensitivity and specificity were 70. 7% and 90. 9% respectively when NMO-IgG was used to discriminate NMO from MS. NMO patients with positive NMO-IgG had significantly higher EDSS scores ( P ＜ 0. 05 ) . More NMO-IgG seropositive patients had longitudinally extensive cord lesions ( ≥3 segments) than the NMO-IgG seronegative patients (93. 1% vs 66. 7% ). But the difference was insignificant. Conclusion NMO-IgG is a specific biomarker of NMO. NMO-IgG can facilitate an early differentiation of NMO from MS. NMO-IgG seropositivity is related to graver symptoms and it may predict an aggravation.

Objective To evaluate the efficacy and safety of high-dose α-lipoic acid in the treatment of diabetic polyneuropthy with regards to sensory symptoms and nerve conduction velocity. Methods A total of 236 diabetics with symptomatic polyneuropathy were enrolled into this 5-center, randomized,double-blind and placebo-controlled study of α-lipoic acid 1800 mg daily ( n = 117) or matching placebo ( n = 119) for 12 weeks. The primary outcome was total symptom score (TSS). Secondary end points included nerve conduction velocity, individual symptom score, HbA1c and safety parameters. The above parameters were reviewed and recorded at zero point and after treatment for 2, 4, 8, 12 weeks separately. Results 73. 27%patients with symptomatic polyneurnpathy improved after treatment with α-lipoic acid for 12 weeks versus 18.27% with placebo. TSS declined by 2.6 ±2. 3 with α-lipoic acid. And it was more than 0. 7 ± 1.4 versus placebo (P ＜ 0. 05 ). TSS decreased quickly after treatment with α-lipoic acid for 2 weeks (P ＜ 0. 05 ). And it was better than placebo. Individual symptom scores of pain, extremity numbness, burning sensation or resting abnormal sensations were significantly diminished as compared to those before treatment and placebo group ( all P ＜ 0. 05 ). Nerve conduction velocity had no change. HbA l c further decreased at the end of trial after α-lipoic acid treatment ( P ＜ 0. 05 ). The incidence rates of adverse effects were 25.4% vs 11.8% in the treatment and control groups. The major manifestation was burning sensation from throat to stomach ( 12. 7% ). Conclusion Oral treatment with high-dose α-lipoic acid for 12 weeks may improve symptoms in patients with diabetic polyneuropathy. Dose of 600mg thrice daily for 2 weeks has marked effects with a reasonable safety.

Objective To compare the difference and clinical significance of geometrical characteristics of tibial plateau between Uighur nationality and Han people by computed tomography scan and three-dimensional reconstruction. Methods A total of 49 inpatients and outpatients were randomly selected (normal knee without any tibial involvement ) and volunteers of Han people and 45 ones of the uighur nationality at our hospital and cooperative hospitals. Then the subjects were divided into groups according to gender. The following linear geometric parameters of tibial plateau were measured: width of tibial plateau (WTP), width of medial tibial plateau (WMTP), sagittal length of medial tibial plateau (SLMTP), width of lateral tibial plateau (WLTP) and sagittal length of lateral tibial plateau (SLLTP). Results ( 1 ) Males were greater than females in linear parameters in the same group ( P ＜ 0. 01 ); ( 2 ) the groups of Uighur nationality were greater than groups of Han people in linear parameters in the same gender( P ＜ 0.05 ); ( 3 )the gaps between WMTP and WLTP, SLMTP and SLLTP of Uighur nationality were all more approximate than those of Han people ( P ＜ 0. 05 ). Conclusion The geometrical characteristics of tibial plateau have some visible discrepancy between Uighur nationality and Chinese Han people. The prosthetic design concept and technology of total knee replacement targeting the Uighur nationality should take into consideration the discrepancy.

Objective To analyze causes of serious fungal corneal ulcer resulting in infectious endophthalmitis and explore clinical strategies of avoiding the failure of antifungal therapy. Methods Etiological factors, pre-hospital treatments, clinical features and laboratory findings of 47 inpatients with fungal corneal ulcer resulting in endophthalmitis from January 1999 to December 2008 in Qingdao eye hospital were retrospectively reviewed. Results Rural residents (95.7%) dominated in 47 cases with a mean age of (49. 8 ± 10.1 ) years. Ocular trauma was the leading cause of fungal corneal ulcer ( 66. 0% ) . Three patients were ever treated with hormone drugs after the fungal infection. Primary, secondary and tertiary hospital accounted for 68. 1%, 17.0% and 14.9% among first medical consultation sites. Diagnostic accuracies of fungal corneal ulcer in three grade hospitals were 31.3%, 62.5% and 71.4%respectively. The average interval from the onset of disease to the admission into our hospital was (29 ±23 )days. The dominating pathogen was genus Fusarium ( 91.5% ) with F. solani (48. 9% ), F. oxysporum (31.9%) and F. moniliforme (8. 5% ). Antifungal drug sensitivity tests were performed in 21 patients.The first three sensitive drugs were natamycin (88. 9% ), voriconazole (78. 6% ) and amphotericin B(61.9%). The first three drug-resistant ones were miconazole (90. 5%), fluconazole (66. 7% ) and itraconazole (61.9%). Conclusion Main causes of fungal corneal ulcer resulting in infectious endophthalmitis included lower diagnostic accuracies of first medical consultation in primary hospitals,abuses of non-sensitive drug and delayed treatment of patients. Improving clinical capabilities of doctors in primary hospitals, emphasizing antifungal drug susceptibility tests, and consummating the social security system and the referral system could be effective measures to avoid therapeutic failures.

Objective To confirm whether DHBV cccDNA could be detected in serum of DHBVinfected ducks after liver injury. Methods Twenty four ducks with persistent DHBV infection were divided into 4 groups with the following treatments: A, D-galactoamine ( D-GalN, 2. 2 g/kg) and lipopolysaccharide (LPS, 100 μg/kg); B,10 mg/kg of carbon tetrachloride (CCl4) every 12 h twice following D-GalN and LPS; C,15 mg/kg of CCl4 every 12 h twice following D-GalN and LPS; D,normal saline as normal control (NC). At 0 h, 24 h, 36 h and 48 h post-treatment, sera were collected from each duck for determination of serum DHBV load, DHBV cccDNA and alanine aminotransferase (ALT). And ducks were eventually sacrificed to obtain liver specimens for pathological assessment of liver lesions and determination of intrahepatic total DHBV DNA and DHBV cccDNA. Results (1)No obvious pathological change was observed in the liver of ducks from NC group while the indices of liver injury were significantly different between Groups A, B and C; (2) DHBV cccDNA was undetectable in the sera of ducks from NC and A group at all time points. In contrast, DHBV cccDNA, varying from 3. 17 × 103 copies/ml to 1.72 × 104copies/ml, was detected in the sera of 2 ducks from Group B and 3 ducks from Group C at 36 h posttreatment. The occurrence of DHBV cccDNA in serum was significantly correlated with the degree of liver injury while no significant association with serum ALT level and DHBV load as well as with the level of intrahepatic total DHBV DNA and DHBV cccDNA was observed. Conclusion DHBV cccDNA may be detected in the serum when the liver of duck is seriously damaged. The incidence of DHBV cccDNA occurrence in the serum is significantly associated with the severity of liver injury.

Objective To investigate the effects of blueberry on the proliferation and activation of hepatic stellate cell (HSC) and its mechanism. Methods Rat HSC were isolated by type Ⅳ collagenase digestion and Nycodenz density gradient centrifugation. The cultured HSC was incubated at different concentrations of 10% blueberry serum. The 10% DSHX serum was used as positive control and 10%normal rat serum group as control. MTT colorimetric assay was used to detect the HSC proliferation. Col Ⅰ of culture supernatant was detected by ELISA. The expression of α-SMA in HSC was measured by immunocytochemistry staining while the expressions of Nrf2 and HO-1 were determined by Western blot. Results Compared with controls, the low and high-dose blueberry serum groups significantly inhibited the HSC proliferation (P ＜0. 05 ). It had the same inhibitory effects as the positive control serum group( P ＞0. 05). Col Ⅰ of culture supernatant obviously decreased ( P ＜ 0. 05 ). And the expression levels of α-SMAin low and high-dose blueberry serum groups decreased significantly ( P ＜ 0. 05 ). And there were similareffects in low & high-dose blueberry serum and positive control serum groups. Western blot showed that theexpressions of Nrf2 and HO-1 in blueberry and positive control serum groups were higher than that in control group. And the increment was more significant in the low and high-dose blueberry serum groups( P ＜0.05 ).Conclusion Blueberry can significantly inhibit the proliferation and activation of HSC and reduce the synthesis of extra-cellular matrix. It may have potential preventive and protective effects on hepatic fibrosis.The mechanism may be related to an elevated expression of HO-1 through the Nrf2 pathway.

Objective To study the design, implementation and clinical evaluation of an anesthesia information management system. Methods To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. Results With the system, kinds of patient data could be collected, stored, analyzed and archived,kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. Conclusion The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provid clinical proof.

A 41-year-old female was diagnosed with "schizophrenia" and had been treated with various antipsychotic drugs. In the last two years, she had been orally taking "chlorpromazine" 50 mg/d and "clozapine" 250 mg/d. 　　

The 2nd National Academic Conference on Anxiety Disorders, sponsored by the Psychiatry Branch of the Chinese Medical Association and organized by the Anxiety Disorder Cooperation Group and the Trauma Prevention and Treatment Cooperation Group, was held in Xi'an, Shaanxi Province from August 6-8, 2010. The conference was the only large-scale academic exchange conference on the theme of anxiety disorders in China. About 400 delegates from all over the country participated in the conference, including psychiatric experts, clinicians from psychiatric specialist hospitals and general hospitals and media.