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Objective:To compare the technique between concave distraction and convex resection in the treatment of congenital cervicothoracic scoliosis and evaluate its curative effect.Methods:Data of congenital cervicothoracic scoliosis patients from January 2010 to January 2020 were collected, among which 5 were males and 3 were females. The patients' age was 12.5±4.5 years old (range 6-20 years old). One case had C 7 wedged vertebra, 4 cases had T 1 hemivertebra and unbalanced vertebra, 2 cases had T 2 hemivertebra and 1 case had fused facet joint and wedged lamina in T 1. All patients had different degrees of vertebra fusion. Convex resection technique (one stage anterior and posterior combined hemivertebrae resection and annular osteotomy) was used to treat 4 cases before 2015; Concave distraction technique (A combination of anterior and posterior release, intervertebral space and facet space distraction, cage placed and fusion) was used to treat 4 cases after 2015 and 2 of them had 2 segments distraction. Perioperative neurological, vascular and wound related complications were recorded. The main parameters were structure Cobb angle, cephalic and caudal compensatory Cobb angle, mandibular incline, neck tilt, shoulder balance and head shift were measured pre-operation, post-operation and at the last follow-up. Results:All patients' surgeries were completed successfully. In convex resection group, the duration of surgery was 201±100 min (range 113-300 min) per vertebra, the estimated blood loss was 294±153 ml (range 100-450 ml) per vertebra, the hospital stay was 14±3 d (range 11-18 d) and follow up time was 51±11 months (range 36-60 months). In concave distraction group, the duration of surgery was 117±14 min (range 101-129 min) per vertebra, the estimated blood loss was 119±36 ml (range 85-167 ml) per vertebra, hospital stay was 17±3 d (range 14-20 d) and follow up time was 28±21 months (range 12-60 months). Convex resection group had longer operation time and more blood loss per vertebra than concave distraction group. In convex resection group, structural Cobb angle was 45.1°±21.0° pre-operation and 22.7°±15.3° post-operation, which was corrected significantly ( Z=6.53, P=0.038). The correction rate was 54.8%±30.9%. Cephalic compensatory Cobb angle was 22.1°±8.2° pre-operation and 8.2°±5.8° post-operation, which was corrected significantly ( F=6.01, P=0.049). The correction rate was 66.8%±15.1%. Mandible incline was 7.8°±3.1° pre-operation and 3.5°±1.5° post-operation, which was corrected significantly ( F=8.02, P=0.018). The correction rate was 51.0%±29.7%. In concave distraction group, structural Cobb angle was 32.2°±27.2° pre-operation and 16.3°±16.7° post-operation, which was corrected significantly ( F=7.43, P=0.024) . The correction rate was 59.0%±24.7%. Caudal compensatory Cobb angle was 18.9°(17.2°, 32.1°) pre-operation and 9.5°±10.3° post-operation, which was corrected significantly ( Z=6.00, P=0.049). The correction rate was 64.0%±24.1%. Clavicle angle was 3.9°±2.3° pre-operation and 0.3°±0.4° post-operation, which was corrected significantly ( F=1.75, P=0.040). The correction rate was 97.0% (48.5%, 99.8%). There was no significant difference in the correction rate of all radiographic parameters between the two groups. At the last follow-up, the patients' appearance of head, neck and shoulder were improved compared with those before surgery. In convex resection group, 2 patients showed nerve root stimulation symptoms postoperatively on convex side. One patient developed C 5 nerve root palsy which weakened deltoid muscle and the other patients presented with reduced triceps muscle strength. In concave distraction group, one patient developed C 5 nerve root palsy on convex side. All these symptoms recovered by conservative treatment 3 months after operation. Conclusion:It is safe and effective to treat congenital cervicothoracic scoliosis with convex resection technique and concave distraction technique. The concave distraction technique has the advantages of more safety, less operating time, less blood loss and easier to perform and has a wider application prospect.
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Women with gestational hyperglycemia tend to encounter breastfeeding difficulties, which may lead to breastfeeding failure or short duration of breastfeeding. Antenatal breastmilk expression, stimulating or massaging the breasts during pregnancy to produce milk and to collect and store colostrum, is beneficial to lactogenesis, thereby reducing formula feeding, promoting the transition to exclusive breastfeeding and increasing the exclusive breastfeeding rate. This review summarizes the safety and feasibility of antenatal breastmilk expression for women with gestational hyperglycemia, aiming to provide breastfeeding guidance for this population.
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Objective:To explore the safety, feasibility, and short-term outcome ofdistraction on the concave side in the treatment of patients with congenital cervical scoliosis.Methods:Between August 2015 and December 2019, 11 patients with congenital cervical scoliosis underwent distraction technique on concave side, among which 5 were males and 6 were females. Age was 9.9±3.1 years old (range 6-16 years old). The primary cervical spine deformity was hemi-vertebra with different degrees of vertebra fusion. 7 cases were in C 3, 3 cases were in C 4 and 1 case was in C 5. Anterior-posterior combined approach was used. Firstly, discectomy and soft tissue release on concave side were made through anterior approach, then distraction on concave side and fusion with internal fixation were made through posterior approach and at last fixation and fusion in anterior approach were made. In this study we measured structure Cobb angle, compensatory Cobb angle, mandibular incline, shoulder balance and the angle difference of trapezius muscle preoperation and post operation. Perioperative neurological,vascular and wound related complicationswere recorded. Results:All patients' surgeries were completed successfully. Eight patients received single site distraction and 3 patients received distraction in two sites. The duration of surgery was 466±141 min (range 150-659 min), the estimated blood losswas 387±191 ml (range 100-660 ml) and follow up time was 12.2±9.5 months (range 3-24 months). Structural Cobb angle was 28.9°±13.1° pre-operation and 7.4°(3.0°, 27.7°) post-operation at 3 months, which was corrected significantly ( Z=-2.934, P=0.003). The correction rate was 58.1±26.1% (range 18.8%-97.6%). Structural Cobb angle was 13.2°±12.3°at 1 year post operation and had no significant difference compared with 3 months post operation ( t=1.960, P=0.107). Compensatory Cobb angle was 18.3°±6.1° pre-operation and 9.4°±7.3° post-operation at 3 months, which was corrected significantly ( t= 5.071, P<0.001) and the correction rate was 51.3%±28.3% (range 2.4%-94.7%). Compensatory Cobb angle was 8.9°±7.7° at 1 year follow up and was corrected significantly ( t=5.253, P=0.003) compared to 3 months after surgery and the correction rate was 61.4%±26.9%. Two patients developed C 5 nerve root dysfunction and 1 patient developed numbness on the index and middle fingers after surgery. All of them occurred on the concave side and recovered by conservative treatment. Conclusion:The application of distraction on the concave side in the treatment of congenitalcervical scoliosis is with good feasibility and clinical safety. Short-term follow-up showed excellent resultswith a promising future.
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OBJECTIVE@#To assess the value of single sperm sequencing in preimplantation genetic diagnosis.@*METHODS@#A male patient with achondroplasia due to a de novo FGFR3 variant was subjected to single sperm isolation and sequencing. Twenty single sperm samples were isolated by mechanical immobilization, and their whole genome was amplified. PCR primers were designed for the variant site and 25 flanking single nucleotide polymorphism (SNP) loci, and the PCR products were sequenced to determine the chromosomal haplotype which did not harbor the pathogenic variant. Biopsy samples of 12 embryonic trophoblasts were taken. Following whole genome amplification, high-throughput sequencing was carried out to detect the carrier status of the embryos. Wild type blastocysts were selected for transplantation. Amniotic fluid samples were taken at 19 weeks of gestation to confirm the status of the fetus.@*RESULTS@#Eight SNP were selected by single sperm sequencing, with which the haplotypes were successfully constructed. Preimplantation genetic testing indicated that 5 embryos have carried the pathogenic variant and 7 did not. Testing of amniotic fluid sample during the second trimester of pregnancy confirmed that the fetus did not carry the FGFR3 gene c.1138G>A variant.@*CONCLUSION@#For male patients carrying de novo pathogenic variants, SNP sites can be selected through single sperm sequencing, and haplotypes can be constructed by linkage analysis for preimplantation genetic diagnosis.
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Objective:To investigate the effect of milking diary combined with syringe collection of colostrum on early lactation.Methods:Totally 80 cases of separated mothers and infants hospitalized in the maternity ward of our hospital from February to November 2018 were selected as research objects, February to June as control group, July to November as experimental group, 40 cases respectively, two groups were given routine maternal lactation, experimental group in regular maternal lactation guidance, on the basis of guiding diary records milking and provides the syringe collection of colostrum. Comparison of two groups of maternal postpartum 3 days milking frequency and milking, lactation, start time, lactation Ⅱ period time, breast tenderness and 42 days exclusive breastfeeding rates.Results:Postpartum 24 hours, 48 hours, 72 hours of milking times of delivery woman in experimental group were respectively (7.25 ± 1.53), (7.40±1.26), (8.50±0.82) times, which were higher than (4.18 ± 2.62), (6.35±1.73), (7.35±1.72) times in control group, the difference was statistically significant ( t values were -6.408, -3.102, -3.824, P < 0.01). Milking 49-72 hours was 50.30 ml, which was significantly higher than 30.70 ml of control group, the difference was statistically significant ( Z value was 3.773, P < 0.01); mammary start time, lactation Ⅱ period significantly ahead of time, respectively (9.82 ± 3.62) hours in advance, and (15.83 ±0.78) hours, the difference was statistically significant ( t values were 2.480,4.871, P<0.05); breast pain Ⅲ degrees within 72 hours of experimental group 5.0% (2/40) was significantly lower than the control group 25.0% (10/40), 42 days exclusive breastfeeding rate 62.5% (25/40) was significantly higher than the control group 22.5% (9/40), the differences were statistically significant ( χ2=6.772, 13.095, P<0.05). Conclusion:Joint syringe collection colostrum milk a diary method can effectively improve maternal milk, increase the amount of milk secretion, and early lactation start time and duration of lactation Ⅱ period, so as to promote exclusive breastfeeding rate and duration of breastfeeding, and can effectively reduce the degree of breast tenderness, worthy of clinical popularization and application
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Objective:To investigate fathers′ knowledge, attitude and practice of breastfeeding and to analyze the related factors.Methods:From August 2018 to April 2019, 200 fathers of newborns in a Shanghai tertiary obstetrics and gynaecology hospital were surveyed about their breastfeeding knowledge, attitude and practice by convenient sampling and self-designed questionnaires.Results:The average knowledge score was 9.80±2.61, the attitude score was 38.71±4.45, the behavioral score was 39.72±6.48. Multiple linear regression results showed that parents′ education level and the wives′ delivery times were the main factors affecting breastfeeding knowledge score ( t values were 2.016, 2.068, 2.988, P < 0.05). The fathers′ knowledge score and the wives′ delivery method were the main factors affecting attitude score ( t values were -3.029,5.225, P < 0.05). Attitude score and infants′ age stage were the main factors affecting behavior score ( t values were 1.985, 2.633, P<0.05). Conclusion:Fathers′ breastfeeding attitude was positive, but they still had wrong perceptions. There were many deficiencies in breastfeeding related behaviors of fathers. It is necessary for hospitals, communities or other relevant institutions to educate fathers with knowledge related to breastfeeding, to encourage fathers to pay more attention to breastfeeding and urge fathers′ behavior improvement, so as to increase the rate of breastfeeding and promote the health of mothers and infants.
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Objective To investigate the clinical efficacy of anterior cervical surgery by comparative analyzing hand dysfunction using brief Michigan hand questionnaire(Brief MHQ)in Hirayama disease patients.Methods From Aug 2011 to Dec 2016,27 patients of hirayama disease who underwent surgery were enrolled in this study.The study group consisted of 27 men.The mean follow-up period was 41.1 months.The levels of surgery included 18 cases of C4-C7,6 cases of C3-C6,2 cases of C4-C6 and 1 case of C5-T1.Brief MHQ were evaluated for the 27 patients.According to the Wilcoxon analysis,the unchanged domains were analyzed with the multifactor Logistic regression analysis by preoperative duration of symptoms,age of onset,and number of affected extremities.Dynamic flexion-extension lateral X-rays were performed at baseline and at final follow-up.Results No failure of internal fixation was detected on dynamic flexion-extension lateral X-rays.Five domains of preoperative Brief MHQ had lower scores,including Function,Satisfaction,Aesthetics,Activities of daily living,Work domain.With the exception of Aesthetics and Pain domain,all the other four domains showed significant improvement after surgery.The total score was 38.44±5.83 at base-line and 43.19±4.47 at follow-up.The score of Function was 5.19±1.36 at baseline 6.37±1.15 at follow-up;The score of Satisfaction was 5.56±1.22 at baseline 6.60±1.05 at follow-up;The score of Activities of daily living was 6.33±1.84 at baseline 7.60±1.47 at follow-up;The score of Work was 6.85±1.75 at baseline 7.67±1.33 at follow-up.The risk factors of postoperative outcomes reported in the literature included duration of disease at the time of surgery,age of onset,and extremity involvement.According to the Logistic regression,pre-operation duration was the risk factor for Aesthetics domain and the cut-off time was 1.75 years.Conclusion Four domains of Brief MHQ score were improved significantly after anterior surgery for patients with hirayama disease.Brief MHQ was useful to evaluate the hand dysfunction and clinical efficacy in patients with hirayama disease.
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Objective To assess the mid-term clinical and radiological outcomes of anterior cervical internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure.Methods All of 31 patients underwent anterior cervical internal fixation and fusion were retrospectively analyzed with a minimum of 5 years follow-up in our hospital between May 2008 and May 2011,whose disease progressively deteriorated after six-month's conservative therapy(neck collar)preoperatively.There were 30 males and 1 female with an average age of 19.0±2.7 years which ranged from 16 to 27.The clinical outcomes included forearm and hand muscle atrophy and strength.The radiological outcomes included range of motion(ROM)of the whole cervical spine and unstable segments,as well as venous flow empty phenomena and "snake eyes" sign on MRI in the flexed position.All were recorded at 3 month,1 year,3 year and 5-6 years follow-up time points after surgery.The preoperative and postoperative quantitative variables were analyzed by paired t test,and a P<0.05 was used to indicate statistical significance.Results All the patients showed no further progression of symptoms of muscular weakness or atrophy.At the end of 5-6 years follow-up,24 of the 31 patients(77.4%)showed improved muscle strength and 16 of the 31 patients(51.6%)showed improved atrophy.Thirty-one patients had a forearm muscle strength of 4 to 5 at the last follow-up,with an average of 4.9±0.3,which was superior to preoperative 0 to 5(3.6±1.0);grip strength was 3 to 5 kg,with an average of 3.9±0.7 kg,significanthigher than 1 to 3.8 kg(2.5±0.8 kg)before surgery.Score of muscle strength of the 31 patients at the end of 5-6 years' follow-up was 4.9±0.3(4 to 5),which was significantly higher than preoperative.Postoperative X-rays at the end of 5-6 years' follow-up revealed that all the cases' internal fixation was at the proper position,and no losing or broken of the internal fixation were identified.Dynamic X-rays of cervical spine showed the range of motion(ROM)of the whole cervical spine was significantly decreased after the operation.The ROM of preoperation was 77.8o±12.70 and that of 5—6 years postoperation was 27.90±7.60.The unstable segments of cervical spine became stable postoperatively.The flexible position MRI of cervical spine showed the spinal cord was completely relieved,without new compression.Venous flow empty phenomena disappeared and no "snake eyes" sign was identified.Conclusion Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable mid-term clinical and radiological outcomes.This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.
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Objective To investigate the clinical characteristics and associated risk factors for patients with mixed Candida/bacterial bloodstream infections (BSIs).Methods A retrospective study was conducted in the Second Affiliated hHospital of Zhejiang University School of Medicine from February 2012 to June 2015.The clinical data of cases was collected,and the clinical characteristics,the microbiology data and outcomes in patients with mixed Candida/bacterial BSIs confirmed by blood culture were compared with those with candidaemia.A Logistic regression analysis was performed to investigate the independent risk factors.Results A total of 136 candidaemia cases were analyzed including 40 cases (29.4％) of mixed Candida/boacterial BSIs and 96 cases of candidaemia.Among the 136 candidas strains,the proportion of non-albicans exceeded the albicans (50.7％ vs 49.3％),although the later was still the predominant one.There was no significant difference in the distribution of candidas strains between patients with mixed Candida/bacterial BSIs and patients with candidaemia.In patients with mixed Candida/bacterial BSIs,25 strains (61.0％) of gram-positive cocci and 16 strains (39.0％) of gram-negative bacilli were isolated.Compared with patients with candidaemia,patients with mixed Candida/bacterial BSIs needed longer period of antifungal therapy [12.0 (4.0-25.0)days vs 7.0 (3.0-13.5) days,P=0.027],but the crude 30-day and 90-day mortality did not differ between the two groups (40.0％ vs 32.3％;45.0％ vs 36.5％;both P＞0.05).Univariate analysis revealed that the prior hospital stay,ICU admission at the onset of candidaemia,blood transfusion,human albumin infusion,mechanical ventilation,linezolid use and high SOFA score were related with the occurrence of mixed Candida/bacterial BSIs (all P＜0.05).Multivariate analysis showed that only high SOFA score was the independent risk factor (P=0.003).Conclusions Gram-positive cocci were the predominant species in mixed Candida/bacterial BSIs.Compared with candidaemia,mixed Candida/bacterial BSIs needs a longer ICU stay,a longer hospital stay,and a prolonged antifungal therapy.High SOFA score is the independent risk factor for mixed Candida/ bacterial BSIs.
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Objective To observe the feasibility of early enteral nutrition (EEN) in adult patients during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and its related clinical results. Methods Thirty-four patients admitted to the Intensive Care Unit (ICU) of Ningbo Medical Center Li Huili Hospital from January 2012 to December 2017 to receive VA-ECMO treatment were selected as the study objects. All patients received EEN after exclusion of contraindications; the target calories were calculated by using 104.65 kJ·kg-1·d-1(25 kcal·kg-1·d-1) and according to 1.2 g·kg-1·d-1, the target protein requirements were calculated. Within one week of EN energetic treatment, if the feeding amount reached 80% or over of the above calculated targets, the EN administration was fulfilling the standard, thus the patients were divided into a standard group and a non-standard group, After ICU admission, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, multiple organ dysfunction syndrome (MODS) score, the time from the beginning of ECMO to the start of EN, time reaching feeding standard, VA-ECMO persistent days, ICU days of stay, total hospitalization days, hospital mortality, and reasons for feeding interruptions were recorded, and the effects of EEN on prognosis of patients during VA-ECMO were analyzed in the two groups. Results The APACHE Ⅱ score and MODS score of the non-standard group were higher than those of the standard group on admission of ICU (APACHE Ⅱscore: 25.50±5.62 vs. 19.91±8.53, MODS score: 11.08±3.26 vs. 6.73±2.05, both P < 0.05), and the hospital mortality was lower in the standard group than that in non-standard group [40.9% (9/22) vs. 83.3% (10/12), P < 0.05]. The comparisons of differences in time from the beginning of ECMO to the start of EN, time of reaching feeding standard, VA-ECMO treatment days, ICU days of stay, hospitalization days between the two groups were of no statistical significance (all P > 0.05). The most common reason for interruption of feeding was high gastric residual volume (GRV). Conclusion Whether a critically ill patient receiving VA-ECMO can reach the target feeding amount in a week or not is related to the degree of disease severity; it is difficult for a seriously ill patient to reach the target amount of feeding, that may affect their prognosis.
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Objective To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 μg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. Methods A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 μg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. Results 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation Ⅱ score [APACHE Ⅱscore: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P 100 μg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE Ⅱ score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.
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The continuing education system at the Peking University Health Science Center for vis-iting scholars (Research program for young and middle-aged doctors) is a relatively advanced and compre-hensive medical continuing education system in China, among which, the tutorial system is a good method to guide the visiting scholars of continuing education. On this basis we conducted scholars learning effect questionnaire survey and combined with the feedback results, discussed the advantages and disadvantages of the current educational system of visiting scholars in China, and put forward some concrete suggestions on the development of the continuing education in China.
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Objective To study the expression of cyclooxygenase-2 (COX-2) in colorectal cancer,and its relationship with the sensitivity of rectal cancer neoadjuvant radiotherapy.Methods 102 rectal cancer patients with preoperative radiotherapy were selected from January 2013 to January 2016.The COX-2 expression of samples were detected by immunohistochemical.We analyzed the relationship of tumor and adjacent to carcinoma tissue COX-2 expression,radiation sensitivity and the prognosis of patients.Results 71 cases with radiation sensitivity and 31 radiation resistance cases,radiation sensitive rate was 69.6％.The COX-2 expression in the tumor tissue was significantly higher than adjacent tissue (P ＜ 0.05),radiation sensitive patient proportion with positive and strong positive COX-2 expression was significantly lower than the radiation resistance (P ＜ 0.05).The adjacent to carcinoma tissue's COX-2 positive expression of radiation resistance group proportion was significantly higher than the radiation sensitive group (P ＜ 0.05).The tumor COX-2 positive OR strongly positive (OR:4.21,95％ CI:1.26-7.17),tissue adjacent to carcinoma COX-2 positive (OR:8.15,95％ CI:1.43-38.21) were risk factors for neoadjuvant radiotherapy resistance.The survival analysis showed that tumor tissue COX-2 expression of negative OR weakly positive patients survival significantly extended.Conclusions There were significant correlations between the expression of COX-2,neoadjuvant radiotherapy sensitivity and prognosis in colorectal cancer patients.the joint detection biopsy COX-2 expression in colorectal cancer patients with tumor and cancer adjacent tissues,may screening out patients sensitive to radiation and chemotherapy,which making patient better prognosis.
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Objective:To retrospectively analyze the clinical data of the patients with reoperation for cervical myelopathy due to progressing ossification of the posterior longitudinal ligaments,with previous open-door expansive laminoplasty,and to evaluate the outcomes.Methods:From May 2006 to July 2012,a retrospective study was performed on a consecutive series of 17 patients with previous open-door expansive laminoplasty,who had received the reoperation for cervical myelopathy due to progressing ossi-fication of the posterior longitudinal ligaments.The reoperation was performed based on the clinical mani-festations and segments of responsibility.The anterior approaches were performed in 12 cases,and the posterior approaches in 5 cases.The correlation between the clinical factors and Japanese Orthopedic As-sociation (JOA)scores or the JOA recovery rate was evaluated by Pearson or Spearman correlation test. The pre-and post-operative JOA scores were analyzed by repeated measures ANOVA and the JOA recovery rates were compared with paired t test.Results:The mean follow-up was 137.5 months (range 60-348 months).There were no serious complications after surgical procedures.There was one case that had C5 palsy in the first operation and had recovery after one week.Another case had C5 palsy in the reoperation with posterior approach,which had recovery at the end of 6 months post-operation.Three cases had the cerebrospinal fluid leakage of the reoperation,with two cases in the anterior approaches and one case in the posterior approach.There was no significant correlation between the clinical variables and JOA scores or JOA recovery rates.The JOA scores of the patients in the first operation were improved from 9.4 ±4.1 to 12.8 ±2.8 (P<0.01),and the JOA recovery rate was 45.6%.The JOA scores of the reoperation were improved from 10.2 ±2.8 to 12.7 ±2.4 (P<0.05)at the end of 6 months and 14.3 ±1.9 (P<0.01)by the last follow-up.There were significant differences between the JOA recovery rates by the last follow-up (63 .2%)and at the end of 6 months (39 .3%)of the reoperation or 45 .6%of the first opera-tion (P<0.01).Conclusion:The reoperation for cervical myelopathy duo to progressing ossification of the posterior longitudinal ligaments can significantly promote the recovery of the spinal cord,based on the clinical manifestations combined with segments of responsibility of the imaging.
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Objective To analysis the correlation between patient selection and heterotopic ossification (HO) after cervical artificial disc replacement.Methods Data of 48 patients with cervical spondylosis (34 cervical spondylotic myelopathy and 14 nerve-root type) who had undergone Bryan cervicadisc replacement from December 2003 to December 2008 were reviewed retrospectively,and all the patients had been followed up for more than 5 years.There were 21 males and 27 females with an average age of 42 years old (range,20-53 years).There were 38 single level replacement (C3-4 3 cases,C4-5 5 cases,C5-6 28 cases,C6-7 2 cases),9 double level replacement (C4-5,C5 6 4 cases;C5-6,C6-7 5 cases) and 1 three level replacement (C3-4,C4 5,C5-6) as a total of 59 surgical segments.The occurrence of HO was defined by McAfee classification on cervical lateral X-ray.Four factors were used in patient selection including gender,range of motion (ROM) of the target level,alignment of the functional spine unit (FSU) of the index level,and the disc height ratio between surgical level and the adjacent levels.The correlation between these four factors and HO was evaluated by logistic regression.The receiver operating characteristic (ROC) curve and area under the ROC curve were used to evaluate the significant result of logistic regression and the optimal diagnostic value.Results 48 patients were all followed up for an average period of 70.3 months (range,60-120 months).The occurrence rate in this study was 33.9％ (20/59 segments).Only one factor,the disc height ratio of the target level and its adjacent levels,presented statistical correlation with HO.ROC analysis showed that the area under the ROC curve of disc height ratio was 0.813 and the optimal diagnostic threshold was 0.9.Conclusion The disc height ratio of the target level and adjacent levels was the only patient selective factor correlated with the occurrence of HO.For those with disc height loss exceeding 10％ comparing to adjacent levels,it is not indicated for cervical artificial disc replacement with Bryan prosthesis.
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<p><b>BACKGROUND</b>Adjacent segment disease (ASD) is common after cervical fusion. The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).</p><p><b>METHODS</b>Patients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion. A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments. Plate-to-disc distances (PDDs), developmental cervical canal stenosis on X-ray, cervical disc degeneration grading, and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.</p><p><b>RESULTS</b>Thirty-four patients with complete radiographic data were included in the ASD group. The causative segments of ASD included nine cases of C3-4, 18 cases of C4-5, three cases of C5-6, and four cases of C6-7. The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients. PDD distributions were similar between the ASD group and the control group. Developmental cervical canal stenosis was a risk factor for ASD, with an odd ratio value of 2.88. Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group. In the upper-level ASD group, the disc bulge impingement was (19.7±9.7)%, which was significantly higher than that of the control group of (11.8±4.8)%.</p><p><b>CONCLUSIONS</b>ASD was more likely to develop above the index level of fusion. Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.</p>
Subject(s)
Humans , Male , Middle Aged , Cervical Vertebrae , Pathology , General Surgery , Decompression, Surgical , Intervertebral Disc Degeneration , Diagnosis , Magnetic Resonance Imaging , Radiography , Risk Factors , Spinal Fusion , Spinal Stenosis , Diagnostic ImagingABSTRACT
[Objective]To summarize the growth of 51 famous experts in traditional Chinese medicine, in order to provide the young and middle-aged scholars of this area with studying materials and references. [Methods] Finding the similarities and making a summary by interviewing, organizing and ana-lyzing the growing experiences of these 51 experts. [Results]Being enthusiastic about traditional culture of Chinese medicine and having careful y read re-lated classics when studying medicine, most of the experts have either experiences of learning from famous doctors, or strong interest motivated by learning the practical effect of traditional Chinese medicine. They have been insisting on a lifetime, perseverant, diligent and strenuous learning, and they are good at summarizing. In addition, they have attached great importance to medical ethics and self-cultivation, which is considered to be the general characteristic of their bril iance. [Conclusions] To cultivate talents of modern Chinese medicine under the roof of col eges and institutes, it is important to develop their interest first, then to put great emphasis on reading classics, learning from famous doctors, summarizing through the way of “reading-clinical verification-reading again”, and final y, paying great attention to the education of medical ethics.
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<p><b>BACKGROUND</b>Open-door laminoplasty is widely used in the treatment of cervical spondylotic myelopathy (CSM). This study aimed to investigate the profiles of and correlation between objective and subjective short-term outcome assessments after open-door laminoplasty for CSM.</p><p><b>METHODS</b>We retrospectively analyzed surgical outcomes in 129 consecutive CSM patients who underwent open-door laminoplasty in Peking University Third Hospital from February 2008 to November 2011. Both objective and subjective assessments were evaluated before surgery, 3 months after surgery, and 1 year after surgery. We then analyzed the profiles of and correlation between objective and subjective short-term outcomes.</p><p><b>RESULTS</b>The Modified Japanese Orthopaedic Association (mJOA) score was significantly improved at 3 months (P < 0.01) and 1 year (P < 0.01) after surgery. Bivariate Logistic regression showed that sensory improvement contributed more to the recovery rate than motor function improvement at 3 months after surgery, while motor function contributed more to the recovery rate at 1 year after surgery. On the subjective assessment (the short form (SF)-36 ), there was no significant improvement at 3 months after surgery (P > 0.05), while physical function (PF), role-physical (RP), and social function (SF) were notably improved at 1 year after surgery (P < 0.01). Improved mJOA score correlated with improvements in PF, RP, bodily pain, general health (GH), vitality (VT), and SF (P < 0.05) at 3 months after surgery; PF, GH, VT, and SF were associated with improved mJOA scores at 1 year after surgery.</p><p><b>CONCLUSIONS</b>Patients benefit from surgery by postoperative restitution of neurological function with early recovery of sensory function, followed by a gradual transition to motor function improvement. At the early stage of recovery, improvement in the mJOA score essentially correlated with improvements in the physical domains of the SF-36, while at the later stage, mJOA score improvement was associated with improvements in both mental and physical domains of the SF-36.</p>
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Female , Humans , Male , Middle Aged , Laminoplasty , Reference Standards , Retrospective Studies , Spinal Cord Diseases , General SurgeryABSTRACT
Objective To investigate surgical strategy and outcome for cervical metastasis in different anatomical segments.Methods Data of 31 patients,who had undergone surgical treatment for cervical metastasis from 2001 to 2009,were retrospectively analyzed.Two anatomical regions were defined:upper cervical spine (C1 and C2)and subaxial cervical spine plus cervicothoracic junction (C3-T1).VAS score,Frankel grade,Tomita score and Karnofsky performance scale were used to evaluate pain,neurological status,expected survival time and general health.The improvement of symptoms,survival time and characteristics of surgical strategies for different anatomical regions were analyzed.Results Twenty-four patients were followed up successfully.An effective recovery in neck pain and quality of life was found after operation.The median survival time was 45.0 months.In upper cervical spine group,the surgical strategies included posterior occipitocervical fixation combined with 125I seed brachytherapy and other surgical methods,and the median survival time 48.0 months) of patients who underwent 125I seed brachytherapy was longer than that 22.0 of patients treated with other surgical methods.In C3-T1 metastasis group,patients who underwent combined anterior-posterior approach total spondylectomy had a longer survival time than those treated with anterior corpectomy.Conclusion Surgical treatment can effectively relief neck pain,maintain or improve neurological function and improve quality of life.Doctors should choose different surgical strategies according to anatomical region of cervical metastasis.For upper cervical spine,the main purpose of surgery is to stabilize the cervical spine; the posterior occipitocervical fixation is usually chosen,and the 125I seed brachytherapy is useful in local control of metastasis.For subaxial cervical spine and cervicothoracic junction,the anterior corpectomy is usually chosen,and a combined anterior-posterior approach total spondylectomy can be used for patients with corresponding conditions.
ABSTRACT
ObjectiveTo explore the relationship between brain iron deposition and pathogenesis of tardive dyskinesia (TD) in schizophrenia.MethodsThe corrected phase (CP) of basal ganglia was measured in schizophrenia with TD( n=18) and without TD( n =18 ) using susceptibility weighted imaging MRI.Abnormal Involuntary Movement Scale (AIMS) was applied for clinical assessment of TD.ResultsAfter adjusting for age,sexual,and antipsychotic dosage,the mean CP of substantia nigra (SN) and caudate nucleus (CN) were significantly lower in schizophrenia patients with TD ( ( - 0.194 ± 0.040 ) rad,( - 0.089 ± 0.023 ) rad) than those without TD ( ( - 0.163 ± 0.033 ) rad,( - 0.076 ± 0.013 ) rad ; P =0.022,0.023 ).Lower mean CP in CN correlated with higher severity score of AIMS in TD patients ( r =- 0.468,P =0.034).Logistic regression analysis showed that the lower CP vaule in SN (β=-72.12,P=0.029) and CN(β=- 156.43,P=0.037),aging (β=0.379,P=0.042)were associated with the onset of TD.ConclusionThe results imply that the excess iron accumulation in basal ganglia may be associated with pathogenesis of TD in schizophrenia.