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BACKGROUND:Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body. OBJECTIVE:To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.METHODS:307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical University from July 2008 to January 2014, were enrol ed in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which al owed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely. RESULTS AND CONCLUSION:Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69%). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were fol owed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.
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Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.
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[ ABSTRACT] AIM:To study the effects of soybean isoflavones on mitochondrial ultrastructure, neuronal apopto-sis and expression of cytochrome C, caspase-9 and caspase-3 in the rats with cerebral ischemia/reperfusion.METHODS:Adult healthy SD rats ( n=60 ) were randomly divided into 3 groups: sham group, ischemia/reperfusion injury ( I/R ) group and soybean isoflavone ( SI) pretreatment group.Soybean isoflavones (120 mg· kg-1 · d-1 ) were fed by gastric lav-age for 21 d.The global ischemia/reperfusion model of the rats was established by blocking 3 vessels, and then reperfused for 1 h after 1 h of ischemia.The morphological change of the cerebral cortex cells was observed under light microscope. The mitochondrial ultrastructure of the cerebral cortex cells was determined by transmission electron microscope.The apop-totic rate of the cerebral cortex cells was detected by flow cytometry.The expression of cytochrome C, caspase-9 and caspase-3 in the cerebral cortex cells was determined by semi-quantitative RT-PCR and immunohistochemical techniques. RESULTS:Disintegration of mitochondria membrane and disappearance of the mitochondrial cristae were seen in I/R group.Compared with I/R group, the change of ultrastructure of mitochondria was significantly improved by soybean isofla-vone pretreatment, and the neuronal apoptotic rate was also significantly decreased (P<0.01).The mRNA expression and protein content of cytochrome C, caspase-9 and caspase-3 in I/R group were obviously higher than those in sham group ( P<0.01).Compared with I/R group, the mRNA expression and protein content of cytochrome C, caspase-9 and caspase-3 in SI group were significantly decreased (P<0.01).CONCLUSION: Soybean isoflavones attenuate cerebral ischemia/reperfusion injury by stabilizing the structure of mitochondria, preventing cytochrome C release to the cytoplasm, inhibiting the activation of caspase-9 and caspase-3 and decreasing cell apoptosis.
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The relatively independence and separation in the teaching of clinical medicine and basic medicine limits the ability training of students,and the combination of basic and clinic medicine in teaching has become the core issues and trends in medical teaching reform.So the conventional teaching patterns were reformed in pathophysiology by applying combination of basic and clinic medicine in teaching.In order to accelerate medical students to early exposure to clinical medicine Bengbu medical college changed the teachers' teaching ideas,promoted the local integration of the courses of basic and clinical medicine and the combination of basic and clinic medicine teachers in teaching,reformed mechanisms in teaching management and teaching operation.We also tested the preliminary reform effects by way of students' evaluation of the teaching and examination,and discussed the unfavorable factors affecting the educational reform and thought out some countermeasures.
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Objective To investigate the effects of resuscitation with limited fluid on rabbits with uncon-trolled hemordaagic shock. Method Uncontrolled hemorrhagic shock was produced in 40 rabbits. When the mean arterial pressure dropped to 40 manI-Ig and maintained for 30 minutes, resuscitation was initiated with Ringer solu-tion infusion into rabbits in large volume for group N3 (125 mL/kg) ,moderate volume for group N2 (92 mL/kg) and small amount for group N1 (57 mL/kg), and a drop of fluid was not given to rabbits of group N4. Besides, rob-bits of group N5 were controls without shock. MAP, fatality, volume of blood loss, SOD and Her were observed for 120 minutes or until death. Data were analyzed using SNK-q test and rank test. Results MAP, SOD and Het were higher, and fatality and blood loss were lower in group N5 than those in groups N1, N2,and N3 (P<0.01 ). MAP,fatality,blood loss and Het of group N4 were worse than those of groups N1,N2 and N3 (P<0.01). The blood loss and fatality in group N3 were significantly higher than those in groups N1 and N2 (P<0.01 ). SOD of kidney in group N3 was significantly lower than that in group N1 and N2(P<0.01). As the volume of fluid in-creased during resuscitation, Het of all animals was gradually becoming lower. As MAPS in groups N2, N3 and N4 were gradually becoming lower and lower, death increased. Conclusions Limited fluid resuscitation (57～92mL/kg) should be recommended to the therapeutic strategy for uncontrolled hemorrhagic shock.
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BACKGROUND: The standardized treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing non-stemmed hip prosthesis (NSHP) can be used as an alternative device for young patients. The NSHP relies on proximal femoral metaphyseal and neck fixation. The theoretic advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. On the other hand,clinical investigations published reported THR had high loosening rate of the prosthesis, which greatly limits its long-term clinical results; the aim of NSHP is to give the femoral prothesis a kind of biological fixation to decrease the loosening rate of the prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using NSHP.OBJECTIVE: To evaluate the outcome of NSHP for the treatment of young patients with hip disorders.DESIGN: Case analysis.SETTING: Department of Orthopaedics, the First Affiliated Hospital of Guangxi Medical University.PARTICIPANTS: Fifteen patients (17 hips) with hip disorders, who were treated at the Department of Orthopaedics,First Affiliated Hospital of Guangxi Medical University between 2001 and 2005, were retrieved. The involved patients included 8 males and 7 females. They were aged (37.8±9.8) years ranging from 21 to 49 years when they underwent operation. Indications for implantation included avascular necrosis (7 hips), posttraumatic osteoarthritis(4 hips), primary osteoarthritis(3 hips), osteoarthritis secondary to dysplasia(3 hips). Informed consents were obtained from all the patients before operation. The neotype of non-stemmed hip prosthesis (NSHP) was made of Co-Cr-Mo casting alloy with good biocompatibility by Shanghai Fusheng Medical Equipment Co., Ltd (Guoyao guanxie (shi) No. 2002-3040397; Guoshi Yaojianxie(zhun) No. 2005-3460799).METHODS: Fifteen patients (17 hips) with hip diseases subjected to the replacement of total hip with NSHP. Patients were followed-up once every other 6 months in the postoperative first year, then once every year, 5 years in total. The follow-up visit included functional evaluation and X-ray evaluation. ① Functional evaluation: Evaluative criteria of Harris joint function scale were adopted: full marks (point) =100, ≥ 80 excellent, ≥ 60 good, 40 fair and ＜ 40 poor; The following clinical data were documented: relief of pain, ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and so on. Pain was evaluated by using visual analogue scale (VAS),which ranged from 0 (no pain) to 10 (worst possible pain). ② X-ray evaluation: A standardized radiographic assessment was performed using an anteroposterior view of the pelvis. The following radiological data were recorded: preoperative grade of osteoarthritis as classified according to the method from Busse et al, preoperative grade of femoral head necrosis as classified according to the method from Ficat et al, inclination angle of the operated and the untreated side,radiolucencies according to the method of Buergi et al, heterotopic ossifications, as classified according to the method of Brooker et al. Postoperative adverse events and complications were observed and revision operation was needed if necessary.MAIN OUTCOME MEASURES: Correlative conditions of patients who were followed up for 5 years: ① Inserting angle of prothesis and the collodiaphyseal angle in the opposite side. ②Radiolucency and heterotopic ossification classification.③preoperative osteoarthritis classification, preoperative avascular necrosis of femoral head classification. ④ Revision operation, adverse events and complications. ⑤ Postoperative functional evaluation: Relief of pain (Harris joint function score), ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and VAS results.RESULTS: Fifteen patients were involved. One patient was lost after 3-month treatment and the other patients were followed up for 5 years. ① Postoperative functional evaluation results of patients. In the postoperative 5-year follow-up visit, hip joints of 13 patients (15 hips) were still in situ, pain lessened or disappeared in 11 patients (84.6% ,11/13),12 patients(92.3%, 12/13) would undergo the procedure again, 10 patients (76.9%, 10/13) were able to lie on the operated side; The average of Harris hip score was (72±19.6). The average Harris hip score did not vary significantly between the different diagnosis groups (P ＞ 0.05). Postoperative VAS was 2.6±2.2 on average. There was no significant difference in the hip joint pain among different diagnosis groups (P ＞ 0.05); Nine patients required no pain medication (69.2%,9/13).Two patients (15.4% ,2/13) occasionally took nonsteroidal anti-inflammatory drugs and two patients (15.4% ,2/13) took nonsteroidal anti-inflammatory drugs on a regular basis. ② X-ray evaluation results of patients: Preoperative osteoarthristis classification: One hip had grade 1 joint degeneration, 3 hips had grade 2 joint degeneration and 6 hips had grade 3 degeneration. Preoperative avascular necrosis of femoral head classification: Out of 7 patients with avascularnecrosis of femoral head, 4 patients had stage 3 femoral head necrosis, and 3 patients had stage 4 femoral head necrosis. In the postoperative 5-year follow up, 1 patient had radiolucency. Because the range of radiolucency was very small, progression was not quick and clinical symptoms were not severe, so revision operation was not conducted;In the postoperative 6th month, the inclination angle averaged (135.2±6.8)° on the untreated side and (132.2±6.5)° on the treat side. One patient with congenital hip dysplasia and a previous varus derotational osteotomy had a postoperative inclination angle below 120°. Patients with postoperative inclination angles between 125° and 140° had significantly less hip pain than the rest of the series. Heterotopic ossifications classification: Three patients had postoperative heterotopic ossifications, one hip had grade 1 heterotopic ossification, 1 hip had grade 2 heterotopic ossification, and 1 hip had grade 3 heterotopic ossification.③ Revision operation: one patient (5.9%,1/17)required a revision total hip arthroplasty due to pain. Good bone stock of the proximal femur was found in the patient which allowed implantation of a conventional medullary anchored prosthesis. This revision surgery and postoperative rehabilitation were uncomplicated.④ Adverse events and complications: Hip dislocation occurred postoperatively in one patient (5.9%,1/17). Other complications included trochanter bursitis (n=1), fistula (n =1), and seroma (n =1).CONCLUSION: ① NSHP provides biological fixation for femoral prothesis by bone proliferation through the windows with connective tissues surrounding the prothesis and has the characteristics of low stress and deformation, high intensity and rigidity, and anti-loosening, thus, may prolong its live lime. ②Revision surgeries are facilitated by the good bone stock remaining in the proximal femur. ③ The short- and medium-term therapeutic effects of total hip arthroplasty are satisfying in young patients.
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AIM To investigate the possibility of microvolume rodent ventilator in improving the quality of global ischemia-reperfusion injury model in mice. METHDOS Global cerebral ischemia-reperfusion injury was preduced in mice by obstructing and decompressing bilateral common carolid arteries and pressuring and decompressing cervical soft tissue, artificial respiration was performed using rodent ventilator before those procedures. EKG, ECG was detected and pathological examination. RESULTS Rodent ventilator was used to keep essential physiologic ventilative volume befer pressure, EKG change was not been found in observed duration in all animals. The suppressed cephalograph was displayed continuously in various time in ischemic and reperfusion injury. Pathological examination indicated that the damage was worse progressly in cerebral cortex and hippocampus, as times of ischemic and reperfusion prolonged. CONCLUSION Using microvolume rodent ventilator success rate and stability is increased obviously in model of global cerebral ischemia-reperfusion injury in mice and mortality was decreased greatly.