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Adult atlantoaxial complex fractures, an acute injury which is rare in clinic, may lead to neurological damage or even death. Their current treatments can be conservative or surgical. The conservative treatment may involve collar bracket, Halo bracket, and sterno-occipital mandibular immobilizer (SOMI) while the surgical treatment mainly involves anterior cervical fixation and posterior cervical fixation. This review expounds on the current literature concerning the treatment of adult atlantoaxial complex fractures so as to provide reference for correct choice of treatment methods for this kind of fractures.
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Objective To analyze the correlation of clinical phenotype and genotype and gene mutation frequency characteristics of 21-hydroxylase deficiency,and to provide the basis for clinical diagnosis and methods for early intervention.Methods The clinical phenotypic signs and examination results of 14 cases with 21-hydroxylase deficiency were collected from September 2008 to December 2016 in Children's Hospital of Shanxi Province.Point mutations,deletions and conversion mutations for gene CYP21A2 coding 21-hydroxylase were detected through using next generation sequencing(NGS) and multiplex ligation-dependent probe amplification (MLPA).The captured mutations were further confirmed with Sanger sequencing.Furthermore,the family members underwent the co-segregation validation through the Sanger sequencing or MLPA in those captured mutated sites.Results Among the total 14 cases,9 cases were identified as the salt wasting,5 cases the simple virilizing;10 cases of compound heterozygous mutations,and 4 cases of homozygous mutations.Analysis of the 14 patients revealed 8 different kinds of mutations in CYP21A2 gene.The most frequent mutations of CYP21A2 gene were I2G [50％ (14/28)] and I173N [21.4％ (6/28)],followed by Arg357Trp[10.7％ (3/28)].Del[10.7％ (3/28)] mutations including E247fs,Gly1 1 1fs and R484fs.Q319X [3.6％ (1/28)] and Arg355His[3.6％ (1/28)] were rarely found.Missense mutation was found in 10 cases,splicing mutation in 14 cases,frameshifi mutations in 3 cases,nonsense mutations in 1 case.All of the mutations were inherited from their parents,and no new mutation was found.The most common mutations for salt wasting and simple virilizing were respectively I2G[50％ (9/18)] and I173N [50％ (5/10)].Collectively,genotypes and phenotypes were matched with each other.Conclusions The combination of clinical phenotypes with laboratory examination by gene sequencing and comprehensive analysis,is helpful to early diagnosis,differential diagnosis and optimized treatment,which will improve prognosis and provide guidance for genetic consultancy.
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Unilateral facet dislocation of the lower cervical spine is an important subgroup of cervical spine injuries,accounting for from 12％ to 16％ of all cervical spine injuries.Unilateral facet dislocation occurs the most commonly at the C5-6 level,and is closely related to the anatomic and morphometric features of the cervical facet.This injury has been attributed to combined flexion and rotation,but it remains unclear whether flexion or rotation is the component of greater importance.Its treatment includes nonoperative and operative measures but optimal treatment has not been established.It is generally accepted that a recommendable treatment protocol begins with closed reduction and proceeds depending on whether the closed reduction succeeds and traumatic disc herniation is present or not.
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Objective To evaluate the therapeutic effect and toxicities of low dose Gemcitabine combined with Oxaliplatin in the treatment of advanced or metastatic uroedthelial carcinoma.Methods A total of 42 patients pathologically confirmed advanced or metastatic urothelial carcinoma (23 bladder cancer cases,11 ureteral carcinoma cases,and 8 renal pelvic carcinoma cases) were reviewed.Karnofsky score for each patient before treatment was more than 60.Combined treatment with Gemcitabine and Oxaliplatin regimen was as follows:Gemcitabine 700 mg/m2,iv infusion at day 1,8 and day 15,Oxaliplatin 100 mg/m2,iv infusion at day 2.The regimen was administered for more than 2 cycles (every 4 weeks) and the response rate was evaluated.The regimen was used in palliative chemotherapy and adjuvant chemotherapy,respectively.Results According to WHO evaluation criteria on therapeutic effectiveness,7 patients (16.7％) had complete response,13 patients (30.9％) had partial response,14 cases (33.3％) remained stable status,and 8 cases (19.1％) had progression.The overall response rate was 47.6％.The main side effects included thrombocytopenia,leucopenia,nausea,vomiting and alopecia,which were mild to moderate and disappeared when the chemotherapy was ceased.No chemotherapy related death occurred.Conclusions Combined treatment with low dose Gemcitabine and Oxaliplatin is effective for advanced or metastatic urothelial carcinoma,with mild and tolerable toxicities.
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Serum levels of CXC chemokine ligand 10 (CXCL10) and chemokine receptor 3 (CXCR3) were determined in 50 patients with type 1 diabetes mellitus (T1 DM) and 30 normal control subjects by ELISA method.The results showed that serum levels of CXCL10 and CXCR3 in T1DM patients were significantly higher than those in normal subjects [(258.17 ± 39.12 vs 96.47 ± 26.91) ng/L,(851.87 ± 70.04 vs 441.82 ± 72.24) pg/ml,both P＜0.05].Serum level of CXCL10 in patients dropped sequentially with durations of diabetes ＜6 weeks,≥6 weeks or ＜3 years,and ≥ 3 years,being statistically significant between groups (P＜0.05).These results suggest that serum levels of CXC10 and CXCR3 may reflect the immune activity in T1DM.
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Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.
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Objective To differential the biologic characteristics and multiple differentiation potential of mesenchymal stem cells in nucleus pulposus in (NP-MSC) scoliosis patient and patient with degenerative interverthral disc.Methods The human nucleus pulposus-mesenchymal stem cells were isolated and cultured with enzyme digestion from 2 patients of scoliosis and 2 patient with degenerative intervertbral disc separately.Cellular proliferation was detected with MTT assay and trypan blue.The immunophenotype expression of NP-MSC was detected by flow cytometry in scoliosis and degenerative group.The multiple differentiation ability of cells was assessed respectively using alizarin red dye,Oil red O dye and immunohistochemical staining.Results The primary cell morphology of scoliosis NP-MSC was the shape of spindle,while the degenerative NP-MSC was inhomogeneous.However,both of them became spindle shape after passages.The scoliosis NP-MSC was stronger than degenerative one in metabolic activity and proliferation.The percentage of positive antigen expression of CD44,CD105 and CD29 was 97％-100％ in scoliosis NP-MSC group,but 88.7％-97％ in the degenerative group.The expression of mature cell marker CD24 was negative in both groups.Furthermore,the MSC i.isolated from both groups differentiated along the osteogenic,chondrogenic but not adipogenic lineages.Conclusion The scoliosis and degenerative NP contains mesenchymal stem cells.Moreover the scoliosis NP-MSC had stronger ability of cell metabolic activity and proliferation.These cells have multiple differentiation potential with the exception of their adipogenic differentiation ability.
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ObjectiveTo investigate the effects on QT dispersion in patients who received maintenance hemodialysis by dialysate with different concentration of potassium. MethodsTook 57 patients who received maintenance hemodialysis as dialysis group, took another 30 healthy subjects as control group, patients in dialysis group alternatively received hemodialysis by dialysate with potassium concentration of 2.0mmol/L and 3.0mmol/L once. QT interval of both groups were recorded by 12-lead synchronized ECG and then QT dispersion and QTcd were calculated. ResultsQTd and QTcd of dialysis group were(52.7 ±8.2) and(63.2 ±9.0)ms respectively and which were significantly higher than control group, the difference between groups was statistically significant( t =2. 638,2. 750, both P ＜ 0.05 ) ; QTd, QTcd and the incidence of arrhythmia of 2.0mmol/L K + group were ( 63.5 ± 7.6), ( 72.3 ± 8.0)ms and 22.8％ ( 13/57)respectively and which were all significantly higher than 3.0mmol/L K + group,the differences between groups were statistically significant ( t =2. 245,2.351, x2 =5. 599, all P ＜ 0.05 ). ConclusionQT dispersion reflectsed the heterogeneity of ventricular repolarization and electrical instability,and the use of dialysate with potassium concentration of 3.0mmol/L could shorten QT interval and reduce the incidence of arthythmia.
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Objective To explore the indications of cervical artificial disc replacement (ADR) based on radiographic evaluation and different anterior decompression methods. Methods From January 2008 to July 2009, 175 patients with cervical spondylosis or disc herniation who underwent anterior decompression were involved in this study. Patients were distributed to different operative groups based on the preoperative radiographic evaluation. One hundred and forty-five cases were treated with fusion operation, and the others received ADR. Operative methods were as follows: 1) Anterior cervical discectomy and fusion (ACDF); 2)Anterior cervical discectomy and subtotal vertebrectomy; 3) Anterior subtotal vertebreetomy and fusion; 4)ProDisc-C ADR. The patients with single-level of cervical spondylotic myelopathy were divided into ACDF and ADR groups according to different operative methods. Clinical outcomes of two groups were evaluated by Japanese Orthopaedic Association (JOA) score. The range of motion (ROM) of the segment was recorded in ADR group at the 1st month, 3rd month, 6th month and 12th month postoperatively. Results The indication of ADR was cervical spondylosis with slight disc calcification or small vertebral posterior osteophytes. Under this condition, decompression could be obtained thorough intervertebral space and ADR be implanted. If cervical spondylosis was associated with vertebral posterior huge osteophytes, serious intervertebral narrow or fusion, serious disc calcification ,ossification of the posterior longitudinal ligament and extensive cervical spinal stenosis, subtotal vertebrectomy was necessary. The mean improvement rates of ACDF and ADR were 66.05% and 67.13%. There was no difference between two groups (P ＞ 0.05). No difference of ROM was found before and after surgery in ADR group (P ＞0.05). Conclusion Only decompression can be achieved thorough through the intervertebral space, and ADR is suitable for cervical spondylosis. ACDF and ADR have similar outcomes in treatment of single-level of cervical spondylotic myelopathy. But ADR has the advantage of maintaining ROM of the operative segment.
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Objective To evaluate the efficiency of Flixotide in decreasing the incidence of asthma following bronchiolitis.Methods 23 children with brochiolitis received Flixotide daily while other 29 subjects not intervented as control.The intervention duration was 60 days,then followed up for more then 1 year.Results After following up over 1 year,only 3 cases in 29 patients with brochiolitis receiving Flixotide developed into asthma.However,24 cases in control group developed into asthma.The incidence of asthma was 13.04% and 82.76% in two group,respectively.Conclusion Flixotide may be an effective intervention to prevent the development of asthma after bronchiolitis.
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OBJECTIVE: To optimize the extraction technology of Jingzhi guanxin granules.METHODS: The extraction technology of Jingzhi guanxin granules were optimized using shattering extraction with solvent,refluxing extraction and primary extraction with the content of tanshinone ⅡA,salvianolic acid B,paeoniflorin,ferulate and hydroxysafflor yellow A and extraction rate as index.RESULTS: The optimal extraction process was as follows: Jingzhi guanxin powder,6 fold 95% alcohol,extracting for 10 min in the first time,6 fold 60% alcohol,extracting for 10 min in the second,6 fold 20% alcohol,extracting for 10 min in the third.CONCLUSION: Using shattering extraction with solvent for Jingzhi guanxin granules,extraction rate of each constituent are higher than that of primary extraction.This extraction process is simple in operation and save time.
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Objective To optimize the extraction process of Jingzhi Guanxin Recipe. Methods With the amounts of tanshinone ⅡA,salvianolic acid B,paeoniflorin,ferulic acid and hydroxysafflor yellow A as observation parameters,uniform design method was used for the optimization of wet-shattering extraction process of Jingzhi Guanxin Recipe. Results The optimum extraction process was as follows:adding 6-fold 95 %alcohol for the first time of exaction,adding 6-fold 60%alcohol for the second time,adding 6-fold 20 %alcohol for the third time,and shattering for 10 minutes every time. Conclusion This optimized process is efficient,economic and simple.