Primary adrenal NK/T cell lymphoma: a clinicopathologic analysis of six cases / 中华病理学杂志

Objective: To investigate the clinicopathologic features of primary adrenal NK/T cell lymphoma (PANKL). Methods: Six cases of PANKL were collected at Henan Provincial People's Hospital from January 2000 to December 2021. The clinicopathologic features including morphology, immunophenotype, treatment and prognosis were retrospectively analyzed, and relevant literature was reviewed. Results: There were two males and four females. The median age was 63 years (ranged from 57 to 68 years). The tumors involved bilateral adrenal glands in 4 cases and unilateral adrenal gland in 2 cases. The main clinical symptom was low back pain without obvious cause. Serum lactate dehydrogenase (LDH) is elevated in five cases. The imaging feature was rapidly enlarging mass initially confined to unilateral/bilateral adrenal glands. Morphologically, the lymphoid cells were mainly medium-sized with a diffuse growth pattern. Coagulative necrosis and nuclear fragmentation were common. Angioinvasion was seen. Immunophenotypically, the neoplastic cells were positive for CD3, CD56 and TIA-1 while CD5 was negative in 5 cases. All cases were positive for EBER by in situ hybridization with more than 80% proliferative activity by Ki-67. Four cases received chemotherapy, one case underwent surgery, and one case underwent surgery with chemotherapy. Follow-up was done in 5 cases; one case was lost to follow-up. Three patients died with a median survival of 11.6 months (3-42 months). Conclusions: PANKL is rare with highly aggressive clinical presentation and poor prognosis. Accurate diagnosis entails correlation of histomorphology, immunohistochemistry, EBER in situ hybridization and clinical history.

Investigation and analysis of occupational hazards in construction of power transmission and transformation project / 中华劳动卫生职业病杂志

Objective: To investigate the occupational hazard factors and exposure levels of workers during the construction of power transmission and transformation projects. Methods: Analysis and identification of occupational hazard factors were carried out for typical construction process of 6 power transmission projects and 3 substation projects in September 2018. The on-site occupational health investigation was carried out to detect and analyze the exposure levels of workers to occupational hazard factors. Results: The time weighted average concentration (C(TWA)) of crushing workers exposed to silica dust and welders exposed to welding fume in substation projects were 2.72 and 14.03 mg/m(3), respectively. The 8 h equivalent sound level results of exposure noise of carpenters in power transmission projects and crushing workers, reinforcement workers, carpenters, scaffolders, road builders in substation projects were 87.9, 92.5, 87.1, 92.5, 93.0 and 90.2 dB (A) , respectively. The 4-hour time equal energy frequency weighted vibration acceleration of hand-transmitted vibration of bricklayer in power transmission projects, bricklayer, general worker 3, road builder 1 and road builder 2 of substation projects were 5.36, 5.21, 5.28, 10.71 and 5.22 m/s(2), respectively. The effective irradiance of electric welding arc light of welders' limbs in power transmission projects and substation projects were 401.19, 319.68 μW/cm(2), respectively. All of the above exceeded the requirements of occupational exposure limits. The occupational radiation levels and exposure limits of hazardous chemical factors met the requirements of each post. Conclusion: During the construction of power transmission and transformation projects, the exposure levels of occupational hazard factors in multiple posts exceed the standard. The main responsibility of employers for occupational disease prevention and control should be implemented, and targeted comprehensive measures should be taken to reduce the exposure levels of occupational hazard factors of workers.

Role of Toll-like receptors in human papillomavirus infection-caused cervical cancer / 中华微生物学和免疫学杂志

Persistent infection with high-risk human papillomavirus (HR-HPV) is a well-defined etiology of cervical cancer, but not all HR-HPV infections lead to cervical cancer, indicating that many factors are involved in the regulation of HR-HPV pathogenicity. Toll-like receptors (TLRs) are a class of pattern recognition receptors that specifically recognize pathogen-associated molecular patterns (PAMPs) to provoke host innate and adaptive immunity against viruses. Relevant studies have shown that HR-HPV alters the local immune microenvironment by regulating the expression and signaling pathways of TLRs, leading to persistent infection with HR-HPV as well as cervical cancer. This review summarized and discussed the immune function and possible pathogenesis of TLRs in HPV infection-caused cervical cancer and the application of TLRs agonists in HPV vaccines.

Modified incision to prevent the postoperative spinal lateral angulation in surgery via anterior approach for lumbar fracture / 中国骨伤

OBJECTIVE@#To explore a method of modified incision to prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.@*METHODS@#A total 40 patients with lumbar fracture from January 2016 to Jun 2017 were internalized in the study. Including 28 males and 12 females, aged from 27 to 68 years with an average of (39.5±14.9) years. Among them, 28 cases caused by high fall, 9 cases by heavy injury, 3 cases by traffic accidents; and 35 fractures were located at L₁,4 at L₂,1 at L₃. All the fractures were type A based on AO classification. According to Frankel classify of spinal cord injury, 5 cases were grade A, 1 case was B, 10 cases were C, 15 cases were D, 9 cases were E. The patients were divided randomly into modified incision groups and routine incision groups. All patients were treated with decompression, internal fixation and titanium mesh supported bone graft fusion via anterior approach. All the internal fixation materials were ANTERIOR (Medtronic Inc). Incision direction and incision plane were improved in modified incision groups. The coronal Cobb angle and the angle between the vertebral screw and the corresponding endplate were analyzed before and after operation.@*RESULTS@#Pre-and post-operative coronal Cobb angles were (1.20±3.26) °, ( 2.16±3.55)° in modified incision groups and(1.22±4.42)°, (3.91±3.78)° in routine incision groups respectively. And there was no statistical difference before operation, and there was statistical difference after operation between two groups(=0.017). There was no lateral angulation of more than 5 degrees in modified incision group, but there was lateral angulation of 5 to 10 degrees in routine incision group in 6 cases. The incidence of lateral angulation about 5 degrees after operation was significantly different between two groups (=0.010). There was significant difference in the angle between the proximal two vertebral screws and the corresponding endplate between two groups (0.05).@*CONCLUSIONS@#The improvement of incision direction and plane can effectively prevent the postoperative spinal lateral angulation via anterior approach for lumbar fracture.

Expression and clinical significance of coagulation factorⅢin non-small cell lung can-cer patients with hypercoagulability / 中国肿瘤临床

Objective:To study the expression of coagulation factorⅢin patients with non-small cell lung cancer(NSCLC)with hyperco-agulability and its clinical significance,and to explore the relationship between its expression level and the clinicopathological features and the survival period.Methods:There were 74 patients with NSCLC with hypercoagulability and 42 without hypercoagulability,con-firmed using pathological and biochemical tests in Yunnan Cancer Hospital from January 2013 to October 2014.The enzyme-linked im-munosorbent assay(ELISA)was performed to detect the expression of serum coagulation factorⅢand its relationship with clinico-pathological features and prognosis was analyzed.Results:Serum coagulation factorⅢlevel in patients with hypercoagulable NSCLC before chemotherapy was 560.32-200.34 ng/L,which was significantly higher than that in patients without hypercoagulability(463.29-159.22 ng/L)(P=0.008),and significantly higher than that in patients after chemotherapy(471.39±160.31 ng/L)(P=0.000).Serum coag-ulation factorⅢlevel in patients with hypercoagulable state of NSCLC was related to lymph node metastasis(P=0.026),distant metas-tasis(P=0.025),and tumor-node-metastasis staging(P=0.007).They were negatively correlated with prothrombin time(r=?0.638,P=0.032)and activated partial thromboplastin time(r=?0.702,P=0.028),and positively correlated with fibrinogen(r=0.715,P=0.008)and platelets (r=0.597,P=0.007).The 1-to 3-year overall survival of patients with NSCLC with high coagulation factorⅢexpression was significantly lower than that of patients with low coagulation factorⅢexpression.Conclusions: The expression level of serum coagu-lation factorⅢin patients with high coagulation state of NSCLC is related to lymph node metastasis and TNM staging,which has cer-tain guiding significance for predicting the survival of patients.

Discussion on Cultivation and Practice of Medical Humanistic Quality of Excellent Doctors:Taking Yangtze University as Example / 中国医学伦理学

The humanistic nature of medicine determines that medical humanistic quality training must be car-ried out in the education of excellent doctors. Based on the requirements of excellent doctor"with the aim to culti-vate position competency", Yangtze University, as a pilot institution for the reform of excellent doctors training mode, adopts a comprehensive training mode of medical humanistic quality, incorporates the cultivation of excellent doctors ' medical humanistic quality into the teaching plan to ensure the implementation of medical humanistic qual-ity cultivation institutionally;sets up general education, imparts humanistic knowledge and strengthens humanistic cultivation;integrates medical humanistic quality education into professional education to elevate the height of ex-cellent doctors' medical humanistic quality; integrates medical humanistic quality into clinical practice as an im-portant clinical ability;reforms teaching methods of medical humanistic quality and emphasizes the quality of medi-cal humanistic education, and carries out the student characteristic activity of"Xinglin Cultural Festival"and"The 8 One" to shape the student healthy personality and cultivate their healthy psychology.

Competition-based cooperation:Reconciliation of interests in Accountable Care Organizations in the United States / 中国卫生政策研究

The integration of medical resources is essentially the process of readjusting interests, and only when the interests of all parties are balanced, the effective integration of medical resources will be achieved. ACOs are now the most popular medical model for integrating medical resources in the United States. In the formation and operation of ACOs,the government has played a role of management and guidance on the basis of market allocation of resources. By the way of savings and risks sharing,the government encourages medical service providers to enhance collaboration and coordination,and strengthening patient protection by improving the medical service quality control, empowering patients' freedom of choice of health care suppliers, and launching anti-monopoly investigations for the purpose of putting a competitive pressure on ACOs. The development of ACOs might have certain reference signifi-cance for China to integrate medical resources. To establish an integrated medical care system in China,on the basis of the basic role of the market allocation of resources, the department of social medical insurance should effectively play the role of medical insurance purchaser,strengthening encouragement,guidance,and restraint of and supervision to medical institutions and medical staff.

Treatment of Denis type B thoracolumbar burst fractures by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach / 中华创伤杂志

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.

Clinical analysis of morphine hydrochloride sustained-release tablets combined with celecoxib in the treatment of advanced lung cancer with moderate to severe cancer-induced pain / 国际肿瘤学杂志

Objective To explore the efficacy,safety and life quality of patients of morphine hydrochloride sustained-release tablets combined with celecoxib in the treatment of advanced lung cancer with moderate to severe cancer-induced pain.Methods A total of 247 patients of advanced lung cancer with moderate to severe cancer-induced pain were randomly divided into combination therapy group (n =127) and morphine monotherapy group (n =120) using simple random sampling digital table method.The differences of dose,efficacy,adverse drug reactions and life quality between the two groups were analyzed.Results In achieving similar analgesic effect,the average maintenance dose of morphine in combination therapy group was (52.51 ±19.92)mg/d,lower than that in monotherapy group [(58.75 ±20.64)mg/d,t =-2.414,P =0.017].The incidence of constipation in combination therapy group was 34.6％,lower than that in monotherapy treatment group (47.5 ％,x2 =4.218,P =0.040).The life quality of the two groups were improved,and the life quality improvement rate in combination therapy group was 59.8％,higher than that in monotherapy treatment group (43.3％,x2 =6.736,P =0.009).Conclusion Morphine hydrochloride sustained-release tablets combined with celecoxib is effective in the treatment of moderate to severe cancer pain,which can reduce the dosage of morphine and reduce adverse reaction,so as to improve the life quality of the patients with advanced lung cancer.

Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdomi-nal muscle and retroperitoneal approach / 中华骨科杂志

Objective To investigate the clinical efficacy and indication of surgical treatment of L5S1 tuberculosis us?ing a medial edge of rectus abdominal muscle and retroperitoneal approach. Methods From Jan. 2010 to Nov. 2014, totally 18 cases of L5S1 tuberculosis were surgically cured by debridement, fusion and internal fixation via a medial edge of rectus ab?dominal muscle and retroperitoneal approach. There were 10 males and 8 females, with an average age of 35.6±10.1 years (21 to 55). The mean course of disease was 5.3±2.2 months. The primary destruction lesions were located at L5S1, and one patient of whom L4 was also involved, three cases S2 involved, and one S3 involved. Abscess pre sacrum was noticed in all cases. Six patients were combined with abscess in vertebral canal. Neural deficiency was detected in 3 patients, all grading as Frankel D. Dubousset's lumbosacral angle was 104°-126°, mean 114.6°±6.0°. Formal anti?tuberculosis medicine treatment was given for at least 2-3 weeks. All patients were treated using a medial edge of rectus abdominal muscle and retroperitoneal approach. Af?ter debridement, a tri?cortical iliac bone was used for structural inter?vertebrae fusion. The iliac bone was fixed to the sacrum by one cortical screw. Operation time, volume of blood loss, and surgery complications, including wound infection, looseness and shift of internal fixation, sinus occurrence, vascular injury, retrograde ejaculation in male patients were evaluated. The X?ray and 3D CT of lumbosacral spine, together with ESR and CRP were used to evaluate the control of tuberculosis during fol?low?up. The Dubousset's lumbosacral angle, visual analogue score, and the Frankel grade were compared between preoperative and postoperative. The bone graft fusion were also observed. Results The operation time was 147±16 min in average. The mean blood lose was 275 ± 77 ml. No vascular or neurological injury was noticed. There was also no retrograde ejaculation happened in this group. All patients were followed up from 18 to 28 months. Dubousset's lumbosacral angle was 122.4°±3.8° post?operatively and 121.4°±3.7° at the final follow?up. There was a significant difference between the lumbosacral angles pre and post operation, whereas no statistical difference between the post operation and the final follow?up. Bone fusion was noticed in all cases. All pa? tients have intact neurological function at the final follow?up. No screw breakage or graft bone migration occurred. VAS was 5.6± 1.09 pre?operation and 0.83±0.71 at the 3rd month's follow?up, and there was a significant difference between them. Conclusion Surgical treatment of L5S1 tuberculosis by debridement, fusion and internal fixation via a medial edge of rectus abdominal muscle and retroperitoneal approach is an effective method in terms of minimal trauma, low rate of modality, good ability in restore and maintenance of lumbosacral junction alignment and high fusion rate.

Influence of Hesperidin Pretreatment on the Expression of TNF-α and IFN-γ in Concanavalin A-induced Acute Liver Injury in Mice / 医药导报

Objective To explore the protective effect of hesperidin pretreatment on concanavalin A (Con A)-induced acute liver injury and the effect on expression of TNF-α and IFN-γ. Methods Seventy-two SPF C57BL/ 6 mice were randomly divided into three groups: normal control group, model control group and hesperidin group. Acute liver injury model was established by injected with Con A. The hesperidin group was treated intragastrically with 1 000 mg·kg-1 hesperidin for 10 days. Model control group was treated intragastrically with the same volume of 0. 5% of sodium carboxymethyl cellulose. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase ( AST) were measured. Pathological changes in hepatic tissue were observed under microscope. The expression of TNF-α and IFN-γ mRNAs in hepatic tissue was measured by reverse transcription polymerase chain reaction ( RT-PCR). The contents of TNF-α and IFN-γ in serum were detected by ELISA. Results Compared with model control group, the contents of ALT and AST in serum were significantly decreased (P0. 05). Conclusion Hesperidin pretreatment protects mice from Con A-induced acute liver injury possibly by inhibiting the expression of TNF-α and IFN-γ in the liver of mice.

Clinical characteristics and stage I operation of anterior and posterior approaches for the treatment of cervicothoracic junction (C7T1) fracture-dislocation / 中国骨伤

<p><b>OBJECTIVE</b>To summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.</p><p><b>METHODS</b>From January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.</p><p><b>RESULTS</b>The average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.</p><p><b>CONCLUSION</b>Cervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.</p>

Prevention of postoperative cerebrospinal fluid leakage with absorbable hemostatic fluid gelatin / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effectiveness of absorbable hemostatic fluid gelatin in preventing postoperative cerebrospinal fluid leakage.</p><p><b>METHODS</b>The clinical data of 17 patients with dura mater tear were retrospectively analyzed from March to September in 2003. There were 16 males and 1 female, aged from 16 to 67 years old with an average of (39.6 ± 15.4) years. The injury site was at cervical vertebrae in 1 case, thoracic vertebrae in 9 cases, thoracolumbar junction in 4 cases, lumbar vertebrae in 3 cases. There were burst fracture in 4 cases and fracture-dislocation in 13 cases. According to ASIA grade, 12 cases were grade A, 2 cases were grade B, 2 cases were grade D, 1 case were grade E. Two cases caused by traffic accident, 10 by high falling, 4 by heavy parts crash, 1 by stairs fell during the earthquake. Absorbable hemostatic fluid gelatins were used to plug the dura mater tear,in order to prevent postoperative cerebrospinal fluid leakage. Postoperative drainage were recorded every day.</p><p><b>RESULTS</b>Of 17 patients, 15 cases did not develop with cerebrospinal fluid leakage. Two cases develop with cerebrospinal fluid leakage after operation and their drainage were removed at 6 to 7 days after operation. In all cases, no complications related with cerebrospinal fluid leakage occurred, such as headache, dizzy, fever,neck resistance, rash, incision disunion, incision infection, hematoma, neurologic symptoms aggravation. No abnormal phenomena was found on incision surrounding at follow-up of 9 months.</p><p><b>CONCLUSION</b>Using absorbable hemostatic fluid gelatin to plug the dura mater tear during operation is an effective method in preventing postoperative cerebrospinal fluid leakage.</p>

Effectiveness of nano-hydroxyapatite/polyamide 66 cage in anterior spinal reconstruction: a mid-term study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the mid-term effectiveness of nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage in the anterior spinal reconstruction.</p><p><b>METHODS</b>There were 177 patients who undergone the anterior decompression and fusion with n-HA/PA66 cage and internal fixation between January 2008 and January 2010 included in this study. There were 117 male and 60 female patients aged from 18 to 74 years. The diagnoses included cervical fracture in 47 patients, thoracic or lumbar fracture in 50 patients, cervical spondylopathy in 58 patients, spinal tuberculosis in 17 patients and spinal tumor in 5 patients. The X-ray and three-dimensional CT were followed up in all these patients to observe the spinal alignment, the rate of fusion and the rate of n-HA/PA66 cage subsidence and translocation. The neurological functions of patients with spinal fracture were evaluated by Frankel grading; the improvement of the clinical symptoms of the other patients were assessed by visual analogue scale (VAS) scores and Japan Orthopaedic Association (JOA) scores or SF-36 scores.</p><p><b>RESULTS</b>All the 177 patients had been followed-up for 36 to 70 months after surgery (average 51 months). Except the slight cage translocation been found in the only one patient with cervical fracture, no cage prolapsed or breakage was exist in our patients up to the last follow-up. In the patients with spinal fracture, the mean time for fusion was 4.5 months, the rate of fusion was 95.9% and the rate of cage subsidence was 5.2%; while in the patients with cervical spondylopathy, the mean time for fusion was 4.4 months, the fusion rate was 96.5% and the subsidence rate was 5.2%; while in patients with spinal tuberculosis, the mean fusion time was 5.5 months, the rate of fusion was 94.0%, the rate of subsidence was 5.9%; and in the patients with tumor, the mean time for fusion was 6.0 months, the fusion rate was 100%, and the cage subsidence was found in only one patient. The preoperative symptoms of each patient were improved to varying degrees after surgery. At the last follow-up, the Frankel grading of patients of spinal fracture with incomplete paralysis improved 0 to 2 classes; the VAS, JOA or SF-36 scores of the other patients were improved significantly than their respective scores before surgery (t = 2.982, 4.126 and 3.980, P < 0.05).</p><p><b>CONCLUSIONS</b>The n-HA/PA66 cage has much higher rate of osseous fusion and lower cage subsidence, it is an ideal cage which can provide effective restoring and maintaining for the spinal alignment and intervertebral height. Moreover, the mid-term clinical results of anterior reconstruction with this cage in the patients with spinal trauma, degeneration, tuberculosis or tumor are well content.</p>

Sodium butyrate inhibits HMGB1 expression and release and attenuates concanavalin A-induced acute liver injury in mice / 生理学报

The purpose of the present study is to explore the protective effects of sodium butyrate (SB) pretreatment on concanavalin A (Con A)-induced acute liver injury in mice. The model animals were first administered intraperitoneally with SB. Half an hour later, acute liver injury mouse model was established by caudal vein injection with Con A (15 mg/kg). Then, levels of serous alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using standard clinical method by an automated chemistry analyzer, tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were measured by ELISA, and pathological changes in hepatic tissue were observed by using HE staining and light microscopy. The expression and release of high-mobility group box 1 (HMGB1) were assessed by using reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry and ELISA. The results showed that the pretreatment of SB significantly protected Con A-treated mice from liver injury as evidenced by the decrease of serum ALT, AST (P < 0.01) and reduction of hepatic tissues necrosis. SB also decreased levels of serous TNF-α and IFN-γ (P < 0.01). Furthermore, the expression and release of HMGB1 were markedly inhibited by SB pretreatment (P < 0.05 or P < 0.01). These results suggest that the attenuating effect of SB on Con A-induced acute liver injury may be due to its role of reducing the TNF-α and IFN-γ production, and inhibiting HMGB1 expression and release.

Clinical outcomes of Prestige LP cervical disc replacement: a prospective, controlled, single site trail with 24-month follow-up / 中华骨科杂志

ObjectiveTo prospectively compare the effects of Prestige LP cervical disc replacement with those of anterior cervical discectomy and fusion (ACDF) in treatment of cervical disc herniation.MethodsFrom January 2008 to March 2010,a total of 87 patients were enrolled at our site as study investigating ACDF versus Prestige LP cervical disc prosthesis.Forty-four patients received the investigational device (arthroplasty group) and 43 underwent a single-level ACDF (fusion group).Visual analogue scale(VAS) neck/arm pain,Japanese Orthopedics Association (JOA) score,Short Form-36 (SF-36) both physical and mental,flexion-extension range of motion of operative and adjacent segments were evaluated preoperatively and 1 week and 3,6,12,24 months postoperatively.ResultsA total of 78 patients (89.7％) were followed up for an average 12.4 months(range,6-24).Both groups have favorably demonstrated improved functional outcomes for JOA,VAS scores and SF-36.The improvement in the VAS and JOA scores were equivalent at each follow-up point between the two groups(P＞0.05).However,arthroplasty group had statistically significant improvement as assessed by the SF-36 scores compared with the fusion group at some follow-up points (P＜0.05).In arthroplasty group,the postoperative range of motion of operative and adjacent segments showed no statistical difference with the preoperative counterpart(P＞0.05),and fusion was successful in 92.1％ of control patients.ConclusionPrestige LP cervical disc replacement is a feasible alternative to ACDF for patients with persistently symptomatic cervical disc disease and matching the inclusion criteria.

Application of CBL combined with LBL in medical immunology teaching and its effect / 中华医学教育探索杂志

Objective To investigate the value of case-based learning(CBL) combined with lecture-based learning (LBL) in medical immunology teaching.Methods Totally 85 clinical medicine students of 2010 grade in medical school of Yangtze university were divided into two groups:control group(n=43) and experimental group(n=42).The students in control group were received LBL while those in experimental group were received CBL combined with LBL.Teaching effectiveness was evaluated by questionnaire survey and theoretical test.Results The questionnaire showed that the abilities of comprehension,expression,analysis,practice and cooperation were significantly better in experimental group than in the control group(P＜0.05),the results of test showed that the total scores and the scores of choice and clinical case analysis were markedly higher in experimental group than in the control group(P＜0.05).Conclusions The teaching model of CBL combined with LBL is helpful to develop students' comprehensive quality and creative ability and it is worth further promoting in medical immunology teaching.But there are some problems need further improvement.

Management of esophageal fistula caused by anterior cervical spine surgery / 中华骨科杂志

Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

Comparison of screw' inserting angle through the 11th and 12th rib anterior approaches for L1 burst fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare screw's inserting angle through the 11th and 12th rib in treating L1 burst fracture, explore effects on inserting screw and postoperative angle.</p><p><b>METHODS</b>From October 2007 to October 2010, 108 patients with L1 brust fracture treated through anterior approach were analyzed,including 68 males and 40 females, aged from 21 to 64 years (mean 38.22 years). All patients were divided into the 11th (A, 51 cases) and 12th (B, 57 cases) approach. The data of operation time,blood loss, duration of incision pain, JOA score, Oswestry score, VAS score, quality of life (SF-36), recovery of nervous function, coronal Cobb angle, included angle between screw and plate were observed.</p><p><b>RESULTS</b>All patients were followed up for 9 to 37 months, mean 23 months. The operation time, blood loss, duration of incision pain, in group A were lower than group B (P<0.05), JOA score, Oswestry score, VAS score, SF-36, recovery of nervous function had no significant differences (P>0.05). There were no differences in Cobb angle before operation, but had significance after operation (P=0.000). There were statistically significance between two group in angle between screw and plate (P=0.000, P=0.003).</p><p><b>CONCLUSION</b>The 11th rib approach for the treatment of L1 burst fracture has less effects on screw, less trauma and less angle between screw and plate.</p>