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For the moment, the surgical treatment of severe rigid cervical kyphosis is still one of the difficulties in the treatment of spinal deformity. There were not consistent in the stage of correction, choice of osteotomy method, osteotomy scope and approach. In this paper, It was expected to get further understanding by sharing one case of severe cervical kyphosis treated by anterior and posterior approach, and reviewing literature. The patient was a 23-year-old female who had functional limitation due to cervical deformity for 3 years. It showed that the cervical kyphosis vertex was C 3, 4 segment, the Cobb angle was 86°, the flexibility was 8.1%, and the atlantoaxial vertebra was dislocated and unstable by the examination of X-ray, MRI, CT and CTA examination. The cervical segmental, sequence, morphological characteristics of pedicle and lateral mass, and running of the vertebral artery were also evaluated. The deformity was corrected by a one-stage operation combined anterior and posterior approaches for intervertebral and atlantoaxial release, osteotomy of the posterior lamina articular process and fusion with bone grafting. The cervical lordosis angle was recovered to 6.7°. The patients were followed up for 4 years. There were no operative and perioperative complications and we obtained satisfied surgical result.
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Objective:To compare the effects of circular arch device and dressing device on the secretion of collagen, matrix metalloproteinase (MMP-1), transforming growth factor (TGF-β) of fibroblasts in the treated skin, and to explore the changes and mechanisms.Methods:The animals were purchased from the Southern Medical University Laboratory Animal Center. Using the established animal model, 54 mice were randomly divided into three groups: 18 mice each group, including control group, dressing device group and and circular arch device group. At the first, third and fifth day after negative pressure suction treatment, dermal thickness and density of collagen levels were and eosin staining, collagen level in local skin was determined using spectrophotometry, and MMP-1 and TGF-β levels were determined using enzyme linked immunosorbent assay.Results:Dermal thickness level was increased significantly in negative suction treated groups [after 5 days of treatment, control group: (71±8) μm; circular arch device group: (351±9) μm; dressing device group: (267±12) μm, P< 0.05]. Compared with the control group, collagen level in the dermis was significantly higher in circular arch device groups [after 5 days of treatment, control group: (30.9±4.3) mg/g; circular arch device group: (72.7±3.6) mg/g, P< 0.05]. TGF-β level in circular arch device treated group was increasing gradually, and markedly higher than that in the dressing device group and the control group [after 5 days of treatment, control group: (0.24±0.1) ng/ml; circular arch device group: (0.78±0.08) ng/ml; dressing device group: (0.39±0.18) ng/ml, P< 0.05], while MMP-1 level was decreasing. In addition, TGF-β and MMP-1 levels in the dressing device treated group remained stable during the entire experiment. Conclusions:The interface of the circular arch negative pressure suction device can effectively activate the fibroblasts, promote the secretion of TGF-β and collagen, and thicken the skin tissue.
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Posterior lumbar fusion is one of the effective methods for the treatment of lumbar degenerative diseases, which have been recognized by the majority of spine surgeons. However, it is found that lumbar fusion brings some problems with application, research and understanding move on. Adjacent segments degeneration (ASD) is one of the main reasons for reoperation after lumbar fixation and fusion. Therefore, dynamic stabilization system used in lumbar diseases has become a research hotspot in spinal surgery. Regarded as an alternative instead of rigid fusion, lumbar transpedicular dynamic stabilization system is gradually applied in clinical practice. It has become one of the most widely used non-fusion methods due to its advantages on maintaining the stability of surgical segments and on retaining intervertebral mobility. However, an emergence of new technique often meets conflicts from traditional concepts. Scholars have explored and evaluated the lumbar dynamic fixation technology in the aspects of biomechanics, clinical efficacy and prognosis. Some studies have explored the application and its related complications of lumbar transpedicular dynamic stabilization in common lumbar degenerative diseases. Comprehensively, the clinical effects of this technology have been confirmed by many studies. It can be used as an alternative instead of rigid fusion in the treatment of unstable segments after nerve decompression. There are still some limitations of this technique. It is necessary to conduct more multi-center randomized controlled trials according to the indications, contraindications, advantages, disadvantages and related risks. Further studies could improve the device in line with the anatomical characteristics of Chinese people and serve patients better.
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Objective@#To investigate the correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis.@*Methods@#A total of 103 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed, including 22 male patients (21.4%) and 81 female patients (78.6%). There were 2 cases of L2 spondylolisthesis, 10 cases of L3 spondylolisthesis, 81 cases of L4 spondylolisthesis, and 10 cases of L5 spondylolisthesis. The average age was 58.55 ±0.88 years old. Each patient underwent lumbar lateral X-ray, and lumbar MRI, and the imaging data were collected. MRI images were obtained to measure and calculatethe ratio of the fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area (LCSA/TCSA) in slipped segments and non-slipped segments. Lumbar lateral radiographs were obtained to measure and calculate slipped ratio. All data were analyzed by SPSS 23.0. Paired-samples T test was carried out to investigate whether there were LCSA/TCSA differences between in slipped segments and non-slipped segments. The correlation between LCSA/TCSA in slipped segments and slipped ratio was analyzed by using Pearson correlation coefficient system. P=0.000 was considered statistically significant.@*Results@#The degree of multifidus muscle atrophy (FCSA/TCSA) in the upper non-spondylolisthesis segments and the multifid muscle atrophy (FCSA/TCSA) in the degenerative spondylolisthesis segments (t=-12.618, P=0.000). there was significant difference between them. The degree of multifidus muscle atrophy (FCSA/TCSA) of degenerative spondylolisthesis was correlated with the spondylolisthesis ratio, and the correlation coefficient was -0.425. There was a high negative correlation between FCSA/TCSA ratio and spondylolisthesis ratio of degenerative spondylolisthesis.@*Conclusion@#The degree of multifidus muscle atrophy in degenerative spondylolisthesis is more serious than that in the upper non-spondylolisthesis segments, and there is a positive correlation between the degree of multifidus muscle atrophy in degenerative lumbar spondylolisthesis and the degree of lumbar spondylolisthesis in degenerative lumbar spondylolisthesis patients.
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The study showed a case of missed diagnosis of Leriche syndrome. Patients with intermittent claudication were diagnosed as lumbar spinal stenosis by local hospital with lumbar MRI. When conservative treatment was ineffective, the patients were treated in our spine clinic. However, the lumbar MRI showed no significant stenosis, and arteriovenous ultrasound also showed no abnormality. Vascular surgeons believed that patient’s symptoms had little correlation with vascular lesions. After careful reading of lumbar spine MRI, we found that the signal intensity of abdominal aorta increased unevenly below L2 vertebral level. CTA examination of abdominal aorta revealed sclerosis of abdominal aorta and common iliac artery, stenosis and occlusion of abdominal aorta and common iliac artery lumen below the level of renal artery orifice. The patient was finally diagnosed as Leriche syndrome.
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Objective To investigate the correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis.Methods A total of 103 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed,including 22 male patients (21.4％) and 81 female patients (78.6％).There were 2 cases of L2 spondylolisthesis,10 cases of L3 spondylolisthesis,81 cases of L4 spondylolisthesis,and 10 cases of L5 spondylolisthesis.The average age was 58.55 ±0.88 years old.Each patient underwent lumbar lateral X-ray,and lumbar MRI,and the imaging data were collected.MRI images were obtained to measure and calculatethe ratio of the fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area (LCSA/TCSA) in slipped segments and non-slipped segments.Lumbar lateral radiographs were obtained to measure and calculate slipped ratio.All data were analyzed by SPSS 23.0.Paired-samples T test was carried out to investigate whether there were LCSA/TCSA differences between in slipped segments and non-slipped segments.The correlation between LCSA/TCSA in slipped segments and slipped ratio was analyzed by using Pearson correlation coefficient system.P=0.000 was considered statistically significant.Results The degree of multifidus muscle atrophy (FCSA/TCSA) in the upper non-spondylolisthesis segments and the multifid muscle atrophy (FCSA/TCSA) in the degenerative spondylolisthesis segments (t=-12.618,P=0.000).there was significant difference between them.The degree of multifidus muscle atrophy (FCSA/TCSA) of degenerative spondylolisthesis was correlated with the spondylolisthesis ratio,and the correlation coefficient was-0.425.There was a high negative correlation between FCSA/TCSA ratio and spondylolisthesis ratio of degenerative spondylolisthesis.Conclusion The degree of multifidus muscle atrophy in degenerative spondylolisthesis is more serious than that in the upper non-spondylolisthesis segments,and there is a positive correlation between the degree of multifidus muscle atrophy in degenerative lumbar spondylolisthesis and the degree of lumbar spondylolisthesis in degenerative lumbar spondylolisthesis patients.
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The study showed a case of missed diagnosis of Leriche syndrome.Patients with intermittent claudication were diagnosed as lumbar spinal stenosis by local hospital with lumbar MRI.When conservative treatment was ineffective,the patients were treated in our spine clinic.However,the lumbar MRI showed no significant stenosis,and arteriovenous ultrasound also showed no abnormality.Vascular surgeons believed that patient's symptoms had little correlation with vascular lesions.After careful reading of lumbar spine MRI,we found that the signal intensity of abdominal aorta increased unevenly below L2 vertebral level.CTA examination of abdominal aorta revealed sclerosis of abdominal aorta and common iliac artery,stenosis and occlusion of abdominal aorta and common iliac artery lumen below the level of renal artery orifice.The patient was finally diagnosed as Leriche syndrome.
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According to the literature review, using thyroid and thyroid capsule to repair cervical esophageal perforation after anterior cervical spine surgery was just mentioned, but no literature reported operative process in detail. In this study, a 51-year-old male patient was admitted to the hospital because of cervical spine injury. The patient underwent anterior cervical discectomy with the iliac bone graft and ORION plate fixation. Esophageal perforation occurred after anterior cervical spine surgery. After conservative treatment, esophageal perforation didn't heal. A repairing operation was performed to remove the plate and repair esophageal perforation using sternocleidomastoid flap. After repairing surgery 6 months, perforation didn't heal completely. A second repairing surgery was performed to repair esophageal perforation using thyroid and its capsule. After second repairing surgery, esophageal perforation healed. The present study reviewed the literature about cause, clinical manifestation, diagnosis method and treatment of esophageal perforation. Using thyroid and thyroid capsule to repair cervical esophageal perforation could offer a treatment option in repairing esophageal perforation, especially the esophageal perforation after muscle flap repair still didn't heal.
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Objective@#To analyze the necessity of routinely performing foraminoplasty during percutaneous transforaminal endoscopic discectomy (PETD).@*Methods@#A total of 412 patients including 231 males and 181 females with an average age of 39.1±13 (20-80) years were enrolled in the present study. All patients were preoperatively diagnosed with single-segment lumbar disc herniation and underwent PETD by the same surgical group. The affected segments were at L3-4 in 32 cases, L4-5 in 289 cases, and L5S1 in 91 cases. Among them, 306 cases had no prolapse, 89 had mild up/down prolapse, and 17 had severe prolapse. MRI sagittal imaging was used to measure the height and width of the intervertebral foramen of L3, 4, L4, 5 and L5S1 segments, the distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle and the distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process. The necessity of performing foraminoplasty was evaluated by measuring the change of intervertebral foramen width using dynamic X-ray and verified during operation.@*Results@#The height of the intervertebral foramen of L3,4, L4,5 and L5S1 segments were 1.99±0.25, 1.89±0.15 and 1.52±0.26 cm, respectively. The width of the intervertebral foramen was 0.78±0.14, 0.75±0.13 and 0.64±0.13 cm, respectively. The distance between the lower edge of vertebral pedicle and the upper edge of the lower vertebral pedicle were 1.14±0.17, 1.05±0.16, and 0.98±0.19 cm, respectively. The distance between the point 3 mm to the ventral side of the intervertebral space to the superior articular process were 1.11±0.31, 1.17±0.20, and 0.95±0.14 cm, respectively. The width of the intervertebral foramen of the L3, 4 and L4,5 segments was significantly greater at the over-flexion position than at the over-extension position (P<0.05). Intraoperative verification showed that 347 cases (group A) did not need foraminoplasty. However, the other 65 patients (group B) needed foraminoplasty, including 31 at L4, 5 segment and 34 at L5S1 segment. One patient in group A and one in group B underwent revision operation due to residual intervertebral disc. At 2 years of follow-up, recurrence occurred in 4 patients in group A and 2 patients in group B. The ODI score and JOA score in group A and B were 18%±9%, 24.2±1.3 and 16%±7%, 23.9±1.3, respectively. There were not significantly different between patients in group A and B (t=1.70, P=0.090; t=1.71, P=0.088). The VAS score of lumbar pain of patients in group A was better than that of patients in group B (P<0.05).@*Conclusion@#Most of PETD of L3-S1 segments can reach the therapeutic target without performing foraminoplasty with half-half technique combined with far lateral access technique. Due to the special anatomical position of L5-S1 segment, the probability of performing foraminoplasty during operation is much higher. Performing foraminoplasty or not depends on the preoperative measurement of foramina and verification during the operation.
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OBJECTIVE@#To compare 3 commonly used methods for drug delivery via the lumbar spinal subarachnoid space in rats.@*METHODS@#We compared the effects of 3 methods for drug delivery via the lumbar spinal subarachnoid space in Sprague Dawley rats, namely acute needle puncture, chronic catheterization via laminectomy, and non-laminectomized catheterization. Body weight changes of the rats were measured, and their general and neurological conditions were assessed after the surgeries. The motor function of the rats was examined using rota rod test both before and after the surgeries. Nociceptive tests were performed to assess nociception of the rats. HE staining was used to examine local inflammation caused by the surgeries in the lumbar spinal cord tissue, and lidocaine paralysis detection and toluidine blue dye assay were used to confirm the precision of drug delivery using the 3 methods.@*RESULTS@#Both needle puncture and catheterization via laminectomy resulted in a relatively low success rate of surgery and caused neurological abnormalities, severe motor dysfunction, hyperalgesia, allodynia and local inflammation. Catheterization without laminectomy had the highest success rate of surgery, and induced only mild agitation, slight cerebral spinal fluid leakage, mild sensory and motor abnormalities, and minimum pathology in the lumbar spinal cord. Catheterization without laminectomy produced less detectable effects on the behaviors in the rats and was well tolerated compared to the other two methods with also higher precision of drug delivery.@*CONCLUSIONS@#Catheterization without laminectomy is a safe, accurate and effective approach to lumbar drug delivery in rats.
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Objective To investigate the treatment and prognosis of spinal giant cell tumors recurrence after total spondylectomy.Methods Between February 2001 and February 2016,five female patients suffered from spinal giant cell tumors recurrence after total spondylectomy were retrospectively analyzed.They underwent total spondylectomy with an age ranging from 17 to 63 years old (average 32.6 years).Four cases were primary cases and 1 was recurrent case at the first time of visit.Tumors were located in the thoracic vertebrae in 3 cases,including 1 case in T10 and 2 cases in T11.Tumors were involved in lumbar vertebrae in 2 cases,which were L2 and L5,respectively.According to Tomita spinal tumor classification,all cases were type 5.The Frankel classification for spinal cord injury was grade A in 1 case,grade C in 1 case,grade D in 1 case and grade E in 2 cases.Reoperation was introduced to treat the recurrent tumors after total spondylectomy with adjuvant radiotherapy and drug.The effect of tumor therapy,postoperative complications,nerve function and so on were observed in follow-up.Results One patient was treated with total en bloc spondylectomy (TES) and 4 patients was treated with piecemeal total spondylectomy.The operative approach was onestage posterior approach in 4 patients and combined antero-posterior approach in 1 patient.One patient received radiotherapy and 1 patient was treated with bisphosphonate post operation.The spinal cord function recovered to grade D in 1 patient and grade E in 4 patients.The average interval of recurrence after total spondylectomy was 12-57 months (average 29.6 months).At the second visit,the Frankel classification was grade C in 1 patient.Grade D and grade E were in 2 patients,respectively.Three patients were treated with reoperation to resect the tumors.One patient received radiotherapy and another one was untreated.All 5 patients were followed up with 47-196 months (average 108 months).Four patients survived without tumor and 1 patient without treatment for recurrence survived with tumor.Two patients occurred internal fixation fractures were treated with revision surgery.One of the patients had postoperative spinal canal infection and was cured after internal fixation removal,irrigating and drainage,and antibiotic treatment.The loosening screw in 1 patient was fixed again.Two patients suffered from obvious titanium mesh subsidence (＞ 5 mm).In the last follow-up,there were 1 patients with Frankel grade A,1 with grade D and 3 with grade E.Conclusion Active reoperation combined with radiotherapy and drugs therapy can significantly improve the prognosis of patients with recurrent spinal giant cell tumors after total spondylecmy.
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Objective To analysis causes of surgical failure of percutaneous lumbar endoscopic discectomy (PLED) for lumbar degenerative diseases.Methods Forty-six patients (31males,15 females),who underwent unsuccessful PLED (including percutaneous transforaminal endoscopy discectomy,PTED;percutaneous interlamina endoscopy discectomy,PIED) or percutaneous endoscopic lumbar decompression,were included in this study.Unsuccessful surgeries included no relieve of lumbar and limb pain and numbness right after surgeries;aggravated after surgeries that need revision 1～3 moths after surgeries;new symptoms appeared after surgeries;still had severe low back pain (VAS ＞5 points) 3 months after surgeries;had recurrence of lumbar disc herniation at the same level.The average age was 46±11 years old (20-81 years old).The primary diagnosis was lumbar disc herniation in 43 cases,and lumbar spinal canal stenosis in 3 cases.Forty-two cases accepted single level surgeries,others accepted twolevel surgeries.One case underwent PLED twice,others underwent one-time surgery.Results The causes of surgical failure included misdiagnosis in 10 cases,inappropriate surgical indication in 10 cases,inappropriate surgical technique in 12 cases,recurrent disc herniation in 9 cases,and persistent low back pain in 6 cases.Misdiagnosis cases included avascular necrosis of femoral head in 2 cases,missed diagnosis of cervical myelopathy in 1 case,mental disorder in 1 case,severe central spinal canal stenosis in 3 cases,and unidentified diagnosis in 3 cases.Inappropriate surgical indication cases included performing PLED for severe central spinal canal stenosis in 3 cases,PLED for only low back pain in 6 cases,untreated responsible disc herniation at adjacent level in 1 cases.Inappropriate surgical technique cases included incomplete removal of protruded disc in 11 cases,nerve root injuryin 1 case.Conclusion The causes of surgical failure of PLED mainly included misdiagnosis,inappropriate surgical indication,incomplete removal of protruded disc,and recurrent disc herniation.Improving diagnosis and indication selecting ability may help to avoid surgical failure.
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OBJECTIVE:To investigate the effects of different drying methods on contents of active ingredients in leaves of Eu-commia ulmoides,and provide reference for establishing its drying methods after habitat harvesting. METHODS:Different drying methods [natural drying in the shade for 72 h,natural drying in the sunlight for 36 h,drying beside or over a fire(60℃6 h,80℃2 h,100℃1 h,120 ℃ 0.5 h),microwave vacuum freeze drying for 12 h,vacuum freeze drying for 12 h] were used for process-ing. HPLC was conducted to determine the contents of aucubin,geniposidic acid,chlorogenic acid and geniposide in samples and compare with the untreated fresh products. RESULTS:Contents of 4 ingredients in samples after the 2 freeze drying were close to these in fresh samples,which were higher than samples after other drying. CONCLUSIONS:Drying methods show significant ef-fects on the effective ingredients in leaves of E. ulmoides. Compared with natural drying in the shade and natural drying sunlight and drying beside or over a fire,microwave vacuum freeze drying and vacuum freeze drying can make better retention of the active ingredients in fresh leaves of E. ulmoides.
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OBJECTIVE:To investigate the effects of different drying methods on contents of active ingredients in leaves of Eu-commia ulmoides,and provide reference for establishing its drying methods after habitat harvesting. METHODS:Different drying methods [natural drying in the shade for 72 h,natural drying in the sunlight for 36 h,drying beside or over a fire(60℃6 h,80℃2 h,100℃1 h,120 ℃ 0.5 h),microwave vacuum freeze drying for 12 h,vacuum freeze drying for 12 h] were used for process-ing. HPLC was conducted to determine the contents of aucubin,geniposidic acid,chlorogenic acid and geniposide in samples and compare with the untreated fresh products. RESULTS:Contents of 4 ingredients in samples after the 2 freeze drying were close to these in fresh samples,which were higher than samples after other drying. CONCLUSIONS:Drying methods show significant ef-fects on the effective ingredients in leaves of E. ulmoides. Compared with natural drying in the shade and natural drying sunlight and drying beside or over a fire,microwave vacuum freeze drying and vacuum freeze drying can make better retention of the active ingredients in fresh leaves of E. ulmoides.
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Objective To review and analyze the clinical effect of combined posterior mini-invasive fixation with anterior debridement via small incision for the treatment of single segment lumbar vertebral tuberculosis. Methods Totally 31 cases with single segment lumbar tuberculosis (both borderline tuberculosis) without attachment involvement underwent one-stage anterior debridement, interbody fusion and posterior mini-invasive fixation from July 2010 to July 2015. Among these patients, 19 were male and 12 were female. The average age was (36.1±17.8) years old (ranged 21-61 years old). The average course of disease was 11(9, 12) months (ranged from 2 to 16 months). All were single segment involvement, and the involved segment was L2-3 in 7 cases, L3-4 in 10 cases, L4-5 in 6 cases, and L5-S1 in 8 cases. The clinical manifestations included lumbar back pain in 31 cases with an average pain visual analog score (VAS) of 7(6, 8) points. ASIA grade of spinal cord injury was E in 25 cases and D in 6 cases. Paravertebral abscess occurred in 22 cases and iliac fossa gravity abscess appeared in 9 cases. Kyphosis was observed in 12 cases and the average Cobb angle was 21° ± 6° . Quadruple anti-tuberculosis chemotherapy was used for at least 2 weeks preoperatively. Posterior mini-invasive fixation was fulfilled on prone position, including mini-invasive percutaneous screws in 18 cases and pedicle screw fixation via Wiltse approach in 13 cases. Posterior distraction and deformity correction were performed simultaneously for patients with kyphosis. Then the patients were changed to lateral position for anterior debridement, bone grafting and/or titanium mesh fusion. Results The average operation time was (204±54) min (ranged 160-240 min) in 31 patients, and the mean blood loss was (168±73) mL (ranged 100-300 mL). Delayed healing of anterior incision occurred in 1 case and the incision healed after two-week dressing of wound. The incision healed well in the rest 30 cases. No complications such as nerve function, blood vessel injury were found in patients. The VAS scores of the 3 days after operation were 1.3 ± 0.3 and 2.1 ± 1.4 in percutaneous group and Wiltse approach group, respectively, and the difference between them was statistically significant ( P<0.05). The VAS score of low back pain was 2(1, 3) points in all the 31 patients three months after operation, which was significantly lower than that before surgery (P<0.05). The six patients with neurological symptoms recovered to E grade after operation. The average Cobb angle correction was 15°±5° in 12 patients with kyphosis (P<0.05), which was significantly decreased compared with that before surgery (P<0.05). All patients were followed up for an average of (36.8 ± 9.3) months (ranged from 12 to 72 months). The clinical healing of tuberculosis was achieved at the final follow-up in all the 31 patients. No complications were observed, such as lumbar kyphosis, internal fixation loosening and breakage, dislocation and titanium mesh subsidence. Conclusion Mini-invasive posterior internal fixation and anterior debridement via small incision is effective for the treatment of single segment lumbar vertebral tuberculosis in lesion debridement and spine stability reconstruction by short segment fixation. This technique can reduce fused segments, surgical trauma of anterior approach and related complications.
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This paper summarized the experience of caring a patient with pancreatic cancer-related depression treated with pancreaticoduodenectomy and postoperative delayed gastric emptying.The nursing included several key points.On the base of collaboration of muhi-disciplinary teams,to strengthen supportive psychological intervention and safety management after admission;to use multimodal analgesia combined with cognitive behavioral therapy to reduce postoperative pain.After the patient was complicated with gastric emptying obstacles,solution-focus mode,sham feeding and nutritional support programs were implemented.Long-term follow-up with physician-nurse collaboration mode was implemented to enhance quality of life of the patient.
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Objects To evaluate the immune protective effect of dexmedetomidine on breast cancer dur-ing perioperative radical mastectomy via sevoflurane inhalation general anesthesia. To explore reasonable anesthet-ic strategyfor breast cancer radical mastectomy. Methods Patients were divided into two groups. Patients in ex-perimental group receivedgeneral anesthesia with dexmedetomidine and sevoflurane. Control group means general anesthesia with sevoflurane only. In both groups, the level of cortisol, IL-6, IL-8 and of TNF-αin serum were measured at 5 time points , 30 minutes before anesthesia , after cutting skin , after surgery , 24 h after surgery and 72 h after surgery. Results The amount of anesthetic used to induce general anesthesia in the experimen-talgroup were lower than that of the control group.There is no obvious difference of cortisol , IL-6, IL-8 and of TNF-αin serumat the time of 30 min before anesthesia between two groups.Concentrations ofseveral markersin-creasedafter anesthesia, of which experimentalgroup were lower than that of the control group. Conclusions Dexmedetomidine could be immunoprotective for patient with breast cancer during perioperative radical mastecto-my via sevoflurane inhalationgeneralanesthesia. This study recommends usingmultiple anestheticdrugs to anes-thetize patients of breast cancer when performing radical mastectomy.
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OBJECTIVE:To establish a method for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteolo-side and isochlorogenic acid A in Xiaoer ganmao granule. METHODS:HPLC was performed on the column of Hedera C18 with mo-bile phase of acetonitrile-0.1% formic acid aqueous at a flow rate of 1.0 ml/min,the detection wavelength was 254 nm,330 nm and 370 nm,column temperature was 40 ℃,and the injection volume was 5 μl,RESULTS:The linear range was 6.6-105 μg/ml for (R,S)-goitrin (r=0.999 9),9-140 μg/ml for chlorogenic acid (r=0.999 9),9-144 μg/ml for luteoloside (r=0.999 8) and 9-138 μg/ml for isochlorogenic acid A(r=0.999 6);the limits of quantitation were 330 ng,450 ng,450 ng and 450 ng,limits of detection were 66 ng,90 ng,90 ng and 90 ng,respectively;RSDs of precision,stability and reproducibility tests were lower than 3%;recoveries were 95.01%-98.77%(RSD=1.48%,n=6),95.14%-98.91%(RSD=1.52%,n=6),95.11%-97.54%(RSD=0.93%,n=6) and 95.58%-99.63%(RSD=1.73%,n=6). CONCLUSIONS:The method is simple and accurate,and suitable for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteoloside and isochlorogenic acid A in Xiaoer ganmao granule.
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Objective To compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (M-TLIF) and Wiltse-approach TLIF (W-TLIF) in treating single-level degenerative lumbar disease.Methods A retrospective review was performed on the 57 patients with single-level degenerative lumbar disorder managed via M-TLIF (n =27) and W-TLIF (n =30) from December 2009 to December 2010.In M-TLIF group degeneration at the L4-5 disc were noted in 11 cases and at the L5-S1 disc in 16 cases.And 19 cases were diagnosed with lumbar isthmus spondylolisthesis (17 with Grade Ⅰ spondylolisthesis and 2 with Grade Ⅱ spondylolisthesis),4 lumbar spinal stenosis and instability,2 lumbar disc herniation combined with huge posterior osteophytes,1 recurrent lumbar disc herniation after lumbar fenestration,and 1 recurrent lumbar spinal stenosis after decompression.In W-TLIF group degeneration at L4～5 disc were noted in 12 cases and at the L5-S1 disc in 18 cases.There were 19 cases diagnosed with lumbar isthmus spondylolisthesis (18 with Grade Ⅰ spondylolisthesis and 1 with Grade Ⅱ spondylolisthesis),3 with lumbar disc herniation,and 8 with lumbar spinal stenosis.Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) were used to measure low back and leg pain.Modified Brantigan score was used to assess lumbar interbody fusion.Results Operative time was not significantly different between the two groups (P ＞ 0.05).Incision length and mean blood loss were (5.1 ± 0.7) cm and (90.1 ± 10.5) ml in M-TLIF group,but were (6.9 ± 1.0)cm and (155.3 ±21.2)ml in W-TLIF group (P＜0.05).At postoperative 1 and 3 days VAS in M-TLIF group was (2.1 ± 0.5) points and (1.0 ± 0.1) points respectively,but in W-TLIF group was (3.6 ± 0.1) points and (2.4 ± 1.0) points respectively (P ＜ 0.05).Intraoperative X-ray fluoroscopy frequencies were (46 ± 9) times in M-TLIF group and (7 ± 2) times in W-TLIF group (P ＜ 0.05).Mean period of follow-up was 26.7 months (range,24-36 months).At final follow-up,JOA score,VAS for leg pain and lumbar interbody fusion rate revealed no significant differences between the two groups (P ＞ 0.05),but VAS for lumbar pain was (1.0 ± 0.2) points in M-TLIF group versus (1.9 ± 0.3) points in W-TLIF group (P ＜0.05).Twenty-four cases (89％) had Brantigan score of 3 or over in M-TLIF group and 27 cases (90％) in W-TLIF group,indicating a similar interbody fusion rate (P ＞ 0.05).Conclusions Both lumbar fusion methods are effective in treatment of lumbar degenerative disease.M-TLIF lumbar fusion results in small amount of bleeding,small incision and significantly improved lower back pain as compared with W-TLIF,but W-TLIF involves less exposure to the X-rays.
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Objective To study the clinical application of thymidine kinase 1(TK1) in diagnosis of common malignant tumors . Methods The serum TK1 levels of 444 cancer patients and 161 healthy individual(control group) were tested by western blot-en-hanced chemiluminescence assay .Results Compared with control group ,the levels of TK1 in patients with lung cancer ,gastrointes-tinal cancer or breast cancer were significantly higher(P<0 .05) .The positive rates of TK1 in lung cancer ,esophageal cancer ,colon cancer ,colorectal cancer ,breast cancer ,cervical cancer and ovarian cancer were respectively 52 .0% ,59 .6% ,62 .9% ,60 .0% , 62 .1% ,32 .3% ,21 .4% and 11 .0% .Compared with control group(the positive rate of TK1 was 0 .0% ) ,the positive rate of TK1 in lung cancer ,gastrointestinal cancer or breast cancer were significantly higher(P<0 .01) .Conclusion The test of serum TK1 is a valuable marker in common malignant tumor auxiliary diagnosis .