Deep learning-based dose prediction in radiotherapy planning for head and neck cancer / 南方医科大学学报

OBJECTIVE@#To propose an deep learning-based algorithm for automatic prediction of dose distribution in radiotherapy planning for head and neck cancer.@*METHODS@#We propose a novel beam dose decomposition learning (BDDL) method designed on a cascade network. The delivery matter of beam through the planning target volume (PTV) was fitted with the pre-defined beam angles, which served as an input to the convolution neural network (CNN). The output of the network was decomposed into multiple sub-fractions of dose distribution along the beam directions to carry out a complex task by performing multiple simpler sub-tasks, thus allowing the model more focused on extracting the local features. The subfractions of dose distribution map were merged into a distribution map using the proposed multi-voting mechanism. We also introduced dose distribution features of the regions-of-interest (ROIs) and boundary map as the loss function during the training phase to serve as constraining factors of the network when extracting features of the ROIs and areas of dose boundary. Public datasets of radiotherapy planning for head and neck cancer were used for obtaining the accuracy of dose distribution of the BDDL method and for implementing the ablation study of the proposed method.@*RESULTS@#The BDDL method achieved a Dose score of 2.166 and a DVH score of 1.178 (P < 0.05), demonstrating its superior prediction accuracy to that of current state-ofthe-art (SOTA) methods. Compared with the C3D method, which was in the first place in OpenKBP-2020 Challenge, the BDDL method improved the Dose score and DVH score by 26.3% and 30%, respectively. The results of the ablation study also demonstrated the effectiveness of each key component of the BDDL method.@*CONCLUSION@#The BDDL method utilizes the prior knowledge of the delivery matter of beam and dose distribution in the ROIs to establish a dose prediction model. Compared with the existing methods, the proposed method is interpretable and reliable and can be potentially applied in clinical radiotherapy.

Application of flipped classroom combined with online interactive teaching in clinical clerkship of cardiology / 中华医学教育探索杂志

Objective:To explore the application effect of flipped classroom combined with online interactive teaching in clinical clerkship of cardiology.Methods:The study collected 56 students from Batch 2017 five-year clinical medicine undergraduate class of Medical College of China Three Gorges University and they were randomly divided into experimental group and control group in average. The control group adopted the traditional teaching method while the experimental group adopted the combined teaching method. The differences of test scores after teaching were compared between the two groups and the feedback of students on the two methods was also analyzed. SPSS 12.0 was used for t test and chi-square test. Results:The final score of clinical thinking in the experimental group (84.38±3.18) was significantly higher than in the control group (75.43±5.85) ( P<0.05), and the satisfaction of the experimental group to the teaching mode was [86% (24/28)], which was significantly higher than that of the control group [50% (14/28)]. More than 80% of the students in the experimental group regarded that the combined teaching method was helpful to promote the interaction between teachers and students, master relevant knowledge, and improve learning interest and learning efficiency. Conclusion:This combined teaching method can enhance students' clinical thinking ability, learning enthusiasm and efficiency, and finally effectively improve the effect of clerkship.

Chinese Herbal Medicines Prevent and Treat Atopic Dermatitis by Improving Skin Barrier： A Review / 中国实验方剂学杂志

Atopic dermatitis is a chronic， refractory and inflammatory skin disease with the clinical manifestations of severe pruritus and recurrent attacks. It has a high incidence and is closely correlated with other allergic， autoimmune or infectious diseases， which can cause a variety of secondary diseases and mental and psychological disorders， seriously affecting the life quality of patients. Chinese herbal medicines have been used for the prevention and treatment of atopic dermatitis for thousands of years， and many Chinese herbal medicines （including compound prescriptions） effective for this disease have been recorded. These medicines generally have little adverse reactions and the treated patients have low recurrence rate of atopic dermatitis. According to the evidence of modern medicine， the onset of atopic dermatitis is related to the impairment of skin barrier function， abnormal immune response， and abnormal differentiation of mast cells， antigen-presenting cells， and eosinophils. Additionally， it is associated with mental， endocrine， metabolic and other factors. The defect of skin barrier function and the dysfunction of immune system are the main pathogenesis of atopic dermatitis. In recent years， scientists have achieved certain progress in improving skin barrier function with Chinese herbal medicines. This paper systematically summarizes the studies about the application of Chinese herbal medicines in regulating the expression of epidermal proteins， epidermal lipids， aquaporins， tight junction proteins， and antimicrobial peptides in recent 10 years， aiming to clarify the pathological mechanism and provide reference for the clinical research and application of Chinese herbal medicines in the treatment of atopic dermatitis.

Research Progress on Pharmacological Effect of Astragali Radix-Angelicae Sinensis Radix on Invigorating Qi and Activating Blood / 中国实验方剂学杂志

Astragali Radix-Angelicae Sinensis Radix （AA） is a basic pair of drugs mainly targeting the syndrome characteristics of Qi and blood diseases. LI Dong-yuan's Danggui Buxuetang （DBT） is composed of AA， which is mainly used to tonify Qi and generate blood， with main indications of Qi deficiency and blood deficiency， blood heat and so on. It is favored by doctors because of its refined prescription and remarkable curative effect. However， there are many compatibility ratios of AA in different prescriptions in ancient books， and their efficacy and indications are also slightly different. This research showed that DBT also had the effect of invigorating Qi and activating blood， and the previous study of the group showed that 3∶1 compatibility ratio of the two herbs in the total amount of 36 g had more obvious effect of invigorating Qi and activating blood. By consulting the relevant literature， it was found that the drug pair had a certain effect of invigorating Qi and activating blood in various compatibility ratios such as 1∶1， 3∶1， 1∶5， 3∶2， 2∶1， 5∶1. The corresponding pharmacological effect mainly included regulating the energy metabolism of substances， regulating immune function， reducing blood viscosity， anti-oxidation stress， anti-inflammation， lowering blood lipids， lowering blood sugar， protecting heart function， protecting blood vessel wall， intervening angiogenesis， fighting against organ tissue fibrosis and so on. Regardless of the AA single-medicine's activating blood effect and the theory that "Qi circulation leads to blood circulation" or the drug pair's manifestation in modern pharmacological effects， all of these have confirmed that AA's effect of invigorating Qi and activating blood does exist， and the difference of action performance caused by different ratios of AA is closely related to dosage and proportion， which needs further study. Based on the study focusing on the effect of tonifying Qi and generating blood， it is easy to ignore the effect of invigorating Qi and activating blood， which limits the clinical application of the latter. Therefore， the tonifying Qi and activating blood circulation effect of the drug pair is reviewed in this paper， so as to provide a theoretical basis for its clinical rational drug use and related research.

Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb / 中国骨伤

OBJECTIVE@#To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation.@*RESULTS@#The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L and 27 cases of LS. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation.@*CONCLUSION@#The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.

Effect of Astragali Radix Membranaceus in Promoting Blood Circulation and Its Modern Pharmacology Research / 中国实验方剂学杂志

Astragali Radix membranaceus is first recorded in Shennong Bencaojing, which has the effect in replenishing Qi and rising Yang, strengthening the body surface resistance, inducing diuresis to alleviate edema, and supporting for detoxication and tissue generation. As an essential medicine for invigorating Qi and invigorating the spleen, it is often used in diseases, such as Qi deficiency and fatigue, spleen deficiency diarrhea and so on, and has been well known by doctors. In recent years, scholars have a comprehensive understanding of the mechanisms in replenishing Qi, invigorating spleen and promoting water. However, Tao Hongjing first recorded that Astragali Radix membranaceus can " clear the evil blood between the five organs" . In Bencaojing Jizhu, this herbal medicine has the effect in promoting blood circulation at the same time. At present, traditional Chinese medicine often explains the mechanism of this herbal medicine in promoting blood circulation based on the theory of " replenishing Qi and activating blood circulation" and " blood circulation due to Qi circulation" , which however is not equivalent to the fact that this herbal medicine has no blood circulation effect. By summarizing the records of Astragali Radix membranaceus in the herbal literatures of the previous dynasties, it was found that its promoting blood circulation effect was widely used. In summary of the applications of traditional prescriptions and modern prescriptions in promoting blood circulation, Astragali Radix membranaceus can remove obstruction and activate blood circulation, activate blood and promote diuresis, activate blood circulation and strengthen the body resistance, which can best reflect the effect in activating blood circulation of this medicine. Modern pharmacology shows that Astragali Radix membranaceus has a good regulatory effect on the molecular mechanism of blood stasis pathological indexes by activating blood circulation. Due to no in-depth research, there is still room for study. Therefore, this paper thoroughly explores the mechanism of action of Astragali Radix membranaceus in promoting blood circulation by summarizing the effects of Astragali Radix membranaceus in literatures of previous dynasties and modern pharmacological studies, in order to expand the clinical application of Astragali Radix membranaceus and provide theoretical guidance for clinical treatment.

Leucosceptroid B from glandular trichomes of Leucosceptrum canum reduces fat accumulation in Caenorhabditis elegans through suppressing unsaturated fatty acid biosynthesis / 中国天然药物

Obesity that is highly associated with numerous metabolic diseases has become a global health issue nowdays. Plant sesterterpenoids are an important group of natural products with great potential; thus, their bioactivities deserve extensive exploration. RNA-seq analysis indicated that leucosceptroid B, a sesterterpenoid previously discovered from the glandular trichomes of Leucosceptrum canum, significantly regulated the expression of 10 genes involved in lipid metabolism in Caenorhabditis elegans. Furthermore, leucosceptroid B was found to reduce fat storage, and downregulate the expression of two stearoyl-CoA desaturase (SCD) genes fat-6 and fat-7, and a fatty acid elongase gene elo-2 in wild-type C. elegans. In addition, leucosceptroid B significantly decreased fat accumulation in both fat-6 and fat-7 mutant worms but did not affect the fat storage of fat-6; fat-7 double mutant. These findings indicated that leucosceptroid B reduced fat storage depending on the downregulated expression of fat-6, fat-7 and elo-2 and thereby inhibiting the biosynthesis of the corresponding unsaturated fatty acid. These findings provide new insights into the development and utilization of plant sesterterpenoids as potential antilipemic agents.

Application of percutaneous vertebroplasty with the second injection for poor dispersion bone cement of Kümmel disease / 中国骨伤

OBJECTIVE@#To investigate clinical effect of percutaneous vertebroplasty with second injection for poor dispersion bone cement of Kümmel disease.@*METHODS@#Eighty-eight patients with Kümmel disease were treated with vertebroplasty from February 2014 to December 2017, and 16 patients were found cement dispersion unsatisfactory during initial cement injection and were undertaken second cement injection during operation. Among patients, there were 1 male and 15 females aged from 63 to 82 years old with an average age of 72.7 years old. Distribution of fractured vertebrae were followed: 1 patient was on T₁₀, 1 patient was on T₁₁, 3 patients were on T₁₂, 8 patients were on L₁, 1 patient was on L₂, and 2 patients were on L₃. VAS and ODI score were compared before operation, 2 days after operation and the latest following-up, anterior vertebral height and local kyphosis angle of fractured vertebrae with intravertebral cleft were also observed. Postoperative complication was recorded.@*RESULTS@#All patients were followed up from 5 to 22 months with average of 14.1 months. ODI score before operation, 2 days after operation and the latest following-up were 72.3±12.1, 56.8±5.0 and 12.1±5.3 respectively; VAS score before operation, 2 days after operation and the latest following-up were 7.8±0.6, 3.0±0.4 and 2.4±0.7, respectively; ODI score at 2 days was improved compared with before operation, while ODI and VAS score at the latest following-up was improved than that of 2 days after operation. Vertebral anterior compression rate and Cobb angle of the fractured vertebrae with intravertebral cleft were respectively corrected from (37.8±5.4)% and (15.1±2.0)°preoperative, to (4.7±1.4)% and (4.4±2.2)° at 2 days after operation, (4.9±1.5)% and (4.8±2.4)° at the latest following-up, there was significant difference between before operation and 2 days after operation, while there was no difference between 2 days after operation and the latest following-up. Three patients occurred cement leakage without pulmonary embolism and neurological impairment. Four patients occurred adjacent vertebrae fracture. There was no incidence of recollapsed vertebrae during follow-up period.@*CONCLUSIONS@#Percutaneous vertebroplasty for Kümmel disease could receive satisfactory clinical results when cement dispersion was inadequate during initial cement injection by the second injection, and effectively prevent occurrence of vertebral re-collapse.

Effect of the proximal level on post-laminoplasty loss of lordosis / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the effect whether or not retaining muscle ligament complex of C2 attachment on cervical spine kyphotic deformity after single open-door laminoplasty.</p><p><b>METHODS</b>A total 40 patients with cervical spondylotic myelopathy underwent single open-door laminoplasty from February 2011 to June 2014 were retrospectively analyzed. Of them, single open-door for C₃-C₆ was 40 cases (group A), including 28 males and 12 females, with an average age of (68.4±9.3) years old;and single open-door for C₄-C₆ plus C₃ laminectomy decompression (in order to protect the muscle ligament complex of C₂ attachment) was 40 cases (group B), including 26 males and 14 females, with an average age of (66.8±8.4) years old. Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), Cobb angle of sagittal plane from C₂-C₇, cervical range of motion were used to evaluate effects before operation and at the latest follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 24 to 31 months with an average of(26.5±3.4) months. There was no significant differences in VAS, JOA scores and cervical range of motion before surgery between two groups (>0.05) and all above items were significantly improved at the latest follow-up (<0.05), but there was no significant difference between two groups(>0.05). There was no significant difference in cervical Cobb angle before surgery between two groups(>0.05), and postoperative Cobb angle had obviously improved in two groups(<0.05), but the improvement of group B was better than that of group A.</p><p><b>CONCLUSIONS</b>Starting the laminoplasy on C₄ level and retainning the muscle ligament complex of C₂ attachment can obviouly decrease cervical spine syphotic deformity.</p>

Application of Gemstone Spectrum Imaging for anterior spinal artery in patients with cervical spinal injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the value of Gemstone Spectrum Imaging (GSI) CT anterior spinal artery angiography in the patients with cervical spinal cord injury, and to evaluate the correlation between the change of the blood flow of the anterior spinal artery and the postoperative recovery of nerve function.</p><p><b>METHODS</b>From January 2014 to June 2016, thirty patients who underwent cervical open door laminoplasty for spinal cord injury were retrospective analyzed and included 21 males and 9 females with an average age of (46.4±9.7) years old ranging from 33 to 59 years. Within 2 weeks after injury, open door laminoplasty was performed through cervical posterior approach. Among them, there were 8 cases of 3 segments of open door decompression, 18 cases of 4 segments, 4 cases of 5 segments. GSI CT were performed at 3 days before operation and 5 days after operation. The anterior spinal artery was reconstructed and evaluated the improvement of blood flow after operation. The cervical JOA score was calculated at 1 day before operation, 5 days after operation and 1, 6 and 12 months after operation, and the JOA score improvement rate of the corresponding follow-up points was calculated.</p><p><b>RESULTS</b>All patients were followed up for 12 to 30 months with an average of (17.4±7.6) months. The iodine content ratio (ASA/VA) of the anterior spinal artery before and after operation was 0.75±0.20 and 0.89±0.02 respectively, the postoperative improvement was significantly higher than that before operation(<0.01). The average ASA/VA improvement rate was(21.05±12.45)% after operation. There was a positive linear correlation between the improvement of blood flow and the improvement of JOA score at 1, 6 and 12 months after operation.</p><p><b>CONCLUSIONS</b>GSI CT anterior spinal artery angiography is safe and feasible, the imaging is satisfactory, it can quantitatively evaluated the blood flow of the anterior spinal artery. There was a positive linear correlation between the improvement of blood flow in anterior spinal artery and the recovery of neurological function. Early postoperative improvement of blood flow in the anterior spinal artery can be used as a reference index for predicting the recovery of neurological function in patients.</p>

Analysis of complications of percutaneous endoscopic lumbar discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD), and discuss how to avoid these complications.</p><p><b>METHODS</b>The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed, including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L₃,₄, 68 of L₄,₅ and 58 of L₅S₁. The incidences of intraoperative and postoperative complications were analyzed.</p><p><b>RESULTS</b>There was spinal dura mater injury in 1 patient, but no cerebrospinal fluid leakage and nerve function deficit was found, the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater; two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients; all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery.</p><p><b>CONCLUSIONS</b>PELD have a steep learning curve, and the technology is a safe and effective method in treating lumbar disc herniation, but the beginners must have enough open surgery experience, and to grasp indications strictly.</p>

Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects and multifidus muscle injury of different approaches, including unilateral Wiltse intermuscular approach and intramuscular approach combined with contralateral decompression, in treating thoracolumbar burst fracture.</p><p><b>METHODS</b>Forty-three patients with thoracolumbar burst fracture were enrolled in the study from January 2010 to December 2014, including 29 males and 14 females with an average age of 42.3 years old(ranged from 21 to 64 years old). The patients were treated with posterior pedicle screw fixation and unilateral decompression and were divided into Wiltse intermuscular approach group (group A) and intramuscular approach group (group B) according to surgical approach. Operation time and intraoperative bleeding were recorded for all patients; visual analogue scale(VAS) was compared 1 d preoperatively, 1 week, 12 months postoperatively between two groups; preoperation and 12 months postoperatively, the fractured vertebral canal and two-sides multifidus muscle of the same section were observed and compared by CT measure between two groups.</p><p><b>RESULTS</b>All the patients were follow-up for 14 to 21 months with an average of 16.3 months. Partial wound non-healing occurred in 3 patients and the wound ultimately healing after debridgement suture and change dressings. No screw breakage was found. There was significant difference in operation and intraoperative bleeding operation between two groups (<0.05), while there was no significant difference in VAS score of 1 d preoperatively, 1 week, 12 months postoperatively between two groups(>0.05). As for CT measurement results, postoperative vertebral canal narrow ratio was significant decreased in all patients(<0.05), while perioperative changes of the two-sides multifidus muscle cross section area and density were significant in group A (<0.05), but there was no significant difference in group B (>0.05). Neurologic status of all patients got recovery at final follow-up.</p><p><b>CONCLUSIONS</b>The method of unilateral Wiltse intermuscular approach combined with contralateral decompression for the treatment of thoracolumbar burst fracture has good clinical effects, also it is less invasive and less damage to multifidus muscle compared with intramuscular approach.</p>

Correlation Research between Pharmacological Method State and Natural Attribute of Chinese Herbs / 中国中西医结合杂志

Pharmacological method state is a method to explain the principle of Chinese herb according to its external phenomenon such as shape, color, texture, features, and so on. The natural attribute of Chinese herb include shape, color, texture, smell, harvesting time, medicinal parts, chemical components, and so on. Though both of them have different key points, the natural attribute of Chinese herb can also be used to explain its medicinal mechanism. Therefore, the correlation research between pharmacological method state and the natural attribute of Chinese herb has some significance.

Cervical single open door laminoplasty with lateral mass screw fixation for the treatment of cervical spondylotic myelopathy with cervical instability / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the outcomes of single open door laminoplasty with lateral mass screw fixation in treating cervical spondylotic myelopathy (CSM) with cervical instability.</p><p><b>METHODS</b>From March 2010 to October 2012, 25 patients with spondylotic myelopathy and cervical instability underwent single open door laminoplasty with lateral mass screw fixation. There were 18 males and 7 females, aged from 57 to 68 years with the mean of 57 years. Japanese Orthopaedic Association (JOA) scores were used to evaluate clinical effects before operation and final follow up. Radiographical measures were made in change of Cobb angle by sagittal plane from C₂ to C₇, and cervical range of motion.</p><p><b>RESULTS</b>All the patients were followed up from 18 to 36 months with an average of 25.6 months. Cerebrospinal fluid leakage occurred in 1 case, incision fat necrosis in 1 case, C₅ nerve root palsy in 4 cases. JOA scores was improved from preoperative 5.2±2.1 to 11.3±2.4 final follow up. Cobb angle was changed from preoperative (6.5±3.4)° to (13.2±4.9)° final follow up. Cervical range of motion was changed from preoperative (30.4±9.2)° to (26.5±8.4)° final follow up.</p><p><b>CONCLUSIONS</b>As an effective treatment to CSM with cervical instability, single open door laminoplasty with lateral mass screw fixation has the advantage of extensive application scope, safety and steady, but the incidence rate of complication must be reduced.</p>

Outcomes and related factors of C₅ nerve root palsy after cervical posterior single open-door laminoplasty / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical outcomes and related factors of C₅ palsy following cervical laminectomy in treating multi-segments cervical spondylotic myelopathy.</p><p><b>METHODS</b>From January 2010 to June 2014, 80 patients with spondylotic myelopathy underwent C₃-C₆ open-door laminoplasty(group A) and 80 patients C₄-C₆ open-door laminoplasty (group B). The mean age was (68.4±9.2) years (44 males and 36 females) in group A and the mean age was (66.8±8.9) years (48 males and 32 females) in group B. Japanese Orthopaedic Association(JOA) score, Visual Analogue Score, incidence of C₅ palsy, time of onset, grade of muscle weakness, other accompanying cervical nerve root palsies, recovery time were used to evaluate clinical effects before operation and at last follow-up. Radiographically, changes of Cobb angle of sagittal plane from C₂-C₇, cervical range of motion, minimal spinal cord diameter on MRI were analyzed before operation and at last follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 6 to 15 months with an average of (12.4±3.2) months. No obvious differences were observed between change of VAS of cervical and upper limb, JOA, Cobb angle, cervical range of motion, minimal spinal cord diameter on MRI. C₅ nerve root palsy occurred in 7 cases (8.75%) in group A, including 4 cases of upper limb pain, 3 cases of upper limb pain, and 2 cases of residual upper limb pain and sensory loss at the last follow-up. C₅ nerve root palsy occurred in 5 cases (7.5%) in group B, 3 cases of upper limb pain, 2 cases of upper limb sensory loss, and all patients recovered normal radiation pain and sensory loss at the last follow-up. There was no significant difference in the incidence of C₅ nerve root palsy between the two groups. C₅ nerve root palsy, deltoid muscle, accompanied by neurological symptoms, recovery time were(2.3±1.0) N, 30 cases (37.5%), (11.4±1.0) weeks in group A, (2.8±0.8) N, 23 cases (28.8%), (8.2±0.8) weeks in group B, there was no significant difference on deltoid muscle decreased between the two groups, accompanied by neurological symptoms and the recovery time in group A was worse than the group B.</p><p><b>CONCLUSIONS</b>Comparison of the two kinds of operation, the probability of postoperative C₅ nerve root palsy was equal, but the C₅ nerve root palsy in patients with C₄-C₆ open-door laminoplasty showed lighter symptom and faster recovery.</p>

Clinical application of unilateral axis translaminar screws in upper cervical instability with vertebral artery variations / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical outcomes of the posterior C1,2 screw-rod combined with C2 unilateral translaminar screw and contralateral pedicle screw fixation and autogenous bicortical iliac crest graft fusion in treating upper cervical instability with vertebral artery variations.</p><p><b>METHODS</b>From June 2008 to December 2012, the clinical data of 12 patients with upper cervical instability underwent C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion were analyzed retrospectively. There were 8 males and 4 females with a mean age of 47.5 years (ranged, 16 to 77 years). Patients suffered from occipitocervical activity limitation of motion with pain or not, VAS was 0-7 points with an average of (3.50 +/- 2.71) points. Unilateral vertebral artery hypoplasia was demonstrated by vertebral arteriography (VAG) or CTA in all patients. Cervical X-ray and CT scans were done within 7 days after surgery in order to confirm internal fixation position. Internal fixation loosening and breakage, reduction losing, bone fusion ratio were observed during follow-up.</p><p><b>RESULTS</b>No nerves and vertebral artery injuries occurred during operation. Cervical pain obviously decreased and VAS was (0.92 +/- 0.90) points. Cervical alignment of 12 patients had well-recovered by X-ray while Atlantoaxial ventral lamina cortex of 1 case was encroached by CT scan without neurological symptom. All patients were followed up for 6 months to 3 years, no internal fixation loosening and breakage, reduction losing were found. All patients obtained bone fusion in 6-12 months after operation.</p><p><b>CONCLUSION</b>Posterior C1 lateral mass screws-C2 unilateral laminar and contralateral pedicle screws fixation combined with autogenous bicortical iliac crest graft fusion can achieve biomechanical stability and raise the successful rate of bone fusion, while avoiding the risk of vertebral artery injury and overcoming the insufficient of bone fusion during bilateral laminar screws placement as well. Posterior C1 lateral mass screws fixation is a safe and effective additional method in treating upper cervical instability with vertebral artery variations.</p>

Effect of Probiotics on Allergic Rhinitis in Df, Dp or Dust-Sensitive Children: A Randomized Double Blind Controlled Trial.

Objective: To study, we examined the effect of Lactobacillus salivarius on the clinical symptoms and medication use among children with established allergic rhinitis (AR). Design: Double blind, randomized, controlled trial. Setting: Hualien Tzu-Chi General Hospital. Methods: Atopic children with current allergic rhinitis received 4 × 109 colony forming units/g of Lactobacillus salivarius (n=99) or placebo (n=100) daily as a powder mixed with food or water for 12 weeks. The SCORing Allergic rhinitis index (specific symptoms scores [SSS] and symptom medication scores [SMS]), which measures the extent and severity of AR, was assessed in each subject at each of the visits - 2 weeks prior to treatment initiation (visit 0), at the beginning of the treatment (visit 1), then at 4 (visit 2), 8 (visit 3) and 12 weeks (visit 4) after starting treatment. The WBC, RBC, platelet and, eosinophil counts as well as the IgE antibody levels of the individuals were evaluated before and after 3 months of treatment. Results: The major outcome, indicating the efficacy of Lactobacillus salivarius treatment, was the reduction in rhinitis symptoms and drug scores. No significant statistical differences were found between baseline or 12 weeks in the probiotic and placebo groups for any immunological or blood cell variables. Conclusions: Our study demonstrates that Lactobacillus salivarius treatment reduces rhinitis symptoms and drug usage in children with allergic rhinitis.

Effects of Radix aconiti lateralis preparata and Rhizoma zingiberis on energy metabolism and expression of the genes related to metabolism in rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the influence of Radix aconiti lateralis preparata and Rhizoma zingiberis, two species of Chinese medicinal herbs with hot property, on energy metabolism and gene expression spectrum, and to analyze the possible mechanism of their effects.</p><p><b>METHODS</b>Forty-eight specific pathogen free Wistar rats were randomly divided into a Radix aconiti lateralis preparata group, a Rhizoma zingiberis group, and a control group. They were intragastrically treated with concentrated decoction of Radix aconiti lateralis preparata, Rhizoma zingiberis and normal saline respectively for 20 days. Toe temperature (TT), energy intake (EI), digestible energy (DE), and metabolizable energy (ME) were measured. The content of adenosine triphosphate (ATP) and energy charge (EC) in hepatic tissue were measured with high performance liquid chromatography (HPLC). The activity of ATPase and succinate dehydrogenase (SDH) in the liver were detected with chemical colorimetry. The gene expression in the liver was detected with Illumina's rat Ref-12 gene array. The differential expression genes were selected, annotated and classified based on Gene Ontology (GO). Real-time quantitative reverse-transcriptase PCR (Q-RT-PCR) was used to test the accuracy of results.</p><p><b>RESULTS</b>Compared with the control group, the TT on the 10(th) day after the beginning of administration and ATP in the Radix aconiti lateralis preparata and Rhizoma zingiberis groups increased significantly (P<0.05). EI/body mass (BM), DE/BM, ME/BM, the hepatic EC and the activity of Na(+)-K(+)-ATPase, Ca(2+)-Mg(2+)-ATPase and SDH of liver increased significantly only in the Radix aconiti lateralis preparata group (P<0.05). There were 592 differential expression genes in the Radix aconiti lateralis preparata group and 1 159 in the Rhizoma zingiberis group compared with the control group. Among the differential expression genes, genes related to metabolic processes were the most significant based on GO analysis. There were 337 strips of gene differential expression in common in both Radix aconiti lateralis preparata and Rhizoma zingiberis groups compared with the control group.</p><p><b>CONCLUSIONS</b>Herbs with hot property such as Radix aconiti lateralis preparata and Rhizoma zingiberis could improve the energy metabolism in rats, through influencing the metabolic process of sugar, lipid, and amino acid. It could also promote the production, storage, and utilization of energy by regulating the gene expression related to metabolism, which may be the main molecular mechanism of warming yang and dispelling cold for the treatment of the cold syndrome according to Chinese medicine theory.</p>

Clinical screening of patients with cerebral arteriosclerosis combined with vertebral artery abnormalies / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical screening and value of vertebral artery ultrasound, Transcranial doppler (TCD), Magnetic resonance angiography (MRA) and Computed tomography angiography (CTA) in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography (DSA).</p><p><b>METHODS</b>From January 2006 to September 2010, 186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients, 133 cases were males and 53 cases were females,ranged from 30 to 84 years (with a mean of 63.8 years). All the patients were estimated by DSA; 172 cases were estimated vertebral artery ultrasound and TCD; 53 cases were estimated by MRA; 25 cases were estimated by CTA. The positive results by DSA were seen as case group, while the negative results were seen as control group. The sensitivity, specificity and concordance rate among four groups were calculated.</p><p><b>RESULTS</b>The abnormality rate of vertebral artery with DSA, vertebral artery ultrasound, TCD, MRA and CTA separately was 50.00% (93/186), 30.81% (53/172), 49.42% (85/172),15.10% (8/53) and 40.00% (10/25). According to DSA standard, the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%, the specificity was 89.41%, and concordance rate was 69.77%; while the sensitivity of TCD was 68.48%, the specificity was 72.50%, and concordance rate was 70.35%; the sensitivity of MRA was 21.43%, specificity was 92.00%, and concordance rate was 54.72%; the sensitivity of CTA was 63.64%,the specificity was 78.57%, and concordance rate was 72.00%.</p><p><b>CONCLUSION</b>The reasonable and combined application of vertebral artery ultrasound, TCD, MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease, cervical massage technique should be paid highly attention, which may cause vertebral artery injury and other complications.</p>

Observation of extracellular matrix damage in the kidney of rats with multiple organ dysfunction syndrome / 中华急诊医学杂志

ObjectiveTo determine the levels of type Ⅳ collagen and matrix metalloproteinase-9 ( MMP-9 ) in the serum and kidney of rats with the multiple organ dysfunction syndrome ( MODS ) and investigate the mechanism of extracellular matrix damage in renal failure of MODS.MethodsForty adult male Sprague- Dawley (SD) rats were randomly (ramdom number) divided into two groups,namely the normal control group ( n =8 ) and the MODS model group ( n =32 ).The rats of model group were further divided into four sub-groups as per different intervals,6 h,12 h,24 h and 48 h,after modeling (n =8 in each).The animal models of MODS were established by two hits,the left eyeball of each model rat was removed to bleed to 2 ml bloocd/100 g body weight and lipopolysaccharide ( LPS,5 mg/kg) was injected into intraperitoneal cavity of model rats four hours later. The same volume of saline instead was injected intraperitoneally into rats of control group.All rats were sacrificed at different intervals.Creatinine (Cr)and blood urea nitrogen (BUN) were determined by using a Hitachi Automatic Biochemical Analyzer.The histological changes in renal tissue were observed under light microscope and transmission electronic microscope.The levels of serum type Ⅳ collagen and MMP - 9 protein were measured by using enzyme linked immunosorbent assay (ELISA).Type Ⅳ collagen and MMP- 9 protein levels in renal tissue were detected by western blot.One - way ANOVA was used for comparison among multiple groups.Results Compared with the control group,Cr and BUN were significantly higher in MODS group ( P ＜0.05 ).There were no histopathological changes in kidney of rats in control group,and the renal injury was serious in rats with MODS.The remarkable edema of basement membrane and defect of collagen fibers in renal tissue were observed in MODS group.Compared with the control group,the levels of MMP-9 in serum increased 6-48 hours after modeling and peaking at interval of 12 hours after modeling ( P ＜ 0.05 ).The protein levels of type Ⅳ collagen increased not significantly in 6 h group and 12 h group in comparison with control group (P ＞ 0.05 ),while those in 24 h group and 48 h group significantly increased ( P ＜ 0.01 ).The levels of MMP -9 in renal tissue of rats with MODS increased in 6 h group and 12 h group (P＜0.05),peaked in 24 h group ( P ＜ 0.05 ),and decreased in 48 hours.However,the level of Ⅳ collagen in serum of rats with MODS decreased significantly 6-48 hours after modeling (P ＜ 0.05 ) Conclusions The injury of extracellular matrix is an important factor to the kidney damage in MODS and it may he used for early diagnose and as a treatment target for kidney injury in MODS.