A multicenter retrospective clinical study on "symptomatic facet of residual bone mass", a rare complication of percutaneous trasforaminal endoscopic discectomy / 中华骨科杂志

Objective Retrospective study and report on cases of "symptomatic facet of residual bone mass" caused by percutaneous transforaminal endoscopic discectomy (PTED),to analysis of its causes and revision strategies.Methods Seven cases of "symptomatic facet of residual bone mass" after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment,to analysis of the causes,clinical features and revision strategies of the rare complication.Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers).The average age of the subject is 67.29±9.64 years (range from 57-83 years).Among them there were 1 male and 6 female.PTED was performed for all cases with lumbar disc herniation or stenosis.The operative segments were 1 of L2,3,2 of L3,4,3 of L4,5,1 of L5S1.Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later.Two cases were appeared symptom of contralateral irritation,and the rest were aggravated by the original symptoms.Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac.The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness.Foraminoplasty was performed during PTED in all patients.After CT scan,5 cases of bone mass were found on the same side of operation,and 2 cases were in the contralateral side.The shortest time for revision was 2 days and the longest 3 months.After conservative treatment,the symptoms were relieved in only one case.Revision surgeries were performed for all the other 6 cases,2 with microendoscopic discectomy (MED),1 mobile microendoscopic discectomy (MMED),1 small incision operation,1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF).The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55.Conclusion FTED may lead to residual bone mass in lumbar foraminoplasty.The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment.The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms.A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective.

Modified drilling template for placement of cervical anterior transpedicular screws / 中华创伤骨科杂志

Objective To evaluate the accuracy in placement of cervical anterior transpedicular screws (ATPS) under the guidance of our modified drilling template.Methods Eight wet cadaveric specimens of adult cervical spine,4 male and 4 female ones,were used for this experiment.Data of CT thin layer scanning of the cervical specimens in DICOM format were imported into software Mimics 17.0.After 3D models of the cervical vertebrae were reconstructed,the optimal trajectory was designed for ATPS placement in the transparent mode of the 3D models.Normal and our modified drilling templates for ATPS placement were designed and manufactured by 3D printing.The 2 kinds of drilling templates were used to assist ATPS placement onto one cervical vertebra,with laterality randomized.Altogether 64 pieces of ATPS were placed,with 32 ones for each drilling template.Postoperative CT scanning was conducted to evaluate the accuracy in ATPS placement.The 2 kinds of ATPS template were compared in terms of the deviations between actual and ideal trajectories in direction (caudal-angle and extroversive-angle) and position (X and Y axes) of the entry point.Results Our modified drilling template led to one screw penetrating the pedicle cortical bone while the normal drilling template led to 4 screws penetrating the pedicle cortical bone,yielding an accuracy rate of 96.9％ and of 87.5％ respectively.The extroversive-angle deviation (0.72°±0.69°),caudal-angle deviation (0.91°±0.70°),X axis shift (0.53 ±0.40 mm) and Y axis shift (0.54 ±0.42 mm) related to the modified template were all significantly smaller than those related to the normal template (1.16° ± 0.70°,1.49°±0.68°,0.88±0.40mm,1.22±0.42mm,respectively) (P ＜0.05).Conclusion Compared with a normal ATPS template,our modified drilling template for ATPS may be advantageous in better fitness,greater stability,increased accuracy in screw placement,and protection of adjacent discs.

Efficacy and safety of modified suanzaorentang on primary insomnia: A double-blind randomized placebo-controlled study / 中国心理卫生杂志

Objective:To evaluate the efficacy and safety of modified suanzaorentang,on primary insomnia over a period of 4 weeks on both subjective and objective sleep quality.Methods:A prospective,randomized,double-blind,placebo-controlled trial (RCT) involving 162 primary insomniac subjects (mean age 47 years,range 21 to 64 years;female:68.5％) was conducted at 2 university hospital sleep centers in Hong Kong.Among 162 subjects,86％ (n =139) completed the whole trial.Participants received either 4 weeks Chinese herbal formula (modified suanzaorentang group) or placebo by block randomization.Main outcome measures were subjective measures of sleep quality,and objective outcome measures including sleep onset latency,wake after sleep onset,sleep efficiency and sleep stages derived from polysomnography,and sleep variability from actigraphy.Results:After 4-week of treatment,the treatment group showed more improvement in subjective sleep quality as measured 100 mm visual analogue scales [deepness of sleep,95％ CI =-16.0(-22.1--9.9) vs.-7.1 (-13.3--1.0),P ＜ 0.05;refreshing sleep,95％ CI =-12.0(-18.2--5.8) vs.-2.2(-8.9-4.5),P ＜ 0.05] than placebo group.However,the two groups did not have any differences over the objective measures and the Insomnia Severity Index total score.No difference in overall adverse events was found between the two groups.Conclusion:The study shows that a short term (4 weeks) treatment of modified suanzaorentang could improve perceived sleep quality but not subjective sleep difficulty or objective sleep parameters.In particular,modified suanzaorentang has good safety profile and tolerability.

Clinical Biomarkers of Neurodegeneration in REM Sleep Behavior Disorder

Rapid eye movement sleep behavior disorder (RBD) is currently considered as a prodromal stage of alphasynucleinopathies neurodegeneration. The update data suggested that over 80% patients with idiopathic RBD eventually developed neurodegenerative disease after a mean of 14 years interval from the onset of RBD. A series of potential biomarkers have been identified to predict the development of neurodegeneration in idiopathic RBD, including olfactory loss, color vision deficit, depression, mild cognitive impairment, excessive daytime sleepiness, dopamine dysfunction, and tonic electromyographic activity. Early recognition of the predictive markers of neurodegeneration in idiopathic RBD is essential for development of intervention or prevention strategies at the presymptomatic stage. Nonetheless, the current literature is lacking biomarkers that might reflect the alpha-synuclein neuropathology at the earliest stages. Future studies with large samples and systematic follow-up are needed to confirm more potential markers of neurodegeneration at its early stages.

A qualitative study on informed consent about the risk assessment of pressure ulcers in surgical patients / 现代临床护理

Objective To assess the informed consent about risks of pressure ulcers so as to effectively prevent pressure ulcers and reduce the disputes between the nurses and patients.Method An in-depth interview was conducted among 12 senior nurses in the operating room,the interview content recorded and analyzed to summarize some themes.Results In the link of informed consent on pressure ulcers,6 problems were found,e.g.,the standardization of methods for informed consent and the content,pressure ulcer risk assessment scale special for clinical specialties,lack of complementarity of assessment and prevention measures,importance of clear signature on the informed consent,time for informed consent signature,attitude of the families and the skills on answering related questions.Conclusions The implementation of the informed consent about the risk assessment of the pressure ulcer for surgical patients depends on the specification of the conversation,and the assessment scale special for the clinical specialties.Both improved preventive measures and preventive ability of the pressure ulcers are of great importance.

Differences between objective and subjective sleep quality in chronic primary insomniacs and the correlated factors / 中国神经精神疾病杂志

Background The severity of difficulty in falling asleep and the insufficiency of the sleeping time in the primary insomniacs always were overestimated, even after medication and improving the objective sleep quality. Moreover, remarkable psychosomatic symptoms were found in patients and the symptoms were significantly linked to the self-reported sleep quality. So in this study, it was designed to explore the differences between objective and subjective sleep quality and its correlative factors in chronic insomniacs.Methods A total of 55 chronic primary insomniac cases diagnosed by DSM-Ⅳ diagnostic criteria for primary insomnia and 15 normal controls were rated with Pittsburgh sleep quality index (PSQI),State-Trait Anxiety Inventory (STAI), and the Subjective General Condition Form. All cases and the controls were then examined by the whole-night polysomnography (PSG) records.Results Compared with the objective parameters of PSG, the subjective parametersiu chronic insomniacs had significantly longer sleep latency and lower total sleep time and sleep efficiency [ (80. 3± 73.7)min v.s. (23.2 ± 25.4) min, (157.8±141.7)min v.s. (332.2±154.7)min , (0.52 ±0. 27) min v.s. (0. 67 ± 0. 28) min, respectively, P ＜0. 001 ]. The difference between subjective and objective sleep latency was related to the total scores of STAI, TAI and SAI ( r = 0. 402,0. 374 and 0. 397, respectively, P ＜ 0. 05).Conclusions There were significant differences between objective and subjective estimations of sleep quality in chronic insomniacs,and they might result in the overestimation of the severity of insomnia. The differences between subjective and objective sleep quality in the chronic insomniacs were significantly correlated with the levels of anxiety.

The utility of Liebowitz Social Anxiety Scale in the patients with social anxiety disorder in Chinese / 中国神经精神疾病杂志

Background During the past two decades, a number of rating scales were developed to facilitate diagnosis and assessment of subjects with social anxiety disorder. One of the most commonly used scales for the assessment of social anxiety disorder is the Liebowitz social anxiety scale (LSAS). The LSAS is widely used in epidemiologic investigations and clinical researches,and its assessment in the pharmacotherapy efficacy for social anxiety disorder is superior to any other scale. So we designed this study to explore the validity and reliability of the LSAS in Chinese patients with social anxiety disorder and normal control, and to find the difference of the scores between the patients self -report version and clinician-administered version. Methods Fifty five patients meeting the DSM-Ⅳ diagnostic criteria for social anxiety disorder and 168 normal controls who were screened from 222 college students were rated by LSAS, social phobia scale and self-made General Information Forms. Results The Cronbath α of LSAS for the patients and the normal controls was 0.83 and 0.77, respectively. The 4-week test-retest reliability for total scores and its factors scores of LSAS in 31 normal controls were ranging from 0.68 to 0.79. The ROC area under curve value in discriminating the patients from normal controls was 0.87±0.03; the total score of 35 was considered to be the best cut-off score for LSAS, then its sensitivity was 0.77 and its specificity was 0.81; and no significant difference between the self-report version and clinician-administered version. Conclusions The LSAS is good in internal consistency and test-retest reliability, and has high sensitivity and specificity in discriminating the patients and the controls. There is no significant difference in the total score and each factor scores of LSAS between self-report version and clinician-administered version.

Restless Leg Syndrome and Sleep Quality in Pregnant Women / 中国心理卫生杂志

Objective : To investigate the incidence of Restless Legs Syndrome (RLS) in pregnant women and the effect of the RLS on the sleep quality of the women during pregnancy. Methods: 113 pregnant women were evaluated by using International RLS Scale, PSQI (Pittsburg Sleep Quality Inventory). Results: The prevalence of RLS in pregnant women in the outpatient department was 12.4% (14/113), the percentage of RLS pregnant women with PSQI total score higher than 7 was 28.6%, and that was 10.1% in the pregnant women without RLS (x2 =3.86,P

Study on the protoplast preparation and regeneration of Gliocladium sp. producing antiinflammation compound 6,22-diene-5,8-epidioxy ergosta-3-hydroxy / 中国生化药物杂志

Purpose　The aim is to study the conditions of preparation and regeneration of Gliocladium sp. (F) protoplast. Methods　 Different enzyme systems, enzymolysis time, osmotic pressure stabilizers were studied to investigate their influence on the productivity and regenerating rate of Gliocladiumsp. F protoplasts. The HPLC method was used to determine EP (6,22-diene-5,8-epidioxy ergosta-3-hydroxy) content.Results　The higher productivity of protoplasts was obtained when mycelia of strain F growing for 60 hours was digested at 28℃ for 4 hours by solution containing 2% cellulase and 2% helicase dissolved in 0.5 mol/L mannitol and the medium containing 0.5mol/L mannitol as osmotic pressure stabilizer would be suitable for protoplast regeneration. According to the EP productivity detected by HPLC, high positive rate of the regenerated strains growing in the medium containing 0.5mol/L mannitol could be got. Conclusion　The results will promote the research of strain F mutantgenesis and will be helpful for obtaining the strain more effectively biosythesizing compound EP.

The Sleep Habits of Children 4 to 12 Years Old in Guangdong / 中国心理卫生杂志

Objective:To understand the sleep duration, sleep habits, the prevalence rate of sleep problem and its related factors on the children range from 4 to 12 years old. Methods:The parents of 727 children range from 4 to 12 years old were asked to answer The Children's Sleep Habits Questionnaire (CSHQ) and the general information forms, which were used to rate their children.Results:The average sleep time on bed of the children was 9.6?0.9 hours, with no difference between males and females. The total scores of CSHQ were 36.8?13.6, and the prevalence of sleep problem was 31.0%. The total scores of CSHQ among 4-6 years old group, 7-9 years old group and 10-12 years old group were significant different (42.4?14.1?34.9?12?31.8?12, respectively ;P