Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Background Hepatitis B is one of the major infectious diseases of mankind, and up to now, there is no effective way to handle it. Recent clinical trials have shown the potential advantages of Kurorinone an extract of Chinese herb, in treament of chronic HBV infection. Objectives Systermically review the safety and efficacy of Kurorinone in treatment of chronic HBV infection. Search strategy With the searching terms including Kurorinone, its products’ name, hepatitis B and chronic carrier status, the trials registers of the Cochrane Hepato- Biliary Group, the Cochrane Complementary Medicine Field, and the central database of the Cochrane Library as well as MEDILINE, EMBASE and Chinese Biomedical CD Database were searched from their date of inception onward. 20 Chinese medical journals and relevant academic conference proceedings have been searched by hand. The reference lists of identified documents were checked as the complementary search. Inclusion Criteria All RCTs that tested Kurorinone for chronic HBV infection were included in this review. Method of the review According the demand of Cochrane systematic review, selection of trial for inclusion, assessment of methodological quality, data extraction and data syntheses would be conducted for each included trial.
Objective To explore an improved surgical approach to the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion to treat lumbar burst fracture and to evaluate its preliminary clinical application. Methods From June to October 2006, 4 patients (2 males, 2 females; age, 17-39 years) with Denis B type lumbar burst fracture underwent the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion. The fracture occurred in 2 patients at L1 and 2 at L2. According to the Frankel scales assessment, before operation, 2patients were at Grade B and the other 2 at Grade C, and the visual analogue scale (VAS) was 7.00±0.82. Radiological evaluation was performed, which revealed the kyphosis Cobb angel of 22.94±11.21°, the adjacent superior and the inferiorintervertebal disc heights of 12.78±1.52 mm and 11.68±1.04 mm, espectively, and the vertebral canal sagittal diameter of 9.56±2.27 mm on the computer tomography (CT) scan. The neurological and the radiological evaluations were also made immediately and 3 months after operation. Results The anterior single segmental decompression and fusion operations were performed successfully in all the patients. The average operating time was 166±29 min and the average amount of blood loss was 395± 54 ml. The Frankel scales assessment showed that at the time immediately after operation, one of the 2 Grade B patients had an improvement to Grade C, but the other patient had no improvement. One of the 2 Grade C patientshad an improvement to Grade D, but the other patient had no improvement. Three months after operation, the 2 Grade B patients had an improvement to Grade C. The 2 grade C patients had an improvement to Grade D or E. The VAS score was significantly decreased to 3.50±1.29 after operation and to 1.25±0.50 3 months later （P＜0.05）. The vertebral canal sagittal diameter was significantly increased to 19.76±3.82 mm (Plt;0.01), but it was maintained to 19.27±3.41 mm3 months later, with no significant difference（Pgt;0.05）. The patients’ kyphosis Cobb angle was significantly improved to 8.71±5.41° (P＜0.05) , but it was maintained to 9.52±5.66° 3 months later, with no significant difference（Pgt;0.05）. The heights of the adjacent discs remained unchanged. No complication was observedduring and after operation, and the radiological and the CT scanning evaluations 3 months later showed no failure of the internal fixation. Conclusion The superior and posterior partial resection of the fractured vertebral body followedby the single segmental fusion can effectively decompress the vertebral canal and maintain the spine stability in treatment of the Denis B type fracture thoughthe longterm effectiveness requires a further follow-up.
5–20 wt% trimethoxysilylpropyl octadecyldimethyl ammonium chloride (QAS) was used to modify Poly (ε-caprolactone) (PCL)-gelatin hybrid to fabricate non-leaching antibacterial nanofiber membranes (PG-Q) by electrospinning. The results from scanning electron microscopy (SEM) and transmission electron microscopy (TEM) indicated that the QAS leaded to phase separation between the QAS and PCL. Hydrophilic test demonstrated that the PG-Q nanofiber membranes had hydrophobic surface, which was help for peeling off the dressing from the wound. Additionally, the physical and chemical cross-linking between the QAS/PCL and QAS/gelatin were confirmed by Fourier transform infrared (FTIR), which were good for long lasting antibacterial effect. The PG-Q membranes also showed excellent cell-biocompatibility. Furthermore, compared with pure PCL nanofiber membrane, the PG-Q nanofiber membranes, especially PG-Q15 (QAS: 15 wt%) and PG-Q20 (QAS: 20 wt%), showed a considerable increase in the bacteriostatic rate of S. aureus and P. aeruginosa (more than 99% after 12 h). Therefore, electrospinning non-leaching antibacterial nanofiber membranes could be an optimal choice for antibacterial wound dressing.
Objective To investigate the role of mitochondrial autophagy mediated by PINK1 (homologous phosphatase tensin induced kinase 1) /Parkin (Parkinson’s protein) signaling pathway in severe pneumonia of rats. Methods Twenty rats were randomly divided into control group and model group (severe pneumonia model), with 10 rats in each group, to explore the effects of severe pneumonia on lung function and pathology in rats. Then, 30 rats were randomly divided into control group, model group and mdivi-1 (mitochondrial autophagy inhibitor) group, with 10 rats in each group, to further explore the effects of severe pneumonia on mitochondrial autophagy indicators of rats. ResultsCompared with the control group, the resting ventilation volume [(3.44±0.22) vs. (1.58±0.18) mL/min] and airway resistance ratio (77.48±3.84 vs. 47.76±5.54) in the model group were decreased (P<0.05). In the model group, the lung tissue was injured and a large number of inflammatory cells were infiltrated. The protein and mRNA expression levels of Parkin, PINK1 and microtubule-associated protein1 light chain 3 in lung tissues of model group were increased (P<0.05). Compared with model group, the ratio of resting ventilator-to-airway resistance in mdivi-1 group increased (P<0.05). The injury and inflammatory infiltration of lung tissue were improved in mdivi-1 group. The expression levels of Parkin, PINK1 and microtubule-associated protein1 light chain 3 protein and mRNA in lung tissues of mdivi-1 group were decreased (P<0.05). Conclusion Mdivi-1 can improve the abnormal lung function structure in rats with severe pneumonia, and the mechanism may be related to mitochondrial autophagy mediated by PINK1/Parkin signaling pathway.
Objective To investigate the effect of constitutively active Akt1 gene on rat engrafted islets in apoptosis and revascularization, and to explore potential method of gene therapy in the islet transplantation. Methods Rat islet which was transfected constitutively actived Akt1 gene via adenovirus vector using MOI=500. Thirty-six streptozotocin induced diabetic Wistar rats were divided into 3 groups complete randomly: Adv-CA-Akt1 group, Adv-LacZ group and simple transplantation group. Blood glucose and insulin were determined after operation. TUNEL was used to detect the apoptotic islet cells. HE and immunohistochemical staining of insulin were used to evaluate the histology of the islet grafts. The microvessel density (MVD) was determined by CD31 immunohistochemical staining. Results The fasting glucose level in Adv-CA-Akt1 group restored to normal 2 days after transplantation. However, in Adv-LacZ group and simple transplantation group, it reduced but still kept being hyperglycemia. And the serum insulin level was higher than other two groups ( P ＜ 0.05). Compared to simple transplantation group and Adv-LacZ group, apoptotic rate decreased 25% in Adv-CA-Akt1 group, a large number of islet grafts were seen under the capsule of the kidney, which were positively stained by insulin antibody. In the other two groups, the islet groups mass were lighter, and few positively stained by insulin antibody. MVD showed lighter positive endothelial cells stained by CD31 antibody in the other two groups than Adv-CA-Akt1 group ( P ＜ 0.05). Conclusion Constitutively activate Akt1 gene can prolong graft survival during early posttransplant period, and can accelerate the revascularization of islet grafts effectively.
目的 评估非小细胞肺癌患者中癌症相关性乏力的发生情况及其与患者临床病理特征和生存期之间的相互关系。 方法 应用简明疲劳量表中文版评估2008年12月－2009年12月间收治的72例初治肺癌患者，入组患者均完成根治性手术及术后生存随访。 结果 72例早期非小细胞肺癌患者中，无乏力9例（12.5%），轻度乏力48例（66.7%），中度乏力15例（20.8%），重度乏力0例（0%），乏力总体发生率为87.5%。乏力指数与患者的年龄、性别、吸烟史均无相关性，与患者的体力状况评分（ECOG PS）、TNM分期呈正相关，与中位生存期呈负相关，均有统计学意义（P＜0.05）。 结论 癌症相关性乏力作为非小细胞肺癌患者中普遍存在的一种症状，不仅能够反映患者当时的主观感受和生活状况，还可能是判断患者术后病理分期及最终总生存期的预测因素。
Health insurance system has been proved to be an effective way to promote the quality of health service in many countries. However, how to control health expenditure under health insurance system remains a problem to be resolved. Some developed countries like UK, Canada and Sweden linked their health technology assessment results with decision making and health insurance management, and made prominent achievements in both expenditure control and quality improvement. China is carrying out its health system reform and running a new health insurance project. Using the experiences of other countries is undoubtedly of great importance in developing and managing our health insurance system.
Objective To investigate the correlation between dynamic intrinsic positive endexpiratory pressure ( PEEPidyn) and volume dependence of elastance and resistance of respiratory system ( Evd/Rvd) derived from nonlinear analysis of respiratory mechanics in COPD patients during pressure support ventilation ( PSV) . Methods Twenty-five COPD patients mechanically ventilated using mode of PSV were ventilated at a PSV level of no less than 20 cm H2O in a period of 15 minutes to attain so-callednear-relaxation state. The pressure( P) , flow( V′) and volume( V) data were analyzed by nonlinear mode of respiratory motion. PEEPidyn was determined by esophageal balloon-tipped catheter technique. The correlations between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were analyzed. Results The correlation coefficients between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were 0. 85,0. 80, and 0. 90, respectively. Conclusions Nonlinear mode of respiratory motion is suitable to analyze respiratory mechanics of COPD patients mechanically ventilated using mode of PSV. There are good correlations between PEEPidyn and Evd,Rvd as well as Evd ×Rvd which may be used to noninvasively monitor PEEPidyn in mechanically ventilated COPD patients using mode of PSV.
Objective To investigate the surgical method and prel iminary cl inical result of managing the patient with lumbar burst fracture but not suitable for single-level fixation and fusion surgery with the reservation of the fractured vertebral body and the anterior decompression. Methods From September 2007 to December 2008, 11 patients with lumbar burst fracture underwent the removal of the posterior superior corner of the injured vertebral body, the removal of the inferior intervertebral disc adjacent to the injured vertebral body, bone graft fusion, and internal fixation. There were 8 males and3 females aged 21-48 years old (average 29.4 years old). All the fractures caused by fall ing from high places. Imaging exams confirmed all the fractures were Denis type B burst fracture. The fracture level was at the L1 in 4 cases, the L2 in 4 cases, the L3 in 2 cases, and the L4 in 1 case. Before operation, the nerve function was graded as grade B in 4 cases, grade C in 3 cases, and grade D in 4 cases according to Frankel scales; the visual analogue scale (VAS) was (7.30 ± 0.98) points; lateral X-ray films displayed the kyphosis Cobb angel was (24.94 ± 12.21)°; the adjacent superior and inferior intervertebral disc height was (12.78 ± 1.52) mm and (11.68 ± 1.04) mm, respectively; CT scan showed the vertebral canal sagittal diameter was (9.56 ± 2.27) mm; CT three-dimensional reconstruction revealed that the intact part of the injured vertebra was less than 50% vertebra body height and the fracture l ine crossed the pedicle. The time from injury to operation was 3-11 days (average 4.8 days). The neurological and radiological evaluations were carried out immediately and 3 months after operation, respectively, and compared with the condition before operation. Results All the patients successfully underwent the surgery. The wound all healed by first intention. All the patients were followed up for 6-18 months (average 14 months). All the patients had a certain degree of nerve function recovery. The Frankel scales in all the patients were increased by 1-2 grade immediately and 3 months after operation. The VAS score was (2.80 ± 1.49) points immediately after operation and (1.54 ± 0.48) points 3 months after operation, suggesting there were significant differences among three time points (P lt; 0.05). The vertebral canal sagittal diameter was significantly enlarged to (18.98 ± 4.82) mm immediately after operation and was (19.07 ± 4.37) mm 3 months after operation. The Cobb angle was (7.78 ± 4.52)° immediately after operation and (8.23 ± 3.57)° 3 months after operation. There were significant differences between before and after operation (P lt; 0.05). For the adjacent superior and inferior intervertebral disc height, there was no significant difference when the value immediately or 3 months after operation was compared with that of before operation (P gt; 0.05). X-ray films and CT scan 3 months after operation showed good internal fixation without theoccurrence of loosing and displacement. Conclusion For the treatment of lumbar burst fracture, the method of reserving the injured vertebral body and anterior decompression can decompress the vertebral canal and shorten the duration for bony fusion.