Objective To investigate the effect of the penetration of mini-plate mass screws into facet joint on axial symptoms in cervical laminoplasty. Methods A retrospective analysis was made on the clinical data of 52 patients who underwent unilateral open-door cervical expansive laminoplasty fixed with Centerpiece mini-plate between September 2009 and December 2011. There were 42 males and 10 females, with a mean age of 61.2 years (range, 34-83 years). Seventeen patients exhibited simple degeneration cervical canal stenosis, 25 patients had multilevel cervical disc protrusion, and 10 patients had ossification of posterior longitudinal ligaments. Disease duration ranged 1-120 months (median, 11 months). The Japanese Orthopedic Association (JOA) score was used to assess neurological function, and JOA recovery rates were calculated. The visual analogue score (VAS) and the neck disability index (NDI) were used to evaluate the axial pain and neck daily activities. The axial symptoms and other complications were recorded. The cervical canal diameter, cervical curvature, cervical canal cross area, and open angle were measured according to the X-ray films, CT scans, and MRI scans. The postoperative CT three dimensional (3-D) reconstruction images were used to identify whether the screws penetrated into the facet joints. All the patients were divided into 3 groups according to involved facet joints: no joint penetrating group (no penetrated facet joint), oligo-joint penetrating group (one or two penetrated facet joints), and multi-joint penetrating group (three or more penetrated facet joints). Results Five patients suffered from C5 nerve palsy, and 2 patients had cerebrospinal fluid leakage. The follow-up time ranged 3-35 months (mean, 15.7 months). At the final follow-up, the JOA scores, NDI, cervical canal diameter, and cervical canal cross area were significantly improved when compared with preoperative ones (P lt; 0.05). At 1 week after operation, CT 3-D reconstruction showed that 16 patients had no penetrated facet joint, 23 patients had one or two penetrated facet joints, and 13 patients had three or more penetrated facet joints. There was no significant difference in age, gender, disease duration, operation time, intraoperative blood loss, and follow-up time among 3 groups (P gt; 0.05). And at the final follow-up, there was no significant difference in JOA score, VAS score, cervical curvature, cervical canal diameter, cervical canal cross area, the JOA recovery rates, and lamiae open angle among 3 groups (P gt; 0.05). The NDI of the multi-joint penetrated group was significantly higher than that of other 2 groups (P lt; 0.05). Axial pain occurred in 1 case of no penetrating group, in 4 cases of oligo-joint penetrating group, and in 5 cases of multi-joint penetrating group, showing no significant difference among 3 groups (χ2=4.881, P=0.087). Conclusion The penetrations of lateral mass screws into articular surface of facet joint may contribute to the axial symptoms after cervical laminoplasty. The risk of axial symptom raises accompany with increased penetrated facet joints.
Objective To explore if the modified unilaterally-open expansive laminoplasty using bridge grafting and reconstructing posterior ligamentous complex methods is effective in preventing persisting axial symptoms, restriction of neck motion, and loss of cervical curvature. Methods From June 2000 to October 2005, 138 patients with cervical spondylotic myelopathy underwent this procedure. Of them, 78 who were followed for more than 2 years (group A) were included in this study. Another 69 patients who underwent conventional unilaterally opendoor laminoplasty served as controls(groupB). The JOA scores and the incidence of newly developed or deteriorated axial symptoms were recorded. Preoperative and postoperative ranges of neck motion were measured on lateral flexion and extension radiographs. Preoperative and postoperative cervical curvature indices were calculated according to Ishihara’s method. Results The patients of group A were followed 24-44 months (mean 33 months), and the patients of group B were followed 2453 months(mean 35 months). The operative time was 114±20 min in group A and 70±25 min in group B,showing statistically significant difference(P＜0.05). The operative blood loss was 280±72 ml in group A and 210±80 ml in group B(P＞0.05). Accordingto JOA scoring, the average recovery rates were 67.0%±17.3% in group A and 65.0%±21.4% in group B(P＞0.05). Postoperative development or deterioration of axial symptoms occurred in 12% of patients in group A and 51% of patients in group B, showing statistically significant difference(P＜0.05). Postoperative range of neck motion was 88.0%±10.1% of the preoperative one in group A and 64.0%±16.3% in group B(P＜0.05). There was no significant difference between preoperative(15.3±8.2) and postoperative(13.5±9.3) cervical curvature index in group A, whereas the mean value of postoperative index (11.1±5.7) was significantly smaller than that of preoperative one (17.2±13.5) in group B (Plt;0.05). Conclusion This new procedure was less invasive to the posterior extensor mechanism than the conventional unilaterally-open laminoplasty and was effective in preventing postoperative morbidities.
Objective To identify the correlative symptoms of breast cancer patients and their influence on quality of life. Methods The cross-sectional study was used. A face-to-face survey was administered to 200 breast cancer patients, using two scales: ① Memorial Symptom Assessment Scale(MSA); ② European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire (Version 3) [EORTIC QLQ-C30]. Results The top five most highly prevalent symptoms were: lack of energy, hair loss, nervousness, sweating and worry. The five most frequent symptoms were: lack of energy, difficulty in sleeping, dry mouth, lack of appetite and sweating. The five most severe symptoms were: hair loss, lack of energy, difficulty in sleeping, nervousness and a change in food preference. The top five symptoms causing much distress were: hair loss, a feeling of“I don’t look like myself”, difficulty in sleeping, lack of appetite and lack of energy. The major factors influencing quality of life were: lack of energy, worry, pain, difficulty in sleeping, constipation, irritability, dry mouth, sweating, numbness/tingling in hands/feet, changes in skin, diarrhea, nausea, lack of appetite, and shortness of breath. Adjusted R square was 0.790. Conclusions The most conspicuous symptom in breast cancer patients is lack of energy. The symptom that distresses patients most is hair loss. The other notable symptoms are: “I don’t look like myself”, difficulty in sleeping, and lack of appetite. In addition, the quality of life is influenced by fourteen symptoms, and these symptoms account for 79.0% of the variance in quality of life.
Objective To assess the effectiveness and safety of fukangpian in the treatment of opiate withdrawl symptoms. Methods We performed an electronic search for Cochrane Library (2004 version of Cochrane Controlled Trials Register), Medline (1966-2004), EMbase (1974-2004), and handsearched some Chinese journals for additional articles (such as CBM disc, VIP, CNKI, CMCC) (1980-2004). The quality of included randomized controlled trials was evaluated and meta-analysis was performed. Results We collected 31 studies about fukangpian, of which two studies involving 403 patients met the inclusion criteria. These two studies were of poor quality. Cmpared with clonidine, fukangpian showed a greater decrease than Clonidine group in the withdrawal symptom score for day 1 to day 4 (WMD of 9 points at day 4, 95%CI 5.47 to 12.52). Cmpared with placebo, the two studies for change in the withdrawal symptom score, fukangpian showed a greater decrease at day 1 to 3, but not at day 4 (WMD of 4.10 points at day 4, 95%CI -8.36 to 16.56; 1 study). Conclusions Based on the current evidence fukangpian is an effective and safe drug for abstinence of drug addiction. More high quality randomized controlled trials are required to promote the strength of evidence.
摘要:目的:探讨盆腔脓肿的临床表现,超声诊断结果及手术探查情况以提高诊疗水平。方法:对2000年1月~2006年12月我科收治的25 例手术治疗的盆腔脓肿病例进行回顾性分析。结果：其临床表现主要为腹痛、发热、腹部或盆腔包块等。超声声像显示:盆腔内不规则囊性或多房性输卵管卵巢肿块,囊内不均质光点,伴有或不伴有盆腔积液。手术探查表现为:盆腔粘连,一侧或双侧输卵管脓肿或输卵管卵巢脓肿。结论:盆腔脓肿的临床表现不典型,术前易出现误诊和漏诊;随着病情的变化,结合临床表现、 阳性体征的发现及超声诊断可以提高其检测率。Abstract: Objective: To explore the clinical symptoms, ultrasonography diagnosis results and surgical treatment results of pelvic abscess, thus to raise the diagnosing standard and treatment level from Jan.2000 to Dec. 2006. Methods: Carries on the review analysis to 25 example feminine pelvic abscess patient’s clinical diagnosis material. Results: The principal clinical symptoms of pelvic abscess are abdominal pain and fever,tissue mass is palpated in the abdomen or pelvic cavity and is detected. Sonographic appearance of the pelvis demonstrated irregular, uniloculated or multiseptated cystic tuboovarian mass with nonhomogenic internal echoes, with or without pelvic fluid collection. Surgical results showed some adhesions in pelvis, uniorbilateral pyosalpinx or tuboovarian complex abscess. Conclusion: The pelvic abscess displays not typically,,there is a comparatively high rate of misdiagnosis and missed diagnosis before the surgical treatment.The rate of missed diagnosis is by mistake high.Unifies the clinical symptoms,the masculine symptom, the auxiliary inspection and the guidance of ultrasound,may raise the diagnosis rate of accuracy.
ObjectiveTo explore the relation between ultrasound images of endometriosis and its clinical symptoms. MethodsChoosing clinical data of 300 patients with endometriosis pathologically diagnosed between January 2009 and January 2014, we retrospectively analyzed ultrasound images and clinical symptoms, using Chisquare test for statistical analysis, and the index P<0.05 was statistically significant. ResultsIn patients with big endometriosis' nidus, the menstrual quantity increased, menstrual cycle prolonged, the incidence of abnormally vaginal bleeding was high (χ2=11.749, P=0.001; χ2=4.847, P=0.028; χ2=5.686, P=0.017). In patients whose endometriosis were located in posterior uterine wall, the menstrual quantity increased, and the incidence of abnormally vaginal bleeding was high (χ2=5.188, P=0.023; χ2=49.691, P<0.001). The size of endometriosis' nidus had nothing to do with dysmenorrhea, constipation and frequent micturition (P>0.05). The position of endometriosis' nidus had nothing to do with menostaxis, dysmenorrhea, constipation and frequent micturition (P>0.05). ConclusionThe size of endometriosis' nidus has a connection with the clinical symptoms of menorrhea, menostaxis and abnormally vaginal bleeding; the position of endometriosis' nidus has a connection with the clinical symptoms of menorrhea and abnormally vaginal bleeding. The results of ultrasonography should be combined with clinical symptoms in diagnosing endometriosis, avoiding missed-diagnosis and misdiagnosis.
ObjectiveTo summarize the research progress of black cohosh root extract in the treatment of menopausal symptoms for patients with breast cancer. MethodsDomestic and foreign literatures about the effect of black cohosh root extract in the treatment of menopausal symptoms for patients with breast cancer were collected to make a review. ResultsBlack cohosh root extract was a kind of herbal preparations. In the treatment of menopausal symptoms in breast cancer patients, it not only had significantly curative effect but also had less adverse reactions. ConclusionsIn the treatment of menopausal symptoms in breast cancer patients, black cohosh root extract gives people a new treatment idea. It has significant side effect and can be widely promoted and applied in clinical.
ObjectiveTo systematically review the methodological quality of evidence-based guidelines on non-pharmacology management of behavioral and psychological symptoms of dementia, so as to provide references for taking caring for the dementia with behavioral and psychological symptoms. MethodsGuidelines concerning non-pharmacology treatment of behavioral and psychological symptoms were searched from websites of guideline development, websites of medical association and literature databases from inception to May 31st 2016. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences and similarities between recommendations of included guidelines were compared. ResultsA total of 544 literatures were identified and 6 of them were included. All the included guidelines were from abroad. The average scores of guidelines in six domains of AGREE Ⅱ were:scope and purpose 88.89%, stakeholder involvement 65.74%, rigor of development 63.72%, clarity of presentations 86.11%, applicability 50.69%, and independence 37.50%. The overall qualities of the included guidelines were grade B. The recommendations of the included guidelines were almost consistent. Recommended non-pharmacology management of behavioral and psychological symptoms of dementia included leisure and recreation activity, reminiscence therapy, behavioral therapy, training of caregivers, physical environment modification, animal-assisted therapy, massage, physical activity and patient-centered approach. ConclusionThe overall quality of included guidelines is relatively high. More efforts are needed to improve the applicability and independence of guidelines. There is still no local guideline concerning non-pharmacology recommendations on behavioral and psychological symptoms of dementia in China. It is suggested to develop guideline that is suitable for Chinese condition as soon as possible.
ObjectiveTo summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease. MethodRelated literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease. ResultsGastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect. ConclusionPathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.
Long-term chronic internal jugular vein (IJV) insufficiency, originally viewed as a non-pathological finding, may result in cerebral venous outflow disturbance, leading to cerebral venous ischemia and cerebral nervous functional disorders. In this article we discuss probable etiologies, symptoms, diagnosis and treatment of IJV disturbance, so as to provide some insights for clinicians.