An overview of research based on intestinal microecology to explore musculoskeletal attenuation diseases / 肠外与肠内营养

Sarcopenia,osteoporosis and osteosarcoporosis,which belong to the same category of musculoskeletal unit disease,seriously impair the homeostasis of the musculoskeletal system in the aging process of the human body.In recent years,researchers have applied various emerging technologies to conduct multi-disciplinary,multi-level and multi-dimensional research on musculoskeletal decay disease,and have come to realized that the disease involves complex biochemical and mechanical crosstalk,and the intestinal microecology has also aroused great interest in this crosstalk because of its profound impact on musculoskeletal health.In view of this,this paper takes the close relationship between intestinal microecology and musculoskeletal decay disease as the starting point,and under the guidance of the overall concept,we deeply analyzes the mechanism and regulatory information behind this relationship,and on this basis,we excavates the potential therapeutic targets for musculoskeletal decay disease,so that we can provide new ideas and strategies for the management of the disease in the context of the musculoskeletal subunit.

Long-term outcomes of posterior release and reduction for irreducible atlantoaxial dislocation / 中华骨科杂志

Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.

Application Progress of High-Throughput Sequencing Technology in Forensic Diatom Detection / 法医学杂志

Diatom detection is an important method for identifying drowning and throwing corpses after death and inferring the drowning sites in forensic examination of corpses in water. In recent years,high-throughput sequencing technology has achieved rapid development and has been widely used in research related to diatom taxonomic investigations. This paper reviews the research status and prospects of high-throughput sequencing technology and its application in forensic diatom detection.

Improved Glass Bead-Vortex Oscillation Method for DNA Extraction from Diatom / 法医学杂志

OBJECTIVES@#To examine the effect of improving diatom DNA extraction by glass bead - vortex oscillation method.@*METHODS@#The DNeasy PowerSoil Pro kit was used as control, two plant DNA extraction kits with different principles (New Plant genomic DNA extraction kit and Plant DNA Isolation kit) and one whole blood DNA extraction kit (whole blood genomic DNA extraction kit) were selected to extract diatom DNA from lung tissue and water sample of the same drowning case. The combination of mass ratio of glass beads with different sizes and vortex oscillation time was designed, and the optimal DNA extraction conditions were selected with the addition of glass beads oscillation. The extracted products of the conventional group and the modified group were directly electrophoretic and detected by diatom specific PCR. Finally, all the extracts were quantified by qPCR, and the Ct values of different groups were statistically analyzed.@*RESULTS@#When the frequency of vortex oscillation was 3 000 r/min, the optimal combination of DNA extraction was vortex oscillation for 4 min, and the mass ratio of large glass beads to small glass beads was 1∶1. The DNeasy PowerSoil Pro kit was used as a reference, and the Ct value of 10 mL water sample was greater than that of 0.5 g tissue. The Ct values of the other three kits used for plant DNA extraction decreased after the glass beads-vortex oscillation method was used, and the Ct values of the tissues before and after the improvement were statistically significant (P<0.05). The whole blood genomic DNA extraction kit used in this study could successfully extract diatom DNA, the extraction of water samples was close to DNeasy PowerSoil Pro kit, after the modified method was applied to tissue samples, the difference in Ct value was statistically significant (P<0.05). However, when the three kits were used to extract diatom DNA from water samples, Ct values before and after the improvement were only statistically significant in New Plant genomic DNA extraction kit group (P<0.05).@*CONCLUSIONS@#The improved glass bead-vortex oscillation method can improve the extraction efficiency of diatom DNA from forensic materials, especially from tissue samples, by plant and blood DNA extraction kits.

Efficacy of Y type osteotomy in the treatment of severe post-tuberculous thoracolumbar kyphosis / 中华骨科杂志

Objective:To explore the clinical efficacy and surgical indications of Y type osteotomy in the treatment of post-tuberculous thoracolumbar severe angular kyphosis.Methods:From March 2012 to June 2018, 36 patients with post-tuberculous thoracolumbar severe angular kyphosis were treated with Y type osteotomy, including 22 males and 14 females, aged 23.6±5.7 years (range, 7-57 years). The parietal vertebrae of kyphosis were located in the upper thoracic vertebra in 3 cases, the thoracic vertebra in 11 cases, the thoracolumbar segment in 17 cases, and the lumbar vertebra in 5 cases. The Cobb angle of kyphosis before the operation was 92.8°±23.3° (range, 60°-147°). The visual analogue scale (VAS), American Spinal Injury Association (ASIA) neurological function grade, and Kirkaldy-Willis function score were used to evaluate the clinical effect. The imaging evaluation indexes were interbody kyphosis angle and spinal bone fusion.Results:The operation was successful in all the 36 patients. The operation time was 210 ±25.9 min (range, 180-270 min), the intraoperative blood loss was 520 ±110 ml (range, 400-800 ml), and the postoperative follow-up time was 26.38±1.75 months (range, 22-30 months). The postoperative kyphosis Cobb angle was corrected to 16.5°±7.7° (range, 5°-35°), which was significantly improved compared with that before operation( t=25.438, P<0.01), and the correction rate was 82.2%. At the last follow-up, the kyphosis angle was 16.5°±7.1° (range, 6°-32°), which was not significantly different from that after the operation. The preoperative VAS score was 7.3±1.8 (range, 3-9), and the postoperative VAS score was 2.4±0.8 (range, 1-3), while the improvement rate was 67.1%. At the last follow-up, it was 1.1±0.6 (range, 0-2), and the improvement rate was 85.0%. According to the Kirkaldy-Willis functional score, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases at the last follow-up, with an excellent and good rate of 91.7%. Before the operation, 9 cases were accompanied by neurological dysfunction (ASIA grade: grade C in 2 cases, grade D in 7 cases). At the last follow-up, all the 9 patients recovered to grade E. During the operation, the electrophysiological nerve monitoring was abnormal in 2 patients, and the awakening test was negative in 1 case. In another patient, neuroelectrophysiological monitoring after posterior column osteotomy showed a decrease in bilateral sensory and motor function. There was no compression around the spinal cord in the osteotomy area, so the operating bed was gradually folded and partially restored to kyphosis and temporarily fixed with double rods. Neuroelectrophysiological monitoring suggested the recovery of nerve function. The awakening test showed that the nerve function of both lower limbs recovered close to the preoperative state, and further osteotomy and internal fixation was performed 2 weeks later. The nerve function of both lower limbs returned to normal after 3 months. After the operation, one patient's muscle strength of the lower limbs decreased from grade 5 to grade 3, and the sensory function was normal. After symptomatic support treatment such as neurotrophic drugs, it returned to normal 2 weeks later. 1 case developed delayed neurological dysfunction 1 year after the operation. Neurotrophic drugs and rehabilitation treatment improved it. The sinus of the incision was formed in one case 3 months after the operation and healed after debridement and suture. Conclusion:Y typeosteotomyis a safe and effective method for patients with post-tuberculous thoracolumbar severe angular kyphosis. Compared with traditional osteotomy, anterior support bone grafting can be avoided, and spinal shortening can be reduced.

Unilateral or bilateral posterior fenestration debridement and bone graft fusion for the treatment of lumbosacral brucellosis spondylitis / 中华骨科杂志

Objective:To analyze the application and clinical efficacy of one-stage unilateral or bilateral fenestration, debridement, interbody fusion combined with posterior internal fixation for the treatment of lumbosacral brucellosis spondylitis.Methods:All patients with lumbosacral brucellosis spondylitis were retrospectively analyzed, who underwent fenestration, debridement, interbody fusion combined with posterior internal fixation from June 2013 to June 2019. A total of 48 patients were enrolled in this study. According to the surgical method, they were divided into two groups. Unilateral fenestration group: 27 cases of one-stage posterior unilateral fenestration, debridement, interbody fusion combined with posterior internal fixation were performed, 21 males and 6 females, aged 23-71 years; Bilateral fenestration group: 21 cases of one-stage posterior bilateral fenestration, debridement, interbody fusion combined with posterior internal fixation were performed, aged 26-58 years. There were 16 males and 5 females. The preoperative and postoperative clinical symptoms, neurological function, C-reactive protein, the surgery duration time, the blood loss, and erythrocyte sedimentation rate were observed. The internal fixation device was evaluated for looseness or fracture by imaging examination. The Bridwell classification criteria were used to evaluate the bone graft fusion. Postoperative complications were also assessed.Results:All patients completed the operation successfully, and the diseased tissues were sent for pathological examination during the operation, and all of them were diagnosed as brucellosis. All patients were followed up for 12-48 months (mean 23.7 ±6.3 months). C-reactive protein, erythrocyte sedimentation rate, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Scores (JOA) were significantly improved in both groups at different time points after operation. There was no significant difference in the general condition before operation between the two groups ( P>0.05). The mean operation time and mean blood loss were 120.5±34.1 min and 214.4±150.2 ml, in the unilateral fenestration group; 187.1±30.3 min and 455.8±250.5 ml in the bilateral fenestration group; and the difference was significant ( t=8.123, t=2.962, P<0.05) . The postoperative lumbar and leg pain were significantly relieved. There was no significant difference in C-reactive protein, erythrocyte sedimentation rate, VAS, ODI and JOA scores between the two groups at the same time point. In the bilateral fenestration group, one patient developed incision infection half a month after the operation, who underwent debridement and drainage, and finally cured. There was no significant difference in the time of bone graft fusion between the two groups ( t=0.542, P>0.05). At the last follow-up, all the patients were completely fused. Conclusion:Unilateral or bilateral fenestration, debridement and bone graft fusion and internal fixation for the treatment of lumbosacral brucellosis spondylitis can achieve good clinical results, and the former has the advantages of short operation time and low cost.

Influencing factors of health literacy among college students in a university / 中国职业医学

OBJECTIVE: To analyze the status and influencing factors of the health literacy(HL) of college students in a comprehensive university. METHODS: A total of 3 360 students from in a comprehensive university of Xinjiang Production and Construction Corps was selected using multi-stage stratified cluster random sampling method. The HL level of college students was investigated and evaluated with self-edited Xinjiang Construction Corps College Students Health Literacy Questionnaire. RESULTS: The HL level of college students was 17.1%. The HL level of medical students was higher than that of non-medical students(35.4% vs 10.0%, P<0.01). Logistic regression analysis results showed that among the medical students in grade three or four, those with medium and excellent academic achievement, and Han nationality had a positive effect on their HL level(P<0.01). Among the non-medical students, female and medicine related optional courses had a positive effect on their HL level(P<0.05). Students in the sophomore year had a negative effect on their HL level(P<0.05). CONCLUSION: There is a big difference in the level of HL between medical students and non-medical students. Medical college students and non-medical college students have different factors affecting HL, medical education is related to improving HL.

Surgical treatment of post-traumatic epiphyseolisthesis at odontoid process in children / 中华骨科杂志

Objective:To evaluated the indications, methods, outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods:Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016, including 1 male and 4 females. Initial surgery age were at1.7~5.4 years old, averaged (39.6±19.4) months and were 0.67-8 months, averaged (87.0±95.1) days. Disease duration ranged from 23 days to 8 months, with an average of 88 days. X-ray, CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression. Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre- and post- operation. During the follow-up, X-ray and CT were performed to assess the fusion condition of the grafted bone.Results:The duration of operation was ranged from 75-145 months, with an average of (101.0±20.7) months; Blood loss ranged from 50-100 ml, with an average of (70.0±21.2) ml; follow-up duration ranged from 6 to 48 months, with an average of (23.5±17.6) months. Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E. Among the five cases, two received satisfactory reduction, two cases received incomplete reduction, and one experienced failure reduction. The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery, with an average of (9.5±3.4) months. The physiological curvature of cervical remained well without bone resorption, nonunion, pseudoarthrosis, as well as screw loosening or broken. Internal fixation of 2 cases were removed.Conclusion:Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice. The detailed diagnosis of medical history, physical examination and comprehensive imaging evaluation. The posterior approach technique of C1-2 was feasible and effective, which could obtain decompression, reconstruction andstability all together.

Comparison of efficacy between anterior and posterior combined approach and posterior reduction alone in the treatment of basilar invagination with irreducible atlantoaxial dislocation / 中华骨科杂志

Objective:To compare the clinical efficacy and complications of combined anterior and posterior approach and simple posterior release reduction and internal fixation in the treatment of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) .Methods:The medical records of 47 patients with basilar invaginationdepression complicated with refractory atlantoaxial dislocation who received surgical treatment from July 2000 to December 2017 were retrospectively analyzed. The patients were divided into anterior and posterior combined approach group (23 cases) and posterior approach group (24 cases). Key observation indicators include: Chamberlain line (CL), Wackenheim line (WL), McGae line (ML), atlantodens interval (ADI), cervicomedullary angle (CMA), clivus-canal angle (CCA), JOA scores (Japanese Orthopedic Association, JOA) and Ranawat grade.Results:The average follow-up was 48.7±31.2 months in the A-P group and 44.4±33.4 months in the P group. The average preoperative JOA score of the A-P group was 8.20±2.75 points and 14.98±1.05 points at the last follow-up, and the improvement rate was 77.35%±11.35%. The average preoperative JOA score of the P group was 8.06±2.52 points, and the last follow-up was 14.71±0.62 points, and the improvement rate was 74.38%±10.52%. There was no statistically significant difference between the two groups in JOA score ( t=0.877, P=0.262) and improvement rate ( t=1.478, P=0.206) at the last follow-up. The preoperative CL, WL, ML, ADI, CMA and CCA angles of the A-P group were 13.12±5.76 mm, 6.94±3.55 mm, 7.04±4.57 mm, 9.75±2.06 mm, 110.85°±13.6°, 95.32°±18.3°, respectively. The last follow-up was 1.68±2.53 mm, -2.76±2.26 mm,-1.52±2.43 mm, 1.12±1.55 mm, 149.26°±12.6°, and 141.42°±13.7°, respectively, with statistically significant differences from preoperative. The preoperative CL, WL, ML, ADI, CMA and CCA angles of P group were 12.52±5.17 mm, 6.59±3.04 mm, 6.94±4.32 mm, 9.88±1.93 mm, 115.35°±12.4°, 97.25°±16.4°, respectively. The results of the last follow-up were 2.00±3.67 mm, -3.06±1.85 mm, -1.76±2.88 mm, 1.17±1.18 mm, 146.76°±11.4° and 137.56°±10.4°, respectively, which were statistically significant compared with the preoperative results. There was no significant difference between the two groups in preoperative and final follow-up. The average bone graft fusion time of the A-P group was 9.2±4.9 months, and the average bone graft fusion time of the P group was 9.5±4.7 months. There was no statistically significant difference in the bone graft fusion time between the two groups ( t=0.547, P=0.382). Postoperative complications occurred in a total of 8 cases in the two groups, including 6 cases (21.7%) in the combined approach group and 2 cases (8.3%) in the posterior approach group. The incidence of complications in the posterior approach group was significantly lower than that in the combined approach group. Conclusion:The clinical and imaging results of the treatment of basilar depression with atlantoaxial dislocation by one-stage posterior release reduction and internal fixation are basically the same as those obtained by the anterior and posterior combined approach, but the complication rate of the posterior approach is significantly lower than that of the anterior and posterior combined approach.

The application of a new intraoperative assessment method of coronal balance in surgical treatment of scoliosis / 中华骨科杂志

Objective@#To introduce a new method for assessing coronal balance in surgical treatment of scoliosis, and to explore its effectiveness in preventing postoperative coronal imbalance.@*Methods@#The data of forty-six consecutive patients, who underwent posterior surgery for spine deformity correction from January 2016 to December 2016, were retrospectively analyzed. The series included 19 males and 27 females with an average age of 28.24±21.16 years (7-76 years), and with lower instrumented vertebra (LIV) located at the level of L3 or below. Point-line method was used to evaluate coronal balance by determining whether the center of upper instrumented vertebra was located at the measuring rod passing through the centers of symphysis pubis and LIV among all patients during surgery. Preoperative, postoperative 1 week and 3 months Cobb angle, coronal balance distance (CBD), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Scoliosis Research Society Questionnaires-22 (SRS-22) were measured and recorded, and statistical analysis was conducted. And then, subgroup analysis was performed according to preoperative coronal imbalance classification to further evaluate the effectiveness of the new method.@*Results@#Among 46 patients in this study, the prevalence of preoperative coronal imbalance was 47.82% (22/46). Of them, ten patients were type B coronal imbalance and eleven patients were type C coronal imbalance. The prevalence of coronal imbalance at one week after operation was 17.39% (8/46), and the prevalence of coronal imbalance at final follow-up was 10.87% (5/46). The results showed that the mean main Cobb angle was 57.24°±26.51° and 14.71°±10.17° at pre-operation and immediate post-operation, respectively. The difference was statistically significant compared to preoperative value (t=13.211, P=0.000), and the average improvement rate was 73.53%±1.88%. Preoperative coronal balance distance CBD ranged from 2.76 mm to 66.73 mm, with an average of 22.54±13.97 mm; the mean CBD was 16.00±14.85 mm at immediate post-operation. The difference was statistically significant (t=3.665, P=0.001), with an average correction rate of 25.58%±52.39%. Our clinical outcome analysis showed that among 46 patients, the preoperative VAS was 8.11±0.89, and the final follow-up VAS was 4.15±0.79. There was a significant difference between pre-operation and the last follow-up (t=21.529, P=0.000). The preoperative ODI score was 49.76±5.84, and the final follow-up ODI score was 25.74±3.92. The difference was statistically significant (t=44.434, P=0.000). The preoperative SRS-22 was 10.57±2.13, and the final follow-up SRS-22 was 21.89±2.35. Compared to pre-operation, the difference was statistically significant (t=24.023, P=0.000). The subgroup analysis showed that in patients with type B coronal imbalance, the mean Cobb angle correction rate was 70.34%±6.02% at immediate post-operation, and there was a significant difference compared to pre-operation (t=5.437, P=0.000); the average CBD correction rate was 37.45%±29.03%, and significant difference was found (t=2.607, P=0.028). In type C patients, the average Cobb angle and CBD correction rate at immediate post-operation was 72.92%±3.67% and 44.79%±5.63%, respectively, and significant difference was found (t=7.319, P=0.000; t=7.545, P=0.000).@*Conclusion@#Point-line method was a simple and effective technique for intraoperative assessment of coronal balance, which could assist surgeons to objectively evaluate the result of restoration of the coronal alignment. The use of point-line method is contributed to improve clinical outcomes of spinal deformity correction surgery, and to prevent the occurrence of postoperative coronal imbalance.

Application of contralateral supplementary puncture in unilateral percutaneous vertebroplasty for poor bone cement dispersion / 中国骨伤

OBJECTIVE@#To evaluate the clinical value of contralateral supplementary puncture in unilateral percutaneous vertebroplasty(PVP) with poor cement dispersion.@*METHODS@#From January 2015 to December 2016, PVP was performed unilaterally in 285 patients(319 vertebrae) with osteoporotic compression fractures(OVCF). Contralateral percutaneous puncture was performed in 13 patients with poor cement dispersion. Among the patients, 5 cases were male and 8 patients were female, ranging in age from 63 to 88 years old; 1 case of T₁₁, 4 cases of T₁₂, 3 cases of L₁, 2 cases of L₂, 1 case of L₃, and 2 cases of L₅. The time from injury to operation ranged from 1 to 16 days. The VAS score, ODI score, residual low back pain and loss of vertebral height were observed.@*RESULTS@#The VAS score and ODI score of 13 patients who underwent contralateral supplementary puncture were significantly improved (<0.01), and there was no postoperative residual low back pain. During the follow-up period, there was no significant difference in the height loss between the two sides of the vertebral body (0.35 to 3.69 mm on the original puncture side and 0.59 to 3.66 mm on the supplementary puncture side).@*CONCLUSIONS@#For unilateral PVP with poor cement dispersion, contralateral puncture can reduce the occurrence of postoperative residual pain; at the same time, can reduce the difference between the loss of height on both sides of the vertebral body, and then prevent the occurrence of lateral vertebral deformity, which is a safe and reliable method.

Comparison of Ways of Extubation after Tracheotomy / 中国康复理论与实践

@#Objective To optimize the ways of extubation after tracheotomy.Methods From August, 2016 to April, 2018, 118 patients after tracheotomy for brain injury were divided into early extubation group (n=74) and conventional extubation group (n=44). The success rate and tolerance of extubation were compared, and the biochemical markers of blood were tested before and seven days after extubation. The early extubation group was divided into disposable extubation group (n=37) and occlusion tube-extubation group (n=37), and their success rates of extubation were compared.Results There was no significant difference in success rate between the early extubation group and the conventional extubation group (χ2=0.016, P>0.05). The tolerance was less in the early extubation group on the first day of extubation (χ2=4.909, P<0.05), and it was not different seven days and 15 days after extubation (χ2<1.995, P>0.05). The procalcitonin, hypersensitive C reactive protein and white blood cell count decreased (t>2.680, P<0.05), and hemoglobin and albumin increased seven days after extubation (t>11.620, P<0.001). There was no significant difference in the success rate between the disposable extubation group and the occlusion tube-extubation group (χ2<2.902, P>0.05).Conclusion Satisfactory cough and deglutition reflex are the core indexes of successful extubation, other indications may not influence on the success of extubation but on tolerance. Extubation may benefit to control the complications of tracheotomy. The disposable extubation is more recommended.

Intravenous thrombolysis for acute ischemic stroke: New evidence and focus / 第二军医大学学报

Acute ischemic stroke (AIS) has the characteristics of high morbidity, disability and mortality. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for AIS in time window is an effective treatment recommended by domestic and overseas guidelines. However, intravenous thrombolysis has shortcomings, such as short time window, low recanalization rate and high risk of bleeding. Therefore, in recent years, studies on prolonging the time window, using low-dose rt-PA or a new generation of thrombolytic agent, and thrombolysis combined with anti-thrombotic therapy have been carried out worldwide. Based on the studies on intravenous thrombolysis, this paper discusses several issues, including extending time window, low-dose rt-PA thrombolysis, and new generation of thrombolytic agent.

Differential expression of microRNAs related to apoptosis in human osteoblasts induced by sodium fluoride / 中国组织工程研究

BACKGROUND: Long-term excessive intake of fluoride, especially through drinking water, can cause chronic fluorosis of bone. The disease can lead to bone damage and deformity, and is difficult to recover.Unfortunately, we have not developed a noninvasive or minimally invasive method for its early diagnosis. OBJECTIVE: To observe the expression of apoptosis-related miRNAs under the action of excessive fluorine in human osteoblasts. METHODS: The fluorine model was established in the human osteoblasts by cultured with 20 and 40 mg/L sodium fluoride for 24 and 48 hours, respectively. The expression levels of apoptosis-related miRNAs were determined by PCR array. RESULTS AND CONCLUSION: After 24-hour treatment of sodium fluoride, 48 kinds of miRNAs were upregulated and 4 ones were down-regulated in the osteoblasts. After 48-hour treatment of sodium fluoride, 21 kinds of miRNAs were upregulated and 2 ones were down-regulated. It showed that nine up-regulated miRNAs and one down-regulated miRNA were same in two periods. The 10 miRNAs are selected for target gene analysis on bioinformatics software that refer to the effect of anti-apoptosis and pro-apoptosis, which is of great significance for the early identification of skeletal fluorosis.

Clinical efficacy of one-stage posterior debridement,Smith-Petersen osteotomy,compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis / 中华骨科杂志

Objective To discuss the clinical efficacy and surgical indications of one-stage posterior debridement,Smith-Petersen osteotomy(SPO), compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis. Methods All of 32 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one-stage posterior debridement,SPO, compressive fusion and instrumentation from March 2010 to October 2016,including 23 males and 9 females,aged 2 to 77 years old,average(39.2±17.8)years.All patients were treated by preoperative quadruple anti-tuberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months.Preoperative and postoperative changes in clinical symptoms,nervous func-tion,the situation of the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)with strict follow-up,as well as other re-lated complications were observed.The spinal fusion rate and fusion situation,changing of the physiological curvature,as well as loosening or breaking of the internal fixation device were detected through regular imaging examination.Results The surgery du-ration time was 90-150 min,average(120±19.6)min,and the blood loss was 150-600 ml,average(320±88.9)ml.Postoperative follow-up time was 1 to 3 years,average 2.3 years.The symptoms of tuberculosis poisoning in all patients were obviously relieved and the nutritional status was improved gradually. The visual analogue scale(VAS) improvement rate was about 92%. The VAS score in the preoperative and the last follow-up was statistically significant.All patients'ESR and CRP returned to normal levels at the last follow-up.The Kirkaldy-Willis function score showed that the total fine rate was 93.75%.9 patients with spinal neurologi-cal impairment were postoperative improved significantly.Except 1 patient's Asia grade improved from the B to C,others returned to normal condition.30 cases recovered.Pleural effusion was observed in 3 cases treated with closed thoracic drainage and antibi-otics.The drainage tube was removed after 5-7 d.Incision fistula were observed in 1 patient at 1 month after discharge and recov-ered after debridement and drugs adjustment.Internal fixation loosening was found in 1 elderly patient after 6 months after surgery which was treated with hyperextended brace and anti-osteoporosis drugs.No tuberculosis recurrence was found.Conclusion One-stage posterior debridement, SPO, compressive fusion and instrumentation is a simple, effective and safety surgical approach, which has great application value for surgical treatment of patients with thoracolumbar spinal tuberculosis.

Finding of a NDM-1 carbapenems-producing Leclercia adcarboxglata / 临床检验杂志

Objective To investigate the resistance mechanism of a carbapenems-resistant Leclercia adcarboxglata.Methods The species was identified by the automatic microbial analyzer,matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA sequence analysis.The conventional drug susceptibility test was detected with automatic microbial analyzer,and the minimum inhibitory concentration (MIC) for imipenem was examined by E-test.The phenotypes of carbapenemase were detected by modified carbapenem inactivation method (mCIM) and the genotypes of resistance genes were detected by polymerase chain reaction (PCR) and DNA sequencing.The characteristics of the carried plasmid were analyzed by conjugation test and S1pulsed-field gel electrophoresis (S1-PFGE).Results The clinical isolates of Leclercia adcarboxglata were resistant to imipenem,other beta-lactam antibiotics(except aztreonam) and aminoglycosides,but sensitive to quinolones and sulfonamides.The conjugation test resulted in a drug-resistance spectrum of the receptor strain E.coli J53 similar to Leclercia adcarboxglata bacteria.The phenotype of carbapenemase was positive.PCR amplification and sequencing analysis showed that blaNDM-1,blaTEM and aac (6')-Ib were detectable in the isolates simultaneously,while the conjugon only carried blaNDM-1.S1-PFGE revealed that Leclercia adcarboxglata carried 3 plasmids.Conclusion The carbapenems resistance of Leclercia adcarboxglata may contribute to carrying blaNDM-1 gene which may exist in an around 100 kb plasmid transmitted with conjugation.

One-staged release and reduction by posterior approach to treated basilar invagination with irreducible atlantoaxial dislocation / 中华骨科杂志

Objective To evaluate the safety and effectiveness of one stage surgery of release and bone reduction by posterior approach to treat basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD),and to explore the indications and crucial techniques of posterior approach.Methods All of 17 Consecutive patients (8 males and 9 females) with BI and IAAD who underwent release and reduction by posterior approach from July 2000 to June 2015 were enrolled in the present study,the mean age was 35.2±13.8 years with a range of 12-56 years.The clinical symptoms and signs was recorded,and preoperative imaging examination,including anteroposterior,lateral,dynamic films,MRI and CT of cervical spine,were performed to identify the series.There were 14 cases with atlanto-occipital fusion,7 cases with C2,3 fusion,6 cases with Chiari malformation,6 cases with Syringomyelia,and 8 cases with myelomalacia.The clinic symptoms include occiput/neck pain in 15 cases,cervical movement limitation in 13 cases,short neck in 9 cases,torticollis in 12 cases,Paresthesia in 14 cases,weakness in 13 cases,tendon reflexes hyperfunction in 16 cases and ataxia in 13 cases.The postoperative X-rays,MRI or CT were used to observed the results of decompression,fixation and fusion.Neurological function was assessed by JOA scale and Ranawat's score before,after surgery and at final follow-up.Pre-and post-operative Chamberlain (CL),Wackenheim (WL),McGae (ML),atlantodental interval (ADI) and cervico-medullary angle (CMA) were analyzed by student t-test.Results The average operation time was 145 mins (90-210 mins) and blood loss was 175 ml (150-350 ml).The average follow-up was 44.47 months (9-94 months).JOA score was increased from 8.06 preoperatively to 15.20 postoperatively,the improvement rate was 77.2％.Preoperative Ranawat's score was Ⅱ in 1 case,Ⅲla in 12 cases,ⅢB in4 cases.Postoperative score was Ⅰ in 13 cases,Ⅱ in 4 cases.The preoperative CL,WL,ML,ADI and CMA were (12.52±5.17) mm,(6.59±3.04) mm,(6.96±4.32) mm,(9.88± 1.93) mm,115.35°± 12.40°,respectively.and the postoperative CL,WL,ML,ADI and CMA were (2.0±3.67) mm,(-3.06±1.85) mm,(-1.76±2.88) mm,(1.17± 1.18) mm,136.76°±11.44°,respectively.The perioperative complications were discovered in 2 cases,including 1 case of infection and1 case of cerebrospinal fluid(CSF) leakage.Conclusion Primary surgery of nerve release and bone reduction by posterior approach may be safe and efficient for the treatment of BI and IAAD.Preoperative evaluation,proper surgical indications and advanced surgical techniques are important for treatment results.

Analyzing the clinical effect of one-stage anterior transplantation with iliac crest allograft or autograft in the treatment of thoracolumbar tuberculosis / 中华骨科杂志

Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.

Analyzing the clinical effect of one-stage anterior transplantation with iliac crest allograft or autograft in the treatment of thoracolumbar tuberculosis / 中华骨科杂志

Objective To evaluate the safety, feasibility and clinical efficacy of one-stage anterior transplantation with ili-ac crest allograft or autologous in the treatment of thoracolumbar tuberculosis. Methods From January 2012 to June 2015, 235 cases of thoracolumbar tuberculosis were treated with allogeneic or autologous iliac crest graft combined with internal fixation dur-ing one-stage after radical debridement, which were reviewed retrospectively. These cases were divided into two groups:allograft group (162 cases) and autograft group (73 cases). In allograft group, there were 87 males and 75 females, with a mean age of 42.5 (range 2-80) years. In autograft group, there were 41 males and 32 females, with a mean age of 40.3 (range 14-68) years. The oper-ation time, bleeding volume, hospital stay, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, visual ana-logue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, the changes of American Spinal Injury Association (ASIA) scale for neurological classification of spinal and graft fusion satisfaction rate in each groups were evaluated respectively before and after surgery. Results The operation time was (122.41±30.55) min in allograft group and (141.56±25.69) min in auto-graft group, the difference was statistically significant. The average hospital stay and bleeding volume were no significant differ-ence between the two groups. In each group, VAS scores, JOA scores, ESR and CRP level and the changes of ASIA scale were sig-nificant difference between pre-and post-operation, but these index showed that there were no significant differences between the two groups. The mean ESR level was (16.46±7.39) mm/h in allograft group, and (13.61±6.85) mm/h in autograft group 3 months af-ter the operation. The fusion time (8.13 ± 1.97) months in allograft group was significantly longer than that in autograft group (5.37± 1.72) months, the difference was statistically significant. At final follow-up, the graft fusion satisfaction rate and the changes of ASIA showed no significant difference. Perioperative complications including gastrointestinal dysfunction in 5 cases (allograft group in 3cases;autograft group in 2cases), and pulmonary infection in 6 cases (allograft group in 4cases;autograft group in 2cas-es). Postoperative complications including kyphosis in 4 cases (allograft group in 3cases;autograft group in 1case), tuberculosis re-currence in 5 cases (allograft group in 3cases;autograft group in 2cases), sinus formation in 5 cases (allograft group in 3cases;auto-graft group in 2cases), chronic pain of the donor site in 6 cases (group autograft). Conclusion There was no significant difference between allogeneic iliac graft and autologous iliac graft in the treatment of thoracolumbar tuberculosis. Allogeneic iliac bone may be the ideal substitute of autologous iliac bone for the clinical treatment of thoracolumbar tuberculosis.

Clinical efficacy of one-stage transforaminal debridement, interbody fusion and posterior instrumentation for treatment of thoracolumbar spinal tuberculosis / 中华骨科杂志

Objective To discuss the clinical efficacy and surgical indications of one?stage transforaminal debridement, interbody fusion combined with posterior instrumentation for thoracolumbar spinal tuberculosis. Methods All of 34 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed,treated by one?stage transforaminal debridement, interbody fusion and posterior instrumentation from June 2010 to April 2013, including 21 males and 13 females, aged 21 to 64 years old, av?erage 38.2 years. All patients were treated by preoperative quadruple antituberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situa?tion of the erythrocyte sedimentation rate (ESR) and C?reactive protein (CRP) with strict follow?up, as well as other related compli?cations were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 60-150 min, average 110 min, and the blood loss was 80-550 ml, average 320 ml. Cerebrospinal fluid leakage occurred in one case. All of the operations were completed successfully without nerve or spinal cord injuries. Postoperative follow?up time was 1 to 4 years, average 2.5 years. Clinical symptoms improved significantly in three months after operation. The visual analogue scale (VAS) improvement rate was about 93%. All patients' ESR and CRP returned to normal levels at the last follow?up. The Kirkaldy?Willis function score showed that the total fine rate was 94%. 12 cases of patients had various degrees of neurological dysfunction before operation, which were back to normal at the final follow?up, except one case of ASIA class B turned to C. Inci?sion fistula formation happened in one case at the third months after surgery, and the wound was healed after debridement. All pa?tients got solid fusion between vertebral body, and there was no graft absorption or collapse, pseudarthrosis, tuberculosis recur?rence, and loosening or breaking of internal fixation devices. Cunclusion One?stage transforaminal debridement, interbody fu?sion and posterior instrumentation is a simple, effective and safety surgical approach, which has great application value for surgi?cal treatment of patients with thoracolumbar spinal tuberculosis.