Population Pharmacokinetics of Voriconazole and Optimization of Dosage Regimens Based on Monte Carlo Simulation in Patients With Liver Cirrhosis.

Because voriconazole metabolism is highly influenced by liver function, the dose regimen of voriconazole should be carefully assessed in patients with liver cirrhosis. We aimed to identify significant factors associated with plasma concentrations. Blood samples were collected from patients with liver cirrhosis who received voriconazole, and voriconazole concentrations were determined. One-compartment model with first-order absorption and elimination appropriately characterized the in vivo process of voriconazole. The typical population value of voriconazole clearance (CL) was 1.45 L/h and the volume of distribution (V) was 132.12 L. The covariate analysis identified that CYP2C19 gene phenotype and Child-Pugh classification were strongly associated with CL and body weight had a significant influence on V. The results of the Monte Carlo simulation suggested that CYP2C19 gene phenotype was a critical factor for determining voriconazole dosage in patients with liver cirrhosis. The extensive metabolizer patients with Aspergillus fumigatus infections could be treated effectively with a recommended dose of 75 mg twice daily in mild to moderate liver cirrhosis and 100 mg once daily in moderate severe liver cirrhosis. However, the recommended dosage for Candida albicans infections patients was not achieved in present study.

[Preliminary study on effective components of Tripterygium wilfordii for liver toxicity based on spectrum-effect correlation analysis].

In this paper, the spectrum-effect correlation analysis method was used to explore the main effective components of Tripterygium wilfordii for liver toxicity, and provide reference for promoting the quality control of T. wilfordii. Chinese medicine T.wilfordii was taken as the study object, and LC-Q-TOF-MS was used to characterize the chemical components in T. wilfordii samples from different areas, and their main components were initially identified after referring to the literature. With the normal human hepatocytes (LO2 cell line)as the carrier, acetaminophen as positive medicine, and cell inhibition rate as testing index, the simple correlation analysis and multivariate linear correlation analysis methods were used to screen the main components of T. wilfordii for liver toxicity. As a result, 10 kinds of main components were identified, and the spectrum-effect correlation analysis showed that triptolide may be the toxic component, which was consistent with previous results of traditional literature. Meanwhile it was found that tripterine and demethylzeylasteral may greatly contribute to liver toxicity in multivariate linear correlation analysis. T. wilfordii samples of different varieties or different origins showed large difference in quality, and the T. wilfordii from southwest China showed lower liver toxicity, while those from Hunan and Anhui province showed higher liver toxicity. This study will provide data support for further rational use of T. wilfordii and research on its liver toxicity ingredients.

High prevalence of thalassemia in migrant populations in Guangdong Province, China.

BACKGROUND: The objectives of this study were to estimate the prevalence of thalassemia and to analyze the need for public health services for migrant populations in different cities in Guangdong Province, China. METHODS: A cross-sectional survey was conducted in 21 cities of Guangdong Province. Twenty-three types of a- and ß-globin gene mutations were detected in a total of 14,230 pregnant women and 14,249 husbands. RESULTS: There was a 16.45% prevalence of thalassemia among the 28,479 individuals, and the prevalences of α-, ß-, and combined α-/ß- thalassemia were 12.03%, 3.80%, and 0.63%, respectively. Compared with the native city residents in the province, the migrants from within the province and the immigrants from outside the province had lower prevalences of thalassemia, but the prevalence values were >11%. CONCLUSIONS: The prevalence values for thalassemia gene mutations were high in all three population groups studied in Guangdong Province. The results indicate that all segments of the Guangdong population should be screened for thalassemia.

Longterm outcome after the decompressive surgery for thoracic myelopathy due to the ossification of the ligamentum flavum / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the long-term surgical outcome of thoracic myelopathy caused by the ossification of the ligamentum flavum (OLF) and evaluate the related risk factors.</p><p><b>METHODS</b>Forty-four patients who underwent decompressive laminectomy with thoracic OLF between January 1990 and December 2005 and got more than 5 years follow-up were retrospectively reviewed. Among these 44 cases, there were 29 male and 15 female whose ages at operation were 52 years averagely (27-68 years). The 2-year follow-up results and long-term outcomes were classified according to the modified Epstein's standard, and then the rates of excellent or good (REG) were calculated. The correlation between the long-term REG and the patients' ages, durations of symptoms, decompressed levels, and dural leak were analyzed.</p><p><b>RESULTS</b>The mean follow-up period of these 44 cases was 8.5 years (5-19 years). The REG at 2 years after laminectomy was 77.3% (34/44), while the long-term REG was 65.9% (29/44). There was one case who had suffered from an acute spinal cord injury got a poor post-operative outcome. The other 43 cases had chronic durations, including 22 cases whose pre-operative durations of symptoms were less than 12 months and 21 cases whose durations were equal to or more than 12 months. And the long-term REG of these two groups were 77.3% (17/22) and 57.1% (12/21) respectively (P>0.05). The REG of those cases whose decompression levels were limited in T1-T9 was 78.9% (15/19), while that of those cases whose laminectomy was relevant to thoracolumbar segment (T10-L2) was 58.3% (14/24) (P>0.05). There were 7 cases who had excellent or good short-term results and poor long-term outcomes. The reasons of these changes included coexistence of lumbar spinal stenosis in three cases and the growth of the OLF at the adjacent levels in four cases.</p><p><b>CONCLUSIONS</b>Although the short-term results of the decompressive surgery for thoracic OLF is good, the regular long-term follow-up is necessary because the symptoms may reoccur or deteriorate secondary to lumbar spinal stenosis or the growth of OLF at the adjacent levels near former decompressive levels; the duration of symptoms which is more than one year and the decompression levels that is involved to T10-L2 segments are possibly related to the poor long-term outcomes.</p>

The posterior surgical treatment of old tuberculous kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the results of posterior osteotomy and correction in the surgical treatment of old tuberculous kyphosis.</p><p><b>METHODS</b>From June 2004 to December 2008, 31 cases of old tuberculous kyphosis with posterior osteotomy and correction technique were treated. There were 12 cases of male and 19 cases of female. The average age was 33.4 years. Pedicle subtraction osteotomy or vertebral column resection were applied in surgery. The kyphosis angle, lumbar lordosis angle and sagittal balance condition of the spine were measured before and after surgery, as well as follow-up. The Frankel grading system for neurological function of lower extremities, the Oswestry disability index (ODI) for life quality, and patient satisfactory index (PSI) for satisfaction of surgery were applied before surgery and at follow-up.</p><p><b>RESULTS</b>The average kyphosis angle was 94° ± 27°, the average lumbar lordosis angle was 71° ± 20°, and the average sagittal C(7) plumb line was (-15 ± 44) mm away from the balance region before surgery. The average kyphosis angle decreased to 26° ± 11° in one week after surgery, with an improvement rate of 71.4%. The average follow-up time was 22.5 months. The average kyphosis angle was 28° ± 12° at the final follow-up, with an improvement rate of 70.0%. The average lumbar lordosis angle was 46° ± 11°, with an improvement rate of 35.1%. The postoperative kyphosis angle and lumbar lordosis angle were significantly different with that of pre-operation (for kyphosis angle: t = 16.3, P < 0.05; for lumbar lordosis angle: t = 8.1, P < 0.05). The average sagittal C(7) plumb line was (-4 ± 22) mm away from the balance region at the final follow-up, with an improvement rate of 73.4%. The Frankel grading were E in 13 cases, D in 13 cases, and C in 5 cases before surgery, and were E in 20 cases, D in 8 cases, and C in 3 cases at the final follow-up. The average ODI was 13 ± 12 before surgery, and was 7 ± 8 at the final follow-up, with an improvement rate of 45.2%. The PSI results showed a satisfied rate of 90.3%.</p><p><b>CONCLUSION</b>Good results can be achieved by applying proper posterior osteotomy and correction technique according to the severity of old tuberculous kyphosis.</p>

Circumspinal decompression through a single posterior incision to treat thoracolumbar disc herniation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Various surgical approaches have been successfully used in the treatment of thoracolumbar disc herniation (TLDH). Although the anterior transthoracic approach has a reputation for better visualization than the posterolateral and lateral approaches, it involves the manipulation of the thoracic and pulmonary structures. Thus, this approach is technically demanding and prone to compromising the respiratory system. An ideal approach would involve adequate visualization and be accomplished through the posterior midline approach that is familiar to spine surgeons. The objective of this retrospective preliminary clinical study was to introduce a new surgical procedure, circumspinal decompression through a single posterior incision, for the treatment of TLDH (T10/11-L1/2) and to evaluate the surgical outcome of this procedure by comparing it to the conventional anterior transthoracic approach.</p><p><b>METHODS</b>In this study, 15 patients (10 males, 5 females; mean age 51 years) with symptomatic TLDH underwent the circumspinal decompression through a single posterior incision procedure between January 2008 and December 2009. Altogether, 17 herniated discs were excised, with 2 discs at T10/11, 4 discs at T11/12, 5 discs at T12/L1 and 6 discs at L1/2. Of these patients, 13 were followed up with a mean follow-up period of 23.5 months. Clinical outcomes, including operative time, blood loss, perioperative complications, postoperative time of hospitalization, neurologic status improvement, back pain and correction of local kyphosis, were investigated by comparing these data with the results from patients who underwent the anterior transthoracic approach for TLDH during the same period. The patients' neurologic status was evaluated by a modified Japanese Orthopedic Association (JOA) scoring system of 11 points. Neurologic status improvement after the surgery was assessed by calculating the recovery rate, which was equal to the (postoperative JOA score-preoperative JOA score)/(11-preoperative JOA score)×100%. The rates of patients who improved at the final follow-up were also assessed.</p><p><b>RESULTS</b>The mean operative time was 183 minutes, the mean blood loss was 1067 ml, and the mean postoperative hospitalization time was 8.4 days. Three patients suffered perioperative complications, but none of these complications involved the respiratory system. Local kyphotic angles at the fusion levels were reduced. Of the 13 patients that were followed up, 12 improved at the final follow-up, with a mean recovery rate of 52.8%. Patients who underwent the circumspinal decompression procedure showed a higher percentage of improvement at the final follow-up, a higher degree of local kyphosis correction and a lower percentage of complications (especially respiratory complications) compared to patients who underwent the anterior transthoracic decompression procedure.</p><p><b>CONCLUSIONS</b>The circumspinal decompression through a single posterior incision procedure is an effective and safe technique that is comparable to anterior tranthoracic approach for the surgical treatment of TLDH patients. It could be an attractive choice in certain circumstances.</p>

The impact of thoracic and thoracolumbar angular kyphosis on pelvic shape and sagittal alignment / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the impact of thoracic and thoracolumbar angular kyphosis on pelvic shape and sagittal alignment.</p><p><b>METHODS</b>From May 2002 to June 2010, the sagittal spino-pelvic parameters were analyzed in lateral standing radiographs of 32 patients (mean age 29.6 years) with thoracolumbar angular kyphosis. The parameters included Cobb angle of kyphosis, lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT) and sagittal vertical axis (SVA). All pelvic parameters in the patients were compared with those reported in historical normal subjects. All patients were treated by using kyphotic correction and fusion. The preoperative and postoperative parameters were compared. The pelvic parameters were also compared between the patients with kyphotic apex located at T(1-8) and those located at T(9-12) and thoracolumbar junction. The linear regression analysis was used to investigate the independent factors of PI.</p><p><b>RESULTS</b>The mean kyphosis was 90.1° (31° - 138°). The mean age of kyphosis occurrence was 6.1 years. The mean PI, SS and PT were 34.8°, 35.8° and -0.7° respectively. The PI and PT were significantly smaller (P < 0.001) in the patients than those in normal subjects while the SS was similar. The kyphosis was improved to 27.9° post-operatively. There was no difference in PI values between pre-operation and postoperation (P > 0.05). The PI and SS in patients whose kyphosis located at thoracic spine (T(1-8)) were significantly higher than those at T(9)-L(2). Instead of patients' age and LL, the preoperative Cobb angle of kyphosis and the levels where kyphosis located were two independent impact factors of PI.</p><p><b>CONCLUSIONS</b>The kyphosis occurred at childhood may influence pelvic shape and alignment significantly. The lower kyphotic apex located and the bigger kyphosis, the greater impact on the pelvic morphology. The surgery can improve the kyphosis, but can not change the sagittal pelvic morphology. Early treatment of thoracolumbar angular kyphosis is beneficial not only to reconstruction of spine alignment but also to the formation of sagittal pelvic morphology.</p>

Clinical outcomes of surgical correction for ankylosing spondylitic kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of posterior surgical corrective methods for ankylosing spondylitic kyphosis.</p><p><b>METHODS</b>From June 2003 to June 2008, 21 cases of ankylosing spondylitic kyphosis received posterior surgical correction. There were 17 male and 4 female, and the average age was 39.5 years (range, 20 to 57 years). The total spine X-ray and CT were used to evaluate sagittal balance and thoracolumbar spine kyphosis angle, and chin brow-vertical angle was obtained from clinical lateral photograph. The surgical goal was to correct sagittal imbalance and chin brow-vertical angle. The simulated osteotomy was performed in computer before surgery to determine the correction methods. The surgical methods included: 16 cases of monosegmental closing osteotomy correction, 3 cases of anterior opening-posterior closing osteotomy correction, and 2 cases of combined pedicle subtraction osteotomy in thoracolumbar spine and Smith-Peterson osteotomy in lumbar spine. All patients were followed up after surgery, and the improvement of sagittal imbalance, chin brow-vertical angle and thoracolumbar spine kyphosis angle were assessed. The symptoms relief and satisfied rate were also evaluated.</p><p><b>RESULTS</b>The average operation time was 4.4 hours, and the average blood loss was 1770 ml. Before surgery, the average thoracolumbar kyphosis angle was 62.1°, the average anterior shift of C(7) plumb line was 172.9 mm, and the average chin brow-vertical angle was 34.9°. The average follow-up was 28.8 months after surgery. The average correction rate of thoracolumbar kyphosis angle was 60%, the average improvement rate of anterior shift of C(7) plumb line was 64%, and the average correction rate of chin brow-vertical angle was 98%. The improvement rate of back pain was 64% during follow-up. The total surgical satisfactory rate was 95%.</p><p><b>CONCLUSION</b>Based on the simulated osteotomy in computer before surgery, according to the characteristics of ankylosing spondylitic kyphosis, different posterior osteotomy and correction methods can achieve good results.</p>

Combined segmental resection osteotomy with dual axial rotation correction, fixation and fusion for the treatment of severe angular kyphosis / 中华外科杂志

<p><b>OBJECTIVE</b>To design a new surgical correction and fixation technique for the treatment of severe angular kyphosis, observe the feasibility, safety and effectiveness of the technique.</p><p><b>METHODS</b>From May 2004 to February 2007, 16 cases with severe kyphosis (average 90.8 degrees, range 50 degrees-130 degrees) were treated with segmental resection osteotomy, section distraction, dual axial rotation correction and instrumentation fusion technique. The patients were inspected by local and total spine anteroposterior and lateral radiography pre-and postoperatively. The kyphotic Cobb angle was measured and 7 cases combined scoliosis Cobb angle was also measured. The Frankel Grading for neurological function, Oswestry Disability Index (ODI) and Patients Satisfactory Index (PSI) were evaluated preoperatively, postoperatively and at follow-up. The back pain relief was also observed.</p><p><b>RESULTS</b>The average surgical duration was 6.9 hours. The average blood loss was 4000 ml. The complications include 1 shifting of artificial vertebrae, 3 nerve root injury, 3 dural tear and 1 transitory dysfunction of lower extremity. All of these complications were relieved greatly after feasible treatment. The average follow-up time was 25 months. The average kyphotic angle was 90.8 degrees preoperatively, which was improved to 26.9 degrees immediately after surgery, and got an average correction rate of 72.5%. At follow-up, the average kyphotic angle was 28.9 degrees, and correction rate was 70.1%. The 7 cases who combined with scoliosis had an average Cobb angle of 35.9 degrees preoperatively, which decreased to 4.4 degrees immediately after surgery, and the correction rate was 87.2%. The correction rate was kept until follow-up (78.6%). Some patients got an improved neurological function. The Frankel Grading were E in 5 cases, D in 5 cases, C in 5 cases, and B in 1 case preoperatively. There were 10 cases of E grade, 3 cases of D grade, and 3 cases of C grade at follow-up. Except 3 cases who had no symptoms before surgery, the average ODI was 18.9 preoperatively, and 10.8 postoperatively. The average improvement of ODI was 52.7%. The PSI result showed a satisfied rate of 93.8%. The back pain of 3 cases were totally relieved after surgery.</p><p><b>CONCLUSIONS</b>Segmental resection osteotomy with dual axial rotation correction and fusion technique is an effective way to treat severe angular kyphosis. It is a safe technique and has high correction rate. The long-term results is acceptable.</p>

Generation of mouse FANCL antibody and analysis of FANCL protein expression profile in mouse tissues.

Fanconi anemia complementation group L (FANCL) is a novel Fanconi anemia protein, which mono-ubiquitinates FANCD2 as a ubiquitin E3 ligase, and plays a crucial role in DNA damage repair and chromosome stability maintenance. FANCL is involved in the proliferation of primordial germ cells (PGC) in early embryonic stages, and may play a role in the development of germ cells by forming a novel testis-specific network with testis-specific proteins in the adult testis. FancL cDNA sequence was cloned by RT-PCR from mouse testis total RNA, and expressed in E. coli BL21(DE3). Rabbit FANCL polyclonal antiserum was generated using the recombinant protein as the antigen. To prepare an antigen column for affinity purification of FANCL-specific antibody, recombinant His-tagged FANCL was purified by Ni(2+)-charged HiTrap Chelating HP column and coupled to an NHS-activated HiTrap column. To confirm the activity and specificity of the FANCL antibody, we constructed plasmid pCMV-HA/FANCL to transfect HEK 293T cells. Transiently expressed HA-FANCL fusion protein was analyzed by immunoblotting with both the FANCL antibody and HA monoclonal antibody. The antibody was used in Western blotting to check the expression of FANCL protein in mouse tissues. We found wide expression of FANCL in brain, muscle, heart, lung, liver, spleen, kidney, testis, ovary and uterus, indicating the functional importance of this novel protein.

[Study on the current status and relative factors on reproductive health of unmarried floating population in Huizhou City].

OBJECTIVE: To understand the current status and relative factors of reproductive health (RH) on unmarried floating population. METHODS: Both quantitative and qualitative surveys were employed. Quantitative survey would include questionnaire admimistration, physic examination and laboratory test while qualitative study including focus/nominal group discussion, individual and resource persons interview. All of the investigative targets were selected under informed consent. RESULTS: Among 1333 investigated unmarried floating population, the mean score on knowledge of RH was 12.97 +/- 12.20 (the full score was 100). Among studied persons, 10.20% of them were in favor of unmarried sexual activity while 50.64% of them did not care about it and 26.90% of them had ever experienced sexual activity. Among females who experienced sexual activity, 25.45% of them had induced abortion. It was found, through multivariate logistic analysis, that sexual activity at younger age, less education, agreed on having sexual activity under partner's request, sexual activity in half of a year, and pregnancy were the major risk factors on RH of unmarried floating population. CONCLUSION: The problem on the current status of RH among unmarried floating population needs to be addressed as they were lack of knowledge on RH and having more risk factors on RH.

New type spinal osteotomy with cage inserting anteriorly and closing posteriorly to correct thoracolumbar kyphosis by a single posterior approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, safety and efficacy of surgical correction of thoracolumbar kyphosis, using the new type spinal osteotomy with cage inserting into the intervertebral gap anteriorly and closing posteriorly by a single posterior approach.</p><p><b>METHODS</b>Since 2003, eight consecutive patients with thoracolumbar kyphosis were treated surgically. There were 4 male and 4 female with the mean age of 35 years old (from 14 to 58 years old). There were 3 cases of congenital kyphosis with scoliosis, 1 case of old spinal tuberculosis kyphosis, 2 cases of post-traumatic kyphosis, 1 case of ankylosing spondylitic kyphosis with old stress fracture and 1 case of iatrogenic kyphosis post-op of laminectomy due to the removal of ependymoma from cauda equina. The apex level of kyphosis was T(11) in 1 case, T(12) in 2 cases, L(1) in 3 cases and L(2) in 2 cases. The average preoperative Cobb angle of kyphosis was 73 degrees (range from 42 degrees to 90 degrees), there were 3 cases associated with scoliosis, with the mean preoperative Cobb angle of scoliosis was 25.7 degrees (range from 20 degrees to 36 degrees). According to the Frankel grading system, 2 cases were classified as Grade C, 2 cases as Grading D and 4 cases as Grading E preoperatively. All the patients had severe thoracolumbar dorsum pain with difficulty of sitting. The bladder sphincter function disturbance were also found in 3 cases. The main procedures of the new type spinal osteotomy consisted of temporary rod installation, trans-intervertebral spinal osteotomy, circumferential decompression of the spinal cord, dissection and complete cut of the anterior longitudinal ligament, spreading the intervertebral gap with the distraction forceps during the instrumentation correction maneuver and replaced by the cage filled with autograft bone inserting into the intervertebral gap, then the closing maneuver followed.</p><p><b>RESULTS</b>The average operation time was 4.5h (range from 3.5 to 6 h), and the mean blood loss volume during the operation was 2280 ml (range from 700 to 4200 ml). All patients underwent surgery safely and there were no major complications related to the surgical procedures, apart from CSF leakage of 1 case postoperatively and transient low blood pressure of 1 case intraoperatively. Localized kyphosis, scoliosis were reduced from an average of 73 degrees to 8.3 degrees and 25.7 degrees to 18.7 degrees respectively with an average 12.8 months follow-up. Bony fusion were achieved in all patients and there was no correction loss. Neurologic improvement occurred in 1 case from Frankel Grade C to Grade D, and 1 case from Frankel Grade D to Grade E after the surgery. The bladder sphincter function were also found improved in 2 cases postoperatively.</p><p><b>CONCLUSIONS</b>The new type spinal osteotomy with cage inserting anteriorly and closing posteriorly by a single posterior approach was a safe, reliable and effective surgical procedure for the treatment of the thoracolumbar kyphosis with the Cobb angle from 40 degrees to 90 degrees. Compared with the other common spinal wedge osteotomies, the deformation danger, such as hanging down, kinking or dural buckling could be effectively prevented, a better correction rate is also achieved significantly with this new type procedure.</p>

Lumbar interbody fusion using autologous bone marrow mesenchymal stem cell-calcium phosphate ceramic composite in rhesus monkey / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the osteogenic capacity of autologous bone marrow mesenchymal stem cells (BMSCs)-calcium phosphate ceramic composites in vitro and implanted as a bone graft substitute for lumbar anterior interbody fusion in rhesus monkeys.</p><p><b>METHODS</b>From March 2003 to April 2005, 9 adult rhesus monkeys underwent lumbar L(3 - 4) and L(5 - 6) discectomy and interbody fusion via an anterior retroperitoneal approach. Two fusion sites in each animal were randomly assigned to two of three treatments: autogenous tricortical iliac crest bone graft (autograft group, n = 6) or cell-free ceramic graft (ceramic group, n = 6) or BMSCs-ceramic composite graft (BMSCs group, n = 6). Autologous BMSCs were culture-expanded and stimulated with osteogenic supplement. The cell-ceramic composites were constructed in a rotary dynamic cell culture system. The spinal fusion segments were evaluated by radiography, biomechanical testing, histologic analysis and histomorphometric analysis at 3 months post-surgery.</p><p><b>RESULTS</b>Biomechanical testing showed that spinal segments from the autograft group and the BMSCs-ceramic group were statistically and significantly stiffer than the cell-free ceramic group. The BMSCs-ceramic group and the autograft group showed equivalent biomechanical stiffness by statistical analysis. Histologically, both the autograft group and the BMSCs-ceramic group achieved osseous union, but the cell-free ceramic group had a fibrous union. Quantitative histologic analysis showed that the amount of bone formation was significantly greater in the autograft group and the BMSCs-ceramic group compared with the cell-free ceramic group. However, the amount of ceramic residue was significantly greater in the cell-free ceramic group versus the BMSCs-ceramic group.</p><p><b>CONCLUSIONS</b>The results indicate that BMSC-ceramic composites can enhance bone regeneration and achieve osseous spinal fusion 3 months after the implantation in rhesus monkey interbody fusion model. Cell-free ceramics has an unsatisfactory efficacy in spinal fusion due to its tense fibrous fusion.</p>

Clinical characteristics and treatment of flexion-distraction stage I injuries in subaxial cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics and treatment of flexion-distraction stage I injuries in subaxial cervical spine.</p><p><b>METHODS</b>Twelve cases of flexion-distraction stage I injuries with delayed symptoms, admitted in our hospital between January 1995 and December 2004, were studied retrospectively. In acute phase, all of 12 cases had neck pain and limited neck movements, neurological deficits were found in 6 of 12 cases. Eight cases had a correct diagnosis, and 2 cases had a error diagnosis, 2 cases missed. All cases were satisfactory by the primary conservative treatment. After 274 days average asymptomatic intervals, all of 12 cases had recurrence of neck pain, delayed neurological deficits were found in 10. MRI showed that all of 12 cases were unstable injuries.</p><p><b>RESULTS</b>All of the 12 patients were treated operatively. Decompression, fusion and fixation were performed by anterior approach in 9 cases, and by combined anterior and posterior approach in 3 cases. The average follow-up period was 33.1 months. Neck pain had great recovery in all cases, 10 cases with neurological deficits, 7 returned normal. Radiographic evidences of intervertebral bony fusion and good cervical alignment were observed in all of 12 cases.</p><p><b>CONCLUSIONS</b>Flexion-distraction stage I injuries is often caused by ligament and disc injuries, and often missed with subtle symptoms and radiographic changes. Inadequate primary treatment options are often due to failure to recognize the instability, and maybe result in delayed injuries. MRI is helpful for the early accurate evaluation of spinal stability. Unstable injury require early surgical treatment. The anterior approach operation is recommended to most of these patients with acute and old injuries. Combined anterior and posterior approach operation should be considered in these patients who have old injuries with stiff kyphosis.</p>

[Functions of FANCL in primordial germ cell formation and Fanconi anemia].

Fanconi anemia (FA) is a rare autosomal recessive disorder characterized clinically by congenital abnormalities, progressive bone marrow failure and cancer susceptibility. Cells from individuals with Fanconi anemia manifest features of spontaneous chromosomal instability and hypersensitivity to DNA cross-linking agents such as mitomycin C. Over 11 known Fanconi anemia gene products are involved in DNA damage response pathway. In the pathway, monoubiquitination of FANCD2 is a key step. A novel protein FANCL is a component of the nuclear FA complex, functioned as an ubiquitin E3 ligase and monoubiquitinylated FANCD2. FANCD2-Ub is targeted to chromatin, where it interacts with BRCA2 to repair DNA damage. In early embryo stage, FA pathway is probably involved in proliferation of PGCs. Mice deficient in FA proteins, such as FANCL, FANCC and FANCA, have a drastic reduction of primordial germ cells (PGC), resulting in male and female infertility in adult. In the adult male, FANCL and a few testis-specific proteins, GGN1 (gametogenetin protein 1), GGNBP1 (gametogenetin binding protein 1), GGNBP2 and OAZ3 (ornithine decarboxylase antizyme 3) form a novel testis-specific complex functioning in spermatogenesis. FANCL is involved in proliferation of PGCs in early embryo stage, and development of germ cells in adult.

Surgical correction of post-traumatic kyphosis of thoracolumbar spine / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the effectiveness of surgical correction for post-traumatic kyphosis of thoracolumbar spine.</p><p><b>METHODS</b>From 1996 to 2003, 33 consecutive patients with post-traumatic kyphosis of thoracolumbar spine were corrected surgically. The mean age was 40.3 years (range, 13 - 65 years). The mean time between the initial injury and surgical correction was 36.0 months (range, 6 - 220 months). The kyphotic deformity averaged 40.8 degrees (range, 20 degrees - 82 degrees ). All the patients had neurological deficits. Twelve patients had obvious back pain. Seven patients lost sphincter function completely and nineteen patients lost the function partly. Twenty-three patients had ever undergone laminectomy and/or instrumentation. The treatment procedure consisted of anterior release and posterior spinal osteotomy with instrumentation (15 patients), posterior closing wedge osteotomy with instrumentation (12 patients), anterior release and instrumentation (6 patients).</p><p><b>RESULTS</b>Kyphosis was corrected from an average of 40.8 degrees to an average of 5.7 degrees, the corrective rate was 86.0% (40.8 degrees - 5.7 degrees /40.8 degrees). There were no severe complications. The average follow-up period was 24.6 months (range, 6 - 84 months). There was no loss of correction at follow-up. Ten of these patients showed an improvement in neural function by one or two levels according to the classification. Sphincter function recovered partly in ten patients. Back pain was relieved significantly in all of twelve patients with back pain preoperatively. Bony fusion was achieved in thirty-two patients. One patient had nonunion and achieved bony fusion after revision.</p><p><b>CONCLUSION</b>Posterior closing wedge osteotomy was suitable to kyphosis less than 40 degrees. Anterior release and posterior spinal osteotomy was effective, especially to the patients with severe kyphosis deformity or with operation history. Patients with incomplete neurological deficits and/or severe back pain could get benefit from osteotomy of spine, even if their medical history was long.</p>

[Survey of health status and healthcare service demand of perimenopausal women in Guangdong].

OBJECTIVE: To understand the health status and healthcare service demand of perimenopausal women in Guangdong Province so as to explore the mode and methods for implementing climacteric and senectitude healthcare. METHOD: Using the method of stratified and cluster sampling and according to the geographical features of Guangdong Province, we selected 4 500 perimenopausal women aged 40-65 years from 5 relatively small cities (representatives of the urban areas) and 4 counties (representatives of the rural areas) for this survey. RESULTS: The average age of natural menopause was 48.6 years in this cohort of women, and was 48.9 years in women from the urban areas and 48.3 years in those from the rural areas. The total incidence of diseases was similar in the urban and rural areas (38.5% vs 39.5%), accounting for an incidence of 39% in the total subjects. The 6 most prevalent diseases were bone and joint disease (12.5%), hypertension (9.2%), myoma of the uterus (6.8%), gastric or duodenal ulcer (5.2%), cardiac disease (2.7%) and diabetes mellitus (2.2%). In bone and joint disease, knee joint disease and lumbar vertebrae disease were the commonest (34.3% vs 32.8%), and the incidence of bone fracture was 2.5%. Perimenopausal syndrome had a prevalence rate of 68.1%, and the most distressful symptoms were sleeplessness, muscular, bone and joint pain, fidgety, dizziness, of which 86.8% were mental symptoms and 86.0% body symptoms. Women(71.2%) with perimenopausal symptoms received no medical treatment, and only 20.5% had ever sought medical care in the department of obstetrics and gynecology, often taking traditional Chinese medicines (53.9%). Only 1.4% of the symptomatic women received hormone therapy, the rate varied from 1.0% in the rural areas to 1.8% in the urban areas. CONCLUSION: Perimenopausal syndrome and its related diseases severely affect the physical and mental health of perimenopausal women, who demand extensive healthcare services.

Treatment of spinal fractures complicating ankylosing spondylitis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the treatment of spinal fractures in ankylosing spondylitis.</p><p><b>METHODS</b>Nineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively.</p><p><b>RESULTS</b>All of 19 cases were up to the diagnosis standards of ankylosing spondylitis. Eleven patients had cervical fracture and 8 had thoracolumbar fracture. Of the patients with cervical fracture, fractures occurred at C(5 - 7) in 9 patients. Of the patients with thoracolumbar injury, stress fractures were seen in 7 patients and all of seven fractures occurred at T(10)-L(2). Sixteen of the 19 patients sustained fractures through three columns of the spine. Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture. All of the 19 patients were treated operatively. Four different surgical procedures were used in patients with cervical fracture; decompression, fusion and stabilization with instrumentation by anterior approach were performed in 9 patients. Of the patients with thoracolumbar fractures, four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases. Eighteen patients had an average follow-up period of 46.6 months. Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1. Radiographic evidence of fusion was observed in all of the 18 patients. Two patients suffered neurological deterioration during surgery. One patient died from cerebrovascular infarction. Two patients had pneumonia after the operative procedure.</p><p><b>CONCLUSIONS</b>Spinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury. Shearing fracture usually occurs at the lower cervical spine (C(5 - 7)) and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine. Surgical intervention may be indicated in this injury. Fracture union and neurological improvement can be achieved in most patients treated by operation. We suggest that, fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture, and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture. Complications is not rare after surgery and appropriate preventive measures are necessary for these patients.</p>

Reoperation after surgical treatment of lumbar spondylolisthesis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the causes of failure following surgical treatment of lumbar spondylolisthesis, procedures for redo surgery and the final result of reoperation.</p><p><b>METHODS</b>20 patients who had a repeat operation for lumbar spondylolisthesis were studied retrospectively. On average 24.3 months following the previous surgery, all of these patients had recurrence or progression of back and leg pain. All of 20 patients were reoperated by means of three different procedures.</p><p><b>RESULTS</b>The causes of failure were post-operative destabilization (6 cases); progressive spondylolithesis (3 cases) implants failure (10 cases) and mistake segment (one case). After reoperation, a mean 34.1 months' follow-up was made. The excellent or good rate was 90%. Incorporation of graft was found in 18 cases with fusion by inter-transverse process and 2 cases by intervertebral space. New bone formation was found in 6 out of 8 cases that had a simultaneous intervertebral cage implant. No implant failure was found in all patients.</p><p><b>CONCLUSIONS</b>Simple laminectomy or discectomy was not indication for lumbar spondylolithesis. No bone graft or union was the main causes of implant failure. Posterior instrumented fusion with laminectomy decompression can be used in the patients who had a prior surgery of simple discectomy or anterior intervertebral bone graft. Except for posterior instrumented fusion with extensive laminectomy decompression, Intervertebral fusion should be considered in the patients who had a prior surgery of laminectomy decompression with instrument, anterior intervertebral fusion (ALIF) was recommended for these cases.</p>

[Genetic polymorphism of six short tandem repeat loci in the Han population in Hebei province of China].

OBJECTIVE: This article reports a population genetic study on six short tandem repeat(STR) loci, D7S820, D19S253, D12S391, D5S818, D16S539 and D8S1179, in a sample of unrelated Chinese Han individuals(n=122-173) living in Hebei province. METHODS: DNA extraction from blood samples (200 in number) and multiplex amplification of the above six loci were carried out. Using denaturing polyacrylamide gel electrophoresis and silver stain, the authors investigated the distribution of allele frequencies of the six loci in Han population in Hebei province. RESULTS: The STR polymorphisms at all of the six loci were observed in Chinese Han population in Hebei province. The observed heterozygosities of D7S820, D19S253, D12S391, D5S818, D16S539 and D8S1179 were 0.828, 0.757, 0.769, 0.837, 0.785 and 0.852, respectively. The measured values of the power of discrimination (PD) were 0.914, 0.919, 0.940, 0.909, 0.917, 0.944; of the mean exclusion chance(MEC) 0.618, 0.740, 0.801, 0.557, 0.655, 0.696 and of the polymorphism information content (PIC) in Chinese 0.771, 0.760, 0.762, 0.708, 0.776 and 0.794, respectively. CONCLUSION: The genotype distributions of the six STR were in accordance with Hardy-Weinberg equilibrium. The numerical values of the PD and MEC are relatively high in Hebei province, and thus can be of significant application in population genetics and forensic medicine.