Epidural abscess T5T8 due to methicillin-resistent staphylococcus aureus in an immunocompetent patient.

A 28-year-old man was admitted with severe thoracic pain, a body temperature of 37.20, paraplegia and sphincter disturbances. MRI revealed an epidural abscess T5T8. A decompressive laminectomy T5T8 was performed and the abscess was removed. A methicillin-resistent Staphylococcus aureus was cultured. Vancomycin was administered. Six months later muscle testing showed values from 3/5 to 4/5. MRI is the first choice diagnostic tool. Laminectomy, drainage and intravenous antibiotics constitute the basic treatment. Antibiotics alone can be sufficient in case of whole spine involvement, lumbosacral localization without neurological symptoms, fixed neurological deficit, complete paralysis for more than 72 hours, or severe concomitant medical problems.

Optimized pathway to schistosomiasis elimination in China: a scrutiny using a marginal benefit approach / 中国血吸虫病防治杂志

Following concerted efforts for over 7 decades, great achievements have been gained in the national schistosomiasis control program of China. Currently, China is moving towards the stage of schistosomiasis elimination, when the major task is to make full use of available resources to improve schistosomiasis surveillance and response to sustainably consolidate gained schistosomiasis control achievements and prevent re-emerging schistosomiasis. There is therefore an urgent need for optimization of interventions for schistosomiasis elimination. Based on analysis of socioeconomic features at different stages of the national schistosomiasis control program in China, this review discusses the relationship between the needs of assessment of schistosomiasis elimination interventions and the optimized strategy of schistosomiasis elimination at different stages of the national schistosomiasis control program using a marginal benefit approach and proposes the optimized schistosomiasis elimination strategy that allows the highest marginal benefit with currently available schistosomiasis elimination costs, so as to provide the optimal strategic pathway to schistosomiasis elimination and facilitate the achievement of the targets set in Healthy China 2030.

Epidemiological characteristics and transmission routes of COVID-19 asymptomatic infected patients in Shaanxi Province / 西安交通大学学报(医学版)

【Objective】 To assess the epidemiological characteristics and transmission risk of asymptomatic COVID-19 infection in Shaanxi Province. 【Methods】 A dense population database of COVID-19 cases in Shaanxi Province was constructed as of March 26, 2020, and 28 asymptomatic infected patients were selected through case epidemiological investigation report for descriptive analysis. 【Results】 In Shaanxi Province, the majority of asymptomatic COVID-19 infections were in the 20-59 years old group, and women took up a higher proportion than men. 82.14% of asymptomatic infections were found in the centralized isolation state. Nearly 80% of asymptomatic infections and confirmed cases were mainly exposed by living together in the family. The median number of days from last contact with the source of infection for all asymptomatic infected persons was 13, with 3 (10.71%) showing clinical symptoms. Epidemiological investigations showed that asymptomatic infections could spread as a result of shared family life. 【Conclusion】 At present, imported cases in Shaanxi Province continue to exist. Considering the concealed transmission of asymptomatic infections, prevention and control work is still facing challenges.

Use of landsat TM satellite surveillance data to measure the impact of the 1998 flood on snail intermediate host dispersal in the lower Yangtze River Basin.

To assess the impact of the 1998 flood on snail distribution in the lower Yangtze River Basin, two study areas were selected, one in the Poyang Lake region, and the other along the Yangtze River in Jiangsu province. Using image analysis software, geocoded Landsat TM data were used to create TNDVI maps based on the formula TNDVI=Sqrt[(band4-band3/band4+band3)+0.5]. The images taken in the flood season were classified to produce a map depicting water and land. The images taken during springtime were processed and classified based on TNDVI. Composite images were created based on the time difference analysis, combining the flood season maps and spring vegetation maps to produce a map in which potential snail habitats were identified. When compared with ground survey data collected in the spring of 2000, the correspondence rate between potential snail habitats identified by image analysis of 1998-1999 Landsat TM data and ground survey data was over 90% in both regions. Results indicate that ecology based Landsat TM image analysis provides a new way to predict snail distribution under specific environmental conditions associated with the extent of the annual flood season.

Open and closed kinetic chain exercises promote the recovery of function after anterior cruciate ligament reconstruction / 中华物理医学与康复杂志

Objective To compare the clinical effects of open kinetic chain (OKC) exercises with those of closed kinetic chain (CKC) exercises and limited open kinetic chain combined with closed kinetic chain exercises on rehabilitation after the anterior cruciate ligament reconstruction.Methods Ninety-four patients recovering from single-bundle anterior ligament reconstructions were enrolled and randomly divided into an OKC group (n =33),a CKC group (n =30) or a limited open kinetic chain combined with closed kinetic chain group (combined group) (n =31).Lysholm score,International Knee Documentation Committee (IKDC) score,KT-1000,and active and passive range of motion were evaluated for the 3 groups three and six months after the surgery.Results Three months after surgery,significant differences were found among the 3 groups in Lysholm scores [(87.00±4.79),(83.67± 3.55) and (86.71±3.62) respectively],IKDC scores [(89.45±4.79),(86.40±3.76) and (88.58±3.60) respectively],KT-1000[(1.99±0.30),(1.05±0.26) and (1.02±0.24) mm],as well as active and passive range of motion [(10.06±2.06),(7.73±1.41) and (8.10±1.35) mm;(9.76±2.26),(7.87±1.89) and (8.39±1.62) mm] (P＜ 0.05).Six months after surgery,no significant differences were found in Lysholm scores and IKDC scores(P＞0.05),but significant differences were found in KT-1000,and active and passive range of motion(P＜0.05) compared to those at 3 months after surgery.Moreover,there were no significant differences between the OKC and combined groups in Lysholm scores and IKDC scores(P＞0.05),but significant differences between them in active and passive range of motion (P＜0.05).There were no significant differences between the CKC and combined groups in Lysholm scores,IKDC scores,KT-1000,and active and passive range of motion(P＜0.05).Conclusion Combining limited open kinetic chain exercise with closed kinetic chain exercise is safe and reliable in the rehabilitation after anterior cruciate ligament reconstruction.

Optimum combination of orientation parameters of total hip prosthesis / 中华创伤杂志

Objective To study the optimum combination of orientation parameter of total hip prosthesis and acetabular safe zone on condition that the range of motion for activities of daily living (ADL) is fulfilled.Methods A three-dimensional generic parametric and visually kinematic simulation module of THA was developed.Range of motion ( ROM ) of hip flexion ≥ 110°,internal-rotation ≥30° at 90° flexion,extension ≥30° and external rotation ≥40° were defined as the normal criteria for ADL.ROM of hip flexion ≥ 120°,internal-rotation ≥45° at 90° flexion,extension ≥30° and external rotation ≥40° were as the severe criteria.The ranges of changes in general ratios (GRs) of head-neck,femoral neck antevemion ( FNA ),operative inclination (OI) and anteversion (OA) of acetabulur components were 2.0-2.92,0°-30°,10°-60°,and 0°-70° respectively.Within the limits of the upper two activity criteria,the synchronous OA of acetabulur components was calculated with every 5°change in OI of the cup,and the collodiaphyseal angle ( CDD ) was set as 135°.The safe-zone of combination of acetabulur operative anteversion (OA) and inclination (OI) was defined as the area that fulfilled the two mentioned criteria of ROM without cup-neck impingement.All parameters were analyzed by using SAS 6.12 software.Results The safe zone of acetabdar angle rose with the increase of GRs of head-neck and the safe zone of severe criteria was smaller than that of normal criteria.When the CDD angle was 135°,the sum of average aeetabular OA and acetahular OI plus 0.816 times of the FNA equaled to 84.76° innormal criteria; and the sum of average acetabular OA and acetabular OI plus 0.873 times of the FNA equaled to 92.04° in severe criteria.Conclusions A high GR of head-neck greatly increases the size of safe-zone of acetabular angle.The higher demand of ROM of hip joint requires the smaller safe zone of acetabular angle,as can be corrected by increasing the GR of head-neck.The optimum combination between the sum of average acetabular OA and acetabular OI ( Y) plus FA (X)in the normal criteria and severe criteria can be estimated by using the following formulae:Y1 =-0.816X1 + 84.76 (R2 =0.993 ),Y2 =-0.873X2 + 92.04( R2 =0.999) respectively.

Suture anchors fixation in the treatment of acute distal avulsion fracture of patella / 中华骨科杂志

Objective To investigate the feasibility and clinical effects of suture anchors technique for acute distal avulsion fracture of patella. Methods From January 2007 to July 2009, 33 patients(18males and 15 females, ranging from 28 to 72 years, with an average of 49.3 years) were treated with the suture anchors technique. The average time from injury to surgery was 3.5 days(2 to 7 d). Injury reason: traffic accident in 12 cases, injured in daily life in 11 cases, sports injury 9 cases, no clear trauma history in one case. The Bostman evaluation system, follow-up X-ray, and knee mobility were used to analyze the clinical effects of suture anchors technique. Results All patients obtained the follow-up and the average time was 16.5 months(12 to 23 months ). One patient suffered foreign body reaction, and his wound healing was good after operation. The remaining patient wound healing was good. No complications were found in all patients,such as popliteal fossa artery, tibial nerves or peroneal nerve complication. Bostman patella fracture functional score 27.3±2.3 points at the sixth months follow up, 28 cases were rated as excellent, 5 cases were good, and the excellent and good rate was 100%. Six months later, X-ray showed bone healing, knee activity recovered well. The Range of Motion was extension for -2.5°±2.1° and flexion for 122°±5.3°. Conclusion Suture anchors fixation in treatment of acute distal avulsion fracture of patella has a good efficacy, safety and reliability advantages, and without the second operation. This technique provides an alternative in lower pole patella fracture.

Anatomical study of motor branches from tibial nerve transfer to restore the deep fibular nerve / 中华显微外科杂志

Objective To explore the feasibility of tibial nerve motor branches transfer to the deep fibular nerve in an anatomical study.Methods Twenty-three sides lower limbs from 12 adult cadavers which preserved in Formalin were used for dissection of the tibial nerve and its all motor branches,and the proximal deep and superficial fibular nerve.Experimental measurement were performed for the parameters of each branch such as length,diameter,the location of original point relative to the level of the fibular head.The diameter of proximal part of the deep fibular nerve was measured simultaneously.Finally,the length from original point of each branch to the fibular neck was also measured during simulation of nerve transfer procedure.Results The average length of motor branches to the flexor digitorum longus muscle,to the flexor hallucis longus muscle and the superficial branches to the soleus muscle were (95.70 ± 13.40)mm,(96.90± 13.60)mm and (73.60 ± 12.00)mm respectively.Their average diameter were (0.63 ± 0.16)mm,(0.65 ±0.20)mm and ( 1.56 ± 0.26)mm respectively.The average diameter of proximal deep fibular nerve was (2.54± 0.26)mm.Based on length,branches to the flexor digitorum longus muscle and flexor hallucis longus muscle were adequate for direct nerve transfer to the deep fibular nerve in all specimens without interpositional grafr.And in 22 specimens (95.7 percent),the superficial branches to the soleus muscle were long enough to directly transfer.Other branches of the tibial nerve were not adequate for direct nerve transfer Conclusion This study confirmed the anatomical feasibility of using motor branches from tibial nerve for direct transfer to restore the deep fibular nerve.The superficial branches to soleus muscle were the best donor nerve if considering the branches,length,diameter and the difficulty of surgical procedures.

The pair ringer technology for bony avulsion of the posterior cruciate ligament under arthroscopy / 中华骨科杂志

Objective To investigate the feasibility and clinical effects of the pair ringer technology for bony avulsion of the posterior cruciate ligament under arthroscopy. Methods From January 2005 to July 2009, 23 patients were treated with the pair ringer technology for bony avulsion of the posterior cruciate ligament by arthroscopy. There were 15 male and 8 female, with an average of 39.3 years (ranging from 28 to 52 years). There were 4 cases of type Ⅱ, 14 type Ⅲ, and 5 type Ⅳ according to Meyer-Mckeever classification. The outcome measures were X-ray and MRI testing, Lysholm and Tegner knee function score. Results All the operations were finished in an hour. There were no complications as nerve injury or infection occurred in the study. The patients were followed-up for an average of 16.5 months (12-23 months). The Lysholm score rose from 50.3±6.1 preoperatively to 89.7±8.3 at the six months postoperatively (t=18.34, P=0.0007). The Tegner score rose from 1.7±0.5 preoperatively to 5.7±1.3 at the six months postoperatively (t=13.77,P=0.0008). All of the patients recover a functionally stable knee and have considerably improved knee function compared with their preoperative status. Conclusion The pair ringer technology under arthroscopy is a liable method for bony avulsion of the posterior cruciate ligament. This minimally invasive technology leads to rigid fixation, early rehabilitation.

Coverage the soft tissue defect in the foot and ankle with peroneal artery perforator-based sural neurocutaneous island flap / 中国基层医药

Objective To study the methods and therapeutic effect of coverage the soft tissue defect in the foot and ankle with neurocutaneous sural artery island flap.Methods 30 patients had been reconstructed foot and ankle soft-tissue defects with neurocutaneous sural artery island flap,the area of soft tissue defect from 2.0 cm × 3.5 cm～ 8.0 cm× 16.5 cm,the flaps were designed with the size measuring 2.5 cm × 4.0 cm to 8.5 cm × 18cm.Results 26 flaps survived completely and 4 with partial or margin necrosis,the wound infection occurred in 6 patients and were treated with dressing,shin graft and antibiotic drug.Conclusions Sural neurocutaneous island flaps are easy to separate.Major arteries are not injured.It is the ideal flap to repair the soft tissue defect around ankle and foot,the texture,color and contour of the flap is similar to recipient area.

Anatomy of the attachment of the medial patellofemoral ligament of human knee / 解剖学报

ObjectiveTo study the anatomic characteristic of the attachment of medial patellofemoral ligament and its function in patellar stability. MethodsThirty adult cadaver knees were used for anatomic study, and the attachments of medial patellofemoral ligament were observed and measured. Results The femoral attachment of medial patellofemoral ligament was anchored to the bone between the medial femoral epicondyle and the adductor tubercle. The fibers here were thin and narrow, and became thick and wide to the anterior. The patellar attachment was in the superior two-thirds of the medial margin of the patella. The fiber here were the thickest and the widest. Conclusion The anatomic characteristic of the attachment of medial patellofemoral ligament was revealed, providing anatomical bases for surgery.

Accuracy of "funnel technique" in the thoracic pedicle screw instrumentation: experimental and clinical study / 中华创伤杂志

Objective To evaluate the accuracy of thoracic pedicle screw placement using the "funnel technique" and investigate its consistency in experimental study and clinical application.Methods The clinical data of three human cadavers and 11 patients with the installation of at least one thoracic pedicle screw at T1 -T12 from August 2006 to July 2008 were retrospectively analyzed. One junior spine surgeon lack of experience were responsible for placing these screws with the "funnel technique".The accuracy of screw placement and the complications related to the use of thoracic pedicle screws were analyzed by assessing postoperative CT scans. Results The mean follow-up time was 23.1 months,which showed no vascular or visceral complications, or iatrogenic neurological injury. The rate of unintended cortex perforations was 14% (10/72) in cadavers and 15% (8/55) in patients, respectively.The critical perforation occurred in two screws (3%) in cadavers and one screw (2%) in patients. There was no statistical difference between the percentage of cortex perforations in cadavers and patients. Of all the 11 patients, screw violation occurred laterally in six ( 11% ), medially in one ( 2% ) and superiorly in one (2%). No violations occurred inferiorly or anteriorly. For all patients, only one screw needed revision. The perforations made by the junior spine surgeon occurred in six screws in the first cadaver, three in the second cadaver and one in the third cadaver. Conclusions The "funnel technique" is a simple,safe, accurate and cost-effective technique for pedicle screw placement. The result of the experimental study is consistent with that of the clinical application. "funnel technique" is helpful for junior spine surgeons to master the technique of thoracic pedicle screw placement.

Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament / 解剖学报

Objective To provide an anatomic evidence for the double-bundle posterior cruciate ligament (PCL) reconstruction, the sizes and locations of the attachments of the PCL to the tibia and the femur were measured. Methods We studied 30 cadaveric knees. PCLs were divided into anterolateral and posteromedial bundles to the insertion footprint, and those locations were measured and described. Results The distances from the center of the femoral insertions of the anterolateral and posteromedial bundles to the anterior margin of the medial femoral condyle were (8.52±1.81)mm and (11.63±1.81)mm. The vertical distances from the center of the femoral insertions of the double-bundle to the intercondylar roof were (4.67±0.55)mm and (10.32±1.23) mm. The vertical distances from the tibial insertion of the center of the double-bundle to the plane of the tibial articular surface were (8.43±1.21)mm and (14.52±2.31)mm. The distances from the medial margin of the articular cartilage of the tibial plateau to the center of the tibial insertions of double-bundle were (47.44±6.23)mm and (45.95±6.32)mm. The areas of the insertions of the anterolateral and posteromedial bundles on the femur were (107.12±15.25)mm~2 and (65.35±10.27)mm~2. The areas of the insertions of the double-bundle on the tibia were (50.07±11.33)mm~2and (51.08±10.22)mm~2. Conclusion The anatomic characteristic of the attachment of the anterolateral and posteromedial bundles was revealed, providing anatomical bases for surgery.

Isometry of grafts in PCL reconstruction under femoral tunnel shifting condition / 医用生物力学

Objective To explore the isometry of grafts in PCL(posterior cruciate ligament)double-bundle re-construction under femoral tunnel shifting condition.Method Knee specimens from ten fresh frozen cadavers were used.PCL were divided into anterolateral bundles(ALB)and posteromedial bundles(PMB)to the inser-tion footorint.The anterior,postedor,proximal,distal and central points of the two bundles'femoral attachment site were respectivelyanchored to the middle of the PCL's tibial attachment site by the trial wires.Changes in length of the intra-articular part of the wires were recorded while the knee was flexed from 0°to 120°.Result The length changes in every point were compared.All of the maximal length changes of ALB's proximal,pos-todor points and PMB's proximal points were not greater than 2mm.No significant difference between the length changes of ALB's proximal point and posterior(P=0.864>0.05)was found.Conclusions The femo-ral tunnel for the PCL double-bundle reconstruction should be located as follows:ALB should be at the middle point of upper edge of femoral attachment site(proximal point),while PIVIB at the middle point of femoral attachment site(proximal point).

Three-dimensional finite element analysis on computer aided reconstruction of hip capsular ligament and its biomechanical significance / 中华创伤杂志

Objective To discuss biomechanical mechanism of reconstructed joint capsule ligament stabilizing hip joint by means of three-dimensional finite element analysis.Methods A finite element model of total hip arthroplasty(THA)including ischiofemoral ligament reconstruction was construtted by using finite element analysis software Unigraphics NX 2.0 and SolidWorks 2006 to simulate seated leg crossing and obtain peak resisting moment and range of motion prior to impingement.Results The current form of finite element model was characterized by large deformation multi-body contact,large interfacial sliding and high elasticity and could clearly reflect real anatomy and biomechanical behavior of ischiofemoral ligaments.Compared with model with only metal,model of ischiofemoral ligament reconstruction could reduce the peak polyethylene stress at the impingement site and at the head egress site by typically 17%and 31%respectively,increase peak resisting moment by nearly 57%and provide 2.29-fold stability.Conclusions As a discrete structure within the posterior capsule of the hip joint,the ischiofemoral ligament may be the most important contributor to the mechanical integrity of the posterior stability structure.The joint capsule ligament must be reconstructed in hip arthroplasty.

Arthroscopically assisted mini-incision arthrolysis for the stiff knee / 中国矫形外科杂志

[Objective]To discuss the method and effectiveness of arthroscopically assisted mini-incision arthrolysis for the stiff knee.[Method]A small lateral suprapatellar incision was made in all 26 patients suffered from stiff knee,and the scissors were introduced the joint to release the adhesive tissues of patellofemoral joint.All adhesive tissues between the medial,lateral retinaculum and the femur,and the between vastus intermedius and femur were released subsequently.After the release of the adherence between the fat pad and femoral condyle,the lateral retinaculum was dissected 1 cm lateral to the patellae,and the dissection of medial retinaculum was applied at the insertion of the vastus medialis.Eventually,arthroscopic debridement and hemostasis combined with manipulative release was applied to remove all remanent adhesive bundles and scar tissues.[Result]Follow-ups were maintained for an average of 19 months(range,from 8-32 months).An increase in the average range of motion of the knee was attained from 32 degrees preoperatively to 113 degrees postoperatively.No complications such as skin necrosis,wound dehiscence,tendon rupture and fracture had occurred during the follow-up period.[Conclusion]The advantages of arthroscopically assisted mini-incision arthrolysis for the stiff knee include simple procedure,minimal trauma,and quick rehabilitation.Otherwise,reservation of the insertion of vastus medialis is of great importance not only for the maintenance of extensive strength and stability of the knee,but also for the functional recovery and the reduction of complications.

The Relationship between A-type Character with Different Classification of TCM and Emotional Disturbance in Coronary Artery Disease Patients / 中国中医药信息杂志

Objective To investigate the relationship between different behavior types with classification of TCM and emotional disturbance in coronary artery disease (CAD) patients. Methods Two hundred and forty-two CAD patients were investigated and grouped to A or B type behavior with type A behavior pattern questionnaire (TABPQ) and symptom check-list 90 (SCL-90). To analysis the emotional disturbance in two groups and investigate their relations with syndrome classification of TCM. Results SCL-90 factor score of anxiety and depression in CAD patients was obviously higher than Chinese norm. Factor score of depression, anxiety, hostility, phobia, paranoid and psychotic state in A-type behavior group was obviously higher than that in B-type group, with statistical significance (P

Prevention of early dislocation rate after total hip arthroplasty with posterior capsulotendinous repair / 中国矫形外科杂志

[Objective]To investigate the clinical results and significance and mechanism of early dislocation rate after total hip arthroplasty following the posterolateral approach with posterior capsulotendinous repaired.[Method]The incidence of early dislocation and the prosthetic range of rotation motion among 212 consecutive primary THAs with the posterior capsule and the short external rotators which had been sutured to the medius tendon was reviewed retrospectively,and was compared to the results of 486 consecutive unilateral primary THAs with a complete posterior capsulectomy.[Result]During a 6 months to 5 years(3.7 years in average)following-up,there were significant differences between two groups.In patients with posterior capsulotendinous repair,two of 224 primary total hip arthroplasty(0.9%) had an early posterior dislocation.In patients with a complete posterior capsulectomy,27 of 486 primary total hip arthroplasty(5.6%) had an early dislocation.The difference was statistically significant(x~2=8.51,P

Application of radiofrequency vaporization in arthroscopic treatment of knee disorders / 中国微创外科杂志

Objective To investigate effects of radiofrequency vaporization in arthroscopic treatment of knee disorders.Methods Arthroscopic surgery was conducted in 126 consecutive cases of various knee disorders by using the Arthrocare 2000 System,includng 72 cases of meniscus injury,20 cases of synovitis,15 cases of osteoarthritis,8 cases of patella subluxation,6 cases of synovial syndrome,and 5 cases of anterior cruciate ligament rupture.Results All the patients were followed postoperatively.Knee function evaluation with the Neer Scores showed excellent outcomes in 82 cases,good in 35 cases,and fair in 9 cases,the rate of excellent-or-good outcomes being 92.9%.Conclusions Application of radiofrequency vaporization under arthroscopy for knee joint disorders has advantages of simple and accurate performance,effective hemostasis,minimal invasion,and quick recovery of joint functions.

Clinical Observations on the Treatment of Senile Skin Pruritus with Yin-reinforcing and Blood-nourishing Drink Plus Electroacupuncture / 针灸推拿医学（英文版）

Purpose: To investigate the clinical effect of Yin-reinforcing and Blood-nourishing Drink plus electroacupuncture in the treatment of senile skin pruritus. Methods: Eighty patients were randomly divided into two groups. The treatment group was treated with Yin-reinforcing and Blood-nourishing Drink plus electroacupuncture and the control group, with Western medicine. Results: The total effective rate was 100.0% in the treatment group and 67.5% in the control group (P＜0.01). Conclusion: This therapy has a better effect on senile skin pruritus.