Objective To analyze the results and indications of anterior, posterior or combined surgery for thoracolumbar burst fractures. Methods A retrospective review of surgically managed thoracolumbar burst fractures from 1998 to 2003 was performed. There were 76 males and 13 females, and the age of the patients were from 17 to 51 years with an average of 36.8 years. The fractures were located at T11 in 10, T12 in 21, L1 in 29, L2 in 18 and L3 in 11. According to Magerl classification, type A fractures were 68, and type C were 21. Of the 89 patients, 41 received posterior surgeries, 40 anterior surgeries, and 8 combined anterior and posterior surgeries. Operative notes, preoperative and postoperative neurological status, radiographs, CT scans, and follow-up records were reviewed. Results All of the 89 cases had successful surgery. Seventy-eight patients were followed-up for 6 to 48 months (average 12 months). Neurological status improved at least 1 ASIA grade in all of the 65 patients who had preoperative incomplete paraplegia. In the posterior surgeries, pedicle screws broken in 2 cases, deep infection in 1 case which was cured after debridement. The correction of anterior vertebral body height and Cobb's angle averaged 9.4 mm and 14.8? postoperatively, and the correction loss averaged 0.5 mm and 7.5? respectively at 6 months after surgery. And the correction loss was most evident at the above disc spaces, then the below disc spaces. In the anterior surgeries, leakage of cerebrospinal fluid in 2 cases which cured with dressing change, the other cured after debridement, implant removal and posterior fixation. The spinal canal was enlarged, and the spine recovered normal curvature. No evident correction loss, pseudoarthrosis or implant failure was noted at follow-up. Conclusion The choice of anterior, posterior or combined surgery for thoracolumbar burst fractures depends on neurological status and column stability. The vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.

Objective To analyze the results of one-stage combined anteroposterior surgery in lateral position for serious thoracolumbar fracture dislocation. Methods A retrospective review was performed for surgically treated thoracolumbar fractures from October 1998 to September 2005. Of all the 192 patients, the 34 serious cases were treated with one-stage combined anteroposterior surgery. There were 25 males and 9 females, 34.2 years old on the average (ranging from 18 to 56 years). Segments involved: T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 8 cases, L3 in 5 cases, L4 in 2 cases and L4,5 in 1 case. According to the Classification of Magerl, there were 12 cases of type A3, 2 cases of B1, 2 cases of B2, 12 cases of C1, 4 cases of C2 and 2 cases of C3. During the operation the patients were in lateral position. Laminectomy and pedical screw insertion were performed posteriorly first; anterior corpectomy, reduction and strut graft were accomplished through an additional anterior approach. The final fixation was finished by clapping the strut graft with pedical screw system. Operative notes, preoperative and postoperative neurological status, ASIA scales, radiographs, CT scans, and follow-up records were reviewed. Results All these surgeries were performed successfully without any neurological deterioration. 32 of 34 patients were followed-up for 6 to 60 months (13 months on average). Neurological status improved at least 1 ASIA grade in 24 patients with preoperative incomplete paraplegia. 6 patients complained intercostals nerve injury symptom which alleviated with conservative treatment. During follow-up, lumbar physical lordosis was reconstructed and no evident correction loss, pseudoarthrosis or implant failure was noted. Conclusion One-stage combined anteroposterior surgery can be accomplished in a lateral position. It was proved to be an effective treatment for serious thoracolumbar fracture dislocation.

Objective To study the microanatomy of the petrosal vein(PV) and discuss the surgical management of the vessel during microvascular decompression.Methods A total of 15 cadaveric(30 PVs) heads were obtained from dead adults.The position,morphology,branches,and variation of the PV,and anatomical relationship between the trigeminal,facial and acoustic nerves and the vessel were observed.Sixty patients with trigeminal neuralgia or hemifacial spasm were also enrolled in this study.Microvascular decompression was performed on the cases,and the PV and its branches were observed during the operation.Results The PV is formed by the union of 2 to 3 branches.It passes through the the subarachnoid space and terminates in the inner two third of the superior petrosal sinus.Classfied by number of the unilateral PVs,3 types of the vessel has been observed:single-stem(9 sides,30.0%),double-stem(17 sides,56.7%) and triple-stem types(4 sides,13.3%).Moreover,according to the anatomical relationship between the end of the PV and auditory meatus,the vein has 3 subgroups:interior-side(17/55,30.9%),intermediate(24/55,43.6%),and exterior-side(14/55,25.5%) subgroups.In our specimens,8 PVs(the main stem or a branch) touched the trigeminal nerve,and 19 PVs were less than 1 mm away from the nerve.None of the PVs connected to the faical and acoustic nerves.In the 60 patients who recieved microvascular decompression,107 PV branches(19 single-stem veins,35 double-stem vessels,and 6 triple-stem veins) were found during the operation,among which 33 belonged to interior-side subgroup,46 were classifed as intermediate type,and 28 were exterior-side veins.Conclusions Management of the PV is the key step for cerebellopontine angle surgery.The vein or its branches can be cut off when they compress the surrounding tissues or obstruct the surgical field.

Tetrodotoxin(TTX) is a potent sodium channel blocker. It can affect the generation of action potentials of cell membranes by blocking sodium channel. Damaged tissues express a Tetrodotoxin resistant(TTX R) Na + current which provides a potential target for therapeutic intervention in a range of pain states. We summarize the influence of tetrodotoxin on sodium channel and the possible mechanism of the analgesic effect.

BACKGROUND:Bone marrow mesenchymal stem cells as non-hematopoietic stem cells from the mesoderm mostly come from the bone marrow, which have a stronger self-renewal ability, multilineage differentiation ability and low immunogenicity and are easy to receive the introduction of foreign genes. Therefore this kind of cells have become the research hotspot in recent years. OBJECTIVE:To summarize the latest clinical application and advancement of bone marrow mesenchymal stem cels in the treatment of various diseases. METHODS: PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and SinoMed (http://www.sinomed.ac.cn/zh/) databases were searched by the first author using the keywords of bone marrow mesenchymal stem cells, therapy to identify the relevant articles published in English and Chinese, respectively, from 2011 to 2016. After excluding repetitive, irrelevant or Meta-analysis literatures, we enrolled 49 literatures for final analysis. RESULTS AND CONCLUSION:Studies on bone marrow mesenchymal stem cells have achieved new grades in the treatment of respiratory system disease, cardiovascular disease, urinary system disease, nervous system disease, liver disease, diabetes mellitus, hematological system disease, autoimmune disease, graft-versus-host disease, motor system disease, although its application has the risk of oncogenicity. Further investigation on the oncogenicity of bone marrow mesenchymal stem cells will be gradually explored, aiming to a better clinical use of bone marrow mesenchymal stem cells.

Objective To develop an ultra-high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to simultaneously detect the contents of gallic acid, syringin, phellodendrine, aesculin and rhein in the gallnut lotion. Methods An UPLC- MS/MS method was established. Separation was performed on an Agilent Poroshell 120 EC-C₁₈(2.1 mm×150 mm, 2.7 μm)with a gradient mobile phase system of 0.2% formic water-acetonitrile solution. The flow rate was 0.3 ml/min. The temperature of column was 30 ℃. The injection volume was 2 μl. The MS detection was in dynamic MRM mode. Results gallic acid, syringin, phellodendrine, aesculin and rhein were successfully separated using this method, with good linear relationship as the ranges of 153.8-15380、10.31-1031、5.265-526.5、50.70-5070、1.054-105.4 ng/ml, respectively. The precision, repeatability, stability and recovery were good. Conclusion This UPLC-MS/MS method is stable, rapid, and reproducible., It is suitable for detecting the contents of gallic acid, syringin, phellodendrine, esculetin and in the gallnut lotion.

Objective To explore the methods of internal fixation for femoral neck fractures and evaluate the biomechanical characteristics of the interlocking expanding compressive screw (IECS)of Type HZS. Methods Based on the special biomechanical characteristics of the femoral neck fracture, the device of internal fixation was designed to consist of main screw, bifurcate screw, boost screw cap, washer, compressive screw cap, oblique interlocking screw and main screw cap. Its biomechanical performances were evaluated through comparison with those of the dynamic compressive screw (DCS), twin compressive screw (2CS) and three cannulated screws (3CS) respectively. Results The mechanical performances of the femoral neck fracture fixed with the interlocking expanding compressive screw were superior to those of the others in displacement ,axial and level stiffness, torsional strength and stiffness and terminal loading. Conclusion Interlocking expanding compressive screw can efficiently withstand the splitting, torsional, shearing, tensional and compressive forces in the fracture, and is simple, safe and easy to use. [

Objective To investigate the effects of different culture media and pretreatment methods on the results of matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS) for the identification of Vibrio parahaemolyticus,and then provide the optimal conditions.Methods Forty strains of Vibrio parahaemolyticus were collected,and subcultured with the blood agar plate,thiosulfate citrate bile salts sucrose(TCBS) agar plate and double wash agar plate,respectively.The pretreatment methods before mass spectrometry included the smear method,extension method and extraction method.The effects of different culture media and pretreatment methods on the results of MALDI-TOF MS for the identification of Vibrio parahaemolyticus were analyzed by the logistics regression model and Chi-square test of SAS software.Results The detection rate of Vibrio parahaemolyticus was the highest in the combination of blood agar plate with the extraction method(genus level:100％;species level:67.5％),followed by the combination of double wash agar plate with the extraction method(genus level:70％;species level:37.5％).For the genus identification level of Vibrio parahaemolyticus,when the pretreatment method was the same,different culture media produced significantly different detection rates(P ＜ 0.01).However,when the culture medium was the same,there was no significant difference in detection rates for different pretreatment methods (P ＞ 0.05).The odd ratios (OR) of the smear method and extention method relative to the extraction method were 0.66 and 0.95,respectively,and there was no significant difference in detection rates for them(P ＞ 0.05),while the ORs of the TCBS agar plate and double wash agar plate relative to blood agar plate were 0.06 and 0.10,respectively,and there was significant difference in detection rates for them(P ＜0.05).The logistic regression equation was Y=2.95-0.41a-0.05b-2.83c-2.83d(a:smear method;b:extension method;c:TCBS agar plate;d:double wash agar plate).For the species identification level of Vibrio parahaemolyticus,when the extension method or the extraction method was used,different culture media produced significantly different detection rates(P ＜ 0.05).When the blood agar plate was used,different pretreatment methods also produced significantly different detection rates(P ＜ 0.01).The ORs of the smear method and extention method relative to the extraction method were 0.32 and 0.55,respectively,and there was significant difference in detection rates for them (P ＜ 0.05),while the ORs of the TCBS agar plate and double wash agar plate relative to blood agar plate were 0.18 and 0.49,respectively,and there was significant difference in detection rates for them(P ＜0.05).The logistic regression equation was Y =0.20-1.15a-0.61b-1.72c-1.72d(a:smear method;b:extension method;c:TCBS agar plate;d:double wash agar plate).Conclusion For improving the detection rate of Vibrio parahaemolyticus by MALDI-TOF MS,the selection of appropriate culture medium is more important than that of the pretreatment method.It is recommended that the extraction method may be as a conventional pretreatment method,and that the optimal medium is the blood agar plate,followed by the double wash agar plate and TCBS agar plate.

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability.Methods A retrospective review was performed on 15 patients with upper cervical fracture and instability treated with cervical pedicle screw fixation and fusion from September 2006 to January 2009.There were 11 males and 4 females,at average age of 41.2 years(range,18-60 years).Of all,there were five patients with atlas fracture and dislocation(including three simple anterior arch fractures and two Jefferson fractures),three with axis fracture and dislocation,one with dens fractures plus nonunion,two with C2,3 fracture and dislocation and four with atlantoaxial instability without fracture.The main clinical complaints included local neck pain and/or tetraplegia.Halo traction was recommended to restore the cervical sequence preoperatively in all patients.All 15 patients were treated by cervical pedicle screw-rods internal fixation and bone graft fusion.During the operation,the point and angle of the implanted pedicle screws were determined by preoperative X-ray and CT scan and the bony channel drilled with free-hand before implantation of the Summit or Vertex pedicle screws(22-26 mm long)and posterior interlaminar autologous or allogeneic bone fusion.Patients could get out of bed with neck collar at days 1-2 after operation.Results A total of 64 cervical pedicle screws were implanted in all 15 patients,with no vertebral artery injury,spinal cord injury or cerebrospinal fluid leakage.Postoperative X-ray and CT scan confirmed satisfactory internal fixation.The clinical symptoms were improved significantly.Fourteen patients were followed up for 12-36 months,which showed bony fusion,with no looseness or breakage of the screws.Neurologic impairment was improved in all patients,with no complications associated with the cervical pedicle screw.Conclusions Cervical pedicle screw internal fixation can reestablish the upper cervical vertebrae stability and help to recover the spinal cord and nerve function and hence is a reliable method for upper cervical fracture and/or instability.

Objective To analyze the antimicrobial resistance profile of clinical isolates in Shanghai Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine , a member of China Antimicrobial Resistance Surveillance System, during 2015, for the purpose to facilitate rational antimicrobial therapy. Methods Strain identification?and?susceptibility?testing?were?carried?out?for?the?clinical?isolates?using?MicroScan?WalkAway?96?Automated?Systems and Kirby-Bauer method. Results In 2015, a total of 1815 isolates were collected, including gram-negative bacteria (73.2 %) and gram-positive bacteria (26.8 %). The top three frequently isolated species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. ESBL-producing strains were found in 36.3 % of the Escherichia coli isolates, 12.6 % of the Klebsiella (K. pneumoniae and K. oxytoca) isolates, and 28.0 % of the Proteus mirabilis isolates. The prevalence of carbapenem-resistant strains was 0.69 % in Enterobacteriaceae isolates. The prevalence of methicillin-resistant strain was 29.1 % in S. aureus, and 61.4 % in coagulase-negative Staphylococcus isolates. No more than 15 % of the Enterobacteriaceae isolates and no more than 20 % of the P. aeruginosa and Acinetobacter isolates were resistant to carbapenems. No vancomycin-or linezolid-resistant strains were found in Enterococcus or Staphylococcus. Conclusions Antibiotic-resistant clinical isolates are a serious threat for clinical antimicrobial treatment. We should pay more attention to such urgent situation and rational use of antibiotics.