Objective To conduct biomechanical study and three dimensional finite element analysis on lumbar spondylolysis and spondylolisthesis treated with single vertebra reduction and fixation system(LSRF), and to evaluate the long term outcome of isthmic spondylolisthesis treated with direct repair and fixation with LSRF. Methods Biomechanical characteristics of LSRF was tested, and three dimensional finite element model of lumbar spondylolysis and isthmic spondylolisthesis was established, the stress of lumbar in spondylolisthesis was observed after fixation and reduction. Thirty two patients with spondylolysis and isthmic spondylolisthesis were treated with direct repair and fixation with LSRF designed by the authors from 1992 to 1995. Eighteen cases had spondylolysis, and the others accompanied with spondylolisthesis. The patients age was 28-46 years, with an average of 36.4 years. Results The biomechanical study and three dimensional finite element analysis showed that LSRF has good ability in reduction and rigid fixation. All patients were followed up for an average of 5.6 years. The latest radiographs showed that bony union occurred in 29 cases. There was no breakage and pullout of screws except dislocation of hook in 2 patients. By Henderson standard, the result was excellent in 22, good in 6, fair in 2, poor in 2. Conclusion LSRF has stronger fixation strength and higher fusion rate. Direct repair and fixation with LSRF is a good procedure for younger and middle aged patients with spondylolysis and isthmic spondylolisthesis.

Objective To evaluate biomeehanic characteristics of lumbar spondylolysis and spondylolisthesis single vertebrae reduction fixation system (LSRF), and discuss its mechanism of reduction. Method Twenty-four adult isthmus lumbar vertebrae specimen were disconnected and fixed with LSRF, Hefti, Salib's method respectively, and the biomechanic characteristics of the fixation devices were tested. Isthmus of L5 in 4 adult spine specimen was destroyed under loading to produce the spondylolisthesis model, and reduction by LSRF. Result The LSRF has a good ability for reduction and its strength for reduction is 1.6, 2.7 times as high compared with the Hefti, Salib's methods respectively. The mechanism of reduction is that the LSRF used contacted point of lamina by lamina hook as the fulcrum, through the pedicle screw to pull the spondylolisthetic vertebrae, and reduce the anterior displacement of vertebrae. Conclusion LSRF gives rigid fixation and good reduction, and provides a new and effective method for lumbar spondylolysis and isthmic spondylolisthesis.

Objective To explore the difference of myeloperoxidase(MPO)detection results among different types of samples , anticoagulant selection and comparison of detection results .Methods The plasma samples containing EDTA‐K2 or heparin and ser‐um samples of common biochemical tube without containing anticoagulant were collected from 165 persons undergoing healthy physical examination .The MPO level in 3 kinds of sample was detected .Then the detection results in each group were performed the statistical analysis .Results The MPO detection results had statistical difference between plasma samples with different antico‐agulants and between plasma samples with different anticoagulants and serum sample without anticoagulant in the same person (P<0 .05) .Conclusion Different samples types have larger difference in M PO detection results .It is suggested that each laboratory should formulate the corresponding reference intervals according to different anticoagulants ;because EDTA‐K2 anticoagulation plasma is not affected by the release of MPO from in vitro leukocytes ,it is recommended to adopt EDTA‐K2 anticoagulation blood as the first selected of M PO level detection .

Objective To investigate the characteristics of central cord syndrome without fracture or dislocation and assess the effect of surgical management.Methods Twenty-one cases of central cord syndrome without fracture or dislocation were diagnosed with X-ray radiography,CT and MRI and treated surgically.Spinal cord dysfunction and its recovery rate were evaluated using American Spinal Injury Association (ASIA) system.Radiological and clinical evaluation was performed for all cases.Pre-and postoperative ASIA scale and score were statistically analyzed.Results All cases sustained cervical spinal cord compression resulting from cervical disc herniation in 18 cases,of which five were accompanied by ligamentum flavum hypertrophy and reductus,developmental cervical spinal canal stenosis in two cases and posterior longitudinal ligament ossification in one case.Neurological dysfunction involved in the upper extremity in 15 cases and upper and lower extremity in six cases.Mean period of follow-up was 13.5months.ASIA scale was improved from C (n =9) and D (n =12) before operation to C (n =1),D (n =6) and E (n =14) in the last follow-up.ASIA score of motor and sensory dysfunction revealed a (84.3 ±12.5)％ and (62.7 ± 14.6)％ improvements,with significant difference as compared with the preoperative one (P ＜ 0.05).Conclusions Cervical disc herniation is the major factor of spinal cord compression in central cord syndrome without fracture and dislocation.Neurological dysfunction occurs mostly in the upper extremity.Surgery is an effective method to release spinal cord compression and restore neurological function.

Objective To evaluate the quality of life(QOL)of postpartum women within six months after delivery in Pudong New Area in Shanghai.Methods From January 1st to June 30th in 2011,435 postpartum women,discharged from Children and Women's Health Care Hospital in Pudong New Area,Gaoqiao Community Health Service Center and Lujiazui Community Health Service Center in Pudong New Area,were investigated by SF 36 questionaire including eight items [physical functioning (PF),role limitations due to physical problems (RP),bodily pain (BP),general health (GH),vitality (VT),social functioning (SF),role limitations due to emotional problems (RE) and mental health (MH)] and divided into three subgroups according to the duration after delivery (8-42,43-119 and 120 180 d).The SF-36 scores were compared with the control (baseline data of 25 to 36-year-old young women in Pudong New Area) or within the three groups.Statistical methods,such as t-test and analysis of variance,were applied.Results (1) The tota lscore and the scores of the seven items in SF-36 were lower than those of control (total score:74.2±11.7 vs 80.5,PF:79.0±19.0 vs 94.6,RP:47.5±12.2 vs 85.7,BP:74.0±18.7 vs 78.4,GH:73.9±13.1 vs 71.0,VT:69.8±16.2 vs 75.0,SF:78.3±20.1 vs 86.9,RE:63.4±21.7 vs 83.5,t=-11.225,-17.105,-18.914,-4.893,3.688,-6.642,-8.881 and-10.076,all P＜0.05) and no significant difference was found in MH score between the postpartum women and the control (78.3±15.0 vs 77.8,t=0.629,P＞0.05).Compared the SF-36 scores in three subgroups (8 42,43-119 and 120 180 d postpartum),the differences on PF score(73.0±19.1,86.3± 17.1,89.1±12.9),RP score(32.4±18.6,57.7±19.1,79.9±12.0),BP score(70.7±18.0,75.6±19.0,81.6±17.3),SF score(76.3±19.6,78.2±21.7,83.9±19.3),RE score(58.5±12.9,71.4± 18.3,70.1± 19.5) and SF-36 total score (72.2± 11.1,76.1± 12.8,78.0± 11.1) were all significant (F=37.744,60.640,13.137,5.185,4.577 and 10.548,allP＜0.05).The PF,VT,RE and total score of postpartum women at 120-180 days after delivery were still lower than those of the control group(t=-4.174,-2.353,-3.341 and-2.166,all P＜0.05).Conclusions The QOL of postpartum women within six months after delivery is not good enough.Up to 120-180 days after delivery,the QOL remains.More efforts should be made to improve the QOL of postpartum women by the whole society.

Specialty English of Medical Laboratory is a comprehensive and overlapping discipline and plays a major role in multiple medical courses, including Life Science, Clinical Medicine and Laboratory Medicine.However, its teaching practices are limited due to the extensive contents, scattered basic knowledge points, complexities of language learning processes and high demanding of sophisticated teaching skills.Since internet technology′s breakout and the web-based education expanding in the past decade, personalized flipped classroom has drawn considerable attention in the education field and became a hop-spot in teaching practice system.In the present study, the concepts of flipped classroom and basic characteristics of Specialty English of Medical Laboratory were elaborated, as well as the reconstructing teaching processes, exploring the concrete plan for teachers and students in undergraduate program.

BACKGROUND:Whether lumbar spondylolisthesis needs to be treated with reduction remains controversial.OBJECTIVE:To investigate the clinical effectiveness of pedicle screw fixation combined with posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis in the patients aged more than 70 years old.METHODS:The clinical data of 30 patients with degenerative spondylolisthesis aged over 70 years old undergoing pedicle screw fixation combined with posterior lumbar interbody fusion were analyzed retrospectively.The Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were compared and analyzed before and after surgery.RESULTS AND CONCLUSION:(1) Among 30 patients,12 were male and 18 female,the average age was (75.1±6.7) years old,and all were followed up for more than 12 months.(2) The postoperative Visual Analogue Scale,Oswestry Dysfunction Index and the Japan Orthopedics Association scores were significantly improved compared with baseline (P ＜ 0.05).According to the Japan Orthopedics Association scores,3 cases were cured,24 were significantly effective,and 3 effective.(3) Graft fusion was achieved at all patients,the average fusion time was (5.13±0.65) months.(4) The average operation time was (225.6±23.4) minutes,the average intraoperative blood loss was (470±45.5) mL,and the average follow-up time was (25.8±3.5) months.(5) Six patients presented complications (20％),including one case of dural tear,two cases of paralytic intestinal obstruction,and three transient lower extremity nerve symptoms.(6) These results indicate that if the associated disorders are strictly controlled,pedicle screw fixation combined with posterior lumbar interbody fusion can achieve good surgical results in the treatment of degenerative spondylolisthesis in the elderly.

Objective To study the role of Anopheles anthropophagus in malaria transmission and transmission threshold so as to provide basis for vector surveillance and malaria control strategy. Methods Parasitological and entomological methods were used in the investigation at 5 villages of Xinyang City, Henan Province. Results From July to August, 1999, 74 febrile cases (10\^9% of the total population) were examined. Among them 50 were infected, the incidence in the population of surveyed spots was 7\^4%. Active detection was made in another randomly selected two villages and found that the parasite rate in the inhabitants was 2\^0%, and the positive rate of IFA was 8\^4%. Only vivax malaria was detected. An.anthropophagus and An.sinensis were collected, with An.anthropophagus as the predominant one in human dwellings. The estimated man\|biting rate and the human blood index were 4\^9388 and 0\^7858 respectively. The vectorial capacity of An. anthropophagus was 5\^5296. The critical man\|biting rate of An.anthropophagus was 0\^2407 as calculated by the formula (ma=-rlnP/abP\+n) according to Macdonald′s model.The local man\|biting rate was 20 times higher than that of the critical man\|biting rate. Conclusion The results demonstrated that An.anthropophagus is the principal vector in malaria transmission in the area. The findings imply that the critical man\|biting rate is of practicable importance in vector surveillance.

Objective:To explore the effect of small dose of low molecular weight heparin on the prognosis of elderly patients with severe pneumonia using systematic evaluation method.Methods:Databases including Wanfang data, VIP, CNKI, SinoMed, PubMed, Embase and Cochrane Library were searched for randomized controlled trial (RCT) studies about the comparison of conventional therapy and low molecular weight heparin on prognosis of elderly patients with severe pneumonia from the time of database establishment to August 2019. The patients in conventional treatment group were treated by improving ventilation, anti-infection, eliminating phlegm, relieving asthma and maintaining homeostasis while those in low molecular weight heparin group were subcutaneously injected with low molecular weight heparin of 4 000 U, once a day for 7 days. The patients' main outcomes included the oxygenation index (PaO 2/FiO 2) after 7 days of treatment, duration of mechanical ventilation, mortality in hospital, and secondary outcomes included acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and coagulation function after 7 days of treatment, the length of intensive care unit (ICU) stay, and incidence of bleeding. Data extraction and quality evaluation were conducted. The Meta-analysis of included studies that met the quality standards was performed using RevMan 5.3 software. Funnel diagram analysis was used to analyze the parameters with no less than 10 studies enrolled. Results:A total of 14 RCT studies were enrolled involving 1 173 elderly patients with severe pneumonia, among whom 590 received low molecular weight heparin while the other 583 received conventional therapy. All the included studies were well designed and of high quality. The results of Meta-analysis showed that compared with conventional therapy, small dose of low molecular weight heparin significantly elevated PaO 2/FiO 2 after 7 days of treatment [mean difference ( MD) = 19.25, 95% confidence interval (95% CI) was 16.88 to 21.61, P < 0.000 01], shortened the duration of mechanical ventilation ( MD = -48.88, 95% CI was -67.42 to -30.33, P < 0.000 01), and decreased mortality in hospital [odds ratio ( OR) = 0.40, 95% CI was 0.22 to 0.73, P = 0.003] and APACHEⅡ score after 7 days of treatment ( MD = -3.38, 95% CI was -3.94 to -2.83, P < 0.000 01), and shortened the length of ICU stay ( MD = -4.51, 95% CI was -5.75 to -3.27, P < 0.000 01). There was no significant difference in the changes of coagulation parameters after 7 days of treatment or the incidence of bleeding between low molecular weight heparin group and conventional therapy group [7-day thrombin time (TT): MD = 0.57, 95% CI was -0.15 to 1.28, P = 0.12; 7-day prothrombin time (PT): MD = 0.32, 95% CI was -0.35 to 0.98, P = 0.35; 7-day fibrinogen (FIB): MD = -0.17, 95% CI was -0.45 to 0.10, P = 0.22; incidence of bleeding: OR = 0.86, 95% CI was 0.36 to 2.07, P = 0.74]. The funnel diagram showed that there was publication bias of included 10 studies about APACHEⅡ score after 7 days of treatment. Conclusion:Small dose of low molecular weight heparin can improve the prognosis of elderly patients with severe pneumonia and it has no obvious side-effect on coagulation function.

Objective To investigate the impact of various distribution of bone cement on the early clinical outcomes in osteoporotic vertebral compression fracture (OVCF) patients treated with percutaneous kyphoplasty (PKP).Methods A total of 312 patients (54 males and 258 females,mean age 69.37 years) who diagnosed as OVCF and received PKP treatment from January 2015 to July 2017 were enrolled in the present study.All subjects were divided into two groups according to different distribution of bone cement:the shaped "O" distribution (group O,113 cases),in which bone cement in the vertebral body presented whole crumb,no separation or loss of bone cement,and the shaped "H" distribution (group H,199 cases),in which bone cement in the vertebral body presented two briquettes,connected with or without a small amount of bone cement.Demographic data,surgical details,radiographic data,and clinical outcomes (at preoperatively,two-days and one-year follow-up) were compared between the two groups.Results There was no significant difference in bone mineral density (BMD),operation duration,blood loss,and occurrence of leakage of bone cement between two groups.In comparison with group O,group H was accompanied with higher volume of injected bone cement and higher proportion of bilateral approach (P＜0.05).Both groups achieved significant improvement of VAS scores after surgery,while the group H had a dramatical reduction of VAS scores at one-year follow-up compared with two-days follow-up (P＜0.05).In addition,group H had a better restoration of VAS scores at one-year follow-up than group O (P＜0.05),though no significant difference was observed at preoperative and two-days follow-up.Both groups achieved significant improvement of radiographic data after surgery (P＜0.05) with similar effects of correction.Conclusion Either shaped "H" or shaped"O" distribution of bone cement can obtain satisfied early clinical effects of PKP for the treatment of OVCF.Compared with shaped "O" distribution,shaped "H" distribution can achieve better pain relief at early follow-up.