BACKGROUND:Percutaneous kyphoplasty is the main treatment for senile osteoporotic thoracolumbar fractures, but increasing number of patients who have not been treated with anti-osteoporosis therapy after operation develop secondary fractures due to decreased bone mineral density and changes of stress. OBJECTIVE:To investigate the feasibility of consecutive 2-year zoledronic acid treatment following percutaneous kyphoplasty for preventing secondary vertebral fracture. METHODS: 186 elderly patients with thoracolumbar compressive fractures were divided into experimental (n=84) and control (n=102) groups based on their willingness to receive zoledronic acid treatment or not after percutaneous kyphoplasty. The experimental group was treated with calcium and alfacalcidol fololwed by 2 years of zoledronic acid treatment, while only calcium and alfacalcidol treatment was done in the control group. The bone mineral density, pain and function were respectively assessed by dual energy X-ray absorptiometry, visual analogue scale and Oswestry disability index, and the number of refractures was calculated at baseline and at the 2nd year after the second injection of zoledronic acid. RESULTS AND CONCLUSION:The bone mineral density, visual analogue scale and Oswestry disability index scores at 2 years after treatment in both two groups were significantly superior to those at baseline (P < 0.05). The number of refractures in the experimental group (n=1) was significantly less than that in the control group (n=9) (P < 0.05). These results suggest that zoledronic acid can prevent secondary fractures after percutaneous kyphoplasty in the elderly with osteoporotic thoracolumbar fractures, improve long-term function and clinical effectiveness.

Objective To investigate the resistant mechanism of Streptococcus pyogenes to ciprofloxacin and its homology.Methods Forty-eight isolates of Streptococcus pyogenes were collected from patients diagnosed with scarflet fever in districts of Beijing in March,2012 and MIC to ciprofloxacin and other 7 common antibiotics in clinic were detected by using blood M-H agar dilution method.Thirteen isolates,which have MICs≥4 mg/L against ciprofloxacin,were detected for mutations of Fluoroquinolone resistance genes gyrA,gyrB,parC,parE.At the same time,4 isolates,with MIC ≤ 0.25 mg/L against ciprofloxacin,were used for comparison.Homology analysis of 17 isolates from different areas of Beijing was performed by using the method of pulsed field gel electrophoresis.Results Sensitive rates of Streptococcus pyogenes to levofloxacin,ampicillin and penicillin were all 100％.The resistance rates to tetracycline,erythromycin and clindamycin were 91.7％ (44/48),91.7％ (44/48) and 89.6％ (43/48),respectively.MIC50 of ciprofloxacin,levofloxacin and moxifloxacin was 2 mg/L,1 mg/L and ≤ 0.25 mg/L,respectively ; MIC90 was 4 mg/L,2 mg/L and 0.5 mg/L,respectively.Of the 48 isolates of Streptococcus pyogenes,12 isolates showed the MIC at 4 mg/L,while one isolate has a MIC against ciprofloxacin at 8 mg/L,which isolated from Chaoyang district.Analysis of sequence of chromosome mediated fluoroquinolone resistance genes in those 13 ciprofloxacin non-susceptible isolates exhibited that there were 12 isolates that harbored Ser79Phe/Tyr mutation and 10 isolates harbored Ala121Val in parC gene.It is shown that one isolate contained Ser79Phe mutation in parC gene in the occurring of Ser371Leu mutation in parE gene for the first time,but there was no marked increase in ciprofloxacin MIC (MIC =4 mg/L).There were no mutations in gyrA and gyrB genes.The PFGE results demonstrated that the 17 tested isolates could be divided into 7 clones.The clone A isolates from Chaoyang,Daxing,Fengtai,Shunyi and Shijingshan district have a MIC ≥ 4 mg/L against ciprofloxacin,which covered 69.2％ of all MIC ≥4 mg/L isolates.The clone C isolates from Huairou district were MIC ≥4 mg/L isolates.B,D,E,F and G clones isolates come from different districts.Conclusions The mutation of parC gene was the main reason that contribute to the slightly increase of ciprofloxacin MIC in Streptococcus pyogenes isolated from Beijing.The PFGE analysis showed that there was a small scale prevalence caused by the infection of Streptococcus pyogenes in some districts.

Blotting, Western ; Cell Cycle Checkpoints ; Cell Line, Tumor ; Chaperonin 60 ; metabolism ; HEK293 Cells ; Humans ; Mitochondria ; metabolism ; Reactive Oxygen Species ; metabolism ; Real-Time Polymerase Chain Reaction ; Sirtuin 3 ; genetics ; metabolism

ObjectiveTo observe the clinical efficacy of the Modified Tongmai Anshen Formula （通脉安神方加减， MTAF） in the treatment of stable angina pectoris （SAP） with sleep disorders. MethodsA total of 148 patients suffering from SAP with sleep disorder were included and randomly divided into control group and treatment group， with 74 patients in each group. The control group received conventional western medicine， and the treatment group additionally received MTAF （1 dose per day）， both for 4 weeks. The changes in angina pectoris symptoms， traditional Chinese medicine （TCM） syndromes， sleep quality， quality of life， serological indicators including serum intercellular adhesion molecule-1 （ICAM-1） and vascular cell adhesion molecule-1 （VCAM-1）， brain-derived nerve growth factor （BDNF） and tyrosine kinase receptor B （TrkB） were compared between groups before and after treatment， and the safety was evaluated. ResultsIn the treatment group and the control group， the total effective rates of TCM syndromes（82.43% vs 52.70%）， angina pectoris （79.73% vs 64.86%） and sleep （89.19% vs 68.92%） showing significant difference （P＜0.001）. After treatment， the total TCM syndrome score， primary symptom score， secondary symptom score， and secondary symptoms sleeplessness， restlessness， tiredness and fatigue individual score， angina pectoris score， PSQI total score and each item score were all significantly reduced in both groups， while the SF-36 single item score significantly increased （P＜0.05）. The total TCM syndromes and primary symptom scores， secon-dary symptoms sleeplessness， restlessness， tiredness and fatigue individual score， angina pectoris score， time to fall asleep， sleep quality， hypnotic medication， sleep disturbance， daytime dysfunction score and PSQI total score were significantly lower in the treatment group than those in the control group after treatment （P＜0.05）， while the somatic pain， general health status， social functioning， emotional functioning， mental health， and health change were significantly higher in the treatment group （P＜0.05）. After treatment， ICAM-1 and VCAM-1 level significantly decreased （P＜0.05）， and BDNF and TrkB levels increased （P＜0.05） in the treatment group， while BDNF level significantly decreased in the control group （P＜0.05）. The TrkB level was significantly higher in the treatment group compared to the control group after treatment （P＜0.05）. A total of four adverse events occurred during the treatment， none of which were considered to be related to this study. ConclusionMTAF can significantly improve angina pectoris symptoms， TCM syndromes， sleep quality and quality of life in patients suffering from SAP with sleep disorders， the mechanism of which may be related to the protection of vascular endothelial function and central neurons.

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ²=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ²=5.460, P=0.019), multiple ECF (χ²=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ²=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ²=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ²=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ²=179.699, P<0.001), sepsis (χ²=211.851, P<0.001), hemorrhage (χ²=85.300, P<0.001), pulmonary infection (χ²=60.096, P<0.001), catheter-associated infection (χ²=10.617, P=0.001) and malnutrition (χ²=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.