Objective To investigate the popularity and distribution of Paragonimus westermani in Nankun Mountain,Northern suburban of Guangzhou.Methods 2012 snails and 63 crabs were picked from creeks.Three feces samples of wild cats in epidemic area and two feces samples of domestic cats inoculated with P.westermani metacercariae were collected.The cercariae,metacercariae and eggs of P.westermani were detected.P.westermani-positive cats were identified by detection,in which adults of Paragonimus were checked.P.westermani eggs artificially inoculated were also anatomized.Results Infection ratio in snails was 0.15‰(3/2000),while infection ratio of P.westermani metacercariae in crab was 100%(59/59),with an intensity of infection of 2~516 metacercariae per crab,and 2~10 matacercariae per gram crab.Snails and crabs were identified to be Semisulcospira libertina type and Sinopotamon pinheense type,respectively.P.westermani eggs were also found in two feces samples from wild cats,with an infection ratio of 66.66%(2/3).Eleven adults of P.westermani were found in two domestic cats inoculated with P.westermani.Conclusion Nankun Mountain in northern suburban of Guangzhou as an ultra-high infectious focus of P.westermani(Grade I) is reported for the first time.In view of the fact that P.westermani is one of the major disease paragonimus and the infectious focus Nankun Mountain nature reserve is an 4 A scenic spot and popular summer resort,tourists can become infected by P.westermani by drinking water from streams,springs and ponds.More attention should be paid to prevent human infection with P.westermani in Nankun Mountain.

Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in some cases to compromise the need of the accepting site.Results All 53 flaps survived after transplantation while skin exfoliation occurred in 5 cases due to flap thinning.Four cases sustained partial necrosis and was cured by trimming and dressing changes.Five to 14 months' post-operative followup showed satisfactory accepting-site morphology with good speech function and swallowing recovery.All donor sites were closed primarily without skin-grafting,leaving no donor-site complications including incision disruption,scar hyperplasia and muscle strength degeneration of the lower limb.Conclusion Multiple perforators have been accu rately located preoperatively in free-style harvest approach of ALTPFs,thus optimal effects can be reached with decreased donor-site morbidity and improved aesthetic outcome to the uttermost,which accords with the refined,personalized and minimal invasive development concept of modem reconstructive surgery.

Objective o evaluate the characteristics and treatments of the medial-extension type of posterior malleolar fractures.Methods Data of 75 patients with posterior malleolar fractures from May 2007 to December 2010were retrospectively analyzed.13 patients whose X-ray showed Cotton fracture while CT scan showed medial-extension type of posterior malleolar fractures were involved in this study.There were 8 males and 5 females,with an average age of 40.3 years old (range,15-75 years).The mechanisms of injuries were as follow:6 patients with falling injury,4 patients from motor vehicle accidents and 3 patients from severe sprain.All the patients combined with distal fibular fracture.The preoperative clinical manifestations included foot and ankle swelling,deformity and restricted movement.The fracture line could be found on coronary X-ray.10 of those patients had double lines sign in medial malleolus.According to Haraguchi CT scan classification system,8 patients were Type Ⅰ fractures (61.6％,8/13),3 with Type Ⅱ fractures (23％,3/13),and 2 with Type Ⅲ fractures (15.4％,2/13).Posterior medial incision,cannulared screws after reduction were conducted.Wound and fracture healing were recorded postoperatively.Function was evaluated according to Baird-Jackson criterion.Results All 13 cases had been followed up for 8-45 months (mean 16 months).Post-operation X-ray showed articular surface displacement was less than 1mm; widening of the medial ankle mortise was no more than lmm; anatomy reduction was achieved or approximately achieved.All cases got union and the union period was 12-20 weeks with an average of 15.1 weeks.The incisions were primary healed in all patients.According to Baird-Jackson criterion,10 cases were excellent and 3 were good.76.9％(10/13) patients got excellent results.No instrument failure,fracture displacement,and infection were found.All patients could walk without accessory appliance.Conclusion Most of medial-extension type of posterior malleolar fractures have articular cartilage damage.It may be caused by rotational force combined with axial load.It needs open reduction and internal fixation early.The posterior medial incision has certain superiority.

OBJECTIVETo establish the rat model of acute spinal cord injury, followed by aprimary study on this model with ¹H NMR based on metabonomics and to explore the metabonomics and biomarkers of spinal cord injury rat.

METHODSTwenty eight-week-old adult male SD rats of clean grade, with body weight of (200±10) g, were divided into sham operation group and model group in accordance with the law of random numbers, and every group had 10 rats. The rats of sham operation group were operated without damaging the spinal cord, and rats of model group were made an animal model of spinal cord incomplete injury according to the modified Allen's method. According to BBB score to observate the motor function of rats on the 1th, 5th, and 7th days after surgery. Postoperative spinal cord tissue was collected in order to pathologic observation at the 7th day, and the metabolic profilings of serum and spinal cord from spinal cord injury rats were studied by ¹H NMR spectroscopy.

RESULTSThe hindlimb motion of rats did not obviously change in sham operation group, there was no significant difference at each time point;and rats of model group occurred flaccid paralysis of both lower extremities, there was a significant difference at each time; there was significant differences between two groups at each time. Pathological results showed the spinal cord structure was normal with uniform innervation in shame group, while in model group, the spinal cord structure was mussy, and the neurons were decreased, with inflammatory cells and necrotic tissue. Analysis of metabonomics showed that concentration of very low density fat protein (VLDL), low density fat protein (LDL), glutamine, citric acid, dimethylglycine (DMG) in the serum and glutathione, 3-OH-butyrate, N-Acetyl-L-aspartic acid (NAA), glycerophosphocholine (GPC), glutamic acid, and ascorbate in spinal cord had significant changes(<0.05).

CONCLUSIONSThere are significant differences in metabolic profile from serum and spinal cord sample between model group and sham operation group, it conduces to explain the changes of small molecular substances in serum and spinal cord tissue after spinal cord injury, this provides the research basis for targeted research on the role of metabolic markers in patients with acute spinal cord injury.

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.

Objective: To compare the clinical efficacy of the preserving insertion point of the rectus abdominis-Pfannenstiel approach with traditional Pfannenstiel approach in the treatment of pelvic anterior ring injuries. Methods: A retrospective analysis was performed on 43 cases with pelvic anterior ring injuries treated from September 2008 to February 2016. Among them, 20 cases were treated with the preserving insertion point of the rectus abdominis-Pfannenstiel approach (modified approach group) including 14 males and 6 females, aged 18-58 years, with an average age of 36.9 years. According to Tile classification of pelvic fractures, there were 8 cases of B1 type, 4 cases of B2 type, 2 cases of B3 type, 4 cases of C1 type and 2 cases of C2 type. And 23 cases were treated with traditional Pfannenstiel approach (traditional approach group, 16 cases of males and 7 cases of females, aged 19-59 years, with an average age of 36.8 years). Tile classification of pelvic fractures: 9 cases of B1, 4 cases of B2, 3 cases of B3, 4 cases of C1 and 3 cases of C2). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative reduction, postoperative functional and complications were compared between the two groups. Results: 43 patients were followed up for 12-40 months, with an average of 20.5 months. All fractures healed in 8-20 weeks, with an average time of 10 weeks. Duration of anterior approach: 119.0±18.3 min in the modified approach group and 93.7±17.8 min in the traditional approach group (t=4.597, P< 0.05). Intraoperative blood loss: 206.0±38.2 ml in the modified approach group and 252.4±46.1 ml in the traditional approach group (t=-3.560, P< 0.05). Postoperative hospital stay: 14.5±3.0 d in the modified approach group, and 20.0±4.4 d in the traditional approach group (t=-4.775, P< 0.05). Postoperative reduction was evaluated according to the Matta reduction criteria, among which 15 cases were excellent and 5 cases were good in the modified approach group; 17 cases were excellent and 6 cases were good in the traditional approach group. According to the Majeed score, the postoperative function of pelvic fracture was excellent in 10 cases, good in 7 cases, and acceptable in 3 cases, with an excellent and good rate of 85.0% (17/20). There were 11 excellent cases, 8 good cases and 4 fair cases in the traditional approach group, with an excellent and good rate of 82.6% (19/23). There was no statistically significant difference between the two groups (χ²=0.04, P >0.05). Complications: 2 cases of internal fixation loosening and 2 cases of coital pain occurred in the modified approach group after surgery, with a complication rate of 20.0% (4/20). Postoperatively, 1 case of superficial infection, 1 case of pulmonary infection, 1 case of internal fixation loosening, 1 case of screw broken and 4 cases of coital pain occurred in the traditional approach group, with a complication rate of 34.8% (8/23). Conclusion Both approaches can achieve satisfactory results in the treatment of anterior pelvic ring injury. The preserving insertion point of the rectus abdominis-Pfannenstiel approach for the treatment of anterior pelvic ring injuries has the advantages of less bleeding, faster recovery and shorter hospitalization time.