Objective To investigate clinical results of the treatment of posterior shoulder instability in a combined way of bone block procedure and posterior capsulorrhaphy. Methods The double contrast CT arthrography was performed for 5 patients suffering from posterior shoulder instability so as to detect the pathology. The treatments combining bone block procedure and posterior capsulorrhaphy were carried out according to the pathological conditions of bone and soft tissue. Results The double contrast CT arthrography showed posterior bone defects, posterior glenoid labrum tear and enlargement of posterior capsular cavity. After the bone block procedure and posterior capsulorrhaphy, no patients complained shoulder instability in the follow-up of 5 to 38 months. Conclusions Many pathological factors may induce posterior shoulder instability, which should be corrected by an appropriate operation rather than a “standard”method of operation. For patients involving several pathological factors, a combined operation may be needed in order to correct various pathological changes.

Objective To analyze the characteristics, surgical timing and treatment of middle super thoracic fractures. Methods 35 cases of middle super thoracic fractures (T1 10) were retrospectively reviewed. Among them, 25 cases were complete injury of the spinal cord and 10 cases were neurologically incomplete injury. The bleeding in operations at different times, the ASIA grades and the sensorimotor scores were analyzed. Results The follow up showed that the ASIA grade increased by 1 to 2 degrees in 10 cases of incomplete spinal cord injury, while in complete spinal cord injury the ASIA grades hardly increased but the sense and motion scores could be improved by about 20. Conclusions Middle super thoracic fractures often involve multi vertebra body, and the spinal cord is injured severely. Decompression, fusion, internal fixation from posterior approach can obtain a satisfactory result. Neurologically incomplete injury should be treated as soon as possible, while complete injury of the spinal cord should be treated around 2 weeks after the injury.

Objective To investigate the anatomic structure of the Chinese people,develop the procedure of minimally invasive total hip arthroplasty through the anterolateral intermuscular approach and investigate its clinical outcome.Methods Three fresh adult cadavers(6 hips)were used for study of the anatomic construction of the anterolateral intermuscular approach in Chinese people.Sixteen patients were treated with minimally invasive total hip arthroplasty through anterolateral intermuscular approach.The clinical results and operation technique were recorded.Results The anterolateral intermuscular approach was a triangle muscular interval slightly parallel to the femur.The medial-superior angle of the triangle muscular interval consists of the anterior border of gluteus medius and tensor fascia lata muscle with juncture of muscles,where the inferior branch of superior gluteal nerve entered into tensor fascia lata muscle.The average incision length was 8.8 cm(7-10 cm),with mean blood loss of 350 ml(250-550 ml).The patients took out-of-bed activity 3-5 days after operations.During operations,anterior border injury in deep portion of the gluteus medius muscle was observed in seven patients and the injured muscles were trimed or repaired.All patients were followed up for 18-39 months(averaged 27.7 months).Most of the patients had excellent location of the phantoms,except that one acetabulum had a little pitch angle and two acetabulums had a little abduction angle.No complication was observed.The mean Harris scores of hip for all patients was increased from preoperative(39.1±6.7)points to(80.6±11.3)points on six month,(88.7±9.6)points on 12 month and(91.4±13.5)points on 24 months(11 patients).No patient suffered from gluteus medius muscle weakness during the follow-up.ConclusionAnterolateral intermuscular approach has the advantages of simple anatomic construction,small incision,little operative injury,muscle sparing and fast recovery without separate muscle or tendon and is suitable for the Chinese patients.Exact incision and special operative instruments should be emphasized to avoid the increase of acetabular pitch angle and abduction angle.

Objective·To analyze high-risk factors of infection of multidrug resistance Klebsiellapneumonia (MDR-Kpn) and difference of therapeutic effects for different treatments.Methods·One hundred and ten MDR-Kpn strains were collected from a hospital.K-B slip diffusion method was utilized to detect the drug susceptibility of all the strains.Based on electronic medical records system,MDR-Kpn infected group included 51 patients and control group was picked out,including 51 patients as well (byl:1 ratio basing on the infected group according to the rules of under the same department,similar basic disease and all the patients in the control group isolated with the strain of Kpn).Thirty-nine clinical information of MDR-Kpn infected and control groups are collected to make single-factor analysis of high risk factors of the infection with MDR-Kpn.Multi-factor analysis was utilized between MDR-Kpn infected and control groups.The lasting time of different antibiotics used in MDR-Kpn infected patients were made statistics between effective and inefficacy patients.Results·Drug susceptibility test showed that sulfonamide,phosphonomycin and amikacin,were the three most sensitive antibiotics for 110 MDR-Kpn strains.12 clinical information,such as blood transfusion、sputum suction、invasive ventilation were all high-risk factors for the infection of MDR-Kpn (P＜0.05).The lasting time during with carbapenems (P=0.025) was statistically different between effective (n=28)and non-effective group (n=23) of MDR-Kpn infection patients.Conclusion·Controlling and eliminating high-risk factors do help to protect and decrease the infection of MDR-Kpn.Using carbapenems correctly has great influence on prognosis.

Objective To investigate the antimicrobial resistance of clinical isolates from Renji Hospital,Shanghai Jiao Tong University School of Medicine during the period from 2005 to 2015.Methods Antimicrobial susceptibility testing was carried out according to Kirby-Bauer method.Results were analyzed according to CLSI 2015 breakpoints.Results A total of 55 155 nonduplicate clinical isolates were collected from 2005 to 2015.The top 5 most frequently isolated bacterial species were E.coli (15.0％),P.aeruginosa (14.0％),A.baumannii (11.9％),K.pneumoniae (11.8％) and S.aureus (10.2％).Gram positive cocci and gram negative organisms accounted for 35.8％ and 64.2％,respectively.The prevalence of methicillin-resistant strains in S.aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) was 70.2％ (3 967/5 650) and 83.2％ (4 997/6 004).No staphylococcal strain was resistant to vancomycin,teicoplanin or linezolid.Fifteen strains of Enterococcus were found resistant to vancomycin.The average prevalence of ESBLs-producing strains was 70.4％ (5 843/8 300) in E.coli,53.5％ (3 500/6 539) in Klebsiella spp.and 44.1％ (557/1 263) in P mirabilis.A few carbapenemaseproducing K.pneumoniae strains were identified for the first time in 2012 with the prevalence of 0.6％ (4/656),and the prevalence hit high (30.1％,142/472) in 2015.The prevalence of carbapenemase-producing E.coli was 2.0％ (16/787) in 2015,and almost zero in the other years.The prevalence of extensively drug-resistant A.baumannii and P.aeruginosa was 39.1％ (2 566/6 556) and 4.0％ (308/7 704),respectively.Extensively drug-resistant strain was identified in 9 of the strains of 189 E.aerogenes isolates.Conclusions Bacterial resistance is still on the rise,which poses a major challenge to clinical antimicrobial therapy,especially the multi-drug resistant and extensively drug resistant bacteria.

Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease (GERD) patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring.Methods From August 2012 to November 2015,GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected.The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia.Student's t test,x2 test and Fisher's exact test were performed for comparison analysis.Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD,and at the same period completed esophageal high-resolution manometry.Among them,there were 17 GERD patients (8.8％) with dysphagia and 177 patients (91.2％) without dysphagia.The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders (5/ 17),but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders (10.2％,18/177).The integrated relaxation pressure,residual pressure of lower esophageal sphincter (LES),and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia ((9.70±0.98) mmHg (1 mmHg=0.133 kPa) vs (7.02±0.30) mmHg,(12.75±1.35) mmHg vs (9.18±0.42) mmHg,(106.80± 11.97) mmHg vs (70.82±3.48) mmHg,(82.66±10.70) mmHg vs (56.93±3.11) mmHg),and the differences were statistically significant (t=2.601,2.488,2.887,2.308,all P＜0.05).Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia ((2 128.94±310.47) mmHg · cm · s vs (1 029.88±90.16) mmHg · cm · s),and the difference was statistically significant (t =3.400,P =0.001).However,residual pressure of upper esophageal sphincter was significantly lower than that of patients without dysphagia ((2.84±1.21) mmHg vs (6.18±0.38) mmHg,t=-2.650,P=0.009).Conclusions Esophageal motility disorder of GERD patients with dysphagia is severer than that of patients without dysphagia.High resolution esophageal manometry can provide objective evidence of esophageal dynamics of GERD patients,which can guide the diagnosis and treatment of GERD.

Objective To report the prenatal molecular diagnosis for two gravida in a family with spondylepiphyseal dysplasia congenita(SEDC)caused by G504S mutation of COL2A1 gene.Methods DNA of the two fetuses was extracted from amniotic fluid at the 19+3 and 18+6 weeks of gestation respectively.Direct sequencing of two samples were performed after amplifying exon 23 of COL2A1 containing the potential mutation.The femur length and biparietal diameter of the first fetus were measured by sonographic scans every two weeks from 17+3 weeks to 27+3 weeks of gestation,and for the second fetus these parameters were measured from 16+1 to 19+1 weeks of gestation.Results Sequncing analysis revealed the first fetus and his mother presented the same mutation which is specifically associated with SEDC,but the second fetus did not show the mutation of COL2A1 gene.Biparietal diameters of the both fetuses were appropriate for gestational age.Femur length of the second fetus was normal for gestational age but that of the first fetus was shortened evidently after the 23 week of gestation.The parents of the first fetus determined to terminate the pregnancy.A medical termination was carried out at 27+5 weeks of gestation and a male fetus with a relatively large head and short limbs was delivered.The radiological findings of the fetus were consistent with SEDC including generalized platy spondesand shortened long bones.Conclusions Prenatal molecular diagnosis is important for the fetus with risk of SEDC and useful for genetic counseling.Genotype of fetus with risk of SEDC can be identified before sonographic scan.Molecular genetic analysis in conjunction with sonographic monitoring was helpful in prenatal diagnosis of SEDC.

Objective To report a familial dentinogenesis imperfecta type Ⅱ (DGI type Ⅱ) with a novel splicing mutation in DSPP (dentin sialophosphoprotein) gene.Methods Based on the result of linkage analysis performed previously to map the candidate gene DSPP in the family, the promoter,the first four exons and exon-intron boundaries of DSPP were directly sequenced for the members of the DGI type Ⅱ family. Denaturing high performance liquid chromatography (DHPLC) analysis was performed to confirm the results of sequencing.Results A novel splicing mutation of 23 bp deletion in intron 2 of DSPP gene was identified by DNA sequence analysis. The mutation changed acceptor site sequence from CAG to AAG, and might result in functional abolition of possible branch point site in intron 2. DHPLC result was consistent with that of sequencing. The mutation may be identified in all affected individuals, but not found in normal members of the family and 50 controls.Conclusion These results suggest the deleted mutation of DSPP gene causes DGI type Ⅱ in the family. The mutation has not been reported before.

Failure of spermatogenesis is the main clinical manifestation of male infertility. Multiple factors including genetic factors may affect spermatogenesis. Azoopermia factor (AZF) is closely involved in spermatogenesis. This paper reviews recent progress made in the study of AZF and its role in spermatogenesis and male infertility.
Azoospermia ; etiology ; genetics ; Humans ; Infertility, Male ; etiology ; genetics ; Male ; Spermatogenesis ; genetics