OBJECTIVETo design a clinically applicable transoralpharyngeal atlantoaxial reduction plate (TARP), introduce the operation procedure, and evaluate its preliminary clinical effects.

METHODSA novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxial dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxial reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxial joints and TARP was used to immobilize subsequently the atlas and axis.

RESULTSClinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperational effect was satisfactory.

CONCLUSIONSThe design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxial dislocation and may have excellent prospects for further clinical applications.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Bone Plates ; Bone Screws ; Decompression, Surgical ; methods ; Equipment Design ; Female ; Humans ; Internal Fixators ; Joint Dislocations ; surgery ; Male ; Mouth ; surgery ; Spinal Fusion ; methods

OBJECTIVETo study relevant anatomical features of the structures involved in transoral atlanto-axial reduction plate (TARP) internal fixation through transoral approach for treating irreducible atlanto-axial dislocation and providing anatomical basis for the clinical application of TARP.

METHODSTen fresh craniocervical specimens were microsurgically dissected layer by layer through transoral approach. The stratification of the posterior pharyngeal wall, the course of the vertebral artery, anatomical relationships of the adjacent structures of the atlas and axis, and the closely relevant anatomical parameters for TARP internal fixation were measured.

RESULTSThe posterior pharyngeal wall consisted of two layers and two interspaces: the mucosa, prevertebral fascia, retropharyngeal space, and prevertebral space. The range from the anterior edge of the foramen magnum to C(3) could be exposed by this approach. The thickness of the posterior pharyngeal wall was (3.6+/-0.3) mm (ranging 2.9-4.3 mm) at the anterior tubercle of C1, (6.1+/-0.4) mm (ranging 5.2-7.1 mm) at the lateral mass of C(1) and (5.5+/-0.4) mm (ranging 4.3-6.5 mm) at the central part of C(2), respectively. The distance from the incisor tooth to the anterior tubercle of C(1), C(1) screw entry point, and C(2)screw entry point was (82.5+/-7.8) mm (ranging 71.4-96.2 mm), (90.1+/-3.8) mm (ranging 82.2-96.3 mm), and (89.0+/-4.1) mm (ranging 81.3-95.3 mm), respectively. The distance between the vertebral artery at the atlas and the midline was (25.2+/- 2.3) mm (ranging 20.4-29.7 mm) and that between the vertebral artery at the axis and the midline was (18.4+/- 2.6) mm (ranging 13.1-23.0 mm). The allowed width of the atlas and axis for exposure was (39.4+/-2.2) mm (ranging 36.2-42.7 mm) and (39.0+/-2.1) mm (ranging 35.8-42.3 mm), respectively. The distance (a) between the two atlas screw insertion points (center of anterior aspect of C(1) lateral mass) was (31.4+/-3.3) mm (ranging 25.4-36.6 mm). The vertical distance (b) between the line connecting the two C(1) screw entry points and that connecting the two C(2) screw entry points (at the central part of the vertebrae, namely 3-4 mm lateral to the midline of C(2) vertebrae) was (21.3+/-2.7) mm (ranging 19.4-24.3 mm), with an a/b ratio of 1.3-1.5. The screws of TARP had a lateral tilt of 12.2 degrees+/-0.4 degrees(ranging 10.2 degrees-14.6 degrees) at C(1) and a medial tilt of 7.3 degrees+/-0.3 degrees (ranging 5.1 degrees-9.4 degrees) at C(2) relative to the coronal plane.

CONCLUSIONSAn atlanto-axial surgery through transoral approach is safe and feasible. This approach is suitable for an anterior TARP internal fixation, and the design of the internal fixation system should be based on the above anatomical data.

Atlanto-Axial Joint ; anatomy & histology ; surgery ; Bone Plates ; Bone Screws ; Cadaver ; Decompression, Surgical ; methods ; Humans ; Internal Fixators ; Joint Dislocations ; surgery ; Mouth ; surgery ; Spinal Fusion ; methods ; Vertebral Artery ; anatomy & histology

Objective To explore the potential risk factors to Ymman endemic sudden cardiac death (YESCD) and provide evidence for prevention. Methods Twenty-two cases and 24 controls were randomly selected from YESCD areas and non-YESCD areas, respectively. Both cases and controls were interviewed with unified questionnaires. Univatiate X2 test and multivariate conditional logistic stepwise regression was conducted with SPSS 13.0. The optimal regression model was established and evaluated. Results The univariate X2 teat revealed that presence or absence of 5 potential factors might possibly be associated to YESCD: appropriate places for storing dining utensils, pens for livestock, consumption of mushrooms, exposure to any pesticides, and sudden climate changes before onset(X2=12.206,4.779,5.741,6.120,10.754, P<0.05). Multivariate conditional logistic stepwise regression demonstrated that consumption of mushrooms was a protective factor(OR=0.115, P<0.05) and sudden climate change was a risk factor(OR=36.592, P<0.01). Conclusions Sudden climate change might be a risk factor contributing to YESCD, and eating mushrooms before the prevalence seasons may provide some protection.

OBJECTIVEBy studying the mode and morphologic character of high fall injuries on the scene, and exploring the injury situation of different heights, different fall ways and postures, to provide a reference for the forensic identification of high fall injury.

METHODSAll the high fall cases were statistically analysed according to their gender, age, ground-touching posture, fall height, site and type of the injury.

RESULTSAmong 134 high fall cases, 98 were male and 36 were female with the age ranging from 2-71 years (37.6+/-16.9 on average), in which, 10-60 years old group consisted of 110 cases (82%). Most cases fell from windows or roofs (73%) and the touching objects were cement ground or shaft bottom of elevators. Among these cases, head injury was generally serious, followed by chest and abdominal injuries. The morphologic changes depend upon the height, nature, as well as the posture at the point while the body touches the ground.

CONCLUSIONMorphologic study of high fall injury assists medicolegal physicians to make correct identifications of the cause and nature of high fall injuries.

Accidental Falls ; mortality ; Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Forensic Medicine ; Humans ; Infant ; Male ; Middle Aged ; Posture ; Trauma Severity Indices ; Wounds and Injuries ; diagnosis ; mortality

OBJECTIVETo observe the electroacupuncture (EA) pretreatment at Baihui (GV20) on the concentration of adenosine deaminase (ADA) and adenosine, and to evaluate its effects on the neurologic function score and the infarction volume after middle cerebral artery occlusion (MCAO) ischemia/reperfusion (I/R), thus exploring its mechanisms for relieving the ischemia/reperfusion injury.

METHODSTotally 54 male SD rats were randomly divided into 3 groups, the sham-EA group, the EA group, and the control group, 18 in each group. Rats in the control group were not intervened after anesthesia. Rats in the EA group were needled at Baihui (GV20) for 30 min. Rats in the sham-EA group received the same procedure as those performed in the EA group without electricity connected. The changes of adenosine and ADA contents were detected at 30, 60, and 120 min after EA respectively. The I/R model was established. Totally 48 male SD rats were randomly divided into 6 groups, i.e., the model group (Group A), the EA group (Group B), the EA +8-Cyclopentyl-1,3-dipropylxanthine (DPCPX) group (Group C), the EA + DMSO group (Group D), the Deoxycoformycin (Deo) group (Group E), and the normal saline group (Group F). Rats in Group B, C, and D received EA for 30 min before modeling. Rats in Group C and D were peritoneally injected with DPCPX (1 mg/kg) and DMSO (1 mL/kg) at 30 min before EA. The neurologic function score was evaluated and the infarct volumes were detected after 24-h reperfusion.

RESULTSCompared with the sham-EA group, there was no statistical difference in the contents of the adenosine or ADA in the control group at each time point (P > 0.05). Compared with the control group at the same time point, the content of ADA significantly decreased at 60 min in the EA group [(315.0 +/- 22.9 U/L), P < 0.05], and restored to the normal level at 120 min after EA. The content of adenosine increased in the EA group at 120 min [(20.4 +/- 2.2) ng/microL, P < 0.05]. Compared with the model group, the neurologic function score decreased (P < 0.05) and the infarct volumes were obviously reduced (P < 0.01) in Group B, D and E. There was no statistical difference in the neurologic function score or the infarct volumes in other groups, when compared with the model group (P > 0.05)

CONCLUSIONEA at Baihui (GV20) showed protective effects on the cerebral I/R rats, which might be achieved through lowering the ADA concentration and elevating the adenosine content, and further activating adenosine A1 receptor.

Adenosine Deaminase ; metabolism ; Animals ; Brain Ischemia ; metabolism ; Electroacupuncture ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism

OBJECTIVETo investigate the role of mitofusin-2 gene (mfn2) in apoptosis in human breast carcinoma cell line MCF-7 cells after in vitro transfection.

METHODSpEGFP mfn2 was transfected by sofast in vitro. Expression of GFP was observed by Western blot, and the MCF-7 cell proliferation was measured by MTT and cell counting. Apoptosis in MCF-7 cells was observed in annexin-V/PI and chondrosome transmembrane potential of MCF-7 marked in JC-1 by FCM. The Ultrastructure of cells was observed by transmission electron microscopy.

RESULTSThe stable expression of GFP in MCF-7 cells was confirmed by Western blot. Mfn2 significantly inhibited cell proliferation, revealed by MTT, and decrease chondrosome transmembrane potential. Exogenous mfn2 gene significantly induced apoptosis. The apoptotic rate was increased from 3.6% to 16.0% (P < 0.05). Mfn2 gene induced break down and loss of mitochondrial cristae, and rarefaction of mitochondrial ground substance. Swollen mitochondria intensely aggregated around the cell nuclei.

CONCLUSIONMfn2 can strongly induce apoptosis in MCF-7 cells, which may be associated with decrease of mitochondrial transmembrane potential.

Apoptosis ; Breast Neoplasms ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; Female ; GTP Phosphohydrolases ; Green Fluorescent Proteins ; genetics ; metabolism ; Humans ; Membrane Potential, Mitochondrial ; Membrane Proteins ; genetics ; metabolism ; Mitochondria ; ultrastructure ; Mitochondrial Proteins ; genetics ; metabolism ; Plasmids ; Recombinant Proteins ; genetics ; metabolism ; Transfection

OBJECTIVETo design transoralpharyngeal atlantoaxial reduction plate (TARP), evaluate its biomechanical performance and observe its preliminary clinical effect.

METHODSA brand-new TARP system was designed, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operation instruments. Twelve fresh occipital bone-C(3) specimen were designed for biomechanical test including range of motion (ROM) (n = 6) and screw pull-out strength (n = 12). Preliminary clinical application of TARP was reported.

RESULTSThe reduction mechanism of the TARP system was designed cleverly. TARP had equal effect with Magerl + Brooks and it was more stable than the other three clinically widely used atlantoaxial fixators: Magerl, Brooks and anterior transarticular screw fixation through C(2) vertebral body. TARP's C(1) and C(2) screws were strong enough for atlantoaxial arthrodesis and their antipull-out performance was excellent. Clinical application on irreducible atlantoaxial dislocation proved that TARP had the function of instant reduction, the operation was feasible and the operation effect was significant.

CONCLUSIONTARP's design is novel and it has excellent biomechanical performance. The operation procedure is simple and reasonable. Furthermore, instant reduction could be completed during the operation and the fixation is strong. Above all, TARP is creative and will have excellent prospect.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Equipment Design ; standards ; Equipment and Supplies ; adverse effects ; standards ; Female ; Humans ; Joint Dislocations ; etiology ; surgery ; Male ; Orthopedic Procedures ; methods ; Pharynx ; surgery ; Treatment Outcome

OBJECTIVETo study the basic therapeutic function of Tiaokou (ST 38).

METHODSAccording to clinically multi-central randomized controlled and single-blind test principle, 257 cases of periarthritis of shoulder were divided into two groups, a test group (n = 124) treated with oral anti-inflammatory analgesic medicine combined with acupuncture at Tiaokou (ST 38), and a control group (n = 133) treated with oral anti-inflammatory analgesic medicine. Their therapeutic effects were compared.

RESULTSThe total effective rate for stopping pain was 96.0% in the test group and 91.7% in the control group with a very significant difference between the two groups (P< 0.01). And the total effective rate for improvement of shoulder activity was 86.3% in the test group and 59.4% in the control group with a very significant difference between the two groups (P<0.01).

CONCLUSIONOral anti-inflammatory analgesic medicine combined with acupuncture has obvious therapeutic effect on periarthritis of shoulder, which is better than that of simple oral anti-inflammatory analgesic medicine.

Humans ; Periarthritis ; therapy ; Shoulder ; Shoulder Pain ; therapy ; Single-Blind Method

Objective: To analyse the fractions and trends of cancer burden attributable to population ageing, adult population size, age-specific incidence and case fatality rate in China between 1990 and 2019. Methods: We extracted data from the database of Global Disease Burden Study, including the number of cancer cases, deaths and corresponding population of 29 cancer types for Chinese adults aged 25 years and older from 1990 to 2019. Using the cancer deaths in 1990 as a reference, we employed a decomposition method to express cancer deaths as the product of four factors among men and women from 1991 to 2019. The fractions attributable to cancer deaths among total cancer deaths in that year were calculated and its time trends were assessed. Results: In 2019, we estimated that there were 2 690 000 cancer deaths among adults aged 25 and older in China. Of which, cancer deaths attributable to population ageing, adult population size, age-specific cancer incidence and case fatality rate were 740 000 (27.5% of total cancer deaths in 2019), 1 091 000 (40.6%), 198 000 (7.3%) and -728 000 (-27.1%), respectively. In 2019, lung cancer, stomach cancer, esophageal cancer, liver cancer and colorectal cancer ranked the top five cancers among population ageing attributable to cancer deaths. For 29 cancer types, the fractions of population ageing attributable to cancer deaths among total deaths of that cancer were ranged from 9.3% to 40.5%. The ageing attributable to cancer deaths and its fractions were increased rapidly since 1997, while those estimates were negative before 1997. Conclusions: The population ageing process in China was one of the major contributors to the increase in cancer burden in recent years, which has caused more cancer deaths than that by age-specific cancer incidence. Accordingly, activities toward healthy ageing would be the key to cancer prevention and control.
Adult ; China/epidemiology* ; Esophageal Neoplasms ; Female ; Global Burden of Disease ; Humans ; Incidence ; Liver Neoplasms ; Male

Objectives: To investigate the influence of duration of antibiotic therapy on the prognosis of patients with AML who had Gram-negative bloodstream infection during consolidation chemotherapy. Methods: Data were collected retrospectively from 591 patients enrolled from the registered "A Phase III study on optimizing treatment based on risk stratification for acute myeloid leukemia, ChiCTR-TRC-10001202" treatment protocol between September 2010 and January 2016 in different treatment cycles. Results: A total of 119 episodes of Gram-negative bloodstream infection occurred during consolidation chemotherapy. Excluding the 5 episodes in which fever lasted longer than 7 days, 114 episodes of infection were analyzed. The median neutrophil count was 0 (0-5.62)×10(9)/L, median neutropenia duration was 9 (3-26) days, median interval of antibiotics administration was 7 (4-14) days. Logistic regression analysis showed that there is no significant difference on 3-day recurrent fever rate and reinfection by the same type bacteria between antibiotics administration ≤7 days or >7 days (1.2% vs 3.0%, P=0.522, OR=0.400, 95% CI 0.024-6.591; 18.5% vs 21.2%, P=0.741, OR=0.844, 95% CI 0.309-2.307). Propensity score analysis confirmed there was no significant difference on same pathogen infection rate between antibiotics application time ≤ 7 days or >7 days (P=0.525, OR=0.663, 95% CI 0.187-2.352). No infection associated death occurred within 7 or 30 days in both groups. Conclusion: Discontinuation of therapy until sensitive antibiotics treated for 7 days does not increase the recurrent fever rate and the infection associated death rate. Indicating that, for AML who had Gram-negative bloodstream infection during consolidation chemotherapy, short courses of antibiotic therapy is a reasonable treatment option when the infection is controlled.
Anti-Bacterial Agents/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols ; Bacteremia/drug therapy* ; Consolidation Chemotherapy ; Humans ; Leukemia, Myeloid, Acute ; Prognosis ; Retrospective Studies