OBJECTIVETo investigate the character, diagnosis and treatment of multiple-level fractures of the cervical spine.

METHODSForty-three patients (38 male, 5 female) with multiple-level fractures of the cervical spine were retrospectively analysed in our hospital from 1988-2001.

RESULTSAmong 36 patients with multiple contiguous fractures of the cervical spine, 32 cases were injured at low cervical spine; 7 patients were non-contiguous spinal fractures in which there were 5 cases injured at upper and lower cervical spine. The frequently injured sites were vertebral body (31 patients), laminae (25 patients), spinous process (9 patients), vertebral arch (4 patients), transverse process (5 patients), lateral mass (5 patients); level frequently affected were C(4), C(5), C(6) and C(7); 21 patients were treated with anterior vertebrectomy and fusion, 10 patients with posterior laminectomy and fixation, 2 patients with both anterior and posterior decompression and fixation. 60.5% were flexion-compression injury. 10 patients with conservative treatment.

CONCLUSIONSContiguous type was more common than non-contiguous type in multiple level cervical spinal fractures; Injured sites always located at lower cervical spine in contiguous cervical fractures different from that fractures of atlas, axis and lower cervical spine in non-contiguous type; Unstable segments and level of spinal cord injury were at lower cervical spine; Operations must obtain both decompression and stability of spine.

Adolescent ; Adult ; Cervical Vertebrae ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; surgery ; therapy ; Retrospective Studies ; Spinal Fusion ; Spinal Injuries ; diagnosis ; surgery ; therapy

OBJECTIVETo investigate the mechanism of Hangman's fracture and its clinical manifestation and treatment.

METHODSTen patients with Hangman's fracture treated at our hospital from 1988 to 2001 were analysed.

RESULTPatients were injured by motor vehicle accidents (7 patients), object hitting on the head (1), and fall (1). Injuries were classified as type I (1 patient), type II (5), type IIa (2) and type III (2).

CONCLUSIONSMotor vehicle accident and fall are major causes of Hangman's fracture with neurological deficits but limited motion and neck pain. Hangman's fracture is easily diagnosed using lateral cervical X-ray and CT. Hangman's fractures of types I, II and IIa can be treated conservatively, but those of type III or spinal cord injury require surgical stabilization.

Adolescent ; Adult ; Axis, Cervical Vertebra ; injuries ; Female ; Follow-Up Studies ; Fracture Fixation ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; diagnosis ; surgery ; Spinal Fusion ; Traction ; Young Adult

OBJECTIVETo evaluate the efficacy of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression in cervical myelopathy.

METHODSThirty-five patients with cervical myelopathy were treated by the procedure of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression. The preoperative average JOA scale score was 8.7 point (Range 4-15).

RESULTSSixty-nine vertebral were corpectomized and 104 levels were decompressed and fused with an average of 3 levels. Among the cases, 1 vertebrae was corpectomized in 7 cases, 2 vertebra in 22 cases, 3 vertebra in 6 cases. There were no surgery-related complications. The patients were followed up from 11-37 months, with an average of 17.4 months. No plate breakage, screw loose, graft infection, lysis and absorption was discovered. The fusion rate was 100%, the average time of fusion was 9.3 months (range from 6-15 months). The postoperative average JOA scale score was 14.8 point (range 7-17), the recovery ratio was 73.5% and the excellent and good results was 82.8%.

CONCLUSIONSThe use of allogenic strut bone graft and instrumentation for anterior cervical fusion following subtotal corpectomy and decompression in cervical myelopathy may not only simplify surgical procedure and decrease injuries and complications, but also the fusion is satisfactory and reliable.

Bone Transplantation ; Cervical Vertebrae ; surgery ; Female ; Follow-Up Studies ; Humans ; Laminectomy ; Male ; Spinal Fusion ; Spinal Osteophytosis ; surgery ; Transplantation, Homologous ; Treatment Outcome

To study the allele frequencies and their polymorphism characteristics of human platelet antigen (HPA) and human leucocyte antigen-I (HLA-I) in Chinese xi'an population, the types of HPA and HLA-I in 375 Chinese xi'an voluntary platelet donors were detected by PCR-SSP and PCR-SSO as well as flow cytometry with magnetic beads, and were analyzed. The results showed that there was no polymorphism in HPA-7-HPA-14, HPA-16 and HPA-17 which only expressed-aa type, the -bb type was only detected in HPA-3 and HPA-15, 9 out of 16 samples for the HPA-5ab phenotype simultaneously expressed HPA-15ab, the other 7 samples expressed HPA-15bb, no HPA-15aa phenotype was observed. Phenotypes detected in this study were HPA-1aa-17aa, HPA-1ab, -2ab, -3ab, -3bb, -4ab, -5ab, -6ab, -15ab and -15bb. Among 375 cases, HLA-A specificity of 16 species was observed, which accounted for 76% (16/21) of detectable phenotype specificity in this locus, moreover, 11 species showed frequency > 1%; HLA-B specificity of 36 species was observed which accounted for 84% (36/43) of detectable phenotype specificity in this locus, moreover 23 species showed frequency > 1%, these species were covered by common specific HLA-I in northern China, 264 species haplotype HLA-A-B were found in 375 cases, the frequency of 30 species was > 1%. It is concluded that the gene frequency distribution of HPA and HLA-I in Chinese Xi'an population is in accordance with population of northern China on the whole, but it has its own characteristics.
Adolescent ; Adult ; Alleles ; Antigens, Human Platelet ; genetics ; Asian Continental Ancestry Group ; genetics ; Blood Donors ; China ; Female ; Genes, MHC Class I ; Humans ; Male ; Middle Aged ; Phenotype ; Young Adult

OBJECTIVETo study the effects of different perioperative treatments on the number and proportion of gut flora in SD rats.

METHODSForty-eight SD rats were randomized into 8 groups including the control group, antibiotics group, bowel preparation group, fasting group, antibiotic-bowel preparation group, antibiotics-bowel preparation-fasting group, bowel preparation-surgery-antibiotics-early postoperative feeding group (early feeding group), and bowel preparation-surgery-antibiotics-postoperative fasting group. The rats were sacrificed and stool specimens were collected from the cecum. Stools were diluted and transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared in terms of E.coli, Bacteroides, Bifidobacterium, and Enterococcus.

RESULTSCompared with the control group, the total bacteria, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count and the bacillus/coccus ratio were significantly elevated(P<0.05). In the bowel preparation group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). In the fasting group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). Early postoperative feeding increased E.coli, Enterococcus, and total bacteria count(P<0.05), and lowered bacillus/coccus ratio(P<0.05) as compared to the fasting group.

CONCLUSIONSAntibiotics, bowel preparation, and fasting have influence on the gut flora of SD rats in count and bacillus/coccus ratio, leading to dysbiosis. Early postoperative feeding may improve dysbiosis.

Animals ; Feces ; microbiology ; Male ; Microbiota ; Perioperative Care ; methods ; Rats ; Rats, Sprague-Dawley

Recombineering, a new genetic engineering technology based on high efficiency in vivo homologous recombination, can be used in target DNA knock-in, knock-out and gene cloning. In the process of gene subcloning mediated by Recombineering technique, high-quality target DNA fragments were difficult to obtain using in vitro overlapping PCR,therefore the efficiency of in vivo homologous recombination was severely interrupted. To solve this problem, some technology improvements have been established based on the principle of Red recombinases. The PCR DNA fragments of egfp and kan genes with complementary sequences on the end of each fragment were co-introduced into a pcDNA3.1 vector and Red recombinases containing E. coli DY331 host cells by electroporation. A recombinant plasmid pcDNA3.1-egfp-kan was screened directly by antibiotic marker. The positive rates can reach to 45%. The EGFP gene expression of pcDNA3.1-egfp-kan can be observed by transient transfection of 293 eukaryotic cells.
Bacteriophage lambda ; enzymology ; genetics ; DNA, Recombinant ; genetics ; Electroporation ; Escherichia coli ; genetics ; Gene Fusion ; genetics ; Genetic Engineering ; methods ; Green Fluorescent Proteins ; genetics ; metabolism ; Plasmids ; genetics ; Recombinases ; genetics ; metabolism ; Recombination, Genetic

OBJECTIVE: To determine the cellular compatibility of combined deproteinized bone(DPB) coated with hepatocyte growth factor (HGF), and to observe the adherent effect of osteoblasts in response to HGF. METHODS: Osteoblasts were isolated from fetal rabbits. Osteoblasts were cultured with DPB coated with HGF and deproteinized bone as experimental group and contral group, respectively. The proliferation and alkalinephosphatase activity were tested. Their growth was examined by inverted phase contrast microscope and scanning electronmicroscope. RESULTS: The osteoblasts were attached to the outside and inside surfaces and grew well. HGF/DPB could stimulate the alkalinephosphatase activity of the osteoblasts and improve the proliferation of the osteoblasts. CONCLUSION HGF/DPB has good biocompatibility and bone induction. HGF could improve the adherent effect of DPB on osteoblasts, and it could be used as scaffold material for the bone tissue engineering.
Animals ; Biocompatible Materials ; pharmacology ; Bone Substitutes ; metabolism ; Bone and Bones ; cytology ; Cell Proliferation ; Cells, Cultured ; Female ; Fetus ; Hepatocyte Growth Factor ; pharmacology ; Osteoblasts ; cytology ; Osteogenesis ; Pregnancy ; Rabbits ; Tissue Engineering ; methods ; Tissue Scaffolds

BACKGROUNDLower cervical dislocation with locked facets is common in cervical injury. The locked facets include unilateral and bilateral types. Different successful closed reduction rates has been achieved between unilateral and bilateral types by using rapid skull traction, which was commonly used to reduce the cervical dislocation. It is important to investigate a suitable management specific to patients with different types of cervical locked facets.

METHODSA total of 38 patients with cervical dislocation with locked facet due to cervical injury treated by rapid skull traction and operation from 1988 to 2005 were reviewed. Rapid skull traction was used in all the patients. Successful closed reduction rate was 88.0% in patients with bilateral cervical locked facets and that was 15.4% in those with unilateral cervical locked facets. These data were then statistically compared by Chi-square test. Patients who were reduced successfully underwent anterior cervical discectomy and fusion at the injured level, and those who failed in closed reduction received posterior open reduction and fixation.

RESULTSIn this series, there was statistically significant difference (P < 0.05) in the rate of successful closed skull traction reduction between unilateral and bilateral locked facets dislocation. Unilateral cervical locked facets dislocation was not easily reduced by skull traction which was suitable for reduction of bilateral cervical locked facets dislocation. However, unilateral cervical locked facets dislocation can be reduced by posterior open reduction.

CONCLUSIONSUnilateral cervical locked facets dislocation should be treated immediately with posterior open reduction and instrumentation. Bilateral cervical locked facets dislocation can be reduced by rapid skull traction firstly and anterior cervical discectomy and interbody fusion later.

Adult ; Aged ; Cervical Vertebrae ; injuries ; Diskectomy ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fusion ; Traction

OBJECTIVETo analyze lymph node (LN) metastasis patterns and determine the appropriate extent of LN dissection in distal-third gastric cancer.

METHODSClinical data of 545 patients with distal third gastric cancer undergoing radical operation in the Fujian Provincial Hospital between 2001 and 2010 were analyzed retrospectively. The metastasis rate for each LN station was analyzed stratified by the depth of tumor invasion.

RESULTSThe incidence of LN metastasis in this cohort was 38.2% (208/545). LN metastasis rate in mucosal cancer was 2.0% (2/99) and involved LNs were limited to station 1 LN stations. LN metastasis rate in submucosal cancer was 18.9% (18/95), significantly higher than that in mucosal cancer (P<0.01). The metastasis rates to groups No.7, 8 and 9 in station 2 were 5.3% (5/94), 3.2% (3/94), and 1.1% (1/89) respectively. In addition, 3 cases (3.2%) had metastasis in station 2 outside the range of groups 7, 8 and 9 including groups No.1, 11p and 12. Gastric cancer invading the muscularis propria or deeper layers showed an significant increased rate of metastasis (P<0.01).

CONCLUSIOND1 dissection seems to be sufficient for mucosal cancer. Standard D2 dissection should be performed for cancers of the muscularis propria or deeper. For submucosal cancer, an extended D1+ dissection is required for complete removal of metastatic nodes.

Aged ; Female ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

Objective :To explore therapeutic effect of single and double stent implantation on coronary bifurcation le-sions.Methods : Clinical data of 455 patients with coronary bifurcation lesions , who received drug-eluting stent (DES) implantation in General Hospital of PLA from Jan 2014 to Oct 2016 ,were retrospectively analyzed .Accord-ing to interventional strategy ,patients were divided into single stent group (n＝235) and double stent group (n＝220).The lesion distribution ,lesion features of proximal ,distal and bifurcation ,stent implantation ,surgical selec- tion ,postoperative instant blood flow ,clinical adverse events were observed and compared between two groups .Re-sults :There were no significant difference in general data ,lesion distribution suggested by coronary angiography ,le-sion feature of proximal ,distal and bifurcation between two groups , P＞0. 05 all.All patients used Cross-over tech-nique in single stent group ,while double stent group used Crush (46.81%) ,Culotte (37.73%) ,T-stent and V-stent surgery .There were no significant difference in postoperative instant TIMI blood flow grade 3 rate of main vessel and side branch between two groups , P＞0. 05 both .During hospitalization ,incidence rate of nonfatal myocardial infarction in double stent group was significantly higher than that of single stent group (7.27% vs.2.98%) , P＝0.037. During 12-month follow-up ,compared with single stent group ,there was significant reduction in restenosis rate (5.53% vs.1.36%) , and significant rise in incidence rate of nonfatal myocardial infarction (2.55% vs. 6.82%) in double stent group ,P＝0.016 ,0.030 respectively .Conclusion :The therapeutic effect between single and double stent implantation treating coronary bifurcation lesions is no significant ,but restenosis rate of double stent group significantly reduces and incidence rate of nonfatal myocardial infarction significantly rises .