0.05).In 25.28% of the population in the Second Songhua River region,the hair Hg content exceeded 1 mg/kg.In 21.85% and 16.67% of the population of Wujiazhan town and Songyuan city,the hair Hg content exceeded 1 mg/kg.Conclusion In the investigated area,the level of hair mercury shows a downtrend,but there still is health risk from mercury exposure.

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

OBJECTIVETo evaluate the efficacy and safety of percutaneous pedicle screw fixation (PPSF) and open pedicle screw fixation (OPSF) in the treatment of single level of thoracolumbar fracture.

METHODSDatabases including Pubmed, Embasem, CNKI were searched to collect clinical trials of the clinical safety and efficiency of PPSF and OPSF for single level of thoracolumbar unstable fracture, relevant proceedings and references were also retrieved manually. Studies from 1990 to 2014 that met the inclusion and exclusion standards were researched. The data were extracted and the methods from the studies were also evaluated. Data analysis was conducted with the Review Manager 5.3 software. Observation targets included operation time, intraoperative bleeding, postoperative bleeding, hospitalization time, the bed time, postoperative vertebral Cobb angle, vertebral body height, pain score and the length of incision operation.

RESULTSFifteen papers were finally studied, including 2 randomized controlled trials (RCT) and 13 case-control studies, involving 789 patients. Compared with OPSF, the PPSF in treating thoracolumbar fracture had shorter operation time, smaller operation incision, less intraoperative and postoperation bleeding, shorter hospitalization days, fewer pain (P<0.00001), the less improvement in the change of Cobb angle (P=0.0006). There was no significant difference in the improvement of vertebral body height (P=0.36), the bed time from operation to exercise (P=0.38) between OPSF and PPSF.

CONCLUSIONCompared with OPSF, PPSF is better, safer, and has fewer pain. But there is no evidence that the PPSF is better in the recovery of the spinal height, and they have the same effect in the long-term follow-up for thoracolumbar fractures. PPSF brines minimally invasive to patients with better effect. It is worth further study and clinical research.

Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Pedicle Screws ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; surgery ; Treatment Outcome

BACKGROUND:Intertrochanteric femoral fractures are one of the most common fractures in old patients. How to effectively fix has a great chalenge for orthopedic surgeons. No consensus on which fixation method is optimal has been obtained in the academia. OBJECTIVE: To evaluate the clinical therapeutic effects and complications of minimaly invasive percutaneous proximal femur locking compression plate for senile stable intertrochanteric fractures. METHODS:From May 2010 to May 2012, 98 patients (34 males and 64 females) with stable intertrochanteric fractures were treated with minimaly invasive percutaneous proximal femur locking compression plate fixation. The mean age was 76 years (range, 59-93 years). The mean time between fractures and operation was 3 days (range, 1-5 days). Patients were folowed up regularly after treatment. Healing time, Harris score of hip function recovery and the occurrence of complications were evaluated. RESULTS AND CONCLUSION: Al patients were folowed up for 12-24 months. Al incisions obtained healing by first intention. Al fractures reached clinical healing, and the healing time was 12-20 weeks (16 weeks on average). There was no fixation failure and loosing, rotation, crispatura deformity or screw cutting the femoral head. The function of the hip joint was assessed according to the Harris scoring: excelent in 75 cases and good in 18 cases, with the excelent and good rate of 95%. These data verify that proximal femur locking compression plate can be a feasible alternative to the treatment of stable intertrochanteric fractures. The patients obtained satisfactory outcomes, with less complication, indicating that there is a good biocompatibility between the implant and elderly host.

Community rehabilitation of cardiovascular disease is of great significance. Exercise therapy of cardiovascular disease in communities is necessary and feasible. At present, the main problems China faced to carry out community exercise therapy of cardiovascular disease include: cardiovascular patients with a weak sense of community exercise therapy, lack of professional rehabilitation personnel, inadequate community-based exercise therapy practice and lack of community rehabilitation funding. To solve above problems, we should strengthen the community exercise therapy practice of cardiovascular disease, and promote the cooperation between community rehabilitation and hospital rehabilitation. In all, comprehensive efforts should be made in order to solve the problems.

Para-neoplastic neurological syndrome (PNS) is a series of rare illnesses affecting the nervous system and associated with several malignant tumors. PNS is manifested by various clinical symptoms, which conventionally precede the diagnosis of tumors in months or even years. Although anti-neuronal antibodies can indicate the presence of cancer, numerous false positive and false nega-tive cases are detected. Therefore, the clinical diagnosis of PNS has become a challenge. Position emission tomography/computed to-mography (PET/CT) is an image-fusion method containing anatomical and functional information and can be used to obtain whole-body images by a single scan. Fluoro-deoxy-glucose (FDG) PET/CT imaging can reveal potential malignant lesions in the whole body and diagnose specific types of cancer. This technology can also be applied to assess functional abnormality in the brain and moni-tor its response to treatment. Furthermore, the mechanism, clinical manifestation, and diagnosis of PNS are introduced in this study. Re-cent applications of FDG PET/CT in the diagnosis of PNS are reviewed to improve diagnostic accuracy.

BACKGROUND: Excellent Iow-antigenicity xenogeneic biological valve scaffold is the premise of constructing tissue-engineered valve by using which kind of acellular methods.OBJECTIVE: To explore the optimal preparation method of making tissue engineered heart valves by meesuring efficiency of different acellular methods and ability to preserve the matrix.DESIGN, TIME AND SETTING: The prospective randomly controlled study was performed at the Central Laboratory of Taian Central Hospital from January 2007 to June 2008.MATERIALS: Sixteen specimens of porcine aortic valves were randomly divided into control, NaCI-sodium-dodecyl-sulfate (SDS),trypsin and triton-X100 groups.METHODS: Specimens in the control group were left intact. Three test groups were decelluladzed with NaCI, trypsin andTriton-X100 respectively.MAIN OUTCOME MEASURES: The gross structure, optical and electron microscope ultrastructure of the decelluarated porcineheart valve matrix was compared. The expression of vascular endothelial cell major histocompatibility complex (MHC)- Ⅰ antigenwas detected by immunohistochemical method.RESULTS: Treatment with NaCL-SDS achieved only incomplete decellularization. The main components of extracellular matdxwere reserved completely, but the fibrous components became unclear and swelling. Treatment with trypsin removed cellscompletely, but caused serious structural alterations, with the presence of swollen collagen fiber, crude edge, widen and irregularfiber interspace. Treatment with Triton-X100 achieved both complete decelluarization and preservation of the matrix structure.Valves following treatment of NaCI-SDS, trypsin and Triton-X100 had certain immunogenicity. However, the immunogenicity ofvalves following treatment of trypsin and Triton-X100 was significantly lower compared with the treatment of NaCL-SDS.CONCLUSION: The decellularization method by Triton-X100 is effective and complete. The Triton-X100 method does not changematrix structure and has low immunogenicity.

Objective To discuss the clinical characteristics,injury mechanisms,and treatment options of atlantoaxial complex fractures.Methods Twenty-three patients with atlantoaxial complex fractures were enrolled in the study,including 13 men and 10 women with age ranging from 23 to 63 years (average 42.6 years).Treatment options were determined on the basis of injury patterns of the patients,including nonoperative treatments for 11 patients and operative treatments for 12 patients.Complications and prognosis were evaluated for all patients in follow-up.Results All patients were followed up for average 32 months (range,6-58 months),which showed the recovery of atlantoaxial stability and the bony union or fusion.At postoperative six months,Japanese Orthopedics Association (JOA) score of all patients averaged 14.1 points (range,11.5-15.8 points) with the improvement rate of 82.7％.No complications like spinal cord injury,vertebral artery injury or cerebrospinal fluid leakage occurred in operative treatment group.Conclusions Mechanisms of atlantoaxial complex fractures are largely overextension/compression and lateral bending/compression.Furthermore,treatment plans should be determined in the light of fracture types.

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Aggregatibacter actinomycetemcomitans ; physiology ; Bacterial Adhesion ; Biofilms ; Periodontal Diseases ; microbiology ; Porphyromonas endodontalis ; physiology