Objective To analyze functional improvement of spinal cord and the prognosis of two surgical approaches for the stenosis of cervical spinal canal;to investigate the mechanisms concerning post-terior decompression,fusion with ilium graft and internal fixation and 158 cases who underwent dorsal laminectomy from January 2001 to October 2002 were follow-up for at least 24 months and examined with the evaluation systems of Japanese Orthopaedic Association Score,somatosensary evoked essential and initiative range of motion to compare preoperative,short-term and long-term efficacy.Results According to selected standard of improvement rate,therapeutic effect of 56 sufferers among ventral approach group was analyzed,14 cases(25%)excellent,29 cases(51.79%)good,10 cases(17.86%)fair,3 cases(5.36%)poor;postoperative effect of 62 sufferers from dorsal approach group was analyzed,23 cases(37.10%)excellent,31 cases(50%)good,7 cases(11.29%)fair,1 case(1.61%)poor.Concerning JOA evaluation of spinal cord function,initiative range of motion and correlated parameters of SEP,there was significant difference between two decompression approach in postoperative periods.7 cases from anterior approach and 13 patients from posterior approach disturbed by postoperative complications were gradually rehabilitated through conservative of Cervical 5 spinal root',the essence of above-mentioned symptoms may be cervical cord impairment due to decompression process,which would be alleviated by appropriate intervention;2)The efficiency of posterior decompression get the better of anterior decompression in light of fundamentally enlarging available space approach became a little smaller than normal individuals,however,the corresponding parameters after anterior approach lower than the former two groups.

Objective To investigate the clinical outcomes of transanal local excision (LE) and transabdominal radical surgery (RS) for T1 rectal cancer with distance from anal verge (DAV) ≤ 8.0 cm,and analyze the prognostic factors after non-palliative resection of T1 rectal cancer with DAV ≤8.0 cm.Methods Theretrospective cohort study was conducted.The clinicopathological data of 82 T1 rectal cancer patients with DAV ≤8.0 cm who were admitted to the Fujian Medical University Union Hospital between December 2000 and December 2014 were collected.Among 82 patients,42 undergoing transanal LE and 40 undergoing transabdominal RS were allocated into the LS and RS groups,respectively.Forty-two patients in the LE group received transabdominal RS or postoperative adjuvant radiochemotherapy if results of postoperative pathological examination showed high risk.Observation indicators:(1) comparisons of surgical and postoperative situations between the 2 groups;(2) followup situations;(3) prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm.Follow-up using outpatient examination and telephone interview was performed to detect the defecation and sexual functions,survival and tumor recurrence up to January 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were evaluated with an independent sample t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.The Kaplan Meier method was used for calculating overall survival rate and tumor-free rate,and survival was analyzed using the Logrank test.Multivariate analysis was done using the COX regression model.Results (1) Comparisons of surgical and postoperative situations between the 2 groups:all the 82 patients underwent successful surgery.Of 42 patients in the LE group,28 underwent single transanal LE,2 underwent additional transabdominal RS within 1 month postoperatively,6 underwent postoperative adjuvant radiochemotherapy,5 underwent postoperative adjuvant radiotherapy and 1 underwent postoperative adjuvant chemotherapy (didn't complete course due to poor tolerance).Forty patients in the RS group underwent transabdominal anterior resection of rectum or combined with abdominal perineal resection for rectal cancer.DAV,operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery,cases with pulmonary infection and duration of postoperative hospital stay were (4.9±1.3)cm,(65±33) minutes,(11±7)mL,(1.2±0.4) days,0,(2.2±0.9)days in the LEgroupand (6.7±1.9)cm,(256±35)minutes,(65±47) mL,(2.4±0.8)days,6,(6.9±1.1) days in the RS group,respectively,with statistically significant differences (t =4.882,12.448,3.553,4.025,x2 =6.797,t =10.367,P＜0.05).Cases with intraperitoneal infection,wound infection,urinary tract infection,inflammatory intestinal obstruction,anastomotic fistula,chyle leakage,rectovaginal fistula and positive surgical margin were 0,0,0,0,0,0,0,1 in the LE group and 1,0,0,1,0,2,l,0 in the RS group,respectively,with no statistically significant differences between the 2 groups (x2 =1.063,1.063,2.153,1.063,P＞0.05).All patients with complications were cured by conservative treatment.(2) Follow-up situations:of 82 patients,67were followed up for defecation function (37 in the LE group and 30 in the RS group),40 were followed up for sexual function (25 in the LE group and 15 in the RS group),76 were followed up for survival.Follow-up time was 1-145 months,with a median time of 31 months.Cases with fecal incontinence and sexual dysfunction were respectively 0,0 in the LE group and 4,3 in the RS group,showing statistically significant differences (x2 =5.247,5.405,P＜0.05).Cases with 5-year local recurrence,5-year overall survival rate and 5-year tumor-free survival rate were respectively 1,94.1％,91.0％ in the LE group and 0,87.6％,87.6％ in the RS group,showing no statistically significant differences (x2 =0.833,2.313,0.849,P＞0.05).(3) Prognostic factors analysis after non-palliative resection of T1 rectal cancer with DAV ≤ 8.0 cm:results of multivariate analysis showed that age was an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤8.0 cm after non-palliative resection (RR =1.254,95％ confidence interval:1.055-1.491,P＜0.05).Conclusions Transanal LE in treatment of T1 rectal cancer patients with DAV ≤ 8.0 cm is consistent with RS in local control and long term prognosis,and the protection of defecation and sexual functions in LE is superior to that in RS.Age is an independent factor affecting prognosis of T1 rectal cancer patients with DAV ≤ 8.0 cm after non-palliative resection.

Objective To investigate the trends in and characteristics of syphilis epidemiology in China,and to provide a scientific basis for the development of control strategies.Methods An epidemiological study was performed on syphilis cases reported from 31 provinces,autonomous regions and municipalities between 2000 and 2013.Results The reported syphilis incidence increased yearly from 6.43 per 100 000 person-years in 2000 to 32.86 per 100 000 person-years in 2013,with an average annual growth rate of 13.37％.Syphilis was reported in most (99％) counties/districts in China mainland except for a few remote mountain areas,with a significant difference in the incidence of syphilis between different regions.The regions with a high incidence of syphilis included minority areas in Northwest China (Xinjiang,Qinghai and Ningxia),Minjiang River area,Yangtze River Delta (Zhejiang,Shanghai),Zhujiang River Delta (Guangxi,Guangdong),etc.There had been a rapid increase in the incidence of syphilis in some regions previously reported to have a low incidence (such as Guizhou,Shaanxi,Henan,etc).Among the reported cases,female patients predominated with an average male/female ratio of 0.92 ∶ 1.The incidence of syphilis was highest in the age group of 20-39 years,but increased yearly by more than 30％ in the population aged ＞ 60 years.Of 20 occupations,peasant workers accounted for the highest proportion (31.56％) of syphilis cases,and retired population showed the most rapid increase by about 27.35％ per year.The constituent ratio of primary and secondary syphilis in all the syphilis cases had declined yearly,while that of latent syphilis increased by more than 50％ after 2010.Conclusions Syphilis remains a major public health issue in China,and measures based on the epidemiological features are urgently needed to effectively control epidemic syphilis.

Objective To observe the clinical efficacy of comprehensive muscle-region therapy based on Chuang Medicine in treating cervical spondylosis of neck type.Method A hundred patients with cervical spondylosis of neck type were randomized into a treatment group and a control group, 50 cases in each group. The treatment group was intervened by the comprehensive muscle-region therapy based on Chuang medicine (muscle-region tuina, fire-needle acupuncture of Chuang medicine, and cupping), while the control group was by regular acupuncture treatment. The Visual Analogue Scale (VAS) score and symptoms and signs scores were observed before and after intervention, and the clinical efficacies were compared.Result The VAS scores respectively after 1 and 2 treatment courses were significantly different from that before intervention in the treatment group (P<0.05,P<0.01). The VAS score after 2 treatment courses was significantly different from that before intervention in the control group (P<0.05). After 2 treatment courses, the VAS score in the treatment group was significantly different from that in the control group (P<0.05). After treatment, the symptoms and signs scores (pain intensity, pain-affected area, number of tender points, limited motion, and general score) were significantly different from that before intervention in the treatment group (P<0.01, P<0.05). In the control group, the pain intensity, limited motion and general score after treatment were significantly different from that before intervention (P<0.05,P<0.01). After treatment, the symptoms and signs scores in the treatment group were significantly different from that in the control group (P<0.05,P<0.01). The total effective rate was 100.0% in the treatment group versus 84.0% in the control group, and the difference was statistically significant (P<0.05).Conclusion Comprehensive muscle- region therapy in Chuang medicine is an effective approach in treating cervical spondylosis of neck type.

Objective To investigate the effects of permissive hypercapnia (PHC) strategy used in ventilated newborn swine with respiratory failure on cerebral blood flow (CBF) and tissue metabolism. Method Eighteen newborn swine were randomly (random number) divided into 3 groups (n = 6): PHC, normocapnia (NC) and normal control groups. In PHC (PaCO2 50～60 mmHg) and NC (PaCO2 35 ～ 45 mmHg) groups, newborn swine were ventilated for treating respiratory failure induced by meconium aspiration. CBF was measured by using colored microsphere tracking technique. Cerebral oxygen metabolism rate (CMRO2), cerebral glucose metabolism rate (CMRGlu), and cerebral lactate production (CLP) were measured. Results After ventilation for 6 hours and 12hours, CBF in NC group decreased more significantly than those did in control group, and CMRGlu and CLP increased more significantly than those did in control group. In NC group, CMRO2 decreased more prominently than it did in control group 12 hours later. The CBF/CMRGlu and CBF/CLP ratios in NC group were lower than those in control(P＜0.05). There was no significant difference in CBF/CMRO2 ratio between NC and control groups. After ventilation for 6 hours, CBF in PHC group was lower than those in control group. But after ventilation for 12hours, CBF in PHC group increased and there was no significant difference in CBF between PHC group and control group (P＞O.05). There were no significant differences in CMRGlu, CLP and CMRO2 between PHC group and control group. The CBF/CMRGlu and CBF/CLP ratios in PHC group were lower than those in control, but higher then those in NC group (P＜0.05). There was no significant difference in CBF/CMRO2 ratio between PHC and control groups. Conclusions The reduction of cerebral blood flow and the disturbance of CBF autoregulation disturbance occur in ventilated newborn swine with hypoxemia respiratory failure. PHC may attenuate the reduction in CBF and the disturbance of CBF autoregulation.

Objective To investigate the clinical efficacy of anterior pelvic plating plus percutaneous lumbo-iliac rod/screw fixation in the treatment of pelvic fractures which are vertically and rotationally unstable and combined with unilateral sacral fracture of Denis type Ⅱ.Methods From January 2008 to November 2012,19 patients were treated for compound injury to the anterior and posterior pelvic rings complicated with sacral fracture of unilateral Denis type Ⅱ using anterior pelvic plating plus posterior percutaneous fixation of lumbo-ilium with screws.Their improvement in neurological function,reduction outcome and clinical effectiveness were evaluated by comparing preoperation and 2 years postoperation in terms of visual analogue scale (VAS),Japanese Orthopaedic Association (JOA) score for lower back pain,MOS Item Short-form health survey (SF-36 comprehensive scale),modified Roland-Morris Disability questionnaire (RDQ),Oswestry disability index (ODI),Gibbons overall scale,Majeed total score,sacral kyphosis abnormity,bias of sagittal/coronal vertical axis (SVA/CVA),pelvic incidence,pelvic tilt,lumbar lordosis,vertical displace,and leg length discrepancy.Results The differences respectively reached statistical significance for the aforementioned clinical and imaging parameters between preoperation and 2 years postoperation (P ＜ 0.05).By Majeed scoring,13 cases were rated as excellent,4 as good and 2 as fair.By Tometta/Matto scoring postoperatively,the fracture reduction was rated as excellent in 12 cases,as good in 6 and as fair in one.The complications of incision infection or necrosis,secondary neurovascular damage,implant failure or mal-union was not observed.Perfect nerve functional recovery and sufficient imaging reduction were achieved in all but one patient who had to receive decompression and release for sacral canals or foramens.According to Mohammad criteria,15 patients were engaged in the jobs with the same intensity and property as their pre-injury ones.Conclusions The simultaneous hybrid performance of anterior reconstruction plating combined with unilateral lumbar/sacral pedicle and iliac screwing may be a safe,reliable and satisfactory treatment for pelvic fractures of AO/Tile C1 type which involve unilateral sacral Denis type Ⅱ.

Objective To investigate epidemiological characteristics and trends of gonorrhea in China, and to provide a scientific basis for the development of control strategies. Methods An epidemiological study was performed on gonorrhea cases reported from 31 provinces, autonomous regions or municipalities directly under the central government between 2000 and 2014. Results The reported incidence rate of gonorrhea decreased from 22.92 per 100 000 in 2000 to 7.25 per 100 000 in 2014, with the average annual rate of decrease being 7.89%. There was a significant difference in the incidence of gonorrhea between different regions. The regions with the highest incidence rate of gonorrhea were Yangtze River Delta region(Zhejiang, Shanghai, Jiangsu)and Zhujiang River Delta region(Guangdong, Guangxi, Hainan), followed by northwest China (Xinjiang, Ningxia, Inner Mongolia). The incidence of gonorrhea was higher in males than in females, and the average male/female ratio increased from 1.96 ∶ 1 in 2000 to 4.52 ∶ 1 in 2014. The population aged 20 - 44 years showed high incidence of gonorrhea, and the highest incidence rate of gonorrhea was observed in the age group 25 - 29 years in both men and women. The incidence of gonorrhea decreased in all the age groups from 2000 to 2014 except the age group 15 - 19 years with an annual growth rate of 4.18%. Of 20 occupations, peasant workers accounted for the highest proportion (26.00%)of reported gonorrhea cases, and the number of reported gonorrhea cases showed a decreasing trend in all the occupations. Conclusions Gonorrhea remains a major public health issue in China, and effective measures based on epidemiological features are urgently needed to control gonorrhea.

Objective To investigate epidemiologic features of genital Chlamydia trachomatis (Ct) infection in China,and to provide scientific evidence for developing control strategies.Methods A descriptive epidemiological study was conducted to analyze personal,spacial and temporal distribution of genital Ct infection cases reported from 105 national sexually transmitted disease (STD) surveillance sites in China between 2008 and 2015.Results The reported incidence rate of genital Ct infection increased from 32.48 per 100 000 in 2008 to 37.18 per 100 000 in 2015,with the average annual rate of increase being 1.95％.There was marked variation in the reported incidence of genital Ct infection (range,＜ 1/100 000-615.99/100 000) among different STD surveillance sites,which was relatively high in the Pearl River Delta region,Yangtze River Delta region,Minjiang River region and some ethnic minority areas in western China,but low in north China and central China.In addition,no cases were reported at a few sites in rural areas.The reported annual incidence rate was higher in females than in males from 2008 to 2015,and the ratio of male to female cases decreased from 0.61:1 in 2008 to 0.46:1 in 2015.Among all age groups,the sexually active population aged 20-44 years showed high reported incidence of genital Ct infection,with the highest reported incidence observed in the group aged 25-29 years (range,116.72/100 000-142.98/100 000);the group aged 15-19 years showed the highest average annual rate of increase (10.06％) in the reported incidence of genital Ct infection.Among all kinds of medical institutions,general hospitals had the largest number of reported cases (range,66.00％-74.22％),followed by gynecology hospitals,Maternal and Child Health (MCH) hospitals and specialized dermatovenereology hospitals.Conclusions Genital Ct infection has been one of important public health issues in China,more attention should be paid to its prevention,and effective preventive measures are needed to be developed according to epidemiologic features.

Objective To investigate the efficacy of continuous veno-venuous hemodialysis/filtration(CVVHD/F) for the treatment of multiple organ dysfunction syndrome(MODS)caused by severe infection and to explore the mechanism in children.Method Nineteen cases of pediatric septic shock with MODS were treated with CVVHD/F in Children's Hospital Affiliated to Shanghai Jiaotong University from December 2002 to November 2007.The clinical data were studied including mortality rate,serum electrolytes,arterial partial pressure of oxygen (PO2),artery partial pressure of carbon dioxide(PCO2),FiO2/PO2,urine output,blood pressure,doses of vasoactive agents,Cr,BUN,etc.Results Cannulation and CVVHD/F were well performed in a total of 19 cases,with median age 33.4±36.5 months(from 3 months to 8 years) ,with their gender ratio of male(13 cases)to female (6 cases) to be 68.4% and 31.6%.The mean pediatric crifcal illness score(PCIS) was 69.1±10.4 and Median Pediatric Risk of Mortality score(PRMS Ⅲ)12.66±7.85,respectively.The duration of CWHD/F was 92 hours(ranged from 16 hours to480 hours).FiO2/PO2,PCO2,and PO2 were iraproved significantly after 12 to 24 hours CVVHD/F in patients with acute respiratory distress syndrome(ARDS) or lung edema (P<0.05).The concentrations of serum kalium,natrinm and HCO3- level resumed to well-balanced in 24 hours (P<0.05).The serum Cr and BUN were decreased to normal range(P<0.05).The mortality rate was 63.2%.Conclusions CVVHD/F was effective for treatment of septic shock with MODS in pediatric by improving oxygenation,maintaining normal serum electrolytes,conecting metabolic acidosis,increasing the tissue perfusion and eliminating the serum Cr and BUN.

Objective To estimate the maternal.neonatal morbidity associated with induction deliveries compared with spontaneous deliveries in 41 gestational weeks uncomplicated primiparae.Methods Three hundred and seventy.four uncomplicated primiparous deliveries at 41 gestational weeks at Peking Union Medical College Hospital from Sept 2002 to Apr 2007 were reviewed.including 225 women undergoing induced labor and 149 women undergoing spontaneous labor.The induction methods included drug induction (173),rupture of membrane induction(5)and combined drug with rupture of membrane induction(47).The maternal morbidity,delivery method,matemal cost on hospital stay and neonatal asphyxia associated with induction deliveries or spantaneous deliveries were retrospectively analyzed.Results (1)There was no maternal death.The caesarean section rate in the induction group(44.0%,99/225)was significantly higher than that of spontaneous group(18.1%,27/149;P<0.05).(2)No statistically significantdifference(P>0.05)was observed between induction group and spontaneous group in the following puerperal complications:postpartum hemorrhage(2.7%,6/225 and 1. 3%,2/149 respectively),puerperal morbidity(0.9%,2/225 and 0.7%,1/149 respectively),severe amniotie fluid contamination (11.6%,26/225 and 13.4%,20/149 respectively),wound infection(0.9%,2/225 and 0.7%.1/149 respectively),urinary retention(4.4%,10/225 and 3.4%,5/149 respectively),traumata(0.4%,1/225and 0 respectively)and neonatal asphyxia(1.3%,3/225 and 2.0%,3/149 respectively).(3)The average duration of first stage of labor in the induction group(413 min)Was not significantly different from tllat of spontaneous group(461 min;P>0.05).In the induction group,more women had precipitate lahore(P