Objective To discuss the value of thoracolumbar injury classification and severity score (TLICS) and load-sharing scores in guiding selection of the indications of combined anteroposterior surgery for thoracolumbar fractures. Methods A total of 216 patients with thoracolumbar fractures treated surgically from January 2006 to January 2008 were involved in the study. Combined anterior and posterior surgery was carried out in 48 patients including 32 males and 16 females (at average age of 39 years, range 18-55 years). Segments involved T11 in two patients, T12 in eight, L1 in 20 and L2 in 18. According to the classification of Magerl, there were 20 patients with type B1 fractures, 15 with type B2, four with type C1 and nine with type C2. Neurologic status based on ASIA classification was at grade A in five patients, grade B in 16, grade C in 16, grade D in nine and grade E in two. All patients were operated in lateral position at one stage within 14 days after injury, with posterior laminectomy and pedicle fixation, anterior corpectomy, reduction and strut graft. Forty-five patients were followed up for 14-38 months. Plain X-ray radiographs and reconstruction CT were taken to observe the bone healing. Local kyphosis and vertebral canal were also measured. All the patients were evaluated with TLICS and load-sharing scores. Results Lumbar physical lordosis was reconstructed, with no evident correction loss,pseudoarthrosis or implant failure noted during follow-up. The patients treated with combined surgery had TLICS score ≥5 points, load-sharing scores ≥7 points and were combined with posterior ligamentous complex injury, so the fracture could not be sufficiently decompressed and reconstructed with single anterior or posterior surgery. Of all, 45 patients were followed up for 14-38 months (mean 25 months), which showed that all the combined surgeries were performed successfully, with bone fusion and neurological status improved for at least one ASIA grade. No complications like implant breakage, loosening, titanium mesh displacement or subsidence were observed. Conclusions LICS is basically helpful for guiding selection of combined surgery, but does not well evaluate the canal compromise, to which the load-sharing scores can supplement. These two evaluation systems should be applied together. The anteroposterior surgery can be recommended when the patients are with TLICS≥5 points, load-sharing score ≥7 points and combined with ligament complex injury.

BACKGROUND:Gait deviations are the important diagnosis criteria and surgical indications of cervical myelopathy. Conventional three-dimensional gait laboratory failed to apply in clinics due to complex operations and time consuming. In recent years, a portable gait analyzer based on the micro-sensors is emerging and developing, it has been verified by clinical practice, al owing gait analysis in the ward.
OBJECTIVE:To quantitatively analyze gait characteristics of patients with cervical spondylotic myelopathy (CSM) by a portable gait analyzer.
METHODS:From March 2013 to November 2013, 15 CSM patients and 30 healthy subjects were enrol ed in the study. The involved patients were accompanied by gait abnormalities. A portable gait analyzer was used for gait analysis. Subjects walked on a 30-meter corridor back and forth for 120 meters. Total y 12 gait parameters were involved in this study, including seven common parameters (single limb support, double limb support, gait cycle, speed, cadence, step length and stride length) and five new parameters (pul ing acceleration, swing power, ground impact, foot fal , and pre-swing angle). Three patients underwent cervical decompression surgery. The gait characteristics were re-evaluated one week later, carrying neck support.
RESULTS AND CONCLUSION:The double limb support and gait cycle duration of CSM group were significantly longer than control group (P<0.05). Speed, cadence, step length, stride length, swing power, ground impact, foot fal , and pre-swing angle of CSM patients were significantly smal er than healthy subjects (P<0.05). No differences were found in single limb support and pul ing acceleration (P>0.05). after cervical decompression surgery, the mean remission rate of Japanese Orthopedics Association scores was 32.5%and lower limb acceleration was improved obviously in the graph one week after surgery. Varying degree of correlation was seen between Japanese Orthopedics Association scores and the detected 12 gait parameters in CSM patients. The portable gait analyzer can effective measure the pathological gait deviation in CSM patients with abnormal gaits, and assists to evaluate the lower limb functions.

Objective: To investigate whether plasma microRNAs has-let-7d and has-let-7e can be used as potential molecular markers for workers with occupational exposure to mercury. Methods: October 2013, the workers with occupational exposure to mercury who worked in a mercury thermometer factory and participated in occupational health examination were selected as subjects, and biological samples and basic data were collected. The subjects were divided into chronic mercury poisoning group,mercury absorption group,and control group,with 30 individuals in each group. AmicroRNA microarray combined with RT-qPCR was used to measure the expression of has-let-7d and has-let-7e in the three groups, the receiver operating characteristic(ROC)curve was used to analyze the values of has-let-7d and has-let-7e in the diagnosis of occupational chronic mercury poisoning,a software platform was used to predict target genes. Gene ontology enrichment analysis and KEGG pathway analysis were also performed. Results: Compared with the control group, the chronic mercury poisoning group and the mercury absorption group had significant increases in the expression of has-let-7d and has-let-7e(P<0.05). The areas under the ROC curve for microRNAs has-let-7d and has-let-7e in the diagnosis of occupational chronic mercury poisoning were 0.912(95% confidence interval[CI]0.843-0.981)and 0.908(95%CI0.837-0.979),respectively,and there was a significant difference between them(P<0.001). Conclusion Plasma microRNAs has-let-7d and has-let-7e can be used as potential molecular markers for workers with occupational exposure to mercury.

Objective To evaluate the mid-term clinical and radiographic results of artificial disc replacement (ADR) for discogenic low back pain.Methods From July 2004 to July 2007,21 patients with discogenic low back pain,aged from 26 to 67 years,underwent lumbar ADR with the Charité Ⅲ artificial disc at 22 levels and Activ L prosthesis at 2 levels:L4-5 5 cases,L5S1 13 cases,L4-5 and L5S1 3 cases.The diagnosis was proved by discography in all the patients.The clinical and radiographic results were evaluated and compared between pre-,post-operation and finial follow-up.Results All patients were followed up for 4to 7 years (average,5.1 years).There were statistical differences between pre-operation and final follow-up in Oswestry disability index and Visual Analogue Scale for back pain and leg pain.All the prostheses were mobile without dislocation,breakage,subsidence or spontaneous fusion,only a slight scoliosis was noted in one patient.At the ADR levels,the anterior and posterior intervertebral height increased averagely 6.3 mm and 1.9 mm respectively,the lordosis increased 2.9°,and the mean range of motion (ROM) was 4.6°.At the adjacent level proximal to ADR,the intervertebral height and lordosis decreased slightly,and the ROM decreased 2.5°.The total lumbar lordosis increased 7.8°,and the total lumbar ROM increased 2.4°.According to MRI and CT scans,the degeneration of proximal adjacent disc and facet were not evident,however the degeneration of facets at the ADR levels was evident.Conclusion The 5 years results of ADR for discogenic low back pain were satisfactory,with preserved motion at the ADR level,and the degeneration of adjacent level was not evident.However,there was obvious degeneration in facet joints of the ADR level.

One hundred eighty-four cases of awake craniotomy in Xijing Hospital from September 2010 to June 2019 were retrospectively included in the study.Patients were divided into Asleep-Awake-Asleep (AAA) group and monitored anesthesia care (MAC) group.In AAA group, general anesthesia was used in the early arousal period, sedatives and analgesics were stopped during the arousal period, and the bispectral index (BIS) value was maintained at 60-80 in the late arousal period.In MAC group, dexmedetomidine and remifentanil were intravenously infused in the early arousal period, and the BIS value was maintained at 60-80 in the late arousal pericd.Dexmedetomidine and remifentanil infused were reduced or stopped according to the Observer′s Assessment of Altertness/Sedation score during the arousal period, so that the patient could be awakened at any time, and the BIS value was maintained at 60-80 in the late arousal period.Compared with AAA group, the consumption of local anesthetic and remifentanil was significantly decreased, the operation and anesthesia time was shortened, the requirement for rescue analgesia was decreased, mean arterial pressure, end-tidal pressure of carbon dioxide (P ETCO 2) and partial pressure of arterial carbon dioxide (PaCO 2) were increased and partial pressure of arterial oxygen (PaO 2) was decreased after laryngeal mask insertion or sedation, and heart rate and PaO 2 were decreased, P ETCO 2 and PaCO 2 were increased after awakening in group MAC ( P<0.05). There were no significant differences in anesthesia failure rate in the awake craniotomy, incidence of adverse events during the arousal period, intraoperative incidence of tachycardia/bradycardia and hypertension/hypotension, Observer′s Assessment of Alertness/Sedation score during the arousal period, rate of postoperative visual analogue scale score>5 after surgery, postoperative requirement for rescue analgesia, neurological deficit rate and rehabilitation discharge rate between the two groups ( P>0.05). Compared with those after laryngeal mask insertion or after sedation, mean arterial pressure, heart rate, P ETCO 2 and PaCO 2 were significantly increased, and PaO 2 was decreased after awakening in AAA group ( P<0.05), and no statistically significant change was found in the parameters mentioned above after awakening in MAC group ( P>0.05). In summary, MAC shortens the operation and anesthesia time, no artificial airway is required, and it is suitable for the short time and minor operation.AAA has a better hemodynamics and oxygenation in the early arousal period, but the patient′s stress is more obvious after awakening, and effective prevention and intervention are needed.

Humans ; Fasciitis/pathology* ; Fibroma/pathology* ; Gene Rearrangement ; Proto-Oncogene Proteins/genetics* ; Ubiquitin Thiolesterase

【Objective】 To evaluate and analyze the impact of COVID-19 epidemic on inventory of red blood cells (RBCs)in local and municipal blood stations in China, and to provide reference for the management of public health emergencies. 【Methods】 Relevant data from 2018 to 2021 were collected, and the differences in the volume of qualified RBCs, the usage efficiency of inventory RBCs, the average daily distribution of RBCs,the blood distribution rate of RBCs prepared by 400 mL whole blood, the difference in the average storage days of RBCs at the time of distribution, the average daily inventory of RBCs and the time of the average daily inventory of RBCs to maintain the distribution in 24 local and municipal blood stations in China during the COVID-19 epidemic and non-epidemic periods were retrospectively analyzed. 【Results】 Compared with non-epidemic periods, the volume of qualified RBCs [(117 525.979 ±52 203.175)U] and the average daily distribution of RBCs [( 156. 468 ± 70. 186) U ] increased significantly, but the usage efficiency of inventory RBCs decreased(97.24%±0.51%) significantly (P<0.05).There was no significant difference in the blood distribution rate of RBCs prepared by 400 mL whole blood(73.88%±20.30%), the average storage days of RBCs distribution(13.040 ±3.486), the average daily stock quantity of RBCs[(2 280.542 ±1 446.538) U ] and the time of the average daily inventory of RBCs to maintain the distribution[(15.062 ±7.453) d] (P>0.5). 【Conclusion】 During the COVID-19 epidemic, the inventory management of RBCs operated well, the overall inventory remained relatively stable, the stock composition and storage period showed no significant change.