BACKGROUND:Some studies have showed that the accuracy and surgery outcome of the percutaneous pedicle screw implantation was superior to open surgery, but the relationship between the angle of pedicle screws and screw stability is stil unclear in previous studies. OBJECTIVE:To investigate the effect of different angles of implanted screws on the stability of pedicle screw. METHODS:A total of 30 vertebral specimens of adult pigs were selected and screws were implanted respectively according to different coronal and sagittal angles. The maximum pul-out strength of screws from each specimen was tested by machine. Load-displacement curves were drew and statistical y analyzed. RESULTS AND CONCLUSION:The maximum pul-out strength and maximum energy of screw with 10° and 15° coronal and sagittal angles implantation were significantly better than those of 0° angle group (P<0.05). When the stress exceeded the maximum pul-out strength, the pul-out strength of screw decreased gradual y. The curves in coronal and sagittal 10° and 15° angle groups was similar, and the slope was better than 0° angle group (P<0.05). These results confirm that the angle of the implanted screw provides effective assistance to the stability of percutaneous pedicle screw. After the looseness of the screws, the pul out strength shows a steady downward trend.

Objective To evaluate clinical effect of expandable intramedullary nail in unreamed treatment of tibia fracture.Methods 31 patients with proximate tibia fracture were treated with expandable intramedullary nail and unreamed.Among those patients,4 cases were compound fracture,27 cases were closed fracture;16 cases were AO/ASIF type A,4 cases were type B and 11 cases were type C.The following-up of 9 months to 5 years(average 2 years) performed after operation.Results The fractures of 30 patients healed up and patients' functions recovered.1 case with comminuted and multiple fracture got delayed union.Conclusion Expandable intramedullary nail is an utility and satisfactory method to treat proximate tibia fracture.

Objective To report a case of Hutchinson-Gilford progeria syndrome,and to make a molecular genetic diagnosis.Methods Peripheral blood samples were collected from a 12-month-old child with HutchinsonGilford progeria syndrome,his parents,and 150 unrelated healthy controls.DNA was extracted from these samples,and PCR was performed to amplify exon 11 of the LMNA gene and its flanking sequence followed by sequencing.Results The patient presented with scleroderma-like tight skin on the trunk,hair loss and prominent scalp veins for 9 months,whose body height and weight were two standard deviations below the mean.Physical examination showed thin skin and prominent superficial veins over the scalp.The skin over the trunk was tight,hard,shiny and dry with a small number of tiny scales,mottled pigmentation and hypopigmentation,induration and hypertrophy giving a cobblestone-like appearance.The subcutaneous fat was diminished on the lower limbs.Skeletal X-ray examination of the left hand revealed phalangeal acroosteolysis.A known heterozygous mutation c.1824C ＞ T (dbSNP:rs58596362) was detected in the exon 11 of the LMNA gene in the proband,but not in his parents or the 150 unrelated healthy controls.Conclusion The mutation c.1824C ＞T in the LMNA gene may be responsible for Hutchinson-Gilford progeria syndrome in this patient.

Objective To explore the pathological changes of the femoral head bone metabolism induced by diabetes mellitus.Methods Seventy rabbits were divided into the control group and experiment group randomly. The control group were injected with saline; while the experiment group were injected with Alloxan through ear-edge vein quickly to establish the immediate diabetes mellitus model. The histopathology, ultrastructure, biochemistry, hemorrheology, and platelet function of all animals of two groups were detected in different periods.Results In the experiment group, 2 animals' bone trabecula were found disorder and vacant bone lacuna was 14% in the 4th week; in the 8th week, 3 animals' part bone trabecula were found breakage, defluxion, vacant bone lacuna was 28%; in the 12th week, 5 animals' bone trabecula were found breakage, defluxion obviously, vacant bone lacuna was 56%. Under TEM, there was some lipid droplet in bone cells, bone cellular necrotized at different levels. Myelosis decrease, the number and diameter of adipose cell increased. In the 8th and 12th week, the content of serum calcium decreased and that of serum phosphorus increased in the experiment group compared with the control group ( P<0.05, P<0.0l), and the product of calcium and phosphorus of the experiment group in the 12th week was lower than that of the control group (P<0.05).Conclusion DM can cause osteoporosis. Capillary fracture happens in the arch bridge structure of femoral head under machine press while being pressed. Along with the course of DM process, capillary fracture accumulates, bone under cartilage compress and collapse. It can oppress bone capillary to cause ischemia. All factors result in the basic pathology and the primary pathogenesy of the femoral head.

Objective To investigate the effectiveness and feasibility of standardized nursing training in reducing the incidence rate of post-endoscopic retrograde cholangiopanography(ERCP) pancreatitis. Methods A total of 521 patients were collected from January 2015 to June 2016 in ERCP therapy as control group.The patients in this group did not have standardized nursing training.A total of 289 patients were selected from July 2016 to April 2017 in ERCP therapy as intervention group.The patients in this group were carried out the standardized nursing training. The incidence of hyperamylasemia and post-ERCP pancreatitis was observed in two groups. Results The incidence of hyperamylasemia and post-ERCP pancreatitis was 12.09%(63/521),7.87%(41/521)in control group,and 7.61% (22/289), 3.11% (9/289) in intervention group,the difference was statistically significant between two groups(χ2=3.972,7.258,P<0.05 or 0.01). Conclusions The standard nursing training and intraoperative coordination can reduce its risk factors, and to reduce the post-ERCP pancreatitis and hyperamylasemia has important meaning and function.

Objective To report a case of Costello syndrome complicated by curis laxa,and to make a molecular genetic diagnosis.Methods Clinical data were collected from a case of Costello syndrome complicated by cutis laxa.Skin tissues were resected from the patient,and peripheral blood samples were obtained from the patient's parents and 150 unrelated healthy controls.Genomic DNA was extracted from these samples,and all the exons and their flanking sequences of the HRAS gene were analyzed by DNA sequencing.Results The 13-month-old female patient presented with growth retardation,severe malnutrition,coarse facial appearance,severely loose skin over the limbs,and decrease or disappearance of subcutaneous fat.A heterozygous mutation c.34G ＞ T (p.Gly12Cys) was detected in exon 2 of the HRAS gene in the patient,but not in her parents or 150 unrelated healthy controls.Conclusion The c.34G ＞ T (p.Gly12Cys) mutation in exon 2 of the HRAS gene may be responsible for Costello syndrome in the patient.

Objective:To explore the status of microsatellite instability (MSI) and its relationship with clinicopathological characteristics of patients with endometrial carcinoma.Methods:The clinical data of 365 patients with endometrial carcinoma who received surgery in Shanxi Province Cancer Hospital between January 2020 and December 2021 were retrospectively analyzed. Immunohistochemistry was used to detect the expressions of 4 DNA mismatch repair (MMR) proteins (MLH1, MSH2, MHS6, and PMS2), estrogen receptor (ER), progesterone receptor (PR), and p53 mutant protein in postoperative cancer tissue samples from 365 patients with endometrial carcinoma. All patients were divided into MSI group (1 or more non-expression of MMR protein) and microsatellite stability (MSS) group (4 proteins were all expressed), and the clinicopathological characteristics of patients in both groups were compared. φ efficient was used to analyze the correlation of MSI with ER, PR, p53 mutant protein expressions. Results:There were 72 cases (19.7%) in MSI group and 293 cases (80.3%) in MSS group; and the age of all patients was (53±19) years (21-83 years). There were statistically significant differences in the proportion of MSI patients in endometrial carcinoma patients with different age [>50 years vs. ≤50 years: 22.1% (61/276) vs. 12.4% (11/89)], tumor diameter [≤2 cm vs. > 2 cm: 25.9% (30/116) vs. 16.8% (42/249)], International Federation of Gynecology and Obstetrics (FIGO) staging [stage Ⅲ-Ⅳ vs. stage Ⅰ-Ⅱ: 31.1% (14/45) vs. 18.1% (58/320)], histological type [type Ⅰ vs. type Ⅱ: 21.7% (71/327) vs. 2.6% (1/38)] (all P < 0.05). There were no statistically significant differences in the proportion of MSI patients with different depth of invasion, degree of differentiation, lymph node metastasis, vascular involvement, and lesion location (all P > 0.05). Among 327 cases of type Ⅰendometrial carcinoma, 1 case was mucinous adenocarcinoma (MSS status), and the other 326 cases were endometrioid adenocarcinoma. Of the 72 patients with MSI, 71 cases were endometrioid carcinoma and the other was 1 of 3 mixed carcinomas in type Ⅱ endometrial carcinoma. There was a negative correlation between MSI and mutant p53 ( φ coefficient was -0.11, P = 0.031), and φ coefficient of the correlation of MSI with ER and PR was -0.03 and -0.06, while there were no statistically significant differences ( P value was 0.578 and 0.255, respectively). Conclusions:Endometrioid adenocarcinoma is the main type of endometrial cancer patients with MSI. MSI in endometrial cancer is correlated with age, FIGO staging, tumor diameter and histological type of patients, while negatively correlated with mutant p53.

Objective Regional homogeneity (ReHo) and functional connectivity (FC) were used to study obsessive-compulsive disorder(OCD),and to explore the mechanism of OCD in resting state.Method Resting-state functional magnetic resonance imaging (RS-fMRI) was performed in 55 patients with OCD (OCD group) and 50 normal controls (control group) matched by sex,age,nationality and education.The data and screening abnormal brain areas were analyzed and compared by DPARSFA2.3 and Rest software in OCD group.Whole brain FC analysis was performed with abnormal brain areas as seed points.Result Compared with the control group,ReHo in right thalamus (MNI:x=9,y=-24,z=6,t=4.3217) and left superior marginal gyrus (MNI:x =-45,y =-30,z =27,t =3.6320) increased and ReHo in right caudate nucleus (MNI:x=3,y=15,z=9,t=-3.1687) decreased in obsessive-compulsive disorder group,and the difference was statistically significant(P＜0.05).Using left superior marginal gyrus,fight thalamus and right caudate nucleus as seed voxels,the whole brain FC analysis showed that there were abnormal functional connections between bilateral cerebellar foot 1/2 area and left supramarginal gyrus,right thalamus and right caudate nucleus (P＜0.05) and the left supramarginal gyrus-bilateral cerebellum feet 1 area-right thalamic circuit and left supramarginal gyrus-bilateral cerebellum feet 1,2-right caudate nucleus-right thalamic circuit existed in 0CD group.Conclusion The left supramarginal gyrus-bilateral cerebellum feet 1 area-right thalamic circuit and left supramarginal gyrus-bilateral cerebellum feet 1,2-right caudate nucleus-right thalamic circuit may play an important role in the mechanism of OCD.

Objective To study the distribution and drug resistance of pathogens in patients with lung cancer,and analyze the prevention strategies. Methods A total of 312 cases of lung cancer patients with infection treated in our hospital from January 2017 to January 2021 were selected as the research objects.The lower respiratory tract secretions,urine and feces were collected for pathogen culture and drug sensitivity test;the distribution and drug resistance of pathogens were analyzed,and the corresponding prevention strategies were formulated. Results Of the 312 patients, 165 (52.88%) had respiratory tract infection, 79 (25.32%) had oropharyngeal infection, and 68 (21.80%) had urinary tract infection.The highest proportion was respiratory infection.Among the 312 patients,398 pathogens were detected of which 212 Gram-positive bacterias (53.27%)were found of which Staphylococcus epidermidis(15.58%)and Staphylococcus aureus(13.07%)accounted for a relatively high proportion. Among 175 Gram-negative strains,Klebsiella pneumoniae(15.94%)and E.coli (10.05% ) accounted for a large proportion.The resistance rate of Gram-positive bacteria,such as Staphylococcus epidermidis and Staphylococcus aureus,to amikacin,gentamicin and penicillin,was more than 50%,which was sensitive to vancomycin. Gram negative bacteria such as Klebsiella pneumoniae and E.coli have high resistance to common antibiotics,and the drug resistance rate to cefepime and cefazolin is more than 50%,and sensitive to imipenem/cilastatin and imipenem/cilastatin.Among 11 fungi,4 cases were resistant to fluconazole , 36.36%,3 to itraconazole,27.27%,0 to ketoconazole and voriconazole,0.00%. Conclusion The distribution and drug resistance of pathogenic bacteria in patients with lung cancer infection in our hospital have certain characteristics,in which Gram-positive bacteria are mainly Staphylococcus epidermidis and Staphylococcus aureus,Gram-negative bacteria are mainly Klebsiella pneumoniae and Escherichia coli,and there are also a small number of fungal infections.Therefore,we should strengthen the monitoring of etiology and drug resistance,and strengthen the management of hospital disinfection Drug sensitivity results of patients,rational use of antibiotics,so as to improve the treatment effect and reduce the risk of infection.