BACKGROUND: The treatment of upper cervical spine disorders through a posterior pedicle fixation approach have been carried out in some domestic large hospitals, but this surgery is still considered as a difficulty of cervical spine surgery. In order to minimize the risk of surgery, the authors designed a program of individual operations, and combined with self-developed pedicle locating and directing speculum to determine precise intraoperative position of pedicle screws, and no report is found by searching related database in China.OBJECTIVE: To improve the one-time success rate of internal fixation screws, to investigate the biomechanical effect of the implant, to formulate a simple, practical, individual protocol for atiantoaxial pedicle screw-plate system based on related data. METHODS: A total of 31 patients were recruited from Department of Orthopaedics in the 251 Hospital of Chinese PLA, between January 2002 and September 2006. Under the guidance of self-made atlantoaxial locating and directing speculum, the entrance point and angle for screw insertion, as well as screw diameter and length were determined according to the results of X-ray and CT measurement. Atlas pedicle screw was inserted at left (19.93±1.32) mm, and right (19.16±1.3) mm; Atlas pedicle screw insertion angle to inside was left (23.72±2.09)°, and right (23.35±1.91)°; Atlas pedicle screw insertion angle to side of head was (9.00±1.20)°. Axis pedicle screw was inserted at left (13.14±0.82) mm, and right (13.85±0.79) mm; Axis pedicle screw insertion angle to inside was left (24.52±1.26)°, and right (20.42±1.42)°; Axis pedicle screw insertion angle to side of head was (25.00±3.00)°.RESULTS AND CONCLUSION: ①Totally 124 pedicle screws were implanted into 31 patients, and 122 screws were of one-time success. The precision rate was 98.39%. Two screws were secondly inserted because of cutting lateral cortical bone of pedicle for deviation of inward angle. ②Occipital neuralgia was found in 2 cases postoperatively and cured after one month of treatment;screws penetrated atlas left vertebral lateral wall in 2 cases, no spinal or vertebral artery injury was found. ③Radiographs showed that atlas was completely reduced in all patients, and apposition of dentoid process of axis fracture was good. CT films showed the screws a good location to the vertebrarterial spinal cord. ④The follow-up visit was averaged of 10.5 months. Bony fusion was found in all patients. No screw-plate breakage was found. No inflammatory or rejection reactions occurred.⑤By JOA scale, there were 16 cases of excellent, 12 cases of good, 2 cases of fine, and 1 case of poor. The excellent and good rate was 90%. It is suggested that the success rate of atlantoaxial pedicle screw-plate mplantation can be improved through a biomechanical angle.

OBJECTIVETo screen proteomic markers of oral precancerous lesion, local and metastatic squamous cell cancer from human saliva.

METHODSSeventeen patients with oral squamous cell carcinoma, six cases with leukoplakia, seven cases with local metastasis and 15 healthy subjects were selected. All patients were diagnosed of T(1)N(0)M(0) and did not accept any preoperative treatment. Saliva samples were collected preoperatively, combined in the chips (CM-10) for two copies, and tested by surface enhanced laser desorption/ionization (SELDI) mass spectrometry respectively. Chips were detected by the PBS-II plus mass spectrometer reader. Mass accuracy was calibrated by the all-in-one peptide molecular mass standard (ciphergen ciosystems).

RESULTSThe differentiated pattern between oral squamous cell carcinoma and healthy people consisted of four biomarker peaks of 5797, 2902, 3883, 4951 (mass/charge) with the sensitivity of 88.24% and specificity of 93.33%. The differentiated pattern between oral squamous cell carcinoma and leukoplakia consisted of three biomarker peaks of 5818, 4617 and 3884 with the sensitivity of 100.00% and specificity of 100.00%. The differentiated pattern between oral squamous cell carcinoma and oral cancer with local metastatic consisted of three biomarker peaks of 55 809 and 5383 (mass/charge) with the sensitivity of 94.12% and specificity of 85.71%.

CONCLUSIONSThe biomarkers selected by SELDI could help in the adjuvant early diagnosis of oral cancer and forecasting the transformation from leukoplakia to oral cancer and metastasis.

Biomarkers, Tumor ; chemistry ; Carcinoma, Squamous Cell ; diagnosis ; Humans ; Leukoplakia, Oral ; diagnosis ; Mass Spectrometry ; Molecular Weight ; Mouth Neoplasms ; diagnosis ; Peptide Mapping ; methods ; Proteomics ; Saliva ; chemistry ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.

Objective To evaluate myocardial apoptosis with 99Tcm-C2A-GST myocardial imaging using the recombined C2A domain of Synaptotagmin Ⅰ by gene engineering. Methods ( 1 ) The C2A gene was inserted into the prokaryotic glutathione S-transferate (GST) fusion protein expression plasmid pGEX-6P-1. The recombinant plasmid was transformed into E. coli BL21. C2A-GST fusion protein was purified after BL21 was induced with isopropyl-β-D-1-thiogalactopyranoside (IPTG). (2)The activity of fusion protein was identified by cell binding test with fluorescein-5-isothiocyanate (FITC)-C2A-GST. (3) The C2A-GST fusion protein was labeled with 99Tcm using 2-iminothiophene hydrocoride method. Radiochemical purity was determined with thin layer chromatography. (4)99Tcm-C2A-GST (7.4 MBq) was injected to ischemia-reperfusion rat models through tail vein. The image was acquired with SPECT at 1 h after injection, and then hearts were removed, rinsed with saline and dyed with triphenyl tetrazolium coride (TTC). The ischemic myocardium was separated from the viable myocardium and was weighted. Its radioactivity was measured by gamma counting. The difference of uptake of radiotracer between ischemic myocardium and normal myocardium was compared using percentage activity of injected dose per gram of tissue ( % ID/g) with standard deviation. SPSS 12.0 and t-test were used for data analysis. Results ( 1 ) C2A-GST fusion protein wassuccessfully expressed and its relative molecular weight was 3.8 × 104. (2) FITC-C2A-GST binding to apoptotic cells could be observed by fluorescent microscopy. (3) The radiochemical purity of 99Tcm-C2A-GST was (98.90 ±0.43)%. (4)The imaging studies showed that there was focal uptake of radioactivity in the ischemic myocardium. In vitro uptake of 99Tcm-C2A-GST was (2.41 ±0.32) % ID/g by the ischemic myocardium, however 99Tcm-C2A-GST-N-hydroxysuccinimide (C2A-GST-NHS) was (0. 82 ± 0. 24) % ID/g. There was statistically significant difference between those two groups (t = 10. 6, P ＜0.01 ). Conclusion The C2A domain of Synaptotagmin Ⅰ expressed by gene engineering can be used as the tracer for noninvasive detection of ischemic myocardium in the ischemia-reperfusion rat model.

Objective To evaluate the effectiveness and safety of gefitinib retreatment beyond progression(GRBP)in non-small cell lung cancer(NSCLC)patients with rare EGFR mutations.Methods We retrospectively analyzed six rare-EGFR-mutation NSCLC patients from Jan 2011 to Dec 2015.Those patients had previous disease control and then disease progression according to Response Evaluation Criteria in Solid Tumors version 1.1(RECIST v1.1)after taking oral gefitinib 250 mg once a day.After that,continuing gefitinib was decided by clinicians′ experience at the same treatment option.The primary endpoints were response rate(RR),overall survival(OS),the first and second progression-free survival(PFS-1 and PFS-2).Safety was assessed according to the NCI-CTCAE version 4.0.Results After initial treatment of gefitinib,4 patients achieved partial response(PR)and 2 patients showed stable disease(SD),with RR being 66.7％.The median PFS-1 and PFS-2 were 10 months(95％CI 6.6-13.4)and 9 months(95％CI 6.9-11.1),respectively.The median OS time was 28 months(95％CI 10.4-45.6).The most common treatment-related adverse events were fatigue,diarrhea,rash,itching and elevated transaminases.Conclusion In our study,gefitinib retreatment beyond disease progression is effective with a manageable tolerability profile.

Primary central nervous system germ cell tumors (CNS-GCTs) in children and adolescents have unique clinical features and methods of treatment compared with those in adults. There is little information about Chinese children and adolescents with CNS-GCTs. Therefore, in this study we retrospectively analyzed the clinical features and treatment outcome of Chinese children and adolescents with primary CNS-GCTs. Between January 2002 and December 2012, 57 untreated patients from a single institution were enrolled. They were diagnosed with CNS-GCTs after pathologic or clinical assessment. Of the 57 patients, 41 were males and 16 were females, with a median age of 12.8 years (range, 2.7 to 18.0 years) at diagnosis; 43 (75.4%) had non-germinomatous germ cell tumors (NGGCTs) and 14 (24.6%) had germinomas; 44 (77.2%) had localized disease and 13 (22.8%) had extensive lesions. Fifty-three patients completed the prescribed treatment, of which 18 underwent monotherapy of surgery, radiotherapy, or chemotherapy, and 35 underwent multimodality therapies that included radiotherapy combined with chemotherapy or surgery combined with chemotherapy and/or radiotherapy. PEB (cisplatin, etoposide, and bleomycin) protocol was the major chemotherapy regimen. The median follow-up time was 32.3 months (range, 1.2 to 139 months). Fourteen patients died of relapse or disease progression. The 3-year event-free survival (EFS) and overall survival rates for all patients were 72.2% and 73.8%, respectively. The 3-year EFS was 92.9% for germinomas and 64.8% for NGGCTs (P = 0.064). The 3-year EFS rates for patients with NGGCTs who underwent monotherapy and multimodality therapies were 50.6% and 73.5%, respectively (P = 0.042). Our results indicate that multimodality therapies including chemotherapy plus radiotherapy were better treatment option for children and adolescents with CNS-GCTs.
Adolescent ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; administration & dosage ; Central Nervous System Neoplasms ; therapy ; Child ; Child, Preschool ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; statistics & numerical data ; Disease-Free Survival ; Etoposide ; administration & dosage ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; Neoplasms, Germ Cell and Embryonal ; therapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo analyze the related factors of the infection after operation of open tibiofibula fractures.

METHODSThe clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December 2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years; all the fractures were unilateral. According to Gustilo typing of fracure, 5 cases were type I, 44 cases were type II, 27 cases were type III a, 56 cases were type III b and 9 cases were type III c. These clinical data included patients' age, gender, body mass index (BMI), underlying diseases, time of operation, fracture site, fracture type, fixation method, postoperative drainage, debridement condition and so on. The postoperative infection conditions were recorded, and the correlation between above factors and infections were analyzed. Finally, the significant related variables were introduced into a Logistic regression model to evaluated their risk.

RESULTSAmong the 141 patients, 22 cases developed with infection (15.6%). The significant relative factors with infection contained fixation method, debridement condition, underlying diseases and postoperative drainage (P < 0.05). The correlativities were stepped up in order, their odds ratios value was 2.451, 3.164, 3.414, 5.117, respectively.

CONCLUSIONActive treatment for underlying diseases before operation, thorough debridement for open wound, suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.

Adolescent ; Adult ; Debridement ; Fibula ; injuries ; Fractures, Open ; surgery ; Humans ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection ; etiology ; Tibial Fractures ; surgery

Objective:To investigate the effect of moxibustion at Shenque (CV 8) on the immune system in rats with different levels of exhaustive exercise.Methods:Fifty-six male Sprague-Dawley (SD) rats were randomly divided into a blank group (n=8),an exhaustive group (n=24),and a moxibustion group (n=24).The exhaustive group was randomly divided into a 1-time exhaustive group,a 4-time exhaustive group and a 7-time exhaustive group,with 8 rats in each group.According to the treatment time,the moxibustion group was randomly divided into a 1-time moxibustion group,a 4-time moxibustion group and a 7-time moxibustion group,with 8 rats in each group.Rats in the exhaustive groups and the moxibustion groups were subjected to replicating the exhaustive swimming models.Rats in each moxibustion group received mild moxibustion for 15 min immediately after the exhaustive modeling,once every other day.Twenty-four hours after the corresponding exhaustive exercise,the rats in each group were tested for the levels of serum immunoglobulin (Ig) G,IgA,IgM and acid phosphatase (ACP),and the morphological changes of spleen tissues were observed.The level of IgA was detected by immunoturbidimetric assay,and the levels of IgG,IgM and ACP were detected by enzyme-linked immunosorbent assay (ELISA).Results:Compared with the 1-time exhaustive group,swimming time of rats in the 4-time exhaustive group was significantly prolonged (P＜0.01),and swimming time of rats in the 7-time exhaustive group was significantly shortened (P＜0.01).Compared with the 7-time exhaustive group,exhaustive swimming time of rats in the 7-time moxibustion group was significantly prolonged (P＜0.01).Compared with the blank group,the IgG level in the 1-time exhaustive group was significantly decreased (P＜0.01),and the levels of IgG,IgA and IgM in the 4-time exhaustive group and the 7-time exhaustive group were all significantly decreased (P＜0.05 or P＜0.01),while the ACP level was increased significantly (both P＜0.01).Microscopically,the number of splenic corpuscles in the 1-time exhaustive group was reduced;the center of some splenic corpuscles in the 4-time exhaustive group was damaged;the number of splenic corpuscles in the 7-time exhaustive group was reduced,and there was no obvious germinal center.Compared with the 4-time exhaustive group,the IgA level in the 4-time moxibustion group was significantly increased (P＜0.01),and the ACP level was significantly decreased (P＜0.01).Compared with the 7-time exhaustive group,the levels of IgG,IgA and IgM in the 7-time moxibustion group were significantly increased (all P＜0.01),and the ACP level was significantly decreased (P＜0.01).Microscopically,the number of splenic corpuscles in the 1-time moxibustion group was reduced;the center of some splenic corpuscles in the 4-time moxibustion group was damaged together with hyperplasia of some splenic corpuscles;blast cells were proliferated in the center of some splenic corpuscles in the 7-time moxibustion group.Conclusion:Moxibustion at Shenque (CV 8) can improve the levels of igG,igA and igM,reduce the ACP level,repair damaged spleen tissues,and enhance the immunity of the body to some extent in the long-term fatigue rats.

OBJECTIVETo probe into an effective method for treatment of endometriosis (EMs) and the mechanism.

METHODSRat EMs model was established and they were randomly divided into a model group, an acup-moxibustion group, a TCM group, an acupuncture and medicine group, with a control group set. The acup-moxibustion group were treated with electroacupuncture at "Xuehai (SP 10)", "Sanyinjiao (SP 6)" and moxibustion at "Guanyuan (CV 4)"; the TCM group were treated with stomach perfusion of modified Mojie Tablet in normal saline; the acupuncture and medicine group were treated with the above two methods; both the control group and the model group were bound and treated with stomach perfusion of saline. After treatment of 35 days, the greatest diameter of the ectopic tissue was measured in the rats, pathological observation of the ectopic tissue was made and matrix metalloproteinase-2 (MMP-2) expression in the ectopic tissue was determined.

RESULTSThe greatest diameter of ectopic tissue and MMP-2 expression in the ectopic tissue in the acupuncture and medicine group were significantly lower than those in the model group, the acup-moxibustion group and the TCM group (P < 0.05); and the ectopic endometrium trended to atrophy, and with necrosis of some epithelial cells.

CONCLUSIONCombination of acupuncture with medicine has a better therapeutic effect on endometriosis and down-regulates the abnormal increase of MMP-2 level to inhibit the invasion of ectopic tissue to extracellular matrix, so as to reduce the ectopic tissue, hence cure of endometriosis.

Acupuncture Therapy ; Animals ; Combined Modality Therapy ; Endometriosis ; enzymology ; pathology ; therapy ; Female ; Immunohistochemistry ; Matrix Metalloproteinase 2 ; analysis ; Medicine, Chinese Traditional ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo investigate the clinical characteristics, diagnosis and therapy of Keutel syndrome, and thereby to minimize the misdiagnosis.

METHODData of a case of Keutel syndrome diagnosed at the Provincial Hospital Affiliated to Shandong University were analyzed and related literature were reviewed.

RESULTAn 8-month-26-day-old boy was presented with inspiratory and expiratory stridor and wheezing after movement on lung auscultation. His craniofacial appearance was characterized by midfacial hypoplasia with a broad depressed nasal bridge. The nose was small and flat. A grade 2-3/6 systolic murmur was heard between the second and third ribs at left edge of the sternum. The end phalanges of his fingers were thickened. Chest radiograph showed tracheobronchial cartilage calcification and tracheobronchial stenosis. Echocardiographic examination revealed the right pulmonary stenosis. With endoscopic surgery, antiobstructive and antibiotic therapy clinical symptoms were improved. Three weeks later he died of lung reinfection after he was discharged from our hospital. English literature search with "Keutel syndrome" as the key word at "PubMed" showed 22 articles covering 26 patients, and the clinical symptoms were hearing loss (91%), persistent respiratory symptoms (68%), recurrent otitis media/sinusitis (67%), growth development delay (52%) in turn, and signs were brachytelephalangism (100%), low nasal bridge (95%), midfacial hypoplasia (93%), cardiac murmur (69%), and auxiliary examinations showed abnormal cartilage calcification (100%), pulmonary arterial stenosis (72%), tracheobronchial stenosis (50%).

CONCLUSIONThe diagnosis of Keutel syndrome should be considered in patients with brachytelephalangism, abnormal cartilage calcification, peripheral pulmonary stenosis, and midfacial hypoplasia. Tracheal stenosis was main clinical manifestation in part of patients.

Abnormalities, Multiple ; diagnosis ; diagnostic imaging ; therapy ; Bone and Bones ; diagnostic imaging ; Calcinosis ; diagnosis ; diagnostic imaging ; therapy ; Cartilage ; diagnostic imaging ; Cartilage Diseases ; diagnosis ; diagnostic imaging ; therapy ; Diagnosis, Differential ; Hand Deformities, Congenital ; diagnosis ; diagnostic imaging ; therapy ; Humans ; Infant ; Male ; Pulmonary Valve Stenosis ; diagnosis ; diagnostic imaging ; therapy ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed ; Tracheal Stenosis ; diagnosis ; diagnostic imaging