Objective To estimate the effect of pedicle screw fixation of thoracolumbar fractures via paraspinal approach and compare it with the conventional posterior midline approach.Methods Forty-two cases of thoracolumbar monosegmental fractures subjected to single posterior pedicle screw fixation and reduction from December 2008 to May 2010 were included in the study.Among the patients,19 cases were operated through paraspinal muscular-sparing approach (paraspinal approach group) and 23 cases through posterior midline surgical approach (conventional approach group).Surgical incision length,operation time,intraoperative blood loss,postoperative drainage volume,postoperative hospital stay,pre-and post-operative VAS and other perioperative indices as well as fracture reduction outcome were compared between the two groups.Oswestry disability index (ODI) was assessed after operation.Results There were no statistical differences between the two groups in aspects of surgical incision length,operation time,postoperative hospital stay,height restoration of fractured vertebra (P ＞ 0.05),but intraoperative blood loss (148.5 ± 26.5) ml,postoperative draining loss (72.9 ± 17.3) ml,postoperative VAS (1.1 ± 0.3) points and ODI (13.4 ± 2.7) points in paraspinal approach group showed statistical differences from those in conventional approach group (P ＜ 0.05).Conclusion Paraspinal muscle-sparing approach is characterized by minor trauma,less bleeding,slight pain and quick recovery as compared with conventional posterior midline approach and hence may be the preferred choice for the treatment of thoracolumbar fracture without spinal canal decompression.

Objective: To investigate constitutional and phys ical stamina status in soldiers with different adaption periods in Tibetan areas . Methods: Two hundred and eithty-two male soldiers from a barr acks at an elevation of 3 600 m were divided into 2 groups: the veteran group ( n=143) in Tibet for 1.45±0.22 year, and the recruit group (n=139) in Ti bet for 0.33±0.00 years. The test items included body weight, cirumference, st a nding long jump, chin-up, 100 m dash and 3 000 m jogging, all were evaluated ac cording to the national military standard, which were Comprehensive Evaluation o f Health in Troops, and Examination and Evaluation of the Physical Stamina of So ldiers. Results: The physical stamina indexes of both the vetera ns and the recruits were up to the national military norm on the whole, ranking as moderate. The veteran group showed no significant difference in standing long jump and 100 m dash,（P<0.05), but obvious lower level in chin-up and 3 00 0 m jogging（P<0.01）, compared with the national military norm. The recr ui t group showed significant lower level in chin-up, 100 m dash, 3 000 m jogging as compared with the national military norm（P<0.01）, and also significant lower level in chin-up and 3 000 m jogging （P<0.05 or P<0.01) as compa red with the veteran group. Conclusion: The physical stamina of both the veterans and the recruits meet the basic national military requirements , ranking as moderate. The soldiers who have been in service for over 1 year hav e better explosive force, but they need more tolerance and aerobic exercises. Th e newly recruited need more exercise to raise tolerance to the hypoxic environme nt in plateau areas so as to shorten the adaption time to high altitude.

Objective: To investigate the effects of psycholog ical factors on treatment and outcome of patients with high altitude pulmonary e dema(HAPE). Methods: In the present study, one hundred and fifty -two patients with HAPE were tested by hospital anxiety and depression scale. Results: The results showed that there were 61 patients (40.13%) with anxiety and 29 patients (19.08%) with depression. The important factors on mental state of patients were preventive education, the first time suffering HA PE, characters of patients, degree of the disease and the medical fee, the less w ere age, sex, occupation and education of patients. Duration of rales of lung an d course of illness were significantly prolonged in HAPE patients with mental di sorders compared to the patients without mental disorder. Conclusion:The study suggests that anxiety and depression might aggravate the state of HAPE.

Objective To screen the splicing isoforms of estrogen receptor βin the Beagle hypothalamic -pituitary -gonadal axis.Methods For ERβmRNA CDS sequence of eight exons, primers were designed confined to the CDS sequences of two sequential exons.Beagle hypothalamus, pituitary, ovary and uterus tissue cDNA were used as template, and corresponding sequences were amplified by PCR.PCR products were sequenced and aligned in the NCBI web site.The correct gene was then analyzed with DNAMAN comparative analysis software and handwork checking up, thus got the ERβsplicing isoforms of Beagle. Results Four beagle ER beta splicing isomers were obtained:exon 4 complete skipping ER βisomer (300 bp missing), two kind of Beagle ERβisoforms with partial exon 4 and partial exon 5 complicated missing (isoformⅠ334 bp missing and isoformⅡ265 bp missing), and exon 7 complete missing ERβsplicing isoforms (181 bp missing).Exon 4 complete skipping and exon 7 complete missing isomers had been obtained full length coding sequence, and the other two splicing isomers were partial coding sequence.Conclusion This project gained four ERβsplicing isomers of Beagle, and that will lay an important foundation for further study of their roles in the Beagle reproductive regulation mechanism.

Objective To quantitative the changing information of estrogen receptor βgene which was in tissue and organ of sex gland during oestrus and dioestrus of Beagles, and to show the different expression situation of hypothalamus-pituitary-gonad axis during oestrus and dioestrus, and providing the basic of theory to research deeply the mechanism of heat of Beagles. Methods As the key gene in regulation reproduction, ERβgene is located in hypothalamus-pituitary-gonad axis, so using Beagles which was in oestrus and dioestrus, and extract the RNA from hypothalamus、pituitary、ovary and uterus respectively,after reverse transcription we detected the expression of ERβgene by real-time quantitative PCR.Results The expression of ERβgene mRNA from ovary、uterus、pituitary、hypothalamus of Beagles which was in dioestrus was 0.35 times, 0.17 times, 0.44 times and 0.43 times than the expression of ERβgene mRNA from ovary, uterus, pituitary, hypothalamus of Beagles which was in oestrus.Conclusion The expression of ERβgene was up-regulation in hypothalamus-pituitary-ovary axis of Beagles which was in oestrus.

Objective:To evaluate the barrier-free level of village clinics of a city in the aging era, for references in improving the barrier-free medical environment for the elderlies.Methods:The village dectors of 156 village clinics in 12 counties of a city were selected as the objects of a questionnaire survey from Dec.2020 to Jan.2021, with 6 evaluation indexes established, each set with 1-10 points. This questionnaires was used to survey the barrier-free construction levels of village clinics. The data were statistically analyzed by rank sum ratio and quadrant graph model.Results:The barrier-free buildings of such clinics scored 32.86 points in average. Among the six indexes, the barrier-free access and doors(7.21 points) scored the highest, and the barrier-free parking space(4.71points) and toilets(3.28 points) scored the lowest. All the counties of the city fell into four categories, including 2 counties with high degree of aging-high level of accessibility, 4 counties with low degree of aging-high level of accessibility, 4 counties with low degree of aging-low level of accessibility, and 2 counties with high degree of aging-low level of accessibility, according to the quadrant graph model built based on the aging degrees and the barrier-free levels of village clinics.Conclusions:The barrier-free level of the village clinics in a city needs to be further improved, and the barrier-free transformation of parking space and toilets should also be strengthened in the future. The government should take different measures in view of conditions of each county to improve the accessibility of village clinics and facilitate the health care-seeking of elderlies.

Objective To examine the feasibility and early effects of unilateral pedicle screw fixation in combination with contralateral translaminar facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach for the treatment of degenerative lumbar spine diseases in elderly patients.Methods A total of 82 elderly patients with degenerative lumbar spine diseases received treatment between January 2015 and June 2016.Of these patients,25 had lumbar spinal stenosis,42 had degenerative lumbar instability,13 had giant lumbar disc herniation,and two had recurrent lumbar disc herniation;There were 69 cases of single segment and 13 cases of double segment lesions.Perioperative evaluation,imaging evaluation,and clinical evaluation were performed,and surgical complications were analyzed.Results The average length of incision was (2.6 ± 0.4) cm in cases of single segment lesions and (4.4±0.5) cm in cases of two segment lesions.The mean operation time was (98.3±19.6) minutes and peri-operation blood loss was (232.2±25.8) ml.The post-operation height of the intervertebral disc space significantly increased at the last follow-up(P ＜ 0.05);the height of the intervertebral disc space was restored and well maintained with internal fixation showing no loosening,breakage or Cage shift.The post-operation lumbar coronal Cobb angle decreased(P＜0.05)while the sagittal Cobb angle increased(P＜0.05)at the last follow-up.There was no significant difference in the area and grade of the multifidus muscle on MRI 12 months after operation.Seventy-two patients were followed up for 12-18 months (mean =16.8 months),and there were 67 cases of intervertebral fusion (93.1％).The last follow-up showed a Japanese Orthopaedic Association(JOA) score of (25.8 ± 1.7),which was significantly higher than the pre-operation score (10.6±1.3),with an excellence rate of 88.9 ％.The Oswestry Disability Index score was significantly reduced,from (50.9±21.6) at pre-operation to (9.6± 4.8) at the last follow-up.There were 78 patients with primary wound healing,three cases of superficial wound necrosis,one case of dural tear,and one case of nerve root injury.No cardiovascular or cerebrovascular incident was observed during or after operation.Conclusions Combined pedicle/facet screw fixation plus interbody fusion through the channel-assisted muscle-splitting approach shows satisfactory short-term effects when used for the treatment of degenerative lumbar spine diseases in the elderly and possesses advantages such as minimal invasiveness,limited bleeding,quick recovery,high fusion rates and significantly improved clinical outcomes.However,further clinical studies are required to assess its medium-and long-term efficacy.

Objective: To explore the method of replanting severed piercing finger micro tissue blocks. Methods: From February, 2001 to October, 2016, 16 cases of severed piercing finger micro tissue blocks were replanted with debridement. The trunk or branch of proper palmar digital artery was anastomosed. Vascular collocations were used such as venous arterialization when there was no anastomotic artery available. Regular postoperative followed-up was performed to observe the recovery of tissue survival, appearance, sensation of flap, and joint function. Results: One case had partial epidermal necrosis, and healed after change of dressing. The finger-disconnected micro tissue blocks of other 15 cases survived well. After 6 months to 2 years of follow-up, the replanted micro tissue blocks were ruddy in color and recovered from S₃ to S₄. The appearance of the 16 fingers was good, and the function of joints was restored. Conclusion The finger-disconnected micro tissue blocks should be actively replanted. With skilled microsurgical techniques, the anastomosis of the arterial or venous artery will ensure the success of replantation and survived, as well as to restore good function and appearance.

AIM: To understand the screening and correction of myopia in children and adolescents from the Gannan region of Gansu Province, and to provide guidance for the prevention and control of myopia.METHODS: A cross-sectional stratified cluster sampling study was conducted to select 2 kindergartens and 12 primary and secondary schools in Hezuo City and Zhouqu County, Gannan region of Gansu Province, two classes were randomly selected from each grade, and the whole class was used as a unit for screening. The screening and correction of myopia in children and adolescents were collected for statistical analysis.RESULTS: A total of 5 072 children and adolescents were selected, and 4 806 valid data were finally included after excluding unqualified records. The overall prevalence of myopia was 45.55%, and the prevalence of myopia showed an increasing trend with the increase of grade(P<0.001). The prevalence of myopia in girls(48.66%)was higher than that in boys(42.18%; P<0.001). The prevalence of myopia increased with age(P<0.001), and the age group of 10-12 years old was the fastest growing for myopia, increasing from 25.62% to 60.57%. Furthermore, moderate myopia and high myopia showed an increasing tread with the increase of the grade(all P<0.001). The overall glasses wearing rate of the Gannan region was 28.55%, with a full correction rate of 50.72%, and the glasses wearing rate showed an increasing trend with the increase of grades(P<0.001). The glasses wearing rate of female students(30.84%)was higher than that of male students(26.69%; P=0.008). The full correction rates of low, moderate and high myopia in junior high were the lowest among the 3 phases of studying. The full correction rate of high myopia was the lowest in all phases of studying.CONCLUSION: The prevalence of myopia in children and adolescents from the Gannan region is lower than the national average, but the myopia of children and adolescents is still a trend of young age and high incidence, and the glasses wearing rate of myopia and full correction rate are low.

Objective : To investigate the role of endoplasmic reticulum stress in hepatic insulin resistance induced by intermittent hypoxia in rats． Methods : Twenty-four SD rats were randomly divided into control group ( NC group) and intermittent hypoxia group ( CIH group) ．The NC group was placed in a normoxia environment for 12 weeks，and the CIH group was given intermittent hypoxia for 8 weeks，and then returned to normoxia until the 12th week．In both groups，fasting blood glucose (FBG) ，fasting insulin (FINS) ，and liver inositol-requiring enzyme- 1 α(IRE1 α) ，X-box binding protein 1s(XBP1s) ，forkhead box transcription factor O1 (FoxO1) ，activating transcription factor-6(ATF6) ，cAMP-response element binding protein( CREB) ，CREB-regulated transcription coacti- vator-2( CRTC2) ，double-stranded RNA-dependent protein kinase-like ER kinase ( PERK) ，eukaryotic initiation factor 2 α(eIF2 α) ，protein kinase B ( AKT) ，phosphoenolpyruvate carboxykinase ( PEPCK) ，glucose-6-phosphat- ase( G6Pase) mRNA were measured at baseline，week 8，and week 12 . Results : There was no significant differ- ence in each observation index between the two groups at baseline ; at 8 weeks，the levels of FBG，FINS and the mRNA levels of IRE1α , XBP1s，ATF6，PERK，eIF2 α , PEPCK and G6Pase in the CIH group were higher than those in the NC group (P＜0. 05) ，while the mRNA levels of CREB，CRTC2 and AKT were lower than those in the NC group (P＜0. 05) ; at 12 weeks，there was no significant difference in each observation index between the two groups．Pearson correlation analysis showed(8th week of intermittent hypoxia group) : homeostasis model as- sessment-insulin resistance(HOMA-IR) was positively correlated with FoxO1，CREB，CRTC2 and PERK，eIF2 α mRNA levels (r = 0. 172，0. 595，0. 183，0. 702，0. 608 ; P＜0. 05) while it was negatively correlated with IRE1α , XBP1s，ATF6，AKT mRNA levels (r = －0. 422 ，－0. 327 ，－0. 309 ，－0. 399 ; P＜0. 05) ． Conclusion Intermittent hypoxia can lead to insulin resistance，and endoplasmic reticulum stress may mediate this effect.