The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

As a complex and large microbial community colonized in the human body, the intestinal flora and its metabolites short-chain fatty acids (SCFAs) play an important role in participating in human metabolism, resisting pathogens, and regulating immune mechanisms. In recent years, many studies have found that the intestinal flora is closely related to bone metabolism. The intestinal flora is able to regulate bone metabolism and affect bone mass changes through various pathways such as absorption of nutrition, generation of SCFAs, regulation of immunity, and influence on body metabolism. The potential pathways and mechanisms by which intestinal flora affect bone mass changes were reviewed in this article in bone metabolism. The related study on Traditional Chinese Medicine that has effects in balancing intestinal flora for regulating bone metabolism was also introduced in order to provide new ideas for the prevention and treatment of osteoporosis, a disease related to bone metabolism.

Objective:To provide a promising and optimal laboratory susceptibility-testing method for the clinical usage of antibiotic (polymyxin), four susceptibility-testing methods were performed and the broth microdilution (BMD) was chosen as the gold standard.Methods:A total number of eighty-eight nonduplicate clinical Enterobacteriaceae specimes were collected from January to December of 2019 in the First Affiliated Hospital, Fujian Medical University. Among the clinical specimens, of which six strains were positive for mcr-1. The minimal inhibitory concentration (MIC) of polymyxin of the clinical specimens were examined by the following methods: (1) broth microdilution, (2) colistin broth disk elution, (3) Vitek-2?, (4)BD PhoenixTM,(5)commercial broth microdilution. With BMD as reference, essential agreement (EA), categorical agreement(CA), very major error(VME) and major error (ME) of polymyxins for different methods were analyzed. The Kappa-consistency testing, paired Chi-square testing and the Spearman-rank correlation testing were used to analyze the consistency between the four antimicrobial susceptibility testing methods and the gold standard.Results:Taking broth microdilution as reference, the EA of colistin broth disk elution, Vitek-2?, BD PhoenixTM, commercial broth microdilution were 94.32% (83/88), 92.05% (81/88), 90.90% (80/88), and 96.59%(85/88), respectively. The CA of all the four methods were 100% (88/88). No VME and ME were recorded for four methods. Moreover, the consistency between four susceptibility testing methods and the gold standard is acceptable (Kappa values=1, P<0.001, McNemar test P=1 and r>0.5, P<0.05). Conclusions:In the present work, four susceptibility testing methods all met the standards recommended jointly by the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing, of which the performance of the commercial broth microdilution and CBDE fared relatively well. Thus, these four methods could be routinely used in clinical microbiology laboratory of our hospital for colistin and polymyxin B susceptibility testing.

Objective: To investigate the independent and joint associations of physical activity and sedentary behavior with 20 m shuttle run test (20 m SRT) performance among children. Methods: Using cluster random sampling method, a total of 1 144 children aged 6-12 years from 1 urban primary school in Guangzhou were selected and completed the questionnaire survey, physical examination, and 20 m SRT. Physical activity and sedentary behavior were collected through questionnaire. Poor performance on 20 m SRT run test was defined as standard Z score ≤0, which was calculated according to gender, age-specific mean and standard deviation. Based on moderate-to-vigorous physical activity (MVPA) (≥60 min/d, 30-<60 min/d, or <30 min/d) and sedentary behavior levels (cut-off point: the gender, age-specific 50th percentile value), all participants were divided into six subgroups. Multiple linear regression and Logistic regression were used to analyze the independent and joint associations of physical activity and sedentary behavior with 20 m SRT performance, respectively. Results: Low level of physical activity (β=-2.99, P<0.05) and high sedentary behavior (β=-1.75, P<0.05) were independently correlated with lower 20 m SRT performance. Compared with the reference group (MVPA≥60 min/d and low sedentary behavior), the risk for low performance on 20 m SRT was higher in those with MVPA<30 min/d, or those with high sedentary behavior. The risk for poor performance on 20 m SRT was gradually elevated with decreased physical activity levels in combination with higher level of sedentary behavior(P<0.05). Conclusion Physical activity and sedentary behavior were independently related to 20 m SRT performance among children. There is a clear does-response association, with elevated risks for poor performance on 20 m SRT with decreased physical activity levels in combination with higher level of sedentary behavior.

Objective: To evaluate the association between nocturnal sleep duration and behavioral problems in Chinese school-age Children, and to provide reference for the development of recommended nocturnal sleep duration for school-age children. Methods: A total of 4 160 school-age children selected through cluster random sampling in Guangzhou urban areas. Caregivers reported children’s behavioral problems and sleep habits using parent version of the Strengths and Difficulties Questionnaire (SDQ) and sleep quality questionnaires. Results: The average nocturnal sleep duration per day of school-age children is (9.07±0.76)h, the proportion of children having slept less than 9 h/d was 46%(1 912). There were statistically significant differences in the distribution of sleep duration among children with different chronotype and maternal education levels(P<0.05). There were statistically significant differences in children’s sedentary behavior duration and nap duration at different sleep duration(P<0.05). The association between children’s nocturnal sleep duration and behavioral problems was typically nonlinear and U-shaped(P<0.05). The inflection points of nocturnal sleep duration for total difficulties, emotional problems, conduct problems and peer problems were 9.65, 9.25, 9.42 and 9.30 h, respectively. Conclusion Nocturnal sleep duration shows a nonlinear association with behavioral problems in school-age children. The optimal range of nocturnal sleep duration for mental health is between 9 to 10 hours and the problems of psychological behavior were the least among school-age children.

Objective: To investigate the different patterns of 24-h movement behaviors, and their associations with sociodemographic factors in a nationally representative sample of Chinese children aged 6-13 years. Methods: This study was based on a national multi-centered cluster intervention study involving 31 362 children aged 6-13 years from 7 provinces in China. Questionnaires were used to collect moderate to vigorous physical activity (MVPA), screen time (ST) and sleep duration, as well as sociodemographic variables including age, gender, area of residence, parents’ education level and family income. Generalized linear mixed model (GLMM) analyses were conducted for the 24-hour movement behaviors according to sociodemographic variables. Results: The proportions of individuals meeting the MVPA, ST, and sleep guidelines were 32.2%, 78.5%, 30.1%, respectively. The proportion that meet 0, 1, 2 and 3 recommended items was 9.6%, 47.7%, 35.0% and 7.7%, respectively. Age, gender, parents’ education levels and family income showed associations with PA, ST and sleep. Compared with low parents’ education group, the risk for unhealthy behavioral patterns was lower in those with high parents’ education level(P<0.05). Conclusion The current status of 24-hour physical activity for children aged 6-13 in China is not ideal, and social demographics should be considered when designing targeted interventions to promote children’s health.

OBJECTIVE:To strengthen the supervision of clinical antibiotics use through establishing electronic consultation system. METHODS:Based on hospital information system(HIS)and antibiotic management system,consultation system for anti-biotics of special use(ASU)was established,and the effects of the system after used(Jan. 2014)were also evaluated. RESULTS:Real-time consultation of ASU medical orders and related consultation results inquiry and statistics could be achieved through de-signing ASU consultation application form,establishing consultation experts and confirming their working content,adding statistics function,etc. The consultation have been finished 8275 times from 2014 to 2015. The inspection rate for pathogenic microbes in ASU patients rose from 78.68% in 2013 to 83.90% in 2015. CONCLUSIONS:The establishment and application of ASU consulta-tion system can improve consultation efficiency and quality,so as to promote rational use of antibiotics in the clinic.

Objective To explore the clinical efficacy and safety of modified Ponticelli regimen in treating patients with idiopathic membranous nephropathy (IMN).Methods A retrospective analysis was performed in 90 patients with IMN (type Ⅰ / Ⅱ,79/11 respectively) diagnosed by clinical data and renal biopsy.The patients were divided into modified Ponticelli group (n =23),steroid plus cyclophosphamide (CTX) (CTX group,n =39) and steroid plus cyclosporine A(CsA) (CsA group,n =28) according to the treatment.Liver function,renal function,serum lipid,proteinuria were recorded before and after treatment.Efficacy and adverse reactions were evaluated in three groups.Results (1) In all three groups,the quantity of proteinuria after treatment for 3 months [(3.33 ± 1.53) g/d,(4.70 ± 2.97) g/d,(3.92 ± 2.57) g/d],6 months [(1.60 ± 1.10) g/d,(2.34 ± 1.61) g/d,(2.25 ± 1.78) g/d] was significantly decreased compared with baseline level[(7.26 ± 2.06) g/d,(7.50 ± 2.55) g/d,(7.54 ± 2.70) g/d;P ＜ 0.05].Serum albumin levels at 3 months [(31.42 ± 3.86) g/d,(30.59 ± 5.79) g/d,(30.90 ± 7.87) g/d],6 months [(36.25 ± 4.20) g/d,(34.70 ± 6.70) g/d,(35.36 ± 8.29) g/d] were significantly increased compared with baseline levels [(24.13 ± 2.61) g/d,(23.98 ± 3.79) g/d,(22.94 ± 4.57) g/d;P ＜ 0.05],whereas serum creatinine at 3 and 6 months had no significant changes (P ＞ 0.05).(2) After treatment for 3 months,partial remission rates in modified Ponticelli group,CTX group and CsA group were 39.1％,35.9％,35.7％ respectively and complete remission rates were 8.7％,5.1％,10.7％,which were not statistically significant in all three groups (P ＞ 0.05).At 6 months,partial remission rates in three groups were 56.5％,41.0％,42.9％ respectively and complete remission rates were 21.7％,20.5％,28.6％,which did not suggested significant difference in all three groups either (P ＞ 0.05).(3) In modified Ponticelli group,steroid diabetes,impaired liver dysfunction,infections and gastrointestinal adverse events occurred in 1,1,2 and 2 patients,respectively.In CTX group,steroid diabetes,infections and gastrointestinal adverse events occurred in 5,8 and 2 patients,respectively.In CsA group,steroid diabetes and infections occurred in 1 and 3 patients,respectively.Conclusion Modified Ponticelli regimen to treat patients with IMN has a trend of better outcome than classic CTX regimen.The efficacy is not inferior to CsA regimen with fewer side effects.

Objective To determine the significance of MDR -1 and MRP mRNA expression in periph-eral blood lymphocytes in lung cancer patients with chemotherapy treatment .Methods Peripheral blood samples were taken from each lung cancer patient before chemotherapy and three weeks after the first chemotherapy cycle . The expressions of MDR-1 and MRP were tested for 39 lung cancer cases using RT -PCR technique comparing to 20 normal control cases .Results There was no significant difference for MDR -1 mRNA and MRP mRNA ex-isting in lung cancer cases and control group (P>0.05).MDR-1 and MRP mRNA expressions were increased after treatment of chemotherapy courses in almost all pathological types of lung cancer .Furthermore,the expres-sion level in small cell lung cancer after chemotherapy was significantly higher than that before .Conclusion Chemotherapy may induce the incidence rate of MDR -1mRNA and MRP mRNA expression in lung cancer .Ade-nocarcinoma and squamous cell carcinoma are mainly intrinsic MDR while small cell lung cancer is mainly ac -quired MDR to chemotherapy .Based on the positive expression rate of MDR -1 mRNA and MRP mRNA in pe-ripheral blood ,we may evaluate the results of chemotherapy in lung cancer patients easily and conveniently .

4"-O-isovaleryltransferase gene (ist) was regulated by positive regulatory genes of midecamycin 4"-O-propionyltransferase gene (mpt) in Streptomyces lividans TK24. A BamH I ~8.0 kb fragment from Streptomyces mycarofaciens 1748 was proved that it contained mpt gene and linked with two positive regulatory genes, orf27 and orf28. Orf of mpt was replaced by orf of ist and linked with two regulatory genes or orf27 single, and individually cloned into the vectors pKC1139 or pWHM3 (high copy number), and then transformed into S. lividans TK24. The levels of mpt and ist expression were evaluated by the bio-tramsformation efficacy of spiramycin into 4"-O-acylspiramycins in these transformants. The results showed that 4"-O-isovalerylspiramycins could be detected only in the transformants containing the plasmids constructed with pWHM3. The efficacy of bio-transformation of the transformants containing two regulatory genes was higher than that of orf27 single. So, the positive regulatory genes system of mpt gene could enhance ist gene expression.
Acyltransferases ; genetics ; metabolism ; Bacterial Proteins ; genetics ; metabolism ; Gene Expression ; Genetic Vectors ; Plasmids ; Spiramycin ; analogs & derivatives ; biosynthesis ; Streptomyces ; enzymology ; genetics ; Streptomyces lividans ; metabolism ; Transformation, Genetic