Patients with severe aplastic anemia(SAA)often present with neutropenia,and are particularly susceptible to infections,especially following immunosuppressive therapy.Bacillus cereus is a ubiquitous,opportunistic pathogen capable of colonizing healthy individuals and causing infections through various routes.Neutropenia is a common feature in many hematologic disorders,placing affected patients at higher risk for Bacillus cereus infections.This report describes a rare case of Bacillus cereus bacteremia with multiple abscesses in a patient with SAA during the neutropenic phase following immunosuppressive therapy.Given the rarity of such presentations,relevant literature was reviewed and the diagnostic and treatment process was analyzed in detail,with the aim of providing clinical insights and improving the management of similar cases.

Patients with severe aplastic anemia(SAA)often present with neutropenia,and are particularly susceptible to infections,especially following immunosuppressive therapy.Bacillus cereus is a ubiquitous,opportunistic pathogen capable of colonizing healthy individuals and causing infections through various routes.Neutropenia is a common feature in many hematologic disorders,placing affected patients at higher risk for Bacillus cereus infections.This report describes a rare case of Bacillus cereus bacteremia with multiple abscesses in a patient with SAA during the neutropenic phase following immunosuppressive therapy.Given the rarity of such presentations,relevant literature was reviewed and the diagnostic and treatment process was analyzed in detail,with the aim of providing clinical insights and improving the management of similar cases.

OBJECTIVE: To evaluate the clinical and radiological results of patients with thoracic and lumbar fracture and dislocation treated by posterior transforaminal decompression and interbody fusion. METHODS: From June 2010 to June 2017, posterior transforaminal decompression, interbody fusion combined with pedicle screw fixation were performed in 21 patients with thoracic and lumbar fracture and dislocation. Their clinical and radiological data were collected and retrospectively analyzed, including 15 males and 6 females, aged from 25 to 58 years with an average of 45 years old. According to the criterion of American Spinal Injury(ASIA), preoperative neurological function was graded A in 3 cases, B in 7 cases, C in 6 cases, D in 4 cases and E in 1 case. Operative time and intraoperative blood loss and correlative complications were recorded. And VAS score, ODI and Cobb angle were evaluated before and after surgery. The improvement of neurological function was also analyzed at the final follow-up. Intervertebral bony fusion was observed during the follow-up by CT three-dimensional reconstruction. RESULTS: The operative time was 150 to 240 min with an average of (192±47) min. The intraoperative blood loss was 380 to 750 ml with an average of(603±120) ml. Dura sac tearing and cerebral fluid leakage occurred in 3 cases and were repaired during operation; superficial wound infection occurred in 1 case, and got healing after dressing change. The postoperative follow-up duration was 24 to 45 months with an average of(37.0±9.5) months. VAS score was improved from preoperative 8.9±0.4 to immediately postoperative 4.2±1.3(<0.05). At the final follow-up, VAS score decreased further to 3.6±0.8. ODI was decreased from preoperative (95.30±3.52)% to (32.51±6.30)% at the final follow-up (<0.05). Cobb angle was corrected from preoperative (21.2±8.8)° to immediately postoperative(2.3±3.1)° (<0.05). At the final follow-up, Cobb angle was (3.2±2.5)°, showing no significant difference with immediately postoperative value. The neurological function was grade A in 3 cases, B in 3 cases, C in 5 cases, D in 6 cases and E in 4 cases at the final follow-up. All the patients got solid intervertebral bone fusion in 8 to 13 months after operation, with an average fusion time of (10.3±2.5) months. CONCLUSIONS For the patients with thoracic and lumbar fracture and dislocation mainly involving intervertebral disc and endplate plane, posterior transforaminal decompression and interbody fusion not only is less invasive, but also can effectively reconstruct spinal three column and obtain good biomechanical stability. And, it is beneficial for the good recovery of neurological function.
Adult ; Decompression, Surgical ; Female ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

BACKGROUND: Hyaluronan-methylcellulose hydrogel cannot only be conjugated with short peptide sequences and growth factors to achieve sustained release, but also has a role in blocking dural defects and reducing inflammation. It is an ideal biomaterial for the treatment of spinal cord injury. OBJECTIVE: To investigate the effect of neurotrophin-3 modified hyaluronan-methylcellulose (HAMC-NT-3) hydrogel on the recovery of neurological function in rats with spinal cord injury. METHODS: Fifty-four female Sprague-Dawley rats (provided by the Experimental Animal Center of the Academy of Military Medical Sciences in China) were randomly divided into three groups (n=18 per group) . The sham group only underwent T10 laminectomy. In the model group and the experimental group, an aneurysm clip was used to establish spinal cord injury models after T10 laminectomy. The experimental group was locally injected with HAMC-NT-3 hydrogel. The Basso Beattie Bresnahan function scoring was performed at 1 day, 1, 2, 3, 4, 5, 6, 7, and 8 weeks after surgery. The inclined plane test was performed at 4, 6 and 8 weeks after surgery to evaluate the recovery of hindlimb motor function. ELISA was used to detect the concentrations of inflammatory factors in the spinal cord at 1 week after surgery. Immunohistochemical staining was used to observe the area of syringomyelia, glial fibrillary acidic protein expression and nerve regeneration at 8 weeks after surgery. RESULTS AND CONCLUSION: (1) The Basso Beattie Bresnahan scores of the model group and the experimental group were lower than those of the sham group at various time points after surgery (P < 0.05) . The Basso Beattie Bresnahan scores of the experimental group were higher than those of the model group at 4-8 weeks after surgery (P < 0.05) . (2) In the inclined plane test, the maximum inclined angles of the model group and the experimental group at each time point after surgery were lower than that of the sham group (P < 0.05) . The maximum inclined angles of the experimental group at 6 and 8 weeks after surgery were higher than those of the sham group (P < 0.05) . (3) The concentrations of tumor necrosis factor-α, interleukin-1β, interleukin-6 and interleukin-10 in the experimental group and the model group were higher than those in the sham group (P < 0.05) . The concentrations of tumor necrosis factor-α, interleukin-1β and interleukin-6 in the experimental group were lower than those in the model group (P < 0.05) . The concentration of interleukin-10 in the experimental group was higher than that in the model group (P < 0.05) . (4) Immunohistochemical staining showed that the expression levels of glial fibrillary acidic protein in the experimental group and the model group were higher than those in the sham group, while the expression of glial fibrillary acidic protein in the experimental group was lower than that in the model group. The area of syringomyelia in the experimental group was smaller than that in the model group (P < 0.05) . These results indicate that local injection of HAMC-NT-3 hydrogel can effectively inhibit inflammation as well as astrocyte activation and proliferation, reduce fibrous scar formation, and promote the protection of nerve tissue and the recovery of hindlimb motor function after spinal cord injury.

Objective:To find the better imaging method for the diagnosis of sialolithiasis by comparing the 3 different imaging methods.Methods:32 cases of salivary calculus were examined by sonography,X-ray and cone beam computed tomography(CBCT),the sensitivity,specificity,positive predictive value,negative predictive value were compared among the 3 methods.Results:The sensitivity and negative predictive value of cone beam computed tomography(95.8％ and 80％) was significantly higher than those of sonography(83.3％,50.0％) and X-ray(58.3％,20％)(P ＜ 0.05).Of three imaging methods there was no statistical difference in specificity and positive predictive value.Conclusion:CBCT is more sensitive than sonography or X-ray in the diagnosis of sialolithiasis.

Objective To systematically evaluate the efficacy and safety of posterior short segment and long segment pedicle screw internal fixation in the treatment of thoracolumbar burst fracture. Methods By searching the database, including PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, a comprehensive study was carried out to make a comparison between the posterior short segment and the long segment pedicle screws internal fixation in treatment of thoracolumbar burst fracture, and Meta analysis was performed. Results A total of 14 related studies and 658 patients were enrolled in the study, including 320 patients in short segment group and 338 cases in long segment group, and Meta analysis was performed. The results suggested that there was no significant difference between the short segment group and the long segment group in terms of the deformity angle of the injured vertebra measured after operation and at the last follow?up, and sagittal index at the last follow?up ( MD=-0. 22,95%CI -2. 73,2. 28,P=0. 86;MD=-0. 28,95%CI -2. 23,1. 67, P=0. 78;MD=0. 47, 95%CI -3. 45, 4. 39, P=0. 81 ) . Besides, both groups had no statistical difference in post?operative COBB angle,anterior vertebral height and compression rate of injured vertebrae ( MD=0. 21,95%CI -0. 65,1. 06,P=0. 64; MD=-0. 46,95%CI -1. 40,0. 49,P=0. 34; MD=0. 47,95%CI -2. 28, 3. 21, P= 0. 74 ) , while the differences in COBB angle, anterior vertebral height, compression rate, correction loss were statistically significant at the last follow?up (MD=5. 11,95%CI 2. 81,7. 40,P<0. 0001;MD=-11. 89,95%CI-15. 28,-8. 50,P<0. 00001;MD=6. 46,95%CI 3. 85,9. 07,P<0. 00001) . There was no significant difference in VAS scores and the ODI scores between the two groups at the last follow?up ( MD =0. 01,95%CI -0. 15,0. 17,P=0. 9; MD=-0. 47,95%CI -2. 68,1. 74,P=0. 86),while the two groups showed statistically significant difference in fixation failure ( RR = 0. 08, 95%CI 0. 01, 0. 15, P = 0. 02 ) . Conclusion Posterior long segment pedicle screw internal fixation is more effective in treating thoracolumbar burst fracture than short segment surgery. It can reduce the COBB angle,restore the anterior height of the injured vertebra,and decrease the anterior vertebral pressure.

This article applied stochastic frontier analysis to estimate the efficiency of the 2007 Beijing Medicine Development Foundation,and analyzed the dominant influencing factors of the performance.The following results were found out..(1) The performance of 2007 Beijing Medicine Development Foundation was good in general,however there was a 23％ gap between the actual output and the frontier output.As time passes by,the expected performance will get better.(2) There are large differences existed between various categories of projects and the different levels of institutions and project leaders.The relatively high profile projects,which means large input and more complexity,requires higher level of facility and environmental support,project manager's degree,professional title,while technical efficiency is not obvious for small scale independent innovation projects.

Objective To evaluate the performance of clinical medicine and joint research projects,funded by Capital Medical Research Fund.Method Data of clinical medicine and joint research projects were obtained from the project of Data analysis and evaluation of Capital Medical Development Scientific Research Fund.Out puts include published papers,undergraduate textbooks,prize,patents,students' trainingsnew techniques and follow-up projects; Each project is considered as an evaluation unit,the grant amount as input indicator.Then Data Envelopment Analysis (DEA),software MaxDEA 5.2 were used to calculate the relative performance of these projects.Result The rate of recovery of questionnaire was 77.70％.Among 115projects,the average score of new technology,prize obtained and patent are less than other output indexes.15 projects have no output,7 projects reached the effectiveness of DEA.11 projects obtained the pure technology efficiency,20 projects obtained scale efficiency.Conclusion The funding for projects in 2005 and 2007 are within the appropriate amount,while funding for some projects are excessive; certain projects have less outputs in personnel trainings,publications,the follow-up projects,published papers and achievements.In order to improve project performance,the quantity of published papers and personnel trainings has to be increased.