The incidence of spinal infections,a relatively rare infectious disease,is on the rise due to the empirical use of antibiotics that increases the chances of infection with drug-resistant bacteria,as well as advances in testing technology that have led to an increase in detection rates.Identifying the type of pathogen to target antibi-otics is the key to treatment.However,conventionaldetection methods have low detection rates and are time-consum-ing,which are not conducive to the rapid and accurate diagnosis of spinal infection.Metagenomics next-generation sequencing(mNGS)is a detection technique that can sequence all nucleic acid fragments in samples,the emer-gence of which subverts traditional detection methods and plays an important role in the diagnosis and treatment of spinal infections.This article summarizes the application of mNGS in the diagnosis and treatment of spinal infection.

Objective To investigate the role of cathepsin B(CTSB)inhuman cervical cancer HeLa cellswith Brucella infections.Methods The ctsb knockout(KO)HeLa cell line was constructed using CRISPR/Cas9.The effects of ctsbKO on cell proliferation and survival of intracellular bacteria in case of Brucella infection were detected by CCK-8 assay and intracellular bacteria count while the molecular mechanism of ctsb regulation on Brucella infection was revealed by Western blotting.Results The ctsbKO cell line was constructed.CCK-8 results showed that KO of ctsb had no impact on cell proliferationwith or without Brucella infection.The results of intracellular bacteria count showed a significant decrease in intracellular Brucella four days after infection in the KO cell line.Western blotting assay suggested that the expression levels of autophagy-related proteins were significantly down-regulated in the KO cell line with long-term Brucella infection.Conclusion KO of ctsb inhibits the intracellular survival of Brucella in long-term infections,providing a potential target for the treatment of chronic brucellosis.

Screening for diabetes and its complications contributes to slowing the progression of diabetes mellitus. Based on the setting of grass-roots diabetes complication screening workstation with the concept of two stages of screening and three levels of prevention, we proposed a hospital-community-family integrated diabetes management strategy. This article discusses the background, organization structure, operation mechanism and implementation process of this strategy, aiming to provide reference for constructing a suitable and practical grass-roots diabetes management model.

Objective: Depression was common during coronavirus disease-2019 (COVID-19) pandemic, while the association of perceived stress with depression among vaccinated healthcare workers has not been investigated. This study aimed to address this issue. Methods: We included a total of 898 fully vaccinated healthcare workers during the outbreak of severe acute respiratory syndrome coronavirus 2 Delta variant in Nanjing, 2021. Depression was ascertained by Patient Health Questionnaire-9, with a cut-off score of ≥5 indicative of mild-to-severe depression. Perceived stress, resilience, and compassion fatigue were assessed by Perceived Stress Scale-10, Resilience Scale-25, and Professional Quality of Life Scale version-5, respectively. Logistic regression analyses were used to estimate the odds ratio (OR) and 95% confidence interval (CI), along with subgroup and mediation analyses. Results: The prevalence of mild-to-severe depression was 41.1% in vaccinated healthcare workers. The odd of mild-to-severe depression was increased with higher perceived stress. Compared with vaccinated healthcare workers with the lowest tertile of perceived stress, those with the highest tertile had increased odds of mild-to-severe depression by 120% (OR 2.20, 95% CI 1.46 to 3.31) after multivariable-adjustment. However, perceived stress was not associated with mild-to-severe depression in vaccinated healthcare workers with strong resilience, but was in those with weak resilience (pinteraction=0.004). Further analysis showed that compassion fatigue mediated the relationship between perceived stress and mild-to-severe depression, with a mediating effect of 49.7%. Conclusion Perceived stress was related to an increased odd of mild-to-severe depression in vaccinated healthcare workers during COVID-19 pandemic, and this relationship might be explained by compassion fatigue.

Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.

Objective To analyze the risk factors of incision infection and spinal canal hematoma after lumbar spinal posterior surgery.Methods Data of 33 patients with incision infection and 25 patients with spinal canal hematoma after posterior surgery for lumbar spinal disease from January 2010 to December 2014 were retrospectively analyzed.For the patients with incision infection,20 of them were males and 13 were females,with an average age of 58.85±8.76 years (range 38-79 years).Of these patients,5 were diagnosed with lumbar disc herniation,9 with lumbar spondylolisthesis,15 with lumbar spinal stenosis and 4 with lumbar vertebral fracture.For patients with spinal canal hematoma,17 of them were males and 8 were females,with a mean age of 60.96±11.37 (range,38-77).The diagnoses of them were lumbar disc herniation in 18 patients,spondylolisthesis in 3 patients and spinal stenosis in 4 patients.From the same period database,patients who underwent lumbar posterior lumbar surgery with no postoperative complications were selected by 3:1 ratio as the control group according to age,gender and diagnosis.Results For patients with incision infection,it was found that diabetes mellitus,preoperative RBC,hemoglobin,total protein,albumin,serum calcium,operation time,number of segment fusion,intraoperative blood loss,postoperative WBC,RBC,hemoglobin and platelet were significantly different from those with non-infection group.Moreover,multivariate logistic analysis showed that diabetes mellitus (OR=3.716,P=0.032),preoperative serum calcium (OR＜ 0.001,P=0.001),intraoperative blood loss (OR=1.002,P=0.014),postoperative hemoglobin (OR=0.923,P=0.018) and postoperative platelet (OR=1.007,P=0.017) were independent risk factors for postoperative incision infection.For patients with spinal canal hematoma,it was found that patients' preoperative total protein,albumin,serum calcium,platelet,operation time,intraoperative blood loss and postoperative total protein were significantly different from non-hematoma group.Multivariate logistic analysis showed that preoperative serum calcium (OR＜ 0.001,P=0.001),preoperative total protein (OR=1.298,P=0.043),intraoperative blood loss (OR=1.003,P=0.021) and postoperative total protein (OR=1.080,P=0.028) were independent risk factors for postoperative spinal canal hematoma.Conclusion The preoperative diabetes mellitus,serum calcium,intraoperative blood loss,postoperative hemoglobin and platelet were important risk factors for lumbar incision infection.And preoperative serum calcium,total protein,intraoperative blood loss and postoperative total protein were the risk factors for spinal canal hematoma.

Objective To investigate the clinical effects of scaphoid nonunion fractures by vascularized bone graft which can reconstruct fracture blood circulation. Methods From March 2013 to December 2014, 28 cases of patients with scaphoid fractures and nonunions were studied, including 16 males and 12 females whose age arranged from 19 to 33 years with a mean age of 26.2 years, for whom waist fractures and nonunions accounted 25 cases, and proximal end of scaphoid accounted 3 cases. The patients received treatments, vascularized radial periosteum graft was transversely implanted after radial periosteal flap pedicled on their current branch of the radial artery between the first and second tendinous sheath had been separated. Then 15 cases were fixed by Kirschner wire and 13 by Herbert screw. X?ray films were taken and checked regularly and periodically at 1th, 2nd, 3rd, 6th, 12th month after the operation to follow up fracture union and wrist function rehabilitation. Results All 28 cases of patients were followed up after operation for a period ranging from 5 to 12 months (with an average of 8 months). All patients with scaphoid fractures and nonunions were cured. The fractures and nonunions were clinically healed within 3 to 5 months and the patients didn't suffer from wrist pain basically. The wrist functions of those patients were evaluated according to modified Mayo wrist score:21 were rated as excellent, 5 as fine, 2 as fair, the excellent and good rate was 93%(26/28). The excellent and good rate of Kirsch?ner wire group was 93%(14/15), and the Herbert screw group was 92%(12/13). The difference in the excellent and good rate was not statistically significant between Kirschner wire group and Herbert screw group (χ2=0.011, P=0.916). Conclusion Fixed with Kirschner wire or Herbert screw, using vascularized radial periosteum graft to treat scaphoid fractures and nonunions has good short?term clinical effects. The operation manner with simple operation is an effective treatment, which can improve the blood sup?ply of the scaphoid fracture.

Objective High expression of the valosin-containing protein ( VCP) gene can enhance the metastasis of osteosar-coma via the AKT/PI3K/NF-KappaB/MMP-9 signaling pathway, but the molecular mechanisms underlying the up-regulation of VCP in osteosarcoma cells remains unknown .This study aimed to determine whether miRNA-129-5p can regulate the VCP expression and its targets in human osteosarcoma cells . Methods The microRNA target-predicting software TargetScanhuman 6.2 ( http://www.tar-getscan.org/) was used to predict the possible targets of miRNA-129-5p on the VCP gene.Then, two recombinant gene report vectors containing the wild VCP gene 3′UTR ( psi-VCP vector ) and mutant VCP gene 3′UTR ( psi-VCPmut vector ) were constructed , se-quenced, and identified.The human osteosarcoma U2-OS cells were co-transfected with miRNA-129-5p mimic and psi-VCP vector or psi-VCPmut vector, respectively.A non-specificity mimic transfection served as negative control , and the luciferase activity was detec-ted in each group. Results The software prediction showed only one conserved function site of miRNA-129-5p on the VCP gene 3′UTR163-169 bp.Luciferase activity was significantly lower in the psi-VCP vector +miRNA-129-5p transfection group (15.529 ± 1.902) than in the VCP control group (21.781 ±0.854), VCP mutation experimental group (19.978 ±1.377), and VCP mutation control group (21.952 ±1.516) (P<0.05), with no remarkable difference between the VCP mutation control and VCP control groups (P=0.276). Conclusion miRNA-129-5p can probably regulate the targets of the VCP gene in human osteosarcoma U 2-OS cells.

The chitosan scaffolds with different deacetylated degree were prepared in this study. The morphology of scaffolds were observed using SEM, and the porosity, the water absorbing swelling ratio and the degradation were examined both in vitro and in vitro. The results showed that the chitosan scaffolds with different deacetylated degree exhibited three-dimensional structure with high porosity. With increasing of deacetylated degree, their porosities were 93.46%, 90.02% and 86.71%, respectively. The swelling ratios of chitosan scaffolds were 820%, 803% and 772%, respectively. At the fourth week, the degradation rates were 30.44%, 22.08% and 17.10% in vitro, respectively; while the corresponding rates were 57.48%, 40.23%, 29.53% in vivo respectively. The degradation rate of chitosan scaffold was negatively correlated to deacetylated degree. Furthermore, it showed that the speed of degradation in vivo was faster than that in vitro. We concluded that controlling the deacetylated degree of chitosan can provide a well-matched degradable scaffold material for the reparation of cartilage defects.
Absorbable Implants ; Acetylation ; Animals ; Biocompatible Materials ; Chitosan ; analogs & derivatives ; chemical synthesis ; chemistry ; Female ; Male ; Materials Testing ; Rats ; Rats, Sprague-Dawley ; Tissue Engineering ; Tissue Scaffolds ; chemistry

Objective To explore the therapeutic efficacy of posterior internal fixation and anterior debride-ment with autogenous bone grafts at one stage on tuberculosis of thoracic or lumbar spine . Methods 16 cases of thoracic or lumbar spinal tuberculosis patients were treated with combined anterior (radical debridement and bone autograft) and posterior (instrumentation) surgeries in one stage between September 2003 and September 2007. The degree of the kyphosis (Cobb angle) was measured and the interbody fusion was observed preoperatively and postop-eratively. The ASIA grading system was used to assess the neurological status. Results All patients were followed up for 10 months to 36 months,on average of 12 months. All patients showed sucessful interbedy fusion,but Cobb angle was not progressed. No recurrence or wound infection was found. 6 cases all got nerve function recovery. Conclusion Thoracic or lumbar tuberculosis treated with this surgical technique can achieve stable internal fixation and a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the ky-pbosis particularly.