Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective:To investigate the characteristics of bacterial community in upper gastrointestinal tumors.Methods:The study population was patients with upper gastrointestinal tumors (esophageal cancer and gastric cancer). Gastroscopy was performed on the enrolled patients ( n=17), and the specimens were taken from the tumor sites. At the same time, non-tumor tissues more than 4 cm away from the tumor tissues were taken as the control. After total DNA was extracted and purified, high-throughput 16S DNA gene sequencing was used to detect the microbiota in tumor tissues and control tissues. Bioinformatics analysis was carried out and the differences between groups were compared. Results:16S DNA PCR showed that there was no significant difference in bacterial load between tumor tissues and control tissues. The α-diversity and β-diversity indexes showed that the community composition of the two groups was similar; the samples were discrete and the colony composition was different, but there was no significant difference between the two groups. The results of Venn diagram showed that there were more operational taxonomic units (OTUs) in non-tumor tissues than in tumor tissues (2 068 vs 1 358), indicating that the bacterial species in normal tissues were more abundant than those in tumor tissues. Compared with the control tissues, the percentages of Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium) in tumor tissues were relatively higher (the average percentage was more than twice that of the control). Further paired comparison of the top ten bacteria in the family and genus abundance of the two groups of samples showed that Pseudomonas decreased significantly in tumor tissues at the family ( P=0.041) and genus ( P=0.041) levels, while Prevotella was significantly enriched in tumor tissues at the family ( P=0.031) and genus ( P=0.007) levels. Conclusions:The bacterial community in the tumor microenvironment of the upper gastrointestinal tumor changed, and the species enriched in the tumor site were mainly oral common anaerobic bacteria, such as Prevotellaceae ( Prevotella), Lactobacaceae ( Lactobacillus) and Fusobacteriaceae ( Fusobacterium), especially Prevotellaceae ( Prevotella).

Objective: To explore the clinical effect of reduction and reconstruction of the removed bony structure after one-stage posterior resection of high cervical tumors. Methods: From October 2009 to March 2018, 17 patients including 10 males and 7 females of high cervical tumors who underwent one-stage posterior resection with an average age of 57 years (26~84 years) were reviewed. There were 11 shwannomas, 3 meningiomas and 3 concurrent shwannoma and meningioma arising in the same level, respectively. Reduction with (14 cases) or without internal fixation (3 cases) were performed for the removed C1 posterior arch or C2 laminar and spinous process. The clinical effects were compared with Visual analogue score (VAS), Japanese Orthopaedic Association scores (JOA) and American Spinal Injury Association (ASIA) grade. The cervical lordosis and range of motion were measured with the X-ray before the operation and at the last follow-up. Results: There were no vertebral artery injury or massive hemorrhage during the surgeries. The operation time was 184±43 min, blood loss was 203±223 ml, and mean follow-up period was 29.1±28.2 months. No recurrence was found during the follow-up, and the motor and sensory were significant recovered in all patients after surgery. VAS score and JOA score were significantly improved at the last follow-up. ASIA grade was C for 1 case, D for 11 cases and E for 5 cases before surgery. After surgeries, C improved to D, 8 cases of D improved to E and 3 cases of D failed improved to E. Although the cervical lordosis and range of motion was decreased significantly in the last follow-up in X-ray, no patients complained stiffness and discomfort in rotation or flexion and extension of the neck. Cardiac arrest during operation was occurred in 1 case, and heartbeat recovered after stopping the manipulation. CSF leakage was found in 9 cases and no surgical site infection was occurred. Conclusion Resection of high cervical dumbbell-shape tumors is a demanding surgery with high incidence of complications. The reduction and reconstruction of removed bony structure without fusion could rebuild the stability of high cervical spine and preserve the cervical range of motion as much as possible which improves clinical effect.

Objective To retrospectively analyze clinical features,treatment methods and efficacy of giant cell tumor of bone in proximal tibia,and to investigate risk factors affecting tumor recurrence and functional outcomes.Methods A total of 250 patients with giant cell tumor of bone in proximal tibia confirmed by pathology,who had undergone surgical treatment from March 2000 to July 2014,were enrolled in this study.There were 132 males and 118 females,with an average age of (34.59±12.86) years.A total of 140 patients who were followed up for more than 3 years were included in this study,and there were 72 males and 68 females,with an average age of (34.46± 11.96) years.There were 11 cases of Campanacci grade Ⅰ,58 cases of grade Ⅱ,71 cases of grade Ⅲ and pathological fracture of 47 cases.According to surgical methods,they were divided into bone grafting group (49 cases),bone cement filling group (34 cases),prosthesis group (46 cases) and others group (11 cases).The epidemiology,clinical and radiographic features and risk factors affecting tumor recurrence and functional outcomes were analyzed.Results A total of 140 patients were followed up,the follow-up period was 36-324 months,with an average of 95.4 months,and the median follow-up time was 88 months.Recurrence was found in 26 cases,and recurrence rate was 18.57％,with an average recurrence interval of 25.85 months.Recurrence was found in 17 cases in the first 2 years.The 5-year free survival rate was 77.60％.The recurrence rates were 18.37％ in bone grafting group,20.59％ in bone cement filling group,15.22％ in prosthesis group and 27.27％ in the others group,no statistically difference was found on recurrence rate and free survival rate (P=0.805,P=0.558).Recurrence was not related to all kinds of factors.A variety of related factors affecting postoperative recurrence were analyzed,sex,the first diagnosis of the original recurrence,left and right side,whether the eccentricity,fracture,cortical bone destruction,soft tissue mass,surgical methods,high-speed grinding,auxiliary application,and there was no significant correlation between recurrence and these factors.The MSTS 93 score was 25.26±4.31.Function of the primary patients was better than that of recurrence (P=0.044).Function of the patients treated with curettage with or without internal fixation was better than that with segmental resection (P=0.011).Function of the patients treated with grafting or bone cement filling was better than that with prosthesis or allograft-prosthesis reconstruction (P=0.004).There were no significant correlation between MSTS function score and gender,left and right side,whether the eccentricity,whether fractures,cortical bone destruction (Campanacci grade),whether there is soft tissue mass,whether the use of assisted inactivation,whether the use of grinding or internal fixation.Conclusion Various surgical methods had no significant effect on the recurrence of proximal tibial GCT,as for GCT in proximal tibia,there is no relation between recucrrence and related factors.Whether primary tumor and surgical methods are two important factors affecting limb function.

Objective To evaluate the therapeutic effect and application value of laparoscopy combined with holmium laser in the treatment of intrahepatic and extrahepatic bile duct stones.Methods Retrospectively analyzed the clinical data of 22 cases with intrahepatic and extrahepatic bile duct stones who treated with laparoscopy choledo-choscopy combined with holmium laser lithotripsy(the observation group),and 21 cases who treated with laparoscopy combined with choledochoscopic lithotomy(the control group).The clinical curative effect was compared between the two groups.Results In the observation group,the residual stones completely removed in 21 cases(95.4%),the mean operation time was (130 ±13)min,the intraoperative bleeding volume was (85 ±20)mL,the average hospitali-zation time was (8.3 ±2.0)days,without conversion to open surgery,no incision infection,1 case had residual stones after operation,through T tube sinus tract choledochoscopy took a stone again.In the control group,took net calculi in 13 cases(61.9%),the average operation time was (135 ±20)min,the intraoperative hemorrhage volume was (70 ± 15)mL,the average hospitalization time was (14.5 ±2)days,6 cases converted to laparotomy,incision infection in 2 cases,8 cases had residual stones after operation,through T tube sinus combined with choledochoscopy again take stone,which 2 secondary mirror lithotomy in 6 cases,3 cases of 2 stones.The differences of the two groups in stone from the net rate,conversion rate,average hospitalization time were statistically significant(χ2 =2.203,2.897,t =4.293,P =0.033,0.006,0.017).The differences of mean operation time,intraoperative hemorrhage had were not statistically significant(t =1.176,1.629,P =0.246,0.111).Conclusion It is safe,effective and minimally invasive for the treatment of intrahepatic and extrahepatic bile duct stones with holmium laser combined with endoscopic holmi-um laser.

Objective To compare and discuss the clinical application effect of the end-to-end anastomosis of pancreatic and intestinal anastomosis,binding type of pancreatic and intestinal anastomosis,end-to side pancreatic duct anastomosis and modified pancreatic duct jejunum anastomosis.Methods Collected pancreatoduodenectomy in 95 cases,the end-to-end pancreatico duodenal sleeve type anastomosis in 23 cases,binding type pancreatic enteric anastomosis in 18 cases,end to side pancreaticojejunostomy anastomosis in 28 cases,improvement of the pancreatic duct jejunum end to side anastomosis in 26 cases,compared with four groups of patients with pancreatic enteric anastomosis time and postoperative complications.Results Anastomosis time:A group (34.0 ± 4.6) min,B group (31.0±5.8) min,C group (32.0 ±6.3) min,D group (14.0 ±4.2) min(P=0.037,P＜0.05).And the incidence rate of postoperative pancreatic fistula,bile leakage,abdominal cavity or digestive tract bleeding had no significant difference (P ＞ 0.05).Improvement of the pancreatic tube jejunum end to side coincident with a low incidence of pancreatic fistula,but different pancreatic enteric anastomosis way pancreatic fistula rate difference was not statistically significant,improvement of the pancreatic duct and jejunum mucosa end side group pancreatic enteric anastomosis anastomosis time significantly shorter in the three groups,the difference was statistically significant (P ＜ 0.05).Conclusion Improvement of pancreatic duct jejunum end to side anastomosis with short operation time,low incidence of pancreatic fistula,and the operation is simple and practical,safe.

OBJECTIVETo explore the differences in sensitivity to rapamycin of five esophageal squamous cell carcinoma cell lines with different differentiation and the changes of sensitivity of the cells after siRNA-interfered expression of p70S6K.

METHODSEffects of rapamycin on proliferation of ESCC cell lines with different differentiation, EC9706, TE-1, Eca109, KYSE790 and KYSE450 cells, were investigated using cell counting kit 8 (CCK-8) assay, and according to the above results, the EC9706 cells non-sensitive to rapamycin were chosen to be transfected with p70S6K-siRNA. The changes in sensitivity of cells to rapamycin were measured in vitro and in vivo using CCK-8 kit, flow cytometry and tumor formation in nude mice.

RESULTSCCK-8 results showed that all the five cell line cells were sensitive to low concentration of rapamycin (<100 nmol/L), but TE-1 and EC9706 cells, which were with poor differentiation, showed resistance to high concentration of rapamycin. After EC9706 cells were treated with 50, 100, 200, 500 and 1 000 nmol/L rapamycin and p70S6K-siRNA, the proliferation rates of EC9706 cells were (48.67 ± 1.68)%, (15.45 ± 1.54)%, (14.00 ± 0.91)%, (10.97 ± 0.72)% and (2.70 ± 0.32)%, respectively, and were significantly lower than that of cells treated with 50, 100, 200, 500 and 1 000 nmol/L rapamycin and control siRNA [(74.53 ± 1.71)%, (68.27 ± 1.35)%, (71.74 ± 2.44)%, (76.23 ± 1.02)% and (80.21 ± 2.77)%] (P<0.05 for all). The results of flow cytometry showed that the ratios of cells in G1 phase of the p70S6K-siRNA, rapamycin and p70S6K-siRNA+ rapamycin groups were (53.82 ± 1.78)%, (57.87 ± 4.01)% and (73.73 ± 3.68)%, respectively, significantly higher than that in the control group (46.09 ± 2.31)% (P<0.05 for all). The results of tumor formation test in vivo showed that the inhibitory effect of rapamycin on tumor growth was stronger after the cells were transfected with p70S6K-siRNA, and the inhibition rate was 96.5%.

CONCLUSIONESCC cells with different differentiation have different sensitivity to rapamycin, and p70S6K-siRNA can improve the sensitivity of cells to rapamycin in vitro and in vivo.

Animals ; Antibiotics, Antineoplastic ; pharmacology ; Carcinoma, Squamous Cell ; drug therapy ; metabolism ; pathology ; Cell Differentiation ; Cell Line, Tumor ; Cell Proliferation ; Esophageal Neoplasms ; drug therapy ; metabolism ; pathology ; Humans ; Mice ; Mice, Nude ; RNA, Small Interfering ; Ribosomal Protein S6 Kinases, 70-kDa ; genetics ; metabolism ; Signal Transduction ; Sirolimus ; pharmacology ; Transfection

OBJECTIVE: To explore the developing rule of formants of core vowels with age, and difference with gender. METHOD: 2492 normal people were randomly selected with 1318 males and 93 females,and divided to 4 groups according to age. /a/,/i/,/u/ of each child was recorded. Using D1200 to record normatively, reading data of formants in Real Analysis. Datawere analysis by SPSS13.0. RESULT: Formants of Core vowels had significant difference with age (P < 0.05), generally having a decreasing trend mainly with F1,F2 and deltaA (A1-A2) were different significantly as to gender; There were also significant difference between the formants of the core vowels (P < 0.05). CONCLUSION (1) There are significant effect of age,gender and core vowels(a,i,u)on F1, F2; (2) There are parallel correlation between developing trend of F1, F2 and that of F0.
Acoustics ; Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Female ; Humans ; Male ; Sampling Studies ; Sex Factors ; Speech Acoustics ; Voice ; Voice Quality ; Young Adult

OBJECTIVE: To testify the effect of voice therapy methods for the glottal dysraphism patient with functional voice disorder. METHOD: The subject was a 62 year old man, who had been diagnosed as functional voice disorder of glottal dysraphism. The main therapy was voice training, with normalized noise energy (NNE) as the assessment and monitoring parameter of the voice function. The datum of the baseline period and the treatment period were collected, and were analyzed with A-B Single-Subject Design in statistics. RESULT: NNE had been significantly decreased (P < 0.01) through the systematical voice training. CONCLUSION Voice training had been the effective therapy for the glottal dysraphism patient with functional voice disorder.
Glottis ; physiopathology ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Voice Disorders ; therapy ; Voice Quality ; Voice Training

In the first case, a 15-year-old girl presented with recurrent multiple erythematous edema,bullae and ulceration on the face and extremities for 3 years, which had developed into plaques and nodules on the face and trunk for 6 months. Histology revealed angiocentric and angiodestructive infiltrates with medium-sized atypical lymphoid cells positive for LCA, CD45RO, CD56 and EBV staining throughout the dermis. The patient was diagnosed with extra NK/T-cell lymphoma, nasal-type. She subsequently had a rapid downhill clinical course with resistance to systemic chemotherapy, and died one month later. In the second case, a 44-year-old male was admitted to the hospital with progressive infiltrated mass on the right waist for 1 year, and a 4-month-history of lymphadenectasis. Histologically, there was a massive and dense infiltrate with middle and large-sized, CD4 and CD56-positive lymphoblastics throughout the dennis and subcutaneous tissue. A diagnosis of blastic NK-cell lymphoma was made. The patient was managed with surgical excision followed by systemic chemotherapy. He had been followed up and free of relapse till the time of this writing.CD56 positive cutaneous lymphoproliferative disorders appear to be highly invasive.