Comparison of different obesity indices in predicting risk of hypertension among adults in Gansu Province / 西安交通大学学报(医学版)

【Objective】 To compare the ability of body mass index （BMI）， body fat percentage （BFP）， waist circumference （WC）， waist-to-height ratio （WHtR）， visceral fat index （VFI） and the combinations of two kinds of obesity indices to predict the risk of hypertension. 【Methods】 Data collected in the baseline survey of “Gansu Province’s Urban and Rural Natural Population Cohort Establishment and Tumor Follow-up Study” were analyzed. Area under the curve （AUC） of ROC curve with covariates was used to analyze and compare the effects of individual obesity evaluation index and the combination of two kinds of obesity indices in predicting the risk of hypertension. 【Results】 Analyses of data of 20，079 adults showed that the AUC of BMI， WC， WHtR， BFP and VFI was 0.636， 0.604， 0.615， 0.614 and 0.619， respectively. AUC of the combination of BMI and WC （0.643） was higher than that of BMI （0.636）； however， the change rate of AUC was only 1.09%. AUC of the combinations of WC， WHtR and VFI， the three central obesity evaluation indices， and BFP， a general obesity evaluation index， were lower than that of BMI. The optimal cutoff value for BMI was 24.2 kg/m2. 【Conclusion】 The effect of BMI in predicting the risk of hypertension is better than that of BFP， WC， WHtR and VFI. The effects of the combinations of the two kinds of obesity evaluation indices are not better than that of BMI. To prevent and control hypertension， adults should keep their BMI under overweight.

Effects of breast feeding on BMI growth trajectories in rural western China: A birth cohort study / 西安交通大学学报(医学版)

【Objective】 To describe the BMI growth trajectories from birth to 24 months and examine the effects of fully breastfeeding time and breastfeeding duration on the BMI growth trajectories. 【Methods】 We conducted a follow-up study of a cohort of 1 388 eligible births. Height and weight were measured at birth, every 3 months to 12 months, and every 6 months to 24 months. Detailed demographic, feeding, activity and diseases data were also collected prospectively. Latent growth mixture modeling was conducted to model the BMI growth trajectories from birth to 24 months. Mixed-effects logistic regression analyses were made to examine the impacts of breastfeeding on this outcome. 【Results】 We identified six BMI trajectory patterns in the 1 285 infants analyzed and labeled them as follows: "normative growth" (26.6%), "normal-accelerating growth" (8.7%), "normal-decelerating growth" (11.7%), "lower-persistent growth" (6.6%), "rapid growth" (26.8%), and "rapid-accelerating growth" (19.5%). Mixed-effects logistic regression analyses revealed that fully breastfeeding ≥ 3 months could significantly decrease the risk of "rapid growth" (OR=0.71, 95% CI 0.51-0.98) and "rapid-accelerating growth" (OR=0.53, 95% CI 0.37-0.75). After adjustment for confounding factors, the relationship remained significant (OR=0.61, 95% CI 0.41-0.89; OR=0.46, 95% CI 0.31-0.68). Weaning before 6 months could significantly increase the risk of "rapid growth" (OR=1.76, 95% CI 1.19-2.61) and "rapid-accelerating growth" (OR=2.08, 95% CI 1.38-3.14). These associations persisted after adjustment for confounding factors (OR=1.69, 95% CI 1.08-2.71; OR=1.88, 95% CI 1.18-2.99). 【Conclusion】 In rural Western China, the main BMI growth trajectory patterns include "normative growth" , "rapid growth" , and "rapid-accelerating growth" . Prolonging breastfeeding may reduce excess weight gain during infancy.

Establishment of a dog model of pyogenic spinal infection / 中国组织工程研究

BACKGROUND:Spine infection models are rarely reported in the literature. There are fewer reports on the imaging and histological observations of the animal model of spinal infection. OBJECTIVE:To develop a canine model of pyogenic spinal infection. METHODS:Twelve Chinese dogs were adopted in the study. The dogs were in the right arm recumbent. The surgery was conducted by retroperitoneal approach to expose T12/L1 intervertebral space. The intervertebral discs that exposed the intervertebral space were partial y removed, and the end plate of the adjacent two vertebrae was deliberately curetted out. Suspension with different concentrations of Staphylococcus aureus and sodium morrhuate were injected into the dog intervertebral space. The aim of removal of partial intervertebral discs and destruction of endplate was to make the vertebral body bone better in contact with the bacteria. The same operation was conducted in L5/6 clearance of the animal spine. At 14 days after surgery, animals were sacrificed. The infected intervertebral disc and adjacent vertebral bodies were taken out. Bacterial contents of specimens were quantitatively determined. During sacrificing, partial liver tissues and blood samples were col ected for bacterial culture. The occurrence of systemic infection was observed. RESULTS AND CONCLUSION:(1) Spondylodiscitis of the lumbar spinal column was consistently produced in 90%(9/10) the sites chal enged with 102 colony-forming units (CFU) Staphylococcus aureus. Liver biopsy and blood culture did not show any signs of systematic infections. (2) Two out of four animals implanted the suspension with a concentration higher than 103 CFUs died within 3 days post-implantation. (3) These results suggested that a new canine model of pyogenic spinal infection was developed. This model could be used to test the efficacy of different anti-infection strategies.

Correction of posttraumatic thoracolumbar kyphosis with modified pedicle subtraction osteotomy / 中南大学学报(医学版)

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis.
 Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI).
 Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation.
 Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.

Epidemiological features and risk factors of spontaneous abortion among rural Tibetan women at childbearing age / 中华流行病学杂志

Objective To study the current status and risk factors of spontaneous abortion of women with Tibetan ethnicity at reproductive age in rural areas.Methods Pregnant women who lived in fibet were interviewed on their former reproductive history and being followed on the outcomes of pregnant from 2006 to 2012.Generalized Poisson regression model was used to explore the influencing factors of spontaneous abortion.OR value of the research factors was estimated and its 95％ confidence interval counted.Results There were 1 557 pregnant women under this study,with a total number of 2 687 pregnancies and 2 382 productions.171 women underwent spontaneous abortion,with a total number of 204 times,93 women had histories of abortion,with a total number of 101 times.Among all the Tibetan pregnant women,the ratio between spontaneous abortion and pregnant women was 7.6％ while the rate of spontaneous abortion was 7.9％.Ratio between the number of women who had experienced spontaneous abortion and the total number of women under survey was 11.0％.Pregnancy appeared the important reason on spontaneous abortion.The risk of having spontaneous abortion would increase among women who had more than 3 pregnancies.Results from Poisson regression analysis revealed that the odds ratio (OR) value before the adjustment was 3.921 (95％CI:2.553-6.021) but after the adjustment,it increased to 4.722 (95％CI:2.834-7.866).The increase of production time could reduce the risk of spontaneous abortion in women of childbearing age.Risks related to spontaneous abortion were associated with the number of pregnancies.Women seemed to have lower risk for spontaneous abortion after 2009,with OR value as 0.419(95％CI:0.285-0.616) before,compared to aOR value as 0.580 (95％CI:0.380-0.885) after the adjustment Social-demographic characteristics was not found to be particularly associated with the occurrence of spontaneous abortion.Conclusion Rate of spontaneous abortion among Tibetan women at childbearing age was not particularly high when comparing to those women living in the plain area such as Shaanxi.However,in order to further reduce the incidence of spontaneous abortion among Tibetan women,approaches should include the following items:strengthening maternal health care,extending the spacing of pregnancy and reducing the frequency of pregnancy.

Criteria and implant treatment for pyogenic spinal infection in dogs / 中国组织工程研究

BACKGROUND:Animal model of infection is established using bioluminescent gene-labeled bacteria, which stimulate local environment of spine infection and reveal the pathophysiological mechanism of spine infection. OBJECTIVE:To evaluate the feasibility and safety of anterior one-stage debridement, autogenous iliac bone grafting and titanium plate internal fixation in the management of pyogenic spinal infections in spine. METHODS:Total y 24 Chinese dogs were adopted in the study to develop a canine model of acute pyogenic spondylodiscitis using a bioluminescent strain of Staphylococcus aureus Xen29. The animal models were detected by X-radiography, CT and MRI examinations. After 4 weeks of modeling, al the animals underwent one-stage debridement, autogenous iliac bone grafting and anterior titanium plate internal fixation. Antibiotics contained Cefazolin and Gentamicin were administrated daily since perioperative period to 4 weeks after surgery. The titanium plate and adjacent vertebra were removed surgical y at various postoperative time points (4, 8, 12, 24 weeks) when the dogs were kil ed. The excised tissues and retrieved implants were cultured with conventional bacteria, bacteria 16S rRNA and specific Nuc gene of Staphylococcus aureus. PCR and bioluminescence imaging technique were used to detect the presence of bacteria. RESULTS AND CONCLUSION:The surgical wound was healed uneventful y. Gross observation and MRI examination of the specimens showed that there was no abscess formation or signs of infection recurrence. The infection rate was 41.7%(10/24) and 75%(18/24) in the procedure of conventional bacteria and bacteria 16S rRNA cultivation. The results showed that the sensibility of PCR technique used to detect the presence of bacteria by amplifying the highly conservative gene sequence of 16S rRNA was significantly higher than that of conventional bacterial cultivation procedure (P<0.05). The PCR detection of specific Nuc gene of Staphylococcus aureus showed the existence of Staphylococcus aureus (1/24). However, Staphylococcus aureus Xen29 with genetic marker was not detected around the implant by bioluminescence imaging technique (0/24). Al of the results showed that bacterium adhering to prosthesis in vivo is an universal phenomenon. The bacteria identified from prosthesis which was taken during the surgery and the bacteria by which the spine was infected before the surgery was not homologous. The one-stage debridement, autogenous bone grafting and anterior titanium plate internal fixation is safe and effective in the management of pyogenic spinal infections. Using of internal fixator can not lead to recurrence or persistence of infection.

Study on the Hemoglobin levels among the Tibetan pregnant women in rural Lhasa / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the level of hemoglobin (Hb) and determine the risk factors of Hb concentration among the Tibetan pregnant women in rural Lhasa.</p><p><b>METHODS</b>Between August 2008 and May 2011, a hospital-based study was conducted among 1 530 Tibetan pregnant women after getting their informed consent in agricultural and pastoral areas in maternity clinic or hospital in city, county and township level of Lhasa. Their blood samples were tested and related socio-demographic information was collected. Blood was collected on tip of finger and the Hb concentration was measured using B-Hemoglobin photometer. American Centers for Disease Control and Prevention(CDC) method was used to adjust the Hb measurements based on altitude for estimating the prevalence of anemia. Anemia was assessed according to WHO criteria. A hemoglobin concentration of less than 110 g/L in a pregnant woman was considered an indication of anemia.</p><p><b>RESULTS</b>From August 2008 to May 2011, 1 530 Tibetan pregnant women living at (3 716.4 ± 69.1) m above sea level in rural Lhasa were examined. The findings indicated that average Hb concentration was (122.0 ± 17.5) g/L; the Hb concentration of 1(st), 2(nd) and 3(rd) trimester were (125.5 ± 18.0), (122.5 ± 16.9) and (120.6 ± 17.4) g/L, respectively. The Hb concentration of pregnant women decreased with the increase of gestational age(P < 0.05). Based onCDC method and the adjusted Hb level, the prevalence of anemia in pregnant women were 85.6% (1 310/1 530), the prevalence of anemia of 1(st), 2(nd), and 3(rd)rd trimester were 79.5% (206/259) , 86.1% (395/459)and 87.3% (698/800), respectively (P < 0.05) . The rate of moderate and severe anemia were 46.7% (612/1 310) among pregnant women. Multiple linear regression analysis showed that high Hb level was associated significantly with low family income status (β = 2.74, 95%CI:1.73-3.74), no bad habits (drinking or smoking) (β = 7.34, 95%CI:4.87-9.81) and fewer times of pregnancies(β = -1.62, 95%CI:-2.93--0.31) after adjusting for potential confounding factors.</p><p><b>CONCLUSION</b>Hb concentration level in pregnancy was rather low in rural Lhasa. The increase of family income, reduction the intervals of pregnancies and no bad habits might benefit for the improvement of Hb level of pregnant women in this region.</p>

Factors and revision strategy for failure of thoracolumbar spine internal fixation after burst fracture / 中南大学学报(医学版)

OBJECTIVE@#To analyze the reasons for the failure of thoracolumbar spine internal fixation after burst fracture, and to discuss the strategy for revision surgery.@*METHODS@#From January 2005 to September 2010, 21 patients with thoracolumbar burst fracture received revision surgery after the failure of internal fixation. The etiology included loose of the fixation after anterior surgery in 4 patients, involving malunion with severe kyphosis in 1 patient, pedicle screw malposition in 3, fracture of adjacent segment vertebra in 2, broken of the fixation as non-union of the fracture vertebra in 10 comprising obvious kyphotic deformity in 5, and 2 had developing kyphosis for over distraction of the vertebra followed by pseudarthrosis after removing the internal fixation. After the first operation, symptoms remained in 6 patients, deteriorated in 7, light to moderate improved in 8. Surgical procedures such as anterior corpectomy and reconstruction, replacement of the internal fixation and canal decompression, vertebroplasty, and posterior pedicle subtraction osteotomy were directed based on individual situation.@*RESULTS@#Patients were followed-up for 6-68 (27.0±13.2) months, and demonstrated solid fusion 6 to 12 months postoperatively. No failure of the internal fixation reccurred. No major complications or deterioration of neurologic status were noted. At the last follow-up, the improvement of Frankel grade was 0-2 (1.3±0.7). The mean visual analog scale (VAS) dropped down from 7.6 to 2.1, and the mean oswestry disability index (ODI) decreased from 48.7 to 10.3. Preoperative angle of 7 kyphotic deformity patients was 10 degree-75 degree (42.5 degree±15.3 degree), and was improved to -3 degree-10 degree (2.3 degree±3.7 degree). At the last follow-up, the loss of correction was 0 degree-1.3 degree (0.7 degree±0.3 degree), with the correction rate of 92.3%.@*CONCLUSION@#Solid reconstruction of the anterior and middle column of the spine is the imperative procedure to prevent failure of internal fixation in thoracolumbar burst fractures. Revision surgery with reasonable strategy is beneficial and rewarding with few complications.

Posterior discectomy for the treatment of lower thoracic disc herniation / 中华骨科杂志

Objective To evaluate the therapeutic effect of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation for the treatment of lower thoracic disc herniation.Methods From June 2000 to June 2010,36 cases of lower thoracic disc herniation were treated with method of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation,including 23 males and 13 females,with an average of 42 years old(range,22-61 years old).The courses of disease were from 21 days to 69 months,with an average of 22 months.The lesion locations were T10-11 for 12 cases,T11-12 for 15 cases and T12L1 for 9 cases.Each of the patients underwent X-ray and MR examination,31 of them underwent CT scanning.Twenty-five cases were central protrusion type,7 cases were para-central protrusion type,4 cases were lateral protrusionstype.The clinical results were evaluated by Otanni scored system.Results The operative time was 135-220 min,with average of 155 min.The blood loss was 350-800 ml,with average of 460 ml.All patients were successfully operated without neurological symptoms aggravation and accidents.Cerebrospinal fluid leakage occurred in 12 cases,which was treated by continuous suture or dura patch repair.Two cases with giant disc herniation suffered from muscle strength decrease of lower limbs after surgery,which gradually recovered after drug treatment of hormones,dehydration,high-pressure oxygen and nerve nutrients.Postoperative X-ray examinations showed that there were no internal fixation loosening.The followed-up period was 14 days to 48 months,mean 4 months.According to Otani scored system,there were excellent results in 12 cases,good results in 18 cases and poor results in 1 case.The clinical satisfaction rate was 83.3%.Conclusion Posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation is a safe and effective surgical procedure for the treatment of lower thoracic disc herniation.

Complication of thoracic pedicle screw fixation in spinal deformities / 中南大学学报(医学版)

OBJECTIVE@#To analyze the etiology and prevention of complications related to the pedicle screw technique in the treatment of thoracic scoliosis.@*METHODS@#There were 183 thoracic deformity patients 110 idiopathic scoliosis, 32 adult scoliosis, 28 congenital kyphoscoliosis, 8 Marfan syndrome with scoliosis, and 6 others. All patients' Cobb angles were evaluated preoperatively, intraoperatively, and postoperatively by roentgenograms. The deformity correction rate was calculated. All radiographic evaluations were carried out in a double-blind fashion. The complication rate was analyzed perioperatively and postoperatively.@*RESULTS@#The deformity correction rate was 72%, better than others treated with hook-rod system. The perioperation complication rate was 8.4% (pedicle fracture 1.5%, infection 3.8%, pneumothorax and plural effusion 1.6%, transitory neurological damage 0.5%, and over-bleeding shock 1%). The complication rate at follow-up was 3.6% (infection 0.5%, fatigue fracture 1%, loss of deformity correction 1.6%, and transitory neurological damage 0.5%). Compared with those treated with hook-rod system, the perioperation complication rate, loss of deformity correction, permanent damage, and complications related to the internal fixation were all low.@*CONCLUSION@#The complication rate of pedicle screw fixation system was low in the treatment of thoracic deformity. When surgeons are thoroughly familiar with the technique and related pathoanatomy, and with the spinal cord function wardship by SEP, complications related to the pedicle screw technique in the treatment of thoracic scoliosis will be well controlled.

Accuracy of free-hand thoracic pedicle screw placement in severe idiopathic scoliosis via CT scan / 中南大学学报(医学版)

OBJECTIVE@#To analyze the accuracy of free-hand thoracic pedicle screw placement in severe idiopathic scoliosis via CT scan.@*METHODS@#Twenty patients with complete CT data were chosen out of 58 patients of severe idiopathic scoliosis from June 1996 to December 2006. The Cobb angle of the main thoracic curve was from 82 degree to 142 degree (96.3 degree +/- 14.3 degree). The kyphotic angle in the main curve was 66.2 degree +/- 12.4 degree. The placement of thoracic pedicle screw was completed free-handedly, and the accuracy of screws placement was evaluated with CT thin-slice scan postoperatively.@*RESULTS@#Altogether 174 thoracic pedicle screws were inserted, 157 (90.2%) of which were fully contained within the cortical boundaries of the pedicle.The other 17 screws (9.8%) were misplaced in 9 patients: 11 screws (6.8%) were lateral, 9 of which had a breach 0.05). There was no neural complication in all patients.@*CONCLUSION@#It is fairly accurate place thoracic pedicle screw in severe idiopathic scoliosis free-handedly, with some misplacements.

THE RELATIVE BIOAVAILABILITY OF SELENIUM IN ZIYANG HIGH-Se WHEAT TO SELENIUM-DEFICIENT RATS / 营养学报

A three-phase depletion/repletion/depletion feeding study was designed to investigate the changes of Se levels and glutathione peroxidase (GSH-Px) activities in tissues and blood in rats fed for 6 weeks low-Se diet (6 ppb Se) from a Keshan disease area during the supplementations of Se as Ziyang high-Se wheat (1.175 ppm Se) or sodium selenite (dietary Se 219 and 223 ppb respectively) and after the supplements were discontinued, and to evaluate the relative bioavailability of Se in the wheat. The resalts showed that the average bioavailability of Se in high-Se wheat derived from the values at wk 2, 4 and 6 of supplement was close to that in selenite when plasma, erythrocyte, kidney, liver and cardiac Se contents were used as the response criteria, the relative bioavailabilities being 98%, 104%,100%,96% and 101% (sodium selenite = 100%) respectively. The bioavailability was lower for Se in high-Se wheat (70% or 90%) than for selenite when estimated by erythro-cyte or cardiac GSH-Px activities. However, the bioavailabilities of high-Se wheat Se in various tissues were not all the same at different stages of supplement. In addition, the effect of Se in high-Se wheat in maintaining either Se levels in heart, liver and erythrocyte or GSH-Px activity in heart was superior to that of selenite 3 weeks after the Se supplements were withdrawn.