Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy / 中华医学杂志(英文版)

BACKGROUND@#The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.@*METHODS@#A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.@*RESULTS@#There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.@*CONCLUSIONS@#Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study / 中华医学杂志(英文版)

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.

Comparison of epidemiological and clinical characteristics of COVID-19 patients with and without Wuhan exposure history in Zhejiang Province, China / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

BACKGROUND@#A novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first identified in Wuhan, China, has been rapidly spreading around the world. This study investigates the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients in Zhejiang Province who did or did not have a history of Wuhan exposure.@*METHODS@#We collected data from medical records of confirmed COVID-19 patients in Zhejiang Province from Jan. 17 to Feb. 7, 2020 and analyzed epidemiological, clinical, and treatment data of those with and without recorded recent exposure in Wuhan.@*RESULTS@#Patients in the control group were older than those in the exposure group ((48.19±16.13) years vs. (43.47±13.12) years, P<0.001), and more were over 65 years old (15.95% control vs. 5.60% exposure, P<0.001). The rate of clustered onset was also significantly higher in the control group than in the exposure group (31.39% vs. 18.66%, P<0.001). The symptom of a sore throat in patients in the exposure group was significantly higher than that in the control group (17.30% vs. 10.89%, P=0.01); however, headache in the exposure group was significantly lower than that in the control group (6.87% vs. 12.15%, P=0.015). More patients in the exposure group had a significantly lower level of lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) than those in the control group. There was no significant difference in any degree of COVID-19 including mild, severe, and critical between the two groups.@*CONCLUSIONS@#From the perspective of epidemiological and clinical characteristics, there was no significant difference between COVID-19 patients with and without Wuhan exposure history.

An evaluation of the application of clinical nursing pathway in the rehabilitation of stroke patients / 预防医学

Objective To evaluate the clinical nursing pathway in the treatment of stroke patients in combination with traditional Chinese medicine and western medicine. Methods A hundred patients were randomly divided into observation group and control group, 50 cases of each, which selected in Zhoushan Hospital of Traditional Chinese Medicine from January to December in 2015. The normal nursing methods were used in the control group and the clinical nursing paths were used in the observation group. Results The average value of Barthel score of the observation group was significantly better than that of the control group (55.93±9.12 vs. 46.51±9.29, P<0.05) . The recovery efficiency of the observation group was significantly higher than that of the control group (90.00％ vs. 62.00％, P<0.05) . The score of satisfaction of nursing work in the observation group was higher than that of the control group (9.13±0.49 vs.7.08±0.72, P<0.05), and the average length of stay was shortened (43.62±3.79 vs. 65.13±3.11, P<0.05) respectively compared with the control group, and the curative effect of topsis was evaluated by topsis method, and the Ci value of the observation group (Ci=0.781) was better than that of the control group (Ci =0.219) . Conclusion The clinical nursing pathway could significantly improve stroke patients Barthel score, muscle strength and nursing job satisfaction, and overall reduce the duration of hospital stays.

Research on rules of distribution and development of traditional Chinese medicine syndromes of 2,237 HIV/AIDS cases / 中国中药杂志

HIV/AIDS patients in high prevalence areas with different routes of infection (sexually transmitted 878 cases, 527 cases of intravenous drug user, paid blood donor 652 cases) were choosen for traditional Chinese medicine (TCM) syndrome investigation for one-year clinical follow-up. This paper primarily concluded the nature, location and pathogenesis of AIDS diseases. Deficiency of Yang and Yin, combining deficiency of Qi are the basic deficiency syndromes, while stagnation of dampness, toxic fire are the excess syndromes; the disease location of HIV infector is spleen, main syndrome is deficiency of spleen Qi; the disease location of AIDS patient is kidney, main syndrome is deficiency of spleen and kidney Yang. The pathogenic development tendency is from deficiency of Qi to combining stagnation of dampness and toxic fire, finally to deficiency of Qi and Yin, deficiency of Yang.

Expression of chondromodulin-1 in the adult degenerative intervertebral disc / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the expression of chondromodulin-1 (ChM-I) in human adult degenerative intervertebral disc (IVD) cells and the relationship between ChM-I expression and disc degeneration.</p><p><b>METHODS</b>Three degenerated disc specimens obtained from patients in the treatment of disc degenerative disease from March to April 2009 were used for cell culture. ChM-I expression in IVD cells was examined by RT-PCR and Western blot. The effect of basic fibroblast growth factor (bFGF) on the expression of ChM-I was assessed by real-time PCR and Western blot. From October 2008 to October 2009, 26 human IVD tissues were obtained from patients in the surgical treatment of disc degenerative disease at different stage of degeneration according to MRI. Six IVD tissues removed from patients with metastatic spinal tumor were used as normal control. The expression of ChM-I determined by immunohistochemical analysis was correlated with MRI degeneration grade.</p><p><b>RESULTS</b>RT-PCR and Western blot examination showed that ChM-I was expressed in both adult degenerative anulus fibrosus and nucleus pulposus cells. The mRNA and protein expression of ChM-I were both down-regulated by administration of bFGF with dose-dependent way (P < 0.05). Immunohistochemical analysis showed the percent of ChM-I immunopositive cells in the control group was 0.12 ± 0.03, and the number increased significantly in the advanced degeneration group (P < 0.05).</p><p><b>CONCLUSIONS</b>The current results demonstrate that IVD cells express ChM-I. Administration of bFGF down-regulates the expression of ChM-I. The expression of ChM-I is correlated with the degree of IVD degeneration which means it may involve in the process of IVD degeneration.</p>

The study on high-resolution HLA and human cytomegalovirus (HCMV) viremia in bone marrow transplantation recipients / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To study the correlation between high-resolution HLA-A * 1101, HLA-A * 0201, HLA-A * 2402, HLA-B * 4001, HLA-DRB1 * 0901 with HCMV pp65 antigenemia after bone marrow transplantation (BMT) in China.</p><p><b>METHODS</b>48 recipients doing BMT during 2009. 2-2010. 10 were selected in my hospital; HCMV pp65 was detected by ELISA or immunohistochemical methods. The frequency of HLA-A * 1101, HLA-A * 0201, HLA-A * 2402, HLA-B * 4001, HLA-DRB1 * 0901 alleles were determined by Polymerase chain reaction-sequence based typing (PCR - SBT).</p><p><b>RESULTS</b>(1) The BMT recipients were HCMV pp65 antigenic positive(100%); (2) The positive rate of HLA-A * 1101, HLA-A * 0201, HLA-A * 2402, HLA-B * 4001 showed no obvious difference between 12 lower antigenemia group and 36 higher antigenemia group, the positive rate: HLA-A * 1101 were 33.3% (8/24) and 20.8% (15/72), HLA-A * 0201 were 4.2% (1/24) and 13.9% (10/72), HLA-A * 2402 were 12.5% (3/24) and 19.4% (14/72), HLA-B* 4001 were 16.7% (4/24) and 12.5% (9/72); (3) HLA-DRB1 * 0901 positive rate in higher antigenemia group was higher than the lower (P = 0.048), the positive rate were 4.2% (1/24) and 19.4% (14/72); (4) HLA-DRB1 * 0901 recipients were higher pp65 antigenemia than HLA-A * 2402 recipients (P = 0.007) and HLA-A * 1101 recipients (P = 0.028), HLA-A * 0201 recipients were higher pp65 antigenemia than HLA-A * 2402 (P = 0.02), the pp65 antigenemia showed no obvious difference among the rest of high-resolution HLA groups (P > 0.05).</p><p><b>CONCLUSION</b>HLA-DRB1 * 0901 alleles might be correlated with BMT recipients happened higher pp65 antigenemia, HLA-A * 2402 alleles might be correlated with BMT recipients happened lower pp65 antigenemia.</p>

Association between cervical curvature and cervical sympathetic symptoms / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the association between cervical curvature and cervical sympathetic symptoms.</p><p><b>METHODS</b>The clinical data of 318 patients with cervical spondylosis who underwent surgical treatment in our department between July 2003 and December 2007 were retrospectively analyzed. All patients were divided into group without sympathetic symptoms (n = 284) and group with sympathetic symptoms (n = 34) . The curvatures of both groups on cervical lateral radiographs were measured using Borden method and statistical analysis was performed.</p><p><b>RESULTS</b>The incidence of abnormal cervical curvature in group with cervical sympathetic symptoms were 67.6% (23/34), which was significantly higher than that in group without cervical sympathetic symptoms (50.7%, 144/284) (P < 0.05).</p><p><b>CONCLUSION</b>Cervical curvature abnormality may be an independent factor that affects the cervical sympathetic symptoms.</p>

Dynamic radiographic analysis of sympathetic cervical spondylosis instability / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the correlation between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms as well as the difference of cervical spondylotic subaxial instability between male and female patients.</p><p><b>METHODS</b>We analyzed retrospectively 318 surgical cases of cervical spondylosis treated at Department of Orthopedic Surgery of Peking Union Medical College Hospital between July 2003 and December 2007. All cases were divided into group A without sympathetic symptoms (n=284) and group B with sympathetic symptoms (n=34). Angular and horizontal translation values between two adjacent vertebral bodies from C2 to C7 were measured separately on hyperflexion and hyperextension lateral cervical spine radiographs. Fisher's exact test was used to evaluate the correlation between subaxial cervical instability and sympathetic symptoms. Intragroup correlation between patient gender and subaxial cervical instability was also evaluated.</p><p><b>RESULTS</b>Subaxial instability incidences in groups A and B were 21.8% (62/284) and 55.9% (19/34), respectively. Statistical analysis indicated a definite correlation between subaxial cervical instability and sympathetic symptoms (P=0.000). Among patients without sympathetic symptoms, subaxial instability incidences were 21.4% (37/173) in males and 22.5% (25/111) in females, respectively (P=0.883). While among patients with sympathetic symptoms, subaxial instability incidences were 27.3% (3/11) in males and 69.6% (16/23) in females, respectively, indicating significant difference (P=0.030). Subaxial instability was most commonly seen at C4-C5 intervertebral space in sympathetic cervical spondylosis patients.</p><p><b>CONCLUSIONS</b>High correlation exists between subaxial cervical spine instability and cervical spondylotic sympathetic symptoms, especially in female patients. Hyperextension and hyperflexion radiographs of cervical spine are important to assess sympathetic cervical spondylotic subaxial instability.</p>

Vertebra morphology measurement in adolescent idiopathic scoliosis population / 中华外科杂志

<p><b>OBJECTIVE</b>To measurement the vertebra morphology using multi-planar reformations method of multi-slice spiral CT (MSCT) in AIS girls, and To compare with age and gender-matched controls in order to affirm the morphology results of abnormal development of the anterior and posterior elements in AIS.</p><p><b>METHODS</b>Thoracic and lumbar spine multi-slice spiral CT was undertaken on 52 girls with AIS between the age of 10 and 18 years from June 2004 to May 2008 in Peking Union Medical College Hospital and Beijing Shijitan Hospital, and 54 age and gender-matched non-IS controls. Multiple measurements (including the anterior column and posterior column) of each thoracic and lumbar vertebra were obtained using the 3D-MPR technique. The patients and control were divided into 10-14 years old group and 15-18 years old group. The corresponding vertebral anterior height, vertebral posterior height, transverse distance, vertebra central width, vertebra anterior-posterior distance, area of pedicle, pedicle height, pedicle width, and upper-lower facet distance were compared.</p><p><b>RESULTS</b>Compared with the controls, the 10-14 years old group girls' spine had longer anterior column height, relative shorter posterior column (there are difference from thoracic 2-11 and lumbar 1-3, P < 0.05), relative longer anterior-posterior vertebral distance, vertebral wedging changes in vertebral, distinct vertebral and pedicle asymmetry on the concave and convex side, and upper-lower facet distance asymmetry on the concave and convex side. The difference between the anterior and the posterior column ratio was significantly different from that in the controls (P < 0.01). But there hadn't the same difference in 15 - 18 years old group.</p><p><b>CONCLUSIONS</b>There are differences in coronal plane vertebra wedging changes in AIS patient. There are high vertebra height, relative shorter posterior column, relative longer anterior-posterior vertebral distance, and relative slender vertebra in 10 - 14 years old AIS patients. This may lead to the initial and progression of scoliosis.</p>

Pedicle screw fixation for cervical spine instability: clinical efficacy and safety analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reports of applying cervical pedicle screw (CPS) system in the posterior cervical spine surgeries are limited because of its inherent risk of neurovascular injury. The clinical results of cervical spine instability treated with CPS system were retrospectively analyzed, and the clinical efficacy and safety of this management were evaluated.</p><p><b>METHODS</b>Twenty-five patients with cervical spine instability undergoing posterior C3 - C7 single/double door laminoplasty and free-hand CPS fixation as well as graft fusion were investigated; of whom, 3 were due to trauma, and 22 degenerative cervical pathogenesis. One hundred and fifty in total, CPSs were implanted in 5 cervical segments for 1 patient, 4 for 2, 3 for 18, and 2 for 4. Japanese Orthopaedic Association (JOA) score and its improvement rate, neck disability index (NDI), segmental stability, pedicle cortex perforation rate and other complication-associated parameters were assessed.</p><p><b>RESULTS</b>The average follow-up was 16.6 (6 - 30) months. Compared with pre-operative values, JOA score improved by 4.10 +/- 0.84 points on average (P < 0.05) at 6 months post operation, with a mean improvement rate of 61%. While the pre-operative and 6-month post-operative NDI were 32.96 +/- 6.13 and 16.84 +/- 4.40 (P < 0.05), respectively. At 6-month post-operation and the final follow-up, fused segments were stable. Pedicle cortex perforation rate was 8.0%, with no neurovascular complications observed.</p><p><b>CONCLUSIONS</b>Anatomizing the pre-operative radiographic data facilitates the precise operative design prior to surgery; and CPS system is capable of offering safe and satisfying outcomes in the management of cervical spine instability.</p>

Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal correction of adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the effect of posterior correction and fusion between segmental pedicle screw instrumentation with hybrid constructs in adolescent idiopathic scoliosis (AIS).</p><p><b>METHODS</b>Study the clinical data of 40 AIS patients retrospectively. They were underwent posterior fusion and be distributed into two group, group A was hybrid instrumentation (20 cases) and group B was pedicle screw instrumentation (20 cases). Compared therapy effect, operative time, intraoperative blood loss.</p><p><b>RESULTS</b>The average major curve correction was 82.4% in the screw group and 71.8% in the hybrid group (P = 0.004). After one to three years follow-up, major curve correction was 77.0% and 62.5% respectively (P = 0.001). Average apical vertebral derotation showed 63% correction in the screw group and 32% in the hybrid group (P = 0.001). There was no statistical significance between two group in thoracic sagittal correction, the lowest instrumented vertebra below the lower end vertebra, trunk shift, operative time, and average estimated blood loss. There were no neurologic complications related to hybrid or pedicle screw instrumentation.</p><p><b>CONCLUSION</b>Pedicle screw instrumentation was significantly better than hybrid constructs.</p>

Dynamic analysis of TCM syndrome in 63 patients of SARS / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the dynamic characteristics of symptoms and tongue figure in SARS patients, and the relationship between them and laboratory indexes.</p><p><b>METHODS</b>The dynamic changes of 63 patients, who were hospitalized in authors' hospital from March 11 to April 30, 2003, were observed.</p><p><b>RESULTS</b>The symptoms mostly often revealed in patients of early stage were fever in 56 patients, cough in 41 and weakness or heaviness of limbs in 40, which in patients of middle or crisis stage were cough in 53 and weakness or heaviness of limbs in 43. The clinical symptoms in patients of recovery stage were atypical, they occasionally manifested as limb weakness or heaviness in 17, chest stuffiness or pain in 13, low fever in 11, cough in 12 and expectoration in 11. In the early stage, patients' tongue was pink or red in tongue tip, with thin-white, white-greasy or yellow-greasy coating; in middle stage, tongue in most patients were red, with white-greasy or yellow-thick-greasy coating; in recovery stage, tongues of patients were mostly pink or red in tongue tip, few were dark purple, with thin-white or white-greasy, occasionally yellow-greasy coating.</p><p><b>CONCLUSION</b>TCM syndrome of SARS patients has its characteristics and regularity of changes, which was in accordance with the laboratory findings.</p>

Some technical problems in setting up hospital PACS / 中国医疗器械杂志

Having introduced PACS in brief, this paper presents some technical problems such as the selection of scale, function, database and monitor. And many solutions for these problems are given and compared with each other.