A case of severe hookworm infection / 中南大学学报(医学版)

With the improvement of sanitation, the infection rate of hookworm is greatly reduced and the severe infected case is rarely reported. Combined morphological and molecular biological examinations, a severe hookworm infection patient was diagnosed in Department of Laboratorial Examination, Quanzhou First Affiliated Hospital of Fujian Medical University. The morphological methods such as direct fecal smear microscopy, saturated brine flotation and hookworm larvae culture methods were used to identify the eggs and larvae from stool samples of the patient. There were a large number of hookworm eggs in patient's stool samples, and the average count was 60 840 per gram by modified Kato method, which belonged to severe hookworm infection. Meanwhile, to distinguish the hookworm species, the semi-nested RT-PCR assay was employed to detect hookworm internal transcribed spacer series from eggs in patient's stool samples, and the result showed that the hookworm species was confirmed to be Necator americanus.

Short-term outcomes of femoral neck system versus dynamic hip screws in treatment of femoral neck fractures / 中华创伤骨科杂志

Objective:To compare the short-term outcomes of femoral neck system (FNS) and dynamic hip screw (DHS) in the treatment of femoral neck fractures.Methods:A retrospective analysis was performed of the 105 patients with fresh femoral neck fracture who had been treated by FNS fixation from September 2019 to October 2020 or by DHS fixation from January 2018 to October 2020 at Department of Orthopaedics, The Third Hospital Affiliated to Peking University. In the FNS group of 54 cases, there were 18 males and 36 females with a mean age of (60.7±15.2) years; in the DHS group of 51 cases, there were 14 males and 37 females with a mean age of (63.3±13.2) years. The 2 groups were compared in terms of hospital stay, operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, qualify of reduction, and femoral neck shortening length, Harris hip score and complications at the last follow-up.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up time ( P>0.05). In the FNS group, the median operation time [45.0 (40.0, 59.0) min], intraoperative blood loss [30.0 (20.0, 50.0) mL], incision length [4.0 (4.0, 5.0) cm], intraoperative fluoroscopy frequency [10.5 (9.0, 12.0) times] and hospital stay [2.0 (2.0, 4.0) d] were significantly superior to those in the DHS group [72.0 (55.0, 89.0) min, 50.0 (30.0, 50.0) mL, 7.0 (6.0, 8.0) cm, 18.0 (15.0, 19.0) times, and 3.0 (3.0, 6.0) d] (all P<0.05). There were no statistical differences between the 2 groups in quality of reduction, length of femoral neck shortening, failure rate of internal fixation or Harris hip score at the last follow-up ( P>0.05). There were no such surgical complications as deep infection or femoral head necrosis in either of the 2 groups. Conclusions:In the fixation of femoral neck fractures, both FNS and DHS may lead to fine short-term outcomes. However, compared with DHS, FNS exhibits advantages of simplicity, minimal invasion, less surgical trauma and intraoperative fluoroscopy frequency, and reduced operation time and hospital stay.

Risk factors for failed internal fixation with proximal femoral nail antirotation for reverse intertrochanteric hip fractures / 中华创伤骨科杂志

Objective To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures.Methods A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics,The Third Affiliated Hospital to Peking University.They were 19 males and 26 females,aged from 19 to 97 years (average,71.9 years).According to the AO/OTA classification,there were 7 cases of type 31-A3.1,4 cases of type 3 1-A3.2 and 34 cases of type 3 1-A3.3.Fracture healing was judged according to the X-ray at the time of last follow-up.The patients were assigned into a healed group and a failed group.The 2 groups were compared in terms of gender,age,body mass index (BMI),mechanism of injury,AO classification,type of main fracture line,reduction method,reduction quality,status of lateral femoral wall and tip-apex distance.A multivariate logistic regression model was designed to analyse the dependent variable'implant failure'with a set of independent variables as risk factors.Results The 45 patients were followed up for 12 to 62 months (average,28.4 months).Implant failure was observed in a total of 6 patients (13.3％),3 of whom had helical blade perforation,2 main screw breakage,and one cut-out of helical blade.The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P ＜ 0.05).The multiple logistic regression analysis identified poor reduction quality (OR=30.809,95％ CI:1.052～902.298,P=0.047) and a transverse fracture line (OR =25.639,95％ CI:1.636 ～ 401.917,P =0.021) as risk factors for implant failure.Conclusion Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.

Study progress in treatment of extremity bone defects / 中华创伤骨科杂志

Treatment of extremity bone defects,especially large segmental ones,is a difficult problem encountered by orthopedic surgeons in the clinic.Despite a variety of treatment techniques available,lack of uniform protocols causes patients to suffer enormous physical and psychological pain during their medical treatment.Now that new materials and new techniques are constantly evolving and patients' requirements for functional and morphological recovery of the injured limb become more demanding,it has become a great challenge for orthopedic surgeons to provide an optimal individualized treatment protocol for each patient.This review intends to help surgeons with brief update information on the research progress in the treatment of extremity bone defects.

Risk factors for failed internal fixation with proximal femoral nail antirotation for reverse intertrochanteric hip fractures / 中华创伤骨科杂志

Objective@#To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures.@*Methods@#A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics, The Third Affiliated Hospital to Peking University. They were 19 males and 26 females, aged from 19 to 97 years (average, 71.9 years). According to the AO/OTA classification, there were 7 cases of type 31-A3.1, 4 cases of type 31-A3.2 and 34 cases of type 31-A3.3. Fracture healing was judged according to the X-ray at the time of last follow-up. The patients were assigned into a healed group and a failed group. The 2 groups were compared in terms of gender, age, body mass index (BMI), mechanism of injury, AO classification, type of main fracture line, reduction method, reduction quality, status of lateral femoral wall and tip-apex distance. A multivariate logistic regression model was designed to analyse the dependent variable 'implant failure’ with a set of independent variables as risk factors.@*Results@#The 45 patients were followed up for 12 to 62 months (average, 28.4 months). Implant failure was observed in a total of 6 patients (13.3%), 3 of whom had helical blade perforation, 2 main screw breakage, and one cut-out of helical blade. The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P<0.05). The multiple logistic regression analysis identified poor reduction quality (OR=30.809, 95%CI: 1.052~902.298, P=0.047) and a transverse fracture line (OR=25.639, 95%CI: 1.636~401.917, P=0.021) as risk factors for implant failure.@*Conclusion@#Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.

Factors associated with screw penetration after plating for proximal humerus fractures of Neer types Ⅱ&Ⅲ / 中华创伤骨科杂志

Objective To analyze the factors that influence screw penetration after plating for proximal humerus fractures of Neer two-or three-part.Methods We reviewed the patients with proximal humerus fracture of Neer types Ⅱ & Ⅲ who had been treated from January 2006 to June 2017.The data were documented regarding gender,age,Neer classification,osteoporosis,surgical procedure,cephalic screw number,type of medial support and screw penetration.They were divided into 2 groups according to the presence or absence of screw penetration.x2 test and independent samples t test were used with software IBM SPSS 22.0.The multivariate logistic regression was used to identify the independent risk factors when there were two or more statistically significant factors.The two-side test was used and significance was set to P ＜ 0.05.Results Altogether 78 patients were included in our analysis,including 27 males (34.62％) and 51 females (65.38％) with an average age of 57.41 years (from 18 to 85 years).Their average follow-up time was 7.7 months (from 3 to 24 months).There were 54 Neer two-part fractures (69.23％) and 24 Neer three-part ones (30.77％).Screw penetration was observed in 18 patients (23.08％) but not in the other 60 ones (76.92％).The x2 test and independent samples t test revealed that screw penetration was significantly associated with gender (P =0.003),osteoporosis (P =0.003) and cephalic screw number (P =0.003) but not with age (P =0.256),Neer classification(P =0.754),surgical procedure((P =0.308) or type of medial support (P =0.186).The multivariate logistic regression revealed that osteoporosis (P =0.027) and cephalic screw number (P =0.026) were independent risk factors for screw penetration.Conclusions After plating for proximal humerus fractures of Neer two-or three-part,the patients with osteoporosis and those receiving more than 5 cephalic screws may face a higher risk of screw penetration than those without osteoporosis and those receiving 4 cephalic screws.

Iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade in-tramedullary nails / 中华创伤骨科杂志

Objective To analyze the iatrogenic fractures following treatment of type 12-A humeral shaft fractures with antegrade intramedullary nails. Methods We reviewed the patients who had been treated with antegrade intramedullary nails for type 12-A humeral shaft fracture from October 2006 to March 2017. They were 13 males and 13 females with an age range from 22 to 76 years and an average age of 44. 5 years. Six of them were complicated with other fractures or radial nerve injury. We divided the patients into an iatrogenic fracture ( IF ) group and a non-iatrogenic fracture ( NIF ) group and compared gender, age, fracture type, reaming and nonunion between the 2 groups. Results The follow-up time for the 26 patients ranged from 13 to 182 weeks ( 63. 8 weeks on average ) . Of them, 7 suffered iatrogenic fracture and 4 nonunion. The union time for the other 22 patients ranged from 9 to 29 weeks ( 14. 6 weeks on average ) . All the 7 patients in the iatrogenic fracture group were treated with reaming while only 9 of the 19 patients in the non-iatrogenic fracture group were treated with reaming. Nonunion occurred in 3 patients in the iatrogenic fracture group but in only one patient in the non-iatrogenic fracture group. All the above comparisons were statistically significant between the 2 groups ( P < 0. 05 ) but there were no significant differences in comparisons between the 2 groups regarding gender, age, nail diameter, fracture type, way of locking proximal and distal screws or rate of secondary surgery ( P > 0. 05 ) . Conclusions Antegrade intramedullary nailing may cause an iatro-genic fracture in the treatment of type12-A humeral shaft fractures. The iatrogenic fracture may affect fracture union. Intraoperative reaming may be the risk factor for the iatrogenic fracture.

Phenotypic and mutational analysis of a pedigree affected with hereditary coagulation factor Ⅴ deficiency / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the molecular pathogenesis for a pedigree affected with coagulation factor Ⅴ (FⅤ) deficiency.</p><p><b>METHODS</b>Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), coagulation factor Ⅱ activity (FⅡ: C), FⅤ activity (FⅤ: C), coagulation factor Ⅶ activity (FⅦ: C), and coagulation factor Ⅹ activity (FⅩ: C) were determined with a STAGO automatic coagulometer. FⅤ antigen (FⅤ: Ag) was detected with enzyme linked immunosorbent assay (ELISA). All exons and their flanking regions, and 5' and 3' untranslated regions of the F5 gene were analyzed by direct sequencing. Suspected mutation was verified by reverse sequencing as well as testing of family members. ClustalX software was used to analyze the conservative property of the mutation sites. PROVEAN and MutationTaster online software was used to predict the effect of the mutation on the protein function. Swiss-pdbViewer was used to analyze the protein model and interaction of amino acids.</p><p><b>RESULTS</b>The PT and APTT of the proband were slightly prolonged to 15.2 s and 41.8 s, respectively. And the FⅤ: C and FⅤ: Ag measured 55% and 62%, respectively. The FⅤ: C and FⅤ: Ag of his father and son were decreased to various extent (60%, 65% and 31%, 40%, respectively). A c.911G>A heterozygous mutation (Gly276Glu) was detected in exon 6 of the proband, for which her father and son were heterozygotes. The same mutation was not found in her mother, brother and husband. Conservation analysis showed that the Gly276 is highly conserved across various species. By bioinformatic analysis, the PROVEAN (scored -6.214) indicated Gly276Glu was harmful, and MutationTaster (scored 0.976) suggested that it is pathogenic. Model analysis suggested there are two hydrogen bonds between Gly276 and Ile298 in the wild type protein. When Gly276 was replaced by Glu276, the original hydrogen bond did not change, but the side chain of Glu was extended, which added steric hindrance with the surrounding amino acids, which resulted in decreased protein stability.</p><p><b>CONCLUSION</b>The heterozygous c.911G>A (Gly276Glu) mutation of the F5 gene probably underlies the decreased level of FⅤin the proband.</p>

Diagnosis and treatment for the basicervical fractures of the trochanteric region / 北京大学学报(医学版)

Objective:To evaluate the rate of basicervical fractures and document their diagnosis and treatment.Methods: From January 2005 to May 2016,28 basicervical fractures of the 832 trochanteric fractures were collected and evaluated.The patients were treated with multiple screws,dynamic hip screw (DHS),intramedullary nail.Via the operation time,postoperative hospitalization,loss of blood duration the operation,hidden blood loss,total blood loss,mean union time and the final follow-up Harris hip score,the characteristics of different internal fixations were compared and analyzed.Results: The incidence of basicervical fractures was 3.37％ (28/832) in our study.In the intramedullary nail group (16 patients),the operation time was 55 (20,120) min,the postoperative hospitalization was 3(2,7) d,the intraoperative blood loss was 50(5,100) mL,the hidden blood loss was 533.37 (376.19,987.15) mL,and the total blood loss 627.35 (406.19,1037.16) mL.The union time and final follow-up Harris score were 6 (3,9) months and 90.25 (74,100) min.In the DHS group (8 patients),the operation time was 87.5 (65,115) min,the postoperative hospitalization was 5.5 (2,17) d,the intraoperative blood loss was 100 (50,300) mL,the hidden blood loss was 278.11 (202.43,849.97) mL,and the total blood loss 580.19 (368.55,899.97) mL.The union time and final follow-up Harris score were 5.5 (4,12) months and 85.5 (84,87) min.In the multiple screws group (4 patients),the operation time was 47.5 (35,75) min,the postoperative hospitalization was 5 (2,12) d,the intraope-rative blood loss was 20 (2,70) mL,the hidden blood loss was 150 (100.00,412.01) mL,and the total blood loss 195.00 (120.00,414.01) mL.The union time and final follow-up Harris score were 4 (4,6) months and 80 (61,97) min.The patients treated with multiple screws and intramedullary nail had a shorter operation time than the DNS group,but no obvious difference was found between the other two groups (P=0.367).Postoperative hospitalization had no significant difference among the three groups.The intraoperative bleeding was more in the DHS group,the other two groups had no significant difference (P=0.100).However,the hidden blood loss was more in the intramedullary nail group,the other two groups had no significant difference (P=0.134).The total blood loss in the intramedullary nail group was more than multiple screw group,similar to the DHS group (P=0.483).One patient treated with multiple screws underwent internal fixation failure three months after operation.The mean union time and final follow-up Harris scores had no significant difference among the three groups (P>0.05).Conclusion: Through this study,we found that the incidence of basicervical fractures is low.Fractures with no shift can be confirmed by preoperative X-ray.For displaced fractures,preoperative CT + 3D reconstruction is recommended.Surgical treatment by closed reduction and internal fixation with DHS or intramedullary nail is shown to be very effective.

18 F-FDG PET/CT in assessment of Tomita score for patients with spinal metastases / 中华核医学与分子影像杂志

Objective To investigate the clinical significance of 18 F?FDG PET/CT in assessment of Tomita score in spinal metastases. Methods From October 2012 to October 2015, a total of 77 patients (38 males, 39 females;average age:56.5 years) with suspicious spinal metastasis tumors underwent 18F?FDG PET/CT scan and were included in this retrospective study. Spinal metastasis were confirmed by pa?thology. Each patient was evaluated by the scoring system of Tomita according to the grade malignancy of pri?mary lesions and metastasis of organs and bones in PET/CT. Results Seventy?two patients were osteolytic metastases. Among them, only 23 patients received operative procedure. There were 2 patients with osteoblas?tic metastases, and 3 patients with both osteolytic and osteoblastic lesions. The average Tomita score of opera?tion group was 5.7. Two to three scores were assessed in 2 patients, 4-5 scores in 9 patients, 6-7 scores in 9 patients, and 8-10 scores in 3 patients. The average score of non?operation group was 8.8. One case got 2-3 scores, 2 patients got 4-5, 18 patients got 6-7, and 33 patients got 8-10. Conclusion PET/CT is a convenient and effective tool for assessment of Tomita score in patients with spinal metastases.

Correlation between 3 instruments for measurement of surgical outcomes of tibial plateau fractures / 中华创伤骨科杂志

Objective To evaluate the correlation between 3 different instruments,SF-36 Health Survey,Hospital for Special Surgery (HSS) knee score and Rasmussen Score,for measurement of surgical outcomes of tibial plateau fractures,and their clinical significances as well.Methods Included in this study were 94 patients with tibial plateau fracture who had been consecutively treated and followed up from January 2009 through February 2015 at our department.Their surgical outcomes were measured by SF-36 Health Survey,HSS-knee score and Rasmussen Score respectively for health-related quality of life (HRQL),knee function,and reduction of fracture.Pearson correlation test was used to determine the correlation between the 3 measurement instruments.Results 94 cases eventually finished their following-ups.The mean follow-up was 41.2 months (range,from 12 to 75 months).The Rasmussen scores for their first postoperative X-ray films averaged 14.7 ± 2.1 points,their HSS-knee scores at the final follow-up averaged 81.0 ± 13.7 points,and their SF-36 scores at the final follow-up averaged 85.5 ± 10.0 points.Statistical analysis showed that the HSS-knee score was positively related to the SF-36 score and Rasmussen score (P ＜ 0.05) but not to the Rasmussen score (P ＞ 0.05).Conclusions Fine reduction may be the basis for good functional recovery of the knee and good functional recovery may benefit the HRQL of the patients,but merely good fracture reduction does not promise a high HRQL for patients with tibial plateau fracture.In the treatment of tibial plateau fractures,it is not enough to take care of fracture reduction and functional recovery,and the HRQL of patients should be taken into consideration.More attention should be paid to other important factors influencing the HRQL of patients.

Surgical treatment of inferior pole comminuted fractures of patella with new type ten-sion band / 北京大学学报(医学版)

Objective:To study the effectiveness of inferior pole fracture of patella treating by the new tension band.Methods:From Dec.2011 to Dec.2013, 21 patients with inferior pole fracture of patella were treated with the new tension band which consisted of cannulated screw, titanium cable and shims. There were 21 patients[10 males, 11 females, the average age was 54 years(21 to 79)],of whom,all were“fell on knees”.Results:The average operation time was 89 min (57-197 min),the follow-up visits were done from 7-31 months ( average 18 months) , the bone healing time was from 8-12 weeks (average 10.5 weeks).The post operation assessment was done by Bostman score, from 20 -30 (average 27),10 excellent,and 11 good.No complication occurred.Conclusion:The new tension band is the effective treatment for inferior pole fracture of patella.The internal fixation is reliable, it is simple to operate, and patients can take exercises as early as possible.Therefore, the new tension band has a bet-ter clinical value.

Methods and therapeutic effects in surgical treatment for lower cervical spine fracture and dislocation / 中华创伤杂志

Objective To discuss the selections of surgical treatment for lower cervical spine fracture and dislocation and the treatment outcome.Methods Clinical data of 50 cases of lower cervical spine fracture and dislocation were analyzed retrospectively.There were 37 males and 13 females at mean age of 41 years (range,20-80 years).Forty-four cases underwent anterior fusion,but 4 with ankylosing spondylitis and 2 with extremely unstable cervical spine were treated with combined posterior fusion.Two cases sustaining ankylosing spondylitis and being unable to be operated via the anterior approach due to the maximum neck flexion limits were treated with posterior decompression and fusion.Two cases developed delayed fracture and underwent posterior release prior to the anterior fixation and fusion.Two cases underwent a second surgery with the posterior release,anterior fusion and posterior fusion performed successively.Neurological performance was evaluated using the American Spinal Injury Association (ASIA)scale.Results All the patients were followed up for mean 28 months (range,12-48 months).Implant loosening and redislocation occurred in one ankylosing spondylitis case 2 months after anterior fusion.Other 49 cases achieved bony fusion in 6 months.Neurological function showed no recovery in complete spinal cord injury cases,but improved for average ASIA 1-2 grades for incomplete spinal cord injury cases.Conclusions Anterior surgery provides good reduction and neurological improvement in treatment of lower cervical spine fracture and dislocation.For extremely unstable cases or difficult anterior reduction cases,posterior surgery or combined anterior/posterior surgery should be considered.

Reversed less invasive stabilization system versus intramedullary fixation devices for femoral trochanteric fractures / 中华骨科杂志

Objective To compare the efficacy of reversed less invasive stabilization system (LISS) and intramedullary fixation devices for treatment of femoral trochanteric fractures.Methods Data of 362 consecutive patients with femoral trochanteric fractures who were treated with reversed LISS or intramedullary fixation devices at our institution between March 2004 and May 2011 were retrospectively analyzed.There were 32 males and 38 females treated with reversed LISS.The mean age at injury was 73.4 years.There were 125 males and 167 females treated with intramedullary fixation.The mean age at injury was 74.7 years.The operation time,intraoperation blood loss and length of hospitalization were compared.The patients were asked to fill in a questionnaire of Harris hip score,and radiographs were used to evaluate the bone healing situation.Results The mean operation time was 120 min in reversed LISS group and 80 min in intramedullary group.The length of hospitalization was 12 days in reversed LISS group and 10 days in intramedullary group.More operation time and longer length of hospitalization were needed in reversed LISS group.The intraoperation blood loss was 100 ml in reversed LISS group and 100 ml in intramedullary group.There were 3 DVT in reversed LISS group,10 DVT and 3 PE in intramedullary group.No difference was found in the aspect of intraoperation blood loss,postoperative deep venous thrombosis and pulmonary embolism rate.A total of 320 patients were successfully followed-up,including 63 in LISS group and 257 in intramedullary group.The median Harris score was 75 in LISS group and 77 in intramedullary fixation group respectively.There was no difference of hip function score between two groups.The implant-related complication rate was 11.1％ in reversed LISS group,including 7 implant breakages.In intramedullary fixation group,there were neck screw exiting in 2 patients and cutout in 9 patients.So the implant-related complication rate was 4.3％ in intramedullary fixation group,which is statistically lower.Conclusion Both reversed LISS and intramedullary are effective for the treatment of proximal femoral fractures.There were no major difference in functional outcome between LISS and intramedullary nail.Intramedullary nail is still the choice of priority in most unstable proximal femoral fractures.The implants related complications in reversed LISS group are higher than Intramedullary nail group.However,for the unstable fractures proximal femoral fractures with lateral wall fracture,in which nailing may be difficult,reversely using LISS may be a good alternative.

Virulence Changes between EF A7 and EF A7 cyl Mutant in the Mouse Peritonitis Models / 现代检验医学杂志

Objective The purpose of this study was to understand the pathogenic mechanisms of enterococcal hemolysin and establish the foundation to diagnose and control relevant diseases.Methods Take 30 clean grade ICR mice were randomly divided into ten groups,each 6,1 to 4 groups according to 10-fold gradient amount per 1 ml intraperitoneal injection of 5× 107 cfu/ml~5×1010 cfu/ml of EF A7,group 5 as a control group injected 0.5 ml saline,take another 30 clean grade ICR mice,intraperitoneal injection of 5×107 cfu/ml~5×1010 cfu/ml of EF A7 cyl mutant by the same measures,compared to the original strains of mice infected with mutant strain LD50,and a week after infection mortality was observed in mice daily. Another seven groups of mice with the same bacterial concentration (5×109 cfu/ml)were injected intraperitoneally EF A7 and EF A7 cyl mutant,after infection 6 h,12 h and 24 h comparing the number of leukocytes in peripheral blood of mice,re-spectively,the concentration of TNF-αin the acute phase of cytokines.Results In the mouse peritonitis models the 50% le-thal dose (LD50)of EF A7 cyl mutant was 100 times lower than enterococcus faecalis EF A7.The differences of the survival percentage of EF A7 cyl mutant groups and EF A7 groups have significance (P<0.05).As the changes in boold leukocytes numbers and the TNF-αlevel.Conclusion Cyl gene is probably a major virulence factor of Enterococcus and plays an impor-tant role in the mouse peritonitis model.

Comparative Research on Infection Rates and Gene Spectrum of Cervical Cells in Women Infected with HPV in Quanzhou and Wuhan Regions of China / 现代检验医学杂志

Objective To compare the differences of infect rates and genotype distribution of 21 kinds of human papillomavir-us (HPV)in women cervical cells in Quanzhou and Wuhan regions.Methods Collected gynecological clinic of 10 068 women in cervical cell specimens from November 2012 to January 2014 in Affiliated Quanzhou First Hospital of Fujian Med-ical University and Renmin Hospital of Wuhan University,of which 6 823 cases in Quanzhou,Wuhan region 3 245 cases were detected to identify HPV genotypes by using nucleic acid hybridization technique(HybriMax).Results 2 439 in 10 068 samples of cervical cells were detected to be infected HPV with overall infection rate of 24.23%(2 439/10 068).The overall HPV infection rate in Quanzhou was 22.61% (1 543/6 823),and 27.61% (896/3 245)in Wuhan.The single HPV infection rate in Quanzhou was 17.28% (1 179/6 823),and 19.88% (645/3 245)in Wuhan.The multiple HPV infection rate in Quanzhou was 5.33% (364/6 823),and 7.73% (251/3 245)in Wuhan (The values of P<0.05).The five most common HPV genetypes in Quanzhou was HPV-16,HPV-52,HPV-58,HPV-11 and HPV-CP8304,respectively,in Wuhan was HPV-16,HPV-52,HPV-58,HPV-33 and HPV-18,respectively.Conclusion The overall,single and multiple HPV infection rates in Wuhan were all markedly higher than those in Quanzhou (the values of P<0.05).The most common HPV gene-types in two regions were different.

Factors influencing prognosis of thoracolumbar spinal injury combined with spinal cord injury / 中华创伤杂志

Objective To investigate the factors influencing prognosis in surgical treatment of thoracolumbar spinal injury combined with spinal cord injury so as to assist in the clinical treatment.Methods A retrospective study was made on 77 cases of acute thoracolumbar spinal injury combined with spinal cord injury admitted from July 2005 to April 2011.There were 66 men and 11 women,aged 14-66 years (mean,36.5 years).Neurological performance evaluated using American Spinal Injury Association (ASIA) scale was grade A in 31 cases,grade B in 11 cases,grade C in 10 cases,and grade D in 25 cases.Potential factors affecting the prognosis of spinal cord injury were identified using univariate analysis and incorporated into the Logistic regression equation to filter out the main influencing factors.Results Fifteen cases dropped out at a mean 55.5-month follow-up (range,24-96 months) and follow-up rate was 81％.Univariate analysis selected fracture or dislocation types (P ＜ 0.01),combined injury (P ＜ 0.05),use of glucocorticoid within 8 hours postinjury (P ＜ 0.05),standard transport by medical professionals (P ＞ 0.1),complete injury (P ＜ 0.01),visiting time (P =0.055),cause of disease before operation (P ＜ 0.05) and canal encroachment rate (P ＜ 0.01) as predictors of neurologic recovery in spinal cord injury (P ＜ 0.1).Logistic regression analysis revealed significant prognostic factors were canal clearance (P ＜ 0.01) and use of steroids within 8 hours postinjury (P ＜ 0.05).Conclusion Glucocorticoid pulse therapy within 8 hours postinjury and adequate spinal cord decompression may effectively improve the neurologic prognosis in thoracolumbar spinal injury with spinal cord injury.

Laminar fenestration combined with pedicle screw stabilization for management of thoracolumbar burst fracture with canal encroachment / 中华创伤杂志

Objective To detect the possibility of posterior laminar fenestration combined with screw instrumentation for treatment of thoracolumbar burst fracture with canal encroachment.Methods Between January 2005 and December 2008,52 patients with AO-A3 thoracolumbar fracture underwent laminar fenestration to achieve canal decompression and pedicle screw instrumentation without interbody fusion.Canal encroachment,loss of anterior vertebral height,Cobb' s angle,and neurologic outcome were measured before and after operation.Results All patients were followed up for 24 months.Canal encroachment improved from preoperative (68.3 ± 15.1)％ to postoperative (11.5-3.9)％ (P ＜ 0.05).Cobb' s angle reduced from preoperative (32.5 ± 3.2) ° to postoperative (4.9-± 0.6) ° (P ＜ 0.05).Loss of anterior vertebral height restored from preoperative (50.1 ± 5.6) ％ to postoperative (85.5 ± 5.1) ％ (P ＜ 0.05).At the final follow-up,neurological recovery and fracture healing with no apparent vertebral height loss were noted for all patients.Conclusion Flaminar fenestration combined with pedicle screw stabilization attains good radiographic and clinical results in treating patients with AO-A3 thoracolumbar burst fracture.

Non-fusion without decompression for surgical treatment of unstable AO type A thoracolumbar fractures / 中华创伤杂志

Objective To discuss the role of non-fusion without decompression in surgical treatment of unstable AO type A thoracolumbar fractures. Methods A retrospective study was performed on 42 patients with AO type A thoracolumbar fractures (T11-L2) treated with short segment pedicle screw fixation from February 2004 to February 2008. Patients were divided into two groups, ie, Croup A (treated with short segmental pedicle screw fixation without decompression or fusion) and Group B (treated with short segmental pedicle screw fixation without decompression but with fusion). The pre-operative, postoperative and follow-up local kyphotic angle, vertebrae compression rate were compared between two groups. Results In Croup A, average local kyphotic angle and average vertebrae compression rate were 19.1° (15. 4°-29. 8°) and 46% (30%-63%) respectively before operation, but 5. 0° (0. 3°-10.3°) and 10% (0-28%) respectively after operation. Twenty-one patients were followed up for average 21.2 months (12-46 months), which showed average local kyphotic angle of 7° (1.8°-10.7°) and average vertebrae compression rate of 10% (2% -22%) at final follow-up. In Croup B, average local kyphotic angle and average vertebrae compression rate were 25.8° (15.9°-34.5°) and 55% (30%-76%) respectively before operation, but 7.1° (1.5°-19. 1°) and 15% (0-28%) respectively after operation. Fifteen patients were followed up for mean 17.9 months (12-31 months) , which showed mean local kyphotic angle of 8.3° (0.7°-19.2°) and average vertebrae compression rate of 15% (l%-26%) at final follow-up. There was no pseudarthrosis, implant breakage, pedicle screw pull-out or severe back pain. There was statistical difference in local kyphotic angle and vertebrae compression rate between two groups.Conclusion Unstable AO type A thoracolumbar fractures with minor neurological deficit can be treated with pedicle screw fixation only without decompression or fusion.

Selection of short- or long-segment posterior fixation for treatment of unstable thoracolumbar fractures / 中华创伤杂志

Objective To discuss the selection of short- or long-segment posterior fixation for treatment of unstable thoracolumbar fractures. Methods A total 134 patients with thoracolumbar fractures treated with pedicle instrument fixation from January 2005 to December 2008 were studied retrospectively. According to AO fracture classification, there were 70 patients with type A fractures, 37 with type B and 27 with type C. The patients were divided into two groups according to the number of instrumented levels; short-segment posterior fixation (SSPF) group (four screws; one vertebral body above or below the fractured vertebrae) and long-segment posterior fixation (LSPF) group (eight screws; two vertebral bodies above or below the fractured vertebrae). Clinical outcomes and radiological parameters (superior-inferior endplate angle, vertebral body angle, displacement of vertebral body) were compared according to AO fracture classification. Results All type A fractures were treated with SSPF, mean superior-inferior endplate angle changed from preoperative 21.3° to postoperative 8.5° and 11.1° at final follow up. There was no statistical difference in the correction of Cobb angle for type B fractures in SSPF group (26 patients) and LSPF group (11 patients), while the correction loss of vertebral body angle was 3. 64° in SSPF group and 1.09° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in the correction of Cobb angle for type C fractures in SSPF group (7 patients) and in LSPF group (20 patients), but the correction loss of vertebral body angle was 3.6° in SSPF group and 0. 8° in LSPF group, with statistical difference (P < 0. 05). There was no statistical difference in vertebral displacement correction. Conclusions Most types A and Bl fractures should be treated with SSPF; most types B2, B3 and C fractures should be treated with LSPF.