Genetic Subtypes and Pretreatment Drug Resistance in the Newly Reported Human Immunodeficiency Virus-Infected Men Aged≥50 Years Old in Guangxi / 中国医学科学院学报

Objective To analyze the genetic subtypes of human immunodeficiency virus (HIV) and the prevalence of pretreatment drug resistance in the newly reported HIV-infected men in Guangxi. Methods The stratified random sampling method was employed to select the newly reported HIV-infected men aged≥50 years old in 14 cities of Guangxi from January to June in 2020.The pol gene of HIV-1 was amplified by nested reverse transcription polymerase chain reaction and then sequenced.The mutation sites associated with drug resistance and the degree of drug resistance were then analyzed. Results A total of 615 HIV-infected men were included in the study.The genetic subtypes of CRF01_AE,CRF07_BC,and CRF08_BC accounted for 57.4% (353/615),17.1% (105/615),and 22.4% (138/615),respectively.The mutations associated with the resistance to nucleoside reverse transcriptase inhibitors (NRTI),non-nucleoside reverse transcriptase inhibitors (NNRTI),and protease inhibitors occurred in 8 (1.3%),18 (2.9%),and 0 patients,respectively.M184V (0.7%) and K103N (1.8%) were the mutations with the highest occurrence rates for the resistance to NRTIs and NNRTIs,respectively.Twenty-two (3.6%) patients were resistant to at least one type of inhibitors.Specifically,4 (0.7%),14 (2.3%),4 (0.7%),and 0 patients were resistant to NRTIs,NNRTIs,both NRTIs and NNRTIs,and protease inhibitors,respectively.The pretreatment resistance to NNRTIs had much higher frequency than that to NRTIs (2.9% vs.1.3%;χ2=3.929,P=0.047).The prevalence of pretreatment resistance to lamivudine,zidovudine,tenofovir,abacavir,rilpivirine,efavirenz,nevirapine,and lopinavir/ritonavir was 0.8%, 0.3%, 0.7%, 1.0%, 1.3%, 2.8%, 2.9%, and 0, respectively. Conclusions CRF01_AE,CRF07_BC,and CRF08_BC are the three major strains of HIV-infected men≥50 years old newly reported in Guangxi,2020,and the pretreatment drug resistance demonstrates low prevalence.

Lipoprotein apheresis in patients with familial hypercholesterolemia: a single center research / 中华心血管病杂志

Objective: We evaluated the safety and efficacy of lipoprotein apheresis (LA) in patients with familial hypercholesterolemia (FH) who can't reach low-density lipoprotein cholesterol(LDL-C) target goals with the maximal tolerated dose of lipid-lowering agents. Methods: This was a retrospective cross-sectional study. Between February 2015 and November 2019, patients with FH who were admitted in Fuwai hospital and treated with LA were consecutively enrolled. Based on intensive lipid-lowering agents, these patients received LA by double filtration plasma pheresis (DFPP) method. The changes of lipid levels such as LDL-C and lipoprotein(a)[Lp(a)] were compared before and after LA treatment, and the changes of immunoglobulin (Ig) concentration and LA-related adverse effects were also discussed. Results: A total of 115 patients with FH were enrolled in this study, of which 8 cases were homozygous FH and 107 cases were heterozygous FH. The age was (43.9±12.2) years and there were 75 (65.2%) males, and 108 (93.8%) with coronary artery disease. For pre-and immediately after LA treatment, the LDL-C was (5.20±2.94) mmol/L vs. (1.83±1.08) mmol/L, Lp(a) concentration was 428.70(177.00, 829.50)mg/L vs. 148.90(75.90, 317.00) mg/L (P<0.001), with a decrease of 64.2% and 59.8% respectively. The levels of IgG and IgA measured 1 day after LA treatment were both in the normal range and IgM concentration was below the reference value, the reductions of which were 15.1%, 25.0% and 58.7% respectively (P<0.001). Six patients had mild symptoms of nausea, hypotension dyspnea and palpitation, the symptoms were relieved by symptomatic treatment. Conclusion: For patients with FH who do not achieve LDL-C target goal with the maximal tolerated lipid-lowering agents, especially those with elevated Lp(a) levels, LA, which can significantly further reduce LDL-C and Lp(a) levels, is an effective and safe option.

Hyperactivation of PI3K/AKT/mTOR signal pathway impairs TNF-α-induced autophagy in mesenchymal stem cells from patients with ankylosing spondylitis / 南方医科大学学报

OBJECTIVE@#To investigate the changes in autophagy of mesenchymal stem cells (MSCs) from patients with ankylosing spondylitis and explore the mechanism for decreased autophagy in ASMSCs.@*METHODS@#MSCs collected from 14 patients with AS (ASMSCs) and from 15 healthy donors (HDMSCs) were cultured in the absence or presence of 25 ng/mL TNF-α for 6 h. Autophagy of the cells was determined by immunofluorescence staining of GFP-LC3B, and the results were confirmed by detecting the protein expressions of autophagy markers LC3 II/LC3 I and P62. The mRNA expressions of the related genes were detected using qRT-PCR, and the protein expressions of the autophagy markers and signaling pathway-related molecules were determined with Western blotting. TG100713 was used to block the PI3K/AKT/mTOR signal pathway, and its effect on autophagy of ASMSCs was evaluated.@*RESULTS@#ASMSCs showed significantly weaker GFP-LC3B puncta staining and lower protein expression levels of LC3 II/LC3 I but higher levels of P62 protein (P < 0.05), indicating a decreased autophagy capacity as compared with HDMSCs. TNF-α-induced ASMSCs showed significantly higher protein expressions of p-PI3K/ PI3K, p-AKT/AKT and p-mTOR/mTOR than HDMSCs (P < 0.05), suggesting hyperactivation of the PI3K/AKT/mTOR signaling pathway in ASMSCs. Blocking PI3K/AKT/mTOR signaling with TG100713 eliminated the difference in TNF-α-induced autophagy between HDMSCs and ASMSCs.@*CONCLUSION@#In patients with AS, hyperactivation of the PI3K/AKT/mTOR signaling pathway results in decreased autophagy of the MSCs and potentially contributes to chronic inflammation.

Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery / 中华肿瘤杂志

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

Advance in Home-based Rehabilitation after Spinal Cord Injury (review) / 中国康复理论与实践

Home-based rehabilitation can effectively reduce the clinical complications of patients with spinal cord injury and accelerate the recovery of neurological function, as well as reduce the heavy economic burden on healthcare system. Home-based rehabilitation has shown effectiveness in multiple studies. Neurofeedback could relieve the neuropathic pain of 40% home patients with spinal cord injury. Wearable technology could monitor and promote the recovery of hand motor function. Household portable stimulators and surface electrodes could inhibit unnecessary bladder activity and improve urinary incontinence. Strengthening stretching training at home could reduce shoulder pain in patients with chronic spinal cord injury. Using functional electrical stimulation at home could improve the muscle function of patients with spinal cord injury due to loss of neurotrophic muscle atrophy. There are still some disadvantages of home-based rehabilitation, such as complicated operation, expensiveness and not convenient to carry for training equipment, which need to be further developed.

Clinical Manifestations and MRI Features of Pediatric Spinal Cord Injury after Back Bend / 中国康复理论与实践

Objective:To explore the clinical manifestations and MRI features of pediatric spinal cord injury (SCI) after back bend. Methods:A retrospective study was performed. All the medical records and MRI images of children with SCI after back bend were identified in Beijing Bo'ai Hospital from January 1st, 2002 to August 31st, 2020. Results:A total of 120 SCI children after back bend were reviewed, out of whom 119 cases were girls, one case was boy. The age ranged from 38 to 162 months, with the median age of 76 months. More cases were discovered in July and September every year (32 cases, 26.7%), as well as in weekends (67 cases, 55.8%). The main clinical manifestations were sensory and motor dysfunction of both lower limbs (120 cases, 100%), bladder and bowl incontinence (120 cases, 100%). The common first symptoms included sudden attack of lumbar pain (39 cases, 32.5%), lower limbs paralysis (30cases, 25.0%) and leg pain (10 cases, 8.3%). The peak time of symptoms ranged from five minutes to two days, with the median time of 50 minutes. The MRI features of 104 children with SCI within one week after back bend were as follows: the abnormal signals of MRI in spinal cord involved lower cervical and all the following segments of spinal cord. The number of the segments of spinal cord with abnormal signals ranged from two to 15, with the median of seven segments. The most common segments with abnormal signals were T9 (96 cases, 92.3%), T10 (96 cases, 92.3%) and T11 (90 cases, 86.5%). Among the cases followed up, 48 cases with complete injury demonstrated a vast and serous spinal cord atrophy (SCA) below the injury segments as early as 37 days after the injury, the SCA would become worse at the chronic stage and maybe involve the spinal cord above the injury segments. In 31 cases with incomplete injury, the abnormal signals of MRI in spinal cord were limited in the lumbar enlargement, with a various degree of SCA at the late stage. All the cases were diagnosed as SCI without radiologic abnormality, out of whom 89 (74.2%) cases suffered from thoracic complete SCI, 31 (25.8%) cases suffered thoracic or lumbar incomplete SCI. The common complications included scoliosis, hip joint dysplasia, urinary tract infection, hydronephrosis, osteoporosis, pathological fracture of lower limbs and valgus knee. Conclusion:The main clinical symptoms of pediatric SCI after back bend were sudden lumbar pain, sensory and motor dysfunction of both lower limbs, and bladder and bowl incontinence. Most of the cases were thoracic complete SCI, the MRI features at the early stage were multiple segments of abnormal signals of spinal cord around T9 and T10, and later an extensive severe SCA below the injury segments to the conus medullaris, accompanied by the SCA above the injury segments.

Survey of Neurological Function and Complications of Pediatric Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the outcome of neurological function and the clinical characteristics of complications in children with spinal cord injury. Methods:From 2011 to 2019, children under 15 years old with spinal cord injury were selected in our hospital. Their level of injury and American Spinal Injury Association Impairment Scale (AIS) at one month, three months and one year were recorded. And the complications such as pressure ulcers/scald, urinary tract infection, hydronephrosis/vesicoureteral reflux, constipation, osteoporosis/fracture, deep vein thrombosis, neurodynia, heterotopic ossification, scoliosis and hip dysplasia were analyzed. Results:Of 159 individuals, 41 were boys and 118 were girls, the average age at injury was (6.08±2.57) years. The main cause of spinal cord injury was sports accidents (47.8%), and the main injury sites were thoracic spinal cord injury (89.3%). The cause of spinal cord injury was correlated with age at injury (r = -0.160, P = 0.044), gender (r = -0.458, P < 0.001) and injury sites (r = -0.249, P = 0.002). Complete spinal cord injury counted for 71.7%, and the AIS grade at one month was correlated with that at twelve months (r = 0.984, P < 0.001). The main complications were urinary tract infection (69.2%), constipation (67.9%), hydronephrosis/vesicoureteral reflux (37.7%), scoliosis (25.8%) and hip dysplasia (25.2%). The incidence of ulcers/scald was correlated with injury site (r = 0.179, P = 0.024). The AIS grade three months after injury was significantly correlated with urinary tract infection, constipation, scoliosis and hip dysplasia (|r| > 0.227, P < 0.01). The incidence of ulcers/scald was correlated with osteoporosis/fracture (r = 0.208, P < 0.01). The incidence of urinary tract infection was significantly correlated with hydronephrosis/vesicoureteral reflux, constipation, scoliosis and hip dysplasia (r > 0.261, P < 0.001), as well as osteoporosis/fracture (r = 0.195, P < 0.05). The incidence of hydronephrosis/vesicoureteral reflux was significantly correlated with constipation, osteoporosis/fracture, scoliosis and hip dysplasia (r > 0.146, P < 0.01). The incidence of constipation was significantly correlated with scoliosis and hip dysplasia (r > 0.313, P < 0.01), as well as osteoporosis/fracture (r = 0.160, P < 0.05). The incidence of osteoporosis/fracture was significantly correlated with scoliosis and hip dysplasia (r > 0.342, P < 0.01). The incidence of scoliosis was significantly correlated with hip dysplasia (r = 0.818, P < 0.001). Conclusion:The recovery of neurological function after spinal cord injury in children is closely correlated to AIS. The outcome of complete spinal cord injury is poor. The common complications after spinal cord injury in children demonstrate specific age characteristics, and the incidence of urinary tract infection, constipation, hydronephrosis/vesicoureteral reflux, scoliosis and hip dysplasia are common complications, which need more attention.

Effect of Microelectronic Electromyography Bridge on Motor Function of Extensor Carpi Radialis Longus in Patients with Cervical Spinal Cord Injury / 中国康复理论与实践

Objective:To observe the effect of microelectronic EMG bridge (EMGB) training on the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury. Methods:From March, 2016 to March, 2017, 20 patients with complete cervical 5 spinal cord injury were randomly divided into control group (n = 10) and experimental group (n = 10). The control group received routine wrist extensor muscle training, and the experimental group received EMGB training in addition, for 180 days. The motor function of the affected limb was evaluated by sEMG of extensor carpi radialis longus, Manual Muscle Test (MMT), Wolf Motor Function Test (WMFT) and Spinal Cord Lesion Independence Measure (SCIM). Results:After treatment, the peak value and average value of sEMG of extensor carpi longus of both sides increased in both groups (t > 2.510, P < 0.05), the peak value and average value of the left side were higher (t > 2.759, P < 0.05), and the peak value of the right side was higher (t = 2.691, P < 0.05) in the experiment group than in the control group, however, there was no significant difference in average value of the right side between two groups (t = 2.063, P = 0.054). The scores of MMT increased in both groups (t > 2.569, P < 0.05), and were higher in the experimental group than in the control group (t > 2.278, P < 0.05). The scores of WMFT and SCIM increased in both groups (t > 3.839, P < 0.05), however, there was no significant difference between two groups (t < 1.498, P > 0.05). Conclusion:EMGB training could improve the motor function of extensor carpi radialis longus in patients with complete cervical 5 spinal cord injury.

Advance in Geriatric Traumatic Spinal Cord Injury (review) / 中国康复理论与实践

The incidence and proportion of traumatic spinal cord injury in the elderly are increasing year by year, and it has become the main affected population of spinal cord injury in developed countries. Fall is the main cause of injury. The increase of spinal stenosis, the biomechanical changes of the spine and the hyperextension injuries may be the mechanism of spinal cord injury caused by minor trauma in this population. Traumatic spinal cord injury in the elderly usually requires early surgical treatment. When there are complicated comorbidities, unstable vital signs or mild spinal cord injury without major fracture or dislocation, non-surgical treatment and active rehabilitation can be considered. However, the specific indications and timing of surgery are still controversial. Compared with young people, most elderly patients present with incomplete cervical spinal cord injury and are expected to restore better limb function, following poor recovery of self-care ability. It is important to monitor the functional change throughout rehabilitation and adjust the hours and intensity of training accordingly.

Aquaporin Over-expression for Constipation in Rats with Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the relation between aquaporins (AQPs) and fecal water content in rats with spinal cord injury. Methods:A total of 48 female Sprague-Dawley rats were divided into control group (n= 24) and spinal cord injury group (SCI group,n = 24). SCI group underwent transection at T8, while the control group was only subjected to laminectomy. Posterior limb function was assessed by Basso-Beattie-Bresnahan (BBB) score before modeling and on the 1st, 3rd, 7th, 14th and 28th day after SCI. Fecal water content was measured before modeling and on the 3rd, 14th and 28th day after SCI. Colon specimens were collected to detect the expression of AQP1, AQP3 and AQP4 by immunohistochemistry on the 3rd, 14th and 28th day after SCI. Results:The BBB score was significantly lower in SCI group than in the control group (t > 69.230,P< 0.001) after SCI, as well as the fecal water content (t > 5.814,P< 0.001). The expression of AQP1, AQP3, and AQP4 in the colon was higher in SCI group than in the control group (|t|> 5.165,P < 0.01) on the 3rd, 14th, and 28th day after SCI. The expression of AQPs negatively correlated with fecal water content (r = -0791~-0.730,P< 0.001). Conclusion:The expression of AQPs in the colon of rats after SCI was up-regulated, which was correlated with excessive water absorption after SCI.

Effects of BTE System Intensive Training on Upper Limbs after Cervical Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the effect of BTE system intensive training on upper limbs for cervical spinal cord injured patients in various courses. Methods:From June, 2019 to January, 2020, 60 inpatients with traumatic C6-7 spinal cord injury were selected into sub-acute group (one to two months after surgery, n = 15), recovery group (three to six months after surgery, n = 15), stable group (over six months after surgery, n = 15) according to the course of disease, and control group (over six months after surgery, n = 15). The control group received comprehensive rehabilitation, while the other groups received upper limbs intensive training on BTE system in addition, for four weeks. They were assessed with Upper Extremity Motor Score (UEMS) and Functional Independence Measure (FIM), meassured isometric peak torque (IPT) and isotonic extreme muscle endurance (IEE) of bilateral elbow extensors before and after treatment. Results:All the indexes improved after treatment (t > 3.500, P < 0.01), and they were significantly different among the groups (F > 9.257, P < 0.001), in which, it was the most of UEMS and IPT in the sub-acute group, and IEE and FIM in the recovery group. Conclusion:BTE system intensive training is effective on upper limbs after cervical spinal cord injury. Sub-acute patients may improve more in motor function and explosive power, while patients at recovery stage do better in endurance and activities of daily living. Even stable patients can benefit from it somehow.

Advance in Nutritional Status for Spinal Cord Injury / 中国康复理论与实践

The nutritional status of patients with spinal cord injury affects the rehabilitation and outcome of patients, and has not received enough attention. Joint interventions such as diet control and exercise are effective. In addition, nutrition training for medical staff and nutrition education for patients are necessary, and the relevant nutrition policy of hospital should also be revised. At present, the nutritional assessment criteria for patients with spinal cord injury are not sufficient. Because of the specificity of patients with spinal cord injury, the evaluation criteria for healthy people are not applicable, and it is difficult to detect malnutrition early. A comprehensive evaluation system for patients with spinal cord injury in China should be established using evaluation scales, blood indicators and skin pleat thickness, and nutrition assessment should be used as a part of routine management.

Metabolism Levels in Precentral Gyrus of Patients after Spinal Cord Injury / 中国康复理论与实践

Objective:To investigate the changes of metabolite concentration in the precentral gyrus (primary motor cortex, M1) in spinal cord injury (SCI) patients. Methods:From December, 2018 to October, 2019, 20 SCI patients and 15 healthy controls were scaned with magnetic resonance spectroscopy to measure the concentrations of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and myo-inositol (MI) in region of interest (ROI) of left M1. Results:Concentration of MI was more in the patients than in the controls (t = 3.745, P < 0.01). There was no significant difference in the concentrations of NAA, Cho and Cr, as well as the ratios of NAA/Cr, Cho/Cr, Cho/NAA between the patients and the controls (t < 1.431, P > 0.05). Conclusion:There may be hyperplasia of glial cells in M1 of SCI patients, indicating compensatory repair in cerebral motor cortex.

Etiological Features of Pediatric Spinal Cord Injury / 中国康复理论与实践

Objective:To explore the etiological features and prevention strategies for pediatric spinal cord injury (SCI). Methods:A retrospective study of etiology and demographics features was performed and all the children with SCI (less than 14 years old) were identified in our hospital from January 1st, 2015 to December 31st, 2019. Results:A total of 221 children with SCI were reviewed, with 62 boys and 159 girls. The age ranged from one to 13 years with the median age of six years old. Children aged four to seven years accounted most (55.7%), and were mainly girls (83.7%). Sports and leisure activities (78 cases, 35.3%), non-traumatic causes (56 cases, 25.3%), other traumatic causes (48 cases, 21.7%), transport activities (24 cases, 10.9%) and falling from height (12 cases, 5.4%) were the top five leading causes of pediatric SCI. Among the cases caused by sports and leisure activities, 96.2% (75/78) were related to back bend in dancing exercise, in which most were five to seven years old (80.0%), and all of them were thoracic cord injury without radiologic abnormality, in which 70.7% (53/75) suffered from complete SCI. Conclusion:Pediatric SCI after back bend in dancing exercise is increasing rapidly in recent years. More attention should be paid on education about professional evaluation and the risk of back bend before dancing exercise, and more protective measures should be implemented.

Motor Control Function of Brain in Subacute Complete Spinal Cord Injured Patients: A Functional Magnetic Resonance Imaging Study / 中国康复理论与实践

Objective:To study the changes of brain motor control function in patients with complete spinal cord injury within three to six months. Methods:From January, 2017 to January, 2019, eleven inpatients with complete spinal cord injury and twelve healthy controls were screened with functional magnetic resonance imaging during attempted/executive movement (MA/ME) and motor imagery (MI). The involved area and activation were compared between the groups under tasks. Results:More areas were activated in the patients than in the controls as MA/ME, such as bilateral primary sensorimotor cortex, supplementary motor area, lateral globus pallidus, cerebellum, contralateral thalamus and putamen. During MI, the activation was more in the patients in ipsilateral primary motor cortex, supplementary motor area, dorsal premotor area, contralateral supplementary motor area, insular and basal ganglia. The patients induced more activation as MA than as MI in ipsilateral primary motor cortex, bilateral supplementary motor area and cingulate motor area, and contralateral cerebellum. Conclusion:The activation remains normal in primary motor cortex and supplementary motor area for subacute complete spinal cord injury patients when undergoing motor tasks, but some reorganization may occur in parietal lobe and cerebellum that involve in sensorimotor integration.

Analysis of Sports Injuries from Winter Olympic and Winter Youth Olympic Games / 中国康复理论与实践

Objective:To analyze the characteristics of athletes' sports injuries during the Winter Olympic and Winter Youth Olympic Games. Methods:The information of registered athletes during the 2010, 2014 Winter Olympics and 2012 Winter Youth Olympic Games, including the injury numbers of each sport, damage sites, types and severity of injuries were collected, and the epidemiological characteristics were analyzed. Results:A total of 6370 person-time registered athletes were collected and 789 sports injuries were recorded. The injury rate per 1000 registered athletes was 123.9. An average of 11% of athletes was injured at least once. There was a significant difference in the injury rate among these events (χ2 = 12.301, P = 0.002). Women were more likely to be injured than men (χ2 = 5.220, P = 0.022). The top three sports with the highest injury rate were snowboarding (23.9%), freestyle skiing (23.2%) and Bobsleigh (18.0%); the top three sports with the largest number of injuries were ice hockey (160 person-time, 20.3%), alpine skiing (128 person-time, 16.2%) and snowboarding (113 person-time, 14.3%). The top three most injured sites were knee (54 person-time, 13.6%), head (41 person-time, 10.3%) and lumbar spine/lower back (27 person-time, 6.8%); the top three types of injury were contusion/haematoma/bruise (123 person-time, 30.9%), sprain (dislocation/subluxation or ligamentous rupture) (71 person-time, 17.8%) and strain (muscle rupture/tear or tendon rupture) (47 person-time,11.8%). A total of 251 injuries (31.8%) were expected to result in time loss for the athlete, 81 out of whom were severe injuries (32.3%). Conclusion:There is a mass of sport injuries in winter sports events with different types and severities. The incidence of injury varies with sports, and it is focused on snowboarding, freestyle skiing and Bobsleigh, ice hockey and alpine skiing. It is needed to research the technical characteristics of specific sports, damage risk factors and mechanism to reduce the sports injuries, and to construct green channels for sports injuries, to promote the recovery of function.

Advance in Return to Play after Spine and Spinal Cord Injury for Athletes (review) / 中国康复理论与实践

Spinal injuries caused by competitive sports are common. Spinal diseases are important issues that needs to be solved urgently in the fields of sports injury. Return to play recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. This article reviewed the current situation of athletes return to play after spine and spinal cord injury based on disease classification, including cervical spine (cervical soft tissue injuries, cervical fracture and dislocation, cervical stenosis, cervical disk herniation, stingers and burners), thoracic spine (thoracic fracture), lumbar spine (lumbar strain, lumbar stenosis spondylolysis and spondylolisthesis, lumbar disk herniation), and spinal cord concussion and spinal cord injury. This article also analyzed the criteria for athletes to return to play after spine and spinal cord injuries. It may provide references for future clinical management and consensus/guidelines.

Regularity of Clinical Symptoms about Patients with Sympathetic Cervical Spondylosis / 中国康复理论与实践

Objective:To study the regularity of clinical symptoms of sympathetic cervical spondylosis. Methods:A retrospective study was conducted on 110 patients with sympathetic cervical spondylosis admitted to the outpatient department from 2017 to 2019. The regularity of clinical symptoms of the patients was analyzed, including the sympathetic symptoms of different systems, the property of dizziness, the sequence, time interval and correlation of the symptoms, and whether the numbness of the limbs was accompanied by the symptoms and signs of cervical spondylotic radiculopathy and cervical spondylotic myelopathy. Results:The sympathetic symptoms were complex, involved in digestive system (71.82%), cardiovascular system (83.64%), respiratory system (63.64%), sweat gland (48.18%), eyes (81.82%), ears (60.91%), brain (68.18%) and limbs (70%), mainly sympathetic excitatory. The dizziness of the patients was mainly manifested as muddled brain (66.36%), a few patients were accompanied by external objects or their own rotation and sloshing (23.64%), and a very few patients showed external objects or their own rotation and sloshing (8.18%). Most patients complained chronic neck pain before dizziness and other sympathetic symptoms, accounting for 58.18%. The mean time for progression from neck pain to dizziness was (68.98±64.42) months. There were 77 patients complaining limb numbness, but none of them was found symptoms or signs of cervical spondylotic radiculopathy or cervical spondylotic myelopathy. It seemed to be a part of sympathetic symptoms in the limbs. The severity of dizziness was positively correlated with the course of disease (r = 0.610, P < 0.001), and was also positively correlated with the score of sympathetic symptom (r = 0.301, P = 0.004). Conclusion:The symptoms of sympathetic cervical spondylosis are complex. Muddled brain is the main symptom of dizziness, not vertigo. As the disease progresses, dizziness and sympathetic symptoms gradually worsen. Most sympathetic cervical spondylosis develops from cervical spondylosis. Cervical spondylotic radiculopathy or cervical spondylotic myelopathy may be the more severe forms of cervical spondylosis that develop on this basis。

Diversity of Gut Microbiota in Patients with Acute Traumatic Complete Spinal Cord Injury / 中国康复理论与实践

Objective:To Compare and analyze the gut microbiota and biochemical indexes between patients with acute traumatic complete spinal cord injury and healthy subjects. Methods:From May, 2017 to May, 2018, a total of 44 patients with acute traumatic complete spinal cord injury (patient group) and 33 healthy controls (control group) were included. The clinical data and fresh blood, urine and fecal samples of the two groups were collected. The V3-V4 region of 16S rRNA gene was sequenced and analyzed. Results:The abundance of gut microbiota was higher in the patient group than in the control group, and the structural composition was different. Compared with the control group, the expression of Bacteroidetes decreased (P < 0.05), and the expression of Actinobacteria, Proteobacteria, Synergistetes, Saccharibacteria and Cyanobacteria increased in the patient group (P < 0.05). The serum glucose, low density lipoprotein, triglyceride and total cholesterol were significantly higher in the patient group than in the control group (P < 0 05). There was a significant correlation between these elevated markers and intestinal microbial community structure (P < 0.05). Conclusion:There is gut microbiota dysbiosis in patients with acute traumatic complete spinal cord injury, and the changes of the microbiota are related to the elevation of some serum biomarkers.

Predictive Model for Functional Outcome of Adult Spinal Cord Injury / 中国康复理论与实践

Objective:To explore the related factors affecting the functional outcome of adult spinal cord injury and to establish a predictive model. Methods:A retrospective analysis was made on the medical records of 110 adult spinal cord injured patients with paraplegia from September, 2016 to December, 2018. Quantitative indicators that affected functional outcome were systematically collected, including age, length of stay, number of other diagnostic, number of complications, number of comorbidities, number of operations, days from onset to rehabilitation intervention, and the total scores of Lower Extremity Motor Subscore (LEMS), light touch (LT), pin prick (PP) and modified Barthel Index (MBI) at admission (MBIa) and discharge (MBId), the change values and change rates of MBI were calculated. The correlation coefficients among variables were analyzed. Multivariate linear regression models were established for the MBI total score at discharge and change of MBI score from admission to discharge (MBIc). Results:MBId was significantly correlated with MBIa, the total score of LEMS at admission (LEMSa), the total score of PP at admission, the total score of LT at admission, the number of days from onset to rehabilitation intervention, the number of operations and the number of comorbidities. The fitted regression equation was: MBId = 28.24 + 0.52 × MBIa + 0.24 × LEMSa - 1.23 × number of comorbidities (R2 = 0.64, P < 0.001). The MBIc was significantly correlated with MBIa, the days from onset to rehabilitation intervention and the length of stay. The fitted regression equation was: MBIc = 18.44 - 0.29 × MBIa + 0.06 × length of stay (R2 = 0.29, P < 0.001). Conclusion:The spinal cord injured patients with better functional status, higher motor score and less comorbidity at admission, and longer hospitalization have better functional recovery.