Subclassification and clinical treatment options of refractory atlantoaxial dislocation / 中华骨科杂志

Objective:To subdivide clinical classification of refractory atlantoaxial dislocation, and evaluate the reliability of new subdivide clinical classification of refractory atlantoaxial dislocation.Methods:From January 2010 to December 2018, 48 patients with refractory atlantoaxial dislocation were treated, including 19 males and 29 females, aged 16 to 65 years, with an average of 39.2±13.3 years. According to the changes of relative anatomical position of C 1 and C 2 under general anesthesia with heavy traction of 1/6 body weight, subdivide clinical classification of refractory atlantoaxial dislocation were proposed, and refractory atlantoaxial dislocation was divided into traction loosening type (atlantoaxial angle≥5°) and traction stabilization type (atlantoaxial angle<5°). The traction loosening type was directly reduced by posterior atlantoaxial screw-rod fixation and fusion without anterior or posterior soft tissue release. For traction stabilization type, transoral soft tissue release was performed first, and then transoral anterior reduction plate fixation and fusion or posterior atlantoaxial screw-rod fixation and fusion were performed. Atlantodental interval (ADI) and atlantoaxial angle (AAA) were measured and collected before and after surgery to evaluate atlantoaxial reduction. The space available for the spinal cord (SAC) were measured to evaluate spinal cord compression. Visual analogue score (VAS) was used to evaluate the neck pain levels, and Japanese Orthopaedic Association (JOA) scores was used to evaluate the neurological function. American Spinal Cord Injury Association impairment scale (AIS) was used to evaluate the degree of spinal cord injury. One week, 3, 6, 12 months postoperatively and the annual review of the X-ray and CT scan were checked, in order to evaluate the reduction, internal fixation and bone graft fusion. Results:Among all 48 cases, 22 cases were traction loosening type, of which posterior atlantoaxial screw-rod fixation and fusion were performed in 16 cases and occipitocervical fixation and fusion in 6 cases. 26 cases were traction stabilization type, and they all underwent anterior transoral release, and then, anterior TARP fixation and fusion were performed in 24 cases and posterior screw-rod fixation and fusion in the other 2 cases. X-ray, CT and MRI images and of all patients 1 week after surgery showed good atlantoaxial reduction and decompression of spinal cord. In each of the two types, there was one case lost to follow-up. For 46 cases in follow-up, the follow-up time ranged from 6 to 72 months, with an average of 38.0±17.2 months. Among 46 cases, 21 cases of traction loosening type showed that, ADI reduced from preoperative 9.9±2.2 mm to 2.3±0.9 mm at 3 months after surgery and 2.3±1.0 mm at the last follow-up, AAA increased from preoperative 57.9°±12.3° to 91.0°±2.2° at 3 months after surgery and 90.9°±2.2° at the last follow-up, SAC increased from preoperative 9.8±1.3 mm to 15.1±0.7 mm at 3 months after surgery and 14.9±0.7 mm at the last follow-up, VAS score reduced from preoperative 1.5±2.1 to 0.7±1.0 at 3 months after surgery and 0.3±0.6 at the last follow-up, and JOA score increased from preoperative 10.2±1.7 to 13.3±1.3 at 3 months after surgery and 14.9±1.5 at the last follow-up. Twenty-five cases of traction stabilization type presented that, ADI reduced from preoperative 9.7±2.0 mm to 2.1±1.4 mm at 3 months after surgery and 2.1±1.3 mm at the last follow-up, AAA increased from preoperative 55.8°±9.2° to 90.9°±1.4° at 3 months after surgery and 90.9°±1.3° at the last follow-up, SAC increased from preoperative 10.5±1.0 mm to 15.4±0.5 mm at 3 months after surgery and 14.8±2.8 mm at the last follow-up, VAS score reduced from preoperative 1.7±2.1 to 0.7±0.9 at 3 months after surgery and 0.3±0.5 at the last follow-up, and JOA score increased from preoperative 10.1±1.3 to 12.9±1.5 at 3 months after surgery and 14.4±1.3 at the last follow-up. In the traction loosening type, all the 10 grade D patients were improved to grade E at the last follow-up. In the 2 grade C patients of traction stabilization type before surgery, 1 patient was improved to grade E, 1 patient was improved to grade D, and all 11 patients with grade D were improved to grade E at the last follow-up. Bony fusion was obtained in all patients from 3 to 6 months, with an average of 4.4±1.5 months. During follow-up period, no looseness of internal fixation or redislocation happened.Conclusion:Refractory atlantoaxial dislocation can be divided into traction loosening type and traction stabilization type. For traction loosening type, satisfactory reduction can be achieved by using posterior atlantoaxial screw-rod system without soft tissue release. For traction stabilization type, anterior release is preferable, and then anterior TARP or posterior screw-rod can be used to achieve satisfactory reduction.

A radiological study between anterior and posterior surgery in patients with basilar invagination and atlantoaxial dislocation / 中华骨科杂志

Objective:To analyze the improvement of patients with basilar invagination and atlantoaxial dislocation that treated by anterior or posterior surgery.Methods:50 patients with basilar invagination and atlantoaxial dislocation that underwent simple anterior or posterior surgery from 2009 to 2021 were included. There were 34 females and 16 males with a mean age of 45.04 years (range, 18-65 years). All patients underwent thin- slice CT scan of the neck. Preoperative and postoperative measurements of atlantoaxial joint distance, atlantoaxial joint angle, atlantoaxial joint displacement, Claus' Height, atlas-dens interval, space available for the cord, cervicomedullary angle, C 0-C 2 angle, and C 2-C 7 angle were measured. Then, the data were analyzed by independent sample t test. Results:25 patients (7 males, 18 females) were included in the anterior surgery group, and 25 patients (9 males, 16 females) were included in the posterior surgery group. The mean age of the two groups was 45.24±9.86 years and 44.72±14.06 years, respectively, showing no statistical difference. The mean last follow-up time of the anterior and posterior surgery group was 6.48±3.14 months and 7.04±2.87 months, respectively. The odontoid distance, atlas-dens interval, space available for the cord and cervicomedullary angle in 2 groups were significantly improved after surgery ( P<0.05), while there were no significant differences in the above parameters between 2 groups ( P>0.05). In the anterior surgery group, the distance and angle of atlantoaxial joint were increased, and the atlantoaxial joint displacement decreased significantly. While in the posterior surgery group, only the atlantoaxial joint space increased ( P<0.05). The C 0-C 2 angle was significantly increased and the C 2-C 7 angle was significantly decreased in the anterior surgery group ( P<0.05), but there was no significant difference in these parameters in the posterior surgery group ( P>0.05). In addition, there was no significant difference in parameters between the two groups at the last follow-up compared with those immediately after surgery. Conclusion:Both anterior and posterior surgery can improve the compression of the spinal cord in patients with basilar invagination and atlantoaxial dislocation. Anterior surgery may be more adequate for the extension and reduction of the atlantoaxial joint space, however, excessive enlargement of the lordosis angle in upper cervical may lead to the reduction of the lordosis in lower cervical.

Biomechanical properties of a novel automatic anti-rotation posterior atlantoaxial internal fixation system: a finite element analysis / 中国组织工程研究

BACKGROUND: Atlantoaxial posterior approach is currently the main surgical treatment for atlantoaxial instability and/or dislocation, but the shape of rod in normal screw-rod device system is cylindrical. To obtain satisfactory reduction of atlantoaxis, the rod will be pre-bent obviously before fixation; however, the cylindrical rod will be rotated when tighten the nuts. Extra devices will be required to adjust and maintain the direction of the rod, thereafter, the surgical field will be blocked by the device, and spinal injury will occur once the devices are not held tightly. While the novel automatic anti-rotation rod has the function of anti-rotation during nut-tightening process, and also holds all the advantages of normal rod. Further research should be performed for the differences in biomechanical characteristics between two methods.OBJECTIVE: To investigate the biomechanical properties of the novel automatic anti-rotation rod for internal fixation system of atlantoaxial posterior approach based on three-dimensional finite-analysis model of upper cervical spine.METHODS: The three-dimensional finite element model of upper cervical spine with internal rod fixation system was developed. The biomechanical characteristics of the internal fixation system were analyzed. RESULTS AND CONCLUSION: The traditional and novel three-dimensional finite element model with realistic and geometric similarity contained 198330 elements, 964747 nodes and 246788 elements, 996069 nodes,correspondingly. There was no obvious stress concentration in both two systems, stress was concentrated mainly in the screw-bone and screw-rod interfaces. The stress values of the novel system were higher than those of the traditional system, but the maximum Von Misses Stress of two systems was lower than the yield (795-827 MPa ) and ultimate (860-896 MPa) strength of titanium alloys. These results show that the design of the novel automatic anti-rotation rod-screw fixation system has matched the biomechanical requirements for new internal fixation instruments, and is one safe, effective and practical device for atlantoaxial posterior procedure showing promising application prospect.

Posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis / 中华骨科杂志

Objective To investigate the clinical effect of posterior screw-rod fixation fusion for the treatment of atlantoaxial dislocation due to rheumatoid arthritis.Methods From January 2011 to December 2015,15 patients with atlantoaxial dislocation due to rheumatoid arthritis were treated,including 6 males and 9 females,aged 35 to 75 years (mean 55 years).All cases were evaluated about the difficulty of relocation by extension-flexion X-ray and treated with posterior screw-rod reduction,fixation and autogenous bone grafting under general anesthesia.Atlantodental interval (ADI) was measured and collected before and after surgery.Visual Analogue Scale/Score (VAS),American Spinal Cord Injury Association (ASIA) and Japanese Orthopaedic Association (JOA) scores were comprehensively used to evaluate the clinical effect.1 week,3,6,12 months postoperatively and the annual review of the X-ray and CT were checked,in order to evaluate the reduction,internal fixation and bone graft fusion.Results All patients were reducible dislocation and successfully performed the posterior screw-rod fixation fusion surgery.The patients were followed up for 3 to 24 months (average,15 months).Atlantoaxial solid bony fusion was obtained from 3 to 6 months.ADI reduced from preoperative 6.3±1.7 mm to postoperative 2.2±0.8 mm,VAS score reduced from preoperative 5.4±2.7 to postoperative 1.7±1.0,ASIA motor score improved from preoperative 82.3±15.6 to 95.3±4.5 at 6 months after the surgery,JOA score increased from preoperative 13.8±2.9 to 15.5±1.4 at 6 months after the surgery,and the statistical significance was revealed between preoperation and postoperation.Nine cases were in D grade of ASIA,3 cases improved from D to E grade after surgery,2 cases reached E grade in the other 6 cases after 6 months,2 cases recovered to E grade after 12 months and other 2 cases in D grade got uniformity after surgery.Well internal fixation and no redislocation were found on X-ray and CT during follow-up period.Conclusion Atlantoaxial dislocation because of rheumatoid arthritis was numerously reducible genre.Posterior screw-rod fixation and autogenous bone grafting can gain satisfying clinical efficacy.

Synergetic Protection for Zika Virus / 中国药师

The paper analyzed the structural characteristics, biological characteristics, infection symptoms, detection methods and corresponding protective measures of Zika virus, as well as analyzed coping strategies for high-risk groups (pregnant women and infants).Zika virus is nonsegmented, single-stranded,and positive-sense RNA genome with fast spreading.Fever and arthralgia are its common symptoms.Currently, it can be tested in serum, urine and saliva samples.The virus protection can be classified into overall control from government, total prevention from society and individual protection according to the guidelines.It is severe to prevent and control epidemic situation of Zika virus, and it needs to improve the whole nation's prevention and treatment ability, and it can improve other social problems through Zika virus prevention.

Literature Analysis of Vitamins Utilization in Parenteral Nutrition Prescription in China during 2006-2015 / 中国药房

OBJECTIVE:To investigate the application of vitamins in parenteral nutrition (PN) prescription,and to provide reference for rational use of vitamins in PN. METHODS:Usingparenteral nutritionintravenous nutritionprescription analy-sisrational drug useanalysis of medical orderas keywords,the literatures about the rationality analysis of PN prescriptions were retrieved from CNKI and Wanfang database during 2006-2015,and the utilization of vitamin included in literatures were ana-lyzed and summarized. RESULTS:A total of 34 literatures were included. There were 158874 prescriptions,among which vitamin was used in 145400 prescriptions (91.52%). 12 or 13 kinds of vitamin were used in 73508 prescriptions (46.27%);over-dose drug use was found in 53388 prescriptions(33.60%),and vitamin was not completely added into 18504 prescriptions(11.65%);no vitamin was added into 1663 prescriptions (1.05%). The proportion of the prescriptions including 12 or 13 kinds of vitamin was the highest in northern China (52.00%). 12 or 13 kinds of vitamin were added into the prescriptions and the author believed that the proportion of excessive use of vitamin,incomplete addition of water-soluble vitamin and fat-soluble vitamin in class three grade A hospitals were all lower than hospitals below class three grade A. The prescriptions including 12 or 13 kinds of necessary vi-tamin were adopted in oncology department(97.72%),internal medicine department(86.62%),intensive care unit(77.99%)and surgery department(52.83%). CONCLUSIONS:The standardized use of vitamin PN prescriptions occupies low proportion in Chi-na. It is necessary to enhance the conception that multiple recommended vitamins should be added into PN.

Simultaneous Determination of 3 Effective Ingredients in Compound Thymol Solution by HPLC / 中国药房

OBJECTIVE:To establish amethod for simultaneous determination ofbenzoic acid,methylis salicylas and thymol in Compound thymol solution.METHODS:HPLC was performed on the column of Thermo Hypersil BDS C18 with the mobile phase ofacetonitrile-water-acetic acid(40∶60∶0.02,V/V/V)at a flow rate of 1 ml/min,the detection wavelength was 275 nm,column tem-perature was 30 ℃,and injection volume was 10 μl. RESULTS:The linear range was 0.045 2-0.9030 mg/ml for benzoic acid, 0.0492-0.9844 mg/ml for methylis salicylas and 0.046 4-0.927 0 mg/ml for thymol;RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 98.40%-108.88%(RSD=3.26%,n=9),98.21%-104.07%(RSD=1.87%,n=9) and 96.83-107.09%(RSD=3.33%,n=9),respectively. CONCLUSIONS:The method is simple,accurate and specific,and accurately de-termine the contents of benzoic acid,methylis salicylas and thymol in Compound thymol solution.

Analysis of the Antitumor Essential Medicines Contained in Drug Reimbursement List in China Cities / 中国药房

OBJECTIVE:To provide reference for promoting the prior usage of essential medicines and scientifically selecting of antitumor medicines in the national and local drug reimbursement list. METHODS:Entering the Human Resources and Social Se-curity Bureau websites in 10 cities(Beijing,Shanghai,Guangzhou,Nanjing,Wuhan,Xi’an,Chengdu,Shenyang,Jinan and Gui-yang),drug reimbursement list was downloaded to statistically analyze the containing of antitumor medicines(including 24 essential medicines). RESULTS:In antitumor medicines,there were 5 cities with more than 100 varieties,of which Shanghai had 255 vari-eties,which was far more than other cities;the numbers of medicines in class A were near 30 in all the cities except Beijing(67 va-rieties),and the number of class B was highest in Shanghai and lowest in Beijing. All the drug reimbursement lists in 10 cities con-tained 24 antitumor essential medicines,however,the classification was different according to the dosage forms,among which, parts of formulations of cytarabine(injections),doxorubicin(injections),busulfan (often release oral dosage forms),fluorouracil (often release oral dosage forms,injections),cyclophosphamide(often release oral dosage forms,injections),methotrexate(often release oral dosage forms,injections)and cisplatin were classified as class A medicines in all cities;oxaliplatin(injections)and pa-clitaxel (injections) were classified as class B medicines;busulfan,fluorouracil,cyclophosphamide and methotrexate were classi-fied as class B in Shanghai only. CONCLUSIONS:There are some differences in the distribution of antitumor essential medicines in drug reimbursement list in each city,the varieties in developed cities are relatively more,and developing cities are less. It is sug-gested to consider the tumor epidemiology characteristics and economic situations,reasonably select antitumor essential medicines into drug reimbursement list and reasonably adjust the proportion of class A and B to ensure the basic medication and drugs’reim-bursement.

Osteogenesis study of compound antitumor coral hydroxyapatite in vivo / 中国组织工程研究

BACKGROUND: Compound antitumor coral hydroxyapatite (CCHA) has a good delayed-release and anti-tumor effect. However, whether the high-dose drug contained in the CCHA influences normal induction, conduction and growth of bone tissues at the implant site is unclear.OBJECTIVE: To establish an osteogenesis model of CCHA and to investigate the osteogensis effect and rule of self-made CCHA in vivo. METHODS: Implants of CCHA (20%CDDP-CHA w/w) and CHA(control, 0% CDDP w/w) were implanted into the metaphyseal holes of rabbit femur. X-rays and decalcified histological section of rabbit femoral bone with hematoxylin and eosin staining were used regularly to investigate the degradation of CCHA and CHA, and how bone tissues grow at the implant site. RESULTS AND CONCLUSION: After implantation, CHA crystals were faster than CCHA in connecting with surrounding bone tissues and forming bone bridges. The borderlines of implanted CHA became obscure in 4 weeks. Loose connective tissues were found in pores of the CHA and osteoblasts were growing on the surface. Bone tissues of the surrounding gradually grew into the CHA, finally repaired the bone defects. At the beginning of implantation, CCHA mainly inhibited the growth of surrounding tissues until 6-12 weeks later, normal bone tissues gradually grew into pores of CCHAs, and healed bone defects at 26 weeks. CCHA can inhibit the osteogenesis effects at early stage; however, it can achieve bone healing with surrounding bone defect ultimately.

Application of transoral atlantoaxial reduction plate Ⅲ in treatment of complicated atlantoaxial dislocation / 中华创伤杂志

Objective To evaluate the biomechanical characteristics and the clinical advantage of transoral atlantoaxial reduction plate(TARP)Ⅲ.Methods Design of TARP-Ⅲ was based on TARP-Ⅱ.The screw hole in the axis was moved 1-2 mm upwards and inwards in a plate which turned a vertebral screw into a pedicle screw or an articular process screw.A polyaxial self-lock ring and polyaxial guiding drill were added to the crew hole of the plate.Finally,the withdrawal resist ence force of the three axis screws was tested and TARP-Ⅲ was used in 44 patients with complicated irreducible atlantoaxial dislocation.The axis was fixed with the pedicle screw or the articular process screw.Results The maximum withdrawal resist ence force of the anterior pedicle screw,the articular process screw and the vertebral screw in the axis was(593.1 ± 97.8)N,(469.9 ± 73.3)N and(395.2 ± 75.1)N respectively,with statistical difference between groups among three fixation methods(P ＜ 0.05).All 44 patients were followed up for 5-38 months(average 18 months),which showed complete anatomic reduction in 36 patients and appropriate anatomic reduction in eight,with basic correction of the angles between the brain stem and the spinal cord and sufficient decompression of the spinal cord.The decompression rate of the cervical spinal cord was average 88.2% according to the Yin evaluating method of cervical cord decompression.The improvement rate of spinal cord function was average 76.6% according to Japanese Orthopaedic Association(JOA)score.Conclusion With the design of polyaxial self-lock mechanism,TARP-Ⅲ with the pedicle screw or the articular process screw surpasses TARP-Ⅱ with vertebral screw in aspect of biomechanics.

Nosocomial Infection in Catheterization Room:Surveillance and Management / 中华医院感染学杂志

OBJECTIVE To prevent nosocomial infection from catheterization room and to reduce the rate of postoperative infection, and improve quality of catheterization room medical care. METHODS Air, object surfaces, the hands of medical staff, and using disinfectant in catheterization room were put to the test every month. RESULTS Totally 253 specimens were put surveillance over three years, total qualified rate was 99.6%, that of air was 98.6% and of object surfaces was 100%, for the hands of medical staff was 100%, and for using disinfectant was 100%. CONCLUSIONS Enhancing prevention nosocomial infection can effectively reduce the infection rate. Surveying the catheterization room termly is an important measure to prevent and control the nosocomial infection.

Germicidal Efficacy of Phthalaldehyde Disinfectant: An Experimental Study / 中华医院感染学杂志

OBJECTIVE To evaluate the germicidal efficacy of phthalaldehyde disinfectant.METHODS Suspension quantitative bactericidal test was used to observe its bactericidal efficacy and stability.RESULTS The temperature was 20-21℃.The results showed that the average killing rates of Escherichia coli,Staphylococcus aureus and Candida albicans exposed to the solution containing 5 664mg/L phthalaldehyde for 1 min were 99.99%,and the(average) killing rates of spores of Bacillus subtilis var.niger exposed to the solution containing 5 664mg/L(phthalaldehyde) for 60 min and 90 min was 99.94% and 100%,respectively.When its stock solution was stored at 56℃ under airtight condition for 2 weeks,the content of phthalaldehyde decreased by 3.27%.CONCLUSIONS The phthalaldehyde disinfectant is a good and stable bactericide.

Standardization of medical consumables management / 医疗卫生装备

Objective To ensure medical safety,standardize the management of medical consumables and guarantee clinical work and scientific research.Methods Various regulations are perfected and specific measures are taken.Results The quality of medical consumables is guaranteed and the hospital infection is avoided.Conclusion The standardization of management can facilitate the safety of medical consumables effectively.

A clinical investigation on factors influencing the prognosis of primary liver cancer patients after hepatectomy / 中国普通外科杂志

Objective To explore factors influencing the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy. Methods From May 1994 to January 1998, 189 patients who underwent hepatectomy for HCC were enrolled for reviewing their clinical characteristics, treatment and prognosis. Twenty-two parameters contributing to long-term survival rate (SR) and disease-free SR were analysed. Results The 3,5-year cumulative SR of the whole group was 63%,45%, respectively. The 3,5-year SR and disease-free SR in the curative resection (CR) group ( n =162) were 67%,47% and 45%,26% respectively. Results showed that the way by which a tumor was found, tumor size, portal tumor thrombi, satellite nodule, TNM stage, cirrhosis type, recurrent and treatment, blood transfusion, differentiation grade,and CR were risk factors by individual variable analysis( P =0.0000～0.0034); A multivariable analysis showed that CR, tumor size, tumor finding mode and reoperation were significant factors associating with prognosis( P =0.0000～0.0024). Blood transfusion and type of cirrhosis were closely correlated with tumor-free survival ( P =0.0001). Conclusions Curative resection, tumor size, reoperation for recurrence were important factors for recurrence by multivariate analysis. The severity of concomittant liver cirrhosis and perioperative blood transfusion were closely correlated with postoperative tumor free survival.