Clinical observation of "regulating abdomen and dredging collaterals" rehabilitation technology in the treatment of global developmental delay / 国际生物医学工程杂志

Objective:To observe the clinical efficacy of the rehabilitation technique of "regulating abdomen and dredging collaterals" in the treatment of children with global developmental delay (GDD), and to provide clinical experience and basis for promoting the rehabilitation treatment of GDD.Methods:Eighty-two children with GDD were selected and divided equally into the control and the treatment group according to the random number table method. The control group received conventional rehabilitation treatment, and the treatment group received "regulating abdomen and dredging collaterals" rehabilitation treatment on the basis of the conventional rehabilitation treatment. The duration of treatment for both groups was 5 times a week for 3 months. The developmental quotient (DQ) of the children in both groups was recorded using the Geselll Developmental Scale as an assessment tool to observe the scores of the five functional areas, i.e. gross motor, fine motor, language, adaptive, and personal-social.Results:At the end of the treatment, the DQ values of the children in both groups improved significantly in each energy area (all P<0.05). The treatment group outperformed the control group in terms of total effective rate and gross motor, language, and adaptability (all P<0.05), while the differences between the two groups in fine motor and personal-social energy areas were not statistically significant (all P>0.05). Conclusions:The "regulating abdomen and dredging collaterals" rehabilitation technique is clinically effective in the treatment of GDD, with significant improvement in gross motor, language, and adaptive energy areas.

A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data / 中华胃肠外科杂志

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.

Clinical observation of accordion technique in promoting bone transport and prolonging newborn bone mineralization / 中国骨伤

OBJECTIVE@#To analyze effect of accordion technique on bone mineralization of extended bone segment in treating tibial bone defect with bone transport.@*METHODS@#From May 2017 to October 2019, 22 patients with tibial bone defects were treated with Ilizarov bone-transport technique, and divided into two groups after bone-transport was completed, 11 patients in each group. In observation group, there were 9 males and 2 females aged from 20 to 60 years old with an average of (42.6± 13.3) years old;the length of bone defect ranged from 3 to 13 cm with an average of(6.4±2.6) cm;2 patients were suffered from upper tibial bone defects, 3 patients were middle and 6 patients were lower;patients were treated with accordion technique for 35 days. In control group, there were 10 males and 1 female aged from 41 to 60 years old with an average of (51.6±6.4) years old;the length of bone defect ranged from 3 to 10.7 cm with an average of (6.6±2.5) cm;1 patient was suffered from upper tibial bone defects, 3 patients were middle and 7 patients were lower;patients were treated with lock external fixator to waiting bone mineralization. The content of hydroxyapatite (HAP) extended bone segment was measured after bone-transport completed immediately, 35, 65 and 95 days after bone-transport was completed, respectively, then the mineralization time and healing time were compared between two groups, and the therapeutic effect of bone defect was evaluated by using Paley scoring criteria.@*RESULTS@#Twenty-two patients were followed up from 18 to 36 months with an average of (27.0±6.3) months. The wounds on the bone defects healed spontaneously during bone transport, and there were no wound complications such as skin infection or skin necrosis occurred. There were statisticaldifference in the content of HAP of the extended bone segments at 35, 65 and 95 days after bone-transport between two groups (@*CONCLUSION@#Accordion technique and locking external fixator mineralization in prolonging bone segment healing after bone-transport have the equal clinical effect, while the accordion technique could significantly accelerate the growth rate of HAP and shorten the mineralization time and healing time.

Predictive values of procalcitonin and lactate combined with APACHE Ⅱ score in patients with disseminated intravascular coagulation induced by septic shock / 解放军医学杂志

Objective To explore the predictive values of procalcitonin (PCT) and lactate combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score for disseminated intravascular coagulation (DIC) in patients with septic shock. Methods The clinical data of 164 patients with septic shock admitted to the Department of Critical Care Medicine of Shenzhen Second People's Hospital from January 1, 2015 to December 30, 2018 were analyzed retrospectively. According to International Society on Thrombosis and Haemostasis (ISTH) scoring criteria, the patients were divided into DIC group (n=58, 35.4%) and non-DIC group (n=106, 64.6%). Comparing the differences in clinical data of patients, we can establish a ROC curve to determine the sensitivity and specificity of DIC patients with septic shock for PCT, lactate and APACHE Ⅱ score, and calculate the best cut-off point. Results The AUC of PCT in predicting septic shock with DIC was 0.701(95% CI 0.619-0.784, P<0.001), the cut-off was 41.18 ng/ml, the sensitivity and specificity were 60.34% and 72.64%, respectively. The AUC of lactate was 0.669(95% CI 0.579-0.759, P<0.001), the cut-off was 4.2 mmol/L, the sensitivity and specificity were 51.70% and 77.40%, respectively. The AUC of APACHE Ⅱ was 0.643(95% CI 0.550-0.736, P=0.002), the cut-off of APACHE Ⅱ score was 28.5, the sensitivity and specificity were 53.45% and 74.53%, respectively. The AUC of the three parameters combined was 0.772(95% CI 0.697-0.848, P<0.001), the sensitivity and specificity were 65.50% and 80.20% respectively. Conclusions PCT, lactate and APACHE Ⅱ score can be used to predict the early diagnosis of disseminated intravascular coagulation induced by septic shock, and the combination of the three parameters can improve the accuracy of early prediction.

Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly.@*METHODS@#From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years.@*RESULTS@#The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(=1.346, >0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(0.05).@*CONCLUSIONS@#The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Thickening of the long bone: mechanisms and clinical implications / 中国组织工程研究

BACKGROUND:The thickening of living bone is an important natural rule,and genetic,nutritional and endocrine factors play critical roles in the bone thickening;however,these factors are site-blind.OBJECTIVE:To analyze the mechanism underlying the thickening of the long bone.METHODS:Clinical cases and literature were analyzed.Medline and CNKI databases were retrieved using the keywords of "bone growth in width,skeletal thickening,bone thickening,periosteal apposition" in English and Chinese,respectively.Totally 12 eligible articles were included for result analysis.RESULTS AND CONCLUSION:The mechanical environment of the bone plays a key role in the bone remodeling,which is a site-specific process.The thickening of the long bone is completed through the periosteal apposition,and the coupling effect of stress-angiogenesis-osteogenesis induced by overloading is the pathological basis of bone thickening.The periosteal apposition and periosteal resorption belong to a lifelong dynamic process,and the bending stress is the most important factor to maintain the periosteal osteogenesis.If the bone is shielded from bending stress to a certain extent by the metal fixators,it may lead to bone resorption and thinning,nonunion and other serious consequences.Therefore,the strength of the fixators should match the patient body mass and the thickness of the bone.The marrow cavity is a natural low stress region,so intramedullary fixation theoretically has little effect on the width growth of bone.

Potential clinical value of detecting markers of bone metabolism in patients with ankylosing spondylitis / 中国免疫学杂志

Objective:To investigate the clinical significance of bone metabolism indexes and human leukocyte antigen B27 (HLA-B27)in ankylosing spondylitis(AS)and analyze their diagnostic value. Methods:The subjects were 94 cases of AS patients,239 cases with other diseases and 80 healthy controls, and the results were retrospectively surveyed. Results:In the AS group, the concentration of the β-collagen specific sequence (β-CTX ) was higher ( P<0. 05 ) while the concentrations of osteocalcin ( OC ) , 25-hydroxyvitamin D[25-(OH)D] and parathyroid hormone(PTH)were lower than those in the control group. In the AS group,there was a positive correlation between the concentration of C-reactive protein(CRP)and β-CTX(P<0. 01),and the concentration of CRP was negatively correlated with the concentration of 25-(OH)D(P<0. 05). However,the concentrations of other bone metabolic indexes had no correlation with the concentration of CRP(P<0. 05). The positive rate of HLA-B27 in the AS group was significantly higher than that in other groups(P<0. 05),and HLA-B27 had highly sensitive and specific in the diagnosis of AS. In the AS group,the sensitivity of the concentration of 25-( OH) D was higher than β-CTX,while its specificity was lower than β-CTX. Conclusion:Bone metabolic indexes have great value in early screening and clinical diagnosis of AS,especially β-CTX and 25-( OH) D were more obvious.

Potential clinical value of detecting markers of bone metabolism in patients with ankylosing spondylitis / 中国免疫学杂志

Objective:To investigate the clinical significance of bone metabolism indexes and human leukocyte antigen B27 (HLA-B27)in ankylosing spondylitis(AS)and analyze their diagnostic value. Methods:The subjects were 94 cases of AS patients,239 cases with other diseases and 80 healthy controls, and the results were retrospectively surveyed. Results:In the AS group, the concentration of the β-collagen specific sequence (β-CTX ) was higher ( P<0. 05 ) while the concentrations of osteocalcin ( OC ) , 25-hydroxyvitamin D[25-(OH)D] and parathyroid hormone(PTH)were lower than those in the control group. In the AS group,there was a positive correlation between the concentration of C-reactive protein(CRP)and β-CTX(P<0. 01),and the concentration of CRP was negatively correlated with the concentration of 25-(OH)D(P<0. 05). However,the concentrations of other bone metabolic indexes had no correlation with the concentration of CRP(P<0. 05). The positive rate of HLA-B27 in the AS group was significantly higher than that in other groups(P<0. 05),and HLA-B27 had highly sensitive and specific in the diagnosis of AS. In the AS group,the sensitivity of the concentration of 25-( OH) D was higher than β-CTX,while its specificity was lower than β-CTX. Conclusion:Bone metabolic indexes have great value in early screening and clinical diagnosis of AS,especially β-CTX and 25-( OH) D were more obvious.

Treatment of equinovarus accompanied with ulcer using Ilizarov technology and limited operation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the surgical method and clinical curative effect of Ilizarov technique combined with limited surgical treatment for neurotrophic malnutrition equinovarus accompanied with weight-bearing area ulcer.</p><p><b>METHODS</b>From July 2004 to December 2011, 21 cases of neurological disorders equinovarus with skin ulcer in weight-bearing area were treated including 14 males and 7 females with an average age of 21.3 years old ranging from 8 to 32 years. Among them,19 cases with talipes equinovarus were on account of spina bifid and 2 cases on account of spinal cord injury of lumbar sacral segment. Nine cases were on the left foot and 12 cases were right foot. The ulcer area in out-below side of the fifth metatarsal bone was in 6 cases, in basement of the fifth metatarsal bone in 5 cases,in lateral of calcaneocuboid joint 2 cases, and in lateral of subtalar joint in 8 cases. Surgical procedure included plantar medial release technique, tendo-chilles lengthenning, and three-joint partial osteotomy. During operation,the skin and soft tissue of ulcer were resected and the incision was sutured when the ulcer was in the lateral of subtalar joint, and ankle Ilizarov external fixation for extension was installed after correcting talipes equinovarus partially. For the legacy skin ulcer in weight-bearing area,the Shenrg-ji cream (Chinese characters) was used after operation for one time per day until the wound healed. Adjusting Ilizarov external fixation for correcting residual deformity until it is satisfaction. During this process weight-bearing walking was keeping.</p><p><b>RESULTS</b>All cases were followed up from 6 to 52 months with an average of 28 months. All ulcers were healing and no recurrence. The ulcer healing time was 14 to 36 days postoperative (26 days in average). Eighteen deformity feet were corrected satisfactorily, and recovered fully plantar foot, 3 feet appeared mild deformity after 1 year. Ankle joint activity appeared limited in 15 cases and got completely rigidity in 6 cases. The AOFAS increased from preoperative 34.0±7.2 to 86.0±8.5 postoperatively; 8 feet got excellent, 10 good,3 fair.</p><p><b>CONCLUSION</b>The clinical effect of Ilizarov technique combined with limited operation and the Sheng-ji cream in correction of the talipes equinovarus with skin ulcer in weigh-bearing area on account of neurotrophic malnutrition is satisfactory, the surgical method is simple and the treating course in security, and serious complications can be avoided.</p>

From Wolff law, Ilizarov technology to natural reconstruction theory / 中国骨伤

Wolff law was an adaptable principle of bone, Tension-Stress Principle was equal to Distraction Osteogenesis or Distraction Tissue Regeneration, The Natural Reconstruction theory was a new orthopedic perspective proposed by Prof. QIN after deformity correction using Ilizarov technology. The thought about their relationship originated from a social phenomena, that the crowds and the confusion about export choice in Beijing's subway. Ilizarov technology and Wolff law were one concept related to Mechanics, and the former is completely in line with the latter. In other words, Ilizarov technology is an extension of Wolff law, is a repeated process of micro-trauma and continuous repair of bone trabecular initiated by moden engineering, just trabecular formed along the tension-stress direction. With adjustment of mechanical force,doctor can control the process of fracture healing and bone remolding to a certain extent. Natural Reconstruction theory enlarged the defined range of Wolff law obviously. Not only guided orthopedics clinical and basic research,but also related to the dialectical thinking of the doctor-patient relationship in sociology. There was an inevitable connection among Wolff law, Ilizarov technology and Natural Reconstruction theory. The history of discovery and understanding was a continuous process of thinking,practice and integration.

Surgical treatment for chronic radial head dislocation / 中国骨伤

At present, treatment for chronic radial head dislocation mainly focus on open reduction, and conservative treatment is invalid. While the surgical procedure generally applies to extend ulnar, short radial, reset radial head. Repair or reconstruction of annular ligament is the focus of study. For the dysfunction, radial head resection served as the final choice. Early diagnosis is the key to the treatment of chronic radial head dislocation. While ulnar or radial osteotomy and non-reconstruction of annular ligament is still the main trend of today.

Combined procedure for the treatment of ankle and foot deformities secondary to spina bifida / 中国骨伤

<p><b>OBJECTIVE</b>To study surgical strategies for ankle and foot deformities secondary to spina bifida and treatment methods for different types of deformities.</p><p><b>METHODS</b>From January 1990 and July 2009, 107 patients with ankle and foot deformities secondary to spina bifida were retrospectively analyzed. There were 44 males and 63 females, with an average age of 17.7 years (rangd from 1.3 to 52 years). Among the patients, 58 patients had double ankle deformities, 49 patients had unilateral deformities (22 cases on the left side, 27 cases on the right). Ninety-nine patients with equinus deformities were treated by achilles tendon lengthening and tendon transfering; 25 patients with talipes were treated by release of anterior tendon of ankle and tendon transfer; 17 patients with valgus and varus deformities were treated by tendon transfer and calcaneal osteotomy; 15 patients with flail deformities were managed treated by bone fusion between calcaneus and talus and shortening of achilles tendon; 9 patients with claw toe deformities were treated by bone fusion of interphalangeal joint or Ilizarovs distraction. AOFAS (American Orthopaedic Foot & Ankle Society) comprehensive scoring system was used to evaluate subjective pain and objective functional.</p><p><b>RESULTS</b>Seventy-nine (127 feet) of 107 patients were followed up, and the duration ranged from 48 to 180 months (averaged, 64 months). According to AOFAS scoring system, the results were rated as excellent in 89 feet, good in 26 feet, moderate in 9 feet and poor in 3 feet.</p><p><b>CONCLUSION</b>Treatment strategies for ankle-foot deformities mainly included four principles, deformity correction, muscular balance, joint stability and reservation of foot elasticity. Different combined procedure was applied for different foot deformities and received good therapeutic effects.</p>

A rapid, sensitive and reliable diagnostic test for scrub typhus in China.

Purpose: To evaluate the performances for detection of IgM and IgG antibodies to Orientia. tsutsugamushi (Ot) using a gold conjugate-based rapid diagnostic test (RDT). Materials and Methods: The RDT employing mixture recombinant 56-kDa proteins of O. tsutsugamushi and the mIFA assay was performed on 33 patients from Fujian and Yunnan province respectively and 94 positive sera (36 from Hainan province and 58 from Jiangsu province) from convalescent stages of the patients with scrub typhus respectively and 82 negative sera from healthy farmers from Anhui province and Beijing City respectively in 2009. A comparison of the RDT and mIFA assay was performed by using the c2 test and the P level of ≤0.05 was considered to be significant. Results: Among these 94 positive sera from convalescent stages of the illness and 82 sera from control farmers, the specificity of RDT was 100% for both IgM and IgG tests. In 33 cases with scrub typhus, 5 cases were positively detected earlier by RDT than by mIFA for the IgM test, and 2 cases were positive for the IgG test. The sensitivities of RDT were 93.9% and 90.9% for IgM and IgG, respectively. Considering IgM and IgG together, the sensitivity was 100%. The geometric mean titre (GMT) of IFA and the RDT assay in diluted sera from confirmed cases were 1:37 versus 1:113 respectively (P<0.001) for IgM test and 1:99 versus 1:279 respectively (P<0.016) for IgG. Conclusions: The RDT was more sensitive than the traditional IFA for the early diagnosis of scrub typhus and was particularly suitable for use in rural areas.

Comparison of a rapid diagnostic test and microimmunofluorescence assay for detecting antibody to Orientia tsutsugamushi in scrub typhus patients in China

OBJECTIVE@#To evaluate the detection of IgM and IgG antibodies to Orientia tsutsugamushi (O. tsutsugamushi) by rapid diagnostic test (RDT) and microimmunofluorescence assay (mIFA).@*METHODS@#RDT using a mixture of recombinant 56-kDa proteins of O. tsutsugamushi and mIFA assay were performed on 20 patients from Fujian and 13 patients from Yunnan Province, and 82 sera samples from healthy farmers in Anhui Province and Beijing City in 2009. Comparison of the RDT and mIFA assay was performed by using X(2) test and the P level of <0.05 was considered to be significance.@*RESULTS@#Among these 82 normal sera samples, the specificity of RDT was 100% for both IgM and IgG tests. In 33 samples from patients with scrub typhus, 5 cases were positively detected earlier by RDT than by mIFA in IgM test, and 2 cases were positive in IgG test. Sensitivities of RDT were 93.9% and 90.9% for IgM and IgG, respectively. The sensitivity of combination test of IgM and IgG was 100%. Geometric mean titer diluted sera from confirmed cases by IFA and RDT assay were 1:37 vs. 1:113 (P<0.001) in IgM test and 1:99 vs. 1:279 (P<0.05) in IgG test.@*CONCLUSIONS@#RDT is more sensitivite than mIFA in the early diagnosis of scrub typhus and it is particularly applicable in rural areas.

Limited internal fixation combined with external fixation for the treatment of deformity of the distal end of femur / 中国骨伤

<p><b>OBJECTIVE</b>To study therapeutic effects of limited internal fixation combined with external fixation in the treatment of deformity of distal end of femur, as well as to explore its effect on the function of knee joint.</p><p><b>METHODS</b>From June 2004 to June 2009, 38 patients with deformity of distal end of femur were treated with osteotomy at femoral supracondylar and internalfixation combined with hybrid external fixator. Among the patients, 19 patients were male and 19 patients were female, ranging in age from 14 to 58 years, with an average of 26 years. Six patients had genu valgum, 4 patients had varus of the distal end of femur, 2 patients had varus combined with rotation deformity,3 patients had genu recurvation and 23 patients had deformity of genuflex. The function of knee joint was evaluated according to Dimeglio clinical assessment after the treatment.</p><p><b>RESULTS</b>All the patients were followed up and the during ranged from 6 to 48 months, with a mean period of 23 months. All the deformity obtained satisfactory correction, without complications such as limitation of motion of the knee joint, under correction or over correction,displacement of the section of the osteotomy,internal fixation loosening and fracture. Nineteen patients got an excellent result, 12 good, 5 poor and 2 bad.</p><p><b>CONCLUSION</b>Supracondylar femoral osteotomy and internal fixation combined with hybrid external fixator is a safe and effective surgery for the treatment of deformity of distal end of femur. This method combines the advantages of internal fixation and external fixation.</p>

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida.</p><p><b>METHODS</b>The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed.</p><p><b>RESULTS</b>One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment.</p><p><b>CONCLUSIONS</b>Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.</p>

A sero-epidemiology study on hepatitis E virus infection in Fujian province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the sero-prevalence of hepatitis E virus (HEV) infection among different populations and animals in Fujian province.</p><p><b>METHODS</b>One thousand one hundred and fifty-one serum samples were collected from 5 species of animals including swine, dog, cow, sheep and rat. A total of 2209 and 1722 serum samples from the general population and from the exposed population were collected. Anti-HEV IgG was detected by ELISA. The general population was composed of healthy blood donors and the individuals who had attended physical examination including farmers, handlers, veterinarians, cooks who worked with pigs or chickens while the poultry wholesale suppliers made up the exposure population.</p><p><b>RESULTS</b>The infection rates of HEV in animals were different between species (chi2 = 406.25, P < 0.01) with the highest seen in the pig group. With pigs being kept at home, the rates were between 70.00% and 94.12% but the rate was 39.77% for those families that keeping the pigs at farms. The infection rate of HEV was 23.3% in the general population and 33.3% in the exposed populations, respectively. A significantly higher infection rate for anti-HEV was found in the exposed population when comparing with general population. The positive rate of anti-HEV IgG was significantly higher in the exposed population that closely having had contact with chickens than those who had contact with pigs. The increasing trend of HEV infection rate with age had been found but there was no significant difference between males and females in the general population. In the exposed population, the infection rate in males was significantly higher than that in females.</p><p><b>CONCLUSION</b>The infection ratse of HEV in pigs and in the exposure population were much higher, especially for those persons in close contact with chickens or pigs, suggesting that the sub-clinical infection for HEV might exist. These data further supported the hypothesis that HEV might have been an zoonotic disease.</p>

Mini-invasive distraction technique for treatment of severe ankle and foot deformities secondary to ischemic contracture of the leg / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the Ilizarov mini-invasive distraction technique for the treatment of severer ankle and foot deformities secondary to ischemic contracture of the leg.</p><p><b>METHODS</b>Based on the tension-stress low of Ilizarov, a serial of adjustable three dimensions external distractive instrument was developed in our department. From April 2002 to March 2004, 8 patients with ankle and foot deformities secondary to ischemic contracture of the leg induced by trauma and fracture were treated with the distractive instrument. Of them, 4 patient were male and 4 female, aged from 13 to 31 years with an average of 23 years. Five affected legs were in the left and 3 in the right. Preoperative abnormal style included talipes equines in 6 feet and equinovarus in 2 feet, with extensive scar contracture in the legs. Five patients suffered from failure of soft tissue release before, two patients with severe bony deformity of the feet were underwent limited foot triple osteotomy in this department before the distractive correction. The distraction was begun from 7 d after operation and distractive time from 29 to 60 d with an average 46 d.</p><p><b>RESULTS</b>All of the 8 patients were followed up from 10 months to 29 months, with an average of 13 months. All of deformities in the feet were corrected satisfactorily, full feet contacted with the ground in stand or walking and achieved with good function. No complication, such as pin tract infection, skin necrosis and neurovascular injury was occurred in this group.</p><p><b>CONCLUSIONS</b>Mini-invasive distraction technique for treatment of severe ankle and foot deformity secondary to ischemic contracture of the leg is safe and mini-injury, it is also an effective approach for the treatment of various kinds of rigid foot anomaly.</p>

Combined external skeletal fixation instrumentation with locked intramedullary nailing for tibia lengthening / 中华外科杂志

<p><b>OBJECTIVE</b>To shorten the time of external skeletal fixation on legs, and enhance quality of limb lengthening, avoid complications of shortening, bending, twisting and etc.</p><p><b>METHODS</b>Insert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail, then maintain consolidation of rehabilitation.</p><p><b>RESULTS</b>The group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankle. All cases were treated undergoing twice.</p><p><b>CONCLUSIONS</b>The method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.</p>

Non-fused expression of HAb18GEF by reducing stability of translational initiation region in mRNA / 生物工程学报

To express the extracellular fragement of hepatoma associated antigen HAbl8G(HAb18GEF) in E. coli efficiently in a non-fusing way, the cDNA of HAb18GEF gene was inserted into prokaryotic expression vector pET21a + . The secondary structure and codon adaptation of translational initiation region (TIR, from-30 to + 39) in mRNA of recombinant vector HAb18GEF/ pET21a + was predicted simultaneously by computer-aided design. Stable Stem-Loop structures and many low-usage codons were detected in mRNA-TIR of non-optimized recombinant HAb18GEF/pET21a + vector. The stability of mRNA-TIR in recombinant HAb18GEF/pET21a + vector was reduced with following methods: (1) optimization of secondary structure (2) optimization of codon adaptation. These optimization were realized by non-continual site-directed mutagenesis without changing any amino acid sequence in TIR. After being checked through restriction endonuclease digestion and confirmed through nucleotide sequencing, the pre-optimized and post-optimized recombinant vectors were transformed into competent E. coli JM109-DE3. The resulted recombinant clones were selected randomly and induced by IPTG at 37 degrees C. The induced production of these recombinants was analyzed by SDS-PAGE, indirect ELISA, Western blot, and cell fractionation assay. The amount of HAb18GEF mRNA was also detected by RNA dot blot between pre-optimized recombinant and post-optimized recombinant. The results revealed that recombinant non-fused vectors HAb18GEF/pET21a + were successfully constructed and optimized in the secondary structure and codon adaptation of TIR respectively. The HAb18GEF was expressed efficiently in a non-fusing way in recombinant E. coli by secondary structure optimization or codon adaptation optimization. Whereas, no expression of HAb18GEF was detected in pre-optimized recombinants. The non-fused expression products-HAb18GEF, mainly as inclusion body in E. coli, yielded highly above 29.3%. A trait of expression HAb18GEF was also detected both in intermembrane space and in culture medium due to over-expression and cell leakage. Difference in non-fused expression level of HAb18GEF between secondary structure optimization and codon adaptation optimization was negligible. No difference in amount of transcribed mRNA of HAb18GEF between the pre-optimized and the post-optimized recombinants was detected. To sum up, it's feasible to express hepatoma associated antigen HAb18GEF in a non-fusing way by reducing the stability of TIR in mRNA.