Clinical Features and CT Imaging Findings of Melioidosis Pneumonia / 中山大学学报(医学科学版)

ObjectiveTo summarize and analyze the clinical features and CT imaging findings of melioidosis pneumonia in order to increase awareness of this disease. MethodsA retrospective study was done on clinical and CT imaging data of 68 cases with melioidosis pneumonia diagnosed from January 1， 2012 to April 1， 2023. ResultsOf the 68 cases， 62 presented with acute infection and 6 chronic infection， 88.2% were male， 85.3% were native residents of Hainan， 85.3% were farmers， 77.9% had onset in summer and autumn， 66.2% had diabetes， 100% had fever as the first clinical symptom， and 88.2% were confirmed positive by blood culture. In most patients， white blood cell count， neutrophil ratio， C-reactive protein and calcitonin levels increased， while lymphocyte ratio decreased， but no statistical difference was found between acute and chronic infection groups （P > 0.05）. Of the patients， 36.8% recovered， 42.6% got better， 11.8% patients became therapy-resistant and 8.8% died. CT image showed pathomorphological changes including nodules/masses， patchy ground-glass attenuation or large patchy consolidation or all of these at the same time. Acute and chronic infection groups had significant difference in pathomorphological changes （P = 0.01）， but no statistical difference in other imaging findings. Moreover， 36.8% of the patients developed extrapulmonary infections， 8.8% of which multi-site abscess formation. ConclusionsMelioidosis Pneumonia should be considered if the patient is the sojourner from epidemic area， or has diabetes， high fever and rapid-developing disease， with additional presence of multiple inflammatory lesions in lung CT.

Transanal drainage tube for prevention of anastomotic leak after anterior resection for rectal cancer: a meta-analysis / 中华胃肠外科杂志

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

Triamcinolone acetonide injection in the treatment of upper eyelid retraction in Graves’ ophthalmopathy evaluated by 3.0 Tesla magnetic resonance imaging

Purpose: To evaluate changes in the levator palpebrae superioris (LPS) muscle on 3.0 T magnetic resonance imaging (MRI) after triamcinolone acetonide injection for treating upper lid retraction (ULR) with Graves’ ophthalmopathy (GO) and to explore the value of LPS muscle quantitative measurement for clinical treatment. Methods: Patients with GO showing ULR were studied retrospectively and they underwent 3.0 T MRI scans before and after subconjunctival injection o f triamcinolone acetonide. The largest thickness (T) and highest signal intensity (SI) of LPS muscle on the affected eyes were measured in the sequences of coronal T2?weighted, fat?suppressed fast spin echo imaging (T2WI?fs) and T1?weighted, fat?suppressed, contrast?enhanced fast spin echo imaging (T1WI?fs + C), respectively. The SI ratio (SIR) (LPS muscle SI/ ipsilateral temporalis SI) was calculated individually. Depending on the therapeutic effect, patients were divided into effective group and non?effective group. Independent t?test was used to compare SIR and T of LPS muscle in different treatment groups before treatment, and paired sample t?test was used to compare SIR and T of LPS muscle before and after treatment. Then cut?off level for predicting therapeutic effect and the receiver operating characteristic curve (ROC) curve were analyzed. Results: Sixty?two patients (77 eyes) were enrolled. After treatment, the T of LPS muscle showed significant decrease in all sequences in both effective and non?effective treatment groups. However, changes in SIR of LPS muscle in the two groups were different; SIR of LPS muscle on T2WI?fs and T1WI?fs + C decreased after treatment in the effective group (PT2 < 0.001, PT1 + C < 0.001) and SIR of LPS muscle showed no statistically difference in all sequences (all P > 0.05) in the non?effective group. There was a correlation between SIR of LPS muscle before treatment and after treatment with triamcinolone acetonide injection, which was that SIR of LPS muscle in the effective treatment group was lower than that in the non?effective treatment group on T1WI?fs + C (P < 0.001). SIR of LPS muscle on T1WI?fs + C showed 87.5% sensitivity and 66.7% specificity to predict therapeutic effect (area under the ROC curve [AUC] = 0.840). Conclusion: In GO patients with ULR, 3.0 T MRI can be used to evaluate the response of triamcinolone acetonide injection. SIR of LPS may be a predictor of its efficacy

Molecular epidemiological analysis of measles virus in Beijing from 2015 to 2019 / 中华微生物学和免疫学杂志

Objective:To analyze the molecular epidemiological characteristics of measles virus (MV) in Beijing from 2015 to 2019, and to provide laboratory basis for measles elimination.Methods:Measles virus-positive throat swab samples were collected through the Beijing Measles Laboratory network from 2015 to 2019. After the viral nucleic acid was extracted, 450 nucleotide fragments of the C terminal of the N gene of MV were amplified by RT-PCR. Nucleotide sequencing was performed for the amplified products. The phylogenetic tree was constructed with the representative strains of WHO measles virus genotype D8 genotype reference strains in China and other countries. Genotype identification was conducted and the nucleotide and amino acid homology analysis was carried out. A descriptive analysis of measles cases with D8 and B3 genotypes was conducted.Results:From 2015 to 2019, the genotypes of 546 MV were identified in the city, including 531 of H1a genotype, five vaccine strains, one of B3 genotype, and nine of D8 genotype, among which eight were epidemic strains in 2019. The homology of indigenous H1a genotype MV nucleotide and amino acid was 91.5%-100.0% and 73.6%-100.0%.In 2019, all eight cases of D8 genotype measles were adults, with two being an outbreak and the remaining six sporadic cases.Conclusions:The imported D8 genotype had become the main MV genotype in Beijing in 2019. With the decrease of measles incidence in 2019, native genotype H1a was no longer dominant, while other different genotypes were imported, forming a mixed epidemic trend. It was suggested that in the elimination of measles in Beijing, efforts should be made not only to block the transmission of local measles virus, but also to prevent and control the import and continuous transmission of non-local genotype virus, so as to avoid the risk of establishing local transmission by gradually evolving into a dominant strain.

Curve evolution during bracing in children with scoliosis secondary to early-onset neurofibromatosis type 1: indicators of rapid curve progression / 中华医学杂志(英文版)

BACKGROUND@#Scoliosis secondary to neurofibromatosis type 1 (NF1) in children aged 10°/year) were identified. The age at modulation and the AV before and after modulation were obtained. Patients with (n = 18) and without rapid curve progression (n = 10) were statistically compared.@*RESULTS@#Twenty-eight patients with a mean age of 6.5 ± 1.9 years at the initial visit were reviewed. The mean Cobb angle of the main curve was 41.7° ± 2.4° at the initial visit and increased to 67.1° ± 8.6° during a mean follow-up of 44.1 ± 8.5 months. The overall AV was 6.6° ± 2.4°/year for all patients. At the last follow-up, all patients presented curve progression of >5°, and 20 (71%) patients had progressed by >20°. Rapid curve progression was observed in 18 (64%) patients and was associated with younger age at the initial visit and a higher incidence of modulation change during follow-up (t = 2.868, P = 0.008 and 10°/year is associated with younger age at the initial visit, and modulation change indicated the occurrence of the rapid curve progression phase.

Biomechanical study on the treatment of intertrochanteric fracture of A3.3 type with medial sustainable nail and proximal femoral anti-rotation nail / 中国骨伤

OBJECTIVE@#A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.@*METHODS@#The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.@*RESULTS@#The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant.@*CONCLUSION@#The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.

Ineffective treatment technique of convex epiphysiodesis for congenital scoliosis / 中国骨伤

OBJECTIVE@#To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).@*METHODS@#The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve.@*RESULTS@#The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (<0.05).@*CONCLUSION@#The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.

ClinicalValueofMRQuantitativeFatAnalysisinOrbitsofPatientswithGraves Ophthalmopath / 中山大学学报(医学科学版)

@#【Objective】To measure the orbital fat fraction（FF）of Graves ophthalmopathy（GO）patients and normal individuals with MR Water- fat separation（Dixon） technology ，and to explore the value of orbit MR quantitative fat analysis in diagnosis and treatment for GO patients.【Methods】Forty GO patients and 20 normal individuals who underwent orbital MR imaging were analyzed prospectively from February 2017 to February 2019 in the First Affiliated Hospital of Sun Yat- sen University. All participants received bilateral orbital MR examination with oblique coronary FSE T2- weighted imaging combined with two-point Dixon technique，and then the signal intensity values of ipsilateral extraocular muscles and lacrimal glands on water and fat phase images were measured to calculate FF. The differences of mean FF between the two groups were evaluated，and the correlation between FF of GO and TRAb，CAS score，and the course of GO were conducted by Spearman rank correlation analysis. 【Results】 The median FF of extraocular muscles in GO patients was higher than that of normal individuals，and the result showed a statistically significant difference（P < 0.05）， while the FF of lacrimal glands in the two groups showed no statistical difference. The FF of extraocular muscles in the GO group were correlated with TRAb，CAS score and the course of GO（P < 0.05），especially the course was more correlative.【Conclusions】The fat content of extraocular muscles in GO patients were higher than that of normal individuals ，and there was a positive correlation in the fat content among TRAb，CAS score and the course of GO，suggesting that MR fat quantitative analysis may provide a new reference indexes for the evaluation of clinical staging ，curative effect assessment in GO patients.

Comparison of sagittal plane morphology of spine and pelvis in adolescents with L₅S₁ developmental spondylolisthesis and isthmic spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent.@*METHODS@#Retrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females, aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them, 9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance, slippage degree, slippage angle, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), L₅ incidence(L₅I), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal pelvic thickness(SPT), lumbosacral angle (LSA), sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. 0.05).@*CONCLUSIONS@#Significant different from isthmic spondylolisthesis, adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment, characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance, early surgical intervention is required to restore a balanced spino-pelvic alignment.

A Survey on Intelligent Screening for Diabetic Retinopathy / 中国医学科学杂志(英文版)

Diabetic retinopathy (DR) is one of the leading causes of vision loss and can be effectively avoided by screening, early diagnosis and treatment. In order to increase the universality and efficiency of DR screening, many efforts have been invested in developing intelligent screening, and there have been great advances. In this paper, we survey DR screening from four perspectives: 1) public color fundus image datasets of DR; 2) DR classification and related lesion-extraction approaches; 3) existing computer-aided systems for DR screening; and 4) existing issues, challenges, and research trends. Our goal is to provide insights for future research directions on DR intelligent screening.

lncRNA MALAT1/ miR-141-3p/ZEB1 axis modulates invasion, metastasis and EMT of gastric cancer SGC7901 cells / 中国肿瘤生物治疗杂志

@#Objective: To investigate the regulatory effect of lncRNA MALAT1/miR-141-3p/ZEB1 axis on the invasion, metastasis and epithelial mesenchymal transition (EMT) of gastric cancer (GC) cells. Methods: Thirty-eight pairs of GC tissues (non-necrotic part) and corresponding adjacent tissues (>5 cm away from tumor tissue) removed by general surgery in Wuhan Commercial Hospital from April 2014 to May 2017 were collected. Meanwhile, normal gastric epithelial GES1 cells and GC cell lines (SGC7901, HGC27, BGC823, MKN45 and MKN28) were selected. The expression level of MALAT1 and miR-141-3p in GC tissues and cell lines were detected by qPCR. The effect of MALAT1 knockdown on proliferation, migration and invasion of SGC7901 cells was determined by CCK-8 assay and Transwell assay. WB was performed for measuring the expression level of ZEB1, E-cadherin, N-cadherin and Vimentin. Dual luciferase reporter gene assay was used to validate the relationship among MALAT1, miR-141-3p and ZEB1. CCK-8 assay and Transwell assay were used to detect the effect of MALAT1/miR-141-3p/ZEB1 axis on biological behaviors of SGC7901 cells. Results: MALAT1 was over-expressed in GC tissues and cell lines (P<0.05 or P<0.01). Knockdown of MALAT1 significantly inhibited the proliferation, migration, invasion and EMT of SGC7901 cells (P<0.05 or P<0.01). The results of dual luciferase reporter gene assay showed that MALAT1 directly targeted miR-141-3p, as well as for miR-141-3p and ZEB1. Further experiment indicated that simultaneous over-expression of miR-141-3p and MALAT1 or ZEB1 could restore the biological behaviors of SGC7901 cells, which were inhibited by miR-141-3p. Conclusion: MALAT1 promotes the invasion, metastasis and EMT of GC SGC7901 cells by down-regulating the inhibitory effect of miR-141-3p on ZEB1.

Anti-inflammatory and analgesic activities of ethanol extract of Toddalia asiatica / 中成药

AIM To study the anti-inflammatory and analgesic activities of ethanol extract of Toddalia asiatica Lamn.and the mechanism.METHODS Both inflammatory rat model induced by carrageenan and pain model induced by formalin were applied to investigating the analgesic effect of extract of Toddalia asiatica Lam.ELISA kit was used to detect the contents of β-EP,5-HT and PGE2 in serum of carrageenan-treated rats,contents of TNF-αand IL-1β in skin tissue of inflammatory rats,and content of LTB4 in serum of formalin-treated rats;immunohistochemical method was used to observe the SP and FOS protein expressions in rat spinal cord.RESULTS The ethanol extract of Toddalia asiatica Lam.could significantly reduce the rate of toe swelling.In the formalin test,the ethanol extract of Toddalia asiatica Lam.reduced not only the total licking time,but also the content of PGE2,especially in the high dose group.And lowered serum 5-HT contents were observed in all the three dose groups,but a much better performance was found in both the high and low dose groups,and the high dose group's capability in increasing serum β-EP content was also noticed.TNF-α and IL-1β contents in skin tissue were reduced in various dose groups.Middle and high dose groups inhibited FOS protein expression.And the content of LTB4 in serum was obviously decreased in the high dose group.CONCLUSION The anti-inflammatory and analgesic activities of ethanol extract of Toddalia asiatica Lam.may associate with its power in increasing β-EP in serum,decreasing PGE2,5-HT,LTB4 contents,reducing TNF-α,IL-1β contents in skin tissue,and lowering SP and FOS protein expressions in spinal cord.

Case control studies on unilateral or bilateral pedicle fixation at the level of fracture versus posterior fixation alone in the treatment of thoracolumbar fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of three fixation methods at the level of fracture in treating thoracolumbar fractures.</p><p><b>METHODS</b>From June 2012 to June 2015, 67 patients with thoracolumbar fractures were treated with posterior short-segment pedicle fixation. There were 45 males and 22 females, aged from 13 to 63 years old with an average of 42.5 years. According to the methods of fixation at the level of fracture, the patients were divided into three groups. Group A included 26 patients treated by traditional posterior fixation alone. Group B included 19 patients treated by posterior fixation with unilateral pedicle fixation at the level of fracture. In group C, 22 patients were treated by posterior fixation with bilateral fracture-level screws. Radiological parameters and clinical outcomes were compared among the three groups.</p><p><b>RESULTS</b>All the patients were followed up for 12 to 26 months with an average of 17.6 months. No complications such as incision infection, poor wound healing, internal fixation loosening and breakage were found. Preoperative, postoperative 1 week, and final follow-up, there were no significance differences among the three groups with respect to the relative height of the fractured vertebra (>0.05). The sagittal Cobb angles among the three groups were similar preoperatively, and a week after operation (>0.05). At latest follow-up, the sagittal Cobb angles and the correction loss of Cobb angle in group A were significantly larger than that of groups B and C (<0.05), while there was no statistical difference between group B and group C (>0.05). With respect to visual analogue scale (VAS) scores for back pain, the three groups were similar at preoperatively, a week after operation and the latest follow-up(>0.05).</p><p><b>CONCLUSIONS</b>Compared to traditional posterior fixation alone, unilateral or bilateral pedicle fixation at the level of fracture can significantly decrease the loss of correction in the middle-long term, and reduce the incidence of tardive kyphosis deformity and can obtain satisfactory radiological results and clinical outcomes with safe surgical procedures.</p>

Treatment of spontaneous pneumothorax by mechanical pleurodesis / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax. Methods    A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients. Results    The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05). Conclusion    Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.

Comparing the safety of vaccination on vastus lateralis muscle and deltoid muscle of infants with haemophilus influenzae type b conjugate vaccine / 中华预防医学杂志

<p><b>OBJECTIVE</b>To compare the safety of haemophilus influenzae type b (Hib) vaccine vaccination on vastus lateralis muscle and deltoid muscle of infant.</p><p><b>METHODS</b>A total of 408 3-4 months old infants were divided into vastus lateralis muscle group and deltoid muscle group in Beijing, 2014. They were divided into the vastus lateralis muscle group (204) and deltoid muscle group (204) by extracting random number. Each observation object was given 3 doses of Hib vaccine according to the program. Collected systemic and local reactions after vaccination and calculated the incidence of adverse reactions.</p><p><b>RESULTS</b>A total of 61 infants were quitted during the study, 1 132 doses were observed. The total reactions incidence of Vastus lateralis muscle group and Deltoid muscle group were 33.0% (186/564) and 27.6% (157/568) with no statistical differences (χ² = 3.818, P = 0.059). The two groups incidence at the same day of vaccination (day 0) which the highest were 23.2% (131/564) and 20.6% (117/568), then declined with time (linear trend test vastus lateralis muscle group χ² = 36.600, P < 0.001,deltoid muscle group χ² = 29.947, P < 0.001), day 1 were 20.4% (115/564) and 17.6% (100/568), day 2 were 16.0% (90/564) and 13.4% (76/568), day 3 were 10.3% (58/564) and 10.6% (60/568), day 4-7 were 11.2% (63/564) and 11.3% (64/568). No serious adverse events (SAE) were reported during the study. The local reactions incidence of two groups were 7.1% (40/564) and 7.7% (44/568)with no statistical differences (χ² = 0.176, P = 0.675). The systemic reactions incidence of two groups were 25.9% (146/564) and 20.6% (117/568) with obvious statistical differences (χ² = 4.437, P = 0.035). The fever incidence of vastus lateralis muscle group (11.5% (65/564)) was higher than Deltoid muscle group (4.4% (25/568)) with obvious statistical differences (χ² = 4.868, P = 0.027). The 1st dose incidence of fever and abnormal crying of vastus lateralis muscle group (fever 11.3% (23/204), abnormal crying 19.1% (39/204)) was higher than deltoid muscle group (fever 4.4% (9/204), abnormal crying 11.8% (24/204)) and the 2nd dose of diarrhea of deltoid muscle group (11.6% (22/190)) was higher than vastus lateralis muscle group (5.9% (11/187)) with obvious statistical differences (fever χ² = 15.288, P < 0.001, abnormal crying χ² = 4.224, P = 0.040, diarrhea χ² = 3.829, P = 0.046).</p><p><b>CONCLUSION</b>Both vastus lateralis muscle group and deltoid muscle group had lower incidence of adverse reactions after vaccination. No serious adverse events were associated with vaccination. Vastus lateralis muscle vaccination as well as deltoid muscle vaccination demonstrated safe.</p>

The correlation between T1 tilt and cosmetic shoulder balance in Lenke type 2 adolescent idiopathic scoliosis patients / 中华外科杂志

<p><b>OBJECTIVE</b>To study the relationship between T1 tilt and cosmetic shoulder balance in adolescent idiopathic scoliosis (AIS) patients.</p><p><b>METHODS</b>Seventy-one Lenke type 2 AIS patients were recruited into the present study from January 2010 to December 2011. There were 61 female and 10 male patients, the average age was (15.1 ± 2.9) years (range 10-18 years); the average Risser sign was 2.8 (range 1-5). The patients were photographed from the back in neutral standing position on level ground wearing underpants. Also, all the patients had a standing posterior-anterior radiograph in a relaxed standing position. The cosmetic shoulder height (CSH), which included cosmetic inner shoulder height (CSHi) and cosmetic outer shoulder height (CSHo), were measured in the photographs. Positive value was defined as left shoulder was higher than the right shoulder, and negative value was defined as right shoulder was higher than the left shoulder. CSH > 5 mm was defined as positive CSH, CSH < -5 mm was defined as negative CSH, -5 mm ≤ CSH ≤ 5 mm was defined as leveled CSH. T1 tilts were measured in the posterior-anterior radiographs. Positive value was defined as the left proximal vertebral body up and right lower vertebral body down, and negative value was defined as the right proximal vertebral body up and left lower vertebral body down. T1 tilt > 5° was defined as positive T1 tilt, T1 tilt < -5° was defined as negative T1 tilt, -5° ≤ T1 tilt ≤ 5° was defined as leveled T1 tilt.</p><p><b>RESULTS</b>T1 tilt was found to be significantly correlated with CSHi and CSHo (r = 0.25 and 0.28, P < 0.05).For positive T1 tilt patients, there were 59.0% (36/61) patients with positive CSHo, 37.7% (23/61)with leveled CSHo, and 3.3% (2/61)with negative CSHo.For the patients with leveled T1 tilt, it was 3/10, 5/10 and 2/10.For positive T1 tilt patients, there were 83.6% (51/61) patients with positive CSHi, 11.5% (7/61) with leveled CSHi, and 4.9% (3/61) with negative CSHi; For the patients with leveled T1 tilt, it was 6/10, 2/10 and 2/10.</p><p><b>CONCLUSIONS</b>Although positive correlation is found between T1 tilt and cosmetic shoulder balance, positive T1 tilt is not an indicator of higher left shoulder.Elevated left shoulder, leveled shoulders and elevated right shoulder are all found in positive T1 tilt patients.</p>

Correlation between the shifting of medulla oblongata and cerebellum and syrinx resolution after posterior fossa decompression in Chiari malformation / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate the changes of the position of medulla oblongata and cerebellum following posterior fossa decompression (PFD), and to investigate their influences on the prognosis of the syringomyelia in adolescents with Chiari malformation (CM).</p><p><b>METHODS</b>A retrospective review was performed on all CM patients between September 2006 and September 2011. A subset of 46 patients, including 25 male and 21 female patients, was finally enrolled according to the inclusion criteria. The initial age and duration of follow-up averaged 13.9 years (range, 10-17 years) and 13 months (range, 6-52 months), respectively. On mid-sagittal MRI, the following parameters were evaluated pre- and postoperatively (follow-up ≥ 6 months): the longitudinal and transverse position of bulbopontine sulcus, the fourth ventricle vertex, the lower extreme of cerebella tonsil, the cervico-medullary angle, the maximal syrinx/cord(S/C) ratio and the syrinx length. Changes in these parameters were analysed using the paired samples t test, and for these reaching statistical significances, an additional bivariate correlation analysis was performed to investigate their relation with syrinx resolution.</p><p><b>RESULTS</b>At the latest follow-up, upward shifting of the bulbopontine sulcus was observed in 31 patients(67.4%), with upward shifting of the lower extreme of cerebella tonsil presenting in 35 patients(76.0%). The maximal S/C ratio and the syrinx length were significantly improved postoperatively (t = 7.114 and 7.816, P = 0.000).Significant resolution of the syrinx was demonstrated in 40 patients(86.9%), and more specifically, the average improvement rates of the maximal S/C ratio and the syrinx length were 32% ± 30%and 43% ± 33%, respectively. In addition, the bivariate correlation analysis revealed that syrinx resolution was significantly correlated with the upward shifting of the bulbopontine sulcus (r = 0.332, P = 0.027) and lower extreme of cerebella (r = 0.298, P = 0.044) .</p><p><b>CONCLUSION</b>The upward shifting of the bulbopontine sulcus and the lower extreme of cerebella tonsil might be implicated in the mechanisms of postoperative syrinx resolution.</p>

The effect of sympathectomy on the development and progression of scoliosis in bipedal mice model / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of sympathectomy on the development and progression of scoliosis in bipedal C57BL/6J mice model.</p><p><b>METHODS</b>Sixty female 3-week-old C57BL/6J mice were selected to establish bipedal scoliotic mice model after amputations of forelimbs and tails. All mice were randomly divided into three groups, 20 mice for each group. Group 1 received daily intraperitoneal injection of 0.9% saline (5 mg/kg); while Group 2 and 3 received sympathectomy by daily intraperitoneal injection of propranolol (20 mg/kg) and guanethidine sulfate (40 mg/kg), respectively. Posteroanterior X-rays were obtained at 20th week. Curves were measured using Cobb method and scoliosis was defined as a Cobb angle of > 10°. Incidence of scoliosis and severity of curves were compared among groups using Chi-square test and One-way analysis of variance, respectively.</p><p><b>RESULTS</b>There were 17 (85.0%) mice presented scoliosis in Group 1; whereas 11 (55.0%) and 10 (50.0%) mice presented scoliosis in Group 2 and 3, respectively. The incidence of scoliosis was found to be higher in Group 1, and the difference was statistically significant (χ(2) = 6.172, P = 0.046). As for curve magnitudes, the mean Cobb angle was 20° ± 9° in Group 1, 10° ± 7° in Group 2, and 12° ± 8° in Group 3. The mean Cobb angle of Group 1 was significantly greater than those of Group 2 and 3 (F = 9.545, P < 0.001), but there was no significant difference in mean Cobb angle between Group 2 and 3.</p><p><b>CONCLUSIONS</b>Sympathetic nervous system may be involved in the development and progression of scoliosis in bipedal C57BL/6J mice model. Sympathectomy do not seem to dramatically decrease the incidence of scoliosis, probably due to that bipedalism itself may also be a cause of scoliosis in this animal model.</p>

Association between tartrate-resistant acid phosphatase 5 gene polymorphism and adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate whether the titrate-resistant acid phosphatase 5 (ACP5) gene polymorphisms were associated with the occurrence or curve severity of adolescent idiopathic scoliosis (AIS).</p><p><b>METHODS</b>There were 372 AIS patients from January 2006 to December 2008 and 239 normal controls from March 2005 to August 2006 were recruited. The Cobb angles were ≥ 10° in all AIS patients. Using the haplotype data of Han population from the Hapmap Project, two tag SNPs (rs2229531, rs2071484) were defined for ACP5 gene. PCR-restriction fragment length polymorphism was used for the genotyping.</p><p><b>RESULTS</b>No polymorphism in rs2229531 was found in this study. The genotype and allele frequency distribution in rs2071484 were similar between AIS patients and normal controls (χ(2) = 3.336 and 1.438, P > 0.05). The mean maximum Cobb angles of different genotypes of rs2071484 in ACP5 gene were 38° ± 19° in AA, 34° ± 14° in AG and 38° ± 21° in GG, which were similar with each other among AIS patients who reached skeletal maturity or received surgery treatment (P = 0.157).</p><p><b>CONCLUSION</b>The ACP5 gene is neither associated with the occurrence nor the curve severity of AIS.</p>

Long term outcome of video-assisted thoracoscopic surgery for thoracic adolescent idiopathic scoliosis / 中华外科杂志

<p><b>OBJECTIVE</b>To study the long term outcomes and complications of video-assisted thoracoscopic surgery (VATS) in correcting thoracic adolescent idiopathic scoliosis (T-AIS) with more than five-year follow-up.</p><p><b>METHODS</b>The T-AIS patients underwent corrective surgery by VATS between June 2002 and December 2006 and experienced more than five-year follow-up were retrospectively reviewed. Nine female patients with T-AIS were recruited with a mean age of 14.3 years (range 11 - 16 years) at operation. Radiological parameters including thoracic and lumbar curves, thoracic kyphosis (T(5)-T(12)), sagittal alignment of the thoracolumbar junction (T(10)-L(2)) and lumbar lordosis (T(12)-S(1)) were measured on the X-rays taken preoperatively, 3 months, 2 year postoperatively and at latest follow-up. Complications occurred after operation and during follow-up were retrieved. The Chinese edition SRS-22 was finished by patients at the latest follow-up. Repeated-measures analysis of variance and paired t test were used for statistical analysis.</p><p><b>RESULTS</b>The patients were followed for a mean of 6.2 years (5 - 7.5 years) after VATS. The mean thoracic curve was corrected from 51° ± 8° preoperatively to 20° ± 8° at 3 months post-operation, and 21° ± 12° and 25° ± 13° at 2 year post-operation and latest follow-up, respectively. During the follow-up, no significant changes were observed regarding to coronal and sagittal radiological parameters (P > 0.05). Rod breakage occurred in 1 patient and Adding on was found in another one patient 2 year post-operation. Revision surgery was not needed for the solid fusion achieved and lack of correction loss. The mean score of SRS-22 at final follow-up was 4.3 ± 0.3, with high score in most of the domains.</p><p><b>CONCLUSIONS</b>Loss of curve correction and implant-related complication are found in VATS-treated T-AIS patients at the long-term follow-up. Although the patients show high scores in SRS-22, which indicated higher functional outcome and satisfaction to the operation, special care should be taken for applying VATS to T-AIS patients for the concern of long-term complication.</p>