Socioeconomic and Environmental Determinants to Preterm Birth in Tibetan Women: An Analysis Based on the Hierarchically Conceptual Frame / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Preterm birth is a common cause of death in newborns and may result from many determinants, but evidence for the socioeconomic and environmental determinants of preterm birth in Tibetan women of childbearing age is limited. The aim of this study was to understand the current status of preterm birth in native Tibetan women and investigate the socioeconomic and environmental determinants.</p><p><b>METHODS</b>Data were drawn from a cohort study which was conducted from August 2006 to August 2012 in rural Lhasa, Tibet, China. A total of 1419 Tibetan pregnant women were followed from 20 weeks' gestation until delivery; the loss to follow-up rate was 4.69%. The incidence of preterm birth was estimated to show the status of preterm births in Tibet. Logistic regression models for longitudinal data were established, and odds ratios (ORs) together with 95% confidence intervals (CIs) were used to evaluate the association between the occurrence of preterm birth and 16 selected potential determinants based on the hierarchical conceptual frame.</p><p><b>RESULTS</b>The incidence of preterm birth was 4.58% (95% CI = 3.55-5.80%). After adjusting for health-related variables of the mothers and newborns, socioeconomic and environmental determinants associated with preterm birth included season (spring: OR = 0.28, 95% CI = 0.09-0.84; autumn: OR = 0.21, 95% CI = 0.06-0.69; and winter: OR = 0.31, 95% CI = 0.12-0.82) and calendar year of delivery (2010: OR = 5.03, 95% CI = 1.24-20.35; 2009: OR = 6.62, 95% CI = 1.75-25.10; and 2007-2008: OR = 5.93, 95% CI = 1.47-23.90).</p><p><b>CONCLUSIONS</b>The incidence of preterm birth among native Tibetan women was low and there was a decreasing trend in recent years; however, it is still essential to strengthen seasonal maternal care, extend the spacing between pregnancies, and reinforce adequate maternal nutrition.</p>

Application of an antibiotic crescent-shaped polymethylmethacrylate strut in thoracic vertebral tuberculosis.

Spinal tuberculosis accounts for up to 50% of all cases with musculoskeletal tuberculosis. In patients needing surgical treatment, the use of anterior instrumentation offers the theoretical advantage of more complete debridement and decompression, safer mobilization and reliable deformity correction. However, the placement of instrumentation in an infected area remains a matter of debate. We present a patient with thoracic vertebral tuberculosis using an antibiotic crescent-shaped PMMA strut for spinal reconstruction and fusion. The patient recovered satisfactory and no complication was observed in the follow-up. The antibiotic crescent-shaped PMMA strut can be used as a carrier for antibiotic drug and an ideal alternative for anterior spinal reconstruction. However, long-term outcome in this case requires further evaluation.

Association between the distribution of feeding index and physical development of infants and young children aged 6-35 months in rural areas of Lhasa in 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>Using infant and child feeding index (ICFI) to evaluate the relationship between infant feeding and physical development indicators in rural areas of Lhasa.</p><p><b>METHODS</b>In July and August 2010 in the rural areas of Lhasa, the multi-stage cluster random sampling method was adopted to select 540 Tibetan children who were between 6 to 35 months of age. There were 70, 79 and 391 cases in 6 to 8, 9 to 11 and 12 to 35-month-old group respectively. The basic status of infants, information about breastfeeding and complementary feeding were collected by using designed questionnaires. Their height and weight were measured to calculate the children's weight for age Z-score (WAZ), height for age Z-score (HAZ) and weight for height Z-score (WHZ) and assess feeding index score (out of 17 scores) and analyze the relationship between feeding index and HAZ, WAZ and WHZ.</p><p><b>RESULTS</b>The mean ICFI score of 540 cases was 8.90 ± 2.82.It was 6.84 ± 3.16, 8.16 ± 2.78 and 9.41 ± 2.55 for 6 to 8, 9 to 11 and 12 to 35-month-old infants respectively. There was significant difference between the different month group (F = 30.99, P < 0.05).For the three month groups, the scores of WAZ were 0.10 ± 1.18, -0.09 ± 1.20 and -0.38 ± 0.96; HAZ were -0.60 ± 1.68, -1.02 ± 1.72 and -1.30 ± 1.30; WHZ were 0.62 ± 1.23, 0.69 ± 0.96 and 0.43 ± 0.95 respectively. The ICFI scores of 9 to 11, 12 to 35 and 6 to 35-month-old infants were positively correlated with HAZ (correlation coefficients were 0.25,0.12 and 0.09 respectively, all P values <0.05). There was no correlation with WAZ (correlation coefficients were 0.15,0.08 and 0.03 respectively, all P values >0.05) and WHZ (correlation coefficients were -0.08, -0.02, and -0.07 respectively, all P values >0.05). There were no correlation between ICFI score with HAZ, WAZ and WHZ for 6 to 8 month-old infants (correlation coefficient were 0.06,0.16 and -0.07 respectively, all P values >0.05).</p><p><b>CONCLUSION</b>To some extent, the feeding index can effectively reflect the growth status of these infants and can serve as a comprehensive assessment of feeding situations among Tibetan children in rural areas of Lhasa.</p>

Application of a crescent-shaped PMMA strut in anterior spinal reconstruction of thoracolumbar and lumbar burst fractures: a new technique.

AIM: Our aim was to evaluate the safety and efficacy of the novel crescent-shaped PMMA strut for anterior spinal reconstruction and fusion in patients with thoracolumbar bust fractures. The surgical results using this technique are reviewed. MATERIAL AND METHODS: Six patients suffering thoracolumbar and lumbar fracture using a crescent-shaped PMMA strut combined with fixation for reconstruction of the anterior spinal column. Postoperative radiographic, included plain x-ray and 3-D computed tomography (CT) imaging, evaluated fusion status postoperatively. Pain relief and neurological status was assessed by comparing Frankel Score and Vision Analogue Score (VAS) pre- and postoperatively. RESULTS: All six patients achieved immediate stabilization. No patient needs additional posterior instrumentation stabilization due to loss of sagittal alignment and kyphosis deformity. All patients achieved significant relief of back pain, improvement of neurological function, correction of preoperative deformity and excellent bone fusion results documented on plain x-rays and 3-D CT reconstruction imaging. There were no complications of neurological worsening, wound infection, subsidence and dislodgement of PMMA strut, or anterior instrumentation failure during the follow-up. CONCLUSION: The crescent-shaped PMMA strut is an alternative for anterior spinal reconstruction and fusion in patients with thoracolumbar burst fracture. However, the long-term clinical effects and possible complications need further evaluation.

Analysis on growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the growth and malnutrition status of Tibetan children aged 0 to 35 months in rural Lhasa in 2010.</p><p><b>METHODS</b>Cross-sectional study and multistage sampling design were used to randomly select sampling units. A total of 640 children were studied. Height and weight were measured and nutritional status was evaluated with WHO reference in 2006 using Z-scores. Z-scores of weight-for-age (WAZ), Z-scores of height-for-age (HAZ) and Z-scores of weight-for-height (WHZ) were analyzed.</p><p><b>RESULTS</b>At the age of 18 - 35 months, the children in rural Lhasa were 3.0 cm shorter as compared to the China national length reference. At the age of 6 - 11, 12 - 17 months, weight ((8.84 ± 1.23) and (10.20 ± 1.08) kg) and length ((70.45 ± 4.46) and (76.73 ± 4.78) cm) of boys were significantly higher than girls (weight: (8.42 ± 1.30) and (9.59 ± 1.26) kg; length: (67.61 ± 3.98) and (74.25 ± 4.50) cm) (all P values < 0.05). WAZ and HAZ were -0.17 ± 1.11 and -1.11 ± 1.46, respectively. The HAZ of 18 - 23 months children (-1.51 ± 1.24) was significantly different from the HAZ of 0 - 5, 6 - 11, 12 - 17 months children (HAZ: -0.75 ± 1.50, -0.83 ± 1.72, -1.07 ± 1.55, respectively) (all P values < 0.05), comparison with the HAZ of 24 - 29, 30 - 35 months children (HAZ: -1.41 ± 1.25, -1.24 ± 1.05), the results showed that there were no significant difference (all P values > 0.05), HAZ of 18 - 23 months children was the lowest. The prevalence of stunting, underweight, and wasting were 24.6% (155/630), 5.4% (33/616) and 1.0% (6/608), respectively. The malnutrition of boys was more serious than that of girls, the stunting of 18 - 23 and 24 - 29 months children had reached 35.0% (36/103) and 29.1% (25/86), respectively.</p><p><b>CONCLUSION</b>The growth and development status of children in rural Lhasa under 3 years old was poor, and the malnutrition of local children should not be ignored with variations by gender and months of age.</p>

Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the minimally invasive efficacy and surgical outcome of full-endoscopic discectomy via interlaminar approach for lumbar disc herniation (LDH).</p><p><b>METHODS</b>From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy (FED) group included 16 males and 12 females, the age was 20 - 51 years with a mean (36 ± 8) years, and the course of disease was 18 - 120 d with a mean (68 ± 26) days. There was L(5)-S(1) LDH in 22 and L(4-5) LDH in 6. Headlamp-assisted mini-open discectomy (HAMOD) group, there were 17 males and 11 females. The age was 17-53 years with an average age of (35 ± 9) years, the course of disease was 19 - 110 d with an average (66 ± 24) days, and the herniated disc located at L(5)-S(1) in 15 cases, and L(4-5) in 13 cases. Perioperative parameters (operation time, bleeding volume and length of hospital stay), complications and VAS of leg and back pain (preoperatively, 3 months postoperatively and final follow-up) were statistically analyzed.</p><p><b>RESULTS</b>All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was (71 ± 30) min and the headlamp group was (60 ± 12) min, which there was no statistical difference (P > 0.05). There was no measurable bleeding in full endoscopic group, and the headlamp group was (59 ± 10) ml. The average hospital days in full endoscopic group was (5.7 ± 1.4) days, and the headlamp group was (12.3 ± 3.0) days, there was statistically significant difference in both groups (P < 0.01). The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference (P > 0.05). There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up. With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group (P > 0.05). However, there was statistical significance in VAS back pain between the two groups (P < 0.01).</p><p><b>CONCLUSIONS</b>Compared to the headlamp assisted mini-open technique, the full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.</p>

A long-segment string of bead- like schwannoma of cauda equina: a case report.

Spinal schwannomas are one of the most common intradural extramedullary spinal tumors. However, a string of bead-like intradural extramedullary schwannoma is highly uncommon. In the paper we present a case of a long-segment string of bead-like intradural extramedullary schwannoma of cauda equina from L2 to S2.The patient had been suffering progressive low back pain and sciatica with progressive neurological deficits for three years. She was misdiagnosed as lumbar disc herniation at her first time of hospitalization after a simple lumbar computed tomography (CT) scanning and a discectomy. We found her tumor by magnetic resonance imaging (MRI) and totally removed it. We therefore emphasize differentiating this almost completely curable tumor from other lumbar diseases such as lumbar disc herniation. It is suggested that a reasonable and careful strategy of surgery for these tumors is important.

Cauda equina syndrome caused by a migrated bullet in dural sac.

Cauda equina syndrome (CES) is a serious neurological condition and the most common cause is a central disc herniation. Migration of a bullet down the spinal canal is uncommon. In this report, the authors present an unusual case of cauda equina syndrome caused by a migrated bullet in dural sac. The patient's cauda equina syndrome was related to possible compression of cauda equina resulting from both bone fragments in L1 level and bullet itself in S2 level. The patient's symptoms and neurological deficits resolved considerably after surgery. In our opinion, it is important to pay attention to diversity of injury when confronted with a gunshot wound. It is essential to perform early and sufficient surgical decompression of the cauda equina to provide a better postoperative neurological recovery.

Study on the dietary pattern assessed with semi-quantitative food frequency questionnaire among rural Tibetan women with children younger than 2 years in Lhasa city / 中华流行病学杂志

Objective To explore the dietary pattern of rural Tibetan women with children under 2 years of age.Methods A cross-sectional survey on dietary pattern together with a semiquantitative food frequency questionnaire was conducted among Tibetan women in rural Lhasa in 2008.Results 386 women were investigated with the average age as 28.5 years old and average schooling-years as 4.6.For each member in the woman's family,daily intake of vegetable oil was 25.9 g on average.Daily intake of butter,sugar and salt were 27.8 g,12.9 g and 14.8 g respectively,which were higher than figures from national nutrition and health survey (P＜0.01).Among 91 kinds of food under investigation,only 22 kinds with the frequencies of consumption more than 1 time per day.Three main factors were derived by factor analysis.The first factor represented vegetable pattern characterized with vegetables,grains,fruits and a few animal foods.It was a dominant pattern for the subjects,which explained nearly 10% variance.The second one was Tibetan style pattern in which Tibetan foods and a few vegetables were consumed.The last one called meats and milk products pattern also reflected the Tibetan dietary style.Daily intake of energy for women was 2097.02 kcal which met 91.2% of Chinese recommended nutrients intake (RNI).Daily intake of protein and fat reached 82% of RNI and vitamin A but only 34.7% on RNI.Daily intake of calcium,iron and zinc reached 64.6%,174.1% and 150.7% of RNI,receptively.Grains provided 65% of energy but only 7.4% of the energy and 15.5% of protein were from animal foods."Tsampa" provided 57.6% of iron.Conclusion Vegetable pattern had been the dominant dietary pattern among Tibetan women in rural Lhasa.Intake of energy,protein and some micronutrients were not sufficient.

Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities / 中华外科杂志

<p><b>OBJECTIVE</b>to summarize the complications of posterior vertebral column resection (pVCR) and pedicle screw fixation for the treatment of rigid thoracic and lumber spinal deformity.</p><p><b>METHODS</b>fifty four patients from a single center from February 2000 to February 2009 were included in this study. There were 23 males and 31 females with an average age of 28.3 years (range, 16-58 years). Patients were divided into 4 diagnostic categories: severe scoliosis (n = 9, mean Cobb angle, 91.7°), kyphoscoliosis (n = 22, mean scoliosis, 101.5°, and mean kyphosis, 69.4°), angular kyphosis (n = 21, mean kyphosis, 72.2°), global kyphosis (n = 2, mean kyphosis, 93.6°). All of the patients received one stage pVCR combined correction with pedicle screws and circumferential fusion. Radiographs and hospital charts were reviewed to analyze the outcomes of correction.</p><p><b>RESULTS</b>a mean of 1.4 vertebral levels were resected, the mean operative time was 470 min, and the mean blood loss was 4180 ml. All the patients were followed-up for an average time of 26 months (range, 12 - 66 months). At the latest follow-up, the major curve correction averaged: severe scoliosis 61.4° (67%), kyphoscoliosis 59.7° (56%)/kyphosis 42.3° (59%), angular kyphosis 48.5° (71%), global kyphosis 62.7° (67%). A total of 21 complications (38.9%) occurred in 17 patients, including 5 (9.3%) neurological complications happened in early stage and one case of delayed complete paraplegic. There were 11 (20.4%) non-neurological complications happened in early stage and 5 (9.3%) cases in late stage.</p><p><b>CONCLUSIONS</b>one stage posterior-only vertebral column resection can achieve satisfactory correction of severe deformities with limited flexibility. Given its technically demanding and exhausting features, its potential risk of significant complications should be paid more attention.</p>

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondylitis (AS) and the effect of combined anterior and posterior operation.</p><p><b>METHODS</b>Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D according to Frankel's score. There were 15 cases of Grade III dislocation and 3 cases of Grade II. All patients underwent surgical procedures by combined anterior and posterior approach.</p><p><b>RESULTS</b>There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neurological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up.</p><p><b>CONCLUSIONS</b>The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.</p>

The assessment of accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the accuracy and safety of thoracic pedicle screws placement with interlaminar fenestration technique in severe kyphoscoliosis treatment.</p><p><b>METHODS</b>Twenty-three cases of severe kyphoscoliosis between June 1996 and December 2007 underwent pedicle screw placement of thoracic vertebrae by interlaminar fenestration technique. Postoperative CT scan was performed in all cases; there were 9 males and 14 females with the averaging age 17.8 years old. The preoperative Cobb angle of the main thoracic curve was 97.3 degrees in average. The average kyphotic angle in main curve was 67.4 degrees . Patients who underwent screw placement by closing technique and postoperative CT scan in the same stage with severe kyphoscoliosis were selected as control group (B): there were 22 patients with the averaging age 17.2 years old. The preoperative Cobb angle of the main thoracic curve was 96.6 degrees in average. The average kyphotic angle in main curve was 62.1 degrees . The screw-related complications were analyzed and online measure and analyze the degree of screw penetration according to CT by statistics.</p><p><b>RESULTS</b>There were 209 thoracic pedicle screws being inserted in group A, no spinal cord and large blood vessel injury occurred, 5 patients occurred intraoperative pedicle fracture, dura lesion had 4 patients. Screws misplacement ratio was 8.6%, there were 11 screws located in the thoracic pedicle laterally, 6 screws located in medially, 1 screw presented a moderate anterior cortical perforation. The number of screws misplacement in upper and mild thoracic vertebrae were 15, occupied 83.3%; the number of screws misplacement in lower thoracic vertebrae were 3, occupied 16.7%. There was statistics difference (P < 0.05). Of the total 116 thoracic pedicle screws inserted on the convex side, the ratio of screw misplacement was 5.2%; 93 screws on the concave side, the ratio of screw misplacement was 12.9%, there was statistics difference (P < 0.05). There were 201 thoracic pedicle screws being inserted in group B, no spinal cord and large blood vessel injury occurred, 16 patients occurred intraoperative pedicle fracture, dura lesion had 7 patients. The ratio of screw misplacement was 22.4%, there were 24 screws located in the thoracic pedicle laterally, 11 screws located in medially, 10 screw presented a moderate anterior cortical perforation. The ratio of screw misplacement in Group B was higher than Group A (P < 0.05). All cases received 3.2 years and 3.4 years follow-up. There was no obvious loss of correction in coronal and sagittal plane at the latest follow-up.</p><p><b>CONCLUSIONS</b>It is technically demanding for placement of thoracic screw in the severe kyphoscoliosis treatment. The interlaminar fenestration technique can increase the accuracy and safety of thoracic pedicle screw placement.</p>

One stage posterior vertebral column resection for the treatment of thorciclumbar tuberculosis with kyphotic deformity / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the clinical outcome of one stage posterior vertebral column resection in patients with spinal tuberculosis combined with kyphotic deformity.@*METHODS@#Thirty-six patients with spinal tuberculosis combined with kyphotic deformity underwent posterior one-stage vertebral column resection reducing tension on the spinal cord from 1998 to 2006. The patients were mobilized with a thoracolumbar orthosis for 3 months. All patients had a minimum of a 2-year follow-up, and clinical examinations and radiographs were obtained at 6-month intervals.@*RESULTS@#No perioperative mortality occurred. The average duration of surgery was 208 (145 approximately 385) min. The kyphotic Cobb angle improved from the preoperative average of 57.2 degree(17 degree approximately 86 degree) to a postoperative average of 8.9 degree(-6 degree approximately 27 degree). The average horizontal distance between C(7) and S(1) was 13.6 (8 approximately 19) mm preoperatively and 3.6 (-11 approximately 9) mm postoperatively. Nineteen patients had preoperative neurological deficits. Of them, 89.5% (17/19) showed a postoperative neurologic improvement. Perioperative complications occurred in 3(8.5%) of the 36 patients with pneumonias and superficial infections. Twenty-five patients (69.4%) showed radiographic evidence of solid fusion in the follow-up examinations. In the follow-up, 25% (9/36) patients rated their results as excellent, 66.7% (24/36) as good, 2 as fair, and 1 as poor.@*CONCLUSION@#One stage posterior vertebral column resection for the treatment of spinal tuberculosis with kyphotic deformity is safe and effective. Because this procedure is highly technical, the surgeon must be familiar with the pathoanatomy and the operation must be carefully done.

Levels of hemoglobin concentration and anemia during pregnancy in Lhasa / 中华流行病学杂志

Objective To investigate the distribution of hemoglobin(Hb)and prevalence of anemia in pregnant women living in the Tibetan Plateau area.Methods Random sampling method was used and fingertip blood sample was tested.Related sociodemographic information was collected.We adjusted the hemoglobin measurements based on the different levles of altitude,using three different methods from CDC.Dirren's and Dallman's to estimate the prevalence rates of anemia.Results Three hundred and eighty pregnant women were included.The mean Hb was 127.6 g/L.Tibetan had a lower Hb (126.6 g/L)than people from other ethnicities(134.6 g/L)with rural pregnant women having a higher Hb(130.4 g/L)than that of urban ones(125.9 g/L).After controlling the gestational age,results remained the same.Different method used for correction of hemoglobin would cause different prevalence rates of anemia which were all higher than the pre-adjusted prevalence rates:70.0% for CDC method,77.9% for Dirren's method and 41.3% for Dallman's method respectively.After analyzing the erythrocyte arameters,we could not conclude that population in our study was under the early stage of the iron deficiency anemia.Conclusion Higher altitude could affect the levels of hemoglobin concentration significantly.Currently adopted hemoglobin correction methods might not be suitable for Tibetan pregnant women.We suggested that it was imperative to establish a relationship between altitude and hemoglobin of Tibetan women during pregnancy in order to correctly evaluate the prevalence of anemia.

The introduction of breastfeeding in children under age of three in the counties of western China in 2005 / 中华流行病学杂志

<p><b>OBJECTIVE</b>The study was to describe the breastfeeding status of children under the age of three in counties of western China and to provide evidence to the government for decision-making on intervention.</p><p><b>METHODS</b>A cross-sectional study with probability-proportional-to-size (PPS) sampling method was used. The information on breastfeeding was obtained through memory of the mothers. Fourteen thousand and seventy-seven children were studied. Data on breastfed status in counties of western China was compared with those of the children from the survey of the counties of western China in 2001.</p><p><b>RESULTS</b>The breastfeeding rate of children under 3 years old in western China was 96.5%. However, the overall breastfed rate of children under 6 months were only 33.4%, with rates of 11.4% and 22.0% on exclusively and predominantly breastfed groups respectively. Timely first-suckling rate was 43.5% with the continued breastfeeding rate (1 year) as 64.9%, but the continued breastfeeding rate (2 year) was only 9.7%. Reasons causing mothers to wean would include according to her own intention and to be able to attend the physical labor while exclusive breastfeeding under 6 months was for the growth and development of children, which might reduce the two-week prevalence of diarrhea. Major risks of exclusive breastfeeding of children under 6 months were seen as: level of education of the mothers, economic depression of the counties and mother's nationality (if as minority).</p><p><b>CONCLUSION</b>Most of the children were ever or being breastfed at the time of interview with timely first-suckling took place earlier than in 2001. However continued breastfeeding did not last long. During these five years, the exclusive breastfeeding rate had been at low level, especially at the economic depression and the minority area.</p>

Operative strategy of the thoracolumbar fracture dislocation / 中南大学学报(医学版)

OBJECTIVE@#To explore the operative strategy and clinical outcome of the thoracolumbar fracture dislocation.@*METHODS@#Forty-two patients with the thoracolumbar fracture dislocation were treated with anterior approach (10 patients), posterior approach (28 patients), and anterior combined with posterior approach (4 patients) in order to construct the stabilities of the spine. The ASIA grades were used to evaluate the recovery of the neurological function, and the improvement of the kyphosis deformities was evaluated by the cobb's angle post-operation.@*RESULTS@#All the patients had no complications of injury in the vascular and neurological system. The ASIA grades after the operation were superior to those of pre-operation, and the cobb's angle was rectified distinctly.@*CONCLUSION@#When appropriate operative strategies are adopted, thoracolumbar fracture dislocation can be treated with satisfactory outcome.

Combined anterior and posterior approach for cervical fracture-dislocation with ankylosing spondylitis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the pathological characteristics of cervical spinal fracture of ankylosing spondylitis (AS), and surgical effect by combined anterior and posterior operation.</p><p><b>METHODS</b>Eighteen AS patients with traumatic cervical fracture-dislocation were treated from January 2000 to January 2006. The symptom duration of AS was 14.5 years in average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D in Frankel's score. All patients underwent surgical procedures by combined anterior and posterior approach.</p><p><b>RESULTS</b>There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-anterior procedures. Seven patients had one stage operation and 11 cases underwent two stage. There were some extent neurological improvement in 14 incompletely paraplegic patients, no improvement in 4 complete paraplegia patients. The follow-up period was 21.2 months in average and the bone fusion was 3.6 months. There were 4 complications during perioperative period and 1 in long term follow-up.</p><p><b>CONCLUSIONS</b>The study suggests that anterior combined with posterior approach makes the spine stable and relieves the pressure immediately. It is the reasonable surgical strategy in the treatment of cervical spinal fracture-dislocation with AS.</p>

Pedicle screws in the posterior reconstructive operation of the lower cervical vertebra / 中南大学学报(医学版)

OBJECTIVE@#To explore the efficiency of the cervical pedicle screws in the posterior reconstructive operation of the lower cervical diseases.@*METHODS@#From November 2001 to July 2003, 31 patients suffering from the lower cervical diseases were treated with the posterior pedicle screws fixation. We put the screws in the inferior articular process of the upper centrum, the lateral of the intervertebral facet center (3 - 5 mm the medial edge of lateral mass). The angles of toe-in sagittal plane varied from 30 degrees to 45 degrees, and the screws were from 18 to 26 mm (22.3 mm) in average.@*RESULTS@#There were 193 pedicle screws in this group, and no one had spinal cord injury or vertebral artery injury. The improvement rate was 84.5%. Follow-up was from 9 to 28 months (17 months in average). The screws were fixed properly without being loose and broken, and the bone graft fusions within 9 to 12 months in the X-ray and CT scan examination were satisfactory. The Japanese orthopaedics association score (JOA) was 9.7 preoperatively, but it was raised to 16.3 postoperatively.@*CONCLUSION@#The posterior reconstructive operation with cervical pedicle screws is a good choice for patients with lower cervical diseases.

Screw-rod technique in treating cervical spinal cord injury without fracture and dislocation / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the efficacy of screw-rod technique in treating cervical spinal cord injury without fracture and dislocation.@*METHODS@#The screw-rod technique was used to treat 38 patients with cervical spinal cord injury without fracture and dislocation. The JOA scores before and after the surgery were evaluated.@*RESULTS@#No severe complication occurred. The JOA scores were increased by 4.1, 6.7, 7.8, and 8.1 respectively at 0 th, 4 th, 12 th and 24 th weeks after the operation. Neurological deficits were improved one year after the operation in 1 patient.@*CONCLUSION@#Treating cervical spinal cord injury without fracture and dislocation with screw-rod technique can achive an efficient and safe clinical outcome.

Treatment of spinal metastases by posterolateral approach / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the value of spondylectomy, circumferential decompression, and spinal reconstruction for the treatment of spinal metastases using posterolater approach.@*METHODS@#Thirteen patients with spinal metastases were treated by spondylectomy, circumferential spinal cord decompression, and spinal reconstruction with pedicle fixation and polymethyl methacrylate. The outcome was assessed by pain relief and the improvement in neurologic symptoms.@*RESULTS@#Pain relief was obvious in all patients. Neurologic symptoms improved to various degrees in 6 patients.@*CONCLUSION@#Spondylectomy, spinal cord circumferential decompression and spinal reconstruction with pedicle fixation and polymethyl methacrylate using posterolateral approach are effective surgical method for spinal metastases.