P76 Skip laminectomy versus cervical laminectomy, an analysis of patient reported outcomes, spinal alignment and re-operation rates: the leeds spinal unit experience (2008–2016)

Objectives

To compare clinical, radiological and complication results between skip laminectomy and cervical laminectomy for posterior cervical decompression for cervical spondylotic myelopathy.

Design

Retrospective single institution cohort study.

Subjects

Subjects underwent primary skip or cervical laminectomy between 2008–2016.

Methods

Statistical analysis compared pre- and post-operative differences in Visual Analogue Scale, Neck Disability Index and radiological differences in sagittal alignment of the vertebral bodies. Analysis of re-operation rates was performed.

Results

A total of 42 and 29 patients had skip and cervical laminectomy respectively. Median follow up was 32±23.1 (Range: 1–325) weeks. Post-operatively there was no difference in patient reported outcomes namely Visual Analogue Scale and Neck Disability Index between skip laminectomy and cervical laminectomy groups compared to pre-operatively (p=0.64, p=0.75). No difference was seen in sagittal alignment between both groups following surgery (p=0.65). Three patients (7.1%) in the skip laminectomy group and two patients (6.9%) in the cervical laminectomy group required revision surgery to the cervical spinal region at a different level to the original surgery. No patients needed further instrumentation.

Conclusions

Both skip laminectomy and cervical laminectomy appear to deliver similar outcomes with regards to patient reported outcomes, preserving sagittal alignment and re-operation rates over this short follow-up period.

Modeled changes to the Great Plains low-level jet under a realistic irrigation application

Low-level jets (LLJs) are relatively fast-moving streams of air that form in the lower troposphere and are a common phenomenon across the Great Plains (GP) of the United States. LLJs play an important role in moisture transport and the development of nocturnal convection in the spring and summer. Alterations to surface moisture and energy fluxes can influence the planetary boundary layer (PBL) development and thus LLJs. One important anthropogenic process that has been shown to affect the surface energy budget is irrigation. In this study, we investigate the effects of irrigation on LLJ development across the GP by incorporating a dynamic and realistic irrigation scheme into the Weather Research and Forecasting (WRF) model. WRF simulations were conducted with and without the irrigation scheme for the exceptionally dry summer of 2012 over the GP. The results show irrigation-introduced changes to LLJ features both over and downstream of the most heavily irrigated regions in the GP. There were statistically significant increases to LLJ speeds in the simulation with the irrigation parameterization. Decreases to the mean jet core height on the order of 50 m during the overnight hours were also simulated when irrigation was on. The overall frequency of jet occurrences increased over the irrigated regions by 5-10%; however, these differences were not statistically significant. These changes were weaker than those reported in earlier studies based on simple representations of irrigation that unrealistically saturate the soil columns over large areas over a long period of time, which highlights the importance and necessity to represent human activity more accurately in modeling studies.

[Clinical analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in thalassemia major]

目的

探讨重型地中海贫血（地贫）患者异基因造血干细胞移植（allo-HSCT）后并发自身免疫性溶血性贫血（AIHA）诊断、治疗及转归，以提高地贫患者造血干细胞移植疗效。

方法

回顾性分析2007年7月至2017年12月共计291例行allo-HSCT重型地贫患者的临床资料。

结果

重型地贫allo-HSCT后AIHA发生率为1.72%（5/291）；AIHA中位发生时间为移植后7（5~12）个月，5例移植后AIHA患者直接和间接Coombs试验均阳性，患者主要表现为头晕、乏力、面色苍白、皮肤巩膜黄染、酱油色尿。228例HLA相合同胞供者移植患者有1例（0.43%）移植后发生AIHA，而63例非亲缘供者移植患者有4例（6.36%）移植后发生AIHA。非亲缘供者移植患者AIHA发生率高于HLA相合同胞供者移植患者。1例患者单用泼尼松治疗死亡，4例患者采用甲泼尼龙联合利妥昔单抗治疗有效，目前生存良好，其中2例Coombs试验转阴。

结论

该组重型地贫患者allo-HSCT后AIHA发生率为1.72%，Coombs试验有助于诊断移植后AIHA，非亲缘供者移植病例移植后AIHA发生率高于HLA相合同胞供者移植组，利妥昔单抗联合糖皮质激素是治疗重型地贫allo-HSCT后AIHA的有效方法。

[The molecular mechanisms underpinning auditory neuropathy]

Auditory neuropathy (AN) is a hearing disorder where cochlear inner hair cell and/or the auditory nerve function is disrupted while outer hair cell function is normal. It can affect people of all ages, from infancy to adulthood. People with auditory neuropathy may have normal hearing threshold, or hearing loss ranging from mild to severe; they always have poor speech-perception abilities. It is a heterogeneous disorder which can have either congenital or acquired causes. AN may result from specific loss of cochlear inner hair cells, disordered release of neurotransmitters by inner hair cell ribbon synapses, deafferentation accompanying loss of auditory nerve fibers, neural dys-synchrony or conduction block as a result of demyelination of nerve fibers and auditory nerve hypoplasia. Although the definition of AN includes the central part, its incidence is low, and the etiology and pathology are not clear. The present review aimed to provide an overview of the genetic conditions associated with AN and highlight the neural and synaptic mechanism of AN. Possible strategy for treatments of AN was also discussed.

[Comparison of the etiological constitution of two and three or more recurrent miscarriage]

Objective: To compare the etiological constitution of recurrent miscarriage (RM) between patients with consecutive two and three or more miscarriages through combining the routine examination results and embryonic karyotype. Methods: Patients with a history of two or more consecutive clinical miscarriages (≤12 weeks of gestation) consulting in the RM clinic of the First Affiliated Hospital of Sun Yat-sen University from March 2011 to January 2016 were collected. Six hundred and ninety-six with detailed history recorded, routine clinical examinations of RM and at least once embryonic karyotype were ultimately enrolled in this study. Their etiological constitution of RM were analyzed in groups of consecutive two and three or more miscarriage. The etiologies of RM in analysis consisted of women age, body mass index (BMI) , chromosome abnormalities of couples, uterine abnormalities, endocrinology abnormalities and antiphospholipid syndrome (APS) . Results: (1) Among 696 patients, the abnormal embryonic karyotypes was 60.6% (422/696) and routine RM etiologies was 32.2% (224/696) , leaving the ratio of unexplained RM was only 29.0% (202/696). (2) A total of 717 embryo karyotype were found in 696 patients, included21 cases with twice embryo karyotype results the percentage of normal embryo was 39.7% (285/717) , while abnormal ones was 60.3% (432/717). Among the types of abnormal karyotype, the most common ones (>10%) were trisomy 16 (19.2%, 83/432) , monosome X (11.3%, 49/432) and trisomy 22 (10.9%, 47/432). (3) Among the 696 RM patients, the number of two and three or more miscarriages were respectively 446 (64.1%, 446/696) and 250 (35.9%, 250/696). Comparing groups of three or more miscarriages with two miscarriages, there were significant differencein older age as well as uterine adhesion (P<0.05). But no difference was found in body mass index (BMI) , the rates of chromosome abnormalities of couples, uterine abnormalities except uterine adhesion, endocrinology abnormalities and APS (all P>0.05) between two groups. Conclusions: The abnormal embryonic karyotype is the most common cause of first-trimester RM. The etiological constitution of two and three or more recurrent miscarriages is accordant, suggesting that routine clinical examination and the embryonic karyotype should be started following two consecutive clinical early miscarriages.

[Hospitalization burden of hand, foot and mouth disease in Anhua county of Hunan province, 2013-2016]

Objective: To estimate the serotype and age-specific hospitalization burden associated with hand, foot and mouth disease (HFMD) in Anhua county of Hunan province, between October 2013 and September 2016. Methods: We collected hospitalization records of HFMD patients from 6 virological surveillance hospitals, and reimbursement records through new rural cooperative medical system from 23 township health centers to estimate the age-specific hospitalization burden of HFMD in Anhua. Combined with the results of virological surveillance, the serotype-specific hospitalization burden of HFMD in Anhua, was estimated. Results: During the three years, it was estimated that 3 541 clinical diagnosed HFMD cases, including 3 146 laboratory-confirmed HFMD cases, were hospitalized in Anhua, but only one was diaguosed as being severe. The estimated average hospitalization rate was 723/100 000(95%CI: 699/100 000-747/100 000) for clinical diagnosed HFMD and 642/100 000 (95%CI: 620/100 000-665/100 000) for laboratory-confirmed HFMD between October 2013 and September 2016. The cases caused by Cox A16 (208/100 000) and Cox A6 (202/100 000) had higher hospitalization rates compared with the cases caused by EV71 (130/100 000), Cox A10 (38/100 000) and other enterovirus (64/100 000), and the difference was statistically significant (P<0.001). HFMD-associated hospitalization rates peaked in children aged 1 year (3 845/100 000), and then decreased with age. Compared with the hospitalized HFMD caused by EV71 and Cox A16, Cox A6-associated hospitalizations mainly occurred in younger age groups (P<0.001). Conclusion: Our study revealed a substantial hospitalization burden associated with mild HFMD caused by EV71, Cox A16, Cox A6 and Cox A10, especially in young children, in Anhua.

Nonequilibrium Pair Breaking in Ba(Fe_{1-x}Co_{x})_{2}As_{2} Superconductors: Evidence for Formation of a Photoinduced Excitonic State

Ultrafast terahertz (THz) pump-probe spectroscopy reveals an unusual out-of-equilibrium Cooper pair nonlinear dynamics and a nonequilibrium state driven by femtosecond (fs) photoexcitation of superconductivity (SC) in iron pnictides. Following fast SC quench via hot-phonon scattering, a second, abnormally slow (many hundreds of picoseconds), SC quench regime is observed prior to any recovery. Importantly, a nonlinear pump fluence dependence is identified for this remarkably long prebottleneck dynamics that are sensitive to both doping and temperature. Using quantum kinetic modeling we argue that the buildup of excitonic interpocket correlation between electron-hole (e-h) quasiparticles (QP) quenches SC after fs photoexcitation leading to a long-lived, many-QP excitonic state.

[Research on the correlation between mechanical signaling molecules of hypertrophic scar and post injury time in burn patients in scar remodeling stage]

Objective: To analyze the correlation between integrin β₁, focal adhesion kinase (FAK), extracellular signal-regulated kinase 1/2 (ERK1/2) of hypertrophic scar (HS) and post injury time in burn patients in scar remodeling stage. Methods: Thirty-four patients with 34 HS specimens admitted to Department of Burns and Plastic Surgery of Chengdu No.2 Hospital and Institute of Burn Research of the First Affiliated Hospital of Army Medical University (originally the Third Military Medical University) from May 2013 to April 2016 were recruited by convenient sampling method, and normal skin specimens were obtained from donor sites of another 6 patients from the above-mentioned departments who had scar resection and skin grafting for this cross-sectional and observational study. Vancouver Scar Scale (VSS) was used to assess the height, vascularity, pigmentation, and pliability of scars. Diasonograph was used to assess scar thickness. Immunohistochemical method was used to observe the expressions of integrin β₁, FAK, and ERK1/2 in dermis and epidermis of scar and normal skin. Correlations between the post injury time and the scar thickness, the post injury time and the expressions of integrin β₁, FAK, and ERK1/2 in epidermis of scar, the post injury time and the expressions of integrin β₁, FAK, and ERK1/2 in dermis of scar, the expressions of integrin β₁, FAK, and ERK1/2 in dermis and those in epidermis of scar were analyzed by Pearson correlation analysis. Locally estimated scatterplot smoothing curve fitting line was used to demonstrate the non-linear regression relationship between the expressions of integrin β₁, FAK, and ERK1/2 in dermis and those in epidermis of scar, the scar thickness and the post injury time. Results: (1) The total VSS score of scars of patients was (8.3±2.3) points, with height scored (2.2±0.7) points, vascularity scored (2.0±0.8) points, pigmentation scored (2.3±0.7) points, and pliability scored (1.9±0.7) points. The thickness of scar was (2.8±1.1) mm. (2) The expressions of integrin β₁, FAK, and ERK1/2 in dermis and epidermis of scar were more than those in normal skin. (3) There was significantly positive correlation between the scar thickness and the post injury time (r=0.39, P<0.05). There was significantly positive correlation between the expression of integrin β₁ in epidermis of scar and the post injury time (r=0.33, P<0.05). There were no significantly correlations between the expressions of FAK and ERK1/2 in epidermis of scar and the post injury time (r=-0.03, -0.04, P>0.05). There was significantly negative correlation between the expression of FAK in dermis of scar and the post injury time (r=-0.34, P<0.05). There were no significantly correlations between the expressions of integrin β₁ and ERK1/2 in dermis of scar and the post injury time (r=0.07, -0.23, P>0.05). There were significantly positive correlation between the expressions of integrin β₁, FAK, and ERK1/2 in dermis and those in epidermis of scar (r=0.70, 0.60, 0.64, P<0.01). (4) The expressions of integrin β₁, FAK, and ERK1/2 in dermis and epidermis of scar were changed from downtrend in 1 to 2 months post injury to uptrend in 2 to 3 months post injury, which reached the peak around 3 to 4 months post injury. Hereafter the expressions of mechanical signaling molecules in epidermis of scar were gradually declined, while the expressions of mechanical signaling molecules in dermis of scar were at a quite high level within half a year post injury. Scar thickness was steadily increased after 1 month post injury. Conclusions: In scar remodeling stage of burn patients, the HS thickness increases continuously along with the increasing post injury time in the early stage of scar formation. The vulnerability of integrin β₁, FAK, and ERK1/2 of HS to external mechanical stimuli increases gradually within 4 months post injury.

[Analysis on characteristics of hearing loss in occupational noise-exposed workers in automotive manufacturing industry]

Objective: To investigate the characteristics of hearing loss in occupational noise-exposed workers in automotive manufacturing industry. Methods: According to Technical Specifications for Occupational Health Surveillance (GBZ188-2014) , 530 noise-exposed workers were examined for health and pure tone audiometry during January to June, 2017, and the data were collected for analysis. Poisson regression analysis was used to analysis the relationship between work age and hearing loss. Results: After correction of age and gender, pure-tone threshold of 500, 1 000, 2 000, 3 000, 4 000, 6 000 of the noise-exposed workers in the <3 year-exposure group were 20.15±3.60, 18.80±3.43, 18.54±3.38, 19.10±4.03, 20.32±6.79, 23.48±8.92 dB (A) ; the values in the 3-10 year-exposure group were 20.96±5.38, 19.25±4.76, 19.22±5.29, 20.17±7.50, 21.36±8.88, 25.39±11.60 dB (A) ; the values in the >10 year-exposure group were 20.18±3.67, 18.34±3.60, 18.36±4.25, 18.49±4.41, 20.32±9.24, 22.50±9.57 dB (A) . Poisson regression analysis showed that the relative risk (RR) of hearing loss of the noise-exposed workers compared with the noise-free workers was 4.38 (P<0.05) . Conclusion: The noise-exposed workers in automotive manufacturing industry revealed hearing loss, which was associated with their actual working age of noise exposure.

[The application of ARIMA in forecasting the cases of rabies in China different human groups]

Objective: To understand the situation of rabies in China different human groups. Seasonal ARIMA model is established to make forecasts and to provide suggestions for human rabies controlling in China. Methods: Build a model with data during 2004-2013, and validate the model by data of 2014. Then predict the cases of rabies from 2015-2017. Results: The long term trend is decreasing year by year, while seasonal effect is found that number of the third and fourth quarter are higher than others. The seasonal ARIMA model was built, whose residual are white noise. The RMAE in forecasting of peasants, students and scattered children are 19.10%、49.93% and 68.01%. Conclusion: The decreasing of rabies cases in China with time shows that the measures for control are effective. October for peasants, September for students, August for scattered children are critical period in future for rabies' control. Seasonal ARIMA model is a feasible model in forecasting the cases of rabies in China different groups in some way, error will be reduced by modeling separately for different wave sequence and combining with other models like ARIMA-GARCH.

Forensic Analysis on 52 Medical Malpractice Cases of Cardiac Death

OBJECTIVES

To synthetically analyse the medical malpractice cases of cardiac death in forensic identification, and to explore the generality and characteristic of cause of death, medical malpractice and assessment of participation degree.

METHODS

Totally 52 medical malpractice cases of cardiac death examined in the Xiaoshan Branch Office, Hangzhou Minghao Forensic Judical Appraisal Institute, from January 2015 to April 2018 were collected. The general information of cases, medical institutions and situations of hospital stay, cause of death, medical malpractice and assessment of participation degree were retrospectively analysed.

RESULTS

In 52 cases, the male to female ratio was 2.25:1, and most subjects aged >50-60. Cardiac death caused by hypertensive heart disease or coronary heart disease was most common （67.3%）, followed by viral myocarditis and cardiomyopathy （13.5%）. There were 24 cases involved surgery, and the survival time after surgery was from 1 h to 118 d with a 7 d medium value. There were 63 medical institutes involved in these medical malpractices. Medical malpractice presented in most hospitals more or less, and the participation degree was >20%-30%.

CONCLUSIONS

Forensic appraisal contributes to determine causes of death, which not only provides scientific evidence for medical malpractice identification, but also improves diagnosis and treatment levels of medical institutions.

How does social development influence life expectancy? A geographically weighted regression analysis in China

OBJECTIVES

This study aimed to examine how social development influenced life expectancy from a spatio-temporal perspective.

STUDY DESIGN

Data were taken from the China Statistical Yearbooks for 2001 and 2011, which presented results from 2000 to 2010, respectively.

METHODS

A geographically weighted regression method was performed. A total of 31 provinces were treated as units of our analysis, and four social development dimensions were extracted by exploratory factor analysis.

RESULTS

Generally speaking, healthcare and education development could significantly improve life expectancy. Between 2000 and 2010, the positive effects of social harmony and eco-environment development were gradually increasing. Spatially speaking, the enhancing effect of healthcare development on life expectancy generally declined from south to north China; the improving effect of education development generally declined from southwest China to northeast and northwest China. The geographical distributions of the effects of eco-environment and social harmony development on life expectancy were different between 2000 and 2010; the former declined from the eastern coast to west China in 2000 and declined from northwest to south China in 2010, while the latter first declined from north to southwest China in 2000 and then declined from southwest to northeast China in 2010.

CONCLUSIONS

Because the effects of various social development dimensions on life expectancy vary with time and space, it is necessary to improve certain aspects of social development in specific areas and social stages to efficiently improve life expectancy and population health.

The Fate of In Situ Lens Regeneration is Determined by Capsulorhexis Size

BACKGROUND AND OBJECTIVE

Lens regeneration is an optimal strategy for cataract patients to regain visual acuity with accommodation. We recently designed a novel, minimally invasive capsulorhexis surgical method for cataract removal that achieved functional lens regeneration in human infants. However, small anterior capsulorhexis requires advanced surgical expertise. To examine whether the quality of the regenerated lens can be maintained with enlarged anterior capsulorhexis, we investigated the shape and transparency of the regenerated lenses with different anterior capsulorhexis diameters (ACDs).

METHODS

Thirty-six 4-week-old New Zealand albino rabbits were randomly divided into three groups which underwent lens extraction with different ACDs (Group A: 2.0±0.5 mm, Group B: 4.0±0.5 mm, Group C: 6.0±0.5 mm). The anterior capsule opening area (ACOA) was quantified, and the morphology, weight, and histological characteristics of the regenerated lenses were examined.

RESULTS

Lens regeneration was observed in all three groups. In Group A, the regenerated lenses were relatively complete and transparent. In Groups B and C, the regenerated lenses were doughnut-shaped and opaque. The speed of lens regeneration in Group A was significantly faster than that in Groups B and C. The ACOA in Group A healed quickly and completely approximately 2 weeks after surgery. However, in Groups B and C, ACOA did not heal completely until 12 weeks after surgery. Histological examination showed that in Group A, most of the lens epithelial cells differentiated into well-organized lens fibers. However, in Groups B and C, the regenerated lens fibers were disorganized.

CONCLUSION

Capsulorhexis size is a critical determinant of integrity and transparency in lens regeneration.

Terahertz-light quantum tuning of a metastable emergent phase hidden by superconductivity

'Sudden' quantum quench and prethermalization have become a cross-cutting theme for discovering emergent states of matter^1-4. Yet this remains challenging in electron matter^5-9, especially superconductors^10-14. The grand question of what is hidden underneath superconductivity (SC) ¹⁵ appears universal, but poorly understood. Here we reveal a long-lived gapless quantum phase of prethermalized quasiparticles (QPs) after a single-cycle terahertz (THz) quench of a Nb₃Sn SC gap. Its conductivity spectra is characterized by a sharp coherent peak and a vanishing scattering rate that decreases almost linearly towards zero frequency, which is most pronounced around the full depletion of the condensate and absent for a high-frequency pump. Above a critical pump threshold, such a QP phase with coherent transport and memory persists as an unusual prethermalization plateau, without relaxation to normal and SC thermal states for an order of magnitude longer than the QP recombination and thermalization times. Switching to this metastable 'quantum QP fluid' signals non-thermal quench of coupled SC and charge-density-wave (CDW)-like orders and hints quantum control beneath the SC.

Gasoline exhaust damages spermatogenesis through downregulating α6-integrin and β1-integrin in the rat model

The health influence of air pollution has been an international public health concern. Increasing evidence has suggested that air pollution has been associated with decreased sperm quality. However, the underlying molecular mechanisms are still not fully elucidated. We aimed to verify whether gasoline exhaust leads to reproductive impairment by injuring spermatogonial stem cells and explore its underlying molecular mechanism. Twenty male Sprague-Dawley rats were randomly divided into two groups: the exposure group (n = 10) and the control group (n = 10). After 6-month exposure, the sperm count and morphology were determined. The histological changes in the seminiferous tubules were examined by HE staining. The expression of α6-integrin and β1-integrin was assessed with Quantitative RT-PCR, Western blot and Immunohistochemical staining. Compared with control group, male rats exposed to gasoline exhaust showed significantly reduced sperm count, increased sperm abnormality rate and the total number of spermatogonia, primary spermatocytes, secondary spermatocytes, spermatids were decreased. (all p < .01). The expression levels of α6-integrin and β1-integrin in the exposure group were significantly lower than those in the control group (all p < .01). Our study showed that exposure to gasoline exhaust caused impairment to spermatogonial stem cells through downregulating α6-integrin and β1-integrin.

[Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches for cervical cancer]

Objective: To introduce the laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branched and to evaluate its feasibility and safety for cervical cancer and its effect to bladder function and to provide some reference to simplify the surgical procedures of laparoscopic type C1 hysterectomy. Methods: The clinicopathologic data of the patients with stage ⅠA2~ⅡB cervical cancer and who underwent the laparoscopic C1 hysterectomy based on anatomic landmark of the uterus deep vein and its branches between March 2010 and December 2015 was retrospectively analysed. Results: A total of 99 patients received laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches, in which 93 patients reserved unilateral or bilateral pelvic autonomic nerve successfully, the other 6 patients were transfered to receive type C2 hysterectomy due to adhesions, bleeding or the low possibility of curative resection. The failure rate of the surgery was 6.1% (6/99). The average age of these 93 patients was 44.4±8.2 years (range 25~61 years) and there was one case of stage ⅠA2, 84 stage ⅠB1, 2 stage ⅠB2, 5 stage ⅡA1 and 1 stage ⅡB. The number of patients with squamous cell carcinoma was 67, adenocarcinoma was 19, adenosquamous carcinoma was 3, small cell neuroendocrine carcinoma was 3 and mixed type was 1. The average operation time was 4.1±0.5 h, the average amount of intraoperative blood loss was 103.8±84.0 ml and the mean number of excisional pelvic lymph nodes was 29.7±8.9. There was no patient with positive parametrial margin, positive vaginal margin or intraoperative ureteral injury. The postoperative catheter extraction time was 20.3±8.4 d. The median follow-up time was 20 months (rang 5~44 months), the long-term bladder dysfunction rate was 8.6% (8/93). The numbers of locally uncontrolled and distantly metastasis case were both one and both patients died. The fatality rate were 2.2% (2/93). The two-year disease-free survival and overall survival rate were 97.6% and 96.2%, respectively. Conclusion: Laparoscopic type C1 hysterectomy based on the anatomic landmark of the uterus deep vein and its branches is a safe and feasible treatment method for cervical cancer and it provides a new approach for simplifying the surgical procedures of laparoscopic type C1 hysterectomy.