[Analysis of factors associated with proximal junctional kyphosis after surgery for Lenke type 5 adolescent idiopathic scoliosis]

Objective: To investigate the risk factors associated with the development of proximal junctional kyphosis (PJK) after posterior spinal fusion for in children with Lenke type 5 adolescent idiopathic scoliosis (AIS). Methods: It was a retrospective case-control study that included medical records of 98 children with Lenke type 5 AIS who underwent posterior orthopedic surgery under general anesthesia at the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2013 to December 2018. There were 23 males and 75 females with a mean age of (14.5±2.2) years (10-18 years). Patients were divided into PJK and non-PJK groups according to whether the posterior junctional angle (PJA) was greater than 10° and increased for more than 10° from the preoperative period at the the last follow-up. Univariate analysis was used to analyze the correlation of general data of the children with occurrence of PJK after the operation. Multivariate logistic regression analysis was used to analyze the risk factors of postoperative PJK. Results: There were 35 cases in the PJK group and 63 cases in the non-PJK group. The PJK and non-PJK groups were followed up for (35.6±7.3) months and (36.4±7.5) months, respectively, and the difference was not statistically significant (P=0.637). There was no statistically significant difference between the two groups in general data such as gender, age, and body mass index (all P>0.05), while there were statistically significant differences between the two groups in upper instrumented vertebrea (UIV) location and junctional area posterior ligamentous complex (PLC) injury (all P<0.05). The results of univariate analysis showed that UIV location at T10-T12, junctional area PLC injury, preoperative coronal thoracic curve (TC), preoperative and final follow-up PJA, and preoperative and final follow-up pelvic incidence-lumbarlordosis (PI-LL) were correlated with postoperative PJK (OR=2.50, 5.37, 0.92, 1.12, 1.32, 1.06, 3.35, all P<0.05). Multifactorial logistic regression analysis showed that UIV located at T10-T12 (OR=2.346, 95%CI: 1.582-3.481, P=0.001), junctional area PLC injury (OR=5.112, 95%CI: 1.283-20.418, P=0.023) and last follow-up PI-LL (OR=1.826, 95%CI: 1.558-24.745, P=0.012) were risk factors for the occurrence of postoperative PJK in children with Lenke type 5 AIS. Conclusions: Postoperative UIV fixation to the thoracolumbar segment, PLC injury in the junctional area and excessive postoperative PI-LL in children with Lenke type 5 AIS may be the risk factors for the occurrence of PJK after the operation. It is suggested that avoidance of UIV selection to the thoracolumbar segment, intraoperative protection of the PLC located near the UIV and restoration of a good PI-LL relationship may reduce the incidence of PJK.

[Clinical observation of single-segment cervical adjacent segment disease treated with artificial cervical disc replacement]

Objective: To investigate the clinical outcomes and radiographic results of artificial cervical disc replacement (ACDR) for cervical adjacent segment disease (ASD). Methods: The clinical data of 28 patients with single-segment cervical ASD treated with ACDR in Xi 'an Honghui Hospital from December 2013 to July 2016 were retrospectively analyzed. There were 19 males and 9 females with a mean age of (46±7) years (36-63 years). Preoperative, postoperative 1 month and postoperative 24 months of clinical and radiographic outcomes were recorded and compared. The clinical outcome mainly includes Japanese orthopedic association (JOA), Neck Disability Index (NDI%), Odom score and complications. Imaging assessment mainly included range of motion (ROM) of cervical spine, surgical segment ROM, Cobb angle of surgical segment, degree of adjacent disc degeneration, heterotopic ossification, and prosthesis related image parameters. Results: In terms of clinical outcome, the average JOA score was 12.7±1.5 before surgery, 14.0±1.0 one month after surgery, 15.8±0.9 24 months after surgery, and the improvement rate of JOA was 75%±19%. The mean NDI% was 27.0%±2.8% before surgery, 20.5%±1.6% one month after surgery, and 15.3%±2.8% 24 months after surgery; the difference before and after treatment was statistically significant (F=159.101, P<0.01). Twenty patients were classified with excellent Odom score and 8 patients with good Odom score at the final follow-up. The total ROM of cervical spine, operation segment ROM, operation segment Cobb angle were all improved significantly after the operation (F=4.633, 6.063, 26.952, all P<0.05). There was a statistical difference in Miyazaki classification between adjacent discs above ACDR and below the fusion segment 24 months after surgery (μ(c)=2.12, P=0.034). The incidence of heterotopic ossification was 14.3%. The results of displacement degree of prosthesis were as follow: coronal plane (0.30±0.11) mm, sagittal plane (0.28±0.10) mm; subsidence of the prosthesis: (0.27±0.09) mm. No prosthesis loosening was observed. Conclusions: The clinical outcome of revision of cervical ASD by ACDR is satisfactory. The risk of intervertebral disc degeneration in adjacent segments is significantly lower than that of ACDF due to the presence of certain motor function postoperatively.

[Hemodynamic features and advances in research of goal-directed analgesia for patients with burn shock]

The hemodynamic state of patients with burn shock is extremely unstable. Goal-directed analgesia based on hemodynamic characteristics of different treatment phases is a key point in the treatment of burn shock. This can play active roles in reducing the stress response, decreasing the oxygen consumption, and protecting the organ function. This article reviews the hemodynamic characteristics of burn shock and its need for analgesia in different treatment phases, hoping to provide reference for appropriate analgesia.

[Investigation of molecular epidemiology of methicillin-resistant staphylococcus aureus in department of critical care medicine]

Objective: To investigate the feature of antimicrobial resistance, homology and other molecular epidemiology of methicillin-resistant staphylococcus aureus(MRSA) in Department of Critical Care Medicine(ICU). Methods: From October 2010 to December 2011, 149 strains of MRSA were collected and identified through sputum culture of patients from 10 ICUs of 10 teaching hospitals distributed in 9 chinese central city of China. Susceptibility testing to 18 kinds of antibiotic was performed, the method of pulsed field gel electrophoresis (PFGE) was used to analyze the homology, and the technique of multilocus sequencing typing (MLST) was used to identify the sequence type (ST). Results: Antibiotic susceptibility testing implied that vancomycin, daptomycin and linezolid are 100% sensitive to collected 149 strains of MRSA. Cotrimoxazole resistance rate is about 0-11.1%. Rifampicin resistant rate was less than 25% in 2 hospitals; the resistance rate of gentamicin and moxifloxacin were more than 80% besides of 50% to70% in 3 hospitals; beta lactam resistant rate was 100%. In 149 strains of MRSA, the main types of PFGE were J (28.9%), C (19.5%), G (10.7%), F (8%)types. J, C, G types mainly distributed in the North, while the F type only distributed in the Guiyang region. The MLST type: 8 ST types were determined ultimately. In which, was dominated by ST-239(67 strains, 45%), distributed in the South and North; followed by ST-5 (54 strains, 36.2%), mainly in the Northeast region (χ²=26.42, P<0.01). Conclusions: Vancomycin, daptomycin and linezolid are 100% sensitive drugs to MRSA in ICU; Higher regional homology for MRSA were observed and it is probably that homologic disseminated infection exited in ICU. It is necessary to enhance continuous monitoring and take effective nosocomial infection control action to avoid MRSA homologic outbreak.

Comparison of the VISX wavescan and OPD-scan III with the subjective refraction

OBJECTIVE

To compare the refractive errors measured by the VISX WaveScan, OPD-Scan III and the subjective refraction. The optometry accuracy of computer operated aberrometer used before refractive surgery has been debatable. Hence, a clear study on the role of such automated equipment in optometry is the need of the hour as compared to subjective refraction.

PATIENTS AND METHODS

Seventy-six patients (152 eyes) were recruited from January 2013 to December 2013. All patients were measured with subjective refraction by the phoropter (NIDEK, RT-5100), objective refraction by the WaveScan (AMO Company, USA), OPD-Scan III (Nidek Technologies, Japan). The sphere, cylinder, axis of the three methods were compared and analyzed.

RESULTS

The diopter of sphere power measured by WaveScan was lower than that of the subjective refraction and the difference was 0.13 ± 0. 30D (t = 3. 753, p <0. 001). While the diopter of cylinder power was higher and the difference was 0.13 ±0.43D (t = 3. 664, p <0. 001). There was no significance for sphere, cylinder and spherical equivalent between OPD-Scan III and subjective refraction (p >0. 05). The value of the difference between WaveScan and subjective refraction was 5.87°±6.19°on average, while the difference between OPD-Scan III and subjective refraction was 3.82°±3.95°on average. The differences between the two were statistically significant (t =2. 817, p =0. 006).

CONCLUSIONS

The results of sphere and cylinder measured by WaveScan and subjective refraction were different. As the latest integrated equipment, the Nidek OPD-Scan III gives a more accurate measurement of objective refraction when compared with subjective refraction. The latest Nidek OPD-Scan III may prove to be an useful tool for preoperative optometry deviation based on objective refraction.

Multistability in Chua's circuit with two stable node-foci

Only using one-stage op-amp based negative impedance converter realization, a simplified Chua's diode with positive outer segment slope is introduced, based on which an improved Chua's circuit realization with more simpler circuit structure is designed. The improved Chua's circuit has identical mathematical model but completely different nonlinearity to the classical Chua's circuit, from which multiple attractors including coexisting point attractors, limit cycle, double-scroll chaotic attractor, or coexisting chaotic spiral attractors are numerically simulated and experimentally captured. Furthermore, with dimensionless Chua's equations, the dynamical properties of the Chua's system are studied including equilibrium and stability, phase portrait, bifurcation diagram, Lyapunov exponent spectrum, and attraction basin. The results indicate that the system has two symmetric stable nonzero node-foci in global adjusting parameter regions and exhibits the unusual and striking dynamical behavior of multiple attractors with multistability.

[The diagnostic value of anti-BB-antibody estimation in sarcoidosis]

Anti-BB-antibody estimation was carried out in 100 cases of sarcoidosis, 40 cases of suspected sarcoidosis, 45 cases of pulmonary tuberculosis, 39 cases of pulmonary infections, 17 cases of bronchogenic carcinoma and 60 healthy persons as control. The result showed, that the patients suffering from sarcoidosis had the highest positive rate of anti-BB-antibody levels, whereas the positive rate of anti-BB-antibody levels in patients suffering from suspected sarcoidosis, pulmonary infections and tuberculosis was lower than that in patients suffering from sarcoidosis. Patients suffering from bronchogenic carcinoma and healthy controls had the lowest levels of anti-BB-antibody. It was suggested that sarcoidosis may have some relationship with infection.

[Borrelia burgdorferi may be the causal agent of sarcoidosis]

Serum antibody to Borrelia burgdorferi was measured in 33 patients with sarcoidosis who were confirmed clinically and pathologically. The results showed that 81.8% of the patients were positive. In addition, a strain of Borrelia burgdorferi was isolated from a patient's blood. Fourteen patients received ceftriaxone 2 g per day and/or penicillin 12 million per day and a patient received lincomycin 1.2 g per day. The antibody titer of the patients turned to normal level, their SACE turned to normal range, and chest X-ray findings were markedly improved in 3 cases after the treatment. According to the facts mentioned above, we consider that Borrelia burgdorferi may be the causal agent of sarcoidosis and sarcoidosis might be a special type of Lyme disease.

[Clinical study of rapid bladder filling agent]

The Rapid Bladder Filling Agent (RBFA) was prepared with Polyporus umbellatus, Poria cocos and Furosemidum. The urinary volume and the best filling time of urinary bladder were observed with ultrasonography in 211 cases. The result showed that in experimental group the largest urinary volume in unit time was more than that in control group and shortest filling time was shorter (30.35 +/- 7.9 min) in comparing with control group (145.6 +/- 50.1 min). Clinical observation for 1180 cases proved that the RBFA had the effects of raising the quality of ultrasonographic examination and escalating work efficiency, shortening the waiting time of patients and relieving patients' suffering from excessive filling of urinary bladder. The effective time of the RBFA was fast but the duration was short. The RBFA had no adverse effect.

Borrelia burgdorferi infection may be the cause of sarcoidosis

Serum antibody to Borrelia burgdorferi was measured in 33 patients with sarcoidosis which was confirmed clinically and pathologically. The results showed that 81.8% of the patients were positive for anti-B. burgdorferi antibody. In addition, a strain of B. burgdorferi was isolated from a patient's blood. Fifteen patients received ceftriaxone 2g per day or penicillin 12 million U per day. The antibody titers of the patients decreased to nearly normal levels rapidly. Serum angiotensin converting enzyme (SACE) turned to normal range after the treatment. According to the findings mentioned above, we consider that B. burgdorferi infection may be the cause of sarcoidosis and sarcoidosis might be a specific type of Lyme disease.