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BACKGROUND Posterior fixation without fusion can treat thoracolumbar and lumbar traumatic fractures effectively in certain cases. However, whether patients benefit from implant removal and the correlation between the range of motion (ROM) of the involved segments and the removal time have not been determined. METHODS From 2018 to 2020, we retrospectively reviewed data of patients with AO spine type A or B thoracolumbar or lumbar traumatic fractures who underwent implant removal. A total of 17 patients (group A), 21 patients (group B), and 12 patients (group C) underwent implant removal after the index surgery within 12 months, between 12 and 24 months, and over 24 months, respectively. Clinical and radiological outcomes, including visual analog scale for back pain, patient satisfaction, Oswestry disability index, and EuroQol 5 dimensions questionnaire, for quality of life and segmental ROM were analyzed. RESULTS The average follow-up time was 9.1 ± 5.7 months after implant removal. There were no significant differences in visual analog scale and patient satisfaction among the 3 groups at the same observation time point. Among the 3 groups, patients in group A gained the lowest Oswestry disability index and highest EuroQol 5 dimensions questionnaire scores after removal and at the final follow-up. The best ROM was obtained in group A followed by groups B and C (11.5° ± 6.2°, 5.5° ± 1.6°, and 2.4° ± 0.6°, respectively). CONCLUSIONS Immobilization of the involved segments over 24 months may lead to loss of ROM. Regained segmental ROM is correlated negatively with implant removal time, and removal within 12 months promises a better ROM and quality of life.

Background Posterior fixation without fusion can treat thoracolumbar and lumbar traumatic fractures effectively. However, whether patients benefit from implant removal, as well as the correlation between the range of motion (ROM) of the involved segments and the removal time, has not been determined. Methods Fifty consecutive cases with thoracolumbar traumatic fractures that had undergone implant removal at different times were enrolled. We found 17 patients (Group A), 21 patients (Group B), and 12 patients (Group C) underwent implant removal following the index surgery within 12 months, between 12 to 24 months, and over 24 months, respectively. Clinical and radiological outcomes, including visual analog scale (VAS) for back pain, patient satisfaction, the Oswestry disability index (ODI) and EuroQol five dimensions questionnaire (EQ-5D) for quality of life and segmental ROM were analyzed. Results The average follow-up time was 9.1 ± 5.7 months after implant removal. There were no significant differences in VAS and patient satisfaction among the three groups at the same observation time points. Patients of group A gained the lowest ODI and highest EQ-5D scores after removal and at final follow-up than those in group B and C. The best ROM was obtained in Group A followed by Group B and C (11.5 ± 6.2°, 5.5 ± 1.6° and 2.4 ± 0.6°, respectively). Conclusions Immobilization of the involved segments over 24 months may lead to ankylosis. Regained segmental ROM is correlated negatively with implant removal time. Patients have implant removal within 12 months can gain a better quality of life.

BackgroundInfluenza A(H1N1)pdm09 viruses have undergone rapid evolution, and in recent years the complementary and antagonistic effects of HA and NA have gathered more attentions; however, the effects of co-occurring mutations in HA and NA on the patients’ clinical characteristics are still poorly understood. In this study, we analyzed molecular epidemiology and evolution of A(H1N1) pdm09, explored co-occurring mutations of HA and NA, and investigated effect of co-occurring mutations on patients’ clinical features.MethodsA(H1N1)pdm09 was confirmed by reverse transcription-polymerase chain reaction. HA and NA genes were sequenced and phylogenetically analyzed. Clinical characteristics of the co-occurring mutations were analyzed statistically.ResultsBy analyzing the HA and NA gene sequences of 33 A(H1N1)pdm09 viruses during the 2015–2017 influenza season, we found that all the viruses shared high similarities to each other and the HA genes of these viruses exclusively belonged to subclade 6B.1A. Several unreported substitutions in HA and NA proteins were observed, furthermore, co-occurring mutations of HA-V169T, A278S, E508G, D518E and NA-V67I were detected in 30.3% (10/33) A(H1N1)pdm09 virus strains when comparing with vaccine strains A/California/07/2009 and A/Michigan/45/2015 (H1N1). Sore throat was significantly associated with co-occurring mutations in HA and NA of A(H1N1)pdm09 (χ2,P ConclusionsCo-occurring mutations in HA and NA were detected in A(H1N1)pdm09 isolated during 2015–2017 in Beijing. Symptomatically, sore throat was associated with co-occurring mutations in HA and NA of A(H1N1)pdm09. Therefore, studying the effect and mechanism of co-occurring mutations in HA and NA on patients’ clinical features is of note needed.

Background: Influenza A(H1N1)pdm09 viruses have undergone rapid evolution, and in recent years the complementary and antagonistic effects of HA and NA have gathered more attentions; however, the effects of co-occurring mutations in HA and NA on the patients’ clinical characteristics are still poorly understood. In this study, we analyzed molecular epidemiology and evolution of A(H1N1) pdm09, explored co-occurring mutations of HA and NA, and investigated effect of co-occurring mutations on patients’ clinical features.Methods: A(H1N1)pdm09 was confirmed by reverse transcription-polymerase chain reaction. HA and NA genes were sequenced and phylogenetically analyzed. Clinical characteristics of the co-occurring mutations were analyzed statistically.Results: By analyzing the HA and NA gene sequences of 33 A(H1N1)pdm09 viruses during the 2015-2017 influenza season, we found that all the viruses shared high similarities to each other and the HA genes of these viruses exclusively belonged to subclade 6B.1A. Several unreported substitutions in HA and NA proteins were observed, furthermore, co-occurring mutations of HA-V169T, A278S, E508G, D518E and NA-V67I were detected in 30.3% (10/33) A(H1N1)pdm09 virus strains when comparing with vaccine strains A/California/07/2009 and A/Michigan/45/2015 (H1N1). Sore throat was significantly associated with co-occurring mutations in HA and NA of A(H1N1)pdm09 (χ2, P < 0.05).Conclusions: Co-occurring mutations in HA and NA were detected in A(H1N1)pdm09 isolated during 2015-2017 in Beijing. Symptomatically, sore throat was associated with co-occurring mutations in HA and NA of A(H1N1)pdm09. Therefore, studying the effect and mechanism of co-occurring mutations in HA and NA on patients’ clinical features is of note needed.

Background: Influenza infection was a vital threat to immunosuppressed patients with longer viral shedding; however, data on these populations in China are still lacking. We analyzed clinical characteristics, risk factors for admission to intensive care unit (ICU) and death, and effect of antiviral therapy in these populations.Methods: We analyzed 73 immunosuppressed inpatients tested positive for influenza virus using reverse-transcription polymerase chain reaction during the 2018-2019 influenza season. Medical data were analyzed using descriptive statistics. Univariate analysis and multivariate logistics analysis were used to identify risk factors. Results: The most common immunosuppression type was malignancies with chemotherapy 73.9% (54/73), then hematopoietic stem cell transplantation 19.2% (14/73). The most common presenting symptom was fever in 91.8% (67/73) patients, then cough 59.6% (34/57) and muscular soreness 35.1% (20/57). Complications and co-infections were found in 38.4% (28/73) and 17.8% (13/73) patients respectively, which significantly prolonged the hospital stay. Antiviral treatment after 48 hours was significantly associated with admission to ICU, mechanical ventilation and death. Combination and double dose of neuraminidase inhibitors did not significantly reduce the admission to ICU and death. 15.1% (11/73) patients were admitted to ICU and 8.2% (6/73) patients died. Risk factors for admission to ICU were long symptom onset (OR 5.60, P=0.018) and co-infection with other infections (OR 68.66, P=0.019), and presence of dyspnea was independently associated with death (OR 48.00, P=0.003) through multivariate logistics analysis. Seasonal influenza vaccination in preceding 12 months only took up 2.7% (2/73).Conclusion: Fever and other classical symptoms may be absent in immunosuppressed recipients, and conducting influenza virus detection at the first time is a good choice for early diagnosis. Antiviral treatment within 48 hours is of significance; however, patients may not benefit from combination and double dose of neuraminidase inhibitors. Immunosuppressed patients with dyspnea, long symptom onset and co-infection with other infections are of note needed, because these people have high-risk to severe cases. Inactivated influenza vaccination should be taken into account in immunosuppressed patients.

This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis. The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up. A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°–97°) compared to the postoperative 14° Cobb's angle (10°–21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate. Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity.