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Ion binding proteins (IBPs) can selectively and non-covalently interact with ions. IBPs in phages also play an important role in biological processes. Therefore, accurate identification of IBPs is necessary for understanding their biological functions and molecular mechanisms that involve binding to ions. Since molecular biology experimental methods are still labor-intensive and cost-ineffective in identifying IBPs, it is helpful to develop computational methods to identify IBPs quickly and efficiently. In this work, a random forest (RF)-based model was constructed to quickly identify IBPs. Based on the protein sequence information and residues’ physicochemical properties, the dipeptide composition combined with the physicochemical correlation between two residues were proposed for the extraction of features. A feature selection technique called analysis of variance (ANOVA) was used to exclude redundant information. By comparing with other classified methods, we demonstrated that our method could identify IBPs accurately. Based on the model, a Python package named IBPred was built with the source code which can be accessed at https://github.com/ShishiYuan/IBPred.

Heparin-binding protein (HBP) is a cationic antibacterial protein derived from multinuclear neutrophils and an important biomarker of infectious diseases. The correct identification of HBP is of great significance to the study of infectious diseases. This work provides the first HBP recognition framework based on machine learning to accurately identify HBP. By using four sequence descriptors, HBP and non-HBP samples were represented by discrete numbers. By inputting these features into a support vector machine (SVM) and random forest (RF) algorithm and comparing the prediction performances of these methods on training data and independent test data, it is found that the SVM-based classifier has the greatest potential to identify HBP. The model could produce an auROC of 0.981 ± 0.028 on training data using 10-fold cross-validation and an overall accuracy of 95.0% on independent test data. As the first model for HBP recognition, it will provide some help for infectious diseases and stimulate further research in related fields.

Cyclin proteins are capable to regulate the cell cycle by forming a complex with cyclin-dependent kinases to activate cell cycle. Correct recognition of cyclin proteins could provide key clues for studying their functions. However, their sequences share low similarity, which results in poor prediction for sequence similarity-based methods. Thus, it is urgent to construct a machine learning model to identify cyclin proteins. This study aimed to develop a computational model to discriminate cyclin proteins from non-cyclin proteins. In our model, protein sequences were encoded by seven kinds of features that are amino acid composition, composition of k-spaced amino acid pairs, tri peptide composition, pseudo amino acid composition, geary correlation, normalized moreau-broto autocorrelation and composition/transition/distribution. Afterward, these features were optimized by using analysis of variance (ANOVA) and minimum redundancy maximum relevance (mRMR) with incremental feature selection (IFS) technique. A gradient boost decision tree (GBDT) classifier was trained on the optimal features. Five-fold cross-validated results showed that our model would identify cyclins with an accuracy of 93.06% and AUC value of 0.971, which are higher than the two recent studies on the same data.

We established 340-year chronologies of total ring width, early wood width, and late wood width with tree-ring samples of Pinus taiwanensis at high altitude collected from the western Tianmu Mountain in northern Zhejiang Province. According to the criterion that subsample signal strength (SSS) should be larger than 0.8, the reliable period was from 1810 to 2019. Through the correlation analysis between chronologies and climatic factors, we examined the responses of tree ring growth to climate. The results showed that radial growth of P. taiwanensis was more sensitive to temperature than to precipitation. Comprehensively considering the correlation analysis results for the raw and first-order difference series, early wood width was significantly correlated with the early growing season mean and maximum temperatures of the prior year, while late wood width with prior May and current September mean and maximum temperatures. The correlation pattern of total ring width was similar to that of early wood width, although at a low level. The optimal correlation was between early wood width and prior April-July mean temperature. Based on this relationship, April-July mean temperature of the Tianmu Mountain, East China was reconstructed for the period of 1809-2018 with an explained variance of 61.5%. Both the raw and first-order difference series passed the split sample calibration-verification test. The warm periods were 1809-1833 and 1965-2018, with a cold period in 1834-1964. Temperature had risen rapidly since the 1960s. From the standpoint of low frequency, it reached an unprecedented level since the 1980s over the past 210 years. Spatial correlation analysis showed that the reconstructed temperature series could represent temperature variations of East China, which had a good agreement with a reconstructed regional temperature series from East China. Our results showed that P. taiwanensis had a great potential for paleoclimate reconstruction in East China. [ABSTRACT FROM AUTHOR]

We established 340-year chronologies of total ring width, early wood width, and late wood width with tree-ring samples of Pinus taiwanensis at high altitude collected from the western Tianmu Mountain in northern Zhejiang Province. According to the criterion that subsample signal strength (SSS) should be larger than 0.8, the reliable period was from 1810 to 2019. Through the correlation analysis between chronologies and climatic factors, we examined the responses of tree ring growth to climate. The results showed that radial growth of P. taiwanensis was more sensitive to temperature than to precipitation. Comprehensively considering the correlation analysis results for the raw and first-order difference series, early wood width was significantly correlated with the early growing season mean and maximum temperatures of the prior year, while late wood width with prior May and current September mean and maximum temperatures. The correlation pattern of total ring width was similar to that of early wood width, although at a low level. The optimal correlation was between early wood width and prior April-July mean temperature. Based on this relationship, April-July mean temperature of the Tianmu Mountain, East China was reconstructed for the period of 1809-2018 with an explained variance of 61.5%. Both the raw and first-order difference series passed the split sample calibration-verification test. The warm periods were 1809-1833 and 1965-2018, with a cold period in 1834-1964. Temperature had risen rapidly since the 1960s. From the standpoint of low frequency, it reached an unprecedented level since the 1980s over the past 210 years. Spatial correlation analysis showed that the reconstructed temperature series could represent temperature variations of East China, which had a good agreement with a reconstructed regional temperature series from East China. Our results showed that P. taiwanensis had a great potential for paleoclimate reconstruction in East China.

Objective: To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety., Methods: A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed., Results: All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery ( P <0.05), but there was no significant difference between two groups at the same time point ( P >0.05) . From 1 to 14 days after operation, the neurological function began to gradually recover, and the neurological function grade was increased by 1 to 3 grades. From 3 months after operation to the final follow up, 52 cases recovered completely, 8 cases partially recovered, and 2 cases did not improve. There was no significant difference in ESR and CRP between two groups before admission, 1 month after surgery, and final follow-up ( P >0.05)., Conclusion: After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Objective: To explore the value of multimodal neuroelectrophysiological monitoring technology in the evaluation of spinal cord and nerve root function for the treatment of thoracic tuberculosis with debridement and bone grafting and posterior internal fixation by transcostal transverse process approach., Methods: The clinical data of 25 patients with thoracic tuberculosis underwent debridement and bone grafting and posterior vertebral arch internal fixation by transcostal transverse process approach from December 2018 to September 2019 was retrospectively analyzed. Among these 25 patients, including 14 males and 11 females;aged from 20 to 83 years old, with a mean of (63.45±9.65) years;there were 3 cases of single vertebral body destruction, 13 cases of 2 vertebral bodies destruction, and 9 cases of 3 or more vertebral bodies destruction. All surgical patients underwent intraoperative detection of somatosensory evoked potential(SEP) and transcranial electric stimulation-motor evoked potential(TES-MEP);and electromyography (EMG) was used to monitor the pedicle screw placement and lesion removal. The erythrocyte sedimentation rate(ESR) was used to evaluate the decline of inflammatory indexes, the visual analogue scale (VAS) was used to evaluate the thoracic spine pain, and the Cobb angle and Oswestry Disability Index(ODI) were used to evaluate the improvement of function., Results: All 25 patients were successfully monitored. Five patients had abnormal SEP waveforms during operation, 3 cases were caused by intraoperative clearing of lesions and spinal cord compression during irrigation, timely replacement of instruments and gestures, and adjustment of irrigation water flow rate returned the waveform to normal; one case was caused by a decrease in systolic blood pressure, and the waveform returned to normal after timely treatment of increased blood pressure;after 1 case of SEP waveform abnormality, the operation was suspended for 10 minutes and recovered spontaneously, and the waveform abnormality did not reappear until the end of the operation. Seven patients had abnormal TES-MEP waveforms, 5 cases occurred when the pedicle screw was inserted, the nail path was adjusted in time, and the waveform recovered after nail repositioning;one case was caused by tilting the operation bed during operation, and the waveform gradually recovered after adjusting the tilt angle of operation bed; one case occurred during the correction of the pedicle screw and rod system, and the waveform gradually returned to normal after the contralateral screw and rod correction were completed during operation. In 5 cases, the EMG burst potential was detected at the same time when the TES-MEP waveform was abnormal. After adjustment, the EMG burst potential disappeared. There was no abnormality in the TES-MEP and SEP waveforms at the same time. Postoperative VAS, ESR, Cobb angle, and ODI were improved compared with preoperatively (P<0.05)., Conclusion: In patients with thoracic tuberculosis, the use of debridement and bone grafting and posterior internal fixation by transcostal transverse process approach combined with intraoperative SEP, TES-MEP and EMG monitoring can timely reflect the spinal cord and nerve root function, avoid intraoperative injuries while achieving good fixation and lesion removal.

Objective: To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process., Methods: A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups., Results: All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups ( P >0.05). Intraoperative blood loss was (541.6±35.3) ml in group A, (546.8±27.8) ml in group B, and (540.1±34.5) ml in group C, withno statistically significant difference among three groups( P >0.05). Preoperative anterior vertebral height loss rate was (46.0± 3.1)% in group A, (46.4±3.3)% in group B, and (45.3±3.6)% in group B;at the final follow up, the loss rate of anterior vertebral height among three groups was (8.6±5.0)%, (8.1±4.2)%, (9.4±4.3)%, respectively. There were no statistically significant differences before operation and final follow-up among three groups ( P >0.05). Preoperative Cobb angle was (35.1±4.8)° in group A, (35.2±4.5)° in group B and (35.2±4.5)° in group C, with no statistically significant difference among three groups ( P >0.05);postoperative at 3 days, Cobb angle in three groups was (15.1±3.6)°, (15.3±3.1)° and (15.2±3.4)°, respectively, there was no statistically significant difference among three groups ( P >0.05);at the final follow-up, the Cobb angle among three groups was (17.7±3.3)°, (17.9±3.9)°, (18.6±3.6)°, respectively, with no statistically significant difference among three groups ( P >0.05). The time of bone graft fusion was (5.6±0.5) months in group A, (5.6±0.6) months in group B and (5.8±0.6)months in group C, with no statistically significant difference among three groups ( P >0.05). Frankel classification at the final follow up, 4 cases were grade B, 7 cases were grade C, 10 cases were grade D, and 86 cases were grade E. Spinal nerve function in all three groups recovered to a certain extent after treatment, with no statistically significant difference among three groups ( P > 0.05). Oswestry Disability Index at the final follow-up showed no statistically significant difference among three groups ( P > 0.05)., Conclusion: The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.

Objective: To compare clinical effect of cortical bone trajectory (CBT) screw and pedicle screw (PS) internal fixation in treating senile patients with lumbar tuberculosis., Methods: From January 2014 to January 2017, 42 senile patients with lumbar tuberculosis were divided into CBT group and PS group, 21 patients in each group. In CBT group, there were 12 males and 9 females, aged from 64 to 81 years old with an average of (72.52±9.25) years old, T value of bone mineral density was (-2.69±0.17) g / cm 3 , posterior CBT screw internal fixation and anterior debridement, interbody fusion with bone grafting was performed. In PS group, there were 11 males and 10 females, aged from 63 to 85 years old with an average of (71.42±9.81) years old, T value of bone mineral density was (-2.70±0.21) g / cm 3 , PS internal fixation and anterior debridement, interbody fusion with bone grafting were performed. Length of posterior incision, intraoperative bleeding volume, operation time, time of bone graft fusion and complications between two groups were compared. Level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), segment kyphotic Cobb angle before and after operation were compared, VAS score was used to evaluate pain releasing, JOA score was applied to evaluate clinical effect., Results: All patients were followed up from 12 to 21 months with an average of (15.00±3.57) months. No reoccurrence of lumbar tuberculosis and screw loosing occurred. There were statistical difference in length of incision, intraoperative bleeding volume, operation time between two groups ( P <0.05). Level ofESR and CRP between two groups at 2 weeks, 1 month and 6 months after operation were improved after operation, while there were no differences between two groups ( P >0.05). There were no statistical differences in complications, time of bone graft fusion and segment kyphotic Cobb angle at 1 week after operation between two groups ( P >0.05). There was difference in Cobb angle at 12 months after operation ( P <0.05). For VAS score, there were no difference between two groups before operation and 3 months after operation( P >0.05), but VAS score at 3 months after operation were improved after operation between two groups ( P <0.05).For JOA score, there were no difference between two groups before operation, 3 and 12 months after operation, and JOA score at 3 and 12 months after operation were improved than that of before operation between two groups ( P <0.05)., Conclusion: Both of CBT screw internal fixation and PS screw internal fixation could achieve satisfying results for the treatment of elderly patients with lumbar tuberculosis. PSinternal fixation has a long fixation but great trauma. However, CBT screw internal fixation only needs to fix adjacent segments of the lesion to reduce the fixation range, which has advantages of less trauma and strong screw holding force.

Objective: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis., Methods: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L 4 to S 2 . The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed., Results: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively., Conclusion: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.

Objective: To investigate the effect of preoperative percutaneous drainage in lumbar tuberculosis with psoas abscess, through compare the clinical efficacy of two different methods., Methods: Thirty-six patients with lumbar tuberculosis complicated with psoas abscess in corresponding with the inclusion criteria were admitted in Zhejiang Province Traditional Chinese Medicine Hospital from January 2015 to January 2017. The patients were divided into group A and group B according to the different therapeutic methods. All patients were given the standard anti tuberculosis treatment, and percutaneous catheter drainage was used in group A after admission immediately for psoas abscess before operation, while group B with no special treatment. At 3 weeks after anti tuberculosis treatment, 2 patients were excluded in group B, which had to postpone operation because of no reduction in erythrocyte sedimentation rate(ESR) and C reactive protein(CRP). Finally 34 patients were enrolled in this study. There were 18 cases in group A, including 10 males and 8 females, aged from 24 to 73 years old with an average of(42.5±10.2) years. There were 16 cases in group B, including 9 males and 7 females, aged from 23 to 75 years old with an average of(42.3±9.8) years. All patients were treated with posterior pedicle screw fixation, anterior debridement and bone graft fusion. Anterior surgery bleeding volume, operation time, anterior incision length, postoperative anus exhaust time, VAS score, Cobb angle, ESR, CRP changes and postoperative sinus formation were compared between two groups., Results: All patients were followed up for 6 to 21 months with an average of 13 months. At the last follow-up, no mixed infection, tuberculosis recurrence, pedicle screw loosening and nail withdrawal were found. The average operative time, anterior surgery bleeding volume and anterior incision length of group A were less than that of group B( P <0.05). Postoperative anal exhaust time of group A was lower than that of group B( P <0.05). Improvement degree of ESR, CRP at 3 weeks after anti tuberculosis and 1 week after operation, group A was better than group B( P <0.05), and there was no significant difference between two groups in 1 month and 6 months after operation( P >0.05). There was 1 case sinus formation in group A and 5 cases in group B, there was significant difference in sinus formation rate between two groups ( P <0.05). VAS score and Cobb angle at 1 month after operation was obvious improved( P <0.05), but there was no significant difference between two groups ( P >0.05). Spinal cord nerve injury was obvious improved after operation, but there was no significant difference between two groups., Conclusions: Preoperative percutaneous catheter drainage is a safe and feasible method for the treatment of lumbar tuberculosis with psoas abscess. It can increase the effect of anti tuberculosis before operation, reduce the surgical trauma and reduce the incidence of postoperative complications. It can be recommended in clinical application., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To explore the clinical effect of cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft for lumbar tuberculosis in elderly., Methods: The clinical data of 22 patients with lumbar tuberculosis treated by cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft from February 2015 to December 2016 were retrospectively analyzed. There were 13 males and 9 females with an average age of (73.3±7.1) years old. The pre-operative Frankel grading showed that 2 cases were grade B, 5 cases were grade C, 6 were grade D, and 9 were grade E. Pre- and post-operative kyphosis Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate(ESR) and the Frankel grade were analyzed, the conditions of complication, stability of internal plants, graft fusion were observed., Results: All 22 patients were follow-up for 12 to 24 months with an average of (18.7±4.6) years. Two patients with contralateral psoas major muscle abscess enlarged at 3 months after operation and were cured by drainage under the guidance of type-B ultrasonic. Other 20 cases got primary healing without sinus formation and recurrence of spinal tuberculosis. At the final follow-up, the Frankel grading showed that 3 cases was grade C, 5 cases were grade D, and 14 cases were grade E. The Cobb angle, visual analogue scale (VAS), ESR were respectively decreased from preoperative(17.68±3.86)°, (6.95±2.26) points, (47.14±20.85)mm/h to (4.77±2.47)°, (2.18±1.59) points, (16.77±11.42) mm/h at final follow-up. X-ray and CT scan showed bone union for 3 to 8 months after operation, with a mean time of(4.9±1.2) months., Conclusions: It is effective method to treat lumbar tuberculosis with cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To evaluate the clinical value of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis., Methods: The clinical data of 18 patients with single-level suppurative spondylitis treated by percutaneous endoscopic focal cleaning and drainage from June 2014 to December 2015 were retrospectively analyzed. There were 11 males and 7 females, aged from 46 to 75 years old with an average of (58.89±9.46) years. According to the patient's diagnosis and drug sensitivity results to anti-infection therapy after operation. All the patients were followed up for 12 to 24 months with an average of(15.50±3.45) months. Disease control status was evaluated by laboratory examination of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) before and after operation. Relief of pain was evaluated using visual analogue scale(VAS). Nerve function was assessed by ASIA classification. Clinical effects were evaluated by Kirkaldy-Willis standard. Spinal stability and recurrence of infection were observed by imaging data., Results: All the operations were successful, and no complication as hematoma, nerve injury, infection, cerebrospinal fluid leakage, sinus formation at the site of tube placement, or mixed infection were found. Postoperative bacteriological report was positive in 12 cases, while 6 cases showed no bacterial growth, and the infection status in 13 cases were confirmed by pathological examination. ESR, CRP, VAS at 2 weeks, 3 months after surgery and at the final follow-up were obviously improved( P <0.05). Clinical symptoms were improved significantly at 1 week to 3 months after operation. According to Kirkaldy-Willis standard to evaluate the clinical effect, 14 cases obtained excellent results, 3 good, and 1 fair. Nerve function recovery was based on ASIA grading at the final follow-up. The lost Cobb angles were (1.11±1.18)° on average, with no statistically significant difference before and after operation ( P >0.05). During the follow-up, no recurrent infection has occurred., Conclusions: Percutaneous endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical method, which serves as a new choice for surgical treatment of suppurative spondylitis., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To investigate the application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance., Methods: The 109 pus specimens were obtained from patients who were primaryly diagnosed as spinal tuberculosis. All of the pus specimens were detected by acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay to definite the differences in sensitivity and specificity of mycobacterium tuberculosis among detecting methods. Pus specimens obtained by different methods were deteceded by MTB/RIF test to analyze the self-influence on Xpert MTB/RIF test. The result of liquid fast culturing by BACTEC MGIT 960 was used as the gold standard; and the value of Xpert MTB/RIF assay in detecting rifampin resistance was analyzed., Results: The sensitivity of acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay were 25.92%, 48.15%, 77.78%, respectively. The sensitivity of pus specimens obtained from open surgery, ultrasound positioning puncture and biopsy the sensitivity were 83.78%, 76.47%, 44.68% respectively deteceded by MTB/RIF test. According to the gold standard of the results of liquid fast culturing by BACTEC MGIT 960 assay, the sensitivity and specificity of Xpert MTB/RIF assay in detecting rifampin resistance were 80%(4/5) and 90.70%(39/43), respectively., Conclusions: Xpert MTB/RIF assay has higher value in diagnosis of spinal tuberculosi, and also can detect rifampin resistance. The number of mycobacterium tuberculosis in pus specimens has a great influence in the sensitivity of Xpert MTB/RIF assay., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To explore the clinical effects of one-stage posterior transpedicular screw system internal fixation combined with anterior debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach in treating multiple lumbosacral tuberculosis., Methods: The clinical data of 15 patients with multiple lumbosacral tuberculosis underwent operation from February 2008 to December 2014 were retrospectively analyzed. There were 9 males and 6 females with an average of (47.0±13.9) years old. The lesions involved L₄-S₁ in 12 cases, L₄-S₂ in 1 case, L₃-S₁ in 2 cases. Five cases complicated with nerve root symptoms and 2 cases with cauda equina symptoms. All patients were treated with posterior transpedicular screw system internal fixation combined with anterior L₄,₅, L₅S₁ debridement and bone grafting with modified inverted L-shape incision by extraperitoneal approach. Operation time, blood loss, incision length, first passage of gas by anus were recorded. The condition of bone fusion and focus absorption were observed by lumbar CT and MRI; and ESR and CRP were regularly rechecked., Results: Fifteen patients were followed up for 18-24 months with an average of (20.0±2.73) months. All lumbosacral pain obtained improvement, and no hardware loosening, breaking, or bone graft block loosening was found. The operative time of anterior-posterior approach surgery was 210-250 min with an average of (231.0±12.1) min; the blood loss was 320-705 ml with an average of(495.0±130.3) ml; the incision length was 15-21 cm with an average of (16.4±3.4) cm, and the extended length of inverted L-shape incision was 6 to 9 cm with an average of (7.1±2.6) cm. The time of first passage of gas by anus was 14 to 40 h with an average of (24.1±7.4) h after operation. All bone graft obtained fusion at final follow-up, and spinal cord symptoms got recovery, ESR and CRP restored normal level with no recurred at 3 months after drug withdrawal., Conclusions: The treatment of multiple lumbosacral tuberculosis with posterior transpedicular screw system internal fixation combined with anterior debridement and bone fusion with modified inverted L-shape incision by extraperitoneal approach is feasible and practical. This method has advantages of little trauma, good exposure, less complications and high security., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To explore clinical outcomes and advantages of anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal tuberculosis., Methods: From February 2010 to February 2014, totally 82 patients with lumbar spinal tuberculosis were treated by posterior individual fixation with small-incision focus debridement,including 50 males and 32 females with an average of 50.5 years old. All patients were divided into two groups according to different procedures. Forty-nine patients in group A were treated with anterior small-incision focus debridement with posterior internal fixation through muscle spa ring at stage I ; and 33 patients in group B were treated with focus debridement with posterior internal fixation by extraperitoneal approach at stage I . Postoperative mechanical ventilation time, preoperative and postoperative Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and Frankel grading were observed and compared. Postoperative complications, stability of internal fixation and bone union were compared., Results: All patients were followed-up from 15 to 36 months with an average of 23.7 months. Psoas abscess of three patients in group A and 1 patient in group B on the opposite side increased and were healed by the secondary apocenosis. The other 78 cases were healed at stage I, and no sinus tract formation, incisional hernia, leakage of cerebrospinal and occurrence of spinal tuberculosis were occurred. Fracture healing time ranged from 3 to 7 months with an average of 4.6 months. Postoperative mechanical ventilation time and VAS score in group A was better than group B. There were no statistical differences in Cobb angle, ESR and Frankel grading at the final following-up between two groups., Conclusion: Anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal according to degree of damage is a safe and effective method.

Objective: To investigate the mid-term outcome of operation for thoracolumbar tuberculosis. METHODS : Twenty-eight patiens with thoracolumbar tuberculosis underwent one stage anterior debridement,interbody fusion with bone graft and posterior pedicle screw internal fixation treatment from July 2006 to July 2011. There were 17 males and 11 females. Total 17 patients had nerve injuries ,including 6 cases of grade B, 5 cases of grade C, 6 cases of grade D according to Frankel classification. The poisoning symptoms of tuberculosis and recovery of spinal function were observed. The bone fusion and recovery of [umbar function were evaluated., Results: All the patients were followed up ,and the duration ranged from 39 to 85 months (mean 57 months). The clinical symptoms were controlled gradually, and the thoracolumbar back pain was alleviated after operation. Among the 17 patients with complications of nerve injuries, 3 patients were improved from preoperative grade B to postoperative grade D, 3 patients were improved from preoperative grade B to postopertive E, 5 patients with preoperative grade C and 6 patients with preoperative D were almostly recovered to normal after operation. According to JOA scoring system for curative effect evaluation, the excellent and good rate at the 3rd month, the 1st year, the 3rd year and the 5th year after operation were 67.86% ,82.14% ,85.71% ,89.29% and 91.30% respectively. The results at the 6th month and the 1st year had no statistical differences compared to the results at the 3rd month (P > 0.05); but the results at the 3rd year and the 5th year were better than that at 3 months after operation (P < 0.05); and the results between 3 yesrs and 5 years after operation had no statistical differences (P < O.05). The degeneration of adjacent segments were evaluated according to the California University (Universith of California at Los Angeles , UCLA) score. The degeneration rate was 53.57% (15/28) at the 3rd year after surgery, which was better than that before surgery. Twenty-three patients were followed up for 5 years ,and the degeneration rate was 86.96% (20/23) ,which was better than those of before surgery and 3 years after surgery., Conclusion: The surgical treatment for thoracolumbar spinal tuberculosis can achieve the thorough debridement, reconstruction of spinal stability, recovery of lumbar function and promote the functional recovery of the spinal cord, which is an effective method of treatment. However, the mid term follow-up showed that more severe degenerative changes were found in the postoperative adjacent segment.

Objective: To compare the clinical outcomes between two different methods in the treatment of Bennett fractures., Methods: From May 2005 to June 2009, 31 patients with Bennett fractures were treated with gypsum and percutaneous fragment pin fixation. In gypsum fixation group,there were 17 cases including 12 males and 5 females with an average age of (43.9-5.7) years; according to Buechler classification: 3 cases were I region fracture, 11 cases were II region fracture, 3 cases were III region fracture. In percutaneous fragment pin fixation group,there were 14 cases including 8 males and 6 females with an average age of (45.6 +/- 6.1) years; according to Buechler classification: 3 cases were I region fracture, 9 cases were II region fracture and 2 cases were II region fracture. The observing and comparing items of the two groups included: (1) length of stay, time of fracture healing,failure of fixation; (2) postoperative radiographs comparison according to method of Kjaer-Petersen; (3) cannon scores used for outcome measurement., Results: All the patients in the two groups were followed up, the duration ranged from 6 to 15 months,with an average of (9.0 +/- 3.5) months. The length of stay were (7.0 +/- 2.5) d in gypsum fixation group and (9.0 +/- 3.9) d in percutaneous fragment pin fixation group with statistically significant differences (P < 0.05). The postoperative reduction quality according to method of Kjaer-Petersen, in gypsum fixation group:4 patients got an excellent result, 8 good and 5 poor; in percutaneous fragment pin fixation group,the above data were 8, 6 and 0 respectively;there were statistically significant differences (P < 0.05 ) between the two groups. The time of fracture healing were (6.0 +/- 0.5) weeks in gypsum fixation group and (6.0 +/- 1.9) weeks in percutaneous fragment pin fixation group with no statistically significant differences (P > 0.05). Cannon scores were evaluated at postoperative 3 months,in gypsum fixation group: 6 patients got an excellent result, 8 good and 3 fair; in percutaneous fragment pin fixation group,the above data were 8, 5 and 1 respectively; there were no statistically significant differences (P > 0.05) between two groups. Two patients had fracture re-displacement in gypsum fixation group, and no failure cases in percutaneous fragment pin fixation group., Conclusion: There are satisfied therapeutic effects in two different methods for the treatment of Bennett fractures. However, gypsum fixation has advantage of easy to operate and atraumatic, but unstability and easy to displacement; percutaneous fragment pin fixation has advantage of fixed solidly and better in functional rehabilitation, but big in surgical trauma and long in length of stay.

Objective: To compare and evaluate the effect of autologous cancellous bone and cancellous bone enriching bone marrow stem cell for the repairing the defects of articular cartilage, and purpose the experimental basis for clinical application., Methods: By using the completely random design, 16 adult rabbits were divided into two groups randomly. Autologous cancellous bone and cancellous bone enriching bone marrow stem cells were applied for repairing size-matched, full-thickness articular cartilage defects on the femoral condyle of the knees. The reconstructed tissues were observed by gross, optical and microscopy view and Wakitani score at 12 weeks respectively., Results: In cancellous bone enriching bone marrow stem cells group, articular surface was ivory white and relative evenness, the regenerated tissues integrated well with the surrounding normal cartilage with obscure boundary between them. The thickness of regenerated tissues was two-third of normal cartilage, the Wakitani score was 4.44 +/- 1.41. In autologous cancellous bone group, articular surface was gray and introcession, the regenerated tissues was very thin, the thickness of regenerated tissues was one thirds or one half of normal cartilage, the Wakitani score was 8.93 +/- 1.18. The differences between two groups were significant (P < 0.01)., Conclusion: Cancellous bone enriching bone marrow stem cells are feasible for repairing of large articular cartilage defects with hyaline cartilage. The repairing ability of autologous cancellous bone is inferior.

To date, there is no consensus on the best technique to repair injured posterolateral structures of the knee. We evaluated the effects of a fibular head based isometric reconstruction of the posterolateral knee corner with a double bundle semitendinosus tendon. From February 2001 to February 2005, 18 isometric reconstructions of a chronic posterolateral corner (PLC) injury of the knee were performed using the semitendinosus tendon. The average age of the patients was 39 years, ranging from 19 to 52 years. Twelve were male and 6 female. The time interval between injury and treatment ranged from 1.5 to 14 months. Three patients had simple PLC injuries, 10 had combined PLC-posterior cruciate ligament (PCL) injuries and two of them had undergone a PCL reconstruction elsewhere 6.5 months prior to referral. Three other patients had an associated anterior cruciate ligament (ACL) injury and two had a combination of PLC with ACL and PCL injury. A doubled semitendinosus tendon was threaded through bony tunnels in the fibular head running from the insertion of the lateral collateral ligament (LCL) to the fibular insertion of the popliteo-fibular ligament and both ends were fixed proximally into bony tunnels of the lateral femoral condyle at their respective isometric point. The varus stress test and the posterolateral rotation test were used to evaluate stability of the posterolateral structures. Isometry was optimal between the femoral attachment site of the popliteal tendon to the anatomical insertion of the popliteofibular ligament at the fibular head. The fibular insertion of the LCL is isometric to the anterior or antero-inferior 8-10 mm of the femoral insertion of the LCL. The average follow-up period was 32 months (30-42 months). There was no varus knee instability in full extension. At 30 degrees of flexion two cases demonstrated a grade I varus instability. A fibular head based isometric reconstruction is a reproducible and reliable technique for reconstruction of the posterolateral corner of the knee.

Objective: To explore the isometric attachment site of knee lateral collateral ligament (LCL) in the femoral lateral condyle; to introduce the isometric reconstruction of knee lateral collateral ligament with the long head of biceps femoris tendon., Methods: Among 16 patients with knee injury treated with isometric reconstruction of the lateral collateral ligament, 10 patients were male and 6 patients were female, with an average age of 38.4 years (ranged from 20 to 58 years). Twelve patients were chronic injuries, four patients were acute injuries, with an average duration of 5 days to 11 months. Eleven patients had simple LCL injury,3 patients had LCL injury combined with PCL injury, 2 patients had LCL injury combined with ACL injury. The middle one third of the long head of biceps femoris tendon was cut to be fixed to the isometic bony tunnel of the femoral lateral condyle. The lateral stability of the knee was evaluated mainly through varus stress test., Results: The better isometric attachment site is from the anatomical caput fibulae attachment site or the middle one third of the long head of biceps femoris to the femoral lateral condyle to 8-10 mm in front of the anatomical femoral attachment site of the lateral collateral ligament. The average follow-up period was 13.5 months (ranged from 12 to 24 months). At the 12th month after operation, there was no varus instability in full extension. At 30 degrees flexion, one-grade varus instability was found in 2 patients. In varus stress test the lateral joint space increased less than 5 mm compared to the healthy side., Conclusion: The method provided good stability for the knee and acquired satisfactory clinical results.

Objective: To evaluate the biomechanical personality of the sacroiliac anatomy type Bar-plate system (SABP), which was of fixation usage to the fracture or dislocation of the sacroliliac joint., Methods: Twenty fresh and freeze cadaver pelvises were prepared with pelvic fracture model,compared with different internal fixation systems such as Galveston technique, transiliac rod fixation, reconstruction plate and sacroiliac joint screws using experimental stress analysis methods,and then the stability of the pelvic was obtained and evaluated., Results: Using new SABP system to treat pelvic sacroiliac joint fracture and dislocation was higher 10%, 11%, 16%, 21% in the strength; more 12%, 14%, 21%, 31% in rigidity; less 13%, 14%, 22%, 25% in straining;less 10%, 12%, 16%, 20% in shifting than the Galveston technique, transiliac rod fixation, reconstruction plate and sacroiliac joint screws, with remarkable statistic difference (P < 0.05), and it was even better than cadaver pelvis., Conclusion: To treat pelvic facture, the fixation with new SABP system is of better strength, rigidity and stability, and the SABP system is an ideal new application.