Objective:To investigate the neuroprotective effect and possible mechanism on rats with low dose Lipopoly -saccharide ( LPS) preconditioning after spinal cord injury.Methods:120 female SD rats were randomly divided into the empty virus (EV) group,LPS+empty virus (LPS+EV) group,Nrf2 interference virus (NIV) group,LPS+Nrf2 interference virus (LPS+NIV) group.The model of traumatic spinal cord injury ( TSCI) was established by the modified Allen′s method,motor function of the rat hind limb was assessed by the Basso Beattie and Bresnahan (BBB) score at 1,3,7,14 and 28 d after the operation.The injured spinal cord tissue samples were harvested at each time ,and the pathological changes of rat spinal cord were observed by HE staining ,the Nissl body and neuron survival index were observed by Nissl staining ,the expressions of Nrf2 and GCLC protein level were detected by immunohis-tochemical staining and Western blot.Results:The rat BBB score of LPS+EV group increased significantly than EV group at 7,14,28 d after operation ( P<0.05 ,P<0.01 );The NIV group between LPS+NIV group have no statistical significance at each time.As compared with EV group:the Nrf2 protein of LPS+EV group was expression increased significantly and Nissl staining showed that the neurons survival index was increased at 1,3 and 7 d(P<0.05,P<0.01);The GCLC protein of LPS+EV group was expression increased significantly at 1-14 d( P<0.05 );HE staining showed that the injured spinal cord pathological changes of LPS +EV group was obviously improved.Conclusion:Low dose lipopolysaccharide preconditioning can accelerate the nerve function recovery on rats with traumatic spinal cord injury ,the mechanism may be regulated by activating the Nrf 2 antioxidant stress pathway.

ObjectiveTo investigate the neural mechanism of prospective memory(PM) using functional magnetic resonance imaging (fMRI).MethodsFifteen healthy volunteers were enrolled,and all subjects were scanned with fMRI while performing the event-based PM tasks (double-task paradigm,including the ongoing task and PM task).And the image data were preprocessed and analyzed by using SPM8 software.Results ( 1 ) Compared to the control task,bilateral rostral prefrontal cortex ( x,y,z =6/- 2,54/42,- 8/- 12,t =3.71 ),right somatosensory association area ( x,y,z =14,- 62,64,t =4.64 ),superior temporal gyrus ( x,y,z =42,- 46,16,t =3.95 ) and right paracentral lobule (x,y,z =10,-22,76,t =4.01 ) were activated significantly by the ongoing task (P ＜ 0.001 ).(2) Bilateral rostral prefrontal cortex ( x,y,z =- 2/6,42/54,- 12/- 12,t =3.28) and paracentral lobule (x,y,z =- 30/10,- 22/- 22,72/76,t =4.25 ),left postcentral gyrus ( x,y,z =- 38,- 46,64,t=3.13) and middle occipital gyrus ( x,y,z =- 30,- 70,0,t =3.97 ) were activated significantly by the PM task (P ＜ 0.001 ).ConclusionRostral prefrontal cortex (BA 10 area) is the major area of prospective memory,and medial BA10 area may be involved in the monitoring of external cues.The present study supports the gateway hypotheses of prospective memory.

Objective To study the X-ray features and differential diagnosis of duodenal obstruction in neonates.Methods X-ray data of duodenal obstruction in 52 cases confirmed surgically were analyzed retrospectively.Erect abdominal plain films were done in each case;Upper gastric intestinal investigations(UGI) were performed in 28 cases,and barium or meglumine diatyizoate enemas were done in 36 cases.Results On the plain films,9 cases with single-bubble,29 with double-bubble,6 with tri-tubble,8 with multiple stepladder-like gas-fluid level in the bowel loops were noted.14 cases with completive obstruction and 13 cases with partial obstruction were found in UGI series.Malposition of the jejunum was seen in 8 cases among them.Abnormal location of cecum on barium enema was demonstrated in 30 cases,included 10 cases of microcolon.The etiology of duodenal obstruction included intestinal malrotation 34 cases,duodenal atresia 9 cases,duodenal stenosis 4 cases and anaular pancreas 5 cases.Conclusion Most cases of duodenal obstruction can be diagnosed with plain films combining with clinical materials.Differential diagnosis should be made by UGI series and barium enema.

Constructivism teaching theory emphasizes the central role of student in learning and this theoretical framework holds that learning always builds upon the active exploring and discovering new knowledge.Department of orthopedics in the first affiliated hospital of Chongqing Medical University introduced and implemented constructivism teaching in teachers' research and teaching activity as well as in students' learning.This mobilized students' learning enthusiasm and improved clinical teaching quality.

Objective · To observe the changes of cerebral gray matter pre- and post-treatment with short term drugs in patients with schizophrenia. Methods · T1-weighted brain MRIs were obtained on a 3T scanner in 21 controls and 27 subjects with schizophrenia who were not given antipsychotic medication. The controls and 21 schizophrenia patients received the second scan after 8 weeks of antipsychotic treatment. Voxel-based morphometry (VBM) were used to investigate the differences in gray matter (GM), mainly about the regional GM volumes. Results · GM volumes were significantly smaller in the patient group than those of healthy controls in left cerebellum posterior lobe , left and right parahippocampalgyrus, left middle temporal gyrus(P=0.000, voxels>50). GM volumes extensively decreased after 8 weeks of antipsychotic-treatment compared with pre-treatment in the superior, middle, and inferior temporal gyri, superior,middle and inferior frontal gyri, parahippocampa gyri, cingulate gyri, right supramarginal gyrus, right cerebellum posterior lobe, and right lingual gyrus(P=0.000, voxels>50). Conclusion · Short term antipsychotic treatment (8 weeks) may have adverse effects on the gray matter of patients with acute schizophrenia by reducing the volume of gray matter.

Objective To provide better emergency and patient services in well-equipped comprehensive hospitals, the organization and wisdom therapeutic strategy are of great importance for the recovery of injured patients from the earthquake zone. Method From 12 May 2008, following the 8.0 Magnitude earthquake in Wenchuan county of Sichuan Province, six Chongqing hospitals with third class in grade A were involved in the rescue of the injured patients with great effort. A total of 533 patients were retreated and followed up from quake zone. All the patients were scored with ISS and AIS system. The profiles of the patients examined, operated and clinical infection investigation were documented. Results Of 533 patients, the number of the patients whose ISS is below 16 is 456 (83.6%), the number between 16 and 25 is 65 (12.2%), and the humor above 25 is 12 (2.3%). The patients were classfled based on their fracture parts as follows: head and neck (n = 42), face (n = 7), chest (n = 114), abdominal and cavitas pelvis (n =81), limb and pelvis (n =314), body surface (n =205), with 180 single fracture site, 139 of them being two combined fracture sites, and 114 of them being above three combined fracture sites. Thirty-two of the patients were suffered from amputation. The number of patients suffered from crushing syndrome reached 21, with 281 surgical operations in hospitals. Seventy-nine patients were suffered from infections including 87.3% of pre-hespital infections. The results from bacteria culture and antibiotic susceptibility showed that the infected bacteria mainly involved in Escherichia coli, Staphylococcus anreus, Staphylococcus haemolyticns, Klebsiella pneumoniae, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus, Bacillus aerogenes capsulatus. The antibiotic susceptibility to diverse bacteria has no obvious changes and exists partial overlapping, and infected patients should be given the treatment of cephalosporin, macrolide antibiotic and so on. Conclusions For the emergency conditions after the catastrophe, the comprehensive hospitals must be prepared to meet large quantities of severe trauma and infection therapy. The scientific selection of antibiotics in the combinative therapy is of great importance to the enhancement of early specific treatment, prevention of severe trauma complications and rehabilitation of patients.

Objective:To compare the efficacy of cervical decompression performed at different times in the treatment of incomplete cervical spinal cord injury.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 96 patients with incomplete cervical spinal cord injury admitted to six hospitals including Honghui Hospital affiliated to Xi'an Jiaotong University, etc, from May 2018 to May 2021. There were 36 females and 60 males, aged 28-42 years [(35.2±6.7)years]. The injured segments were at C 3 in 7 patients, C 4 in 15, C 5 in 20, C 6 in 23 and C 7 in 31. According to the American Spinal Injury Association (ASIA) scale, there were 59 patients with grade B, 27 grade C, and 10 grade D. A total of 36 patients underwent cervical decompression within 24 hours after injury (early group), 33 patients within 24-72 hours after injury (late group), and 27 patients within 4-14 days after injury (delayed group). The operation time, intraoperative blood loss, postoperative drainage, length of hospital stay, Cobb angle, height of intervertebral space and space occupation of the spinal canal before surgery and at postoperative 3 days, and ASIA score, ASIA motor score, ASIA light tactile score, ASIA acupuncture sensation score, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck dysfunction index (NDI) before surgery and at postoperative 3 months, 1 year and at the last follow-up and incidence of complications were compared among the three groups. Results:All the patients were followed up for 12-21 months [(16.4±4.2)months]. There was no significant difference in the operation time among the three groups (all P>0.05). The intraoperative blood loss and postoperative drainage volume in the early group were (312.5±5.2)ml and (165.3±45.8)ml, which were higher than those in the late group [(253.5±40.0)ml, (120.4±60.6)ml] and the delayed group [(267.3±36.8)ml and (130.4±38.6)ml] (all P<0.01). There was no significant difference between the late group and the delayed group (all P>0.05). The length of hospital stay in the early group was (5.2±1.6)days, which was shorter than that in the late group [(7.6±2.3)days] and the delayed group [(8.0±1.3)days] (all P<0.05), but there was no significant difference between the late group and the delayed group ( P>0.05). There was no significant difference in the Cobb angle, height of intervertebral space and space occupation of the spinal canal among the three groups before and at postoperative 3 days (all P>0.05). There was no significant difference in the ASIA score, ASIA motor score, ASIA light tactile score, ASIA acupuncture sensation score, VAS score, JOA score and NDI among the three groups before surgery (all P>0.05). At postoperative 3 months, 1 year and at the last follow-up, the ASIA grading of the early group was better than that of the late group and the delayed group ( P<0.05 or 0.01), but there was no statistically significant difference between the late group and the delayed group (all P>0.05). The ASIA motor scores of the early group were (56.4±4.5)points, (76.3±3.6)points and (85.4±6.5)points at postoperative 3 months, postoperative 1 year and the last follow-up, respectively, which were higher than those in the late group [(52.3±2.4)points, (60.3±8.6)points and (72.3±2.4)points] and the delayed group [(51.9±2.3)points, (62.8±4.6)points and (71.9±1.3)points]; the ASIA light tactile scores of the early group were (70.2±2.9)points, (72.6±4.3)points and (78.3±2.3)points, which were higher than those in the late group [(66.2±3.7)points, (68.3±1.6)points and (73.3±1.6)points] and the delayed group [(65.2±2.1)points, (67.8±1.9)points and (72.3±2.5)points]; acupuncture sensation scores of the early group were (71.9±3.1)points, (80.1±3.8)points and (89.1±7.6)points, which were higher than those in the late group [(67.4±2.7)points, (72.6±3.7)points and (77.9±1.8)points] and the delayed group [(68.3±2.2)points, (72.6±3.1)points and (77.2±1.9)points] (all P<0.05). VAS scores of the early group at postoperative 3 months, 1 year and at the last follow-up were (4.3±0.6)points, (2.4±0.3)points and (1.6±0.2)points, which were lower than those in the late group [(5.1±1.3)points, (4.1±0.6)points and (3.0±0.6)points] and the delayed group [(5.0±1.7)points, (4.0±0.8)points and (3.1±0.2)points]; JOA scores of the early group were (12.8±1.6)points, (14.4±2.6)points and (17.9±3.3)points, which were higher than those in the late group [(11.9±1.9)points, (13.3±1.6)points and (8.9±1.3)points] and the delayed group [(11.6±1.8)points, (13.2±1.4)points and (9.3±2.1)points]; NDI scores of the early group were 12.1±3.3, 10.1±2.1 and 7.3±1.4, which were lower than those in the late group (14.4±3.1, 12.3±1.6 and 8.9±1.3) and the delayed group (14.1±2.3, 12.9±1.9 and 9.5±2.1) (all P<0.05). There was no significant difference in all the above-mentioned scores at postoperative 3 months, 1 year and at the last follow-up between the late group and the delayed group (all P>0.05). The incidence of complications was 25.0% (9/36) in the early group, 27.3% (9/33) in the late group and 37.0% (10/27) in the delayed group (all P>0.05). Conclusion:Compared with within 24-72 hours and 4-14 days after injury, cervical decompression performed within 24 hours after injury for patients with incomplete cervical spinal cord injury can shorten the length of hospital stay, improve the function of the spinal cord nerves and relieve pain, with no increase of the incidence of complications.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.