Pedicle screw fixation is widely used in spine surgery, which allows 3?dimensional fixation with a more rigid construct and permits a shorter fusion length. However, conventional pedicle screw fixation has some drawbacks, including signifi?cant muscle dissection for the exposure of bone marks. Although percutaneous pedicle screw technique can compensate for above defects, it requires an additional approach for decompression and bone graft insertion. Besides, the percutaneous pedicle screw technique depends on intraoperative multiplanar fluoroscopy, which results in high risk of radiation exposure of the surgeons and patients. Screw loosening is a well?known complication, especially in osteoporosis patients. Several methods can enhance screw stability, for example, modifying screw design and augmenting vertebral bodies with reinforcing materials that can improve the structural capacity of the deteriorated tissue, however, they also have some disadvantages. Although we can enhance bone?screw by modifying screw design, it is not useful in severe osteoporosis patients. At the same time, bone cement can increase pedicle screw axial pullout strength and fatigue resistance, however, it is associated with a number of inherent disadvantages such as its high exothermic polymerizing temperature, toxicity of the monomer, and risk of leakage to the spinal canal. Santoni et al. intro?duced cortical bone trajectory (CBT) for lumbar pedicle screw with a new screw design that is shorter and smaller in diameter which has been proposed to maximize the thread contact with this higher density bone surface. In addition, the CBT technique fol?lows a caudocephalad path sagittally and a laterally directed path in the transverse plane, engaging only cortical bone in the pedi?cle without the involvement of the vertebral body trabecular space. Finally, the screw insertion point of this technique locates around lateral pars, enabling less tissue dissection. Therefore, it can be an alternative approach to enhance screw fixation strength, and it may rescue failed pedicle screw and be used in minimally invasive spine surgery.

Objective: To observe an abnormal expression of humoral immune response induced by memory B cells in tonsils and peripheral blood of patients with IgA nephropathy ( IgAN) , the variation of memory B cells after tonsillectomy , and to discover the role of tonsillectomy in IgAN .Methods: In the study , 28 patients were diagnosed as IgAN via renal biopsy , and 27 patients suffering from chronic ton-sillitis without nephritis and 10 normal human beings were selected as controls .The expression of memory B cells in the tonsils and peripheral blood was tested by flow cytometry , and the same method was used to test the variation of the expression of memory B cells in peripheral blood of patients with IgAN after tonsil -lectomy.Results:In this study , higher percentages of memory B cells were observed in tonsil and pe-ripheral blood of IgAN patients, which were 5.72%±5.26%, 4.92%±5.10%.After tonsillectomy, the percentage of memory B cells was 1 .10%±0 .65%, lower than that before tonsillectomy ( P <0.05).Meanwhile, in tonsils and peripheral blood , the percentage of memory B cells varied with the variation of the urinary findings of the IgAN patients .Conclusion:The percentage of memory B cell in tonsils and peripheral blood could predict disease progression of IgAN to a certain extent .

Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion (TLIF) surgery.Methods A retrospective study was conducted within 587 patients (average age 57.1 years,range 19-71 years) who underwent unilateral TILF from January 2010 to January 2014 in our hospital,including 334 males and 253 females.Patients were divided into a symptomatic group and an asymptomatic group.The causes of contralateral neurological symptom were evaluated according to the radiological data.The difference of pre-and post-operative contralateral foramen area (CFA),segmental angle (SA) and the clinical treatment outcomes (VAS,JOA score) were compared between two groups.Results Patients were followed up for 9-21 months,average 15.1 months.Post-operative contralateral radiculopathy occurred in 28 (4.8％) of the patients who underwent unilateral TLIF,including contralateral foraminal stenosis in 16 (57.1％,16/28),screw malposition in 5 (17.9％,5/28),contralateral lateral recess stenosis and/or newly developed disc herniation in 3 (10.7％,3/28),hematoma in 1 (3.6％,1/28),cement compression in 1 (3.6％,1/28),and unknown origin in 2 patients (7.1％,2/28).Nineteen (3.2％,19/587) of the 28 patients received revision surgery because of ineffective conservative treatment.Compared with the asymptomatic group,the difference of pre-and post-operative CFA was significantly smaller (-13.8±13.2 mm2) in symptomatic group,while the SA was significantly greater (7.0°±9.8°) in symptomatic group.The JOA score at 3 months after the surgery was significantly improved in asymptomatic group (63.0％±18.1％,P＜0.05).Conclusion The incidence rate of contralateral neurological symptom was 4.8％ in the present study.The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition.The excessive restoration of SA might have an effect on contralateral nerve compression,which should arouse the attention of the surgeon.

Objective:To analyze the number of appeals volume and causes for complaints received by the government hotline against a hospital in Yangzhou during the pandemic of novel coronavirus pneumonia(hereinafter referred to as COVID-19), so as to provide reference for handling such hotline complaints during pandemics.Methods:Retrospective comparative analysis was made on the " 12345" government hotline work orders received from July 28, 2020 to August 28, 2020(routine prevention and control period) and July 28, 2021 to August 28, 2021(pandemic closure and control period). A descriptive analysis was made on the cause types of complaints and the distribution of departments in question, along with an analysis of the correlation between the cumulative number of cases of pandemic development and the number of complaints using Spearman rank correlation method.Results:The number of work orders for a hospital in Yangzhou during the pandemic control period(659 cases) was 7.7 times higher than that in the routine control period(76 cases). Management problems accounted for 96.7%(637 cases) in the level-1 type of the causes of complaints during the closure and control period of the pandemic, and workflow problems accounted for 90.9%(599 cases) in the level-2 type, which increased by 28.3 and 27.7 percentage points respectively compared with the routine prevention and control period; The highest proportion in the level-3 type of causes for complaints during the closure and control period of the pandemic was administrative management, accounting for 87.9%(579 cases). The departments being complained the most during the pandemic incubation period, outbreak period and recovery period of the pandemic were the fever clinic, oncology department and discharge center respectively. The cumulative number of cases of pandemic development was positively correlated with the number of complaints.Conclusions:During the COVID-19, the handling of the government hotline should be analyzed along with the causes of complaints, focusing on patients′ demands, providing timely feedback, developing collaborative management measures, and achieving accurate policy implementation.

Objective:To explore the application effect of structural psychological intervention in patients with acute myocardial infarction (AMI) .Methods:A total of 196 AMI patients who were admitted to Zhumadian Central Hospital from January 2016 to October 2019 were selected as research objects. They were divided into the control group ( n=97) and the observation group ( n=99) according to the random number table method. Patients in the control group received routine nursing intervention, and the observation group performed structural psychological intervention on the basis of the control group. General Self-Efficacy Scale (GSES) , Barthel index, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to compare the effects of intervention. Results:After 2 months of intervention, GSES score and Barthel index of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . After 2 months of intervention, SDS and SAS scores of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Structural psychological intervention can improve the self-efficacy of patients with AMI, and at the same time alleviate negative emotions such as anxiety and depression, thereby helping to improve prognosis.

Waldenstrom's macroglobulinemia(WM)is a lymphoplasmacytic lymphoma associated with immunoglobulin M(IgM),due to its rarity in domestic and international reports,it is often over-looked in clinical treatment,and gradually progressing to end-stage renal disease and affecting patient's prognosis.In recent years,there has been an increase in treatment options for WM.This study re-viewed the diagnosis and treatment of a patient with WM complicated by chronic renal failure,and an-alyzed the progress in diagnosis and treatment of this disease by reviewing relevant literatures from both domestic and international sources.

Waldenstrom's macroglobulinemia(WM)is a lymphoplasmacytic lymphoma associated with immunoglobulin M(IgM),due to its rarity in domestic and international reports,it is often over-looked in clinical treatment,and gradually progressing to end-stage renal disease and affecting patient's prognosis.In recent years,there has been an increase in treatment options for WM.This study re-viewed the diagnosis and treatment of a patient with WM complicated by chronic renal failure,and an-alyzed the progress in diagnosis and treatment of this disease by reviewing relevant literatures from both domestic and international sources.

Objective To investigate the clinical significance of complement activation in patients with HBV related glomerulonephritis (HBV-GN).Methods Biopsy-proven HBV-GN patients admitted in our hospital were retrospectively recruited.Decreased serum C3 level was defined as C3 ＜ 85 mg/dL.According to the serum C3 level,the patients were divided into the decreased serum C3 group and normal serum C3 group,and the pathological and clinical differences were compared between the two groups.According to the intensity of C3 deposition in the kidney,patients were divided into negative and positive group,and the pathological and clinical differences were compared.Results In this study,29 HBV-GN patients were recruited.There were 18 (62.07％) patients in the normal serum C3 group and 11 (37.93％) patients in the decreased serum C3 group.Compared with the patients with normal serum C3 level,patients with decreased serum C3 level had higher serum creatinine level,lower eGFR level,severer mesangial proliferation and renal interstitial fibrosis (P ＜ 0.05).There were 9 (31.03 ％) patients with negative C3 deposition in the kidney,and 20 (68.97％) patients with positive C3 deposition.Higher cholesterol,higher IgG levels,lower serum albumin,serum C 3 levels,lower eGFR level,severer glomerular sclerosis,inflammatory cell infiltration in renal interstitial,renal tubular atrophy,and renal interstitial fibrosis were associated with a higher grade of C3 deposition in the kidney (P ＜ 0.05).Conclusion There are different levels of complement activation in patients with HBV-GN.Local and systemic complement activation is associated with decreased renal function.Complement activation may be involved in the development of HBV-GN.

Objective To investigate the clinical significance of complement activation in patients with HBV related glomerulonephritis (HBV-GN).Methods Biopsy-proven HBV-GN patients admitted in our hospital were retrospectively recruited.Decreased serum C3 level was defined as C3 ＜ 85 mg/dL.According to the serum C3 level,the patients were divided into the decreased serum C3 group and normal serum C3 group,and the pathological and clinical differences were compared between the two groups.According to the intensity of C3 deposition in the kidney,patients were divided into negative and positive group,and the pathological and clinical differences were compared.Results In this study,29 HBV-GN patients were recruited.There were 18 (62.07％) patients in the normal serum C3 group and 11 (37.93％) patients in the decreased serum C3 group.Compared with the patients with normal serum C3 level,patients with decreased serum C3 level had higher serum creatinine level,lower eGFR level,severer mesangial proliferation and renal interstitial fibrosis (P ＜ 0.05).There were 9 (31.03 ％) patients with negative C3 deposition in the kidney,and 20 (68.97％) patients with positive C3 deposition.Higher cholesterol,higher IgG levels,lower serum albumin,serum C 3 levels,lower eGFR level,severer glomerular sclerosis,inflammatory cell infiltration in renal interstitial,renal tubular atrophy,and renal interstitial fibrosis were associated with a higher grade of C3 deposition in the kidney (P ＜ 0.05).Conclusion There are different levels of complement activation in patients with HBV-GN.Local and systemic complement activation is associated with decreased renal function.Complement activation may be involved in the development of HBV-GN.