Objective To analyze and evaluate the effect of posterior circumferential fusion for treatment of the mechanical instability of lumbar spine, and discuss the relative merits,indications and contraindications in this procedure. Methods Two hundred and two patients with mechanical instability of lumbar spine treated by the posterior instrumented circumferential fusion technique from January 2001 to January 2007. One hundred and thirty-two patients were selected who were treated with only one segment fusion and followed up for at least 1 year, of them 97 patients suffered lumbar spondylolisthesis, 35 patients suffered degenerative lumbar instability. X-ray was used to evaluate the fusion condition of the bone graft, and VAS and ODI questionnaire were applied to assess the pain of back and leg,and the conventional function. Results All patients were followed up for 12-84 months, averaged (43±23) months,125 patients got bone fusion, accounted for 94.7%(125/132). The VAS of low back pain was (6.71 ± 1.31) points before operation, while (3.20 ± 1.14) points after operation (P < 0.05) ,and the VAS of leg pain was (8.33 ± 1.78) points before operation,while (4.31 ± 1.15) points after operation (P< 0.05). The ODI was (68.6 ± 14.7) % before operation, while (13.6 ± 1.5) % after operation (P < 0.05). Conclusions Posterior circumferential fusion is a positive and excellent treatment for the mechanical instability of lumbar spine. With its merits, the high fusion rate and good clinical results can be received.

Traumatic spinal cord injury (TSCI) is a common nerve injury in the world, which has a high incidence and disability rate. Intraspinal pressure (ISP) monitoring is performed by placing a pressure sensing probe under the dura of the most severe part of the spinal cord injury after anterior/posterior laminectomy or vertebral body decompression. ISP value is monitored dynamically and objectively in real time by the pressure sensing system. Recent studies have found that ISP monitoring plays an important role in the clinical management and prognosis evaluation of TSCI. The author reviews the recent advance in ISP monitoring in TSCI in order to provide references for the improvement of clinical diagnosis and treatment of TSCI.

Traumatic spinal cord injury (TSCI) is a common nerve injury in the world, which has a high incidence and disability rate. Intraspinal pressure (ISP) monitoring is performed by placing a pressure sensing probe under the dura of the most severe part of the spinal cord injury after anterior/posterior laminectomy or vertebral body decompression. ISP value is monitored dynamically and objectively in real time by the pressure sensing system. Recent studies have found that ISP monitoring plays an important role in the clinical management and prognosis evaluation of TSCI. The author reviews the recent advance in ISP monitoring in TSCI in order to provide references for the improvement of clinical diagnosis and treatment of TSCI.

Different degrees of visual function impairment is the main reason for first visit of children with optic pathway glioma; it seriously affects the quality of life of children. Early diagnosis, timely treatment, maximum preservation or restoration of the children's vision function, and improvement of quality of life of children are major challenges. This article reviews the recent advance in visual function assessments for children with optic pathway glioma, aiming to provide some references for early clinical objective assessment of visual function impairment and clear diagnosis.

OBJECTIVE: To observe the hepatic injury induced by combined exposure to diethylhexyl phthalate( DEHP) and bisphenol A( BPA) in rats and explore the mechanism of oxidative stress. METHODS: Thirty-two specific pathogen free healthy male SD rats were randomly divided into control group,DEHP(750 mg/kg body weight) group,BPA(100 mg/kg body weight) group and combined exposure group,with 8 rats in each group. The rats were gavaged once per day,7 days per week,for 6 weeks. The changes of liver organ coefficient and histopathology were observed. The activities of superoxide dismutase( SOD), glutathione peroxidase( GSH-Px) and the levels of hydrogen peroxide( H2 O2),malondialdehyde( MDA) were detected by spectrophotometry. The relative mRNA expression of antioxidant gene nuclear factor erythroid-2 related factor 2( Nrf2),heme oxygenase-1( HO-1),glutamate cysteine ligase catalytic subunit( Gclc),thioredoxin reductase( Txnrd),superoxide dismutase 3( Sod3) and glutathione peroxidase 1( Gpx1) in liver tissue were examined by real-time fluorescent quantitative polymerase chain reaction. RESULTS: The body weight of DEHP exposure group was lower than that of control group from the beginning of the 2 nd week( P < 0. 05),and the body weight of combined exposure group was lower than control group from the beginning of the 3 rd week( P < 0. 05). The liver mass and organ coefficients in DEHP group and combined exposure group were significantly higher than that of control group( P <0. 05). The results of pathology examination showed that there was necrosis of liver cells in DEHP group,vacuolar degeneration in cytoplasm of BPA group,and severe inflammatory cell infiltration in combined exposure group. The activity of SOD and GSH-Px of each exposure group was reduced( P < 0. 05),the H2 O2 level of each exposure group was increased(P < 0. 05),meanwhile the MDA level in the liver tissue of the BPA group and the combined exposure group increased compared with the control group( P < 0. 05). The relative mRNA expression of Nrf2,HO-1 and Gpx1 in each exposure group were decreased( P < 0. 05),the relative mRNA expression of Gclc,Txnrd and Sod3 in DEHP group and mixed exposure group were decreased compared with the control group( P < 0. 05). The relative mRNA expression of Nrf2,HO-1,Gclc,Txnrd and Sod3 in combined exposure group were decreased compared with the BPA group( P < 0. 05).CONCLUSION: Under the conditions of this study,DEHP and BPA alone or in combination could cause hepatic injury. The combined effect was greater than single effect. The effect of DEHP was greater than that of BPA. The liver injury induced by DEHP and BPA was related to Nrf2 signaling pathway.

ObjectiveTo investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections. MethodsA retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators. ResultsAmong the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×10⁹/L， a sensitivity of 0.725， and a specificity of 0.400. ConclusionACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.