Objective To explore the feasibility and clinical effect of the video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures. Methods 22 patients with thoracolumbar burst fractures were managed by the video-assisted thoracoscopic surgery transdiaphragmatic approach from September 2002 to September 2004. There were 15 males and 7 females, and the age of the patients were from 28 to 71 years with an average of 39 years. The fracture located at T11 in 2, T12 in 10 and L1 in 10. The states of preoperative neurological function were complete paraplegia in 7 cases and incomplete paraplegia in 15 cases. All cases were treated with anterior decompression, autograft and internal fixation with anterior plate fixation systems. Results The average operation time was 230 mins (180 to 320 mins). The average blood loss was 900 ml (500 to 2000 ml). An average followed up period was 19.5 months (9 to 35 months) in all patients. The fracture fragments were cleaned thoroughly and the vertebral canal were decompressed entirely showing on CT films. All patients had successful fusion with an average of 3.8 months. One fixing screw was penetrated into intervertebral space in 1 case. It had been recorrected under a fluoroscopic machine. One case was complicated leakage of cerebrospinal fluid and cured after one week in a prone position. No pleural effusion, pneumothorax and diaphragmatic herniations encountered. 4 cases with complete paraplegia didn't show any improvement, 14 cases had improved obviously in the function of the spinal cord. Conclusion The video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures was feasible, for satisfactory vertebral canal decompression, graft and internal fixation. Diaphragmatic opening and repair can be accomplished safely and effectively without special endoscopic instrumentation. It also precludes the need for retropleural-retroperitoneal and open thoracoabdominal approaches and thus avoids the associated significant morbidity.

Objective To explore the use of integrated two methods in vitro in prediction of eye irritation caused by cosmetics.Method Chorioallantoic membrane vascular assay ( CAMVA), bovine corneal opacity and permeability (BCOP) and Draize rabbit eye irritation test were used to determine the predictive potential of eye irritation of 60 kinds of cosmetics.Results CAMVA method was able to distinguish 41 non-irritant samples and 18 irritant samples.BCOP method was able to predict 35 non-irritant samples , 21 mild-moderate irritant samples and 4 severe irritant samples . Combination of CAMVA and BCOP methods could obviously improve the identification ability of irritation , and the classification consistency with Draize rabbit eye irritation testing reached 98.3%.Conclusions The integrated test strategy combined BCOP with CAMVA can be used to appropriately predict ocular irritation of cosmetics , with a prediction range covering non-irritant to severe irritant samples .

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years (ranged, 19-65 years). The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A (burst in 12 cases, type B (distraction) in 2 and type C (retortion) in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months (12-86 months). The radiograph showed obvious improvement on the injured body height (from 42.62％ preoperatively to 94.33％ postoperatively, P＜0.01) and the canal encroachment index (from 2.67 preoperatively to 0.14 postoperatively, P＜0.01). Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.

Objective To explore the effect of the health management service in patients with metabolic syndrome (MS) by family doctors. Methods A total of 417 patients with MS were screened during a health examination and divided into the intervention and control groups (206 and 211 cases, respectively), using a random digital table. Based on routine health follow-up, the intervention group received increased health management intervention by the family doctor, while the control group was only had followed-up with routine health check-ups.After 1 year,the changes in body mass index(BMI),blood pressure, triglyceride (TG) levels, fasting blood glucose (FBG) levels, and high-density lipoprotein cholesterol(HDL-C)in the two groups of patients were observed.The effect of intervention was analyzed using the paired design t-test and chi-square test.Results In the intervention group,the BMI(25.04±2.92)kg/m2, systolic blood pressure(121.5±15.6)mmHg(1 mmHg=0.133 kPa),TG levels(2.02±1.24)mmol/L,and FBGlevels (5.92±1.75)mmol/L after the intervention,were lower than those before the intervention(25.66±2.64)kg/m2, (128.4±16.5)mmHg,(2.43±1.06)mmol/L,(6.34±1.62)mmol/L;respectively,and these differenceswerestatistically significant(t=2.437,3.598,3.536,2.983,respectively;P<0.05).HDL-C levels after the intervention(1.32± 0.26) mmol/L were higher than thosebefore the intervention (1.26 ± 0.32) mmol/L, and the difference was statistically significant(t=-2.218,P<0.05).In the intervention group,blood pressure,BMI,FBGlevels,and HDL-C levels after the intervention were higher than the normal reference values.The proportion of patients with normal reference valuesafter the intervention were 62.6%, 75.2%, 14.6%, and 52.9%, respectively, which were lower than those before the intervention(92.7%, 85.4% 23.3%, and 63.6%, respectively);thesedifferenceswerestatistically significant (χ2=53.795, 6.777, 5.124, and 4.832, respectively;P<0.05). After 1 year,the control group had lower BMI(24.52±2.69)kg/m2than that before the intervention(25.79± 2.85) kg/m2; thisdifference was statistically significant (t=2.421, P<0.05).There were no significant differences in the systolic and diastolic blood pressure, TG levels, HDL-C levels, and FBG levels. Conclusion Health management byfamily doctors can effectively reduce weight, blood pressure, blood lipids,and blood sugar by interfering with the lifestyle of patients with MS.

The clinical data of patients with chlamydia psitsiti pneumonia confirmed by metagenomic next-generation sequencing (mNGS) who were admitted to the Huizhou Municipal Central Hospital from January 2020 to November 2021 were retrospectively analyzed. Among 21 patients, the serum creatine kinase (CK) was elevated in 10 cases, and 5 cases was complicated with rhabdomyolysis (RM). The symptoms of patients with Chlamydia psittaci pneumonia-induced RM were severe, including high fever, dyspnoea, headache and myalgia; 2 case were complicated by acute kidney injury (AKI) and neurological symptoms. Laboratory testing showed a marked increase in CK, myoglobin (Mb), high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and D-dimer levels in all 5 patients. The chest CT revealed large areas of pulmonary consolidation, ground-glass opacity in 1 case and a small amount of pleural effusion in 2 cases. One patient died from multiple organ failure, and the other 4 patients were discharged with considerable improvement. Patients with psittacosis pneumonia are prone to developing rhabdomyolysis, early detection and early treatment can effectively improve the prognosis of patients.

Objective:To analyze the clinical characteristics of Chlamydia psittaci pneumonia and to investigate the correlation between serum inflammatory biomarkers and severity of the disease. Methods:Sixteen patients with Chlamydia psittaci pneumonia admitted to the Huizhou Municipal Central Hospital from January 2020 to July 2021 were selected as the study subjects, including 10 severe cases and 6 mild cases. Clinical data were collected and analyzed, such as baseline characteristics, clinical symptoms, laboratory inspection and chest imaging manifestations. Results:① Thirteen Chlamydia psittaci pneumonia were associated with a definite bird or poultry contact history. Common symptoms included high fever, chill, cough, fatigue, and anorexia (16 cases), dyspnoea (12 cases), and other systemic symptoms. ② Laboratory test results showed normal white blood cell count (WBC, 10 cases), decreased lymphocyte count (LYM, 13 cases), increased high sensitive C-reactive protein (hs-CRP, 16 cases), D-dimer (15 cases), lactate dehydrogenase (LDH, 13 cases), aspartate aminotransferase (AST, 16 cases) and alanine aminotransferase (ALT, 12 cases) levels, however, the albumin (Alb, 15 cases) lever was decreased. The numbers of CD3 + T cells and CD4 + T cells decreased in 10 patients. ③ The levels of D-dimer, interleukins (IL-2, IL-6, IL-10) in severe Chlamydia psittaci pneumonia were significantly higher than those in mild Chlamydia psittaci pneumonia [D-dimer (μg/L): 10 257±4 203 vs. 1 085±642, IL-2 (ng/L): 1.1 (0.8, 1.7) vs. 0.3 (0.1, 0.7), IL-6 (ng/L): 315 (182, 505) vs. 75 (18, 131), IL-10 (ng/L): 7.0±4.1 vs. 2.3±0.7], but the LYM was lower (×10 9/L: 0.4±0.1 vs. 1.1±0.4), with significant differences (all P < 0.05). ④ Chest imaging manifestations were exudative lesions and large consolidation of lungs. Large consolidation of both lungs can occur in some critically ill patients. Conclusions:Chlamydia psittaci pneumonia is mainly associated with a bird or poultry contact history. The clinical manifestations usually present high fever, dyspnea, normal or slightly increased leucocytes, and lung consolidation. The levels of LYM, D-dimer, IL-2, IL-6 and IL-10 in serum are expected to predict the severity of the Chlamydia psittaci pneumonia.

Objective To study the effect of age-related white matter changes (ARWMC) on first symptomatic ischemic stroke events in the oldsters. Methods For the prospective study, a total of 368 eligible oldsters were enrolled in the study from January 2010 to August 2012. The degrees of ARWMC were assessed by ARWMC scale;according to the scores, they were divided into non ARWMC group, mild-moderate ARWMC group and severe ARWMC group. The patients were followed up once every 3 months. The clinical endpoint events and time (first symptomatic ischemic stroke, myocardial infarction and all-cause death) were recorded. Analyses of variance and Chi-square test were used to compare the differences of clinical data among the 3 groups. COX regression was used to assess the risk differences of first symptomatic ischemic stroke in the oldsters of three groups. Results After an average of follow-up for 48.7 months, 50 participants (13.6％) had first symptomatic ischemic stroke;25 (25.8％) were categorized as the severe ARWMC group, 22 (10.9％) were as the mild-medium group, and 3 (4.4％) were as the non ARWMC group. Among the three groups, the differences in age, history of hypertension, systolic blood pressure, incidence of clinical endpoint events and first symptomatic ischemic stroke, and follow-up time of endpoint events were statistically significant (P<0.05); patients from the severe ARWMC group were the oldest, and had the longest history of hypertension, the highest systolic blood pressure, the highest incidence of clinical end events and first symptomatic ischemic stroke, and the shortest follow-up period for clinical end events. COX regression analysis showed that the risk of first symptomatic ischemic stroke in the severe ARWMC group was about 8 times higher than that in the non ARWMC group (hazard ratio=9.012, 95％CI: 2.310-35.154, P=0.002). Conclusion In oldsters, severe ARWMC often accompany hypertension history and poor blood pressure controll, and it is an independent and serious risk factor for long-term first symptomatic ischemic stroke.