Objective To elevate the efficacy and safety of descending neurogenic evoked potentials (DNEP) monitoring during severe rigid spinal deformity surgery.Methods All of 108 patients (43 males,65 females) who underwent surgical treatment for spinal deformity in our spinal center from July 2010 to August 2013 were retrospectively reviewed.The average age (17.5±5.8) ys(range 12-50 ys),the average following period is 38.6 months(range 24-52 months).Combined monitoring of SEP,MEP and DNEP model were used during surgery.All subjects with no neurological deficits preoperatively and got satisfied outcomes.Respectively evaluate the results of neurophysiological intraoperative monitoring (IOM).Data were collected to elevate the efficacy and safety of DNEP monitoring.Results All of 108 patients,15 patients (13.9％,15/108) showed significant changes of neurophysiological parameters,of which 9 cases (60％,9/15) were identified as true positive and 6 cases (40％,6/15) were identified as false positive.During the following-up period,2 patients developed permanent neurological deficit,and 3 patients showed transient neurological deficit who got fully recovered within 6 months after operation.DNEP showed alert in all 5 patients with truepositive alarm,of which 2 patients developed permanent neurological dysfunction and 3 cases showed postoperative short nerve dysfunction that got fully recovery within 6 months after operation.The sensitivity and specificity of SEP+MEP and DNEP were 100％ and 97.98％,100％ and 98.99％,respectively.Conclusion Combining use of MEP+SEP+DNEP monitoring during surgical treatment of spinal deformities presented to be a highly reliable method for the detection and prevention of iatrogenic injury.The results confirmed a high efficacy and safety of DNEP monitoring during spinal surgery.

Objective: The aim of the study is to validate whether the Recognition Of Stroke In the Emergency Room (ROSIER) scale can be used by general practitioners (GPs) in an emergency medical service (EMS) protocol to transfer stroke patients from primary care center to advanced hospital with acute stroke center. Methods: GPs prospectively performed the ROSIER scale and the Cincinnati Prehospital Stroke Scale (CPSS) on suspected stroke patients as a transfer protocol. All patients were immediately transferred to the Level-II hospital for further treatment. Results: 468 of the 512 suspected stroke patients met the inclusion criteria in this study. The ROSIER scale showed a diagnostic sensitivity of 83.13% (95% confidence intervals [CI] 79.74-86.52%) and specificity of 80.88% (95% CI 77.32- 84.44%). The CPSS showed a diagnostic sensitivity of 78.01% (95% CI 74.26-81.76%) and specificity of 70.59% (95% CI 66.46-74.72%). The Kappa statistic value of the ROSIER scale and the CPSS were 0.601 and 0.454, respectively. The area under the curve (AUC) of ROSIER scale was large than the CPSS (AUC 0.855 vs. 0.791). However, the difference was not significantly different. Conclusions: This study suggest that ROSIER and CPSS could be used in an EMS protocol to transfer stroke patients from a primary care center to an advanced hospital offering thrombolysis service
Stroke

Objective To compare Endobutton plating and clavicular hook plating for acromioclavicular joint dislocation.Methods The clinical data of 46 patients with acromioclavicular joint dislocation were retrospectively analyzed who had been treated at Department of Orthopaedics,The Seventh Affiliated Hospital to Sun Yat-Sen University from October 2015 to December 2017.They were 35 men and 11 women,aged from 18 to 60 years (mean,36.3 years).All dislocations were unilateral,involving the left side in 20 cases and the right side in 26.By the Rockwood classification of dislocations,there were 18 cases of type Ⅲ,24 cases of type Ⅳ and 4 cases of type Ⅴ.Of them,22 were treated with clavicular hook plating and 24 with Endobutton plating.The 2 groups were compared in terms of operation time,incision length,intraoperative blood loss,operation cost,visual analogue scale (VAS) and Constant-Murley scores.Results The 2 groups were comparable because there were no significant differences between them in the general clinical data before operation (P ＞ 0.05).The Endobutton plating group was significantly better than the hook plating group in the incision length (5.3 ± 0.6 cm versus 8.0±1.7 cm) and intraoperative blood loss (101.0±12.3 mL versus 135.0±8.1 mL),but significantly poorer than the latter in the operation cost (RMB 21,343 ±965.2 yuan versus RMB 16,849 ±919.7 yuan) (all P ＜ 0.05).The Endobutton plating group was also significantly superior to the hook plating group in the VAS scores (2.3 ±0.8 versus 3.6 ±0.9) and Constant-Murley scores (96.2 ±4.4 versus 89.3 ±5.2) at 6 months after operation (both P ＜ 0.05).Conclusion In the treatment of acromioclavicular joint dislocation,Endobutton plating may lead to better functional recovery of the shoulder,better pain relief and freedom from secondary surgical removal of the implant.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.