Objective:To analyze predictive risk indicators associated with the development of Kümmell's disease (KD) in patients with osteoporotic vertebral compression fractures (OVCFs).Methods:A 1∶1 frequency-matched case-control study design was employed, selecting patients who visited the Department of Spine Surgery at Liuzhou Workers' Hospital from January 2021 to June 2023. Patients were divided into case and control groups based on whether they progressed to Kümmell's disease (KD). Detailed demographic information, comorbidities, and laboratory data were collected, and baseline characteristics of the two groups were compared. Initial predictive variables significantly associated with the target variable were preliminarily screened through univariate analysis. A correlation heatmap was then constructed to assess collinearity among these variables, followed by further selection of potential predictors using the Lasso regression model. Finally, a multivariable logistic regression model was used for the prediction and analysis of KD-related risk indicators.Results:Univariate analysis identified significant predictors of Kümmell's disease, including patient age, bone mineral density, kyphotic Cobb angle, and multiple vertebral fractures. These were included in the subsequent Lasso regression analysis, which identified key predictors with non-zero coefficients: age, bone density, Cobb angle, multiple vertebral fractures, platelet count (PLT), aspartate aminotransferase/alanine aminotransferase (AST/ALT), albumin (Alb), albumin/globulin ratio (Alb/Glb), alkaline phosphatase (ALP), urea (UREA), serum uric acid (SUA), fibrinogen (Fn), blood glucose (BG), and C-reactive protein (CRP). The correlation heatmap revealed the correlation and collinearity risks between these variables, with ALT and AST/ALT showing a high correlation ( r=0.750) and PLT and Alb showing a low correlation ( r=-0.110). Multivariable logistic regression indicated that the presence of multiple vertebral fractures [ OR=2.078, 95% CI (1.072, 4.025), P=0.030], increased Cobb angle [ OR=1.033, 95% CI (1.008, 1.058), P=0.009], elevated levels of ALP [ OR=1.013, 95% CI(1.004, 1.023), P=0.006], and SUA [ OR=1.004, 95% CI (1.000, 1.007), P=0.043] were associated with an increased risk of KD in patients with OVCFs. Conversely, decreased levels of Fn [ OR=0.996, 95% CI (0.992, 0.999), P=0.008] were linked to an increased risk of KD. Conclusion:Multiple vertebral fractures, increased Cobb angle, elevated levels of ALP and SUA, along with decreased levels of Fn, can be used as early-warning indicators to predict whether patients with OVCFs will develop KD. Monitoring these indicators is crucial for the early detection and intervention in these patients.

BACKGROUND:Steroid-induced osteonecrosis of the femoral head is a refractory disease in the field of orthopedics.There is no definitive idea to fully explain its pathogenesis.With the increased research on the active ingredients of Panax notoginseng interfering with the signaling pathways related to various diseases,the active ingredients of Panax notoginseng that treat steroid-induced necrosis of the femoral head via the regulation of relevant signaling pathways have gradually become a hot research topic. OBJECTIVE:To systematically summarize the literature on the pathological mechanism of steroid-induced osteonecrosis of the femoral head and the regulation of signaling pathways by the active ingredients of Panax notoginseng in recent years,thereby providing a reference for the follow-up study on the active ingredients of Panax notoginseng in the treatment of this disease. METHODS:CNKI,WanFang,and PubMed were searched for relevant literature with the key words of"glucocorticoid,steroid-induced osteonecrosis of the femoral head,pathological mechanism,signaling pathway,Panax notoginseng,active ingredient"in Chinese and English.Documents related to the pathological mechanism of steroid-induced osteonecrosis of the femoral head as well as related to the intervention of active ingredients of Panax notoginseng on the signaling pathway of steroid-induced osteonecrosis of the femoral head were retrieved.A total of 63 documents were finally included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:The main ingredients of Panax notoginseng include Panax notoginseng saponins,ginsenoside,Panax notoginseng saponins,quercetin,kaempferol,etc.Panax notoginseng saponins,ginsenoside Rb1 and quercetin can promote bone repair and angiogenesis by acting on the transforming growth factor-β/bone morphogenetic protein pathway.Panax notoginseng saponins,ginsenoside CK and kaempferol can promote osteogenic differentiation and lipid metabolism by acting on the Wnt/β-catenin pathway.Panax notoginseng saponins and Panax notoginseng saponins R1/R2 act on the MAPK pathway to inhibit osteoclastogenesis and promote bone repair.Panax notoginseng saponins,ginsenoside Rb2 and quercetin can inhibit osteoclast proliferation and promote osteoblastic differentiation by acting on the RANKL/RANK/OPG pathway.Panax notoginseng saponins,quercetin and kaempferol can repair vascular injury and promote osteogenesis by acting on the hypoxia-inducible factor-1α pathway.Panax notoginseng saponins R1,quercetin combined with hydroxyapatite nanoparticles,Panax notoginseng saponins combined with polyethylene-L-lactic acid and other biomaterials have good research prospects in the treatment of steroid-induced osteonecrosis of the femoral head.The active ingredients of Panax notoginseng can regulate the signaling pathways related to steroid-induced osteonecrosis of the femoral head through various mechanisms,and play an active intervention role in the disease.However,the depth and breadth of relevant research are insufficient at present,and the future research should be based on the existing mechanism to explore the specific mechanism of Panax notoginseng regulating different pathways and the interaction between pathways,which will be beneficial to the multi-development of the active ingredients of Panax notoginseng in the treatment of steroid-induced osteonecrosis of the femoral head.

Liver cirrhosis is a major global health burden worldwide due to its high risk of morbidity and mortality. Role of terlipressin for the management of liver cirrhosis-related complications has been recognized during recent years. This paper aims to develop evidence-based clinical practice guidance on the use of terlipressin for liver cirrhosis-related complications. Hepatobiliary Study Group of Chinese Society of Gastroenterology and Hepatology Committee of Chinese Research Hospital Association invited gastroenterologists, hepatologists, infectious disease specialists, surgeons, and clinical pharmacists to formulate the clinical practice guidance based on comprehensive literature review and experts' clinical experiences. Overall, 10 major statements regarding efficacy and safety of terlipressin in liver cirrhosis - related complications were proposed. Terlipressin can be beneficial for the management of cirrhotic patients with acute gastroesophageal variceal bleeding and hepatorenal syndrome (HRS). However, the evidence regarding the use of terlipressin in cirrhotic patients with ascites, post-paracentesis circulatory dysfunction and bacterial infections, as well as in those undergoing hepatic resection and liver transplantation remains insufficient. Terlipressin - related adverse events, mainly including gastrointestinal symptoms, electrolyte disturbance, and cardiovascular and respiratory adverse events, should be closely monitored. The current clinical practice guidance supports the use of terlipressin for gastroesophageal variceal bleeding and HRS in liver cirrhosis. High-quality studies are needed to further clarify its potential effects in other liver cirrhosis-related complications.

Objective:To compare the skin disinfection effect in different marking methods.Methods:From June 2015 to August 2018, samples of 200 healthy volunteers were collected in the operating room of a hospital. Using self-matching design, a blank control area A was set up in the upper abdomen of every volunteer, and sterile markers were used to mark areas B, C, D and E. Areas B and C were directly marked on the abdominal skin (solid line of area B, dashed line of area C) , and areas D and E were marked after the skin was disinfected first (solid line of area D, dashed line of area E) . After disinfection, specimens were collected in areas A, B, C, D, and E for bacterial culture and the disinfection effect was monitored.Results:A total of 1 000 samples were collected from 200 healthy volunteers. Among them, 39 bacterial cultures were positive and the number of colonies detected in the positive samples was 1 to 6 cfu/cm 2. The positive rate of skin bacterial culture in the marked area of solid line was higher than that in marked area of dashed line. The differences in the positive rates of bacterial culture in different areas were statistically significant ( Q=51.87, P< 0.01) . Further pairwise comparison showed that the differences between the areas B and C that were first drawn lines and then disinfected and area A were statistically significant (χ 2=20.05, 9.09, P< 0.05) . However, there was no statistically significant difference between areas D and E that were first disinfected and then drawn lines and area A ( P>0.05) . The detection rate of bacteria in area B was higher than that in area C, and the difference was statistically significant (χ 2=7.97, P<0.05) . The detection rate of bacteria in area D was higher than that in area E, but the difference was not statistically significant ( P> 0.05) . Conclusions:Marking and disinfecting the skin at the surgical site will have an effect on the skin disinfection effect. It is recommended that the skin at the surgical site be disinfected first and then marked, and the method of dashed line marking should be adopted.

Objective To explore the effect of nanow-band imaging (NBI) combined with magnifying endoscopy (ME) in early diagnosis of gastric cancer,and to observe whether it is helpful for inexperienced endoscopists to diagnose.Methods From April 2015 to October 2017,a total of 480 lesions were selected as research objects which were detected in the normal white light endoscopy (WLE).Pathological examination was used as the gold standard for diagnosis.3 experienced doctors were selected to read the endoscopy films.40 intern endoscopy doctors were selected to read the endoscopy filins at the same time after simple training.80 WLE images and narrowband imaging technology combined with magnifying endoscopy (ME-NBI) images were randomly selected to hold a film reading meeting.Real-time voting was used to judge the nature of lesions.Results The accuracy,sensitivity,specificity false positive rate and false negative rate of ME-NBI were 97.9％ (470/480),96.8％ (120/124),98.3％ (350/356),1.7％ (6/356),3.2％(4/124).And WLE values were 91.7％ (440/480),80.6％ (100/124),89.9％ (320/356),10.1％ (36/356),19.4％ (24/124),respectively.The diagnostic accuracy,sensitivity and specificity of ME-NBI were significantly higher than those of WLE (x2 =18.989,16.104,15.859,P≤0.05),and the false positive rate and false negative rate were significantly lower than those of WLE (x2 =22.772,16.104,P ≤ 0.05).The diagnostic results of ME-NBI of 40 endoscopy interns were significantly better than those of WLE (t =11.467,16.188,P ≤0.05).The diagnostic results of NBI by 40 interns were significantly better than that of WLE (t =11.467,16.188,P ≤ 0.05).Conclusions The accuracy of ME-NBI in screening early gastric cancer is satisfactory,and it has certain diagnostic value for inexperienced doctors.

Objective: To examine sleep characteristics of preschool children who were born preterm, which could provide a reference for the future intervention in the risk population. Methods: This retrospective cohort study was conducted from March 2017 to November 2018 in hospitals in cities of Guangzhou, Zhongshan, and Shenzhen, Guangdong Province, China, we recruited 202 preschool children aged 4-6 years, including 40 early-and moderate preterm (gestational age <34 weeks), 56 late preterm (34-36 weeks) , and 106 full-term preschool children (≥37 weeks). Caregivers reported children’s sleep time and habits using Chinese version of Children’s Sleep Habits Questionnaire (CSHQ). Results: Compared to the full-term group, the very-or-moderate-preterm group had shorter nighttime sleep duration (9.07±0.75 vs 9.33±0.59 h; adjusted β=-0.33), shorter total sleep duration (10.39±0.86 vs 11.05±1.32 h; adjusted β=-0.70), higher sleep duration score of CSHQ (4.60 ± 1.57 vs 3.97 ± 1.25 points; adjusted β=0.58), and higher sleepdisordered breathing score of CHSQ (3.78±1.27 vs 3.41±0.71 points; adjusted β=0.49). The late preterm group had lower parasomnias score of CSHQ (8.40±1.65 vs 8.75±1.72 points; adjusted β=-0.57), than the full-term group(P<0.05). When gestational age was analyzed as a continuous variable, it was positively associated with the total sleep duration (adjusted β= 0.06), while was inversely associated with sleep-disordered breathing scores of CSHQ (adjusted β=-0.06). Conclusion Very-or-moderate preterm children have shorter sleep duration and more sleep disordered breathing problems than full-term children, and have more disorders of sleeping duration and sleeping breathing than full-term children, while the late preterm children have less sleeping disorders than full-term children. The children of lower gestational age can have shorter sleep duration and more sleep-disordered breathing which should be addressed in future intervention.

Objective To analyse the memory function and MRI changes in local-advanced nasopharyngeal carcinoma patients before-and after-radiation.Methods Clinical data,dosimetric data,digital span score and MRI of 14 cases with nasopharyngeal carcinom treated in Zhejiang Cancer Hospital from November 2015 to August 2016 were retrospectively analysed.There were 1 case at T2 stage,7 cases at T3 and 6 at T4.They received IMRT or TOMO therapy concurrent with 2 cycles Nedaplatin after 2-3 cycles PF/TP induction chemotherapy.Results The IMRT dosimetric data of 9 cases were available.For hippocampus and temporal lobe,the mean volume was (15.17 ± 2.17) and (95.07 ± 12.26) cm3,respectively,while the mean dose was (1 154.06 ±771.63) and (1 306.61 ±603.69) Gy,and the max dose (3 797.61 ± 1 450.98) and (5 394.17 ± 982.28) Gy,respectively.The equivalent uniform dose (EUD) was (2 233.28 ±872.73) Gy for hippocampus and (3 113.11 ±603.69) Gy for temporal lobe.10 patients received digit span score before-and 3 months after-radiotherapy.The mean score of forward digit span was 8.8 ± 1.8 before radiation and 8.1 ± 1.59 at 3 months after radiation(P ＞ 0.05),while thatof backward digit span decreased from 6.2 ± 1.04 before radiation to 5.3 ± 2.36 at 3 months after radiation (t =3.25,P ＜ 0.05).9 patients' MRI were available.Volume reduction of temporal lobe was observed (t =4.57,P ＜ 0.01) by voxel-based morphometry (VBM).Conclusions Radiation-induced injury to hippocampus and temporal lobe is inevitable in local-advanced nasopharyngeal carcinoma patients.There might be some connection between memory loss and temporal lobe volume atrophy after radiotherapy.Enrollment of larger sample analysis is expected.

Objective To analyze the exposed dose of hippocampus(HC)of T3,T4nasopharyngeal carcinoma patients treated with intensity modulated radiotherapy(IMRT). Methods The bilateral HCs were delineated and were divided into head(HH),body(HB)and tail(HT)for 62 nasopharyngeal carcinoma patients treated with IMRT.The dose parameters of HC were then analyzed. Results The mean dose of left and right HC was(1 127±704)cGy,(1 173±762)cGy. The mean dose of left HH,HB and HT was(1 732±1029)cGy,(820±632)cGy,(423±366)cGy(P=0.000);while the mean dose of right HH, HB and HT was(1 985±1101)cGy,(837±531)cGy,(432±343)cGy(P=0.000).The exposed dose and the volume exposed in different dose of HH were obviously higher than those of HB and HT.The dose parameters of HH,HB and HT decreased in turn. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus correlated with high exposed dose of HC. Conclusions The exposed dose of HH,HB and HT was different in nasopharyngeal carcinoma patients treated with IMRT.The exposed dose of HH was the highest,which should be emphasized especially. The involvement of sphenoid sinus,ethmoid sinus and cavernous sinus suggest high exposed dose of HC.

Objective To analyze the radiation doses to the head, body, and tail of the hippocampus in intensity-modulated radiotherapy(IMRT)for nasopharyngeal carcinoma(NPC). Methods Ten NPC patients treated with IMRT were selected,and the head, body, and tail of both hippocampi were delineated on T1-weighted images. The doses to the hippocampus were then analyzed. WAIS-CR speech test results were tested by paired sample t-test. Results The mean doses to left and right hippocampi were 1 147±976 cGy and 1 011±602 cGy, respectively. The mean doses to the head, body, and tail of the left hippocampus were 1 739± 1 317 cGy, 890± 982 cGy, and 547± 688 cGy, respectively(P=0.042);the mean doses to the head,body,and tail of the right hippocampus were 1 691±942 cGy,744±483 cGy,and 531±603 cGy,respectively(P=0.002).The dose to the hippocampus decreased from the head to the tail, and the irradiated volume also decreased as the dose varied. Conclusions The dose to hippocampus decreases from the head to the tail in NPC patients treated with IMRT,which is worthy of attention.