Objective To investigate the effect of L-carnitine injection on oxidative stress and clinical efficacy in patients with acute anterior ST segment elevated myocardial infarction ( STEMI ) and received primary percutaneous coronary intervention .Methods 70 patients with acute anterior wall STEMI undergoing primary PCI in our hospital were randomly divided into the L-carnitine treatment group and the control group.Patients in both groups received same standardized treatment including aspirin , clopidogrel, statins, ACEI/ARB etc.after PCI.Serum levels of superoxied dismutase ( SOD ) and malondialdehyde ( MDA) were measured at arrival and 7 days after PCI.Laboratory results and echocardiography finding were compared.Results (1) The serum SOD levels in both groups were elevated on day 7 after treatment (P<0.05).The serum SOD level on day 7 in the L-carnitine treatment group was higher than the control group (P<0.05).(2) The serum MDA levels in both groups were lower 7 days after treatment (P<0.05).The serum MDA level in the treatment group was lower than the control group (P<0.05).(3) Echocardiography exam on day 7 showed left ventricular end diastolic diameter ( LVEDd) and left ventricular ejection fraction (LVEF) were more significantly improved compared with the control group (P<0.05).Conclusions For AMI patients receiving primary PCI , L-carnitine injection can increase serum SOD concentration and reduce the production of MDA , showing inhibiting effects on oxidative stress and has protective effect on myocardia .

Methods: From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%–89.9%, and 70.0%–79.9% agreement on each question, respectively. Results: The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. Conclusions The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

Methods: From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%–89.9%, and 70.0%–79.9% agreement on each question, respectively. Results: The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. Conclusions The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

Methods: From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%–89.9%, and 70.0%–79.9% agreement on each question, respectively. Results: The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. Conclusions The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

Methods: From May 2021 to August 2021, panelists were chosen to collect expert feedback using the modified Delphi method, and 74 spine surgeons from across China agreed to participate. Four rounds were conducted: one in-person meeting and three subsequent survey rounds. Each question received at least 70.0% agreement, indicating a consensus. The grade A, B, and C recommendation were defined as having ≥90.0%, 80.0%–89.9%, and 70.0%–79.9% agreement on each question, respectively. Results: The panelist group consisted of 74 experts, and 72, 70, and 69 questionnaires were collected in three rounds, respectively. In total, 24 questions with 59 options reached consensus after the Delphi rounds, including indications (adjacent vertebral diseases after lumbar internal fixation) and contraindications (previous surgery or bone destructive diseases lead to the destruction or absence of bone in the lamina or isthmus); advantages (intraoperative traction of paravertebral soft tissue is small) and disadvantages (not three-column fixation.); preoperative evaluation; complications; and postoperative follow-up evaluation, of CBT. Conclusions The modified Delphi method achieved expert consensus on the clinical use of CBT for lumbar pedicle screws. This consensus document establishes clear guidelines for indications, contraindications, surgical techniques, and postoperative management, thereby enhancing clinical decision-making and promoting the safe and effective use of CBT. While the initial study focused on Chinese surgeons, future research will seek to validate and expand these findings from a broader international perspective.

Antimony ; urine ; Flow Injection Analysis ; Spectrometry, Fluorescence ; methods ; Spectrophotometry, Atomic ; methods

BACKGROUND:To determine if elderly frequent attenders are associated with increased 30-day mortality, assess resource utilization by the elderly frequent attenders and identify associated characteristics that contribute to mortality. METHODS:Retrospective observational study of electronic clinical records of all emergency department (ED) visits over a 10-year period to an urban tertiary general hospital in Singapore. Patients aged 65 years and older, with 3 or more visits within a calendar year were identified. Outcomes measured include 30-day mortality, admission rate, admission diagnosis and duration spent at ED. Chi-square-tests were used to assess categorical factors and Student t-test was used to assess continuous variables on their association with being a frequent attender. Univariate and multivariate logistic regressions were conducted on all significant independent factors on to the outcome variable (30-day mortality), to determine factor independent odds ratios of being a frequent attender. RESULTS:1.381 million attendance records were analyzed. Elderly patients accounted for 25.5％ of all attendances, of which 31.3％ are frequent attenders. Their 30-day mortality rate increased from 4.0％ in the first visit, to 8.8％ in the third visit, peaking at 10.2％ in the sixth visit. Factors associated with mortality include patients with neoplasms, ambulance utilization, male gender and having attended the ED the previous year. CONCLUSION:Elderly attenders have a higher 30-day mortality risk compared to the overall ED population, with mortality risk more marked for frequent attenders. This study illustrates the importance and need for interventions to address frequent ED visits by the elderly, especially in an aging society.

Objectives:To explore the effect of preoperative traction on nerve injury complications in patients with severe spinal deformities undergoing correction surgery.Methods:A retrospective analysis was conducted on 196 patients with severe spinal deformities who underwent orthopedic surgery in our hospital from Decem-ber 2019 to December 2022.A total of 38 patients with severe stiff spinal deformity were treated with Halo-pelvic traction(HPT)before operation,including 17 males and 21 females,aged 20.12±7.82 years old(14 to 30 years),who were included into the HPT group.The other 158 patients with general severe spinal deformity undergone skin traction(ST)with occipital jaw and lower limb traction before operation were included into ST group,which included 61 males and 97 females,aged 15.55±10.38 years old(10-30 years).Posterior correc-tion,fixation and fusion were performed after traction on both groups of patients.The general data,operation-related data,and imaging data before and after treatment(before traction,after traction,and after oepration)were collected,and the contribution rates of preoperative traction and operation to deformity correction were calculated.The abnormal conditions of intraoperative neurophysiological monitoring(IONM)and postoperative nerve injury complications were collected and compared between the two groups.Results:The preoperative Cobb angle of the HPT group was 142.48°±18.77°,which improved to 72.56°±13.26° after HPT,with an im-provement rate of 49.07％;After corrective surgery,it was 55.76°±15.87°,with an improvement rate of 60.87％;5 cases were of＞Ⅳ grade osteotomy,accounting for 13.16％;There were 10 cases with abnormal IONM,accounting for 26.32％;And 3 cases of nerve damage,accounting for 7.90％.The preoperative Cobb angle of the patients in the ST group was 97.90°±19.25°,which was 76.51°±12.68° after traction,with an im-provement rate of 21.85％;After corrective surgery,it was 41.58°±15.84°,with an improvement rate of 57.53％;10 cases were of＞Ⅳ grade osteotomy,accounting for 6.33％;There were 21 cases with abnormal IONM,accounting for 13.29％;And 9 cases of nerve injury,accounting for 5.70％.There was no significant difference in high-grade spinal osteotomy between the two groups(P＞0.05).The difference in the incidence of abnormal IONM between the two groups was significant(P＜0.05),however,there was no significant difference in the incidence of postoperative nerve injury complications(P＞0.05).Conclusions:The applications of HPT and ST occipital jaw-lower limb traction before orthopedic surgery are both effective and safe in patients with spinal deformity,which can reduce the level of spinal osteotomy and reducing the risk of nerve injury compli-cations in severe spinal deformity patients undergoing correction surgery.

OBJECTIVETo evaluate the optimal insertion position of the Coflex lumbar interspinous dynamic stabilization device.

METHODSSix fresh adult human cadaveric lumbar spine specimens (L1-L5) were mounted in a materials testing machine by embedding to clamps with L1 and L5 vertebrae. L3-4 motion segment of each specimen was operated by selective decompression and Coflex interspinous device insertion. The L3 and L4 vertebrae was inserted one needle attached with four marker points respectively, which were used to record the range of motion (ROM). Each lumbar spine specimen was tested according to the loading sequence at 5 groups: intact (keeping lumbar ligamenta and facet joints intact) group, partial destabilized (resection of L3-4 interspinous ligamenta, ligamentum flavum, facet capsule, and bilateral resection 50% of L3 inferior facets) group, 10 mm insertion (distance between apex of U-shaped Coflex and dural sac was 10 mm)group, 5 mm insertion (distance was 5 mm)group, and 0 mm insertion (distance was 0 mm)group. Each lumbar spine specimen was tested repeatedly 3 times according to a loading sequence consisting of flexion, extension, left/right lateral bending, left/right axial rotation, loaded with pure moments of 8 N·m, and was recorded the ROM of operative segment at the third time. ROM of 5 groups in 6 directions respectively were analyzed with one-way ANOVA test and multiple comparisons were based on LSD method.

RESULTSThe means ROM of 5 groups were not all equal in flexion, extension, left/right lateral bending, left/right axial rotation (F = 8.472, 18.301, 7.700, 12.473, 16.809, 6.624; all P < 0.01). The 10 mm insertion group had significant high ROM in 6 directions than the intact group (t = 3.80, 3.82, 4.49, 5.60, 4.96, 2.98, all P < 0.01), but it was no difference comparing with the partial destabilized group (P > 0.05). The ROM of the 5 mm and 0 mm insertion group were no significant differences comparing with the intact group in flexion, extension, left/right axial rotation (P > 0.05), but it were significant differences comparing with the partial destabilized group in the same directions (5 mm insertion group: t = 3.19, 6.34, 5.26, 3.43, all P < 0.01; 0 mm insertion group: t = 4.21, 6.68, 5.81, 3.72, all P < 0.01). There were significant differences in the ROM of left/right lateral bending between the 5mm/0mm insertion groups and the intact group (5 mm insertion group: t = 3.71 and 5.22, all P < 0.01; 0 mm insertion group: t = 3.44 and 4.95, all P < 0.01), but there were no differences comparing with the partial destabilized group in the same directions (P > 0.05).

CONCLUSIONSThe insertion of Coflex interspinous dynamic stabilization device can maintain the stability of a partially destabilized specimen back to an intact one in flexion, extension and axial rotation when distance between apex of U-shaped Coflex and dural sac was ≤ 5 mm, but can't return the stability in lateral bending. The Coflex can't return the stability of a partially destabilized specimen back to an intact one in 6 directions when distance between apex of U-shaped Coflex and dural sac was ≥ 10 mm.

Adult ; Biomechanical Phenomena ; Bone Screws ; Decompression, Surgical ; Humans ; Internal Fixators ; Ligamentum Flavum ; surgery ; Lumbar Vertebrae ; surgery