Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective To establish a pre-audit system for medical orders in hospitalized patients and increase the auditing rate in inpatients. Methods In the pre-audit system for medical orders, browser/server(B/S)and client/server(C/S)hybrid architecture was adopted and JAVA language was used for programming. The pre-audit system for medical orders was linked to the hospital information system and data integration platform,and audit module was improved on the basis of the pre-audit system for prescriptions which had been successfully operated in Xuanwu Hospital of Capital Medical University. More than 20 thousand related rules were added in the audit think tank for rational drug use of prescriptions and serious errors interception for indications,dosage and administration route,appropriate translation of Chinese patent medicine indications,refinement of compatibility taboos,audit of drug allergy risk,appropriate audit for pain medications,and audit for rational drug use related to height,body weight,body surface area,and test values were performed. The audit think tank for rational drug use was formed,which set up the foundation for intelligent examination of medical orders. The medical orders which were not passed by intelligent examination were transmitted to the pre-audit pharmacist to audit for the second time. By comparing the audit rate of medical orders in hospitalized patients before and after adopting the pre-audit system and the qualification rate at the first 4 months after adopting the system,the application effect was preliminarily evaluated. Results After launching pre-audit system for medical orders in June 2017,the examination rate of medical orders in inpatients increased from 42.53%(61 139/143 756)to 100%(at the first 4 months,the number of doctor′s orders was 69 183,74 072,99 816,and 184 184,respectively). At the first 4 months after the system was launched,the pass rate of audit for medication orders was 69.02%(47 753/69 183),84.27%(62 416/74 072),92.69%(92 516/99 816),and 97.21%(179 040/184 184),respectively. The difference in passing rate of audit for medication orders between the 4th month and the first month was statistically significant(χ2=42 548.86,P<0.001). Conclusions The pre-audit system for inpatients′medication orders was successfully established. The intelligent audit for all inpatients realized using this pre-audit system and was of benefit to the rational drug use improvement in hospitals.

Objective To establish a pre-audit system for medical orders in hospitalized patients and increase the auditing rate in inpatients. Methods In the pre-audit system for medical orders, browser/server(B/S)and client/server(C/S)hybrid architecture was adopted and JAVA language was used for programming. The pre-audit system for medical orders was linked to the hospital information system and data integration platform,and audit module was improved on the basis of the pre-audit system for prescriptions which had been successfully operated in Xuanwu Hospital of Capital Medical University. More than 20 thousand related rules were added in the audit think tank for rational drug use of prescriptions and serious errors interception for indications,dosage and administration route,appropriate translation of Chinese patent medicine indications,refinement of compatibility taboos,audit of drug allergy risk,appropriate audit for pain medications,and audit for rational drug use related to height,body weight,body surface area,and test values were performed. The audit think tank for rational drug use was formed,which set up the foundation for intelligent examination of medical orders. The medical orders which were not passed by intelligent examination were transmitted to the pre-audit pharmacist to audit for the second time. By comparing the audit rate of medical orders in hospitalized patients before and after adopting the pre-audit system and the qualification rate at the first 4 months after adopting the system,the application effect was preliminarily evaluated. Results After launching pre-audit system for medical orders in June 2017,the examination rate of medical orders in inpatients increased from 42.53%(61 139/143 756)to 100%(at the first 4 months,the number of doctor′s orders was 69 183,74 072,99 816,and 184 184,respectively). At the first 4 months after the system was launched,the pass rate of audit for medication orders was 69.02%(47 753/69 183),84.27%(62 416/74 072),92.69%(92 516/99 816),and 97.21%(179 040/184 184),respectively. The difference in passing rate of audit for medication orders between the 4th month and the first month was statistically significant(χ2=42 548.86,P<0.001). Conclusions The pre-audit system for inpatients′medication orders was successfully established. The intelligent audit for all inpatients realized using this pre-audit system and was of benefit to the rational drug use improvement in hospitals.

Objective: To evaluate left atrial (LA) function and synchrony in lone atrial fibrillation (LAF) patients by two-dimensional speckle tracking echocardiography (2D-STE) and to explore the predictive value of 2D-STE parameters for AF recurrence after ablation procedure. Methods: Our research included in 2 groups: LAF group,n=50 patients diagnosed in our hospital from 2013-06 to 2015-05; it was further divided into 2 subgroups as Non-LA enlargement subgroup,n=34 and LA enlargement subgroup,n=16 and Control group,n=35 healthy subjects. With sinus rhythm, 2D-STE was conducted to obtain LA peak ventricular systolic longitudinal strain (PALS), strain rate (SRs) and atrial contraction longitudinal strain (ACLS), strain rate (SRa). Standard deviation for the time to peak (TPSD) of regional strain was calculated. TPSD during ventricular systole was named as SDs and TPSD during ventriculardiastole was named asSDa. Results: Compared with Control group, LAF group had reduced PALS (28.34±8.57) vs (38.73±6.13), SRs (1.17±0.31) vs (1.57±0.25), ACLS (14.11±4.91) vs (18.86±3.57 ) and SRa (-1.41±0.58) vs (-1.90±0.30), allP<0.05; while elevated SDs (8.11±3.00) % vs (4.67±1.48) % and SDa (5.57±2.26) % vs (3.11±1.13) %, bothP<0.05. Furthermore, Compared with Control group, Non-LA enlargement subgroup had decreased PALS, SRs, ACLS and SRa, allP<0.05; while increased SDs and SDa, bothP<0.05. Logistic regression analysis indicated that compared with traditional parameters, SDs and SDa could more effectively distinguish LAF patients from normal subjects (SDs with the sensitivity 83%, speciifcity 72% and SDa with the sensitivity 81%, speciifcity 76%). Elevated SDa and SDs were the best predictors for post-operative AF recurrence (SDs with the sensitivity 80%, speciifcity 71% and SDa with the sensitivity 86%, speciifcity 79%). Conclusion: 2D-STE may detect LA dysfunction and dyssynchrony in LAF patients, abnormal parameters could be found in LAF patients without LA enlargement. SDs and SDa were the best predictors for post-operative AF recurrence.

Objective To develop a list of potentially inappropriate medication (PIM) for the Chinese aged people and provide reference for prevention and reduce the medication risk of the aged people.Methods Based on the PIM lists of the United States,Canada,Japan,France,Norway,Germany,South Korea and Austria,and combined with the data of serious adverse drug reactions (ADR) in the aged people collected from China National Center for ADR Monitoring,ADR monitoring center in the People's Liberation Army,Beijing Center for ADR Monitoring and ADR data from Beijing 22 hospitals,we created a preliminary PIM list for the Chinese aged people.Using Delphi technique experts consultation was made for the initial list.Round 1 consultantation invited 32 experts,according to the expert advice to adjust the initial list,and form a revised list.Round 2 consultantation invited 38 experts,according to the expert advice to adjust revised list,and the final version of the PIM list formed.Results A total of 13-class 72 medications or medication classes were selected as the Chinese aged people PIM list,each medicine had 1-6 risk points.The list was divided according to the result of expert evaluation into 35 kinds of high risk medications and 37 kinds of low risk medications.In addition,according to the frequency of drug use,the medications were divided into A and B two categories,including 24 medications or medication classes as the preferred alert medications (A),48 medications or medication classes as routinely alert medications (B).Conclusion PIM list for the Chinese aged people have been developed,which can be taken as reference to intervention and evaluation of China's elderly medication.

Objective To develop a list of potentially inappropriate medication (PIM) for the Chinese aged people and provide reference for prevention and reduce the medication risk of the aged people.Methods Based on the PIM lists of the United States,Canada,Japan,France,Norway,Germany,South Korea and Austria,and combined with the data of serious adverse drug reactions (ADR) in the aged people collected from China National Center for ADR Monitoring,ADR monitoring center in the People's Liberation Army,Beijing Center for ADR Monitoring and ADR data from Beijing 22 hospitals,we created a preliminary PIM list for the Chinese aged people.Using Delphi technique experts consultation was made for the initial list.Round 1 consultantation invited 32 experts,according to the expert advice to adjust the initial list,and form a revised list.Round 2 consultantation invited 38 experts,according to the expert advice to adjust revised list,and the final version of the PIM list formed.Results A total of 13-class 72 medications or medication classes were selected as the Chinese aged people PIM list,each medicine had 1-6 risk points.The list was divided according to the result of expert evaluation into 35 kinds of high risk medications and 37 kinds of low risk medications.In addition,according to the frequency of drug use,the medications were divided into A and B two categories,including 24 medications or medication classes as the preferred alert medications (A),48 medications or medication classes as routinely alert medications (B).Conclusion PIM list for the Chinese aged people have been developed,which can be taken as reference to intervention and evaluation of China's elderly medication.

Objective: To explore the diagnostic value of brachial-ankle artery pulse wave velocity (baPWv) in patients of heart failure with preserved ejection fraction (HFpEF). Methods: A total of 86 consecutive dyspnoea patients without coronary artery diseases (CAD) were studied and they were divided into 2 groups: HFpEF group,n=46 and Control group, the patients had no organic heart disease,n=40. The incremental diagnostic value of HFpEF by baPWv improving the echocardiographic index and plasma BNP level was assessed by logistic regression model, receiver operation curve (ROC) of multi-parameter combination and net reclassiifcation index analysis. Results: Multiple stepwise logistic regression analysis presented that the ratio of early mitral inlfow velocity to tissue Doppler velocity at the lateral mitral annulus, BNP level and baPWv had the independent predictive value for HFpEF diagnosis, P<0.05. The ROC for baPWv with the combination of 2 or 3 parameters was better than the ROC for a single parameter, P<0.05. The baPWv added with 2007 ESC consensus statement signiifcantly improved HFpEF diagnosis, NRI = 0.127,P<0.05. Conclusion: The baPWv combining with current diagnostic criteria could increase the diagnostic value in patients of HFpEF.

Objective To investigate the long-term outcome of old stroke patients after rehabilitation. Methods 25 old hospitalized patients with first attack of stroke in recovery were followed up with Mini-mental Status Examination (MMSE), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), Brunnstrom stages of hemiplegia, modified Ashworth scale (MAS), range of motion (ROM) in hemiplegic ankle, manual muscle test (MMT) of quadriceps femoris, Berg balance scale (BBS), modified Barthel index (BI) and the Zarit burden interview (ZBI) for caregiver before rehabilitation, discharge, 6 and 12 months after discharge. Results The Brunnstrom stages of lower limbs, MAS of upper limbs improved (P<0.05) after 3-month rehabilitation in hospital, as well as the scores of BBS, BI and ZBI. As 6 and 12 months in home, the limb function remained stable, while the scores of BBS, MMSE, BI, SAS, and ZBI improved, but SDS fluctuated (P<0.05). Conclusion It is important to offer the long-term rehabilitation or consultation service when advocating old stroke patients early return to family or community, including psychological support and intervention.