Objective:This study introduces a novel segmented and layered thoracic laminoplasty technique for the treatment of thoracic spinal stenosis (TSS) caused by ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF). The goal is to simplify the surgical procedure, improve safety, reduce iatrogenic injuries, and validate its clinical outcomes through follow-up.Methods:A retrospective analysis was conducted on 23 patients (10 males, 13 females; mean age 58.83±12.01 years) treated at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023. Transverse grooves were created at the superior and inferior vertebral pedicle levels, utilizing the intervertebral ligamentum flavum as a segmental demarcation reference. Partial removal of the distal lamina and medial of the inferior articular process was performed through a cortical window. Under direct visualization, complete removal of ossified ligamentum flavum, proximal portion of lamina, superior articular process. The treatment effect was evaluated by clinical symptoms, signs, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), imaging results (CT and MRI) and complications before or after surgery.Results:All 23 procedures were successfully completed with a mean operative duration of 180(150, 220) min, the surgical time for 71 segments were 67.5(53.8, 120.0) minutes and intraoperative blood loss of 200(100, 300) ml, demonstrating a low intraoperative dural tear rate of 8.70% (2/23). Postoperative imaging (CT/MRI) confirmed adequate decompression in all cases, with significant symptom improvement at final follow-up 21(9, 39) months: 47% (7/15) of patients achieved marked relief of lower limb numbness, 82% (14/17) showed substantial motor recovery, and 54% (7/13) exhibited improved gait stability. Functional outcomes revealed significant enhancements, with JOA scores increasing from 8(6, 8) preoperatively to 9(8, 10) postoperatively ( P<0.05; 43.80% improvement rate) and VAS scores decreasing from 6(5, 7) to 2(1, 4) ( P<0.05). The complications were two dural tears and one suture reaction. Conclusions:Ultrasonic osteotome-assisted segmented layered laminectomy is a safe, effective, and straightforward technique for treating thoracic spinal stenosis caused by OPLL and OLF. It offers shorter operative times, minimal complications, and significant clinical improvement, making it a promising technique for broader clinical adoption.

Objective To construct an acute cerebral infarction risk nomogram prediction model to evaluate the risk of symptomatic intracranial hemorrhage in patients after percutaneous intracranial artery thrombolysis.Methods A total of 272 patients with acute cere-bral infarction who underwent percutaneous intracranial artery thrombolysis in our hospital from January 2021 to February 2024 were selected as the study participants and divided into the training set(n=190)and validation set(n=82)at a ratio of 7∶3.The training set was divided into a bleeding group(n=61)and non-bleeding group(n=129)based on the presence or absence of symptomatic intracranial hemorrhage during the postoperative period,and the general data of the patients in the two groups were compared.Binary logistic regres-sion was used to analyze the factors influencing symptomatic intracranial hemorrhage.The R Language 4.3.3 toolkit was used to construct a predictive model for the risk of symptomatic intracranial hemorrhage.The predictive efficacy,calibration,and clinical applicability of the model were assessed using subject operating characteristic(ROC),calibration,and decision curves.Results Atrial fibrillation,fasting blood glucose level,and preoperative NIHSS scores were identified as factors influencing symptomatic intracranial hemorrhage after percutaneous intracranial artery thrombolysis in patients with acute cerebral infarction.The AUC of the training and validation sets for predicting symptomatic intracranial hemorrhage was 0.986(95％CI:0.974-0.999)and 0.986(95％CI:0.967-1.000),with a sensitivity of 95.08％and 99.98％,and a specificity of 95.35％and 92.98％.Conclusion The risk nomogram prediction model constructed in this study provides an effective tool of clinical value for assessing the risk of symptomatic intracranial hemorrhage after percutaneous intracra-nial artery thrombolysis in patients with acute cerebral infarction.

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Objective To investigate indoor radon concentrations and environmental cumulative doses in residential and office units in Shenzhen, and estimate the average annual effective dose, and to provide data for assessing public health risks. Methods Within the 11 administrative districts of Shenzhen (including the Shenzhen-Shanwei Special Cooperation Zone), 17 residential units and 3 office units were randomly selected as monitoring sites in each district. The units selected represented buildings of different ages and various floors on which the units were located. Radon detectors and environmental cumulative dosimeters were deployed for monitoring. Results The indoor radon concentrations in Shenzhen during the two monitoring periods were (36.6 ± 16.5) Bq/m³ and (19.8 ± 15.3) Bq/m³, respectively. The environmental cumulative doses for the two monitoring periods were (0.33 ± 0.07) mSv and (0.25 ± 0.04) mSv, respectively. The estimated average annual effective dose due to indoor radon in Shenzhen was 0.92 mSv. Conclusion All monitored indoor radon concentrations in Shenzhen were below the national standard of China. The indoor radon concentrations exhibited significant regional variations, were higher in spring than in summer, and showed no statistically significant differences across buildings of different ages or units of various floors. The trends in indoor radon concentrations and environmental cumulative doses were highly consistent. The average indoor radon concentration in Shenzhen was lower than both the global and national levels, indicating a low risk of internal radiation exposure from radon.

The multidisciplinary diagnosis and treatment (MDT) mode plays a positive role in diagnosing and treating difficult and complicated diseases, improving service quality, and promoting the construction of an integrated medical system. In March 2023, Zhejiang Provincial People′s Hospital had launched the " 6 New" MDT management practice to further improve the hospital′s inpatient MDT service level, including new concepts, new architectures, new standards, new processes, new models, and new quality control. This practice had improved the quality and efficiency of MDT management and promoted interdisciplinary integration by strengthening top-level design, establishing MDT leadership and quality control teams, developing relevant standards and specifications, enhancing the level of information management throughout the entire process, implementing diversified MDT models, and implementing quality control measures. As of July 2024, the hospital had established 80 MDT teams covering 30 clinical departments, conduct 120 MDT discussions for hospitalized cases per month, and with the continuous promotion of inpatient MDT work, the number of MDT teams and cases continued to increase. This practice had achieved good results and could provide references for other public hospitals in China to improve the level of inpatient MDT services.

With the widespread implementation of immunoprophylaxis strategies, the primary challenge in HBV infection prevention and control in China has shifted to reducing the burden of existing infections. A crucial approach to decreasing the burden of existing infections is to develop the effective treatment methods to achieve clinical or functional cures within a limited treatment duration for infected patients. The existing infections can be divided into two parts: those that are easy to cure and those that are difficult to treat. Patients who meet the current drug withdrawal criteria and at the same time have HBsAg<100 IU/mL following treatment with nucelos(t)ide analogue therapy are the easier one to treat, accounting for about 12% of the total infections, and the remaining 88% are difficult to cure. A necessary step toward clinical cure is pushing the HBsAg levels of patients to <100 IU/mL, but this driving effect must stem from effective immune reconstitution against HBV. Recent prevention and control, certain characteristics and implementation of clinical cure, and the safe drug withdrawal are discussed here to offer new perspectives on issues related to hepatitis B.

Objective:This study introduces a novel segmented and layered thoracic laminoplasty technique for the treatment of thoracic spinal stenosis (TSS) caused by ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF). The goal is to simplify the surgical procedure, improve safety, reduce iatrogenic injuries, and validate its clinical outcomes through follow-up.Methods:A retrospective analysis was conducted on 23 patients (10 males, 13 females; mean age 58.83±12.01 years) treated at Taizhou People's Hospital Affiliated to Nanjing Medical University from January 2018 to December 2023. Transverse grooves were created at the superior and inferior vertebral pedicle levels, utilizing the intervertebral ligamentum flavum as a segmental demarcation reference. Partial removal of the distal lamina and medial of the inferior articular process was performed through a cortical window. Under direct visualization, complete removal of ossified ligamentum flavum, proximal portion of lamina, superior articular process. The treatment effect was evaluated by clinical symptoms, signs, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS), imaging results (CT and MRI) and complications before or after surgery.Results:All 23 procedures were successfully completed with a mean operative duration of 180(150, 220) min, the surgical time for 71 segments were 67.5(53.8, 120.0) minutes and intraoperative blood loss of 200(100, 300) ml, demonstrating a low intraoperative dural tear rate of 8.70% (2/23). Postoperative imaging (CT/MRI) confirmed adequate decompression in all cases, with significant symptom improvement at final follow-up 21(9, 39) months: 47% (7/15) of patients achieved marked relief of lower limb numbness, 82% (14/17) showed substantial motor recovery, and 54% (7/13) exhibited improved gait stability. Functional outcomes revealed significant enhancements, with JOA scores increasing from 8(6, 8) preoperatively to 9(8, 10) postoperatively ( P<0.05; 43.80% improvement rate) and VAS scores decreasing from 6(5, 7) to 2(1, 4) ( P<0.05). The complications were two dural tears and one suture reaction. Conclusions:Ultrasonic osteotome-assisted segmented layered laminectomy is a safe, effective, and straightforward technique for treating thoracic spinal stenosis caused by OPLL and OLF. It offers shorter operative times, minimal complications, and significant clinical improvement, making it a promising technique for broader clinical adoption.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.

Objective To construct an acute cerebral infarction risk nomogram prediction model to evaluate the risk of symptomatic intracranial hemorrhage in patients after percutaneous intracranial artery thrombolysis.Methods A total of 272 patients with acute cere-bral infarction who underwent percutaneous intracranial artery thrombolysis in our hospital from January 2021 to February 2024 were selected as the study participants and divided into the training set(n=190)and validation set(n=82)at a ratio of 7∶3.The training set was divided into a bleeding group(n=61)and non-bleeding group(n=129)based on the presence or absence of symptomatic intracranial hemorrhage during the postoperative period,and the general data of the patients in the two groups were compared.Binary logistic regres-sion was used to analyze the factors influencing symptomatic intracranial hemorrhage.The R Language 4.3.3 toolkit was used to construct a predictive model for the risk of symptomatic intracranial hemorrhage.The predictive efficacy,calibration,and clinical applicability of the model were assessed using subject operating characteristic(ROC),calibration,and decision curves.Results Atrial fibrillation,fasting blood glucose level,and preoperative NIHSS scores were identified as factors influencing symptomatic intracranial hemorrhage after percutaneous intracranial artery thrombolysis in patients with acute cerebral infarction.The AUC of the training and validation sets for predicting symptomatic intracranial hemorrhage was 0.986(95％CI:0.974-0.999)and 0.986(95％CI:0.967-1.000),with a sensitivity of 95.08％and 99.98％,and a specificity of 95.35％and 92.98％.Conclusion The risk nomogram prediction model constructed in this study provides an effective tool of clinical value for assessing the risk of symptomatic intracranial hemorrhage after percutaneous intracra-nial artery thrombolysis in patients with acute cerebral infarction.

Objective Based on the assumption of spatial heterogeneity,the distribution pattern and risk characteristics of health poverty in middle-aged and elderly people with chronic diseases are described from the perspective of spatial differentiation.In order to providing a theoretical basis for the optimization of subsequent poverty reduction policies and a model policy for other countries.Methods It used factor detector and interaction detector to capture the role of single-factor and multi-factor interactions on the spatial differentiation of health poverty,and risk detectors were utilized to explore the high-risk factors in risky areas Results The single factor explanation of medical assistance and health education activities is prominent,and the factors such as PM2.5,old-age dependency ratio and urban unemployment rate have strong interaction.Furthermore,it identified high-risk factor characteristics in areas at high risk of health poverty.Conclusion The spatial differentiation pattern of health poverty among the middle-aged and elderly chronic disease population in China is the result of the synergistic driving effect of multidimensional factors,and there is variability in the risk characteristics among regions.The government should establish a contextual optimization strategy and pay attention to the joint effect of multiple factors to establish a synergistic management system.