Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective To observe the effect of the self-made reverse leveling device for assisting CT-guided puncture of phantom.Methods The reverse leveling device was made using protractor base,leveling bubble,puncture needle fixator,protractor and protractor pointer,and a puncture phantom was self-made with 18K foam plastic.Using a random function to set the puncture angle,3 physicians performed each 50 punctures at different angles respectively on the puncture phantom without assistance(control group)or under assistance of the self-made reverse leveling device(experimental group),and the absolute values of the errors in angles of puncture needle at head-foot and left-right directions measured on CT among 3 physicians were observed and compared between groups.Taken the absolute values of puncture angle errors at head-foot and left-right directions both≤3° as criteria of qualified puncture,the puncture qualification rates were calculated and compared between groups.Results There was no significant difference of the absolute values of puncture angle error at head-foot or left-right direction with or without assistance among 3 physicians(all P＞0.05).In experimental group,the absolute values of puncture angle error at head-foot and left-right directions were all lower than(both P＜0.001),while the puncture qualification rate was higher than those in control group(52.00%[78/150]vs.4.67%[7/150],χ2=82.752,P＜0.001).Conclusion The self-made reverse leveling device could improve the accuracy of CT-guided puncture of phantom.

BACKGROUND: Durvalumab after chemoradiotherapy (CRT) failed to bring survival benefits to patients with epidermal growth factor receptor ( EGFR ) mutations in PACIFIC study (evaluating durvalumab in patients with stage III, unresectable NSCLC who did not have disease progression after concurrent chemoradiotherapy). We aimed to explore whether locally advanced inoperable patients with EGFR mutations benefit from tyrosine kinase inhibitors (TKIs) and the optimal treatment regimen. METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases from inception to December 31, 2022 and performed a meta-analysis based on a Bayesian framework, with progression-free survival (PFS) and overall survival (OS) as the primary endpoints. RESULTS: A total of 1156 patients were identified in 16 studies that included 6 treatment measures, including CRT, CRT followed by durvalumab (CRT-Durva), TKI monotherapy, radiotherapy combined with TKI (RT-TKI), CRT combined with TKI (CRT-TKI), and TKI combined with durvalumab (TKI-Durva). The PFS of patients treated with TKI-containing regimens was significantly longer than that of patients treated with TKI-free regimens (hazard ratio [HR] = 0.37, 95% confidence interval [CI], 0.20-0.66). The PFS of TKI monotherapy was significantly longer than that of CRT (HR = 0.66, 95% CI, 0.50-0.87) but shorter than RT-TKI (HR = 1.78, 95% CI, 1.17-2.67). Furthermore, the PFS of RT-TKI or CRT-TKI were both significantly longer than that of CRT or CRT-Durva. RT-TKI ranked first in the Bayesian ranking, with the longest OS (60.8 months, 95% CI = 37.2-84.3 months) and the longest PFS (21.5 months, 95% CI, 15.4-27.5 months) in integrated analysis. CONCLUSIONS: For unresectable stage III EGFR mutant NSCLC, RT and TKI are both essential. Based on the current evidence, RT-TKI brings a superior survival advantage, while CRT-TKI needs further estimation. Large randomized clinical trials are urgently needed to explore the appropriate application sequences of TKI, radiotherapy, and chemotherapy. REGISTRATION PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; No. CRD42022298490.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; ErbB Receptors/genetics* ; Lung Neoplasms/drug therapy* ; Mutation/genetics* ; Protein Kinase Inhibitors/therapeutic use* ; Chemoradiotherapy ; Antibodies, Monoclonal/therapeutic use*

OBJECTIVE To summarize the characteristics of treatment outcomes of the patients with biliary sepsis and analyze the risk factors for death.METHODS The patients with biliary sepsis who were treated in Hainan Hospital of Chinese PLA General Hospital from Jun.2019 to Oct.2024 were retrospectively recruited as the re-search subjects and were divided into the survival group and the death group according to 28-day treatment out-comes after the diagnosis of sepsis.The baseline data and the intervention measures during the hospital stay were compared between the two groups of patients,the indexes with statistical significance were set as independent var-iables,and the death was set as dependent variable.Multivariate logistic regression analysis was performed for the risk factors for the 28-day death of the patients with biliary sepsis.RESULTS A total of 103 patients with biliary sepsis were finally included in the study,with 34(33.01％)cases in the death group,69(66.99％)cases in the survival group.Univariate analysis showed that the proportions of patients with no less than 65 years of age,shock and biliary tract obstruction,the average acute physiology and chronic health evaluation scoring system(A-PACHEⅡ)score and average sequential organ failure assessment(SOFA)score were remarkably higher in the death group than in the survival group(P＜0.05).The result of multivariate logistic regression analysis indicated that the advanced age,shock,biliary tract obstruction,APACHE Ⅱ score and SOFA score were the independent risk factors for the short-term death of the patients with biliary sepsis.CONCLUSIONS The risk of 28-day death of the patients with biliary sepsis is associated with the advanced age,shock,biliary tract obstruction,APACHE Ⅱscore and SOFA score.The combination of the above factors has high value in prediction of death.

Objective:To investigate the relationship between different states of cardiac function and their changes during the course of diabetic foot ulcers(DFU), and to evaluate their impact on patient prognosis.Methods:A retrospective analysis was conducted on 194 DFU patients who were rehospitalized at approximately 3-month intervals. Basic clinical data and cardiac function-related indicators were collected at baseline and follow-up. Patients were followed until death or until November 10, 2024. Outcomes including ulcer healing, recurrence, minor amputation, and death were recorded. Logistic regression models were used to analyze the effects of cardiac function status and its changes on these four outcomes. Results:After treatment, the proportion of patients with NYHA class Ⅱ-Ⅲ decreased significantly from 33.5% at baseline to 21.6%( P=0.009). Serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level also decreased after treatment compared with baseline [635.85(59.83, 453.28) pg/mL vs 728.67(81.48, 696.15) pg/mL, P=0.055]. Serum NT-proBNP level was significantly higher in the death group compared to the survival group( P=0.002). The proportion of DFU patients with baseline NYHA class Ⅱ-Ⅲ was significantly higher than that in those with class Ⅰ( P=0.012). Regression analysis showed that an improvement in NT-proBNP levels was associated with a lower risk of DFU recurrence( OR=0.378, 95% CI 0.183-0.779, P=0.008), and improvement in NYHA class was associated with a lower mortality risk( OR=0.074, 95% CI 0.020-0.275, P<0.001). Conclusion:Cardiac function status and its changes during the treatment of DFU patients have strong prognostic implications, particularly in predicting the risk of recurrence and death outcomes.

Objective To observe the effect of the self-made reverse leveling device for assisting CT-guided puncture of phantom.Methods The reverse leveling device was made using protractor base,leveling bubble,puncture needle fixator,protractor and protractor pointer,and a puncture phantom was self-made with 18K foam plastic.Using a random function to set the puncture angle,3 physicians performed each 50 punctures at different angles respectively on the puncture phantom without assistance(control group)or under assistance of the self-made reverse leveling device(experimental group),and the absolute values of the errors in angles of puncture needle at head-foot and left-right directions measured on CT among 3 physicians were observed and compared between groups.Taken the absolute values of puncture angle errors at head-foot and left-right directions both≤3° as criteria of qualified puncture,the puncture qualification rates were calculated and compared between groups.Results There was no significant difference of the absolute values of puncture angle error at head-foot or left-right direction with or without assistance among 3 physicians(all P＞0.05).In experimental group,the absolute values of puncture angle error at head-foot and left-right directions were all lower than(both P＜0.001),while the puncture qualification rate was higher than those in control group(52.00%[78/150]vs.4.67%[7/150],χ2=82.752,P＜0.001).Conclusion The self-made reverse leveling device could improve the accuracy of CT-guided puncture of phantom.

OBJECTIVE To summarize the characteristics of treatment outcomes of the patients with biliary sepsis and analyze the risk factors for death.METHODS The patients with biliary sepsis who were treated in Hainan Hospital of Chinese PLA General Hospital from Jun.2019 to Oct.2024 were retrospectively recruited as the re-search subjects and were divided into the survival group and the death group according to 28-day treatment out-comes after the diagnosis of sepsis.The baseline data and the intervention measures during the hospital stay were compared between the two groups of patients,the indexes with statistical significance were set as independent var-iables,and the death was set as dependent variable.Multivariate logistic regression analysis was performed for the risk factors for the 28-day death of the patients with biliary sepsis.RESULTS A total of 103 patients with biliary sepsis were finally included in the study,with 34(33.01％)cases in the death group,69(66.99％)cases in the survival group.Univariate analysis showed that the proportions of patients with no less than 65 years of age,shock and biliary tract obstruction,the average acute physiology and chronic health evaluation scoring system(A-PACHEⅡ)score and average sequential organ failure assessment(SOFA)score were remarkably higher in the death group than in the survival group(P＜0.05).The result of multivariate logistic regression analysis indicated that the advanced age,shock,biliary tract obstruction,APACHE Ⅱ score and SOFA score were the independent risk factors for the short-term death of the patients with biliary sepsis.CONCLUSIONS The risk of 28-day death of the patients with biliary sepsis is associated with the advanced age,shock,biliary tract obstruction,APACHE Ⅱscore and SOFA score.The combination of the above factors has high value in prediction of death.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Objective:To investigate the relationship between different states of cardiac function and their changes during the course of diabetic foot ulcers(DFU), and to evaluate their impact on patient prognosis.Methods:A retrospective analysis was conducted on 194 DFU patients who were rehospitalized at approximately 3-month intervals. Basic clinical data and cardiac function-related indicators were collected at baseline and follow-up. Patients were followed until death or until November 10, 2024. Outcomes including ulcer healing, recurrence, minor amputation, and death were recorded. Logistic regression models were used to analyze the effects of cardiac function status and its changes on these four outcomes. Results:After treatment, the proportion of patients with NYHA class Ⅱ-Ⅲ decreased significantly from 33.5% at baseline to 21.6%( P=0.009). Serum N-terminal pro-B-type natriuretic peptide(NT-proBNP) level also decreased after treatment compared with baseline [635.85(59.83, 453.28) pg/mL vs 728.67(81.48, 696.15) pg/mL, P=0.055]. Serum NT-proBNP level was significantly higher in the death group compared to the survival group( P=0.002). The proportion of DFU patients with baseline NYHA class Ⅱ-Ⅲ was significantly higher than that in those with class Ⅰ( P=0.012). Regression analysis showed that an improvement in NT-proBNP levels was associated with a lower risk of DFU recurrence( OR=0.378, 95% CI 0.183-0.779, P=0.008), and improvement in NYHA class was associated with a lower mortality risk( OR=0.074, 95% CI 0.020-0.275, P<0.001). Conclusion:Cardiac function status and its changes during the treatment of DFU patients have strong prognostic implications, particularly in predicting the risk of recurrence and death outcomes.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.