Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Background::Bladder cancer, characterized by a high potential of tumor recurrence, has high lifelong monitoring and treatment costs. To date, tumor cells with intrinsic softness have been identified to function as cancer stem cells in several cancer types. Nonetheless, the existence of soft tumor cells in bladder tumors remains elusive. Thus, our study aimed to develop a microbarrier microfluidic chip to efficiently isolate deformable tumor cells from distinct types of bladder cancer cells.Methods::The stiffness of bladder cancer cells was determined by atomic force microscopy (AFM). The modified microfluidic chip was utilized to separate soft cells, and the 3D Matrigel culture system was to maintain the softness of tumor cells. Expression patterns of integrin β8 (ITGB8), protein kinase B (AKT), and mammalian target of rapamycin (mTOR) were determined by Western blotting. Double immunostaining was conducted to examine the interaction between F-actin and tripartite motif containing 59 (TRIM59). The stem-cell-like characteristics of soft cells were explored by colony formation assay and in vivo studies upon xenografted tumor models. Results::Using our newly designed microfluidic approach, we identified a small fraction of soft tumor cells in bladder cancer cells. More importantly, the existence of soft tumor cells was confirmed in clinical human bladder cancer specimens, in which the number of soft tumor cells was associated with tumor relapse. Furthermore, we demonstrated that the biomechanical stimuli arising from 3D Matrigel activated the F-actin/ITGB8/TRIM59/AKT/mTOR/glycolysis pathways to enhance the softness and tumorigenic capacity of tumor cells. Simultaneously, we detected a remarkable up-regulation in ITGB8, TRIM59, and phospho-AKT in clinical bladder recurrent tumors compared with their non-recurrent counterparts.Conclusions::The ITGB8/TRIM59/AKT/mTOR/glycolysis axis plays a crucial role in modulating tumor softness and stemness. Meanwhile, the soft tumor cells become more sensitive to chemotherapy after stiffening, that offers new insights for hampering tumor progression and recurrence.

Objective To observe the clinical effect of endovascular stent implantation in the treatment of patients with ischemic cerebrovascular disease (ICVD) and carotid artery stenosis. Methods A total of 83 patients with ICVD treatment were selected and divided into observation group with 43 cases and control group with 40 cases, and the hemodynamic indicators and degree of internal carotid artery stenosis, neural markers and vascular endothelial function, degree of neurological deficits, clinical efficacy, and adverse reactions were compared between the two groups. Results Peak systolic velocity (PSV), end-diastolic velocity (EDV), and degree of vascular stenosis in both groups showed a downward trend after treatment, and the declines in PSV, EDV and vascular stenosis in the control group were all significantly smaller than those in the observation group (P < 0.05). After treatment, the positive pentraxin-3 (PTX-3) and neuron-specific enolase (NSE) levels in both groups decreased significantly, while functional movement disorder (FMD) and vascular endothelial growth factor (VEGF) levels increased significantly, and the PTX-3 and NSE levels in the observation group were significantly lower than those in the control group, while the VEGF and FMD levels were significantly higher (P < 0.05). After treatment, scores of the National Institutes of Health Stroke Scale (NIHSS) and the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) in both groups decreased, and the decline in NIHSS score and MESSS in the control group was smaller than that in the observation group. Clinical total effective rate was 80.00% in the control group, which was significantly lower than 97.67% in the observation group (P < 0.05). The incidence of adverse reactions in the observation group was 2.33%, which was significantly lower than 22.50% in the control group (P < 0.05). Conclusion Endovascular stent implantation can effectively improve the clinical efficacy of ICVD patients, relieve the degree of vascular stenosis, improve cognitive function, and has higher safety.

Objective To analyse the experience of out-of-hospital self-management in patients with temporary enterostomy after colorectal cancer surgery,aiming to provide a guidance for developing an effectively continuous nursing plan. Methods In this descriptive qualitative study,the purpose sampling method was applied to include 11 patients with temporary enterostomy discharged after colorectal cancer surgery as the study participants between January and October 2023. NVivo12 software and content analysis method were used to analyse the data acquired from interview and to extract the themes. Results Totally,4 themes and 8 sub-themes were extracted,including the lack of stoma management skills and low willingness to learn the skills ( lack of stoma management skills and unwillingness to actively learn skills for stoma management),difficulty in living with stoma (difficulty in living with changes of daily life brought by stoma,and expectations for the life advices of care providers),insufficient psychological and social support (negative emotions towards the life with stoma and lack of psychological support from family,friends and medical staff),and a gap between patients' expectations and actual effects on continuous nursing management (poor effectiveness of continuity of care and the high expectations for continuity of care). Conclusion Further improvement are required for the out-of-hospital self-management skills for the patients with temporary colostomy after colorectal cancer surgery. The skills can be improved by taking multiple measures such as education of nursing skills,advice on daily life,psychological support,and improvement of nursing effectiveness,therefore to enhance the out-of-hospital self-management behaviour of patients with colostomy.

Objective To analyse the experience of out-of-hospital self-management in patients with temporary enterostomy after colorectal cancer surgery,aiming to provide a guidance for developing an effectively continuous nursing plan. Methods In this descriptive qualitative study,the purpose sampling method was applied to include 11 patients with temporary enterostomy discharged after colorectal cancer surgery as the study participants between January and October 2023. NVivo12 software and content analysis method were used to analyse the data acquired from interview and to extract the themes. Results Totally,4 themes and 8 sub-themes were extracted,including the lack of stoma management skills and low willingness to learn the skills ( lack of stoma management skills and unwillingness to actively learn skills for stoma management),difficulty in living with stoma (difficulty in living with changes of daily life brought by stoma,and expectations for the life advices of care providers),insufficient psychological and social support (negative emotions towards the life with stoma and lack of psychological support from family,friends and medical staff),and a gap between patients' expectations and actual effects on continuous nursing management (poor effectiveness of continuity of care and the high expectations for continuity of care). Conclusion Further improvement are required for the out-of-hospital self-management skills for the patients with temporary colostomy after colorectal cancer surgery. The skills can be improved by taking multiple measures such as education of nursing skills,advice on daily life,psychological support,and improvement of nursing effectiveness,therefore to enhance the out-of-hospital self-management behaviour of patients with colostomy.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

OBJECTIVE: Bo investigate the regulatory relationship between NKD1 and YWHAE and the mechanism of NKD1 for promoting tumor cell proliferation. METHODS: HCT116 cells transfected with pcDNA3.0-NKD1 plasmid, SW620 cells transfected with NKD1 siRNA, HCT116 cells with stable NKD1 overexpression (HCT116-NKD1 cells), SW620 cells with nkd1knockout (SW620-nkd1^-/- cells), and SW620-nkd1^-/- cells transfected with pcDNA3.0-YWHAE plasmid were examined for changes in mRNA and protein expression levels of YWHAE using qRT-PCR and Western blotting. Chromatin immunoprecipitation (ChIP) assay was used to detect the binding of NKD1 to the promoter region of YWHAE gene. The regulatory effect of NKD1 on YWHAE gene promoter activity was analyzed by dual-luciferase reporter gene assay, and the interaction between NKD1 and YWHAE was analyzed with immunofluorescence assay. The regulatory effect of NKD1 on glucose uptake was examined in the tumor cells. RESULTS: In HCT116 cells, overexpression of NKD1 significantly enhanced the expression of YWHAE at both the mRNA and protein levels, while NKD1 knockout decreased its expression in SW620 cells (P < 0.001). ChIP assay showed that NKD1 protein was capable of binding to the YWHAE promoter sequence; dual luciferase reporter gene assay showed that NKD1 overexpression (or knockdown) in the colon cancer cells significantly enhanced (or reduced) the transcriptional activity of YWHAE promoter (P < 0.05). Immunofluorescence assay demonstrated the binding of NKD1 and YWHAE proteins in colon cancer cells. NKD1 knockout significantly reduced glucose uptake in colon cancer cells (P < 0.01), while YWHAE overexpression restored the glucose uptake in NKD1-knockout cells (P < 0.05). CONCLUSION NKD1 protein activates the transcriptional activity of YWHAE gene to promote glucose uptake in colon cancer cells.
Humans ; Colonic Neoplasms ; HCT116 Cells ; Cell Line, Tumor ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; RNA, Messenger ; Glucose ; Calcium-Binding Proteins/metabolism* ; Adaptor Proteins, Signal Transducing/metabolism* ; 14-3-3 Proteins/metabolism*

Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.

Objective To evaluate the effect of limited open reduction in the treatment of femoral shaft fractures with intramedullary nail.Methods The clinical data of 39 patients with femoral shaft fractures in the Department of Orthopedic Surgery,Southern Medical University Xiaolan Affiliated Hospital from January 2016 to December 2017 were retrospectively analyzed.All patients were treated with intramedullary nailing.Among them,25 cases were treated with limited open reduction (observation group) and 14 cases were treated with closed reduction (control group).The operation time,fluoroscopy frequency,blood loss volume,infection rate and curative effect were compared between 2 groups.Results The 39 patients were followed up for 7 to 25 (10.3 ± 2.8) months.The operation time and fluoroscopy frequency in observation group were significantly lower than those in control group:(111.4 ± 20.3) min vs.(129.3 ± 21.4) min and (7.0 ± 2.6) times vs.(22.6 ± 7.8) times,but the blood loss volume was significantly higher than that in control group:(454.0 ± 131.4) ml vs.(342.9 ± 120.7) ml,and there were statistical differences (P＜0.05 or ＜0.01);there was no statistical difference in the infection rate and excellent/ good rate between 2 groups (P＞0.05).Conclusions Limited open reduction simplifies the operation steps,shortens the operation time,and has fewer fluoroscopy times and less X-ray time.It can achieve the same effect as closed reduction,and can be used as an effective supplementary means when closed reduction equipment and technology are deficient.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.