For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective　To analyze the causes of death of one case of imported falciparum malaria in Guangxi Zhuang Autonomous Region in January 2023, to provide a reference for the prevention of fatal malaria cases. Methods Interviews were conducted with the doctors who received and consulted the patient, as well as the family members of the patient. Clinical data from the patient's diagnosis and treatment process were collected, and the patient's clinical records and epidemiological investigation data were analyzed. Results The patient, Mr. He, a 53-year-old male from Pingnan County, Guigang City, Guangxi Zhuang Autonomous Region, returned from working in Côte d'Ivoire, Africa, and entered Guangxi on December 26, 2022. He returned home after his centralized quarantine was lifted on January 3, 2023. On January 4th, 2023, the patient developed dizziness and vomiting, considering himself to a possible COVID-19 infection, he did not seek treatment. On the morning of January 6, the patient developed a fever (peak body temperature of 40 ℃), accompanied by fatigue and sore throat, and the preemptive symptoms were aggravated. The patient was admitted to the Guancheng Town Health Center with "Pneumonia" and treated with ribavirin, dexamethasone, ceftriaxone sodium, etc. On January 7, the patient again experienced a high fever (40 ℃) and was discharged to the Emergency Department of the First Affiliated Hospital of Guangxi Medical University. Upon admission, the patient's blood pressure was measured at 78/53mmHg, further comprehensive examination showed a decrease in platelets and abnormalities in liver and renal function, procalcitonin levels at 49.9 ng/mL. Chest CT showed pneumonia, and fluid supplements and antibiotics were given. On January 8, malaria parasites were found in the patient's blood smear, and the patient was diagnosed with malaria (not classified, confirmed as falciparum malaria on January 9th). The patient was recommended to transfer to the provincial malaria-designated hospital, but his family refused. On January 8 at 13:27, the patient excreted approximately 700 g of dark red bloody stools accompanied by blurred consciousness and received hemostasis treatment. After coordinating with multiple parties, four doses of "artemisinin injection " (60 mg/dose) were taken for treatment. At 18:59 on January 8, intravenous administration of 60 mg injectable Artesunate was given, accompanied by symptomatic treatment for fever reduction and rehydration. At 19:40, the patient developed severe hypoglycemia, and severe metabolic acidosis, and blood pressure continued to decrease despite the use of vasopressors. After comprehensive treatment at 3:00 am on January 9, the patient's condition continued to deteriorate, the patient's shock could not be corrected, he lapsed into a coma, and the family requested to be discharged from the hospital. The patient returned home at 7:00 am and died of multiple organ failure at 7:30 am. Conclusions For imported malaria, early and precise diagnosis based on epidemiological history, clinical symptoms, laboratory test results, early antimalarial treatment, and management of organ dysfunction are the keys to avoiding fatal outcomes.

Objective To analyze the short-term clinical efficacy and prognosis of one-stop transcatheter aortic valve replacement (TAVR)+percutaneous coronary intervention (PCI) in the treatment of aortic valve disease with coronary heart disease. Methods The clinical data of patients with aortic valve disease complicated with coronary heart disease who underwent one-stop TAVR+PCI treatment at the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University from January 2018 to June 2023 were retrospective analyzed. The preoperative and postoperative clinical data were compared, and 1-month follow-up results were recorded. Results A total of 37 patients were enrolled, including 22 males and 15 females, with an average age of 69.14±6.47 years. Thirty-six patients recovered and were discharged after the surgery, and 1 (2.7%) patient died during the surgery. Self-expanding TAVR valves were implanted through the femoral artery in all patients. One coronary artery was opened by PCI in 35 (94.6%) patients, and two coronary arteries were opened by PCI in 2 (5.4%) patients. All PCI opened arteries had a stenosis>70%. During the postoperative hospitalization, the complications included pulmonary infection in 11 (30.6%) patients, severe pneumonia in 10 (27.8%) patients, liver function injury in 14 (38.9%) patients, renal function injury in 5 (13.9%) patients, cerebral infarction in 1 (2.8%) patient, atrial fibrillation in 1 (2.8%) patient, ventricular premature beats in 2 (5.6%) patients, atrioventricular block in 2 (5.6%) patients, and complete left bundle branch block in 5 (13.9%) patients. The median postoperative ventilation assistance time was 12.0 (0.0, 17.0) h, the ICU monitoring time was 1.0 (0.0, 2.0) d, and the postoperative hospitalization time was 5.0 (4.0, 7.0) d. There was a significant improvement in the New York Heart Association cardiac function grading after surgery (P<0.001). After surgery, there were 21 (58.3%) patients had minor perivalve leakage, 6 (16.7%) patients had minor to moderate perivalve leakage, and no moderate or above degree of perivalve leakage. After one month of postoperative follow-up, 36 patients showed significant improvement in heart function. There were no patients with recurrent acute coronary syndrome, re-PCI, or cardiovascular system disease related re-hospitalization. Conclusion The one-stop TAVR+PCI treatment for patients with aortic valve disease and coronary heart disease can obtain satisfactory short-term clinical efficacy, which is worth further trying and studying.

Objective:To investigate the effect of bupivacaine liposome for erector spinae plane block on the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.Methods:From July 2023 to January 2024, 128 American Society of Anesthesiologists Physical Status classification ⅠorⅡ patients of either sex, aged 18-75 yr, with body mass index of 18-32 kg/m 2, scheduled for elective thoracoscopic lung resection at the First Affiliated Hospital of Soochow University, were assigned to either bupivacaine liposome group (BL group) or bupivacaine hydrochloride group (BH group) using a random number table method, with 64 patients in each group. Patients received an ultrasound-guided erector spinae plane block following anesthesia induction. BL group received an injection of bupivacaine liposome 20 ml (266 mg) plus normal saline 10 ml, while BH group received an injection of bupivacaine hydrochloride 20 ml (100 mg) plus normal saline 10 ml. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively. Secondary outcomes included the QoR-15 score at 3 days postoperatively, time to first patient-controlled analgesia press, and total opioid consumption within the first 3 days postoperatively. Other outcomes assessed were the time to ambulation, duration of chest tube placement, length of hospital stay, patient satisfaction scores at discharge, and development of adverse reactions during hospitalization. Results:Compared to BH group, QoR-15 scores were significantly increased at 24 h and 3 days postoperatively, the time to first patient-controlled analgesia press was significantly prolonged, the consumption of opioid was reduced within the first 3 days postoperatively, the time to ambulation was shortened, and patient satisfaction scores at discharge were increased in BL group ( P<0.05). There were no statistically significant differences between the two groups in terms of the chest tube duration, length of hospital stay, and incidence of adverse reactions during hospitalization ( P>0.05). Conclusions:Bupivacaine liposome for erector spinae plane block can improve the quality of postoperative recovery in patients undergoing thoracoscopic lung resection.

Objective To measure and analyze the neutron dose equivalent rate produced by an IORT accelerator with 9 and 12 MeV electron energyies,and compare them with those from a Siemens Primus linear accelerator with the same electron energy,in order to provide data reference for the risk of secondary cancer induced by radiotherapy.Methods Using the neutron detector LB6411,the neutron dose equivalent rates produced by the IORT accelerator of 9 and 12 MeV were measured on some key locations,such as the head of the accelerator,cylinder bottom,patient plane with electron energies 9 and 12 MeV.The similar measurements were also performed on the same locations on a Siemens conventional accelerator.The data were collected and analyzed and the result wer compared between the two accelerators.Results Neutron dose equivalent rates from the IORT accelerator with 9 MeV energy were (51.8±3.1),(45.5 ±1.5),(70.5 ±4.9) and (68.2±3.3) μ Sv/h near the head of the accelerator,cylinder bottom,patient plane,with 5.9％,5.4％,17.8％ and 21.5％ lower than at 12 MeV,respectively.The dose equivalent rates at the similar locations from the Siemens Primus accelerator were (277.3 ±1.2),(285.1 ±1.6),(185.1 ±1.8) and (182.8 ±2.4) μSv/h at 9 MeV,with 48.8％,47.6％,48.7％,52.2％ lower than those at 12 MeV,respectively.At the energy of 12MeV,the neutron equivalent dose rate from the IORT was lower by a factor of about 10 than for Siemens Primus accelerator.Conclusions The neutron dose equivalent rates generaged by both the IORT and the Siemens Primus are higher at 12 MeV than at 9 MeV,which would lead to an increased risk of secondary cancer to patients.The traditional medical accelerator produces much higher neutron dose equivalent rates than the intraoperative electron accelerator,for which the appropriate shielding should be takn.

Objective To discuss on the relationship among innovation,scientific nature and ethics in medical articles,in order to improve the academic quality of manuscripts.Methods Take Chinese Journal of Radiological Medicine and Protection as an example,innovation was emphasized in the field of radiation diagnosis and treatment,while the cases lack of innovation were pointed.However,the lessons from many papers showed that those papers only with innovation would be rejected because of defect in scientific nature and ethics.Results Innovation is the soul of the paper,and the scientific and ethical nature is the foundation and premise of innovation.Conclusions While the innovation is emphasized,the scientific nature and ethics of the thesis should be not ignored.These three aspects are integral.

Writing and publishing scientific papers is a very important part of the research work.The quality of the thesis is also an important indicator to measure the achievements of scientific research workers.The quality of the thesis mainly includes the academic quality and the writing quality,but some of the researchers are mostly proficient in practice and neglect the writing,so there are still many writing problems in the manuscript.By reading the submission specification,this article summarizes the common problems in the writing,so as to provide the reference value for the readers.

Objective To establish diagnostic models for pancreatic carcinoma(PC)and to find out the biomarkers related to PC.Methods Serum samples obtained from subjects including PC patients,pancreatic benign disease patients and normal controls were examined with strong anionic exchange chromatography(SAX2)chips for protein profiling using surface enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS).The decision tree models and logistic regression models for evaluating the value of serum biomarkers were assessed.SELDI immunoassay and ELISA were used to identify the biomarker and its level in serum respectively.Results Twentysix mass peaks were different between PC patients and normal controls(P＜0.0 1)and 16 mass peaks were different between patients with PC and with pancreatic benign disease(P＜0.05).The decision tree model had a sensitivity of 83.3%and a specificity of 100.0%in differentiation of PC,which was better than that of CA19-9 by ROC curve.There were significant differences in 6 mass peaks among different stages of PC(P＜0.01).Logistic regression model showed a sensitivity of 81.6%and a specificity of 80.6%in diagnosis of early PC.The M/Z 28068 protein was identified as C14orf166 with a sensitivity of more than 82%and a specificity of more than 88%in diagnosis of PC.Conclusions The diagnostic models based on SELDI-TOF-MS were superior to CA19-9 in diagnosis of PC.The identified biomarker C14orf166 is expected to play a role in the diagnosis of PC.

AIM:We examined the efficacy ofanti-L3T4 McAb in the T cell signaling pathway in treating ex-Derimental antoimmune cardiomyopathy in BALB/c mice,as a model of the autoimmune mechanism involved in human di-latedardiomyopathy(DCM).METHODS:ADP/ATP carrier peptides were used to induce autoimmune cardiomyopathy in BALB/c mice.Afier 3 months.anti-L3T4 McAb WaS administered to deplete CD4+ T ceHs in the mice.Real-time PCR were used to detect the expression of intracellular signaling molecules(p561ck,p59fyn and Zap-70)and cytokine production(IFN-r,IL-2 and IL-4)in T cells.The expression of CIM5 was determined by immunohistochemistry a-nalysis.RESULTS:Reduced expression of p561ck,p59fyn and Zap-70 and the reduced cytokine production of IFN-r, IL-2 and IL-4 in T cells of anti-IJ3T4-treated DCM mice were found.Also,the expression of CD45 in spleen T cells was significantiv decreased in the anti-L3T4-treated group.In contrast,immunization with irrelevant Ab did not protect the mice.the expression of T cell signaling molecules,CD45,and cytokine were not inhibited.CONCLUSION:Thesestudies provide direct evidenee that anti-L3T4 McAb can be all effective immunomodulator to T cell signal molecules and 8ubsequent cytokine production events in ADP/ATP carrier-induced DCM in BALB/c mice.