Percutaneous vertebroplasty is the main surgical therapeutic procedure for vertebral fractures and osteolytic metastases.Although the technique has been widely used clinically,recent studies have reported an increasing number of complications.Heart rupture and pulmonary embolism caused by bone cement leakage are the extremely rare and serious complications.We herein present a case of cardiac rupture and pulmonary embolism caused by bone cement after percutaneous vertebroplasty.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Anticoagulation therapy stands as a key treatment for thrombotic diseases. The consequential bleeding risk tied to existing anticoagulation methods significantly impacts patient prognosis. In the intensive care unit (ICU), patients often necessitate organ support, leading to the inevitable placement of artificial devices in blood vessels, thereby requiring anticoagulation treatment to avert clot formation that might impede organ support. Nevertheless, these patients commonly encounter a heightened risk of bleeding. Hemophilia B, identified in 1953, manifests as a deficiency in coagulation factor Ⅺ (FⅪ), which focused people's perspective on the endogenous coagulation pathway, that is, the contact pathway. Upon interaction between the surface of artificial devices and FⅫ, FⅫ activates, subsequently triggering FⅪ and initiating the "coagulation cascade" within the contact pathway. Inhibitors targeting the contact pathway encompass two primary categories: FⅫ inhibitors and FⅪ inhibitors, capable of impeding this process. This article reviews the role of FⅫ and FⅪ in activating the contact pathway, seeking to illuminate their contributions to thrombus formation. By listing the relatively mature drugs and their indications, clinicians are familiar with this new anticoagulant.

Multi-leaf collimators are devices to block rays from medical linear accelerators, which directly affect doses to targets and organs at risk by adjusting field shape and dose distribution in radiation therapy. As multi-leaf collimators are diversified in structure, there has been growing research on dosimetric comparison of various multi-leaf collimators. In this paper, we introduced the classifications of multi-leaf collimators according to their basic components, as well as the hardware structure and design features of the products of main accelerator manufacturers, including Varian’s Millennium MLC, HD120 MLC, and Halcyon, Elekta’s MLCi/i2 and Agility, and Accuray’s InCise 2 MLC and TomoTherapy. In terms of clinical application evaluation, focusing on radiotherapy plans for nasopharyngeal carcinoma, we reviewed comparative studies on the dosimetry performance of multi-leaf collimators and the effects of relevant parameters on dose distribution. We hope this review on the design and application evaluation of multi-leaf collimators can provide a reference for more innovative design and accelerator selection and parameter setting in clinical individualized treatment.

Objective:To explore the value of ultra-short echo time magnetization transfer (UTE-MT) techniques for quantitatively dynamic monitoring of anterior patellar tendon (patellar tendon, quadriceps tendon) changes in amateur marathon runners before and after competition.Methods:Between October 2020 and January 2021, 23 amateur marathoners in Zhuhai, aged 28-50 (40±6) years, were prospectively recruited. Three-dimensional UTE-MT and dual-echo UTE-T 2* sequence scans of bilateral knee joints were performed before, 48 hours and 4 weeks after the marathon running, respectively. Another 5 non-running volunteers were recruited for verification of sequence stability. UTE-magnetization transfer ratio (MTR) and UTE-T 2* value of the patellar tendon, quadriceps tendon, and 3 tendon-bone insertion points (patellar tendon-tibial insertion point, patellar tendon-patellar insertion point, and quadriceps tendon-patellar insertion point) were measured independently on sagittal images of the knee joint by 2 radiologists. The stability of the 2 serial measurements and consistency tests between the 2 radiologists were assessed with a two-way mixed intraclass correlation coefficient (ICC). Repeated-measures analysis of variance was used to compare the differences in UTE-MTR and UTE-T 2* values of the prepatellar tendon before and after the marathon running. Results:Both UTE-MT and dual-echo UTE-T 2* sequence measurements had good stability, with ICC values of 0.98 and 0.92, respectively. Measurements of UTE-MTR and UTE-T 2* value of the patellar tendon, quadriceps tendon, and the 3 tendon-bone insertion points by the 2 radiologists were in good agreement (ICC>0.80). Forty-eight hours after the marathon running, the UTE-MTR of the patellar tendon, quadriceps tendon, and the 3 tendon-bone insertion points decreased, and UTE-MTR of the patellar tendon continued to decrease 4 weeks after the race, while UTE-MTR of other regions increased. Only the difference in UTE-MTR for the patellar tendon was statistically significant ( F=7.46, P=0.001) among pre-marathon (0.34±0.04), 48 h after the race (0.32±0.04), and 4 weeks after the race (0.31±0.04). UTE-T 2* value was mildly elevated in all regions at 48 h after the marathon running, but the differences among the three points were not statistically significant ( P>0.05). Conclusion:The UTE-MT has better reproducibility and inter-rater reliability. The UTE-MT can be used to monitor the dynamic changes of the prepatellar tendon before and after marathon exercise, where the UTE-MTR of the patellar tendon consistently decreases after marathon exercise.

Objective:To explore the value of synthetic MRI in quantitative monitoring of knee joint structural and cartilage changes of amateur marathon runners before and after the whole marathon.Methods:Totally 26 amateur marathon enthusiasts from Zhuhai City, Guangdong Province were recruited from October 2019 to January 2020. The right knee joints were scanned 1 week before the race and within 48 h after the race. The scanning sequence included the three-dimensional proton density weighted image with isotropic (3D-CUBE-PD) sequence and synthetic MRI sequence. The conventional contrast weighted images T 1WI, T 2WI, proton density (PD) weighted imaging, short-T 1 inversion recovery (STIR) and T 1, T 2, PD mapping were obtained by the latter scans. The 3D-CUBE-PD sequence was used as a reference to evaluate the detection of knee joint lesions. The knee articular cartilage was divided into 8 subregions: central medial femoral condyle (CMFC), posterior medial femoral condyle (PMFC), central lateral femoral condyle (CLFC), posterior lateral femoral condyle (PLFC), medial tibia plateau (MTP), lateral tibia plateau (LTP), patella and trochlear. Based on the synthetic MRI quantitative mapping, the T 1, T 2 and PD values of each cartilage subregion were measured independently by 2 radiologists. The ICC was used to evaluate the consistency of the measurement between observers. The T 1, T 2 and PD values of knee cartilage before and after marathon exercise were compared by Wilcoxon signed rank test. Results:The 2 radiologists had good consistency in the measurement of T 1, T 2 and PD values of knee articular cartilage with the ICC values of 0.912, 0.933 and 0.954, respectively. The synthetic MRI quantitative mapping sequence can detect all cartilage damage ( n=3) and joint effusion ( n=15), and 7 of 9 meniscus injuries were detected. The T 1, T 2 and PD values of the knee cartilage as a whole before the race were higher than those after race, and the differences were statistically significant (all P<0.05). The T 1 values were statistically significant except patellar cartilage and trochlear cartilage, and T 2 values were significantly different in the CMFC, LTP, MTP ( P<0.05). Conclusion:Synthetic MRI has a good display of knee joint structural lesions, and its quantitative parameters T 1, T 2 and PD can detect the changes of knee cartilage before and after marathon.

Objective: To investigate the sodium,potassium and blood pressure of adult residents in Liandu District of Lishui,and to provide evidence for salt reduction intervention. Methods: A stratified random sampling method was used to select residents aged 18 to 69 years in Liandu District from December 2016 to February 2017. A questionnaire survey and physical examination were conducted to collect basic information. The 24-hour urine samples were collected to detect sodium and potassium intake. Results: Among 300 participants,the average daily intake of sodium was（10.59±3.90）g,which was higher in men than in women [（11.11±4.33）g vs.（10.08±3.37）g,P<0.05]. There were 274 participants with average daily intake of sodium more than 6 g,accounting for 91.33%. The average daily intake of potassium was（1.67±0.71）g,which was higher in women than in men [（1.77±0.72）g vs.（1.57±0.68）g,P<0.05]. The average daily intakes of potassium were significantly different among different age groups,with participants aged 20 to 29 years the lowest（P<0.05）. There were 217 participants with average daily intake of potassium less than 2 g,accounting for 72.33%. The ratio of sodium to potassium was 4.7±2.2,which was higher in men than in women（5.3±2.7 vs. 4.1±1.4,P<0.05）and decreased with age（P<0.05）. There were 291 participants with the ratio more than 1.87,accounting for 97.00%. The prevalence of hypertension was 31.67%,which was 33.65% in men and 29.80% in women. Conclusion The residents in Liandu District have high intake of sodium and prevalence of hypertension,yet low intake of potassium.

Objective : To investigate the knowledge,attitude and practice of salt reduction for hypertension prevention among residents in Liandu District of Lishui,and to provide reference for intervention of salt reduction. Methods : Residents aged 18-69 years in two communities and three towns of Liandu District were selected by multistage stratified random sampling method. They were investigated the prevalence of hypertension and knowledge,attitude and practice of salt reduction for hypertension prevention. Logistic regression models were used to analyze the influencing factors for knowledge,attitude and practice of salt reduction for hypertension prevention. Results : Among 1 801 participants,1 509 completed the survey,with a response rate of 83.79%. The prevalence of hypertension was 31.88%. The proportions of the participants who had knowledge, attitude and practice of salt reduction for hypertension prevention were 33.40%,60.70% and 58.58%,respectively. The results of multivariate logistic regression analysis showed that women（OR=1.583,95%CI：1.248-2.008）,hypertension（OR= 1.734,95%CI：1.303-2.308）,30 to 39 years old（OR=0.368,95%CI：0.226-0.597）,junior high school and above education（OR=0.057-0.403,95%CI：0.036-0.577）were the influencing factors for the knowledge of salt reduction for hypertension prevention;women（OR=1.342,95%CI：1.072-1.679）,married（OR=1.582,95%CI：1.167-2.144）,junior or senior high school education（OR=0.235-0.525,95%CI：0.163-0.736）,having the knowledge（OR=2.640,95%CI：2.033-3.430）were the influencing factors for the attitude of salt reduction for hypertension prevention;women（OR=1.632,95%CI：1.304-2.044）,30 to 39 years old（OR=0.494,95%CI：0.346-0.705）,rural residents（OR= 1.617,95%CI：1.276-2.050）,family history of chronic diseases（OR=1.455,95%CI：1.148-1.845）,having the knowledge（OR= 1.396,95%CI：1.084-1.797）,having the attitude（OR=4.059,95%CI：3.203-5.145）were the influencing factor for the practice of salt reduction for hypertension prevention. Conclusion The residents in Liandu District had low levels of the knowledge,attitude and practice of salt reduction for hypertension prevention. The higher levels of the knowledge and attitude of salt reduction for hypertension prevention,the higher level of the practice.

Objective To provide reference for drug use in infant patients with Rhodococcus equi(R.equi) infection. Methods By participating in drug therapy for an infant patient with Rhodococcus equi infection,clinical pharmacist assisted physicians to develop treatment plan and provide reasonable pharmaceutical care. Results Therapeutic selection was improved through pharmaceutical care process. Conclusion Participation of clinical pharmacist can fully play their advantages in the field of drug efficacy,and improve the level of clinical treatment.

Diaphragm is the principal respiratory muscle.Diaphragm dysfunction resulting from mechanical ventilation,chronic cardiopulmonary disease,medicine,cardio-thoracic surgery,septic shock and chronic malnutrition predisposes to weaning failure from mechanical ventilation and prolongs intensive care unit (ICU) stay.Traditionally,the method of assessment of diaphragm structure and function was invasive,lacking specific,and was difficult to be used bedside.A number of recent studies have been suggested that ultrasonographic evaluation has been proposed as an accurate,safe and noninvasive method of quantification of diaphragm structure and function.This article reviews the related researches of technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic structure and function,which may possibly result in timely identification of patients with diaphragm dysfunction and improve the assessment of recovery from diaphragm weakness.