Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To evaluate the optimization effects of ciprofol-based intravenous anesthesia in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.Methods:This study was a prospective randomized controlled study. Eighty elderly patients scheduled for elective retroperitoneal laparoscopic radical nephrectomy were randomized to receive either ciprofol-based (group C) or propofol-based intravenous anesthesia (P group), with 40 patients in each group. Anesthesia was induced by intravenous injection of ciprofol 0.4 mg/kg and maintained by intravenous infusion of ciprofol and remifentanil during operation in group C. In group P, anesthesia was induced by intravenous injection of propofol 1.5 mg/kg and maintained by intravenous infusion of propofol and remifentanil during operation. The onset time of sedative effect following anesthesia induction, hypotension and injection pain during induction and intraoperative hypotension were recorded.Results:Compared to P group, the incidence of hypotension and injection pain during induction was significantly decreased (28% vs 10%, 60% vs 18%, P<0.05); although the difference in the incidence of intraoperative hypotension was not statistically significant (25% vs 15%, P>0.05), the RR was 0.6; no significant change was found in the onset time of sedative effect following anesthesia induction in C group ( P>0.05). Conclusions:Compared to propofol-based intravenous anesthesia, ciprofol-based intravenous anesthesia has certain optimization effects in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.

Objective:To evaluate the optimization effects of ciprofol-based intravenous anesthesia in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.Methods:This study was a prospective randomized controlled study. Eighty elderly patients scheduled for elective retroperitoneal laparoscopic radical nephrectomy were randomized to receive either ciprofol-based (group C) or propofol-based intravenous anesthesia (P group), with 40 patients in each group. Anesthesia was induced by intravenous injection of ciprofol 0.4 mg/kg and maintained by intravenous infusion of ciprofol and remifentanil during operation in group C. In group P, anesthesia was induced by intravenous injection of propofol 1.5 mg/kg and maintained by intravenous infusion of propofol and remifentanil during operation. The onset time of sedative effect following anesthesia induction, hypotension and injection pain during induction and intraoperative hypotension were recorded.Results:Compared to P group, the incidence of hypotension and injection pain during induction was significantly decreased (28% vs 10%, 60% vs 18%, P<0.05); although the difference in the incidence of intraoperative hypotension was not statistically significant (25% vs 15%, P>0.05), the RR was 0.6; no significant change was found in the onset time of sedative effect following anesthesia induction in C group ( P>0.05). Conclusions:Compared to propofol-based intravenous anesthesia, ciprofol-based intravenous anesthesia has certain optimization effects in elderly patients undergoing retroperitoneal laparoscopic radical nephrectomy.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To investigate the safety and efficacy of posterior apical total intervertebral release (IVR) combined with posterior column osteotomy (PCO) in the treatment of rigid scoliosis.Methods:This study retrospectively analyzed the clinical and radiographic data of 27 patients with rigid scoliosis who underwent posterior total IVR combined with PCO in the apical region from July 2017 to September 2023. There were 10 males and 17 females with an age of 19.3±8.8 years (range 11-48 years). Among them, there were 16 cases of idiopathic scoliosis, 7 cases of neuromuscular scoliosis, 1 case of congenital scoliosis, 1 case of Marfan syndrome with scoliosis, 1 case of neurofibromatosis with scoliosis, and 1 case of osteogenesis imperfecta with scoliosis. The mean Cobb angle of the main curve was 75.4°±13.7° (range 58.7°-110.2°) preoperatively. The mean flexibility of the main curvature is 15.7%±4.7% (range 2.5%-24.3%). Preoperative computer tomography showed that the area of the IVR channel in the convex and concave side of the apical region was 128.1±23.3 mm 2 and 89.5±18.6 mm 2, respectively. The area of the convex IVR was significantly higher than that of the concave IVR. Results:All 27 patients underwent surgery successfully. Total IVR was performed at an average of 3.4±0.7 levels in the apical region. SPO and Ponte osteotomy were performed at 2.7±0.7 and 4.9±1.1 levels, respectively. The mean fusion segment is 11.2±2.0. The operation time, estimated blood loss, and follow-up time were 7.5±0.9 hours (range 6.0-9.8 hours), 1 103.7±845.1 ml (range 300-4 500 ml), and 20.0±14.2 months (range 5-56 months), respectively. The preoperative, postoperative, and final follow-up's mean coronal Cobb angles of the main curve were 75.4°±13.7°, 18.2°±6.5° and 18.6°±6.5°, respectively. The mean correction rate was 75.7%±5.3%. In cases of thoracolumbar kyphosis, the preoperative, postoperative, and final follow-up mean sagittal Cobb angles were 47.2°±4.7°, 22.8°±9.1° and 23.8°±8.9°, respectively. The mean correction rate was 49.5%±18.9%. The mean axial vertebral rotation (AVR) in the IVR region was 24.6°±7.6° preoperatively and was corrected to 11.6°±5.6° postoperatively. The mean correction rate for AVR was 54.0%±11.3%. The coronal, sagittal Cobb angles and AVR postoperatively were significantly lower than those preoperatively ( P<0.001). This case series reported 4 cases of postoperative pleural effusion and 1 case of pulmonary infection, and all of them were cured through conservative treatment. One patient developed incision infection 2 months postoperatively and recovered through debridement surgery. Two patients had proximal junctional kyphosis, one of them underwent revision surgery, and another case was treated with braces. Conclusion:Posterior multi-segment total IVR combined with PCO is a safe and effective surgical procedure for the treatment of rigid scoliosis. The procedure of total IVR was recommended as a supplement for better release of the rigid spine when traditional release methods are not effective.

Objective:To analyze the current status and deficiencies of family bed service policies in China, for references for promoting the construction of China′s home health service system.Methods:Key words such as " family bed" and " home health services" were used to search for relevant policies(from January 1, 1984 to May 31, 2023)in Peking University Treasure Database, the State Council′s policy document repository, and official websites of health administrative departments at all levels. NVivo 11.0 software was utilized for a three-level coding process to establish a policy text analysis framework and to identify deficiencies in the construction of policies.Results:A total of 63 policy documents were included, comprising 53 provincial and municipal documents, which were mainly concentrated in economically developed provinces; After three-level coding, 72 third level nodes, 21 second level nodes, and 8 first level nodes(service objects, service providers, service methods, service content, service fees, subsidy policies, hospital bed configuration, and standardized management) were obtained. Among them, the responsibilities of service providers needed to be further clarified, the technical and innovative nature of service content was still insufficient, the charging standards and medical insurance reimbursement policies needed to be improved, the support for subsidy policies was limited, and the use of intelligent devices in bed configuration needed to be strengthened.Conclusions:China′s family bed service policy focused on eight dimensions, covering a comprehensive range of content, but there were still areas that need to be refined and improved. This study suggested that relevant departments should further clarify the responsibilities of service providers, deepen the construction of service connotations, moderately increase government support, promote the intelligent construction of services, and achieve multi-party collaboration to jointly promote the sustainable development of family bed services in China.

Background: Ulcerative colitis (UC) is a diffuse nonspecific intestinal inflammation. Spleen-kidney Yang deficiency combined with liver stagnation is the most common symptom. Sishen Pills-Tongxie Yaofang (SSP-TXYF) is a traditional Chinese medicine (TCM) that is widely used in the treatment of this symptom. However, its pharmacological mechanism and active components remain unclear. Objective: This study elucidated the potential mechanism and active components of SSP-TXYF in the treatment of UC from the perspective of TCM syndrome. Methods: Metascape, STRING, and Cytoscape were used to explore the SSP-TXYF-compound-target-UC network and biological enrichment pathways, so as to screen the active compounds, key targets, and pathways of SSP-TXYF. Through the construction of a rat model with UC, the key targets and active components were verified after SSP-TXYF administration. Results: A total of 77 effective active chemical components, 208 potential targets, and 5 core target genes were screened out. Gene Ontology biological process items and Kyoto Encyclopedia of Genes and Genomes signaling pathways showed that SSP-TXYF played a role in regulating nerve-endocrine, cell proliferation and apoptosis, and immune-related pathways. The main compounds and the target protein exhibited a good binding ability in molecular docking. The results of animal experiments showed that SSP-TXYF could improve UC through IL-6, AKT1, PTGS2, CASP3, and JUN, and nobiletin and wogonin were identified as the main active components. Conclusions: This study suggests that nobiletin and wogonin are the main components of SSP-TXYF in the treatment of UC, which provides effective therapeutic targets and drugs for future clinical treatment of UC.

ObjectiveTo induce the rat model of ulcerative colitis （UC） with spleen-kidney Yang deficiency and liver depression， and explore the efficacy and mechanism of Sishenwan combined with Tongxie Yaofang （SSW&TXYF） based on the therapeutic principles of tonifying spleen， soothing liver， warming kidney， and astringing intestine. MethodSixty male SD rats were randomized into normal， model， mesalazine， and high-， medium-， and low-dose SSW&TXYF groups. The rats in other groups except the normal group were administrated with Sennae Folium decoction and hydrocortisone and received tail clamping for 14 days. On day 14， rats received enema with TNBS-ethanol solution to induce UC. The rats were administrated with corresponding drugs from day 15 of modeling， and the body weight and mental state were observed and recorded. The sucrose preference test was performed from day 25. On day 28， the rectal temperature was measured， and the rats were administrated with 3% D-xylose solution at a dose of 10 mL·kg^-1 by gavage. Blood was sampled 1 h later， from which the serum was collected for measurement of the D-xylose content. The serum， hippocampus， and colorectum samples of rats were collected on day 29. The levels of gastrin （GAS）， adrenocorticotropic hormone （ACTH）， corticosterone （CORT）， cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， interleukin （IL）-4， tumor necrosis factor （TNF）-α， and interferon （IFN）-γ in the serum and 5-hydroxytryptamine （5-HT） in the hippocampus were determined by enzyme-linked immunosorbent assay. Hematoxylin-eosin staining was employed to reveal the colonic lesions. The mRNA and protein levels of p38 mitogen-activated protein kinase （MAPK）， extracellular signal-regulated kinase （ERK）， and c-Jun N-terminal kinase （JNK） in the colon tissue were determined by Real-time PCR and Western blot， respectively. ResultCompared with the normal group， the model group showed decreased body weight， anal temperature， and D-xylose content in the serum and increased GAS content （P<0.01）. The modeling led to cAMP/cGMP unbalance and decreased the ACTH and CORT content in the serum （P<0.01）， the preference for sucrose water， and the 5-HT content in the hippocampus （P<0.01）. Moreover， it shortened the colorectal length and caused massive infiltration of inflammatory cells and severe structural damage in the colon tissue. High， medium， and low doses of SSW&TXYF improved above indicators （P<0.05， P<0.01）， reduced inflammatory infiltration， and repaired the pathological damage of the tissue. Compared with the normal group， the model group showed lowered IL-4 level （P<0.01） and elevated TNF-α and IFN-γ levels （P<0.05， P<0.01） in the serum， as well as up-regulated expression of p38 MAPK， ERK， and JNK （P<0.05， P<0.01）. Compared with the model group， SSW&TXYF elevated the IL-4 level （P<0.01）， lowered the TNF-α and IFN-γ levels （P<0.05， P<0.01）， and down-regulated the mRNA and protein levels of p38 MAPK， ERK， and JNK （P<0.05， P<0.01）. ConclusionA rat model of UC with spleen-kidney Yang deficiency and liver depression was successfully established. SSW&TXYF can significantly mitigate this syndrome by reducing the inflammatory response in the colon and inhibiting the MAPK pathway.

ObjectiveTo construct a mouse model of inflammation-associated colorectal cancer （CAC） by using azoxymethane （AOM）/dextran sulfate sodium （DSS） and investigate the effect of Huangqintang on the gut microbiota structure of mice during the occurrence and development of CAC by 16S rRNA gene high-throughput sequencing. MethodA total of 225 C57BL/6J mice were randomized into 5 groups （n=45）： Normal， model， positive drug （mesalazine）， and high （18 g·kg^-1） and low （9 g·kg^-1）-dose Huangqintang. Except those in the normal group， each mouse was injected with 10 mg·kg^-1 AOM on day 1 and day 5 within 1 week and then given 1.5% DSS solution for 7 days， which was then changed to sterile water for 14 days. This process referred to as one cycle， and mice were treated for a total of 3 cycles. On the first day of DSS treatment， mice were administrated with corresponding drugs by gavage， and the normal group and the model group were administrated with pure water by gavage， once a day until the end of the third cycle. The progression of CAC was divided into inflammation， proliferation， and tumorigenesis stages. At the end of each cycle， the body weight and colon length were measured for mice in each group， and the number of colon tumors in mice was recorded. Meanwhile， the disease activity index （DAI） was determined. The serum levels of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， and carbohydrate antigen-199 （CA199）， a tumor marker in the gastrointestinal tract of mice， were measured by ELISA. Hematoxylin-eosin staining was employed to observe colon lesions. At the same time， 3-5 pellets of fresh feces of mice in the normal group， model group， and high-dose Huangqintang group were collected， from which the fecal DNA of mice was extracted for 16S rRNA gene high-throughput sequencing. ResultCompared with the normal group， the model group showed decreased body weight （P<0.01）， increased DAI， and shortened colon length （P<0.05） at the three stages. Compared with the normal group， the model group showed elevated levels of IL-1β， IL-6， and TNF-α （P<0.05） at the proliferation stage and elevated levels of CA199 at the inflammation， proliferation， and tumorigenesis （P<0.01） stages. Compared with the normal group， the model group presented obvious infiltration of inflammatory cells at the inflammation stage， thickening of the muscle layer and abnormal proliferation of mucosal layer cells at the proliferation and tumorigenesis stages， and final formation of advanced intraepithelial tumor lesions. Compared with the model group， the Huangqintang groups showed no significant improvement in the body weight， decreased DAI score， and increased colon length at the three stages， and the increase of colon length in the tumorigenesis stage was significant （P<0.01）. At the tumorigenesis stage， the administration of Huangqintang inhibited tumor formation and growth， reduced the number of tumors （P<0.01）， lowered the levels of IL-6 （P<0.05， P<0.01）， TNF-α （P<0.05， P<0.01）， and IL-1β at the three stages， and decreased CA199 at the inflammation stage as well as at the proliferation and tumorigenesis stages （P<0.01， P<0.05）. Compared with the model group， the administration of Huangqintang reduced inflammation and abnormal cell proliferation， delaying the occurrence of tumors. Compared with the normal group， the model group showcased decreased alpha and beta diversity and altered structure of gut microbiota at the inflammation， proliferation， and tumorigenesis stages. The administration of Huangqintang adjusted the abundance and diversity of gut microbiota to the normal levels. At the inflammation stage， Huangqintang positively regulated two differential phyla （Firmicutes and Bacteroidetes） and three differential genera （Muribaculaceae， Rikenellaceae_RC9_gut_group， and Flavonifractor） in mice. At the proliferation stage， Huangqintang positively regulated two differential phyla （Bacteroidetes and Patescibacteria） and five differential genera （Muribaculaceae， Rikenellaceae_RC9_gut_group， Candidatus_Saccharimonas， norank_f__UCG-010， and Allobaculum）. At the tumorigenesis stage， Huangqintang positively regulated two differential phyla （Proteobacteria and Patescibacteria） and eight differential genera （Muribaculaceae， Candidatus_Saccharimonas， norank_f_UCG-010， Lachnospiraceae_UCG-006， Allobaculum， Bacteroides， Lachnospiraceae_NK4A136_group， and Flavonifractor） in mice. ConclusionHuangqintang can intervene in the AOM/DSS-induced transformation of inflammation to CAC in mice by correcting inflammation and short-chain fatty acid-related microbiota disorders.

Objective To optimize the method of combining azomethane oxide(AOM)and dextran sodium sulfate(DSS)to create a colitis-associated colon cancer(CAC)model,and to explore the pathogenesis of the intestinal flora in CAC.Methods Model groups A and B were established by one and two injections of AOM,respectively,combined with free drinking of DSS,and a normal control group was injected intraperitoneally with normal saline combined with purified water(n=10 mice per group).The better modeling scheme was selected by comprehensive evaluation of the disease activity index score,colon length,tumor rate,and mortality.Serum levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and tumor markers CA199,CEA,and CA724 were detected by enzyme-linked immunosorbent assay.Colon lesions were evaluated by hematoxylin and eosin(HE)staining.Changes in the intestinal microbiota in CAC mice were detected by 16S rDNA high-throughput gene sequencing analysis of mouse feces.Results Both single and enhanced AOM injections combined with DSS induced CAC mice;however,colon growths were larger,more closely arranged,and their morphological size was more consistent in group B compared with group A,with a tumor-formation rate of 100％.IL-6 levels were increased in the model group compared with the normal group(P＜0.05).TNF-α levels were increased in the model group compared with the normal group(P＞0.05).The CA199 and CEA levels were also significantly increased(P＜0.05),but CA724 levels were not.Infiltration of inflammatory cells in the colon detected by HE pathology was accompanied by high-grade intraepithelial tumor-like changes on the surface of the lumen.The diversity and abundance of intestinal bacteria were decreased in CAC mice compared with normal mice:phyla Verrucomicrobiota and Actinobacteriota were significantly increased(P＜0.05),Bacteroidota and Campilobacterota were significantly decreased(P＜0.05).Akkermansia,Prevotellaceae,Ruminococcus,and Bifidobacterium were significantly increased(P＜0.05),and Roseburia,Rikenellaceae_RC9_gut_group,Anaeroplasma,and Muribaculaceae were significantly decreased(P＜0.05).Conclusions Two injections of AOM combined with 1.5％(1.5 g/100 mL)DSS induced CAC model mice with a high colon-tumorigenesis rate,uniform tumor morphology,and low mortality,and may thus be the preferred modeling scheme for pharmacodynamic experiments.Disorders or dysfunction of the intestinal flora may lead to increased permeability,loss of intestinal mucosal barrier function,and the release of enterogenic endotoxins,Resultsing in a sustained inflammatory response,as an indirect or direct cause of CAC pathogenesis.