BACKGROUND:Spondylolisthesis is a common disease,and there is a lack of effective drugs to treat it.There is still a need to further define the pathogenesis and screen out more suitable therapeutic targets for spondylolisthesis.Mendelian randomization analysis can be used to explore the drugable genes associated with spondylolisthesis and provide valuable guidance for the development of more effective and targeted therapeutic drugs.OBJECTIVE:To explore potential therapeutic targets and effective drugs for spondylolisthesis by means of pharmaceutically available genome-wide Mendelian randomization analysis.METHODS:Using the Finnish database,eQTLGen consortium,drug signature database,drug-gene interaction database,protein-protein interaction database,organic small molecule biological activity database and protein structure database,which contains genome and health information of half a million Finns,data on druggable genes were subjected to two-sample Mendelian randomization analysis and co-localization analysis with data from genome-wide association studies of spondylolisthesis to identify genes highly associated with spondylolisthesis.In addition,GO and KEGG enrichment analysis,protein network construction,drug prediction and molecular docking were performed to provide valuable guidance for the development of more effective and targeted therapeutic agents.RESULTS AND CONCLUSION:In this study,we identified 34 potential drug target genes that were significantly associated with spondylolisthesis,particularly the gene APOBEC3G.This gene showed a significant association with spondylolisthesis outcomes through Mendelian analysis and co-localization analysis,suggesting that APOBEC3G may be a priority therapeutic target.As for other potential mechanisms and drugs,we still need to conduct more in-depth research to determine their roles.This study used a database from a European population,which can be used as a reference for the study of population genetics in China.

BACKGROUND:Spondylolisthesis is a common disease,and there is a lack of effective drugs to treat it.There is still a need to further define the pathogenesis and screen out more suitable therapeutic targets for spondylolisthesis.Mendelian randomization analysis can be used to explore the drugable genes associated with spondylolisthesis and provide valuable guidance for the development of more effective and targeted therapeutic drugs.OBJECTIVE:To explore potential therapeutic targets and effective drugs for spondylolisthesis by means of pharmaceutically available genome-wide Mendelian randomization analysis.METHODS:Using the Finnish database,eQTLGen consortium,drug signature database,drug-gene interaction database,protein-protein interaction database,organic small molecule biological activity database and protein structure database,which contains genome and health information of half a million Finns,data on druggable genes were subjected to two-sample Mendelian randomization analysis and co-localization analysis with data from genome-wide association studies of spondylolisthesis to identify genes highly associated with spondylolisthesis.In addition,GO and KEGG enrichment analysis,protein network construction,drug prediction and molecular docking were performed to provide valuable guidance for the development of more effective and targeted therapeutic agents.RESULTS AND CONCLUSION:In this study,we identified 34 potential drug target genes that were significantly associated with spondylolisthesis,particularly the gene APOBEC3G.This gene showed a significant association with spondylolisthesis outcomes through Mendelian analysis and co-localization analysis,suggesting that APOBEC3G may be a priority therapeutic target.As for other potential mechanisms and drugs,we still need to conduct more in-depth research to determine their roles.This study used a database from a European population,which can be used as a reference for the study of population genetics in China.

BACKGROUND:Observational studies have shown that intervertebral disc degeneration affects sedentary and physical activity levels;however,the causal relationship between sedentary and physical activity levels in the Oswestry disability index score and intervertebral disc degeneration is unclear. OBJECTIVE:To explore the causal relationship between sedentary and physical activity levels in the Oswestry disability index score and intervertebral disc degeneration using the Mendelian randomization method. METHODS:Five features associated with behavioral correlations in the Oswestry disability index score,including time spent watching TV,time spent on the computer,and light/moderate/vigorous physical activity,were selected from large-scale population-based genome-wide association studies,and instrumental variables were extracted for each of these behaviorally related features.Mendelian randomization analyses were performed in conjunction with the extraction of intervertebral disc degeneration as an outcome from the Finn Gen latest version 9 database.The results were analyzed using the inverse variance weighted,MR-Egger regression,simple mode,weighted mode,weighted median estimator,and regression model odds ratios(OR)and 95%confidence interval(CI)to assess the causal relationship between sedentary and physical activity levels in the Oswestry disability index scoring and intervertebral disc degeneration.Cochran's Q was used to test for heterogeneity,MR-Egger intercept to test for multiplicity,and leave-one-out to test the sensitivity of single nucleotide polymorphisms to the causal relationship between exposure factors and disc degeneration. RESULTS AND CONCLUSION:The results of the Mendelian randomization analysis using inverse variance weighted method showed a positive causal association between time spent watching TV/on the computer and the risk of intervertebral disc degeneration(OR=1.775,95%CI:1.418-2.221,P<0.001)/(OR=1.384,95%CI:1.041-1.839,P<0.001),an inverse causal association between light physical activity and the risk of intervertebral disc degeneration(OR=1.000,95%CI:0.999-1.000,P=0.020).MR-Egger intercept analysis indicated there was potential horizontal polytropy between light physical activity and intervertebral disc degeneration(P=0.005),while there was no horizontal pleiotropy between time spent watching TV,time spent on the computer and intervertebral disc degeneration(P=0.521,P=0.851).Cochran's Q analysis showed that heterogeneity was observed between time spent watching TV,time spent on the computer and intervertebral disc degeneration(P=3.33×10-11,P=0.001),and no significant heterogeneity was observed between light physical activity and intervertebral disc degeneration(P=0.186).Overall,there is a bidirectional causal relationship between sedentary and physical activity levels in the Oswestry disability index score and intervertebral disc degeneration,i.e.,not only does intervertebral disc degeneration affect sedentary and physical activity levels in the Oswestry disability index score,but sedentary and physical activity levels in the Oswestry disability index score also affect intervertebral disc degeneration.These findings add to the genetic evidence for a positive effect of light physical activity on intervertebral disc degeneration,indicate that moderate/vigorous physical activity shows no significant causal relationship with intervertebral disc degeneration,and expand the evidence base for sedentary behaviors such as prolonged time spent watching TV/on the computer as a risk factor for intervertebral disc degeneration.

Objective To evaluate the clinical outcomes of robot-assisted percutaneous vertebroplasty(PVP)versus manual PVP in treating osteoporotic vertebral compression fractures(OVCF),and explore the advantages of robotic assistance for clinical decision-making.Methods Patients who underwent single-level PVP for OVCF at the Department of Joint Surgery and Bone Tumor,Beijing Shijitan Hospital,Capital Medical University,between April 2021 and April 2025 were enrolled.The robot group(n=29)and manual PVP group(control,n=88)were followed-up for 1 month.Parameters compared included:total hospital stay,operative time,cement volume,cement leakage rate,nerve injury rate,intraoperative fluoroscopy number,first-attempt success rate of puncture,postoperative versus preoperative anterior vertebral height difference,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)scores preoperatively,at 1-day and 1-month postoperatively.Results No statistically significant differences existed in baseline characteristics(gender,age,fracture-to-surgery interval,and fracture distribution)between groups(P>0.05).The number of intraoperative fluoroscopy times and the ODI index on the first day after surgery in the robot group were significantly lower than those in the control group(P<0.05),and the first-attempt success rate of puncture was significantly higher than that in the control group(P<0.05).There were no statistically significant differences in the other parameters between the two groups(P>0.05).Conclusion Both robot-assisted PVP and manual PVP have good clinical efficacy in the treatment of OVCF.Robot-assisted PVP can reduce the number of intraoperative fluoroscopy times and may have more advantages in improving the first-attempt success rate of puncture and early postoperative lumbar function.However,its reliability needs to be further verified through large-sample randomized controlled studies with multivariate analysis.

Objective To evaluate the clinical outcomes of robot-assisted percutaneous vertebroplasty(PVP)versus manual PVP in treating osteoporotic vertebral compression fractures(OVCF),and explore the advantages of robotic assistance for clinical decision-making.Methods Patients who underwent single-level PVP for OVCF at the Department of Joint Surgery and Bone Tumor,Beijing Shijitan Hospital,Capital Medical University,between April 2021 and April 2025 were enrolled.The robot group(n=29)and manual PVP group(control,n=88)were followed-up for 1 month.Parameters compared included:total hospital stay,operative time,cement volume,cement leakage rate,nerve injury rate,intraoperative fluoroscopy number,first-attempt success rate of puncture,postoperative versus preoperative anterior vertebral height difference,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)scores preoperatively,at 1-day and 1-month postoperatively.Results No statistically significant differences existed in baseline characteristics(gender,age,fracture-to-surgery interval,and fracture distribution)between groups(P>0.05).The number of intraoperative fluoroscopy times and the ODI index on the first day after surgery in the robot group were significantly lower than those in the control group(P<0.05),and the first-attempt success rate of puncture was significantly higher than that in the control group(P<0.05).There were no statistically significant differences in the other parameters between the two groups(P>0.05).Conclusion Both robot-assisted PVP and manual PVP have good clinical efficacy in the treatment of OVCF.Robot-assisted PVP can reduce the number of intraoperative fluoroscopy times and may have more advantages in improving the first-attempt success rate of puncture and early postoperative lumbar function.However,its reliability needs to be further verified through large-sample randomized controlled studies with multivariate analysis.

With the optimization of surgical technologies and postoperative management regimens, the number of lung transplantation has been significantly increased, which has become an important treatment for patients with end-stage lung disease. However, due to the impact of comprehensive factors, such as bronchial ischemia and immunosuppression, the incidence of airway stenosis after lung transplantation is relatively high, which severely affects postoperative survival and quality of life of lung transplant recipients. In recent years, with the improvement of perioperative management, organ preservation and surgical technologies, the incidence of airway stenosis after lung transplantation has been declined, but it remains at a high level. Early diagnosis and timely intervention play a significant role in enhancing clinical prognosis of patients with airway stenosis. In this article, the general conditions, diagnosis, treatment and prevention of airway stenosis after lung transplantation were reviewed, aiming to provide reference for comprehensive management of airway stenosis after lung transplantation and improving clinical prognosis of lung transplant recipients.

ObjectiveTo understand the usage of antibiotics in outpatients in a county of Zhejiang Province from 2015 to 2020， so as to provide a basis for further standardizing the clinical application of antibiotics in this region. MethodsOutpatient records and prescription records of 146 public medical institutions from 2015 to 2020 were extracted from the electronic medical record data sharing platform system of medical institutions in a county of Zhejiang Province. The utilization rates and the number of types of antibiotics used in outpatient patients were described. According to the drug anatomy， therapeutic and chemical classification system （ATC）， clinical application classification and dosage form， the use status of different types of antibiotics was observed. The annual percentage change （APC） was used to analyze the time trend of antibiotic use. Among the antibiotic prescriptions in each year， the proportions of prescriptions aimed for different use reasons and patients were compared to analyze the changes in the structures of antibiotic prescriptions. ResultsDuring 2015‒2020， a total of 2 861 438 prescriptions were issued in146 primary public medical institutions in this county， including 314 642 prescriptions for antibiotics， and the overall utilization rate of antibiotics was 11%. The utilization rate of antibiotics showed a decreased trend across the years （from 14.23% in 2015 to 7.59% in 2020，APC=-11.51%， 95%CI=-0.01%‒-21.7%， t=-12.05， P<0.001） and an obvious seasonal variation character （higher in winter and spring， lower in summer and autumn）. Cefoxitin sodium for injection was the most used antibiotic in 2015， and cefuroxime was the most used antibiotic from 2015 to 2020， respectively. The utilization rates of cephalosporins （APC=-11.06%， 95%CI=0‒-20.89%， t=-22.233， P<0.001）， quinolones （APC=-9.74%， 95%CI=0‒-18.53%， t=-7.652， P=0.002）， macrolides （APC=-17.52%， 95%CI=0‒-17.52%， t=-3.626， P=0.022） and lincoamides （APC=-49.01%， 95%CI=0‒-74%， t=-3.35， P=0.029） showed a decreasing trend across the years. There were differences in the distribution of drug use reasons （χ²=9 458.427， P<0.001）， as well as the age （χ²=5 421.709， P<0.001） and sex （χ²=245.322， P<0.001） of patients. During the observation period， 50.69% of antibiotic prescriptions were used to treat respiratory diseases， with the highest proportion of 57.67% in 2015 and the lowest proportion of 34.93% in 2020. 58.37% of patients were aged 50‒70 years， with a decreasing proportion of patients under 50 years （17.83% in 2015， 6.64% in 2020） and an increasing proportion of patients over 70 years （24.1% in 2015， 38.41% in 2020）. ConclusionThe utilization rate of antibiotics used in outpatients from primary public medical institutions in a county of Zhejiang Province shows a decreasing trend across the years， but higher than that of secondary and above hospitals in China， and also higher than that of primary medical institutions in economically-developed areas. The management and monitoring of the clinical use of antibiotics in the county should be actively strengthened.

ObjectiveTo determine the serum antibody level and risk factors in the adolescent population in a county in Zhejiang Province， following the immunization with inactivated COVID-19 vaccine， and to construct a prediction model for antibody concentration. MethodsWe conducted the study in a county in Zhejiang Province， employing a stratified cluster random sampling strategy in school children who had received the inactivated COVID-19 vaccine. Data on gender， age， type of vaccine， and time of vaccination was collected. Serum samples were also collected to test for anti-S and N IgG antibody against the SARS-CoV-2 by using chemiluminescent immunoassay （CLIA）. Risk factors were determined to construct a prediction model for antibody concentration. ResultsThe IgG antibody concentration was significantly higher in girls， those who received two doses， and those who had simply received the KX vaccine . It decreased with age and time interval between the sampling and last vaccination. The prediction model constructed by random forest regression in the study had a better model fit and predictive ability than that by the multivariable linear stepwise regression. ConclusionGender， age， vaccination dose， type of vaccine， and time of vaccination are associated with vaccination effectiveness of inactivated COVID-19 vaccines in adolescents. Prediction model could predict the antibody level in the vaccinated population， which can provide a new tool for better evaluation of vaccination effectiveness against emerging infectious diseases in future.

BACKGROUND:It has been found in recent observational studies that assessing localized fat mass is crucial in the evaluation of disc degeneration.Although obesity has been recognized as a risk factor for disc degeneration,the causal relationship between fat mass,which is a key factor in obesity,and intervertebral disc degeneration has been unclear in previous studies. OBJECTIVE:To investigate the causal risk factors of intervertebral disc degeneration associated with different distributions of fat mass,thereby enhancing the understanding of the pathogenesis of intervertebral disc degeneration and contributing to the development of preventive,therapeutic,and prognostic strategies. METHODS:Genetic markers associated with trunk and lower limb fat mass were extracted as instrumental variables from the publicly available IEU Open GWAS under the conditions of strong correlation and fulfillment of linkage disequilibrium.These markers were combined with the Mendelian randomization analysis to investigate the relationship between body fat and intervertebral disc degeneration.We used the latest version 9 database of FinnGen and assessed the results using several regression models,including inverse variance weighting,MR-Egger regression,simple mode,weighted mode,and weighted median estimator.We also assessed the heterogeneity of the genetic markers using Cochran's Q test,and multiplicity was assessed using the MR-Egger intercept test.Additionally,we used the leave-one-out method to determine the sensitivity of individual genetic markers to the causal effect of the exposure and outcome.The results were presented as odds ratios(OR)and 95%confidence intervals(CI). RESULTS AND CONCLUSION:The results from the inverse variance weighting method revealed that there was a positive causal relationship between trunk fat mass and the risk of developing intervertebral disc degeneration(OR=1.25,95%CI:1.15-1.35,P＜0.001).Additionally,there was an inverse causal relationship between bilateral lower limb fat mass and the risk of developing intervertebral disc degeneration(OR=0.7,95%CI:0.63-0.78,P＜0.001;OR=0.69,95%CI:0.62-0.76,P＜0.001).Furthermore,the MR-Egger intercept analysis did not detect any potential horizontal pleiotropy.No bias single nucleotide polymorphisms were detected,while heterogeneity tests were present,and the leave-one-out sensitivity analysis suggested reliable results.The results above demonstrate a positive causal relationship between trunk fat mass and intervertebral disc degeneration.As trunk fat mass increases,the risk of intervertebral disc degeneration rises.With an increase in both lower limb fat mass,the risk of intervertebral disc degeneration decreases.Fat content and distribution affects the risk of developing intervertebral disc degeneration and should be given more attention.

Objective:To design a set of assessment tool for the effectiveness of internal performance management in public hospitals, so as to provide reference for optimization hospital internal systems and multi-institutional comparison.Methods:From September 2022 to April 2023, literature review and expert group discussion were used to initially construct an index system for evaluating the effectiveness of performance management in public hospitals, based on the " structure-process-outcome" model. Index quantitative scoring rules and standardized staff questionnaire for supporting use were developed by drawing on the World Management Survey Hospital Edition and Chinese Hospital Management Survey. Two rounds of Delphi consultation were made to rate the importance and measurement feasibility of each index. The analytic hierarchy process was used to determine the relative importance of the finalized indexes. Results:The effective recovery rate of expert consultation questionnaire was 100%, and the authority coefficient was 0.882. The index system consisted of 3 first-level indexes (structure, process, and result), 9 second-level indexes, and 27 third-level indexes. The weights of structure, process and result were 0.307, 0.406 and 0.287, respectively. The second-level indexes with the highest weight were internal effectiveness, informationization, and performance tracking and evaluation, with values of 0.180, 0.156 and 0.115, respectively. The third-level indexes with the highest weight were the construction level of performance management information integration platform, the incentive degree of hospital performance management system to employees, and the scope of performance tracking and evaluation, with values of 0.156, 0.075 and 0.073. The third-level index quantitative scoring rules covered the management activity points that were easy to collect via investigation. Among them, the feasibility of 22 scoring rules were recognized by all the 15 experts, 5 rules were recognized by 14 experts, and 2 rules were recognized by 13 experts. A standardized survey questionnaire covering 25 questions was established based on four third-level indexes: the level of understanding, recognition, satisfaction, and motivation of employees towards the hospital performance management system. The importance scores of each question ranged from 7.43 to 8.71.Conclusions:This study developed a comprehensive suite of assessment instruments, including an index system, a set of quantitative scoring rules, and a standardized staff questionnaire, which could provide reference for hospitals to upgrade their internal performance management levels.