Objectives:To systematically evaluate the risk factors associated with postoperative epidural hematoma in patients undergoing cervical spinal surgery.Methods:PubMed,Embase,the Cochrane Library,Web of Science,CNKI,Wanfang databases,VIP databases and CBM were searched by computer for retro-spective or prospective studies on epidural hematoma in patients undergoing cervical spine surgery published since the inception of the databases to April 2023.Two reviewers screened the literatures according to the inclusion and exclusion criteria,and NOS scale was used to evaluate the quality of the literature included.The basic information of the study,including age,gender and body mass index(BMI),as well as the factors related to the occurrence of epidural hematoma after cervical spine surgery,such as surgical segment,whether combined with posterior longitudinal ligament ossification,operative time,diabetes,hypertension,smoking,use of non-steroidal anti-inflammatory drugs and laboratory related indicators were extracted.The risk of bias analysis of the included studies was performed using funnel plots,and meta-analysis was performed using RevMan 5.4 software.Results:A total of 12 literatures were included,and the NOS quality scores of the in-cluded literatures were all 6-8 points,of which,11 were of high quality and 1 was of medium quality.Meta-analysis showed that male[odds ratio(OR)=2.84,95％confidence interval(CI)(1.73,4.67),P＜0.0001],BMI＞24kg/m2[OR=8.50,95％CI(2.56,25.24),P=0.0005],multiple surgical segments(≥2)[OR=2.26,95％CI(1.42,3.594),P=0.0005],operative time＞2h[OR=1.46,95％CI(1.08,1.97),P=0.01],preoperative administration of non-steroidal anti-inflammatory drugs[OR=3.60,95％CI(1.00,12.99),P=0.05]were the risk factors for epidural hematoma after cervical spine surgery.The results of the funnel plot were used to test the publication bias of the surgical segment and intraoperative blood loss,which were the most influential factors in the literature,and the results showed that there was no publication bias in the surgical segment,while there was partial publication bias in the intraoperative blood loss.Conclusions:Male,BMI＞24kg/m2,multi-segment surgery(sur-gical segment ≥2),operative time＞2h,and preoperative administration of nonsteroidal anti-inflammatory drugs are the risk factors for SEH after cervical spine surgery.

Objective To explore the mechanism of Baihu Decoction in the treatment of acute lung injury based on network pharmacology and molecular docking technology;To carry out experimental verification.Methods The active components and targets of Baihu Decoction were searched through TCMSP and BATMAN-TCM databases,and human gene searches were conducted in GeneCards,NCBI,and OMIM databases.PPI network construction and GO and KEGG pathway enrichment analysis were conducted to determine the important signaling pathways of Baihu Decoction and acute lung injury.Molecular docking of main active components and core target proteins was performed.The effects of Baihu Decoction on survival rate and inflammatory cytokine content in acute lung injury lethal model mice were observed through animal experiments.Results Totally 211 common targets for Baihu Decoction and acute lung injury were screened,and identified effective components such as quercetin,kaempferol,and stigmasterol,etc.Analysis of KEGG pathway enrichment indicated that Baihu Decoction exerted its pharmacological effects in acute lung injury through a variety of signal pathways,including Toll-like receptor signaling pathway,NOD-like receptor signaling pathway,T cell receptor signaling pathway,and MAPK signaling pathway.Molecular docking results showed that Baihu Decoction had good binding strength with MAPK14,STAT3,JUN,MAPK1,MAPK3,FOS and RELA.The results of animal experiments showed that compared with the model group,the survival rate of mice in the Baihu Decoction group was significantly increased,the degree of pathological injury in the lung tissue was reduced,and serum IL-6,TNF-α contents decreased significantly(P<0.05).Conclusion Baihu Decoction can treat acute lung injury by reducing pathological injury to lung tissue and releasing of inflammatory factors.

Objective:To study the clinical characteristics of neonatal leukemoid reaction (NLR).Methods:The newborns with NLR admitted to the neonatal intensive care unit of the Seventh Medical Center of PLA General Hospital from September 2010 to January 2022 were selected as the observation group, and the newborns without NLR, who were admitted to the Hospital at the same time and matched with gestational age and birth weight of the NLR newborns were selected as the control group at a ratio of 1∶2. The gestational age, birth weight, maternal complications, maximum leukocyte count, percentage of neutrophils, C-reactive protein, hemoglobin, platelet count, disease diagnosis and other relevant information of the newborns were recorded, and SPSS 21.0 statistical software was applied to compare the data of the two groups of newborns.Results:A total of 36 cases were in the observation group and 72 cases in the control group. Naive granulocytes were found in the peripheral blood of all patients in the observation group, and leukocyte count was higher than that of the control group [61.7 (54.2, 90.6)×10 9/L vs. 19.6 (14.2,27.3)×10 9/L], the difference was statistically significant ( P<0.001), but there was no statistically significant difference in the percentage of neutrophils, hemoglobin, platelets, and C-reactive protein between the two groups ( P>0.05). The proportion of vaginal delivery, meconium-stained amniotic fluid, and neonatal sepsis in the observation group were higher than that in the control group [69.4% (25/36) vs. 38.9% (28/72), 19.4% (7/36) vs. 5.6% (4/72), 47.2% (17/36) vs. 8.3% (6/72)], and the proportion of gestational diabetes mellitus, gestational hypertension and prenatal use of glucocorticoid was lower than that in the control group, with statistical significance ( P<0.05). There was no significant difference in the incidence of premature rupture of membranes, neonatal asphyxia, intracranial hemorrhage, pulmonary hemorrhage, bacterial meningitis, and bronchopulmonary dysplasia between the two groups ( P>0.05). Conclusions:Newborns with NLR are frequently complicated with sepsis. Early prevention and treatment of maternal comorbidities and active control of infection are important for the prevention and treatment of NLR.

Objective: To study the threshold values of lactic acid (Lac)and buffuer excess (BE) when neonatal umbilical arterial blood gas is at pH <7.20. Methods: A total of 2 518 pregnant women admitted in Beijing New Century Women and Children′s Hospital from January 2017 to February 2019 were enrolled.The general conditions in perinatal period and labor methods were counted.Umbilical cord arterial blood was immediately collected before the first cry of newborn and was detected on the Abbott I-STAT automatic blood gas analyzer from the United States, and then the umbilical arterial blood gas was measured.We analyzed the perinatal factors affecting umbilical arterial blood gas.We studied the threshold values of Lac and BE for neonal asphyxia by receiver operating characteristic curve. Results: (1)Maternal anemia, Streptococcus agalactiae infection, precipitate labour, placenta abnormalities had no significant impact on neonatal umbilical artery blood gas.The Lac value in blood gas was higher in the group of premature rupture of fetal membranes and fetal intrauterine distress.The value of BE was lower in the group with premature rupture of fetal membranes and fetal distress (P<0.05). The Lac value in cesarean section group was the lowest[(1.79±1.25) mmol/L], while that in midwifery group was the highest[(4.45±1.58) mmol/L]. pH value was the lowest (7.25±0.07) in the midwifery group and the highest (7.31±0.06) in the cesarean section group.The value of BE was the lowest in the midwifery group[-(5.66±2.52) mmol/L], and the highest in the cesarean section group[-(2.99±2.28) mmol/L], with statistically significant differences among the three groups (P<0.05). (2) Multiple linear regression analysis showed that fetal delivery mode, fetal intrauterine distress, premature rupture of membranes, and gestational diabetes were the factors affecting Lac level in umbilical artery blood gas of newborns.Methods of delivery, intrauterine distress, premature rupture of membranes and placental abnormalities were the factors that affected the BE value of umbilical artery blood gas in newborns.(3) A total of 199 cases with pH value <7.2 were diagnosed as asphyxia, and the receiver operating characteristic curve of Lac and BE values of neonatal umbilical artery blood gas for the diagnosis of asphyxia was drawn.When Lac was >3.97 mmol/L, the sensitivity and specificity of the diagnosis of asphyxia were 0.864 and 0.791, respectively.When BE was ≤-6 mmol/L, the diagnostic sensitivity and specificity of asphyxia were 0.613 and 0.756, respectively. Conclusion Neonatal umbilical arterial blood gas is affected by many factors.The effect of accouche on umbilical arterial blood gas is large.When there is asphyxia with pH <7.2, the cut points of Lac and BE are >3.97 mmol/L and ≤-6 mmol/L, respectively.

Objective To retrieve and evaluate the evidences for fall prevention in elderly inpatients, and to summary the best evidence. MethodsGuidelines, evidence summaries and systematic reviews related to fall prevention of elderly patients were retrieved in guideline websites and databases by computer from building database to 31st December 2018. Literatures' quality evaluation and evidence grading were carried out with the Chinese version of appraisal of guidelines for research and evaluationⅡ (AGREEⅡ), "2016 Joanna Briggs Institute quality assessment tool on validity evaluation of systematic reviews" and "2014 Joanna Briggs Institute quality level of evidence and grade of recommendation system". ResultsA total of 6 documents were included with 3 guidelines and 3 systematic reviews. Based on evaluation and results extracted, 14 items of the best evidences on fall prevention were summarized in two parts including assessment and prevention, and in 6 aspects involving the medication, facility, environment, functional training, informational support and multifactorial intervention. ConclusionsMedical staff should guide patients to take standardized fall preventive measures to guarantee the safety of patients based on evidence-based medicine.

Objective To evaluate the value of stroke prognostication using age and National Institute of Health Stroke Scale index (SPAN) for outcome after early endovascular treatment for anterior circulation large vessel occlusion.Methods The patients who underwent early endovascular treatment were prospectively,sequentially collected in Yijishan Hospital of Wannan Medical College from December 2014 to September 2017 and Jinling Hospital from March 2014 to March 2017.Individuals whose age in years plus NIHSS score was greater than or equal to 100 were designated as SPAN-100-positive patients,while those with a score less than 100 were designated as SPAN-100-negative patients.We compared the baseline data and perioperative data between the two groups.The 90 days modified Rankin Scale score≤2 was regarded as favorable outcome.Single factor and multivariable Logistic regression analyses were used to determine the association between SPAN-100 and outcomes.Results One hundred and ninety patients were enrolled,20 (10.5％) of which were SPAN-100 positive,and 170(89.5％) were SPAN-100 negative.There were no significant differences between the two groups on postoperative intracerebral hemorrhage and 90 days mortality.Ninety days independence rates were higher in SPAN-100-negative patients (77/170,45.3％) than in SPAN-100 positive patients (4/20,20.0％;x2 =4.681,P =0.030).Multi-factor Logistic regression analysis showed that the higher preoperation systolic pressure (OR =1.030,95％ CI 1.008-1.052,P =0.007),the lower Alberta Stroke Program Early CT Score (OR =1.609,95％ CI 1.056-2.453,P =0.027) and poor collateral circulation(OR =5.714,95％ CI 1.668-19.570,P =0.006) were the independent risk factors of outcomes.Conclusion SPAN-100 is not an independent predictor of favorable outcome after adjusting for factors of outcomes in patients with anterior circulation large vessel occlusion.

Objective The aim of present study was to detect methylation rate of CpG unit of brain derived neurotrophic factor (BDNF) promoter and to study the epigenetic mechanism of autism spectrum disorders (ASD).Methods Total of 12 ASD patients and 12 healthy controls were recruited.The methylation rate of CpG unit in BDNF promoter Ⅰ and Ⅳ were detected using Sequenom MassArray method.The methylation model,correlationship,evolutionary relationship of CpG units in BDNF promoter Ⅰ and Ⅳ were detected and compared between ASD patients and healthy controls.Results The methylation rate was identified in 17 and 8 CpG units in BDNF promoter][and BDNF promoter Ⅳ.A close correlation distance was detected in BDNF promoter Ⅰ CpG units 4,7,10,35,and BDNF promoter Ⅳ CpG units 11.12,14.BDNF promoter][CpG units 4,7,10,35,and BDNF promoter Ⅳ CpG units 11.12,14 could be clustered.ASD patients had a significant lower methylation rate in BDNF promoter Ⅰ CpG unit 5.6 and Ⅳ CpG units 3 and 15 compare with healthy controls (P＜0.05).Conclusions The DNA methylation rate in BDNF pronoter Ⅰ CpG unit 5.6 and Ⅳ CpG units 3 and 15 may be used as potential biomarkers of ASD.

Objective To compare the efficiency of compressive bandage dressing and drainage on the blood loss after total knee arthroplasty (TKA). Methods Patients (n=120) who visited Tianjin General Hospital Bin Hai Branch and Tianjin People's Hospital due to varus knee osteoarthritis and underwent TKA were retrospectively analyzed.There are 20 males and 100 females with, mean age was 65.18±6.88 years. Depending on whether placement of drainage, patients were divided into drainage group (60 cases) and pressure bandage dressing group (60 cases). Blood loss, blood transfusion and full blood count (FBC) were all analyzed after TKA in both groups. Results Blood loss after TKA in drainage and pressure dressing group were (1 026.85±274.44),(789.52±251.58) mL respectively. Blood loss was less severe in pressure dressing group than that in drainage group (t=4.938, P<0.01). Allogeneic transfusions were needed in 14 cases of drainage group and five cases of pres?sure bandage dressing group. The circumstances that requires blood transfusion was significantly lower in pressure bandage group than that in drainage group (χ2=5.065, P<0.05). The postoperative limb swelling and postoperative joint mobility did not show statistical significance (P>0.05). Conclusion Application of compressive bandage dressing in TKA surgery is easy to be operate and can reduce perioperative blood loss and allogeneic transfusion incidence.

Objective:To explore the correlation among cardiac troponin I (cTnI),cardiac troponin T (cTnT),crea-tine kinase isoenzyme (CK-MB)levels and range of myocardial infarction in aged patients with acute myocardial in-farction (AMI).Methods:Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed.Correlation among levels of cTnI,cTnT,CK-MB and range of myocardial infarction were analyzed before and one week after treatment.Results:Compared with before treatment,there were significant reductions in levels of cTnI [(4.63±0.21)μg/L vs.(0.15±0.03)μg/L],cTnT [(0.71±0.05)μg/L vs.(0.17±0.01)μg/L],CK-MB [(40.21±2.13)U/L vs.(23.32±2.11)U/L]and myo-cardial infarction area [(35.25±4.65)mm2 vs.(23.17±3.76)mm2 ]after treatment,P <0.01 all;Pearson cor-relation analysis indicated that cTnI,cTnT and CK-MB were all positively correlated with myocardial infarction area (r =0.99,0.98,0.95,P <0.01 all).Conclusion:Cardiac troponin I,T and creatine kinase isoenzyme are closely related to myocardial infarction range.Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.

Objective: To explore the correlation among cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB) levels and range of myocardial infarction in aged patients with acute myocardial infarction (AMI). Methods: Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed. Correlation among levels of cTnI, cTnT, CK-MB and range of myocardial infarction were analyzed before and one week after treatment. Results: Compared with before treatment, there were significant reductions in levels of cTnI [(4.63±0.21) μg/L vs. (0.15±0.03) μg/L], cTnT[(0.71±0.05) μg/L vs. (0.17±0.01) μg/L], CK-MB [(40.21±2.13) U/L vs. (23.32±2.11) U/L] and myocardial infarction area [(35.25±4.65) mm2 vs. (23.17±3.76)mm2] after treatment, P<0.01 all; Pearson correlation analysis indicated that cTnI, cTnT and CK-MB were all positively correlated with myocardial infarction area (r=0.99, 0.98, 0.95, P<0.01 all). Conclusions: Cardiac troponin I, T and creatine kinase isoenzyme are closely related to myocardial infarction range. Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.