Objectives:To investigate the risk factors of early postoperative complications in patients with a-cute subaxial cervical spinal cord injury after anterior bone grafting and fusion surgery.Methods:The clinical data of 168 cases of traumatic cervical spinal cord injury who underwent anterior surgery in our hospital from January 2017 to November 2021 were retrospectively analyzed.There were 133 males and 35 females.The age ranged from 23 to 82 years,with an average age of 53.8±11.2 years.There were 33 patients with preop-erative comorbidities(19.6％).ASIA classification of preoperative neurological impairment was as follows:34 patients of grade A,10 patients of grade B,62 patients of grade C,and 62 patients of grade D.50 patients were treated with high-dose methylprednisolone(29.8％).135 cases(80.4％)were treated with anterior cervical discectomy and fusion(ACDF),and 33 cases(19.6％)were treated with anterior cervical corpectomy and fusion(ACCF).Early postoperative complications and death of patients during hospitalization period were collected.Univariate logistic regression analysis was used to evaluate possible relationships between early postoperative complications and the factors including sex,age,preoperative comorbidities,cause of injury,neurological level of injury,preoperative ASIA grade,whether there was brain,thoracic and abdominal injury,whether high-dose methylprednisolone treatment was used,time from injury to surgery,preoperative hemoglobin(HGB),preopera-tive albumin(ALB),extent of surgery,surgical method,operative time,and intraoperative blood loss.A multi-variate logistic analysis was performed on the variables with P＜0.2 in the univariate analysis to identify signif-icant independent risk factors.Results:The incidence of early postoperative complications was 29.1％(49/168).Univariate logistic regression analysis showed that the cause of injury(P=0.032),preoperative ASIA grade(P＜0.001),whether combined with brain,thoracic and abdominal injury(P=0.043),whether high-dose methylpred-nisolone treatment was used(P=0.017),preoperative HGB(P=0.002),preoperative ALB(P=0.001)and surgical method(P=0.002)were correlated with early postoperative complications.Multivariate logistic regression analysis showed that preoperative ASIA grades A and B(P＜0.001,OR=5.389,95％CI 2.243-12.950)and high-dose methylprednisolone treatment(P=0.044,OR=2.541,95％CI 1.024-6.303)were independent risk factors for early postoperative complications.Conclusions:Preoperative ASIA grades A and B and high-dose methylpred-nisolone treatment are the independent risk factors for early postoperative complications in patients with acute subaxial cervical spinal cord injury.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.

Objective:To analyze predictive risk indicators associated with the development of Kümmell's disease (KD) in patients with osteoporotic vertebral compression fractures (OVCFs).Methods:A 1∶1 frequency-matched case-control study design was employed, selecting patients who visited the Department of Spine Surgery at Liuzhou Workers' Hospital from January 2021 to June 2023. Patients were divided into case and control groups based on whether they progressed to Kümmell's disease (KD). Detailed demographic information, comorbidities, and laboratory data were collected, and baseline characteristics of the two groups were compared. Initial predictive variables significantly associated with the target variable were preliminarily screened through univariate analysis. A correlation heatmap was then constructed to assess collinearity among these variables, followed by further selection of potential predictors using the Lasso regression model. Finally, a multivariable logistic regression model was used for the prediction and analysis of KD-related risk indicators.Results:Univariate analysis identified significant predictors of Kümmell's disease, including patient age, bone mineral density, kyphotic Cobb angle, and multiple vertebral fractures. These were included in the subsequent Lasso regression analysis, which identified key predictors with non-zero coefficients: age, bone density, Cobb angle, multiple vertebral fractures, platelet count (PLT), aspartate aminotransferase/alanine aminotransferase (AST/ALT), albumin (Alb), albumin/globulin ratio (Alb/Glb), alkaline phosphatase (ALP), urea (UREA), serum uric acid (SUA), fibrinogen (Fn), blood glucose (BG), and C-reactive protein (CRP). The correlation heatmap revealed the correlation and collinearity risks between these variables, with ALT and AST/ALT showing a high correlation ( r=0.750) and PLT and Alb showing a low correlation ( r=-0.110). Multivariable logistic regression indicated that the presence of multiple vertebral fractures [ OR=2.078, 95% CI (1.072, 4.025), P=0.030], increased Cobb angle [ OR=1.033, 95% CI (1.008, 1.058), P=0.009], elevated levels of ALP [ OR=1.013, 95% CI(1.004, 1.023), P=0.006], and SUA [ OR=1.004, 95% CI (1.000, 1.007), P=0.043] were associated with an increased risk of KD in patients with OVCFs. Conversely, decreased levels of Fn [ OR=0.996, 95% CI (0.992, 0.999), P=0.008] were linked to an increased risk of KD. Conclusion:Multiple vertebral fractures, increased Cobb angle, elevated levels of ALP and SUA, along with decreased levels of Fn, can be used as early-warning indicators to predict whether patients with OVCFs will develop KD. Monitoring these indicators is crucial for the early detection and intervention in these patients.

In recent years, in the face of the risks and challenges of public health emergencies, the demand and supply of public health talents are relatively tight, and the reform and exploration of the standardized training of public health professionals has become one of the most urgent and important topics. This study analyzed the problems of curriculum system setting, implementation of practical links and composition of tutors in the training process, and learned that Wenzhou Medical University has carried out practical exploration in strengthening theoretical study, highlighting the combination of research and study, deepening professional practice, etc., which has achieved the orderly promotion of public health training supported by supporting reform measures; Take the post competence as the guidance, and vigorously improve the practicing ability; Based on the process and result assessment, promote the reform of training mode and other preliminary results. However, there are also shortcomings and deficiencies in accuracy, supply and effectiveness. Looking at the current situation, it is suggested to promote mechanism construction, increase skill training, develop training standards, improve supporting measures, establish expert committees and other reform ideas, and explore and implement a new model of degree education connection.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Objective:To investigate the radiotherapy discipline construction and existing problems in non-public hospitals in Zhejiang province and put forward suggestions for improvement.Methods:In 2022, on-site inspection and investigation were carried out in 14 non-public hospitals in Zhejiang province, including equipment configuration and source, discipline setting, personnel qualification and professional experience, academic leaders and admission of patients, etc. Results:For 14 non-public hospitals in Zhejiang province, 19 treatment equipment, 15 positioning equipment and 77 quality control equipment were equipped, and a total of 249 radiotherapy practitioners were employed. A total of 4 224 patients were admitted throught 2022.Conclusion:Multiple problems exist in non-public radiotherapy hospitals in Zhejiang province, such as unscientific discipline setting, fewer professionals, lack of personnel training, unclear management mode, unqualified qualification of partial radiotherapy doctors, and insufficient refinement of clinical quality management, which need to be further improved.