OBJECTIVE:Anterior cervical decompression and fusion is a classic surgical method for the treatment of degenerative cervical spondylosis.The use of nail plates increases the fusion rate and stability and indirectly leads to adjacent vertebral degeneration and postoperative dysphagia.In this paper,the clinical results and complications of ROI-CTM self-locking system and traditional cage combined with screw-plate internal fixation in the treatment of degenerative cervical spondylosis were compared by meta-analysis to provide evidence-based support for the selection of internal fixation methods in anterior cervical decompression and fusion. METHODS:CNKI,WanFang,VIP,PubMed,Cochrane Library,Web of Science,and Embase databases were searched for Chinese and English literature on the application of ROI-CTM self-locking system and fusion cage combined with screw plate internal fixation in the treatment of degenerative cervical spondylosis.The retrieval time range was from inception to July 2023.Two researchers selected the literature strictly according to the inclusion and exclusion criteria.The Cochrane bias risk tool was used to evaluate the quality of randomized controlled trials.Newcastle-Ottawa Scale was used to assess the quality of cohort studies.Meta-analysis was performed using RevMan 5.4 software.Outcome indicators included operation time,intraoperative blood loss,Japanese Orthopaedic Association score,Neck Disability Index,C2-C7 Cobb angle,fusion rate,incidence of adjacent vertebral degeneration,cage subsidence rate,and incidence of dysphagia. RESULTS:Thirteen articles were included,including eleven retrospective cohort studies and two randomized controlled trials,with 1 136 patients,569 in the ROI-C group,and 567 in the cage combined with the nail plate group.Meta-analysis results showed that the operation time(MD=-15.52,95%CI:-18.62 to-12.42,P<0.000 01)and intraoperative blood loss(MD=-24.53,95%CI:-32.46 to-16.61,P<0.000 01)in the ROI-C group and the fusion device combined with nail plate group.Postoperative adjacent segment degeneration rate(RR=0.40,95%CI:0.27-0.60,P<0.000 01)and postoperative total dysphagia rate(RR=0.18,95%CI:0.13-0.26),P<0.000 01)were statistically different.The two groups had no significant difference in Japanese Orthopaedic Association score,Neck Disability Index,C2-C7 Cobb angle,fusion rate,or cage subsidence rate(P≥0.05). CONCLUSION:Applying an ROI-CTM self-locking system and traditional cage combined with plate internal fixation in anterior cervical decompression and fusion can achieve satisfactory clinical results in treating degenerative cervical spondylosis.The operation of the ROI-CTM self-locking system is more straightforward.Compared with a cage combined with plate internal fixation,the ROI-CTM self-locking system can significantly reduce the operation time and intraoperative blood loss and has obvious advantages in reducing the incidence of postoperative dysphagia and adjacent segment degeneration.The ROI-CTM self-locking system is recommended for patients with skip cervical spondylosis and adjacent vertebral disease.However,given its possible high settlement rate,using a fusion cage combined with screw-plate internal fixation is still recommended for patients with degenerative cervical spondylosis with multiple segments and high-risk factors of fusion cage settlement,such as osteoporosis and vertebral endplate damage.

Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization(TACE)for the treatment of locally recurrent breast cancer.Methods The clinical data of 57 patients with locally recurrent breast cancer from January 2018 to December 2020 were retrospectively analyzed.Twenty-four patients(group A)received TACE using adriamycin 12 mg/m2 and paclitaxel 45 mg/m2,which was accomplished by local perfusion into the tumor target blood vessels with microcatheter catheterization,the embolization material was Embosphere microspheres,and the embolization endpoint was occlusion of the main stem of the target vessel.Other 33 patients who received systemic chemotherapy using adriamycin 40 mg/m2 and paclitaxel 135 mg/m2 in the same period were collected as group B.The 6-month disease control rate(DCR),progression-free survival(PFS)and overall survival(OS)were compared between the two groups.Results Successful TACE was accomplished in all the 24 patients of group A,with a technical success rate of 100％.In group A,the 6-month DCR was 87.50％,the median PFS was 12 months,and the median OS was 22 months.In group B,the 6-month DCR was 63.63％,the median PFS was 9 months,and the median OS was 20 months.The differences in the 6-month DCR and the median PFS between the two groups were statistically significant(P=0.04 and P=0.03 respectively),while no statistically significant difference in the median OS existed between the two groups(P=0.21).The incidence of post-embolization syndrome in group A was 75％(18/24),the clinical symptoms included chest wall pain and mild fever,which disappeared 3 days after symptomatic treatment such as pain-relief and antipyretic medication,and no TACE-related serious complications such as target vessel injury,ectopic embolization of embolization materials or chest wall necrosis occurred in all patients.All patients were followed up for a mean period of(19.47±4.96)months(range of 8-24 months)Conclusion For the treatment of locally recurrent breast cancer,TACE is superior to systemic chemotherapy in short-term efficacy.TACE carries no intervention-related serious complications.However,more studies need to be conducted before its long-term efficacy and safety can be clarified.(J Intervent Radiol,2024,33:280-284)

【Objective】 To explore the risk factors of severe postoperative hemorrhage in patients with staghorn renal calculi treated with mini-percutaneous nephrolithotomy (M-PCNL), and to construct a Bayesian network model to predict postoperative hemorrhage. 【Methods】 A retrospective analysis was conducted on 160 patients with staghorn renal calculi who were treated with M-PCNL by surgeons with equivalent qualifications at the First Affiliated Hospital of Xinxiang Medical College during Jan. 2020 and Jan. 2022.A computer-generated random number method was used to divide them into a modeling group (120 cases) and a validation group (40 cases).Patients in the modeling group were divided into severe bleeding group (38 cases) and non-severe bleeding group (82 cases).The general information of the two groups was compared, and the independent risk factors of severe postoperative hemorrhage were analyzed.A Bayesian network model was constructed using R software, the inference prediction was conducted using Netica software, and the performance of the model was evaluated with receiver operating characteristic (ROC) curve. 【Results】 Multivariate logistic regression analysis showed that renal insufficiency (OR: 2.845, 95%CI: 1.563-6.515), mixmum diameter of stones ≥2 cm (OR: 2.063, 95%CI: 1.824-4.555), operation time ≥90 minutes (OR: 3.632, 95%CI: 2.365-7.11), one-stage operation (OR: 2.321, 95%CI: 1.874-6.332), and multi-channel stone removal (OR: 1.842, 95%CI: 1.366-3.687) were independent risk factors of postoperative severe hemorrhage (P<0.05).Based on the above parameters, a Bayesian network model was established, which was then evaluated with the modeling and validation groups internally and externally.The AUC of the modeling group was 0.879 (95%CI: 0.804-0.931, P<0.001), with sensitivity and specificity being 87.68% and 89.63%, respectively.The AUC of the validation group was 0.875(95%CI: 0.818-0.908, P<0.001), with sensitivity and specificity being 87.55% and 89.40%, respectively.The model showed good discrimination. 【Conclusion】 Renal dysfunction, mixmum diameter of stones ≥2 cm, operation time ≥90 minutes, one-stage operation, and multi-channel stone removal are risk factors of severe hemorrhage in patients after M-PCNL.The prediction model has good predictive ability and can effectively describe the complex mechanism between diseases and risk factors.

Sepsis-induced thrombocytopenia-associated multiple organ failure（TAMOF）is a severe subtype of sepsis-related organ dysfunctions，which has high mortality and poor prognosis.The main clinical characteristics are thrombocytopenia caused by infection and multiple organ dysfunction.However，the exact molecular mechanism of TAMOF remains unclear.The current studies have shown ADAMTS-13，which is a von Willebrand factor lyase，plays an important role during the disease.Plasma exchange could be a treatment method，but still need more large-scale randomized controlled trials to verify.In the future，von Willebrand factor and ADAMTS-13 could become the therapeutic targets for new drug development.

Objective To evaluate the applicability of a modified U-shaped forearm flap for the repair of small-and medium-sized defects in the oral and maxillary areas to provide a reference for clinicians.Methods This study was re-viewed and approved by the Ethics Committee,and informed consent was obtained from the patients.Ten patients with small-and medium-sized defects in the oral and maxillary areas underwent surgical repair using modified U-shaped fore-arm flaps.There were 8 males and 2 females aged 43-72 years.The donor site was apposed primarily after harvesting the modified U-shaped forearm skin flap.The flaps ranged from 6 cm × 4 cm to 8 cm × 5 cm in size.Six months after the operation,hand movements(finger extension,fist clenching,wrist rotation upward and wrist rotation downward),the forearm donor site,hand sensations and the satisfaction score for the postoperative quality of the scar at the donor site were evaluated(0 to 10;0:very unattractive,10:very satisfactory).Results A total of 10 patients with modified U-shaped forearm flaps survived.One patient developed venous crisis 24 hours after surgery and survived after surgical ex-ploration.Delayed healing occurred at the donor site of the forearm in 1 patient,and the wounds at the donor site of the forearm in the other patients all healed in the first stage.One patient presented with dysesthesia in the hand 2 weeks af-ter surgery and recovered within 3 months.Six months after surgery,all patients had no limited hand movement and no paresthesia at the forearm donor site or hand.The patients were basically satisfied with the appearance of the donor site,and the average satisfaction score of the subjective questionnaire was 8.4 points.Conclusion Modified U-shaped fore-arm flaps can directly close forearm donor site wounds,which avoids surgical trauma to the secondary donor site and sig-nificantly reduces related complications.Modified U-shaped forearm flaps provide an alternative to conventional forearm flaps for the repair of small-and medium-sized defects in the oral and maxillary areas.

Objective To construct and validate of a nomogram predictive model for high-volume lymph node metastasis(HVM)in multifocal papillary thyroid carcinoma(MPTC).Methods Between January 2010 to January 2024,a total of 1146 and 234 patients with multifocal papillary thyroid carcinoma(MPTC)were diagnosed at Hangzhou First People's Hospital(Center A)and Hangzhou Cancer Hospital(Center B),respectively.Patients from Center A were randomly allocated to training set(n=803)and testing set(n=343)in a 7:3 ratio,while those from Center B(n=234)comprised an external validation set.Independent risk factors for HVM in MPTC patients were identified through univariate and multivariate Logistic regression analysis in training set,leading to the development of a nomogram predictive model.The generalizability of this model was subsequently assessed using both testing set and external validation set.The area under the curve(AUC)of receiver operating characteristic curve,sensitivity,and specificity evaluate the discriminative ability of the model.Results The incidence of HVM was 13.3％at center A and 12.8％at center B.Logistic regression identified male gender(OR=2.91,95％CI:1.835-4.599),maximum lesion diameter(OR=1.05,95％CI:1.021-1.070),and age(OR=0.95,95％CI:0.936-0.972)as independent risk factors for HVM.Anomogram based on these factors showed an AUC of 0.767 with 72.6％sensitivity and 70.2％specificity in training set,and 0.838 with 94.9％sensitivity and 68.4％specificity in testing set,and 0.769 with 63.3％sensitivity and 84.3％specificity in external validation set.The calibration curve demonstrated good agreement with the ideal curve.Conclusion The prediction model constructed based on clinical risk factors can effectively predict the probability of HVM in MPTC patients.

Objective:To analyze the research progress of family psychological education in schizophrenia population, in order to understand the elements and current situation of family psychological education application, and provide guidance for future research in this field.Methods:According to the basic idea of scoping review, research on family psychological education for schizophrenia patients was systematically searched in PubMed, Embase, CINAHL, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine. The search period was from database establishment to March 15, 2023.Results:A total of 15 articles were included, including 11 completely randomized controlled trials, 2 semi-randomized controlled trials, and 2 follow-up studies. The content consisted of the evaluation and intervention forms of family psychological education, and the development and implementation of specific intervention plans.Conclusions:There is limited research on family psychological education for patients with schizophrenia, and the implementation efforts around the world are insufficient. In the future, relevant research can be conducted to develop cost-effective education programs that are in line with China's culture and environment, so that schizophrenia patients and their families can receive evidence-based treatment to improve patient and family outcomes.

Objective:To translate the English version of the Beliefs Toward Mental Illness Scale (BTMI) into Chinese and test the reliability and validity of the Chinese version in college students.Methods:According to the Beaton cross-cultural adaptation guideline, the Chinese version of BTMI was formed. From April to May 2023, a questionnaire survey was conducted on 915 university students from 171 universities in 26 provinces, autonomous regions, and municipalities across China using convenience sampling, to analyze the reliability and validity of the scale.Results:A total of 915 questionnaires were distributed, and 814 valid questionnaires were collected, with an effective recovery rate of 88.96% (814/915). The Chinese version of BTMI had a total of 21 items. The Cronbach's α coefficient of the total scale was 0.922, and the Cronbach's α coefficients of each dimension were 0.745 to 0.921. The half reliability coefficient of the total scale was 0.797, and the retest reliability coefficient of the total scale was 0.903 ( P<0.01). Exploratory factor analysis extracted four common factors, namely social function, risk, incurability, and awkwardness, with a cumulative variance contribution rate of 62.29%. Confirmatory factor analysis showed that all important fitting indicators were greater than 0.900, indicating a good overall model fit. Conclusions:The Chinese version of BTMI has good reliability and validity, which can be used to evaluate the beliefs of Chinese university students about mental illness.

Objective:To analyze and elaborate on the concept and connotation of elder self-neglect, so as to provide reference for nursing practice.Methods:Literature on elder self-neglect was systematically searched on China National Knowledge Infrastructure, WanFang Data, China Biology Medicine disc, PubMed, Web of Science, and CINAHL. The search period was from database establishment to July 5, 2023. The literature was analyzed using Rodgers' evolutionary concept analysis as the theoretical framework.Results:A total of 63 articles were included. Elder self-neglect consisted of four defining attributes of disorder, danger, concealment, and closure. Antecedents contained physiological, psychological, social environment, and other factors. Consequences included the impact on the elderly themselves as well as the impact on others and the society.Conclusions:Elder self-neglect has a profound impact on individuals and society. By analyzing the concept of elder self-neglect and clarifying its conceptual attributes, researchers can conduct in-depth and comprehensive research on it, promoting the development of healthy aging.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.