OBJECTIVE: To explore prevalence, incidence and possible factors of immediate herniated discs after posterior cervical expansive open-door laminoplasty (EODL). METHODS: Totally 29 patients with cervical spinal stenosis and intervertebral disc herniation who underwent EODL from October 2020 to December 2021 were collected, including 24 males and 5 females, aged from 43 to 81 years old with an average of (61.3±9.0) years old;the courses of disease ranged from 1 to 120 months with an average of (36.4±37.0) months. Three or more intervertebral discs on C₃-C₇ were observed. The clinical efficacy was evaluated according to Japanese Orthopaedic Association (JOA) score before operation, 3 days and 1, 3, 6 and 12 months after operation, respectively. The changes of herniated disc before and after operation were measured by multipoint area method and two-dimensional distance method, and incidence and percentage of herniated disc regression were further calculated. Cervical imaging parameters such as Cobb angle (C₃-C₇), intervertebral angle, T₁ slope (T₁S), spinal canal sagittal diameter, K-line angle, dural sac sagittal diameter were measured and compared before and after operation. Pearson correlation was used to analyze correlation between cervical sagittal imaging parameters and disc herniation changes before and after operation. RESULTS: All patients obtained grade A wound healing, and 14 of them were followed up for 3(1.00, 5.25) months. There were no immediate or long-term postoperative complications. Totally 101 herniated intervertebral discs were measured, of which 79 regression numbers were obtained by area measurement. The number of intervertebral disc regressions by distance measurement was 77. There was no statistically significant difference in Cobb angle, intervertebral angle, T₁S and K-line angle of C₃-C₇ (P>0.05), however, there were statistically significant differences in sagittal diameter of spinal canal, sagittal diameter of dural sac, and JOA score before and after operation(P<0.05). The regression ratio of disc herniation ranged from 5% to 50%, and regression ratio of disc herniation was greater than 25% in 45.57%(36/79). Disc herniation in C_4,5 was positively correlated with sagittal plane diameter in C₅(r=0.423, P=0.028). There was a negative correlation between changes of C_3,4 and C_3,4 intervertebral angle (r=-0.450, P=0.041). The improvement rate of cervical JOA score immediately after operation was (59.54±15.07) %, and postoperative follow-up improved to (76.57±14.66) %. CONCLUSION Herniated disc regression immediately after EODL is a common occurrence, and EODL should be selected as far as possible under the premise of satisfying surgical indications. The regression of disc herniation is positively correlated with spinal canal sagittal diameter, and spinal canal should be enlarged as far as possible in the appropriate scope during EODL, so as to create more opportunities and conditions for disc regression and achieve better clinical results.
Humans ; Female ; Male ; Intervertebral Disc Displacement/diagnostic imaging* ; Spinal Stenosis/diagnostic imaging* ; Laminoplasty/methods* ; Middle Aged ; Aged ; Cervical Vertebrae/diagnostic imaging* ; Adult ; Aged, 80 and over ; Intervertebral Disc/surgery*

Based on the interleukin-17(IL-17) signaling pathway, this study explores the effect and mechanism of Bufei Decoction on Klebsiella pneumoniae pneumonia in rats. SD rats were randomly divided into the control group, model group, Bufei Decoction low-dose group(6.68 g·kg~(-1)·d~(-1)), Bufei Decoction high-dose group(13.36 g·kg~(-1)·d~(-1)), and dexamethasone group(1.04 mg·kg~(-1)·d~(-1)), with 10 rats in each group. A pneumonia model was established by tracheal drip injection of K. pneumoniae. After successful model establishment, the improvement in lung tissue damage was observed following drug administration. Core targets and signaling pathways were screened using transcriptomics techniques. Real-time fluorescence quantitative polymerase chain reaction was used to detect the mRNA expression of core targets interleukin-6(IL-6), interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), and chemokine CXC ligand 6(CXCL6). Western blot was used to assess key proteins in the IL-17 signaling pathway, including interleukin-17A(IL-17A), nuclear transcription factor-κB activator 1(Act1), tumor necrosis factor receptor-associated factor 6(TRAF6), and downstream phosphorylated p38 mitogen-activated protein kinase(p-p38 MAPK), and phosphorylated nuclear factor-κB p65(p-NF-κB p65). Apoptosis of lung tissue cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling(TUNEL). The results showed that, compared with the control group, the model group exhibited significant pathological damage in lung tissue. The mRNA expression of IL-6, IL-1β, TNF-α, and CXCL6, as well as the protein levels of IL-17A, Act1, TRAF6, p-p38 MAPK/p38 MAPK, and p-NF-κB p65/NF-κB p65, were significantly increased, and the number of apoptotic cells was notably higher, indicating successful model establishment. Compared with the model group, both low-and high-dose groups of Bufei Decoction showed reduced pathological damage in lung tissue. The mRNA expression levels of IL-6, IL-1β, TNF-α, and CXCL6, and the protein levels of IL-17A, Act1, TRAF6, p-p38 MAPK/p38 MAPK, and p-NF-κB p65/NF-κB p65, were significantly decreased, with a significant reduction in apoptotic cells in the high-dose group. In conclusion, Bufei Decoction can effectively improve lung tissue damage and reduce inflammation in rats with K. pneumoniae. The mechanism may involve the regulation of the IL-17 signaling pathway and the reduction of apoptosis.
Animals ; Interleukin-17/metabolism* ; Drugs, Chinese Herbal/administration & dosage* ; Rats, Sprague-Dawley ; Signal Transduction/drug effects* ; Rats ; Male ; Klebsiella pneumoniae/physiology* ; Klebsiella Infections/immunology* ; Humans ; Lung/drug effects*

With the continuous deepening of medical insurance payment reform, the implementation of the ambulatory patient groups(APG) based point system for payment has posed new challenges to the quality management of outpatient electronic medical record writing, as well as the supervision and operation management of outpatient costs in hospitals. A certain hospital began information technology construction in July 2021. By introducing diagnostic grouping functions into the outpatient electronic medical record system, the hospital strengthened the standardization of medical record writing. It also established an intelligent audit system for medical insurance costs to conduct full-process supervision of outpatient medical expenses and developed an intelligent operation analysis system for outpatient APG to provide a basis for hospital operation management decisions and performance distribution. These measures effectively improved the quality of outpatient medical record, reduced outpatient medical costs, and optimized their structure. The application of the intelligent medical insurance audit system also effectively prevented certain non-compliant issues in medical insurance payments, which can provide a reference for other medical institutions.

Tracheal intubation in emergency and complex scenarios is difficult for critical care medicine residents.Virtual reality(VR)technology has not been used in the training of tracheal intubation in critical care scenarios in China.This project team has developed an emergency tracheal intubation training system for the intensive care unit(ICU)based on virtual simulation technology,and has obtained the computer software copyright registration certificate from the National Copyright Administration(registration number:2024SR1139484).This system uses a case script of acute respiratory distress syndrome(ARDS)secondary to severe acute pancreatitis,sets the roles of patients,family members,nurses and residents,collects digital resources of ICU rescue scenes,computer-aided design(CAD)drawings,instrument models and equipment photos,models instruments and equipment,and uses PICO 4 Pro VR helmets to display the ICU environment in the virtual scene.The key points of skill assessment include tracheal intubation operation,the ability to interpret laboratory results,the ability to judge diseases and the ability to work in teams.The user center contains 3 submodules,namely,the score center,skill analysis and user management.There are 3 user roles in the system,namely,residents,teachers and administrators.The system can track and record the entire operation process,including video recording and playback,and score and comprehensively evaluate each step,thereby realizing an objective and quantitative training and assessment system.By simulating the three-dimensional clinical operation environment of the ICU,the entire process of real tracheal intubation is fully reproduced.Resident doctors are placed in the ICU rescue scene,focusing on training tracheal intubation skills,the ability of doctor-patient communication,on-the-spot response,and teamwork,which is expected to become an important type of standardized teaching in critical care medicine.

Objective To explore the effectiveness of a tracheal intubation training system based on virtual reality(VR)technology in cultivating the clinical practice abilities of resident physicians.Methods Twenty-five first-year resident physicians who were enrolled in the residency programme at Peking University Third Hospital from August 2024 to February 2025 were recruited for this study.All participants completed a questionnaire after receiving VR-based intensive care unit(ICU)emergency tracheal intubation training,to share their experiences with the VR technology-based ICU emergency tracheal intubation training and the shortcomings encountered during the process.Results ① General information:a total of 25 resident physician questionnaires were distributed in this study and received 25 valid responses(response rate 100%).Among the 25 residents,there were 15 males(60%)and 10 females(40%),with an average age of(25.3±0.8)years.Clinical experience was categorised as≤1 year 4 residents(16%),>1-3 years 8 residents(32%),>3-<5 years 5 residents(20%)and≥5 years 8 residents(32%).Among them,3 residents(12%)had no prior tracheal intubation experience,while 11(44%)had performed>10 intubations.Prior to this training,3 residents(12%)had received other forms of virtual tracheal intubation training,whereas 22(88%)had not.During traditional tracheal intubation training,18 residents(72%)reported that they monitored heart rate and blood pressure,whereas 7(28%)did not.In real-world emergency tracheal intubation scenarios,21 residents(84%)experienced role confusion.Additionally,23 residents(92%)believed that opportunities for tracheal intubation practice were too limited,17(68%)thought traditional training provided more guidance from instructors,and 15(60%)valued practical operation opportunities more in tracheal intubation training.②VR-based ICU emergency tracheal intubation training experience:23 residents(92%)considered the VR-based ICU emergency tracheal intubation training effective,with 13(52%)believing it to be more effective than traditional training.Furthermore,23 residents(92%)felt that the VR-based training created a more relaxed learning atmosphere,heightened their interest in learning tracheal intubation,and had better future prospects;22 residents(88%)believed that VR technology facilitated a better understanding of the laryngeal structure;24 residents(96%)thought that VR-based training reduced practical operation risks and better simulated real-world conditions;16 residents(64%)were highly satisfied with the VR-based ICU emergency tracheal intubation operating system;24 residents(96%)considered the case scenarios in the VR-based training reasonable.17 residents(68%)believed that VR-based training offered more learning opportunities,and 19 residents(76%)thought it reduced anxiety during the intubation process.③ Disadvantages of VR-based ICU emergency tracheal intubation:9 residents(36%)tended to overlook obtaining family consent before emergency tracheal intubation prior to the training.Regarding interactivity,5 residents(20%)rated it as excellent,9(36%)as average,and 11 residents(44%)believe that the interactivity was poor;22 residents(88%)felt a lack of tactile feedback during practical operations;20 residents(80%)recommended adding more simulated scenarios;11 residents(44%)believed that,compared to traditional training,VR training lacked practical operation opportunities.Additionally,17 residents(68%)experienced discomfort such as dizziness during the operation.Conclusion VR-based intubation training effectively enhances technical proficiency and psychological preparedness in ICU clinicians,particularly in anatomical visualization and risk-controlled rehearsal.

OBJECTIVE: To observe the clinical effect of Jin's three-needle therapy combined with game therapy on children with autism spectrum disorder (ASD). METHODS: Sixty children with ASD were randomly divided into an observation group and a control group, with 30 cases in each. The children in the observation group received Jin's three-needle therapy combined with game therapy. The acupoints used in Jin's three-needle therapy included Zhisanzhen, Niesanzhen, Sishenzhen and Naosanzhen, and matches acupoints with syndromes. The acupoints included Shenting (GV24), Naohu (GV17) and bilateral Benshen (GB13), Naokong (GB19), Xinshu (BL15), Zusanli (ST36), etc. The needles were retained for 1 h for scalp acupuncture and not retained for body acupuncture. Game therapy included social interaction, music and dance, language stimulation, etc. The children in the control group were treated with the same game therapy in the observation group. Treatments were administered once daily, five times a week, with a three-month course considered as one treatment cycle, and a total of two cycles were provided. The scores of childhood autism rating scale (CARS), autism behavior scale (ABC) and 0-6-year-old Children's neuropsychological development assessment scale (children's psychological scale) were compared between the two groups before treatment and after 3 and 6 months of treatment. RESULTS: After 3 and 6 months of treatment, the CARS and ABC scores of both groups were lower than those before treatment (P<0.01). After 6 months of treatment, the CARS and ABC scores of the observation group were lower than those of the control group (P<0.05). After 3 and 6 months of treatment, the scores of gross motor, fine motor, adaptive ability, language, and social behaviors in both groups were higher than those before treatment (P<0.01). After 3 months of treatment, the observation group showed a greater improvement in gross motor, fine motor, adaptive ability, and social behaviors compared to the control group (P<0.05). After 6 months of treatment, the observation group showed a greater improvement in gross motor, fine motor, adaptive ability, language, and social behaviors compared to the control group (P<0.01, P<0.05). CONCLUSION Jin's three-needle therapy combined with game therapy is an effective method for the treatment of ASD, which shows more obvious advantages than simple game therapy in promoting the improvement of children's ability and reducing related behavior.
Humans ; Autism Spectrum Disorder/psychology* ; Male ; Acupuncture Therapy/instrumentation* ; Female ; Child ; Child, Preschool ; Acupuncture Points ; Treatment Outcome ; Play Therapy ; Combined Modality Therapy

Breast cancer is one of the most common malignant tumors, and postoperative radiotherapy remains an essential component of its treatment. In recent years, hypofractionated radiotherapy has gradually become the recommended approach for postoperative breast cancer treatment. Compared with conventional fractionated radiotherapy, hypofractionated regimens shorten the overall treatment duration, enhance patient convenience, and reduce treatment costs, while achieving comparable long-term efficacy and maintaining good quality of life. Based on relevant domestic and international studies and clinical experience, this consensus establishes expert recommendations regarding indications, prescribed doses, dose constraints for organs at risk (OAR), implementation methods, and plan evaluation for hypofractionated radiotherapy after breast cancer surgery, with a particular focus on moderately hypofractionated (MHF) and ultrahypofractionated (UHF) regimens. MHF radiotherapy is applicable to whole-breast irradiation, chest wall irradiation, and regional nodal irradiation, and is suitable for most breast cancer patients. UHF radiotherapy, which employs a higher dose per fraction to further shorten the treatment course, is suitable for patients requiring rapid therapy or prioritizing treatment convenience. Although the short-term efficacy of UHF radiotherapyis similar to that of MHF radiotherapy, its long-term efficacy and safety require further clinical validation. Meanwhile, potential adverse effects of UHF, such as breast induration and atrophy, should be carefully assessed. Therefore, radiotherapy dose and fractionation regimen should be individualized according to patient-specific factors, particularly considering OAR dose constraints. Rational selection of radiotherapy regimens can minimize adverse effects while maintaining therapeutic efficacy, ultimately improving patient outcomes and quality of life. This consensus provides scientific guidance for the clinical and research application of hypofractionated radiotherapy in breast cancer.

Objective:To verify the applicability of the flight potential evaluation system in the psychological selection of pilots by testing the reliability and validity of the system.Methods:Between September and October 2021, 82 subjects, including 32 pilots and 50 volunteers, were recruited from the Aviation Force and the Air Force Medical Center to complete the flight potential evaluation system test. The pilots and volunteers were divided into the high score group (the top 27% in terms of scores) and low score group (the 27% from the bottom) according to the total score of the evaluation. In order to ensure the consistency of evaluation conditions, some subjects were selected to complete a second evaluation test one week later for reliability analysis. Six flight experts completed the Content Evaluation Form of the Flight Potential Evaluation System while the officer completed the Flight Performance Evaluation Questionnaire as the performance data of the pilots. The pass rates of the pilots and volunteers and discriminability of the flight potential evaluation system were analyzed to test the stability and effectiveness of the system.Results:①The flight potential evaluation system demonstrated a pass rate of 0.75 and a discriminability of 0.30 in pilots, compared with 0.30 and 0.51 in volunteers. The total scores of pilots and volunteers were (7.00±1.16) points and (3.38±2.15) points, respectively, with a statistically significant difference ( t=9.87, P<0.001). Significant differences were found in test scores between high-score group and low-score group for both pilots ( t=10.01, P<0.001) and volunteers ( Z=-4.65, P<0.001). ②Thirty-seven subjects (including 32 pilots and 5 volunteers, all from the Aviation Force) were tested twice, and the Pearson product-moment correlation coefficient for the paired results of 2 identical tests was r=0.750 ( P<0.001). ③As for the content of the evaluation system test, the experts′ degree of agreement and unanimity rate were 1. The evaluation score by the officer was positively correlated with the test score ( r=0.389, P=0.041). Conclusions:The flight potential evaluation system has a strong ability to distinguish flight-related abilities, suggesting that the system can be applied to the psychological selection of pilots and provide data for subsequent tests during the recruitment of candidates.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.