OBJECTIVE: To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). METHODS: The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. RESULTS: The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). CONCLUSION The application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Humans ; Spinal Fusion/instrumentation* ; Titanium ; Cervical Vertebrae/surgery* ; Diskectomy/instrumentation* ; Bone Plates ; Male ; Printing, Three-Dimensional ; Female ; Retrospective Studies ; Middle Aged ; Treatment Outcome ; Benzophenones ; Adult ; Spondylosis/surgery* ; Aged ; Polymers ; Ketones ; Polyethylene Glycols

OBJECTIVE: To evaluate the effectiveness of the single-stage anterior eccentric kyphotic distraction reduction technique (EKD-RT) for treating lower cervical dislocation with locked facet joints, assessing its reduction success rate, neurological improvement, and safety. METHODS: A retrospective analysis was conducted on 67 patients with lower cervical dislocation and locked facet joints (21 unilateral, 46 bilateral) treated between January 2015 and January 2024. There were 39 males and 28 females, with an average age of 49.5 years (range, 22-75 years). The injured segments included C _{3, 4} in 4 cases, C _{4, 5} in 13 cases, C _{5, 6} in 22 cases, and C _{6, 7} in 28 cases. The interval between injury and admission ranged from 2 hours to 2 days (mean, 5.6 hours). Preoperative Frankel grading included grade A in 9 cases, grade B in 28 cases, grade C in 17 cases, grade D in 11 cases, and grade E in 2 cases. Japanese Orthopaedic Association (JOA) score was 7.0±1.4. All patients underwent single-stage anterior cervical discectomy and fusion. Following discectomy at the dislocated level, the EKD-RT was applied to unlock and reduce the locked facet joints, followed by internal fixation. Operation time, blood loss, reduction success rate, and complications were recorded. Interbody fusion status was evaluated using Bridwell criteria. Neurological status was assessed pre- and post-operatively using Frankel grading. Spinal cord function was scored using the 17-point JOA score, and the improvement rate was calculated. RESULTS: Successful reduction of the locked facet joints achieved in all cases. The operation time was 41-85 minutes (range, 63.3 minutes), and intraoperative blood loss was 50-360 mL (range, 125.0 mL). Complications included cerebrospinal fluid leakage in 2 cases; no severe complications such as major vascular injury or recurrent laryngeal nerve injury occurred. All patients were followed up 12-24 months (mean, 17.9 months). At last follow-up, radiological examination confirmed interbody fusion in all patients, with no implant failure or migration. The Frankel grading included grade A in 3 cases, grade B in 9 cases, grade C in 13 cases, grade D in 16 cases, and grade E in 26 cases; the JOA score reached 13.7±2.3; all of which significantly improved compared to preoperative levels ( P<0.05). The improvement rate of JOA score was 66.1%±24.7%. CONCLUSION The EKD-RT is an effective surgical approach for lower cervical dislocation with locked facet joints. It enables safe and efficient reduction of the locked facet joints via a single incision, resulting in significant neurological improvement with a low complication rate.
Humans ; Male ; Middle Aged ; Female ; Cervical Vertebrae/diagnostic imaging* ; Retrospective Studies ; Adult ; Aged ; Zygapophyseal Joint/injuries* ; Joint Dislocations/diagnostic imaging* ; Treatment Outcome ; Spinal Fusion/methods* ; Young Adult ; Kyphosis/surgery*

Objectives:To evaluate the safety and mid-term clinical efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity.Methods:A retrospective study was conducted to analyze the clinical data of el-derly patients with osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity ad-mitted and treated from January of 2017 to October of 2020.According to whether pedicle augmentation us-ing bone cement was used,the patients were divided into a cement-augmented group(22 cases,cement-augmented pedicle screws)and a control group(23 cases,pedicle screws without cement augmentation).In the reinforced group,there were 9 males and 13 females;age ranged from 70 to 91 years,with a mean of 78.68±7.12 years;disease duration ranged from 1.1 to 3.8 years,with a mean of 2.39±0.71 years.In the control group,there were 10 males and 13 females;age ranged from 70 to 89 years,with a mean of 77.73±5.83 years,and disease duration ranged from 0.8 to 3.3 years,with a mean of 2.38±0.67 years.The follow-up period was 36-69 months.The incidence of pedicle screw loosening,correction rate of kyphosis,and improvement rate of visual analogue scale(VAS)and Oswestry disability index(ODI)at final follow-up were compared between the two groups.Results:In the cement-augmented group,1-2 segments of surgical decompression were performed,6-9 segments were fixed and fused,and 14 cases underwent SPO and 8 cases underwent PSO.The operational time was 221±32mins,and the volume of blood loss was 939±113mL.In the control group,1-3 segments of surgical decompression were performed,6-8 segments were fixed and fused,and 16 cases underwent SPO and 7 cases underwent PSO.The operative time was 209±36mins,and the vol-ume of blood loss was 979±111mL.One case in the cement-augmented group and two cases in the control group complicated with cerebrospinal fluid leakage,which were treated with intraoperative repair of the dura mater,tight suturing of the incision,and postoperative Trendelenburg's position.There was no statistical differ-ence in the comparison of decompression segments(t=1.785,P=0.081),fusion segments(t=0.922,P=0.362),oper-ative time(t=1.162,P=0.252),bleeding(t=1.193,P=0.239),and CSF leak complications(x2=0.311,P=0.577)be-tween the two groups.There were no complications of incision infection or leakage of bone cement into the spinal canal causing neurological symptoms.At final follow-up,the screw loosening rate was 0％in the ce-ment-augmented group(0/268)and 18.6％in the control group(45/242).The difference in screw loosening rate between the two groups was statistically significant(x2=54.657,P=0.000).The correction rate of kyphosis defor-mity was(73.27±9.78)％in the cement-augmented group and(55.96±11.31)％in the control group.There was a significant difference in the correction rate of kyphosis between the two groups(t=5.480,P=0.000).The im-provement rate of VAS in the cement-augmented group was(67.94±14.72)％,while in the control group was(74.29±13.18)％.There was no significant difference in the improvement rate of VAS between the two groups(t=1.526,P=0.134).The improvement rate of ODI in the cement-augmented group was(82.01±3.11)％,while in the control group it was(81.96±3.58)％,there was no significant difference in the improvement rate of ODI between the two groups(t=0.41,P=0.968).Conclusions:The application of cement augmentation of pedicle screws in decompression,osteotomy,and long segment fixation fusion for the treatment of thoracolumbar osteo-porotic vertebral compression fractures with spinal kyphosis deformity can effectively reduce the loosening rate of pedicle screws and improve the correction rate,resulting in satisfactory clinical outcomes.

Objective:To investigate the establishment method, coordination points and safe transport management strategy of vena-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with downtime difficulties during cardiopulmonary bypass (CPB).Methods:A observation study was conducted. The patients admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to October 2022 were enrolled. These patients could not be separated from CPB and received VA-ECMO-assisted CPB surgery. The clinical data of the patients were recorded, including the basic information of the patients, the data of VA-ECMO establishment and transport process, the clinical indicators before and after VA-ECMO installation, the operation data of VA-ECMO and clinical outcomes. The experience was summarized from the aspects of extracorporeal membrane oxygenation (ECMO) establishment, transport process, team cooperation, and adverse events during transport. The clinical indicators before and after ECMO operation were compared. According to whether ECMO was successfully weaned, the patients were divided into a successful weaning group and a failure weaning group, and the clinical data between the two groups were compared.Results:Eighteen patients who underwent VA-ECMO-assisted CPB were enrolled, including 10 males and 8 females. The average age was (56.7±12.3) years old. Preoperative left ventricular ejection fraction (LVEF) was 0.46±0.10, and the main reasons for switching to VA-ECMO assistance included right ventricular systolic weakness in 6 cases, total cardiac systolic weakness in 5 cases, left ventricular systolic weakness in 4 cases, high pulmonary arterial pressure in 2 cases, and intractable ventricular fibrillation in 1 case. Among the 18 patients transferred from CPB to VA-ECMO, 10 cases were successfully weaned and 8 cases failed. In ICU, 8 cases survived, 5 cases died, and 5 cases gave up treatment and discharged. The average time for successful CPB to VA-ECMO establishment was (24.6±7.4) minutes, initial blood flow was (3.3±0.4) L/min, and transit time was (8.4±1.5) minutes. ECMO-assisted duration averaged (82.0±69.3) hours. Adverse events occurred in 9 patients during ECMO establishment and transfer. Post-ECMO onboarding for 4 hours, significant improvements were noted in blood lactic acid (Lac), pH value, mean arterial pressure (MAP), central venous oxygen saturation (ScvO 2) as compared with pre-ECMO onboarding [Lac (mmol/L): 10.5±7.0 vs. 15.2±6.8, pH value: 7.38±0.92 vs. 7.26±0.87, MAP (mmHg, 1 mmHg≈0.133 kPa): 74.9±13.7 vs. 58.4±17.0, ScvO 2: 0.678±0.065 vs. 0.611±0.061, all P < 0.01], and vasoactive-inotropic score (VIS) was also decreased (39.8±29.8 vs. 68.9±64.4, P < 0.01). Compared with successful weaning group, the patients in the failed weaning group exhibited higher pre-machine Lac (mmol/L: 18.8±7.8 vs. 12.3±4.3, P < 0.05), longer CPB time [minutes: 238.0 (208.8, 351.2) vs. 200.0 (185.8, 217.0), P < 0.05], and shorter ECMO-assisted time [hours: 19.5 (11.0, 58.8) vs. 94.5 (65.8, 179.8), P < 0.01]. However, there was no statistically significant difference in pre-machine pH value, ScvO 2, MAP, VIS score, and initial blood flow and establishment time of ECMO between the two groups. Conclusions:VA-ECMO is an effective circulatory aid for CPB surgery that cannot be weaned after CPB. The establishment and transfer of CPB "bridge" to ECMO aid depends on multi-disciplinary treatment (MDT) cooperation. The success rate of ECMO weaning is related to the Lac and CPB duration. If it is not possible to detach from the CPB successfully, VA-ECMO should be initiated as early as possible.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

Objective:To review and summarize the best evidence of prevention and control measures of carbapenem-resistant Enterobacteriaceae (CRE) hospital infection, and provide evidence-based reference for health care workers to prevent and control CRE infection. Methods:A literature search strategy was developed to systematically search BMJ Best Clinical Practice, UpToDate, the World Health Organization, the Centers for Disease Control and Prevention website, the European Centers for Disease Control and Prevention website, the International Guidelines Collaboration website, the National Practice Technical Guidelines Library of the United States, the National Institute of Health and Clinical Optimization in the United Kingdom, the Ontario Medical Association of Canada, Maimai Tong, Cochrane Library, Australian Joanna Briggs Institute Evidence-Based Health Care Center database, PubMed, Web of Science, China National Knowledge Network, Wanfang database, VIP database, Chinese Biomedical Literature database of evidence related to the prevention and control of CRE hospital infection. The search period was from January 1, 2018 to October 1, 2023. The literature quality was evaluated independently by two research members, and evidence extraction and synthesis were carried out for the included literature.Results:A total of 10 articles were included, including 6 guidelines, 3 expert consensus articles, and 1 systematic review. 29 best evidences were formed from 6 aspects: preventive monitoring, active screening, contact isolation, environmental cleaning and disinfection, bacterial colonization, and hand hygiene measures.Conclusions:This study summarized the best evidence on the prevention and control measures of CRE infection in hospitals. Clinical staff and management departments should take active and effective prevention and control measures based on the local CRE epidemiological situation and resource requirements to reduce the risk of CRE infection.

Different kinds of poisonous mushrooms contain different toxic components. Acute liver injury caused by amanita mushroom is the main cause of death from poisonous mushroom poisoning in China. Consumption of poisonous mushrooms has an incubation period, there is a false recovery period in the clinical process, and the early performance is slight and does not attract enough attention from doctors, and it is easy to miss the treatment opportunity. The clinical characteristics, treatment and identification of mushrooms containing amanita in 4 patients were analyzed in order to improve clinicians' understanding of the diagnosis and treatment of mushroom poisoning and early species identification.

Different kinds of poisonous mushrooms contain different toxic components. Acute liver injury caused by amanita mushroom is the main cause of death from poisonous mushroom poisoning in China. Consumption of poisonous mushrooms has an incubation period, there is a false recovery period in the clinical process, and the early performance is slight and does not attract enough attention from doctors, and it is easy to miss the treatment opportunity. The clinical characteristics, treatment and identification of mushrooms containing amanita in 4 patients were analyzed in order to improve clinicians' understanding of the diagnosis and treatment of mushroom poisoning and early species identification.

The prevalence of diabetes in China is increasing year by year， and has become a health issue of close concern to the whole society. Glucagon-like peptide-1 （GLP-1） receptor agonist （GLP-1RA）， as a new class of glucose-lowering drugs， is now widely used in the treatment of type 2 diabetes mellitus （T2DM） because of its significant glucose-lowering efficacy and low risk of hypoglycemia. As the level of evidence for its effects on improving cardiovascular system and renal protection and reducing body mass continues to improve， its status in the treatment guidelines for T2DM is gradually increasing. Currently， nine GLP-1RA drugs have been approved for the clinical treatment of T2DM in China. Although all of these drugs exert hypoglycemic effects based on the activation of GLP-1 receptors in the body， the differences in their own structures and natural GLP-1 amino acid homology lead to large differences in pharmacokinetic parameters and clinical efficacy among different analogs. In order to enable clinicians and pharmacists to have a full understanding of the characteristics and clinical evidence of these analogs and to better perform their therapeutic effects， Liaoning Provincial Pharmaceutical Society organized clinical medicine and pharmacy experts to develop a medication guide for nine GLP-1RA drugs to provide a reference for clinical medication needs and promote rational and standardized use by compiling and summarizing the pharmacological characteristics， clinical applications， adverse reactions， interactions， the medications in special populations and medication management.

Objective:To compare the curative effects of posterior atlantoaxial non-fusion fixation and anterior cervical odontoid screw fixation in the treatment of odontoid fracture of Anderson-D'Alonzo type Ⅱ.Methods:A retrospective study was conducted to analyze the clinical data of 21 patients with odontoid type II fracture who had been treated at Department of Spine Surgery, The Central Hospital of Luohe from January, 2015 to January, 2020. The patients were divided into a posterior group subjected to posterior atlantoaxial non-fusion fixation and an anterior group subjected to anterior cervical odontoid screw fixation. In the posterior group of 12 patients, there were 7 males and 5 females with an age of (42.2±11.8) years. In the anterior group of 9 patients, there were 5 males and 4 females with an age of (40.0±9.1) years. The 2 groups were compared in terms of operation time, bleeding volume, intraoperative fluoroscopy, fusion time, cervical rotation and neck dysfunction index (NDI).Results:The differences in the preoperative general information were not statistically significant between the 2 groups, indicating comparability ( P>0.05). The implants were successfully inserted in all patients. Intraoperative fracture reduction was satisfactory and no arteriovenous or spinal cord injuries occurred. The mean follow-up time was (24.5±11.3) months. The operation time [(108.5±15.9) min] and bleeding volume [(48.3±12.2) mL] in the anterior group were significantly less than those in the posterior group [(153.9±34.2) min and (275.8±56.0) mL], and the intraoperative fluoroscopy [(13.0±2.1) times] in the anterior group was significantly higher than that in the posterior group [(7.2±1.4) times] ( P<0.05). There was no statistically significant difference in fracture healing time between the 2 groups ( P>0.05). There was no statistically significant difference either in total cervical rotation or NDI between the 2 groups at the last follow-up ( P>0.05). Conclusions:Posterior atlantoaxial non-fusion fixation can preserve the range of rotation of the cervical spine and reduce the dysfunction of the cervical spine. The anterior screw fixation may result in shorter operation time and less intraoperative bleeding, but more intraoperative X-ray fluoroscopy. Therefore, the 2 internal fixation methods should be adopted on the basis of each individual in the treatment of odontoid type Ⅱ fracture to achieve good curative results.