Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

OBJECTIVE: To investigate the possible mechanism and fracture stability of subtypes of type B Hangman's fracture by using imaging observation. METHODS: Patients with type B Hangman's fractures admitted to multiple centers between January 2008 and October 2023 were selected as the research objects. The clinical data and imaging data of patients who met the selection criteria were extracted. The patients' age, gender, cause of fracture, disease duration, visual analogue scale (VAS) score of neck pain, neck disability index (NDI), and American Spinal Injury Association (ASIA) classification of spinal cord function were collected. Based on the imaging data, the anatomical structure of the contralateral superior articular process fracture, the relationship between the superior articular process fracture line and the position of the odontoid process, the associated posterior vertebral wall fracture and its classification, the incidence of vertebral arch floating and C _{2, 3} instability were observed. The superior articular fracture angle (SAFA), superior articular fracture displacement distance (SAFD), and C ₂ vertebral body rotation (VBRA) were measured. According to the anatomical structure of the contralateral superior articular process fracture, the patients were divided into a pedicle fracture group (POA group), a inferior articular process fracture group (IAP group), and a laminar fracture group (CSL group). The baseline data and imaging indexes were analyzed between groups, and the imaging anatomical characteristics of each subtype of fracture were observed to explore its possible mechanism and fracture stability. RESULTS: A total of 86 cases of type B Hangman's fractures were collected. There were 67 males and 19 females. The mean age was 51.0 years (range, 21-78 years). There were 48 cases of pedicle fracture (POA group), 25 cases of inferior articular process fracture (IAP group), and 13 cases of laminar fracture (CSL group). There was no significant difference in age, gender, cause of fracture, disease duration, VAS score of neck pain, and NDI between groups ( P>0.05). However, the incidence of spinal cord injury in POA group was the highest ( P<0.05). The incidences of superior articular process fracture line posterior to the odontoid process and posterior vertebral wall fracture in POA group were the highest ( P<0.05). The incidences of vertebral arch floating and C _{2, 3} instability in IAP group were the highest ( P<0.05). There were significant differences in SAFA and VBRA between groups ( P<0.05). There was no significant difference in SAFD between groups ( P>0.05). The differences in the incidences of fracture displacement>3 mm and VBRA>5° between groups were significant ( P<0.05). There were 78 cases of unstable Hangman's fracture, including 2 cases of simple C _2、3 instability, 22 cases of simple axis rotation and displacement instability, 8 cases of simple vertebral arch floating instability, and the rest of the patients had two or more types of instability. CONCLUSION The mechanism of different subtypes of type B Hangman's fracture may be that the lateral mass of the rotation of the atlas applied the overextension compression force to the unilateral superior articular process of the axis vertebra, and the contralateral pedicle, inferior articular process and lamina fractures were caused by direct violence or/and rotational violence to different degrees. The decomposition of this type of fracture into C _{2, 3} intervertebral, axis vertebra body displacement and rotation and vertebral arch floating instability is beneficial to the treatment and surgical approach selection.
Humans ; Spinal Fractures/surgery* ; Male ; Female ; Cervical Vertebrae/diagnostic imaging* ; Middle Aged ; Adult ; Tomography, X-Ray Computed ; Aged ; Odontoid Process/injuries* ; Fracture Fixation, Internal/methods* ; Young Adult

Objective To investigate the effect of acupuncture at key muscle movement points combined with exercise training on neurophysiological indicators,muscle tone and quality of life in patients with spinal cord injury(SCI).Methods Eighty SCI patients admitted to the Rehabilitation Diagnosis and Treatment Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from September 2022 to June 2024 were selected.Patients were divided into the control group(receiving routine acupuncture combined with exercise training,40 cases)and the observation group(receiving acupuncture combined with exercise training at key muscle movement points,40 cases)according to the random number table method.The neurophysiological indicators[motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)],limb function[Fugl-Meyer Assessment(FMA),Modified Ashworth Scale(MAS)]and quality of life[Barthel index,functional independence measure(FIM)]were compared between the two groups.Results After intervention,the MNCV and SNCV of median nerve,ulnar nerve,tibial nerve and common peroneal nerve were increased in the observation group than those in the control group(P＜0.05).After intervention,there were higher FMA scores,Barthel index and FIM scores in the observation group than those of the control group,while the MAS score was lower than that of the control group(P＜0.05).Conclusion Acupuncture at key muscle movement points combined with exercise training can effectively improve the neuroelectrophysiological indicators,limb functions and quality of life of SCI patients,which is feasible rehabilitation intervention program.

Objective To investigate the effect of acupuncture at key muscle movement points combined with exercise training on neurophysiological indicators,muscle tone and quality of life in patients with spinal cord injury(SCI).Methods Eighty SCI patients admitted to the Rehabilitation Diagnosis and Treatment Center of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from September 2022 to June 2024 were selected.Patients were divided into the control group(receiving routine acupuncture combined with exercise training,40 cases)and the observation group(receiving acupuncture combined with exercise training at key muscle movement points,40 cases)according to the random number table method.The neurophysiological indicators[motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)],limb function[Fugl-Meyer Assessment(FMA),Modified Ashworth Scale(MAS)]and quality of life[Barthel index,functional independence measure(FIM)]were compared between the two groups.Results After intervention,the MNCV and SNCV of median nerve,ulnar nerve,tibial nerve and common peroneal nerve were increased in the observation group than those in the control group(P＜0.05).After intervention,there were higher FMA scores,Barthel index and FIM scores in the observation group than those of the control group,while the MAS score was lower than that of the control group(P＜0.05).Conclusion Acupuncture at key muscle movement points combined with exercise training can effectively improve the neuroelectrophysiological indicators,limb functions and quality of life of SCI patients,which is feasible rehabilitation intervention program.

Objective:To compare the efficacies of endovascular therapy (EVT) and standard medical therapy in acute ischemic stroke (AIS) patients aged ≥85 years, and analyze the independent influencing factors for poor prognosis of AIS patients after EVT.Methods:Sixty-nine AIS patients aged ≥85 years admitted to Department of Neurology, Xi'an Third Hospital from January 2018 to April 2024, including 40 accepted EVT and 28 accepted standard medicinal therapy, were enrolled. Modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 90 days after onset. General data, prognosis and complications between the EVT group and standard medical therapy group were compared. General data, treatment processes and complications between patients with good prognosis and poor prognosis in the EVT group were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in AIS patients after EVT.Results:Compared with the standard medical therapy, the EVT group had significantly lower NIHSS score at discharge, greater improvement in NIHSS score (NIHSS score at admission-NIHSS score at discharge), lower mRS score 90 days after onset, higher good prognosis rate, lower mortality rate within 90 days of onset, and longer hospital stay ( P<0.05). In the EVT group, 11 patients (27.5%) had good prognosis and 29 patients (72.5%) had poor prognosis 90 days after onset. Compared with the good prognosis group, the poor prognosis group had significantly higher blood glucose level and lower Alberta Stroke Program Early CT Score (ASPECT) on admission ( P<0.05). Multivariate Logistic regression analysis showed that blood glucose on admission ( OR=2.363, 95% CI: 1.134-4.928, P=0.022) and ASPECT score on admission ( OR=0.273, 95% CI: 0.088-0.854, P=0.026) were independent influencing factors for poor prognosis in AIS patients after EVT. Conclusion:AIS patients aged ≥85 years received EVT have better prognosis compared with those accepted standard medical therapy; these patients with high glucose level and low ASPECT score on admission have poor prognosis.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

Objectives:To explore the risk factors of postoperative delirium in elderly patients after cervical spine operation.Methods:The clinical data of 252 elderly patients treated with cervical spine surgery in our hospital from January 2019 to October 2022,including 148 males and 104 females,with a mean age of 68.9±6.1 years(60-91 years)old were retrospectively analyzed.The Confusion Assessment Method(CAM)was utilized to assess whether the patients exhibited delirium after surgery in a week,and they were divided into delirium group and non-delirium group.Data were collected,such as age,sex,disease type,smoking history,drinking history,comorbidities,body mass index(BMI),bone mineral density(BMD),sleep disorders,the Saint Louis University Mental Status(SLUMS)score,surgical approach,American Society of Anesthesiologists(ASA)grade,preoperative hematocrit and electrolytes concentration,preoperative and postoperative 1d hemoglobin and albumin levels,operative time,anesthesia time,blood loss,postoperative hospitalization in ICU,the occurrence of postoperative hypoxaemia and postoperative hypotension within 3 days;Narcotics-related drug use included:anticholinergics,benzodiazepines,dexmedetomidine;Before operation and at 3d after operation,visual analogue scale(VAS)was used to evaluate the pain status,and Japanese Orthopaedic Association(JOA)score and neck disability index(NDI)were adopted to assess the cervical function.The differences between the two groups were analyzed with independent sample t-test or x2 test,and indexes with intergroup difference were analyzed with the binary logistic regression method to determine the risk factors for delirum after operation.Results:There were 31 patients with postoperative delirium and 221 patients without delirium.Univariate analysis showed that age,stroke history,Parkinson's disease,pulmonary disease,sleep disorder,SLUMS score,preoperative albumin level,operative time,anesthesia time,blood loss,postoperative albumin level,postoperative hospitalization in ICU and postoperative hypoxemia were with statistically significant differences between delirium group and non-delirium group(P＜0.05);Sex,disease type,smoking history,drinking history,hypertension,diabetes,BMI,BMD,surgical approach,ASA grade,preoperative and postoperative VAS scores,JOA scores,NDI,and hemoglobin levels,preoperative hematocrit,electrolyte concentration,and the use of anticholinergics,benzodiazepines,and dexmedetomidine were not statistically different between the two groups(P＞0.05).The multivariate logistic regression analysis showed age ≥70 years(OR=2.844,P=0.031),stroke history(OR=3.476,P=0.012),Parkinson's disease(OR=18.815,P=0.003),pulmonary disease(OR=7.213,P=0.000),sleep disorders(OR=3.010,P=0.025),SLUMS score ≤21(OR=4.529,P=0.012),and postoperative hospitalization in ICU(OR=4.131,P=0.005)were the risk factors for delirium after cervical spinal operation.Conclusions:Elderly patients who age ≥70 years,have stroke history,Parkinson's disease,pulmonary disease,sleep disorders,SLUMS score ≤21,and are hospitalized in ICU after operation are prone to delirium after operation in cervical spine.

Objective:To analyze the clinical effect of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with neuromuscular joint facilitation(NJF)technique in improving the enhancement of muscle tone after stroke.Methods:From October 2020 to October 22,a total of 114 patients with increased muscle tone at lower limb during the recovery period of stroke who admitted to Beijing Rehabilitation hospital were selected,and they were randomly divided into the observation group(57 cases)and the control group(57 cases)according to the random number table method.The control group received routine rehabilitation treatment.The observation group added low-frequency rTMS and NJF training on the basis of the routine rehabilitation treatment.The differences of clinical efficacy and various indicators of muscle tone of lower limb before and after treatment between two groups were compared,which included modified Ashwonh score(MAS)scale,functional ambulation category(FAC)scale of the motor of lower limb,Fugl-Meyer motor function scale-Lower limbs(FMA-L),clinical spasmodic index(CSI),modified Barthel index(MBI)of activity ability of daily life,integrated electromyogram(IEMG)and root mean square(RMS)of tibialis anterior muscle of lower limb in electromyogram.Results:After intervention,29 cases appeared significant effect,and 23 cases appeared valid result,and 5 cases appeared invalid result in the observation group,and 20 cases appeared significant effect,and 20 cases appeared valid result,and 17 cases appeared invalid result in the control group.The total effective rate of the observation group was 91.23%,which was significantly higher than 70.18%of the control group,and the difference was statistically significant(x2=8.111,P<0.05).Before intervention,there was no statistically significant difference in each indicator between the two groups(P>0.05).The MAS score,CSI score,IEMG and RMS of two groups after intervention were significantly lower than those before intervention,while the FAC score,FMA-L score and MBI score were significantly higher than those before intervention,and the differences were significant(t=3.377,4.398,5.554,P<0.05),respectively.At the same time,the MAS score,CSI score,IEMG and RMS of the observation group were significantly higher than those of the control group,and the differences were statistically significant(t=11.160,9.625,16.993,8.095,P<0.05),respectively.Conclusion:The combined application of low-frequency rTMS and NJF training can significantly improve the enhancement of muscle tone after stroke,and effectively reduce the muscle tone of lower limb,and improve the motor function of lower limb and the degree of spasticity,and improve the activity ability of daily life.

Objective To establish the Good Agricultural Practice（GAP）for standard operation procedure of Shanghai Pheretima. Methods According to the comprehensive technical requirements of GAP standardized production of Chinese herbal medicine, the key technologies of standardized cultivation and processing were studied in Sangxin Town, Chongming District, Shanghai. Results The production area environment, variety characteristics, breeding technology, pest control, harvesting and processing, packaging, storage and transportation, quality monitoring and other technical links of Shanghai Pheretima were clearly defined and standardized. Conclusion This study provides practical basis for the standardization and modernization quality management of Shanghai Pheretima.

Objective To explore the application value of the pulse index continuous cardiac output monitoring technology (PICCO) in treating severe craniocerebral injury complicating neurogenic pulmonary edema(NPE).Methods Fifty-two cases of severe craniocerebral injury complicating NPE in the intensive care medicine department of this hospital were divided into the observation group and control group,26 cases in each group.The control group adopted the routine neurological treatment measures and guided the fluid infusion by monitoring the central venous pressure(CVP),while on the basis of the control group,the treatment group monitored the hemodynamics by PICCO and guided the fluid management according to the cardiac index(CI),extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),global end diastolic volume index(GEDVI) and intrathoracic blood volume index(ITBVI).The clinical curative effects,hemodynamic indexes,intracranial pressure(ICP),average daily infusion volume,mechanical ventilation time,hospital stay and GOS prognosis evaluation were compared between the two groups.Results The improvement of the heart rate(HR),mean arterial pressure (MAP),oxygenation index(PaO2/FiO2),ICP and other indicators in the observation group was more obvious than that in the control group(P＜0.05);the CVP rise in the control group was more obvious(P＜0.05);CI,EVLWI,PVPI,GEDVI and ITBVI in the observation group were improved and stabilized;the daily average infusion amount,mechanical ventilation time and hospital stay in the observation group were less than those in the control group(P＜0.05);but the good prognosis rate and mortality rate had no significant difference between the two groups(P＞0.05).Conclusion PICCO can better conduct the liquid management,improves the clinical symptoms,shortens the mechanical ventilation time and hospitalization stay,but the results show no significant improvement in prognosis and mortality.