Objectives:To explore the long-term follow-up prognosis and risk factors in patients with neuro-logical function deterioration after expansive open-door laminoplasty at early postoperative stage(within 3 months).Methods:A retrospective analysis was conducted on 17 patients who experienced neurological func-tion deterioration(the mJOA score decreased by ≥ 1 point at postoperative 3 months'follow-up compared with that before operation)at early stage after receiving laminoplasty with the preservation of unilateral muscle-lig-ament complex in our department between January 2006 and December 2012.The patients were divided into non-recovery group(n=5)and recovery group(n=12)based on whether the mJOA score of one patient recovered to one's preoperative level at postoperative 10-year follow-up.The baseline data,perioperative information,postoperative 3-month,1-year and 10-year mJOA score,neck disability index(NDI)score,and visual analog scale(VAS)score,as well as the imaging data[Cobb angle,range of motion(ROM)of the cervical spine,and sagittal vertical axis(SVA)of C2-C7]were collected and compared for regression analysis.The differences be-tween different mJOA categories involved between the two groups were also compared.Results:The proportion of patients with ossification of longitudinal ligament(OPLL)in the non-recovery group was significantly higher than that in the recovery group.There were no statistically significant differences between the two groups in baseline information such as age,gender,BMI,comorbidities,spinal cord T2 high singnal intensity and devel-opmental cervical canal stenosis,as well as perioperative information such as operative time,blood loss and the length of hospital stay(P＞0.05).One patient in the non-recovery group had experienced cerebrospinal fluid leakage and C5 nerve root palsy and 1 patient in the recovery group had experienced cerebrospinal fluid leakage,and the difference wasn't with statistical significance between the two groups.After neurological dete-rioration occurred within postoperative 3 months,imaging examinations were conducted on all the patients and found none insufficient decompression,therefore no secondary surgical treatment was performed.The preopera-tive mJOA scores of the non-recovery group and recovery group were 13.30±2.46 and 14.71±1.41,respective-ly,with no statistically significant difference between the two groups.After early postoperative neurological function deterioration,the mJOA score at 1-year follow-up in the recovery group significantly improved com-pared to that at 3-month follow-up,which wasn't significantly different from the preoperative level,and the mJOA score at 10-year follow-up was significantly higher than the values before surgery and at previous fol-low-up visits.However,in the non-recovery group,the 1-year and 10-year follow-up mJOA scores weren't statistically different from the value at 3-month follow-up.There was no statistically significant difference in VAS scores and NDI scores between the two groups before surgery and at each follow-up;The intragroup comparison of VAS scores and NDI scores in both groups showed no significant difference between different time points.In the recovery group,the Cobb angle increased at each follow-up compared to the preoperative value,and SVA increased significantly at the 10-year follow-up.In the non-recovery group,there was no statistically significant difference in Cobb angle and SVA at each follow-up compared with the preoperative values.The ROMs at postoperative follow-up visits of the recovery group decreased significantly compared to that of preoperation,while no such difference was found in the non-recovery group.In addition,there were no significant differences in Cobb angle,ROM,and SVA between the two groups at preoperation and each follow-up.It was found that the patients in the non-recovery group were more likely to have the sensory function of lower extremity affected in neurological deterioration at postoperative early stage.The logistic re-gression results suggested that OPLL before operation was a risk factor for early postoperative neurological de-terioration that was hard to recovery at 10 years of follow-up.Conclusions:The patients with cervical OPLL before operation who suffer from early postoperative neurological deterioration after laminoplasty tend to be more difficult to recover in the long-term follow-up.

Objectives:To explore the long-term follow-up prognosis and risk factors in patients with neuro-logical function deterioration after expansive open-door laminoplasty at early postoperative stage(within 3 months).Methods:A retrospective analysis was conducted on 17 patients who experienced neurological func-tion deterioration(the mJOA score decreased by ≥ 1 point at postoperative 3 months'follow-up compared with that before operation)at early stage after receiving laminoplasty with the preservation of unilateral muscle-lig-ament complex in our department between January 2006 and December 2012.The patients were divided into non-recovery group(n=5)and recovery group(n=12)based on whether the mJOA score of one patient recovered to one's preoperative level at postoperative 10-year follow-up.The baseline data,perioperative information,postoperative 3-month,1-year and 10-year mJOA score,neck disability index(NDI)score,and visual analog scale(VAS)score,as well as the imaging data[Cobb angle,range of motion(ROM)of the cervical spine,and sagittal vertical axis(SVA)of C2-C7]were collected and compared for regression analysis.The differences be-tween different mJOA categories involved between the two groups were also compared.Results:The proportion of patients with ossification of longitudinal ligament(OPLL)in the non-recovery group was significantly higher than that in the recovery group.There were no statistically significant differences between the two groups in baseline information such as age,gender,BMI,comorbidities,spinal cord T2 high singnal intensity and devel-opmental cervical canal stenosis,as well as perioperative information such as operative time,blood loss and the length of hospital stay(P＞0.05).One patient in the non-recovery group had experienced cerebrospinal fluid leakage and C5 nerve root palsy and 1 patient in the recovery group had experienced cerebrospinal fluid leakage,and the difference wasn't with statistical significance between the two groups.After neurological dete-rioration occurred within postoperative 3 months,imaging examinations were conducted on all the patients and found none insufficient decompression,therefore no secondary surgical treatment was performed.The preopera-tive mJOA scores of the non-recovery group and recovery group were 13.30±2.46 and 14.71±1.41,respective-ly,with no statistically significant difference between the two groups.After early postoperative neurological function deterioration,the mJOA score at 1-year follow-up in the recovery group significantly improved com-pared to that at 3-month follow-up,which wasn't significantly different from the preoperative level,and the mJOA score at 10-year follow-up was significantly higher than the values before surgery and at previous fol-low-up visits.However,in the non-recovery group,the 1-year and 10-year follow-up mJOA scores weren't statistically different from the value at 3-month follow-up.There was no statistically significant difference in VAS scores and NDI scores between the two groups before surgery and at each follow-up;The intragroup comparison of VAS scores and NDI scores in both groups showed no significant difference between different time points.In the recovery group,the Cobb angle increased at each follow-up compared to the preoperative value,and SVA increased significantly at the 10-year follow-up.In the non-recovery group,there was no statistically significant difference in Cobb angle and SVA at each follow-up compared with the preoperative values.The ROMs at postoperative follow-up visits of the recovery group decreased significantly compared to that of preoperation,while no such difference was found in the non-recovery group.In addition,there were no significant differences in Cobb angle,ROM,and SVA between the two groups at preoperation and each follow-up.It was found that the patients in the non-recovery group were more likely to have the sensory function of lower extremity affected in neurological deterioration at postoperative early stage.The logistic re-gression results suggested that OPLL before operation was a risk factor for early postoperative neurological de-terioration that was hard to recovery at 10 years of follow-up.Conclusions:The patients with cervical OPLL before operation who suffer from early postoperative neurological deterioration after laminoplasty tend to be more difficult to recover in the long-term follow-up.

Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.

Objective ToevaluatethereportingqualityofChineseimagingdiagnosticaccuracystudiesbyStandardsforReporting DiagnosticAccuracyStudies (STARD)2015.Methods AticalspublishedinChina,whichoriginatedfrom ChinaBiology Medicine (CBM),ChinaNationalKnowledgeInfrastructure(CNKI)andWanfangDatabasefromJanuary12014toApril82016wereretrievedfor statisticalanalysis.Keywordswereasfollows:"Ultrasound","CT","MRI","X-ray"and"diagnosticstudy".Tworeviewersindependently screenedtheliteraturesandassessedtheincorporatedstudies.Excel2016wasusedtofigureouttheaccordancerateandSPSS (version 17.0)wasusedtoanalyzethedata.Results 152studieswerefinallyincluded.Thenumberandproportionofstudiesonimagingdiagnostic methodswere84 (55.26%)ultrasound,29 (19.08%)CT,16 (10.53%)MRI,and23 (15.13%)withthecombinationoftwoand moremethods.Thecoincidencerateandcorrespondingnumberofsingledocumentreportswereasfollows:0%－10%,1report;11%－20%,4reports;21%－30%,45reports;31%－40%,74reports;41%－50%,24reports;51%－60%,3reports;and61%－70%,1 report.Therewasnosignificantdifferenceofcoincidencerate (P＝0.09)betweendifferentimagingdiagnosticmethods.Also,there wasnosignificantdifferenceofcoincidenceratebetweentheoldentriesinSTARD2003andnewentriesinSTARD2015(P＝0.34). Conclusion ThisstudyprovidesareferencebaselinefortheresearchersandthecliniciansonthequalityofChinesetestreportson imagingdiagnosticaccuracy.Itisshowedthat,thereportsondiagnosticaccuracyofUltrasound,CT,MRIandX-raypublishedbetween January1,2014andApril8,2016aregenerally middleandlow level.

Purpose To evaluate the quality assessed by iconographic diagnostic test system using ROBIS. Materials and Methods"Diagnostic tests, system evaluation, Meta analysis, diagnoses*test, diagnoses*trial, systematic review, meta-analysis" were used as search term to retrieve relevant literatures recorded in CBM, CNKI, Wanfang Data, PubMed, Embase, and Cochrane Library from January. 1, 2014 to December. 31, 2016. After two independent researchers screened the literature and extracted the information, the quality of included literatures was evaluated using ROBIS. Results Totally 219 articles were included in the study, including 93 Chinese literatures and 126 English literatures. The results of subgroup analysis showed that the quality difference between Chinese and English documents was statistically significant (P=0.018); the quality difference between the Chinese literatures and those of other regions was statistically significant (P<0.001); there was no statistical significance in quality difference regarding the year of publication (P=0.34). The ROBIS evaluation results showed that there were only 15 literatures (6.85%) with low-risk, including 2 Chinese literatures and 13 English literatures. Conclusion The quality evaluated by Chinese and English diagnostic test system, which is publicly published in iconographic diagnostic test from 2014 to 2016, is generally low, and the quality of literatures published by domestic scholars and in Chinese is still behind international levels. The maker of system evaluation in this field should prepare their research plans in advance and fully report them in future research, adequately obtain evidence, minimize bias in respects of document screening, information extraction, and evaluation of original research bias, and take into account of results stability, based on which the quality of system evaluation in this field should be further improved.

The United Kingdom is the longest-serving community in the welfare states, and has been serving for more than sixty years so far. The construction of community care service supply model in the United Kingdom is deeply influenced by the neo-liberalism and neo-managerialism, which dominated the reform and development of pur-chasing community care services. Presently, China is actively promoting the government to purchase pension services of public health care combined with the long-term care, especially policy and determination of community-based de-velopment of an elders' service model. Based on the purchased services experience of the United Kingdom combined with the situation in China, this paper puts forward some suggestions such as the repositioning the role of the govern-ment, actively supporting the development of civil service organizations and perfecting the legal system of care serv-ices to be purchased, supporting the development of proposals to reduce the burden on the government and enhance the efficiency of care services through improving their quality.