BACKGROUND:With the continuous advancement of medical technology,the combination of oblique lumbar interbody fusion and percutaneous pedicle screw fixation has become a common method for treating lumbar degenerative diseases;however,there is still a lack of in-depth research on the relationship between changes in anterior convexity angles at different postoperative segments and fusion device settlement.OBJECTIVE:To explore the relationship between changes in anterior convexity angle of different segments and Cage subsidence after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery.METHODS:Patients(93 cases)with lumbar degenerative diseases who underwent oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery in Weifang Hospital of Traditional Chinese Medicine from February 2019 to April 2023 were selected as the research subjects.According to the postoperative disc height loss value,they were divided into Cage subsidence group(25 cases,＞2 mm)and non-Cage subsidence group(68 cases,＜2 mm).Multiple Logistic regression analysis was used to analyze the risk factors for cage subsidence.Stepwise regression was utilized to evaluate the relationship of each risk factor and Cage subsidence.Risk prediction model was built and evaluated.RESULTS AND CONCLUSION:(1)After adjusting for confounding factors,there was still independent correlation between lumbar lordosis loss value and segmental lordosis improvement value and Cage subsidence risk(P＜0.05).(2)Age,oswestry disability index,disc height improvement value,segmental lordosis improvement value,and lumbar lordosis loss value were all independent influencing factors for the occurrence of Cage subsidence(P＜0.05).Among them,age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value were most closely related to Cage subsidence.(3)The results of multivariate Logistic regression model analysis showed that when P=0.80,the Jordan index was the highest and the prediction effect was the best,with accuracy of 89.27％,sensitivity of 86.67％,and specificity of 89.89％.The model evaluation results showed that it had good discrimination and high accuracy.(4)As the lumbar lordosis loss value and segmental lordosis improvement value increase,the risk of Cage subsidence increases,which affects clinical efficacy.(5)It is indicated that age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value are most closely related to Cage subsidence,and clinical doctors should pay more attention.

Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Objective:To explore the clinical characteristics and risk factors for the progression of severe scrub typhus in children.Methods:Clinical data, laboratory and auxiliary examination results, treatment and prognosis data of children with scrub typhus admitted to Xiamen Children's Hospital from July 2014 to March 2024 were collected. The clinical characteristics of scrub typhus in children were analyzed, and the study subjects were divided into severe group and mild group according to their condition. The relevant risk factors for progression to severe cases were analyzed.Results:A total of 42 cases were included, with 34 cases (80.95%) in the mild group and 8 cases (19.05%) in the severe group. All patients(100%) had fever, with the highest incidence of eschar or ulceration (95.24%), followed by lymphadenopathy and splenomegaly. All 42 patients improved or recovered after treatment with azithromycin or doxycycline, with no deaths reported. Compared with the mild group，the severe group had a higher incidence of cough, lymphadenopathy，and hepatomegaly, with statistically significant differences( P<0.05). Compared with the mild group, the severe group showed a decrease in hemoglobin(Hb), platelet, and fibrinogen(Fib) levels, while serum C-reactive protein(CRP), procalcitonin, aspartate aminotransferase, creatine kinase MB, and lactate dehydrogenase (LDH) levels increased, with statistically significant differences( P<0.05). Multivariate Tobit model analysis showed that a decrease in Hb ( OR -0.006，95% CI -0.012-0.000， P<0.05), an increase in CRP ( OR 2.72，95% CI 0.001-0.008， P=0.010), an increase in LDH ( OR 1.76，95% CI 0.000-0.000， P=0.027), and a decrease in Fib ( OR -3.78，95% CI -0.309-0.093， P=0.001) were risk factors for scrub typhus progressing to severe cases. Conclusion:During the epidemic season of scrub typhus, fever accompanied by eschar or ulceration, along with splenomegaly and lymphadenopath aids in the diagnosis of scrub typhus. Decreased Hb and Fib, as well as elevated CRP and LDH, are risk factors for the development of severe scrub typhus in children.

Objective:To investigate the detection and clinical features of human rhinovirus（HRV）infection in children from the Xiamen area.Methods:A retrospective analysis was conducted on children treated at Xiamen Children's Hospital from November 2021 to October 2022.Thirteen types of multiplex respiratory pathogen detection kits were used to screen for 13 common respiratory pathogens. Clinical data of HRV-positive hospitalized children were collected.Results:（1）Among 8 420 children with acute respiratory infections，HRV had the highest detection rate at 20.40%（1 718/8 420），followed by HMPV（10.12%），H3N2（7.46%），HRSV（6.94%），and HPIV（6.59%）.HRV was detected throughout the year，with the highest proportion in May（18.42%）.（2）Out of 1 718 children with HRV infection，863 cases were hospitalized for pneumonia（50.23%，863/1 718）.The median age of hospitalized children was 2.58（1.07，4.20）years old，with 53.77% under 3 years old.（3）The main clinical manifestations of HRV pneumonia were cough（97.68%，843/863），fever（58.05%，501/863），runny nose（57.01%，492/863），nasal congestion（36.96%，319/863），and wheezing（24.33%，210/843）. The HRV pneumonia co-infection group showed statistically significant differences in fever and hospitalization days compared to the single HRV pneumonia infection group（all P<0.05）.（4）Compared to the common pneumonia group，the severe HRV pneumonia group showed statistically significant differences in fever，runny nose，wheezing and hospitalization days the CRP, PCT, LDH levels, and the number of antibiotic applications after hospitalization（all P<0.05）. Conclusion:HRV infection is detected year-round in Xiamen，pneumonia is common，with children under 3 years old being particularly susceptible.It is important to be alert to mixed infections or severe pneumonia.Clinical treatment should avoid unnecessary antibiotic use，actively and provide appropriate treatment.

BACKGROUND:With the continuous advancement of medical technology,the combination of oblique lumbar interbody fusion and percutaneous pedicle screw fixation has become a common method for treating lumbar degenerative diseases;however,there is still a lack of in-depth research on the relationship between changes in anterior convexity angles at different postoperative segments and fusion device settlement.OBJECTIVE:To explore the relationship between changes in anterior convexity angle of different segments and Cage subsidence after oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery.METHODS:Patients(93 cases)with lumbar degenerative diseases who underwent oblique lumbar interbody fusion combined with percutaneous pedicle screw fixation surgery in Weifang Hospital of Traditional Chinese Medicine from February 2019 to April 2023 were selected as the research subjects.According to the postoperative disc height loss value,they were divided into Cage subsidence group(25 cases,＞2 mm)and non-Cage subsidence group(68 cases,＜2 mm).Multiple Logistic regression analysis was used to analyze the risk factors for cage subsidence.Stepwise regression was utilized to evaluate the relationship of each risk factor and Cage subsidence.Risk prediction model was built and evaluated.RESULTS AND CONCLUSION:(1)After adjusting for confounding factors,there was still independent correlation between lumbar lordosis loss value and segmental lordosis improvement value and Cage subsidence risk(P＜0.05).(2)Age,oswestry disability index,disc height improvement value,segmental lordosis improvement value,and lumbar lordosis loss value were all independent influencing factors for the occurrence of Cage subsidence(P＜0.05).Among them,age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value were most closely related to Cage subsidence.(3)The results of multivariate Logistic regression model analysis showed that when P=0.80,the Jordan index was the highest and the prediction effect was the best,with accuracy of 89.27％,sensitivity of 86.67％,and specificity of 89.89％.The model evaluation results showed that it had good discrimination and high accuracy.(4)As the lumbar lordosis loss value and segmental lordosis improvement value increase,the risk of Cage subsidence increases,which affects clinical efficacy.(5)It is indicated that age,lumbar lordosis loss value,disc height improvement value,and segmental lordosis improvement value are most closely related to Cage subsidence,and clinical doctors should pay more attention.

Objective:To explore the clinical characteristics and risk factors for the progression of severe scrub typhus in children.Methods:Clinical data, laboratory and auxiliary examination results, treatment and prognosis data of children with scrub typhus admitted to Xiamen Children's Hospital from July 2014 to March 2024 were collected. The clinical characteristics of scrub typhus in children were analyzed, and the study subjects were divided into severe group and mild group according to their condition. The relevant risk factors for progression to severe cases were analyzed.Results:A total of 42 cases were included, with 34 cases (80.95%) in the mild group and 8 cases (19.05%) in the severe group. All patients(100%) had fever, with the highest incidence of eschar or ulceration (95.24%), followed by lymphadenopathy and splenomegaly. All 42 patients improved or recovered after treatment with azithromycin or doxycycline, with no deaths reported. Compared with the mild group，the severe group had a higher incidence of cough, lymphadenopathy，and hepatomegaly, with statistically significant differences( P<0.05). Compared with the mild group, the severe group showed a decrease in hemoglobin(Hb), platelet, and fibrinogen(Fib) levels, while serum C-reactive protein(CRP), procalcitonin, aspartate aminotransferase, creatine kinase MB, and lactate dehydrogenase (LDH) levels increased, with statistically significant differences( P<0.05). Multivariate Tobit model analysis showed that a decrease in Hb ( OR -0.006，95% CI -0.012-0.000， P<0.05), an increase in CRP ( OR 2.72，95% CI 0.001-0.008， P=0.010), an increase in LDH ( OR 1.76，95% CI 0.000-0.000， P=0.027), and a decrease in Fib ( OR -3.78，95% CI -0.309-0.093， P=0.001) were risk factors for scrub typhus progressing to severe cases. Conclusion:During the epidemic season of scrub typhus, fever accompanied by eschar or ulceration, along with splenomegaly and lymphadenopath aids in the diagnosis of scrub typhus. Decreased Hb and Fib, as well as elevated CRP and LDH, are risk factors for the development of severe scrub typhus in children.

Objective:To investigate the detection and clinical features of human rhinovirus（HRV）infection in children from the Xiamen area.Methods:A retrospective analysis was conducted on children treated at Xiamen Children's Hospital from November 2021 to October 2022.Thirteen types of multiplex respiratory pathogen detection kits were used to screen for 13 common respiratory pathogens. Clinical data of HRV-positive hospitalized children were collected.Results:（1）Among 8 420 children with acute respiratory infections，HRV had the highest detection rate at 20.40%（1 718/8 420），followed by HMPV（10.12%），H3N2（7.46%），HRSV（6.94%），and HPIV（6.59%）.HRV was detected throughout the year，with the highest proportion in May（18.42%）.（2）Out of 1 718 children with HRV infection，863 cases were hospitalized for pneumonia（50.23%，863/1 718）.The median age of hospitalized children was 2.58（1.07，4.20）years old，with 53.77% under 3 years old.（3）The main clinical manifestations of HRV pneumonia were cough（97.68%，843/863），fever（58.05%，501/863），runny nose（57.01%，492/863），nasal congestion（36.96%，319/863），and wheezing（24.33%，210/843）. The HRV pneumonia co-infection group showed statistically significant differences in fever and hospitalization days compared to the single HRV pneumonia infection group（all P<0.05）.（4）Compared to the common pneumonia group，the severe HRV pneumonia group showed statistically significant differences in fever，runny nose，wheezing and hospitalization days the CRP, PCT, LDH levels, and the number of antibiotic applications after hospitalization（all P<0.05）. Conclusion:HRV infection is detected year-round in Xiamen，pneumonia is common，with children under 3 years old being particularly susceptible.It is important to be alert to mixed infections or severe pneumonia.Clinical treatment should avoid unnecessary antibiotic use，actively and provide appropriate treatment.

Objective:To evaluate the impact of postoperative radiotherapy (RT) and associated risk factors on the prognosis of patients undergoing postmastectomy breast reconstruction (PMBR) for breast cancer.Methods:A retrospective analysis was conducted on 1593 breast cancer patients who underwent PMBR at Tianjin Medical University Cancer Institute & Hospital between January 2010 and October 2023. Patients were divided into an RT group ( n = 351) and a non-RT group ( n =1242) based on whether postoperative radiotherapy was administered. The primary endpoints were overall survival (OS) and progression-free survival (PFS), and the secondary endpoint was the incidence of revision surgery. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used for pairing. Continuous variables were compared between the two groups using the independent samples t-tests, while categorical variables were compared using chi-square tests, and survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards model was used to analyze survival influencing factors, and include propensity factors with P<0.2 in univariate analysis into multivariate analysis. Results:In the RT group, there were 3 deaths (0.9%) and 21 cases of disease progression (6.0%); in the non-RT group, 7 patients died (0.56%) and 40 experienced disease progression (3.22%). The median OS was 20.1 months (range: 0.1-164.9), and the median PFS was 19.5 months (range: 0.1-160.9). Pregnancy-associated breast cancer and higher N stage were identified as significant risk factors for OS, while neoadjuvant therapy, absence of adjuvant chemotherapy or endocrine therapy, and higher T stage were significant risk factors affecting patients' PFS. Radiotherapy significantly reduced the survival risk for PMBR patients with pregnancy-associated breast cancer or those receiving neoadjuvant therapy ( P=0.019, 0.027). Compared with other reconstruction methods, implant-based reconstruction was associated with a lower incidence of postmastectomy revision surgery(10.5% vs. 17.0%, P<0.001). Even after radiotherapy, the revision surgery incidence for implant-based reconstruction remained lower than that of other methods (12.2% vs. 14.2%, P=0.591). Compared with other reconstruction types, expander-based reconstruction was associated with an increased incidence of revision surgery (31.9% vs. 10.9%, P<0.001). Conclusions:Postmastectomy radiotherapy can reduce survival risk in PMBR patients with pregnancy-associated breast cancer or who received neoadjuvant therapy, showing positive effects on OS and PFS in high-risk patients. Pregnancy, higher T/N stage, and specific treatment strategies are critical factors influencing the prognosis of PMBR patients. Implant-based reconstruction is associated with a lower incidence of revision surgery, which remains low even after RT, whereas expander-based reconstruction may increase the long-term risk of revision surgery.

Individuals with type 1 diabetes or advanced type 2 diabetes suffer insufficient insulin secretion, leading to symptoms of hyperglycemia. To maintain the normal blood glucose levels, those people with diabetes must administer insulin multiple times a day. However, insulin requirements are influenced by several factors such as diet, exercise, and illness, combined with the narrow therapeutic index, making accurate insulin dosage challenging. Excessive insulin administration can even pose life-threatening risks. In addition, frequent daily insulin injections place considerable physiological and psychological burdens on patients. To tackle these challenges, researchers have embarked on the development of closed-loop insulin delivery systems. These systems adjust insulin dosages in real-time changes based on the patient’s blood glucose levels, therefore enhancing both the safety and effectiveness of insulin therapy. This review categorizes closed-loop insulin delivery systems into two types: electronic-based and material-based systems, based on their compositional attributes. The exploration of both types covers their components, developmental history, clinical applications, current pros and cons, and future directions. The relative strengths and limitations of these two categories of closed-loop insulin delivery systems are also compared and discussed.

OBJECTIVE: To investigate the effect of hyperbaric oxygen (HBO) on paroxysmal sympathetic hyperexcitation (PSH) after brain injury. METHODS: A multicenter retrospective study was conducted. Fifty-six patients with PSH who received HBO treatment from four hospitals in Henan Province from January 2021 to September 2023 were selected as the HBO group, and 36 patients with PSH who did not receive HBO treatment from Zhengzhou People's Hospital from May 2018 to December 2020 were selected as the control group. PSH assessment measure (PSH-AM) score [clinical feature scale (CFS) score+diagnostic likelihood tool (DLT) score] and Glasgow coma scale (GCS) were compared before and after HBO treatment, and between HBO group and control group to evaluate the effect of HBO treatment on prognosis of PSH patients. RESULTS: There were no statistically significant differences in age, gender, PSH etiology, GCS score, time from onset to occurrence of PSH, CFS score, CFS+DLT score and frequency of PSH episodes between the two groups, indicating comparability. The duration of HBO treatment ranged from 3 to 11 days for 56 patients receiving HBO treatment, and the duration of HBO treatment ranged from 3 to 5 courses. Compared with before treatment, after HBO treatment, PSH symptoms in HBO patients were significantly relieved (body temperature increase: 14.29% vs. 64.29%, heart rate increase: 25.00% vs. 98.21%, shortness of breath: 14.29% vs. 76.79%, blood pressure increase: 8.93% vs. 85.71%, sweating: 10.71% vs. 85.71%, muscle tone increased: 19.64% vs. 75.00%, all P < 0.05), CFS+DLT score decreased significantly (16.90±4.81 vs. 22.12±3.12, P < 0.01), GCS score improved (12.31±5.34 vs. 5.95±2.18, P < 0.01). After 30 days of hospitalization, compared with the control group, PSH symptoms in the HBO group were improved (body temperature increase: 14.29% vs. 19.44%, heart rate increase: 19.64% vs. 25.00%, shortness of breath: 10.71% vs. 27.78%, blood pressure increase: 7.14% vs. 22.22%, sweating: 8.93% vs. 25.00%, muscle tone increased: 19.64% vs. 38.89%, all P < 0.05 except body temperature increase), CFS+DLT score decreased (16.90±3.81 vs. 19.98±4.89, P < 0.05), GCS score increased (14.12±4.12 vs. 12.31±4.14, P < 0.01), the length of intensive care unit (ICU) stay was shortened (days: 18.01±5.67 vs. 24.93±8.33, P < 0.01). CONCLUSIONS HBO treatment can significantly relieve the symptoms of patients with PSH after brain injury and provide a new idea for the treatment of PSH patients.
Humans ; Hyperbaric Oxygenation/methods* ; Retrospective Studies ; Brain Injuries/therapy* ; Female ; Male ; Prognosis ; Glasgow Coma Scale ; Autonomic Nervous System Diseases/etiology*