The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

ObjectiveTo identify the rate， population characteristics， and vaccination history of repeat infections among previously infected people in the current epidemic based on the rate of repeat infection and population characteristics of different mutant strains at different times in Pudong New Area of Shanghai， and to provide reference for the prevention and control strategies of novel coronavirus repeat infections. MethodsA total of 9 250 investigated subjects were randomly selected from the new cases of asymptomatic infection and confirmed cases reported by Pudong New Area from March to May 2022. The investigation mainly focused on demographic characteristics， nucleic acid or antigen test results， and symptoms after infection. The repeat infection rates among different populations were compared， and logistic regression was used to analyze the impact of gender， age， and vaccination status on repeat infections. ResultsThe survey sample of 9 250 people had a response rate of 81.85%. There were 4 043 males （53.40%） and 3 528 females （46.60%）， with a median age of 34 years old （P₂₅， P₇₅： 7， 61）. The overall vaccine uptake rate was 59.44% （4 500/7 571）. In December of 2022， there were 563 cases of repeat infection， with an infection rate of 7.44%. The lowest rate of repeat infection was seen in the 3‒ year-old group （2.86%） and the highest rate in the 30‒ year-old group （12.42%）， with significant differences between different age groups. The repeated infection rate for those who had completed their vaccinations was significantly lower （6.57%） compared to those who had not （7.11%）. The age groups of 3‒ years， 70‒79 years， as well as individuals who completed full vaccination and received booster shots were protective factors against repeat infections. ConclusionThe overall rate of reinfection among the infected in Shanghai during the spring of 2022 was low in the outbreak of the Omicron variant， and the rate of reinfection in the 3‒ year-old group was significantly lower than in other age groups. Completing the full course of vaccination significantly reduces the risk of reinfection. Although the reinfection rate is high in individuals who received booster shots， it remains a mitigating factor compared to those who do not receive the vaccine. It is recommended to continue monitoring reinfections in key populations and further strengthen immunization efforts.

Objective To establish a novel localization method for sacral nerve foramen puncture by analyzing the characteristic of sacral nerve foramen trying to help improve the success rate of sacral foramen puncture.Methods Clinical data and sacrococcyx CT and three-dimensional reconstruction imaging data of 158 patients who received sacral nerve modulation(SNM)during Jan.2019 and Aug.2022 in our hospital were retrospectively analyzed.The distance between inferior margin of articulatio sacroiliaca and the internal edge of the 3rd neural foramen(D1),and the distance between the internal edge of the 3rd neural foramen and sacral midline(D2)were measured,and the ratio of D1 and D2 was calculated for precise intraoperative positioning.The measurement data characteristic and puncture results were analyzed.Results A total of 89 males and 69 females were included,with an average age of(49.0±16.9)years.The average D1,D2,and D1/D2 were(29.6±4.9)mm,(13.8±3.2)mm,and(2.2±0.6),respectively.Female patients had greater D1[(30.7±5.5)mm vs.(28.7±4.2)mm,P=0.010]and D1/D2[(2.4±0.7)vs.(2.1±0.5),P=0.001]than male patients.Compared with adults,the adolescents had smaller D1[(29.8±4.7)mm vs.(25.7±5.4)mm,P=0.006].After precise intraoperative positioning using this positioning method,158 patients were successfully punctured,152(96.20％)had excellent intraoperative neural response,2(1.27％)had good response,and 4(2.53％)had average response.Conclusion The surface projection of sacral nerve was approximately at the middle-inner 1/3 of the inferior margin of articulatio sacroiliaca to sacral midline.Through measuring distance from inferior margin of articulatio sacroiliacato sacral midline via X-ray,sacral nerve situation could be performed in surface,which might be a secure way to accessorily situate electrode implantation site for sacral neuromodulation.

Abstract Prevention and control of myopia requires comprehensive measures. Based on the system established earlier, the system is revised and upgraded. The original system emphasizes comprehensive measures and proposes to focus on both the symptoms and root causes. These measures are summarized into six aspects, three address the root cause measures including health education, glasses optics and visual environment, and three address symptoms measures including eye exercises, physical therapy and drugs. The paper is comprehensively supplemented and analyzes the primary and the secondary, and promotes physical therapy from treating the symptoms to treat both the symptoms and the root causes. These improvement measures will help promote the prevention and control of myopia in children and adolescents.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective: To analyze the characteristics of changes in serum cholesterol level in sepsis patients, and to explore its correlation with prognosis. Methods: A retrospective analysis was conducted. Two hundred and six patients with sepsis admitted in the Third People′s Hospital of Dalian from February 2015 to February 2019 were enrolled (observation group), and 206 patients without sepsis hospitalized in the same period were served as control group. The basic clinical data of the two groups were collected, and the results of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and biochemical parameters were compared. The patients with sepsis were divided into death group and survival group, and risk factors influencing the prognosis of patients with sepsis were analyzed with Logistic regression analysis. Results: Compared with control group, the levels of serum TC [(2.49 ± 1.14) mmol/L vs. (3.40 ± 1.26) mmol/L, t=6.240] and HDL-C [(1.66 ± 0.89) mmol/L vs. (2.49 ± 0.81) mmol/L, t=5.532] in observation group were significantly lower (P<0.05), and that of LDL-C showed no statistically significant difference [(1.96 ± 0.91) mmol/L vs. (2.10 ± 0.72) mmo/L, t=0.940, P>0.05]. In observation group, the patients in death group (85 cases) were older than those of the survival group (121 cases)[(75.6 ± 8.6) years vs. (62.5 ± 6.0) years, t=4.565], serum creatinine (SCr) was higher than that of survival group [(246.2 ± 34.6) μmol/L vs. (165.4 ± 35.6) μmol/L, t=5.420], and the levels of serum TC [(2.15 ± 0.59) mmol/L vs. (2.89 ± 1.02) mmol/L, t= 5.475], HDL-C [(1.40 ± 0.42) mmol/L vs. (1.94 ± 0.52) mmol/L, t=4.856] and LDL-C [(1.73 ± 0.56) mmol/L vs. (1.97 ± 0.72) mmol/L, t=4.261] were significantly lower than those of survival group (P<0.05). Logistic regression analysis showed that age was the risk factor of death in sepsis patients (OR=1.256, 95% CI 1.006 -1.056, P=0.012), and TC was the protective factor for the prognosis of sepsispatients (OR=-0.758, 95%CI 0.579-0.867, P=0.014). Conclusions The levels of TC, HDL-C in sepsis patients are significantly lowered, and the levels of TC, HDL-C, LDL-C in death group are significantly lower than those in survival group. TC may be used as a clinical indicator to assess the outcome of sepsis patients.

Objective:To investigate the relationship between neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte (LMR) ratio and prognosis in patients with advanced non-small cell lung cancer (NSCLC).Methods:Total 96 NSCLC patients with stage Ⅲ B and above confirmed by pathological examination in our hospital from March 2014 to 2016 were selected as the research objects. According to the 24-month follow-up results, the patients were divided into survival group (30 cases) and death group (66 cases). The NLR and LMR values of the two groups before chemotherapy were compared. The critical value of NLR and LMR in predicting the prognosis of patients was analyzed by drawing receiver operating curve (ROC); The clinicopathological characteristics of NSCLC patients with different levels of NLR and LMR were analyzed, and Cox proportional hazard regression model was used to analyze the effect of NLR and LMR on the prognosis of patients.Results:The NLR value of survival group was lower than that of death group ( P<0.05), and there was no significant difference between survival group and death group in LMR value ( P>0.05). The area under curve (AUC) value of NLR was 0.785, and the corresponding critical value was 3.19; the AUC value of LMR was 0.536, and the corresponding critical value was 3.66. There were significant difference in tumor node metastasis (TNM) stage and differentiation between NSCLC patients with different NLR values (NLR≥3.19 group and NLR<3.19 group) ( P<0.05), but there were no significant differences in age, gender, smoking, pathological type and lesion location ( P>0.05). There was no significant difference in TNM stage, differentiation degree, age, gender, smoking, pathological type and lesion location in NSCLC patients with different LMR values (LMR ≥ 3.66 group and LMR<3.66 group) ( P>0.05). The increase of TNM stage, differentiation degree and NRL were independent risk factors of poor prognosis in patients with advanced NSCLC ( P<0.05). Conclusions:Increased NLR values in peripheral blood of patients with advanced NSCLC may increase the risk of poor prognosis in patients.

Objective:To explore the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) on nocturnal blood pressure and angina pectoris in patients undergoing cardiac artery bypass graft (CABG) .Methods:From January to December 2018, we selected 76 patients with simple CABG at Beijing Anzhen Hospital affiliated to Capital Medical University by purposive sampling. Before surgery, patients were treated with the portable sleep respiratory monitoring and bedside blood pressure monitoring. Patients were divided into group of mild or no OSAHS ( n=35) and group of moderate or severe OSAHS ( n=41) based on apnea hypopnea index (AHI) . We compared the differences in the baseline data, sleep respiratory examination indexes, nocturnal angina pectoris, blood pressure at 21∶00, 3∶00 and 6∶00 among patients between two groups. Results:Among CABG patients with moderate or severe OSAHS, the systolic pressure at 3∶00 and 6∶00 was (115.8±12.5) mmHg and (156.8±17.5) mmHg respectively all higher than those among CABG patients with mild or no OSAHS with statistical differences ( P<0.05) ; the incidence of nocturnal angina pectoris was 29.27% (12/41) higher than that [2.86% (1/35) ]among CABG patients with mild or no OSAHS with a statistical difference ( P<0.05) . Logistic regression analysis showed that the systolic pressure at 3∶00 could affect the occurrence of nocturnal angina pectoris among CABG patients with OSAHS ( OR=1.050, 95% CI 1.003-1.100, P=0.039) ; the decrease of average oxygen saturation could also affect the occurrence of nocturnal angina pectoris among those patients ( OR=0.628, 95% CI 0.397-0.993, P=0.046) ; the differences were all statistical. Conclusions:Early morning systolic pressure of CABG patients with OSAHS raises, and OSAHS may increase the incidence of nocturnal angina pectoris among CABG patients.

Objective: To investigate the antimicrobial resistance and molecular epidemiology of foodborne Yersinia (Y.) enterocolitica in Pudong New District of Shanghai. Methods: Four kinds of raw food samples were collected in retail circulation sites in Pudong from 2012 to 2016. Cold enrichment method was used to isolate Y. enterocolitica and further detection of biotype, serotype, virulent genes, antimicrobial susceptibility of the isolates and pulsed field gel electrophoresis (PFGE) were conducted. Results: A total of 3 900 raw food samples were collected during this period, including poultry product (n=590), livestock product (n=1 074), aquatic product (n=1 488), vegetable (n=748), in which 111 (2.8%) were contaminated by Y. enterocolitica. The detection rates of Y. enterocolitica in poultry product samples (5.3%, 31/590) and livestock product samples (4.5%, 48/1 074) were higher than those in aquatic product samples (1.6%, 24/1 488) and vegetable samples (1.1%, 8/748). The predominant biotype was 1A (95.5%) and predominant serotype was O∶8 (42.3%). All the strains lacked ail, ystA, yadA and virF genes, which encoded pathogenic Y. enterocolitica. Seventy six (68.5%) strains harbored ystB gene, in which 35 (31.5%) belonged to 1A/O∶8/ystB pattern. Most strains were resistant to ampicillin (74.8%) and amoxicillin/clavulanic acid (70.3%), and non-sensitive rate to Cefoxitin was over 50.0%. No third generation cephalosporin or fluoroquinolone resistant strains were detected, but 38.7% (43/111) strains were multidrug resistant (MDR). Serotype O∶8 and O∶5 strains had 44 and 18 PFGE patterns, respectively. Conclusions The main foodborne exposure sources of Y. enterocolitica in raw food were poultry and livestock products in Pudong New District. 1A/O∶8/ystB was the predominant pattern with potential pathogenicity despite lacks of typical pathogenic virulent genes. The antimicrobial resistant rates of Y. enterocolitica were at a low level, but MDR strains still existed. Molecular types of the isolates showed highly genetic diversity.

Objective To investigate the relationship between brachial- ankle pulse wave velocity (baPWV) and heart rate variability (HRV), cardiac function in patients with essential hypertension.Methods One hundred and eighty patients with essential hypertensive from January 2014 to August 2016 were collected.The patients were divided into elevated group(baPWV≥1 400 cm/s,100 cases) and normal group (baPWV < 1 400 cm/s, 80 cases) according to the baPWV value. The general data, heart function and HRV of the 2 groups were compared. Results The standard deviation of all normal-to-normal(SDNN),standard deviation of all 5-min mean NN intervals(SDANN)and proportion of number of pairs of adjacent normal-to-normal intervals by more than 50 ms(PNN50%)in elevated group were significantly lower than those in normal group: (116.3 ± 17.0) ms vs. (135.8 ± 19.4) ms, (96.0 ± 21.4) ms vs. (120.0 ± 25.1) ms and (9.3 ± 3.1)% vs. (12.0 ± 4.1)%,and there were statistical differences (P<0.01); there was no statistical difference in root mean square of successive differences (RMSSD)between 2 groups(P>0.05);the left ventricular ejection fraction(LVEF)in elevated group was significantly lower than that in normal group:(57.2 ± 7.0)% vs.(63.0 ± 8.2)%,and there was statistical difference (P<0.01); there were no statistical differences in left ventricular end-diastolic dimension (LVDd) and left ventricular end systolic dimension (LVSd) between 2 groups (P>0.05); the interventricular septal thickness (IVST) in elevated group was significantly higher than that in normal group:(11.4 ± 2.5)mm vs.(9.5 ± 1.4)mm,and there was statistical difference(P<0.01).In patients with essential hypertension,there was a significant negative correlation between baPWV and SDNN,SDANN, PNN50%,LVEF(P<0.01),and there was a significant positive correlation between baPWV and IVST (P<0.05).Conclusions The baPWV measured in patients with essential hypertension can effectively reflect the HRV and cardiac function of the patients.