Objective To explore the grading of acute gastrointestinal injury(AGI)events in patients with different severities of acute ischemic stroke(AIS)and correlation of short-term prognosis.Methods AIS patients admitted from the Advanced Stroke Center of the Eighth Clinical Medical College of Guangzhou University of Chinese Medicine from January 2023 to November 2023 were retrospectively selected,and depending on the degree of nerve function defect(NIHSS)scores.AIS patients were divided into two groups:NIHSS ≤ 14 group and NIHSS＞14 group.The National Institute of Health Stroke Scale(NIHSS)score,general baseline data,clinical test indicators,AGI event classification and short-term prognosis were collected at admission.Results A total of 270 patients were included,with an average age of(64.95±13.65)years,70.0％males and 30.0％females.The proportion of AIS patients with AGI incident accounted for 66.30％.AIS patients after AGI incidents,90 days after the onset of the modified Rankin rating scale(mRS)score＞2 points of 83 people,accounting for 30.7％;The poor clinical outcomes of 270 AIS patients with different AGI event grades were significantly different(P＜0.05),among which AGI grade 0 and AGI grade Ⅰ were significantly different from AGI grade Ⅲ and AGI grade Ⅳ,respectively.The incidence of poor prognosis of AGI grade Ⅲ and AGI grade Ⅳ is significantly higher than that of AGI grade 0 and AGI grade Ⅰ.In AIS patients with NIHSS＞14 group,there were significant differences in the adverse clinical outcomes between AGI grade 0,AGI grade Ⅰ and AGI grade Ⅲ(P＜0.05),and the incidence of poor prognosis of AGI grade Ⅲ was significantly higher than that of AGI grade 0 and AGI grade Ⅰ.Multivariate Logistic regression analysis showed that NIHSS score was an independent risk factor for AGI events in AIS patients(P＜0.05).The higher the NIHSS score,the higher the risk of AGI events in AIS patients.And age,NIHSS score,systolic blood pressure is 90 days after AGI events affect AIS patients independent risk factors of poor prognosis(P＜0.05),the higher the age,the greater the NIHSS score,the higher systolic blood pressure of patients with AIS 90 days after AGI events are at higher risk of poor prognosis.Conclusion AGI event grading in patients with AIS of different severity is associated with short-term prognosis.

Objective To explore the grading of acute gastrointestinal injury(AGI)events in patients with different severities of acute ischemic stroke(AIS)and correlation of short-term prognosis.Methods AIS patients admitted from the Advanced Stroke Center of the Eighth Clinical Medical College of Guangzhou University of Chinese Medicine from January 2023 to November 2023 were retrospectively selected,and depending on the degree of nerve function defect(NIHSS)scores.AIS patients were divided into two groups:NIHSS ≤ 14 group and NIHSS＞14 group.The National Institute of Health Stroke Scale(NIHSS)score,general baseline data,clinical test indicators,AGI event classification and short-term prognosis were collected at admission.Results A total of 270 patients were included,with an average age of(64.95±13.65)years,70.0％males and 30.0％females.The proportion of AIS patients with AGI incident accounted for 66.30％.AIS patients after AGI incidents,90 days after the onset of the modified Rankin rating scale(mRS)score＞2 points of 83 people,accounting for 30.7％;The poor clinical outcomes of 270 AIS patients with different AGI event grades were significantly different(P＜0.05),among which AGI grade 0 and AGI grade Ⅰ were significantly different from AGI grade Ⅲ and AGI grade Ⅳ,respectively.The incidence of poor prognosis of AGI grade Ⅲ and AGI grade Ⅳ is significantly higher than that of AGI grade 0 and AGI grade Ⅰ.In AIS patients with NIHSS＞14 group,there were significant differences in the adverse clinical outcomes between AGI grade 0,AGI grade Ⅰ and AGI grade Ⅲ(P＜0.05),and the incidence of poor prognosis of AGI grade Ⅲ was significantly higher than that of AGI grade 0 and AGI grade Ⅰ.Multivariate Logistic regression analysis showed that NIHSS score was an independent risk factor for AGI events in AIS patients(P＜0.05).The higher the NIHSS score,the higher the risk of AGI events in AIS patients.And age,NIHSS score,systolic blood pressure is 90 days after AGI events affect AIS patients independent risk factors of poor prognosis(P＜0.05),the higher the age,the greater the NIHSS score,the higher systolic blood pressure of patients with AIS 90 days after AGI events are at higher risk of poor prognosis.Conclusion AGI event grading in patients with AIS of different severity is associated with short-term prognosis.

Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes.Methods From March 2011 to December 2013,21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed.The patients included 9 males and 12 females,with a mean age of 47.1± 15.6 years old (range,15-71 years old).This series included 12 cases of primary bone tumors and 9 cases of solitary metastases.Preoperative evaluation according to clinical,imaging and pathologic features was performed meticulously to select patients.The length of surgery,estimated blood loss,surgical margins,instrumentation failure,perioperative complications,Frankel scale,visual analogue scale (VAS) for pain,local control rate and overall survival were reviewed and analyzed.Results Total en bloc spondylectomy was performed successfully in all patients.Average operative time and estimated blood loss were 297.6±44.6 min (range,225-420 min) and 2 247.1±904.5 ml (range,900-4100 ml),respectively.The mean follow-up time was 50.4± 17.1 mons (range,24-79 mons).All patients encountered nerve roots stretch and 5 patients (23.8％) showed lower extremeties neurological dysfunction.All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow -up.Cerebrospinal fluid leak was found in 4 patients (19.0％).The VAS score was 1.5±1.4 at post-operation,which was significantly lower than the 6.2± 1.6 in average at operation (P=0.008).Three patients with metastatic tumors died during the follow-up.Titanium mesh cage subsidence was observed in 7 patients (33.3％).No implant failure was occurred during the follow-up.Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible.However,there are many intraoperative neurological complications and the indications for TES are extremely limited.

Objective To evaluate the mechanical stability of alternative reconstruction methods after total en bloc spon?dylectomy in the lower lumbar spine. Methods Eight adult fresh cadaveric lumbosacral spines (L1-S1) were adopted. Total en bloc spondylecotmy of the L4 vertebra was performed after intact testing. Four designed reconstruction samples were tested for the range of motion (ROM) of the spine:1) expandable artificial vertebral body and short posterior instrumentation at L3-L5 (SP), 2) ex?pandable artificial vertebral body and short posterior instrumentation with additional anterolateral fixation at L 3-L5 (ASP), 3) ex?pandable artificial vertebral body and multilevel posterior instrumentation at L2-S1 (MP), 4) expandable artificial vertebral body and multilevel posterior instrumentation with additional anterolateral fixation at L2-S1 (AMP). Nondestructive biomechanical test?ing was performed on each construct under loading control. The ROM for each construct was obtained by applying pure moments in flexion, extension, lateral bending, and axial rotation. Results In flexion, extension and lateral bending, the ROM of all the re?constructed constructs significantly decreased compared to the intact. The ROM of specimens with anterolateral fixation was less when compared to the ones without additional fixation. In lateral bending, MP (L:1.87° ± 0.32° , R:1.97° ± 0.33° ), ASP (L:1.89° ± 0.37°, R:2.08°±0.36°) and AMP (L:1.32°±0.29°, R:1.61°±0.33°) provided significantly less ROM than the SP (L:3.14°±0.35°, R:3.44°±0.34°). In axial rotation, the ROM of ASP (L:4.21°±0.58°, R:4.02°±0.59°) and AMP (L:3.56°±0.55°, R:3.52°±0.48°) was significant decreased when compared to the intact state (L: 7.47° ± 1.00° , R:7.57° ± 0.84° ). MP (L:6.33° ± 0.71° , R:5.88° ± 0.62°), ASP and AMP showed significantly less ROM than the short posterior fixation (L:9.28°±1.01°, R:9.48°±0.98°). AMP sig?nificantly decreased the ROM compared to MP. Conclusion After total en bloc spondylectomy of lower lumbar, long segmental fixation provided more stability to the construct than the short one. Compared to posterior fixation, circumferential fixations showed a higher stability. In contrast, multilevel segmental instrumentation with circumferential fixation did not provided more stability than the short constructs.