Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Adhering to the guidance of party building is an essential requirement for comprehensively promoting the high-quality development of public hospitals.How to solve the problem of"two skins"of party building and business,further promote the deep integration of the party and business has become an important topic for the party building of public hospitals in the new era.Taking Jieyang People's Hospital as an example,this paper introduces the innovation and exploration experience on the par-ty building work round in the hospital,the working mechanism of which is"1+5+5+4"of"Party building leading,five re-sponsibility coordination,five-step linkage and four-type integration".This approach effectively promotes the deep integration and promotion of the party and business,which further lead the high-quality development of various work in the hospital.It can pro-vide reference for exploring and improving the system and mechanism of the integration of party and business,and further promote party leadership in promoting high-quality development in public hospitals.

Adhering to the guidance of party building is an essential requirement for comprehensively promoting the high-quality development of public hospitals.How to solve the problem of"two skins"of party building and business,further promote the deep integration of the party and business has become an important topic for the party building of public hospitals in the new era.Taking Jieyang People's Hospital as an example,this paper introduces the innovation and exploration experience on the par-ty building work round in the hospital,the working mechanism of which is"1+5+5+4"of"Party building leading,five re-sponsibility coordination,five-step linkage and four-type integration".This approach effectively promotes the deep integration and promotion of the party and business,which further lead the high-quality development of various work in the hospital.It can pro-vide reference for exploring and improving the system and mechanism of the integration of party and business,and further promote party leadership in promoting high-quality development in public hospitals.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To investigate the clinical significance and serum changes of asprosin(ASP)levels in patients with essential hypertension and early renal damage.Methods According to urinary albumin/creatinine ratio(UACR),160 patients with essential hypertension were divided into the simple hypertension group(78 cases)and the early renal damage group(82 cases).Another 60 healthy subjects were selected as the control group.The differences of serum ASP,interleukin-6(IL-6)and UACR levels were compared between groups.The correlation between ASP and blood pressure,IL-6 and UACR was analyzed.Logistic regression analysis was used to analyze the factors influencing early renal damage in essential hypertension.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of each index for early renal injury.Results The serum levels of ASP,IL-6 and UACR were higher in the early renal damage group than those in the control group and the simple hypertension group(all P＜0.05).The serum levels of ASP and IL-6 showed an increasing trend with the increase of blood pressure.ASP was positively correlated with systolic blood pressure(SBP),diastolic blood pressure(DBP)and IL-6 levels in patients with essential hypertension(all P＜0.05).Serum ASP was positively correlated with SBP,UACR and IL-6 levels in essential hypertension patients(P＜0.05),and serum ASP was positively correlated with UACR and IL-6 levels in the early renal damage group(P＜0.05).Logistic regression analysis showed that higher levels of SBP,ASP and IL-6 were independent risk factors for early renal damage.ROC curve showed that ASP had the largest area under the curve(AUC)of 0.972(95%CI:0.950-0.993).The AUC of combined detection of ASP+IL-6+SBP was 0.986(95%CI:0.972-0.999).Conclusion The increased serum ASP level in patients with early renal damage in essential hypertension is a good predictor of early renal damage.The combined detection of ASP+IL-6+SBP is better than single detection.

Objective:To detective the cut-off values of amino acid levels in premature infants in Sichuan.Methods:Data of newborns screening for inherited metabolic diseases (IMD) by tandem mass spectrometry in Sichuan Province from January 2018 to December 2019 were retrospectively analyzed.They were divided into premature infant group ( n=2 264, 1 312 males and 952 females) and full-term infant group ( n=53 275, 28 269 males and 25 006 females). The cut-off values of amino acids in dry blood spots were expressed as percentage ( P0.5 - P99.5), and rank sum test was used for comparison between preterm and full-term infants. Results:(1) The distribution of 11 amino acids [alanine (ALA), arginine (ARG), citrulline (CIT), glycine(GLY), leucine (LEU), methionine (MET), ornithine (ORN), phenylalanine (PHE), proline (PRO), tyrosine (TYR) and valine (VAL)] in premature infants were abnormal.(2) The cut-off values of amino acids in premature infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.34-47.04 μmol/L, CIT: 5.66-32.02 μmol/L, GLY: 181.48-909.93 μmol/L, LEU : 71.10-283.29 μmol/L, MET: 4.21-34.51 μmol/L, ORN: 40.58-293.76 μmol/L, PHE: 23.60-106.30 μmol/L, PRO: 77.76-358.24 μmol/L, TYR: 27.52-352.91 μmol/L, VAL: 53.74-228.37 μmol/L.(3) The cut-off values of amino acid in full-term infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.30-42.73 μmol/L, CIT: 5.92-30.35 μmol/L, GLY: 208.17-980.09 μmol/L, LEU: 72.91-287.49 μmol/L, MET: 4.27-33.90 μmol/L, ORN: 48.40-305.59 μmol/L, PHE: 27.63-92.27 μmol/L, PRO: 97.38-372.75 μmol/L, TYR: 40.19-276.54 μmol/L, VAL: 65.75-237.92 μmol/L.(4) Except for PHE ( Z=-0.58, P>0.05), the other indicators were significantly different between 2 groups [ALA ( Z=-15.32, P<0.05), ARG ( Z=-5.62, P<0.05), CIT ( Z=-5.86, P<0.05), GLY ( Z=-14.52, P<0.05), LEU ( Z=-5.62, P<0.05), MET ( Z=-5.22, P<0.05), ORN ( Z=-13.01, P<0.05), PRO ( Z=-22.09, P<0.05), TRY ( Z=-2.09, P<0.05), VAL ( Z=-17.82, P<0.05)]. Conclusions:The establishment of the cut-off values of amino acids in premature infants in Sichuan provides a theoretical basis for laboratory diagnosis of IMD screening, which enhances the accuracy of diagnosis and avoids excessive medical treatment.

Objective:To evaluate the performance, efficacy and safety of a novel portable endoscopy system for upper gastrointestinal examination.Methods:A multicentered, open-label, randomized, non-inferiority controlled study was conducted in 3 clinical research centers from June 2019 to June 2020, and a total of 90 outpatients admitted to Department of Gastroenterology were randomly assigned to the trial group ( n=44) undergoing portable endoscopy and the control group ( n=46) undergoing Olympus endoscopy. The examination success rate, image quality, performance, overall operation satisfaction rate, biopsy success rate and adverse events of the two groups were compared. Results:The examination success rates of the trial group and the control group were 97.73% (43/44) and 100.00% (46/46) respectively with a difference of -2.27% (95% CI: -6.68%-2.13%), higher than the set non-inferiority margin of -10%. Rates of good and excellent image quality were 100% in both groups, and the difference of 0 was higher than the set non-inferiority margin of -10%. There was no significant difference in the rate of good and excellent performance of the operating system between the two groups [97.67% (42/43) VS 100.00% (46/46), P=0.483]. There was significant difference in the overall satisfactory rate of the operation between the two groups [86.05% (37/43) VS 100.00% (46/46), P=0.011]. A total of 9 cases underwent endoscopic biopsy, including 5 cases in the trial group and 4 cases in the control group. The biopsy channels in both groups were smooth and the biopsy were successfully completed. There was no significant difference in adverse event rate between the two groups [25.00% (11/44) VS 10.87%(5/46), χ2=3.07, P=0.080]. All adverse events disappeared in 48 hours, and no severe adverse events or device defect events occurred. Conclusion:The novel portable endoscopic system is comparable to Olympus endoscopic system in terms of the operating performance, the image quality and safety. Therefore, this system is safe and effective for upper gastrointestinal examination.

Objective:To summarize and discuss the concept and clinical manifestations of complex fracture-dislocations of the elbow in children, and compare its injury characteristics, treatment and clinical effect with adults.Methods:From September 2015 to January 2020, 34 patients seen and treated at our institution for complex fracture-dislocations of the elbow were identified, and their medical records and radiographs were reviewed retrospectively. The inclusion criteria were elbow dislocation combined with one or more fractures at the proximal ulna and radius. There were 25 boys and 9 girls, with an average age of 8.3±3.2 years. The left arm was involved in 27 cases, and the right arm was involved in 7 cases. The causes of injury included falling from a scooter in 16 cases, falling from height in 10 cases, cycling in 5 cases and traffic accident in 3 cases. All patients were treated with closed reduction and the application of plaster under local anaesthesia in the emergency room. Then, X-ray, CT and MRI were performed to evaluate the fracture-dislocation and ligament injury. The following treatment plan was comprehensively evaluated according to the size and displacement of the combined fracture block and the stability of the elbow, for example, open reduction with K-wires and tension band or plate fixation for olecranon fracture, open reduction with loop plate fixation for coronal process fracture, closed reduction or open reduction with K-wires or elasticstable intramedullary nail for radial neck fracture.Results:Among the 34 patients, there were 16 cases of transolecranon fracture-dislocation, 1 case of varus posteromedial rotational instability, 4 cases of valgus posterolateral rotatory instability and 13 cases of divergent dislocation of elbow. All patients were followed up for 13(8, 15) months, and the average fracture healing time was 3.5±0.8 weeks, with no failure of internal fixation. In 2 cases of elbow dislocation combined radial neck fracture, one case had ischemic necrosis of the radial head and one case had early closure of epiphyseal plate of the proximal radius. At the last follow-up, all patients had no subluxation, dislocation or instability of the elbow. The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score (MEPS) as excellent in 25 cases, good in 5 cases, fair in 3 cases, and poor in one case, with excellent and good rate 88%.Conclusion:The complex fracture-dislocations of the elbow is rare in children. We have the opinion that the clinical characteristics are dislocation combined with one or more fractures of the proximal ulna and radius. Compared with adults, its pathological characteristics and the scope of injury are similar, but most of the injuries are mild. The clinical manifestations are mainly transolecranon fracture-dislocation and divergent dislocation of elbow. Good results can be achieved in most cases through open reduction with internal fixation for fractures.

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children.Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine from April 2015 to December 2016.They were 14 boys and 7 girls,aged from 5 to 12 years (average,8.6 years).Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm.Of them,2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A),11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B),and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C).The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system.Results All the 21 children were followed up from 9 to 23 months (average,16 months).The fracture union time ranged from 8 to 10 weeks (average,9 weeks) for groups A and B and from 11 to 13 weeks (average,12 weeks) for group C.By the Dhillon scores at final follow-ups,the therapeutic efficacy was evaluated as excellent in one and as good in one in group A,as excellent in 8 cases,as good in 2 cases and as fair in one in group B,and as excellent in 6 cases,as good in one and as fair in one in group C.No early closure of epiphysis,osteonecrosis or fishtail deformity was found in either group A or group B;one case of partial limitation of elbow flexion or extension,one case of fishtail deformity and one case of femoral head necrosis were observed in group C.No infection or skin necrosis was found in any of the 3 groups.Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable,it can make up for the insufficiency of X-rays in judging integrity of the articular surface.In combination with closed reduction,percutaneous puncture or open reduction and internal fixation,intraoperative arthrography can contribute to an increased rate of successful surgery,and reduced complications due to redisplacement.

Objectives To detect the expression of serum high mobility group box-1 (HMGB1) and explore its changes in rats with acute necrotizing pancreatitis (ANP).Methods Intraperitoneal injection of 20％ L-arginine in the dosage of 250 mg/100 g twice every 1 hour was used to establish ANP rat model.Intraperitoneal injection of normal saline solution in equal volume was performed in control rats.Rats were sacrificed at 6 h,18 h,24 h,36 h,48 h,72 h and 96 h after injection.Blood samples were collected to detect serum amylase and HMGB1 level.Pancreatic tissue was collected for pathological examination.Realtime PCR was applied to detect the mRNA expression of HMGB1 in pancreatic tissue.Werstem blot was used to determine HMGB1 protein expression in pancreatic tissue.Results Serum amylase level began to increase at 6 h after modeling,reached the peak at 18 h [(5 070 ± 603) U/L] and returned to normal level after 48 h.Serum amylase activity at 6 h and 18 h in ANP group was much higher than that in control group (1 844 ± 181)U/L(P＜0.05).The expression of HMGB1 began to increase at 6 h,reached to the peak at 36 h [(288.5 ±42.1)μg/L],and then decreased gradually.HMGB1 expressions at each time point in ANP group were significantly higher than those in control group (31.6 ± 10.1) μg/L],and the differences were statistically significant (all P ＜ 0.05).Pathological scores in pancreatic tissues in ANP group were higher than those in control group 0.38 ± 0.52,and the differences were statistically significant (P ＜ 0.05).HMGB1 mRNA expressions at t 6 h,18 h,24 h,36 h,48 h,72 h and 96 h in ANP group were 1.23 ±0.25,2.60 ± 0.46,3.23 ± 0.34,4.77 ± 0.66,2.88 ± 0.56,2.05 ± 0.20,1.33 ± 0.28,which were significantly higher than those in control group 0.44 ± 0.09,and the relative expression of HMGB1 in ANP group at 36 h was significantly higher than those at other time points (all P ＜ 0.05).HMGB1 protein expression in pancreatic tissue in ANP group at 6 h,18 h,36 h,72 h were 1.14 ±0.02,1.15 ±0.01,1.22 ±0.01,1.22 ±0.04,which obviously higher than those in control group(1.0),and HMGB1 expression in ANP group at 36 h was higher than those at other time points (all P ＜ 0.05).Conclusions HMGB1 may participate in systematic inflammation as one of the late inflammatory mediators during ANP.