ObjectiveAge-related macular degeneration （AMD） is one of the leading causes of low vision and blindness in people over 50 years old， and dry AMD （dAMD） is one type for which there is currently no clear treatment. On the basis of the diagnosis and clinical characteristics of dAMD in traditional Chinese and Western medicine， this paper evaluated the fitting degrees of existing animal models of dAMD with clinical characteristics according to the evaluation methods of animal models， and put forward suggestions and prospects. MethodsLiterature on animal models of dAMD was searched against database， and the characteristics of the models were assigned according to the diagnosis criteria of diseases and syndromes of traditional Chinese and Western medicine， and the fitting degrees of the models with clinical characteristics were analyzed and evaluated. ResultsAt present， the animal models of dAMD are mainly established targeting complement factors， chemokines， oxidative damage， lipid/glucose metabolism， and natural strains. Most of the models can simulate the major pathological changes of dAMD， showing the fitting degree of 25%-50% with clinical characteristics in Western medicine. However， the evaluation of traditional Chinese medicine （TCM） syndromes， especially the evaluation of secondary syndromes， is missing， and the models present low fitting degrees with the clinical characteristics in TCM. ConclusionExisting animal models of dAMD are mostly established under the guidance of Western diagnostic standards， which reproduce the main disease characteristics of Western medicine and lack observation of TCM syndromes. Future studies can pay attention to the intervention factors and evaluation systems of spleen deficiency Qi deficiency and liver-kidney Yin deficiency syndrome and build the animal model of dAMD with integration of disease and syndrome based on clinical characteristics of traditional Chinese and Western medicine.

ObjectiveAge-related macular degeneration （AMD） is one of the leading causes of low vision and blindness in people over 50 years old， and dry AMD （dAMD） is one type for which there is currently no clear treatment. On the basis of the diagnosis and clinical characteristics of dAMD in traditional Chinese and Western medicine， this paper evaluated the fitting degrees of existing animal models of dAMD with clinical characteristics according to the evaluation methods of animal models， and put forward suggestions and prospects. MethodsLiterature on animal models of dAMD was searched against database， and the characteristics of the models were assigned according to the diagnosis criteria of diseases and syndromes of traditional Chinese and Western medicine， and the fitting degrees of the models with clinical characteristics were analyzed and evaluated. ResultsAt present， the animal models of dAMD are mainly established targeting complement factors， chemokines， oxidative damage， lipid/glucose metabolism， and natural strains. Most of the models can simulate the major pathological changes of dAMD， showing the fitting degree of 25%-50% with clinical characteristics in Western medicine. However， the evaluation of traditional Chinese medicine （TCM） syndromes， especially the evaluation of secondary syndromes， is missing， and the models present low fitting degrees with the clinical characteristics in TCM. ConclusionExisting animal models of dAMD are mostly established under the guidance of Western diagnostic standards， which reproduce the main disease characteristics of Western medicine and lack observation of TCM syndromes. Future studies can pay attention to the intervention factors and evaluation systems of spleen deficiency Qi deficiency and liver-kidney Yin deficiency syndrome and build the animal model of dAMD with integration of disease and syndrome based on clinical characteristics of traditional Chinese and Western medicine.

OBJECTIVE To formulate an expert consensus on the prevention and control of respiratory infectious diseases in railway stations and trains in China,and to standardize the prevention and control of respiratory infec-tious diseases in railway stations and trains scientifically.METHODS The government authorities organized multi-ple prevention and control experts from transportation,medical care and prevention fields to conduct in-depth re-search through methods such as meetings and on-site investigations,and combined with their practical experi-ence in this field to formulate this expert consensus.RESULTS In-depth studies were conducted on the prevention and control strategies,measures and emergency response system construction of respiratory infectious diseases in railway stations and trains,and this expert consensus was formed.CONCLUSION This expert consensus supple-ments improves the existing prevention and control system for respiratory infectious diseases in railway stations and trains,and provides an important reference basis for the prevention and control of respiratory infectious disea-ses in railway stations and trains.

Objective To explore the factors influencing blood drug concentrations of first-line anti-tuberculosis drugs in fixed-dose combinations by analyzing therapeutic drug monitoring data from tuberculosis patients receiving these regimens.Methods This retrospective study enrolled 224 patients who received treatment at Guangzhou Chest Hospital between January 2020 and December 2024.All participants underwent standardized therapy during the intensive phase,with therapeutic drug monitoring of first-line anti-tuberculosis drugs(ANTDs),including isoniazid(INH)and rifampicin(RFP).Data collection was completed in January 2025,at which time clinical records and measured INH and RFP plasma concentrations were updated.Data analysis was conducted from January to February 2025.Eight baseline variables—gender,age,hypoproteinemia(serum albumin<35 g/L),glomerular filtration rate(GFR),and others—were collected.Univariate chi-square tests and multivariate logistic regression analyses were performed to identify independent risk factors associated with subtherapeutic INH and RFP plasma concentrations.Results Among the study participants,71.43%(160/224)exhibited blood drug concentrations below the reference range for INH,compared to 41.07%(92/224)for RFP.The mean blood concentrations(mg/L,±SD)were 2.532±1.371 for INH and 9.428±4.317 for RFP,respectively.One-way analysis indicated significant associations between male gender,positive etiological test results,and subtherapeutic RFP concentrations(P<0.05),suggesting statistically significant differences.Multivariate regression analysis further revealed that male gender(OR=1.992,95%CI:1.094～3.628)and positive etiological tests(OR=1.929,95%CI:1.058～3.517)were independent risk factors for low RFP levels.Conclusions This study demonstrates that therapeutic drug monitoring(TDM)frequently identifies subtherapeutic RFP concentrations in tuberculosis patients undergoing treatment.Multivariate analysis reveals that male sex and positive pathogen test results are independent risk factors associated with low RFP plasma levels.Consequently,clinicians should exercise heightened vigilance in patients exhibiting these characteristics,promptly implementing TDM to guide individualized dose adjustments.Such an approach is crucial for optimizing treatment efficacy and minimizing the risk of drug resistance development.

Objective To investigate the clinical application of ceftazidime/avibactam(CAZ/AVI)in lung trans-plant recipients with pulmonary infection caused by carbapenem-resistant Gram-negative bacilli(CRGNB),and ana-lyze the factors affecting the prognosis.Methods Lung transplant recipients who had CRGNB pulmonary infection and were treated with CAZ/AVI were included in the analysis.Based on 14-day clinical response,14-day microbial response,and 30-day survival status,the recipients were divided into a clinical response group and a clinical failure group,a microbial response group and a microbial failure group,as well as a survival group and a death group,re-spectively.Univariate analysis was conducted on various data from the two groups.Factors affecting therapeutic ef-ficacy and survival were included in a binary logistic regression model.Independent risk factors for CAZ/AVI anti-infective efficacy and all-cause mortality outcomes were analyzed.Results A total of 43 recipients were included.After 14-day anti-infective treatment,32 recipients(74.42％)achieved clinical response,and 30 recipients(69.77％)achieved microbial response.34 recipients(79.07％)survived 30 days after CAZ/AVI treatment.The Charlson comorbidity index(CCI),proportion of renal dysfunction,and incidence of shock in recipients in the clini-cal response group were all lower than those in the clinical failure group(P＜0.05),while the serum albumin(ALB)level was higher(P＜0.05).The incidence of shock in recipients in the microbial response group was lower than that in the microbial failure group(P＜0.05).CCI,proportion of renal dysfunction,and incidence of shock in recipients in the survival group were all lower than those in the death group(all P＜0.05),while ALB level was higher during treatment period(P＜0.05).Multivariate analysis of 14-day clinical response and 30-day survival showed that higher CCI was an independent risk factor affecting 14-day clinical response of recipients(OR=2.22,95％CI:1.07-4.63),while lower ALB levels(OR=0.72,95％CI:0.54-0.98)and higher CCI(OR=5.27,95％CI:1.18-23.58)were independent risk factors for 30-day all-cause mortality in recipients with pulmonary in-fection after lung transplant.Conclusion CAZ/AVI may be an effective drug for treating pulmonary infection caused by CRGNB in lung transplant recipients.Higher CCI is an independent risk factor for 14-day clinical failure in recipients after CAZ/AVI treatment.Lower ALB level and higher CCI are independent risk factors for increased 30-day mortality in recipients.

Objective:To evaluate any effect of transcranial direct current stimulation (tDCS) on cognitive impairment after an ischemic stroke (IS) using tract-based spatial statistics (TBSS).Methods:Fifty-one patients with mild or more serious cognitive impairment after an IS were divided into an electrical stimulation group (26 cases) and a control group (25 cases) using a random number table. In addition to conventional rehabilitation treatment, the electrical stimulation group was given tDCS, while the control group was given sham tDCS for 15 days. Before and after the treatment, both groups were evaluated using the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Diffusion tensor imaging (DTI) was also performed. TBSS were computed for the differences in fractional anisotropy (FA) between the two groups before and after the treatment, and Pearson correlation analysis was applied to the pre-treatment and post-treatment FA differences within each group and the improvements in MMSE and MoCA scores.Results:After the treatment, the average MMSE and MoCA scores of both groups had improved significantly, but the improvement was significantly greater in the electrical stimulation group. After the treatment, the FA values among the electrical stimulation group had increased significantly in the bilateral genu of the corpus callosum, the bilateral inferior fronto-occipital fasciculus, the bilateral anterior thalamic radiation and the left superior longitudinal fasciculus. In the control group significant increases were recorded only in the left superior longitudinal fasciculus and the left anterior thalamic radiation. The FA change in the left superior longitudinal fasciculus of the electrical stimulation group was then positively correlated with the improvement in MMSE scores ( r=0.42), and that in the left anterior thalamic radiation was positively correlated with the improvement in MoCA scores ( r=0.45). Conclusions:tDCS can significantly improve the cognition of stroke survivors with cognitive impairment and promote the recovery of white matter fiber tracts. The FA values of the anterior thalamic radiation and the superior longitudinal fasciculus may be useful predictors and indicators of the recovery of cognitive function among such patients.

OBJECTIVE: To compare the efficacy of percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar fractures. METHODS: A retrospective case-control study was used to analyze the clinical data of 78 patients with osteoporotic thoracic and lumbar fractures admitted from October 2017 to May 2019. According to the surgical method, it was divided into percutaneous pedicle screw combined with unilateral nail placement combined with unilateral bone cement strengthening group(bone cement group) and percutaneous pedicle screw combined with bilateral nail placement(screw group). In the bone cement group, 40 patients included 16 males and 24 females, with a mean age of (62.1±8.1) years old. In the screw group, 38 patients included 18 males and 20 females with a mean age of (65.1±9.3) years old. The operation time, intraoperative blood loss, length of hospital stay and postoperative complications were compared between two groups. The kyphosis Cobb angle, anterior edge height ratio, central height ratio and pain visual analogue score(VAS) were compared. RESULTS: All patients were followed up for 25 to 36 months. The operation time (70.1±17.3) min of the cement group was shorter than that of the screw group (78.6±18.2) min(P<0.05). There were no significant differences in intraoperative blood loss and length of hospital stay(P>0.05). The VAS in the cement group 1 year 1.5±0.5 and the latest follow-up 0.5±0.3 after operation were lower than 1 year 1.8±0.3 and the latest follow-up 0.8±0.4 in the screw group(P<0.05). The kyphosis Cobb angle, anterior edge height ratio, central height ratio in bone cement group, 1 year (6.2±1.2)°, (86.6±3.5)%, (91.1±2.5)%, the last follow-up (6.4±0.7)°, (85.5±3.3)%, (90.5±6.3)% were better than that of the screw group 1 year (6.8±1.4)°, (83.1±2.4)%, (89.9±3.4)% and the latest follow-up (7.1±1.1)°, (82.6±4.1)%, (87.6±5.9)%(P<0.05). There were 3 cases of bone cement leakage in the cement group, all of which had no clinical symptoms;and 2 cases of pedicle screws were extracted in the screw group, and the screws were removed at the last follow-up. CONCLUSION Percutaneous pedicle screw combined with unilateral nail placement combined with bone cement strengthening and bilateral nail placement in the treatment of osteoporotic thoracic and lumbar compression fractures in the elderly can achieve satisfactory efficacy and effectively relieve the pain of patients, but the former internal fixation system is more stable, and the long-term follow-up can effectively maintain the height of the anterior middle column and the correction of kyphosis deformity, and the incidence of chronic low back pain is lower.
Humans ; Male ; Female ; Aged ; Bone Cements ; Middle Aged ; Thoracic Vertebrae/surgery* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Osteoporotic Fractures/surgery* ; Case-Control Studies ; Bone Nails ; Pedicle Screws

OBJECTIVE: To explore early clinical efficacy and advantages of Huoxue Fang's directional dialysis combined with extracorporeal shock wave in treating rotator cuff injury. METHODS: A retrospective analysis was performed for 42 patients with rotator cuff injury admitted from September 2020 to December 2022, and they were divided into shock wave group and directed dialysis group according to different treatment methods. There were 20 patients in shock wave group, including 12 males and 8 females; aged from 47 to 68 years old with an average of (63.2±3.3) years old;the course of disease ranged from 2 to 6 weeks with an average of (3.1±1.4) weeks;10 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;non-steroidal drugs and extracorporeal shock wave therapy were performed. There were 22 patients in directed dialysis group, including 16 males and 6 females;aged from 44 to 67 years old with an average of (61.0±2.3) years old;the course of disease ranged from 2 to 8 weeks with average of (3.3±1.3) weeks;12 patients with gradeⅠand 10 patients with gradeⅡaccording to Ellman classification;with Huoxue prescription directed transdrug therapy based on shock wave group. Visual analogue scale (VAS), University of California at Los Angeles (UCLA) and range of motion (ROM) were compared between two groups before treatment, 1 and 6 months after treatment;changes of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) between two groups were detected and compared. The complications between two groups were compared. RESULTS: All patients were followed up, shockwave group followed up for 6 to 8 months with an average of (7.1±1.9) months, 6 to 8 months with an average of (7.2±1.8) months in directed dialysis group, with no statistical significance between two groups (P>0.05). At 1 and 6 months after treatment, VAS in directed dialysis group were (3.85±0.99), (1.24±0.75), which were lower than that in shock wave group (4.91±0.89), (1.81±0.84) (P<0.05). UCLA scores in directed dialysis group (25.25±2.34), (32.71±2.33) were higher than those in shock wave group (21.67±3.38) °, (29.11±3.01) °(P<0.05). Forward bending (139.15±20.39) °, (150.14±20.55) °, external rotation (63.46±16.62) °, (73.35±13.82) °, internal rotation (46.99±2.93) °, (58.24±2.10) ° in directed dialysis group were better than those in shock wave group (130.61±22.27) °, (141.28±19.47) °, external rotation (57.36±17.53) °, (68.12±13.64) °, internal rotation (41.21±3.10) °, (49.16±3.21) ° (P<0.05). At 1 and 6 months after treatment, TNF-α, IL-1 and IL-6 in directed dialysis group were (2.12±0.49), (2.06±0.55), (0.69±0.26) μg·L-1;(1.27±0.25), (1.14±0.23), (0.37±0.11) μg·L-1, which were lower than those in shock wave group (2.87±0. 51), (2.67±0.48), (0.92±0.21) μg·L-1, (1.88 ± 0.26), (1.36±0.27), (0.45±0.09) μg·L-1(P<0.05). At the latest follow-up, 8 patients got excellent result, 10 good and 2 poor in shock wave group;10 patients excellent, 10 good, and 2 poor in directed dialysis group;there was no significant difference between two groups (P>0.05). There were no complications such as skin allergy, subcutaneous hemorrhage, ecchymosis, vascular and nerve injury occurred in both groups. CONCLUSION For the treatment of rotator cuff injury, Huoxue prescription combined with extracorporeal shock wave is effective, which could not only release the local adhesion tissue, improve local blood circulation, accelerate absorption of inflammatory exudate of the local soft tissue, and promote recovery of the diseased muscle bond and ligament. It could also effectively relieve shoulder pain, improve shoulder motion, restore shoulder function, improve patients' quality of life.
Humans ; Male ; Female ; Middle Aged ; Aged ; Extracorporeal Shockwave Therapy ; Retrospective Studies ; Rotator Cuff Injuries/physiopathology* ; Adult ; Drugs, Chinese Herbal/administration & dosage* ; Combined Modality Therapy ; Interleukin-6/metabolism*

OBJECTIVE: To investigate the early clinical efficacy of single-position O-arm navigation-assisted oblique lateral interbody fusion(OLIF) combined with minimally invasive percutaneous pedicle screw fixation(PPS) in the treatment of lumbar spondylolisthesis. METHODS: A retrospective analysis was conducted on 22 patients with lumbar spondylolisthesis who underwent OLIF-PPS surgery including 11 males and 11 females with a mean age of (64.6±1.5) years old ranging from 49 to 80 years old between April 2021 and June 2023. All patients presented with lumbosacral pain, lower limb radiating pain, numbness, and had poor responses to conservative treatment. Surgical time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Clinical outcomes were evaluated using the visual analogue scale(VAS) and Oswestry disability index(ODI) preoperatively at 3 days after operation and the final follow-up. Standing lumbar anteroposterior and lateral X-rays were performed to measure disc height(DH), slippage degree, vertebral reduction rate, pedicle screw accuracy, and cage subsidence. RESULTS: All surgeries were successfully completed with a mean follow-up of (27.1±2.2) months (range 18 to 36 months). The mean surgical time was (76.1±12.2) min (range 60 to 93 min), intraoperative blood loss was (86.3±32.2) ml (range 40 to 113 ml), and hospital stay was (7.1±1.2) days. Postoperative VAS significantly improved from (7.2±0.7) preoperatively to (2.3±0.5) at 3 days after operation and (1.7±0.2) at the final follow-up (P<0.05). ODI decreased from (68.5±7.2)% preoperatively to (30.3±3.1)% at 3 days after operation and (16.6±1.6)% at the final follow-up (P<0.05). DH increased from (8.5±1.7) mm preoperatively to (18.1±1.4) mm at 3 days after operation and (17.2±1.1) mm at the final follow-up (P<0.05). Slippage degree improved from (24.1±4.6)% preoperatively to (10.3±4.2)% at 3 days after operation and (10.1±3.2)% at the final follow-up (P<0.05). A total of 88 pedicle screws were implanted with an excellent rate of 98% (86/88). Complications included transient left hip flexion weakness (2 cases) and left anteromedial thigh pain (1 case), all resolved during follow-up. No incision hematoma, infection, screw loosening, or cage subsidence occurred. CONCLUSION Single-position O-arm navigation-assisted OLIF combined with PPS demonstrates satisfactory early clinical efficacy for lumbar spondylolisthesis, with advantages including minimal invasiveness, significant pain relief, effective vertebral reduction, and low complication rates.
Humans ; Male ; Female ; Spondylolisthesis/diagnostic imaging* ; Middle Aged ; Aged ; Spinal Fusion/methods* ; Lumbar Vertebrae/diagnostic imaging* ; Minimally Invasive Surgical Procedures/methods* ; Pedicle Screws ; Aged, 80 and over ; Retrospective Studies

OBJECTIVE: To explore the efficacy and safety of human epidermal growth factor gel in the treatment of pin tract infections after surgery in patients with severe spinal deformity. METHODS: A retrospective case-control study was conducted to analyze the clinical data of 26 patients with pin tract infections after skull-pelvic ring traction for severe spinal deformity admitted from February 2019 to May 2022. Among them, 11 were male and 15 were female;the age ranged from 18 to 31 years, with an average of (24.1±4.3) years;the Cobb angle ranged 80.3° to 120.7°, with an average of (88.6±10.2)°;there were 52 iliac traction pins, 104 pin tract openings, and 38 pin tract infections. According to the Checketts-Otterbum classification, there were 11 infections of gradeⅠ, 13 infections of gradeⅡ, 10 infections of grade Ⅲ, and 4 infections of grade Ⅳ. The patients were divided into the conventional dressing change group (13 cases) and the growth factor group (13 cases) by coin flipping. Clinical efficacy was evaluated by recording the visual analogue scale(VAS) score during dressing change, duration of dressing change, cost of dressing change, positive rate of bacterial culture, wound improvement rate, and wound improvement time. RESULTS: There were no statistically significant differences in VAS or duration of dressing change between the two groups (P>0.05). The cost of dressing change was (800.0±59.5) yuan in the conventional dressing change group and (1 179.5±80.9) yuan in the growth factor group, with a statistically significant difference (P<0.05). There was no statistically significant difference in the positive rate of bacterial culture between the two groups (P>0.05). In the conventional dressing change group, within 20 pin tract infections, 2 infections achieved wound healing, 7 infections showed improvement, and 11 infections were ineffective;in the growth factor group, within 18 pin tract infections 5 infections achieved wound healing, 8 infections showed improvement, and 5 infections were ineffective, with a statistically significant difference between the two groups (P<0.05). The wound healing time was (22.8±4.9) days in the conventional dressing change group and (14.2±2.5) days in the growth factor group, with a statistically significant difference (P<0.05). No complications occurred in either group. CONCLUSION The application of human epidermal growth factor gel in the treatment of pin tract infections after skull-pelvic ring surgery in patients with severe spinal deformity is easy to operate, does not increase patient pain, and has significant efficacy. It shortens wound healing time, effectively promotes wound healing, and has good safety and high cost-effectiveness.
Humans ; Male ; Female ; Adult ; Adolescent ; Retrospective Studies ; Case-Control Studies ; Young Adult ; Epidermal Growth Factor/therapeutic use* ; Traction/adverse effects* ; Gels ; Bone Nails/adverse effects* ; Surgical Wound Infection/drug therapy*