OBJECTIVE To analyze the influencing factors for achieving target plasma drug concentration （trough） （abbreviated as “PDC”） of vancomycin in patients from high-altitude regions and establish a predictive model for PDC using single- center data， providing references for rational clinical drug use. METHODS Inpatients with vancomycin （1 g， q12 h） administered intravenously in our hospital from January 2021 to June 2024 were retrospectively included. Demographic data， liver and kidney function and hematological indexes were collected. Spearman correlation analysis was used to evaluate the correlation between vancomycin PDC and each detection index. Univariate analysis was used to evaluate the differences of each index in patients with different PDC， and the effects of different gender， body mass index， age and underlying diseases （hypertension/diabetes） on vancomycin PDC. Based on the results of correlation analysis and univariate analysis， multiple linear stepwise regression analysis was used to obtain the independent predictors of vancomycin PDC and construct the prediction model. RESULTS A total of 141 patients were included， with an overall attainment rate of 46.81% for the target PDC of vancomycin. Correlation analysis showed that the vancomycin PDC was positively correlated with age， blood urea nitrogen， uric acid （UA）， serum creatinine （CRE） and β2- microglobulin （β2-MG）， and negatively correlated with height， weight， creatinine clearance rate （CCR）， glomerular filtration rate （GFR）， alanine transaminase （ALT）， hemoglobin （HGB）， white blood cell count and neutrophils （P＜0.05）. There were significant differences in age， CRE and other 14 indexes among different PDC groups （P＜0.05 or P＜0.01）. Age and underlying diseases had significant effects on vancomycin PDC （P＜0.05 or P＜0.01）. CCR， direct bilirubin （DBil）， β2-MG， UA， HGB and height （standardized coefficients were －0.371， 0.367， 0.169， 0.232， －0.140， －0.132； P＜0.05） were independent predictors of vancomycin PDC. The F value of the regression equation was 34.858 （P＜0.05）， the R2 was 0.610， and the adjusted R2 was 0.592. CONCLUSIONS The vancomycin PDC of patients in high-altitude regions is affected by multiple factors such as renal function， liver function and hematological indexes. CCR， HGB and height could be used to predict vancomycin PDC negatively， while DBil， β2-MG and UA could be used to predict vancomycin PDC positively. The variables of the established prediction model could explain 59.2% of the variation of vancomycin PDC.

ObjectiveTo investigate the therapeutic effect and mechanism of modified Chunzetang on bladder fibrosis and detrusor function in rats with neurogenic bladder urinary retention induced by spinal cord injury. MethodsIn this study， an improved Hassan Shaker spinal cord transection method was used to establish a model of neurogenic bladder urinary retention induced by spinal cord injury， and rats with a spinal cord injury behavior score of 0 were selected for follow-up experiments. The selected rats were randomly divided into a model group （normal saline gavage）， low-dose traditional Chinese medicine （TCM） group （gavage of 14.4 g·kg^-1 modified Chunzetang）， high-dose TCM group （gavage of 28.8 g·kg^-1 modified Chunzetang）， positive drug group ［intraperitoneal injection of 0.05 g·kg^-1 nuclear transcription factor-κB （NF-κB） inhibitor pyrrolidine dithiocarbamate （PDTC）］， and combination group （intraperitoneal injection of 0.05 g·kg^-1 PDTC + gavage of 28.8 g·kg^-1 modified Chunzetang）. The rats in these groups were administrated with corresponding drugs once a day for four weeks. The BL-420s biofunction acquisition system was used in the experiment to calculate the urodynamic indexes， and the isolated bladder was quickly weighed. The detrusor traction experiment was used to record the minimum bladder contraction tension and frequency in each group. The pathological morphology and tissue fibrosis of detrusor in each group observed by Hematoxycin-eosin （HE） staining and Masson staining were compared. The expression level of α-smooth muscle actin （α-SMA） was detected by immunohistochemistry. Western blot was used to detect the protein expression of NF-κB p65， nuclear transcription factor-κB suppressor protein α （IκBα）， transforming growth factor-β₁ （TGF-β₁）， type Ⅰ collagen （ColⅠ）， and type Ⅲ collagen （ColⅢ） in bladder tissue of rats in each group. Enzyme-linked immunosorbent assay （ELISA） was used to detect the changes in serum levels of IL-6， IL-1β， and TNF-α. ResultsCompared with that in the sham operation group， the pressure at the urinary leakage point in the model group decreased （P<0.01）， and the bladder mass， bladder contractile tension， maximum bladder capacity， and bladder compliance increased （P<0.05，P<0.01）. HE staining showed that the arrangement of bladder epithelial cells was disordered， and the pathological manifestations such as mucosa and myometria neutrophil infiltration were obvious. The lamina propria structure was destroyed， and the muscle fiber arrangement was disordered. The interstitial widening and tissue edema were obvious. Masson staining showed that the bladder wall of the model group had more collagen fiber deposition， and the degree of detrusor fibrosis was more severe. The content of detrusor in the visual field was reduced. At the same time， the protein expressions of NF-κB p65， TGF-β₁， IκBα， ColⅠ， and ColⅢ in bladder tissue of rats in the model group were significantly increased （P<0.01）， and the serum levels of IL-6， IL-1β， and TNF-α were significantly increased （P<0.05）. Compared with that in the model group， the pressure at the urinary leakage point in the modified Chunzetang and positive drug groups was increased （P<0.05）， and the wet bladder weight， minimum bladder contractile tension， maximum bladder capacity， and bladder compliance were restored （P<0.05， P<0.01）. HE and Masson showed that the bladder epithelial cells were relatively neatly arranged， and the structure of the bladder lamina propria was relatively stable. The detrusor bundles were arranged in an orderly manner， and the interstitium was narrow. The degree of tissue edema was relatively low， and the degree of bladder detrusor fibrosis in the modified Chunzetang and positive drug groups was reduced， while the degree of bladder detrusor fibrosis in the positive drug group and combination groups was not obvious. The results of Western blot showed that the expression of NF-κB p65， IκBα， TGF-β₁， ColⅠ， and ColⅢ in bladder tissue， as well as the serum levels of IL-6， IL-1β， and TNF-α in modified Chunzetang and positive drug groups were significantly lower， and the expression of bladder tissue-related proteins and the serum levels of IL-6， IL-1β， and TNF-α in the TCM groups decreased significantly with the increase in dose （P<0.05）. The results of immunohistochemistry suggested that modified Chunzetang could fully affect the expression of α-SMA in bladder tissue. ConclusionModified Chunzetang can inhibit collagen deposition in bladder tissue of rats with urinary retention induced by spinal cord injury， delay the occurrence and development of bladder fibrosis， and protect the normal contractile function of bladder detrusor， and its mechanism may be related to inhibiting the NF-κB/TGF-β₁ signaling pathway， reducing the production of NF-κB p65， IκBα， TGF-β₁， ColⅠ， ColⅢ， and other related proteins， and protecting the muscle strength of detrusor.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Meropenem （MEM） is one of the important drugs for the treatment of severe infections， but the standard dose is often difficult to achieve an effective therapeutic concentration target. This article reviews the related studies on the population pharmacokinetics of MEM in patients with severe infection. It is found that the apparent volume of distribution （Vd） and clearance rate are the most important factors affecting the dose adjustment， and the factors affecting Vd include serum albumin， age， overall weight， shock status， and chest/abdomen/cerebrospinal fluid drainage. The main factors affecting the clearance rate were renal function， renal replacement therapy treatment mode and combination therapy. For adult patients with severe infections in China， MEM is recommended to be administered in an individualized manner based on glomerular filtration rate， with a dosage range of 500 to 1 500 mg given every 4 to 6 hours， and prolonged infusion is preferred. When the minimum inhibitory concentration （MIC） of the pathogenic bacteria reaches 64 mg/L， therapeutic drug monitoring is required. For therapeutic efficacy， it is essential to ensure that the trough concentration remains above the MIC； to prevent drug resistance， it should be maintained above 4×MIC. Regarding safety， it is recommended that the upper limit of the trough concentration be 32 mg/L， and blood sampling for monitoring can be conducted as early as after 1 to 2 doses of administration.

Objective To investigate the effects of Xiaoyukang capsule on neuroinflammation and neuronal apoptosis after Intracerebral hemorrhage(ICH)in rats by regulating JNK/c-JUN signaling pathway.Methods Adult male SD rats were intrastriatally injected with bacterial collagenase Ⅶ to induce an ICH model and they were randomly divided into blank control group,model control group,Xiaoyukang capsule small dose group,medium dose group,and large dose group.Neurobehavioral tests,body mass measurements,hematoma volume statistics,hematoxylin-eosin(HE)staining,immunofluorescence,deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining,enzyme-linked immunosorbent assay(ELISA)and Western Blotting were performed after 3 and 5 days,respectively.Results Compared with the blank control group,the rats in the model control group had severe neurobehavioral defects and weight loss(P＜0.05).The arrangement of neurons in brain tissue was disordered,and there was microglia/macrophages activation,neutrophil infiltration,neuronal apoptosis(P＜0.05).The levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3 and Cleaved Caspase-3 protein around hematoma were significantly increased(P＜0.05),while the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were decreased(P＜0.05).Compared with the model control group,Xiaoyukang capsule large dose group significantly improved the neurobehavioral function of rats,promoted weight recovery and hematoma absorption(P＜0.05).Reduce the pathological injury of brain tissue,inhibition of microglia/macrophages activation,neutrophil infiltration and neuronal apoptosis(P＜0.05).In addition,the levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3,Cleaved Caspase-3 protein around hematoma were significantly decreased(P＜0.05),and the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were increased(P＜0.05).Conclusion Xiaoyukang capsule can improve neurobehavioral defects in ICH rats,promote body mass recovery and hematoma absorption,reduce pathological damage of brain tissue,inhibit microglia/macrophage activation and neutrophil infiltration,its mechanism may be achieved by inhibiting JNK/c-JUN-mediated neuroinflammation and neuronal apoptosis.

Objective To construct a predictive model for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke and evaluate its predictive efficacy.Methods Patients with acute stroke caused by anterior circulation large vessel occlusion who underwent endovascular treatment with successful vascular recanalization(modified thrombolysis in cerebral infarction[mTICI]grade 2b or 3)admitted to the Department of Neurosurgery of Tianjin Union Medical Center(the First Affiliated Hospital of Nankai University)from January 2022 to January 2025 were retrospectively and consecutively included.Patients were divided into effective recanalization group(modified Rankin scale[mRS]score≤2)and futile recanalization group(mRS score＞2)according to the mRS score at 90 days after endovascular treatment.Baseline and clinical data were collected,including sex,age,medical history(stroke history,hypertension,diabetes mellitus,atrial fibrillation),personal history(smoking history,alcohol consumption history),and National Institutes of Health stroke scale(NIHSS)score,blood pressure,blood glucose,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,creatinine,neutrophil-to-lymphocyte ratio,fibrinogen,D-dimer,lymphocyte-to-monocyte ratio,white blood cell count,hemoglobin,albumin,C-reactive protein-to-albumin ratio,platelet-to-lymphocyte ratio at admission.Imaging data including culprit vessel(middle cerebral artery,anterior cerebral artery,internal carotid artery),Alberta stroke program early CT score(ASPECTS),infarct core volume,hypoperfusion area volume,mismatch volume between infarct core and hypoperfusion area,American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)collateral circulation grading,trial of Org 10172 in acute stroke treatment(TOAST)classification.Surgery-related data including onset-to-puncture time,successful puncture-to-vascular recanalization time,immediate postoperative mTICI grade,complications within 24 hours postoperatively(fever,hemorrhagic transformation,symptomatic intracranial hemorrhage),immediate postoperative mTICI grade.Factors with P＜0.05 and without multicollinearity(variance inflation factor≥5)in univariate analysis were included in multivariate Logistic regression model analysis to analyze independent influencing factors for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke.A nomogram prediction model was constructed based on statistically significant factors in multivariate Logistic regression analysis,and Hosmer-Lemeshow test was used to assess the goodness of fit of the model.The receiver operating characteristic(ROC)curve of the nomogram prediction model for predicting futile recanalization after endovascular treatment in patients with anterior circulation large vessel occlusion stroke was drawn,and calibration curve was used to evaluate the calibration of the nomogram prediction model.Results A total of 187 patients who met the criteria of this study were included,comprising 101 males and 86 females,aged 42-85 years,with a mean age of(70±6)years.The mRS scores at 90days after treatment were:0points in 21 cases(11.23%),1 point in 37 cases(19.79%),2 points in 28 cases(14.97%),3 points in 46 cases(24.60%),4 points in 31 cases(16.58%),5 points in 24 cases(12.83%),and 6 points in 0case.There were 86cases in the effective recanalization group and 101 cases in the futile recanalization group.(1)Statistically significant differences between the two groups were observed in age,atrial fibrillation,infarct core volume,admission NIHSS score,neutrophil-to-lymphocyte ratio,lymphocyte-to-monocyte ratio,and C-reactive protein-to-albumin ratio(all P＜0.05).(2)Multicollinearity analysis showed that the variance inflation factors of all independent variables with statistically significant differences in univariate analysis were all＜5,indicating no multicollinearity.Multivariate Logistic regression analysis showed that age(OR,1.101,95%CI 1.046-1.158,P=0.037),infarct core volume(OR,1.350,95%CI 1.202-1.517,P＜0.01),admission NIHSS score(OR,1.501,95%CI 1.213-1.858,P＜0.01),lymphocyte-to-monocyte ratio(OR,0.039,95%CI 0.009-0.179,P＜0.01),and C-reactive protein-to-albumin ratio(OR,6.015,95%CI 1.625-22.257,P=0.007)were independent influencing factors for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke.(3)The receiver operating characteristic curve of the nomogram prediction model for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke was constructed based on statistically significant factors in multivariate analysis showed a specificity of 0.970,sensitivity of 0.895,precision of 0.916,recall of 0.970,and area under the curve of 0.979(95%CI0.962-0.996,P＜0.01).The absolute mean error of the calibration curve was 0.008,with predicted values close to actual values.Hosmer-Lemeshow test results showed that the model had good consistency without overfitting(χ2=4.830,P=0.776).Conclusions Age,infarct core volume,admission NIHSS score,lymphocyte-to-monocyte ratio,and C-reactive protein-to-albumin ratio are all independent influencing factors for futile recanalization after endovascular treatment in acute anterior circulation large vessel occlusion stroke.The nomogram prediction model constructed accordingly can predict the risk of futile recanalization after endovascular treatment in patients with anterior circulation large vessel occlusion stroke.

Objective To construct a predictive model for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke and evaluate its predictive efficacy.Methods Patients with acute stroke caused by anterior circulation large vessel occlusion who underwent endovascular treatment with successful vascular recanalization(modified thrombolysis in cerebral infarction[mTICI]grade 2b or 3)admitted to the Department of Neurosurgery of Tianjin Union Medical Center(the First Affiliated Hospital of Nankai University)from January 2022 to January 2025 were retrospectively and consecutively included.Patients were divided into effective recanalization group(modified Rankin scale[mRS]score≤2)and futile recanalization group(mRS score＞2)according to the mRS score at 90 days after endovascular treatment.Baseline and clinical data were collected,including sex,age,medical history(stroke history,hypertension,diabetes mellitus,atrial fibrillation),personal history(smoking history,alcohol consumption history),and National Institutes of Health stroke scale(NIHSS)score,blood pressure,blood glucose,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,creatinine,neutrophil-to-lymphocyte ratio,fibrinogen,D-dimer,lymphocyte-to-monocyte ratio,white blood cell count,hemoglobin,albumin,C-reactive protein-to-albumin ratio,platelet-to-lymphocyte ratio at admission.Imaging data including culprit vessel(middle cerebral artery,anterior cerebral artery,internal carotid artery),Alberta stroke program early CT score(ASPECTS),infarct core volume,hypoperfusion area volume,mismatch volume between infarct core and hypoperfusion area,American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)collateral circulation grading,trial of Org 10172 in acute stroke treatment(TOAST)classification.Surgery-related data including onset-to-puncture time,successful puncture-to-vascular recanalization time,immediate postoperative mTICI grade,complications within 24 hours postoperatively(fever,hemorrhagic transformation,symptomatic intracranial hemorrhage),immediate postoperative mTICI grade.Factors with P＜0.05 and without multicollinearity(variance inflation factor≥5)in univariate analysis were included in multivariate Logistic regression model analysis to analyze independent influencing factors for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke.A nomogram prediction model was constructed based on statistically significant factors in multivariate Logistic regression analysis,and Hosmer-Lemeshow test was used to assess the goodness of fit of the model.The receiver operating characteristic(ROC)curve of the nomogram prediction model for predicting futile recanalization after endovascular treatment in patients with anterior circulation large vessel occlusion stroke was drawn,and calibration curve was used to evaluate the calibration of the nomogram prediction model.Results A total of 187 patients who met the criteria of this study were included,comprising 101 males and 86 females,aged 42-85 years,with a mean age of(70±6)years.The mRS scores at 90days after treatment were:0points in 21 cases(11.23%),1 point in 37 cases(19.79%),2 points in 28 cases(14.97%),3 points in 46 cases(24.60%),4 points in 31 cases(16.58%),5 points in 24 cases(12.83%),and 6 points in 0case.There were 86cases in the effective recanalization group and 101 cases in the futile recanalization group.(1)Statistically significant differences between the two groups were observed in age,atrial fibrillation,infarct core volume,admission NIHSS score,neutrophil-to-lymphocyte ratio,lymphocyte-to-monocyte ratio,and C-reactive protein-to-albumin ratio(all P＜0.05).(2)Multicollinearity analysis showed that the variance inflation factors of all independent variables with statistically significant differences in univariate analysis were all＜5,indicating no multicollinearity.Multivariate Logistic regression analysis showed that age(OR,1.101,95%CI 1.046-1.158,P=0.037),infarct core volume(OR,1.350,95%CI 1.202-1.517,P＜0.01),admission NIHSS score(OR,1.501,95%CI 1.213-1.858,P＜0.01),lymphocyte-to-monocyte ratio(OR,0.039,95%CI 0.009-0.179,P＜0.01),and C-reactive protein-to-albumin ratio(OR,6.015,95%CI 1.625-22.257,P=0.007)were independent influencing factors for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke.(3)The receiver operating characteristic curve of the nomogram prediction model for futile recanalization after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke was constructed based on statistically significant factors in multivariate analysis showed a specificity of 0.970,sensitivity of 0.895,precision of 0.916,recall of 0.970,and area under the curve of 0.979(95%CI0.962-0.996,P＜0.01).The absolute mean error of the calibration curve was 0.008,with predicted values close to actual values.Hosmer-Lemeshow test results showed that the model had good consistency without overfitting(χ2=4.830,P=0.776).Conclusions Age,infarct core volume,admission NIHSS score,lymphocyte-to-monocyte ratio,and C-reactive protein-to-albumin ratio are all independent influencing factors for futile recanalization after endovascular treatment in acute anterior circulation large vessel occlusion stroke.The nomogram prediction model constructed accordingly can predict the risk of futile recanalization after endovascular treatment in patients with anterior circulation large vessel occlusion stroke.

Objective To investigate the effects of Xiaoyukang capsule on neuroinflammation and neuronal apoptosis after Intracerebral hemorrhage(ICH)in rats by regulating JNK/c-JUN signaling pathway.Methods Adult male SD rats were intrastriatally injected with bacterial collagenase Ⅶ to induce an ICH model and they were randomly divided into blank control group,model control group,Xiaoyukang capsule small dose group,medium dose group,and large dose group.Neurobehavioral tests,body mass measurements,hematoma volume statistics,hematoxylin-eosin(HE)staining,immunofluorescence,deoxynucleotidyl transferase dUTP nick end labeling(TUNEL)staining,enzyme-linked immunosorbent assay(ELISA)and Western Blotting were performed after 3 and 5 days,respectively.Results Compared with the blank control group,the rats in the model control group had severe neurobehavioral defects and weight loss(P＜0.05).The arrangement of neurons in brain tissue was disordered,and there was microglia/macrophages activation,neutrophil infiltration,neuronal apoptosis(P＜0.05).The levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3 and Cleaved Caspase-3 protein around hematoma were significantly increased(P＜0.05),while the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were decreased(P＜0.05).Compared with the model control group,Xiaoyukang capsule large dose group significantly improved the neurobehavioral function of rats,promoted weight recovery and hematoma absorption(P＜0.05).Reduce the pathological injury of brain tissue,inhibition of microglia/macrophages activation,neutrophil infiltration and neuronal apoptosis(P＜0.05).In addition,the levels of pro-inflammatory factors TNF-α,IL-1β and the expression of p-JNK,p-c-JUN,Bax,Caspase-3,Cleaved Caspase-3 protein around hematoma were significantly decreased(P＜0.05),and the anti-inflammatory factor IL-10 and anti-apoptotic protein Bcl-2 were increased(P＜0.05).Conclusion Xiaoyukang capsule can improve neurobehavioral defects in ICH rats,promote body mass recovery and hematoma absorption,reduce pathological damage of brain tissue,inhibit microglia/macrophage activation and neutrophil infiltration,its mechanism may be achieved by inhibiting JNK/c-JUN-mediated neuroinflammation and neuronal apoptosis.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.