Objectives:To investigate the relationship between the improvement of lumbar symptoms and imaging parameters in patients with tandem spinal stenosis(TSS)primarily manifesting as cervical spondylotic myelopathy(CSM)after initial cervical decompression surgery,and to explore related imaging predictive factors.Methods:A retrospective analysis was conducted on 69 TSS patients who underwent primary cervical decom-pression surgery,with an average age of 64.3±10.5 years(ranging from 41 to 86 years old)and a follow-up period of 33.8±5.5 months(ranging from 24 to 48 months).Preoperative symptoms and signs,Nurick gait clas-sification,and preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores for both the cer-vical and lumbar spine were recorded and analyzed.The patients were divided into an improvement group(n=37)and a non-improvement group(n=32)based on the improvement conditions of lumbar spine JOA scores at the final follow-up.Imaging parameters were measured including spinal cord compression ratio,cross-sectional area of the dural sac at the narrowest point of the cervical spinal cord,the ratio of the vertebral canal to the vertebral body and the actual spinal canal width from C3 to C7,and the actual width of the vertebral canal from L1 to L5.The conditions of spinal canal stenosis were evaluated according to the grading system of spinal canal stenosis of cervical and lumbar spine proposed by Lee et al,and the number of cervical verte-brae with a stenosis score ≥1,score at the narrowest part of cervical spinal canal,and the total score of cervical stenosis,as well as the number of lumbar vertebrae with a stenosis score ≥1,score at the narrowest part of lumbar spinal canal,and the total score of lumbar stenosis were calculated.Intergroup comparisons were performed using t tests,chi-square tests,and Mann-Whitney U tests.For the statistic data with statisti-cal differences between the two groups,receiver operating characteristic(ROC)curve was used to determine op-timal thresholds for each parameter,and the area under the ROC curve(AUC)and its corresponding 95％ con-fidence interval(CI)were calculated.Multivariate logistic regression analysis was conducted to identify radiolog-ical predictive factors for non-improvement of lumbar symptoms in TSS patients.Results:The non-improvement group was significantly higher than the improvement group in the total score of lumbar stenosis(5.00±1.68 vs 2.68±1.23,P＜0.001),the number of lumbar vertebrae with a stenosis score≥1(2.47±0.84 vs 1.86±0.95,P=0.004),and the prevalence of redundant nerve roots(14/18 vs 6/13,P=0.017).The AUC of the total lumbar stenosis score was 0.864(P＜0.001,95％CI 0.779-0.950),with an optimal threshold of 3.5(sensitivity:81.3％;specificity:75.7％).The AUC of the number of lumbar vertebrae with a stenosis score ≥1 was 0.691(P=0.007;95％CI 0.565-0.817),with an optimal threshold of 1.5(sensitivity:87.5％;specificity:56.8％).Multivariate logistic regression showed that the number of lumbar spinal stenosis＞1.5(OR=1.493;95％CI 0.392-5.686;P=0.557)and presence of redundant nerve roots(OR=2.815;95％CI 0.740-10.711;P=0.129)had no significant relationship with improvement of lumbar symptoms.The total lumbar stenosis score＞3.5 was significantly related with improvement of lumbar symptoms(OR=10.983;95％CI 3.261-36.994;P＜0.001),which was an independent risk factor for non-improvement in lumbar symtoms after initial cervical decompression in TSS patients.Conclusions:When the total score of lumbar spinal stenosis exceeds 3.5 in TSS patients,the possibility of improvement in lumbar symptoms after initial cervical decompression is small.

Objectives:To investigate the relationship between the improvement of lumbar symptoms and imaging parameters in patients with tandem spinal stenosis(TSS)primarily manifesting as cervical spondylotic myelopathy(CSM)after initial cervical decompression surgery,and to explore related imaging predictive factors.Methods:A retrospective analysis was conducted on 69 TSS patients who underwent primary cervical decom-pression surgery,with an average age of 64.3±10.5 years(ranging from 41 to 86 years old)and a follow-up period of 33.8±5.5 months(ranging from 24 to 48 months).Preoperative symptoms and signs,Nurick gait clas-sification,and preoperative and final follow-up Japanese Orthopaedic Association(JOA)scores for both the cer-vical and lumbar spine were recorded and analyzed.The patients were divided into an improvement group(n=37)and a non-improvement group(n=32)based on the improvement conditions of lumbar spine JOA scores at the final follow-up.Imaging parameters were measured including spinal cord compression ratio,cross-sectional area of the dural sac at the narrowest point of the cervical spinal cord,the ratio of the vertebral canal to the vertebral body and the actual spinal canal width from C3 to C7,and the actual width of the vertebral canal from L1 to L5.The conditions of spinal canal stenosis were evaluated according to the grading system of spinal canal stenosis of cervical and lumbar spine proposed by Lee et al,and the number of cervical verte-brae with a stenosis score ≥1,score at the narrowest part of cervical spinal canal,and the total score of cervical stenosis,as well as the number of lumbar vertebrae with a stenosis score ≥1,score at the narrowest part of lumbar spinal canal,and the total score of lumbar stenosis were calculated.Intergroup comparisons were performed using t tests,chi-square tests,and Mann-Whitney U tests.For the statistic data with statisti-cal differences between the two groups,receiver operating characteristic(ROC)curve was used to determine op-timal thresholds for each parameter,and the area under the ROC curve(AUC)and its corresponding 95％ con-fidence interval(CI)were calculated.Multivariate logistic regression analysis was conducted to identify radiolog-ical predictive factors for non-improvement of lumbar symptoms in TSS patients.Results:The non-improvement group was significantly higher than the improvement group in the total score of lumbar stenosis(5.00±1.68 vs 2.68±1.23,P＜0.001),the number of lumbar vertebrae with a stenosis score≥1(2.47±0.84 vs 1.86±0.95,P=0.004),and the prevalence of redundant nerve roots(14/18 vs 6/13,P=0.017).The AUC of the total lumbar stenosis score was 0.864(P＜0.001,95％CI 0.779-0.950),with an optimal threshold of 3.5(sensitivity:81.3％;specificity:75.7％).The AUC of the number of lumbar vertebrae with a stenosis score ≥1 was 0.691(P=0.007;95％CI 0.565-0.817),with an optimal threshold of 1.5(sensitivity:87.5％;specificity:56.8％).Multivariate logistic regression showed that the number of lumbar spinal stenosis＞1.5(OR=1.493;95％CI 0.392-5.686;P=0.557)and presence of redundant nerve roots(OR=2.815;95％CI 0.740-10.711;P=0.129)had no significant relationship with improvement of lumbar symptoms.The total lumbar stenosis score＞3.5 was significantly related with improvement of lumbar symptoms(OR=10.983;95％CI 3.261-36.994;P＜0.001),which was an independent risk factor for non-improvement in lumbar symtoms after initial cervical decompression in TSS patients.Conclusions:When the total score of lumbar spinal stenosis exceeds 3.5 in TSS patients,the possibility of improvement in lumbar symptoms after initial cervical decompression is small.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

OBJECTIVE To analyze the status of targeted monitoring of the health care-associated infections in in-tensive care unit(ICU)of a three-A hospital of northwest China in recent 7 years so as to provide bases for formu-lating effective prevention and control measures for the health care-associated infections.METHODS The related data were successively collected from the ICU hospitalized patients of the Second Affiliated Hospital of Air Force Medical University who were under the targeted monitoring by nosocomial infection real-time monitoring system from Jan.2017 to Dec.2023.The data included the incidence of infections,infection sites,use of catheters,inci-dence of catheter-related infections,and distribution and prevalence trend of pathogens.RESULTS A total of 49,137 hospitalized patients from five ICU wards of respiratory medicine department,neurosurgery department,neurology department,thoracic surgery department and critical care medicine department were under the monito-ring,1446(1681 case-times)of whom had health care-associated infections,with the infection rate 2.94％,the case-time infection rate 3.42％.The respiratory system was the major infection site of the patients with the health care-associated infections.Among the patients with instrument-associated infections,20.70％had ventilator-asso-ciated pneumonia(VAP),5.71％had urinary catheter-associated urinary tract infection(CAUTI),and 1.96％had catheter-related bloodstream infection(CRBSI).Totally 405 strains of non-repetitive pathogens were isolated from 477 patients with instruments-associated infections,78.77％of which were gram-negative bacteria.The iso-lation rate of multidrug-resistant organisms(MDROs)was 44.12％,and Acinetobacter baumannii was the pre-dominant species of pathogen isolated from the patients with VAP.CONCLUSIONS The targeted monitoring of health care-associated infections may facilitate the awareness of dynamic changes of the infections in a accurate and timely manner so as to provide bases for developing effective prevention and control measures for the health care-associated infection.It is necessary to strengthen the prevention and control of the infections in critical care medi-cine department,neurosurgery department as well as the lower respiratory tract infections and prevent the MDROs infection in the meantime.

Objectives:To evaluate the clinical values of cervical vertebral bone quality(CVBQ)score and cervical endplate bone quality(CEBQ)score in predicting the settlement of Zero Profile(Zero-P)cage after an-terior cervical discectomy and fusion(ACDF).Methods:A retrospective analysis was performed on 72 patients who underwent ACDF with Zero-P cage in the Second Affiliated Hospital of Soochow University.General pa-tient information(including sex,age,comorbidity),laboratory parameters(such as blood calcium and blood glu-cose),surgical details(surgical level and cage type),and imaging data(preoperative cervical MRI and anteropos-terior and lateral X-rays within one week and after more than three months)were collected.On the lateral X-rays taken within one week and＞3 months postoperatively,the heights of the upper and lower margins of vertebrae were measured,and the difference between was defined as the cage subsidence distance.Patients with a subsidence distance ≥ 2mm were assigned to the subsidence group,and those with＜2mm subsidence distance were divided to the non-subsidence group.On preoperative cervical sagittal T1-weighted MRI,plac-ing regions of interest(ROIs)in the medullary region of adjacent vertebral bodies,the subchondral bone region of the endplates,and the cerebrospinal fluid(CSF)in the cerebellomedullary cistern.CVBQ and CEBQ values were the ratios of the average signal intensity of the medullary region of the surgical adjacent vertebral bodies(for CVBQ)and the subchondral bone region of the endplates(for CEBQ)to the signal intensity of the cere-brospinal fluid in the cerebellomedullary cistern.A stratified analysis by gender was conducted to further clarify whether the predictive value of bone quality scores for subsidence is influenced by gender factors.The Pearson correlation coefficient was used to assess the relationship of CVBQ and CEBQ with cage subsidence distance.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic efficacy of CVBQ and CEBQ for cage subsidence.Univariate logistic regression analysis was performed to screen for po-tential risk factors,after that age and diabetes,which showed statistical significance,along with CVBQ and CEBQ,were incorporated into the multivariate analysis to assess their independent effects.Results:Cage sub-sidence occurred in 14 patients(subsidence rate:19.4％).Compared with the non-subsidence group,the subsi-dence group of patients was older(male:61.4±16.5 years vs 51.1±10.8 years,P=0.049;female:62.6±13.1 years vs 51.2±7.8 years,P=0.005)and had a higher proportion of patients with diabetes(male:42.9％vs 3.4％,P=0.018;female:42.9％vs 6.9％,P=0.040).Both CVBQ and CEBQ were significantly higher in the subsidence group(CVBQ-male:2.75±0.73 vs 2.02±0.53,P=0.004;female:2.84±0.69 vs 2.00±0.40,P=0.005;CEBQ-male:2.82±0.688 vs 2.05±0.56,P=0.004;female:2.94±0.68 vs 2.05±0.42,P=0.002).Pearson correlation analysis re-vealed a moderate positive correlation between both CVBQ(r=0.58,P＜0.001)and CEBQ(r=0.59,P＜0.001)with subsidence distance.ROC curve analysis indicated that both CVBQ(AUC=0.83)and CEBQ(AUC=0.85)had good predictive values for subsidence,with CEBQ showing slightly better predictive performance.Univariate logistic regression analysis identified age,diabetes,CEBQ,and CVBQ as risk factors for subsidence(P＜0.05).Multivariate analysis showed that after adjusting for age and diabetes,both CEBQ(OR=11.466,P=0.004)and CVBQ(OR=8.804,P=0.005)remained independent risk factors for subsidence,while age and diabetes lost in-dependent significance.The strength of association with subsidence was greater in CEBQ than in CVBQ.Conclusions:Patients with higher CVBQ and CEBQ scores are more likely to experience fusion cage subsi-dence,and both CEBQ and CVBQ can be used to predict cage subsidence in patients after single-level ACDF,CEBQ has better predictive ability than CVBQ.

Objective:To retrieve, evaluate and integrate the evidence related to postoperative exercise rehabilitation for hip fracture in elderly frail patients, and provide reference for clinical rehabilitation nursing.Methods:Evidence on postoperative exercise rehabilitation of hip fractures in elderly frail patients was systemically retrieved in the guideline websites, professional association websites and databases, such as BMJ Best Practice, UpToDate, PubMed, Web of Science, CINAHL, Cochrane Library, Embase, Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang and VIP, including Best practices, guidelines, clinical decisions, evidence summaries, systematic reviews, and expert consensus. The retrieval time was from the establishment of the database to March 31, 2024.Results:A total of 33 articles were involved, including 12 guidelines, 2 clinical decisions, 7 systematic reviews, 7 expert consensuses, 5 evidence summaries. Forty pieces of evidence were summarized in 7 aspects: the role of exercise, exercise assessment, exercise planning, exercise content, exercise intensity, exercise adherence, exercise nursing, exercise guidance.Conclusions:Healthcare professionals should combine patients' tolerance, rehabilitation goals, and specific clinical situations to target and guide patients in exercise rehabilitation to promote the recovery of postoperative limb function, mitigate frailty, and improve the quality of life.

OBJECTIVE To analyze the status of targeted monitoring of the health care-associated infections in in-tensive care unit(ICU)of a three-A hospital of northwest China in recent 7 years so as to provide bases for formu-lating effective prevention and control measures for the health care-associated infections.METHODS The related data were successively collected from the ICU hospitalized patients of the Second Affiliated Hospital of Air Force Medical University who were under the targeted monitoring by nosocomial infection real-time monitoring system from Jan.2017 to Dec.2023.The data included the incidence of infections,infection sites,use of catheters,inci-dence of catheter-related infections,and distribution and prevalence trend of pathogens.RESULTS A total of 49,137 hospitalized patients from five ICU wards of respiratory medicine department,neurosurgery department,neurology department,thoracic surgery department and critical care medicine department were under the monito-ring,1446(1681 case-times)of whom had health care-associated infections,with the infection rate 2.94％,the case-time infection rate 3.42％.The respiratory system was the major infection site of the patients with the health care-associated infections.Among the patients with instrument-associated infections,20.70％had ventilator-asso-ciated pneumonia(VAP),5.71％had urinary catheter-associated urinary tract infection(CAUTI),and 1.96％had catheter-related bloodstream infection(CRBSI).Totally 405 strains of non-repetitive pathogens were isolated from 477 patients with instruments-associated infections,78.77％of which were gram-negative bacteria.The iso-lation rate of multidrug-resistant organisms(MDROs)was 44.12％,and Acinetobacter baumannii was the pre-dominant species of pathogen isolated from the patients with VAP.CONCLUSIONS The targeted monitoring of health care-associated infections may facilitate the awareness of dynamic changes of the infections in a accurate and timely manner so as to provide bases for developing effective prevention and control measures for the health care-associated infection.It is necessary to strengthen the prevention and control of the infections in critical care medi-cine department,neurosurgery department as well as the lower respiratory tract infections and prevent the MDROs infection in the meantime.

Objectives:To evaluate the clinical values of cervical vertebral bone quality(CVBQ)score and cervical endplate bone quality(CEBQ)score in predicting the settlement of Zero Profile(Zero-P)cage after an-terior cervical discectomy and fusion(ACDF).Methods:A retrospective analysis was performed on 72 patients who underwent ACDF with Zero-P cage in the Second Affiliated Hospital of Soochow University.General pa-tient information(including sex,age,comorbidity),laboratory parameters(such as blood calcium and blood glu-cose),surgical details(surgical level and cage type),and imaging data(preoperative cervical MRI and anteropos-terior and lateral X-rays within one week and after more than three months)were collected.On the lateral X-rays taken within one week and＞3 months postoperatively,the heights of the upper and lower margins of vertebrae were measured,and the difference between was defined as the cage subsidence distance.Patients with a subsidence distance ≥ 2mm were assigned to the subsidence group,and those with＜2mm subsidence distance were divided to the non-subsidence group.On preoperative cervical sagittal T1-weighted MRI,plac-ing regions of interest(ROIs)in the medullary region of adjacent vertebral bodies,the subchondral bone region of the endplates,and the cerebrospinal fluid(CSF)in the cerebellomedullary cistern.CVBQ and CEBQ values were the ratios of the average signal intensity of the medullary region of the surgical adjacent vertebral bodies(for CVBQ)and the subchondral bone region of the endplates(for CEBQ)to the signal intensity of the cere-brospinal fluid in the cerebellomedullary cistern.A stratified analysis by gender was conducted to further clarify whether the predictive value of bone quality scores for subsidence is influenced by gender factors.The Pearson correlation coefficient was used to assess the relationship of CVBQ and CEBQ with cage subsidence distance.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic efficacy of CVBQ and CEBQ for cage subsidence.Univariate logistic regression analysis was performed to screen for po-tential risk factors,after that age and diabetes,which showed statistical significance,along with CVBQ and CEBQ,were incorporated into the multivariate analysis to assess their independent effects.Results:Cage sub-sidence occurred in 14 patients(subsidence rate:19.4％).Compared with the non-subsidence group,the subsi-dence group of patients was older(male:61.4±16.5 years vs 51.1±10.8 years,P=0.049;female:62.6±13.1 years vs 51.2±7.8 years,P=0.005)and had a higher proportion of patients with diabetes(male:42.9％vs 3.4％,P=0.018;female:42.9％vs 6.9％,P=0.040).Both CVBQ and CEBQ were significantly higher in the subsidence group(CVBQ-male:2.75±0.73 vs 2.02±0.53,P=0.004;female:2.84±0.69 vs 2.00±0.40,P=0.005;CEBQ-male:2.82±0.688 vs 2.05±0.56,P=0.004;female:2.94±0.68 vs 2.05±0.42,P=0.002).Pearson correlation analysis re-vealed a moderate positive correlation between both CVBQ(r=0.58,P＜0.001)and CEBQ(r=0.59,P＜0.001)with subsidence distance.ROC curve analysis indicated that both CVBQ(AUC=0.83)and CEBQ(AUC=0.85)had good predictive values for subsidence,with CEBQ showing slightly better predictive performance.Univariate logistic regression analysis identified age,diabetes,CEBQ,and CVBQ as risk factors for subsidence(P＜0.05).Multivariate analysis showed that after adjusting for age and diabetes,both CEBQ(OR=11.466,P=0.004)and CVBQ(OR=8.804,P=0.005)remained independent risk factors for subsidence,while age and diabetes lost in-dependent significance.The strength of association with subsidence was greater in CEBQ than in CVBQ.Conclusions:Patients with higher CVBQ and CEBQ scores are more likely to experience fusion cage subsi-dence,and both CEBQ and CVBQ can be used to predict cage subsidence in patients after single-level ACDF,CEBQ has better predictive ability than CVBQ.

Objective:To retrieve, evaluate and integrate the evidence related to postoperative exercise rehabilitation for hip fracture in elderly frail patients, and provide reference for clinical rehabilitation nursing.Methods:Evidence on postoperative exercise rehabilitation of hip fractures in elderly frail patients was systemically retrieved in the guideline websites, professional association websites and databases, such as BMJ Best Practice, UpToDate, PubMed, Web of Science, CINAHL, Cochrane Library, Embase, Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang and VIP, including Best practices, guidelines, clinical decisions, evidence summaries, systematic reviews, and expert consensus. The retrieval time was from the establishment of the database to March 31, 2024.Results:A total of 33 articles were involved, including 12 guidelines, 2 clinical decisions, 7 systematic reviews, 7 expert consensuses, 5 evidence summaries. Forty pieces of evidence were summarized in 7 aspects: the role of exercise, exercise assessment, exercise planning, exercise content, exercise intensity, exercise adherence, exercise nursing, exercise guidance.Conclusions:Healthcare professionals should combine patients' tolerance, rehabilitation goals, and specific clinical situations to target and guide patients in exercise rehabilitation to promote the recovery of postoperative limb function, mitigate frailty, and improve the quality of life.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.