Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods:From 2018 to 2020, 90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method, including 30 patients in experimental group 1, 30 patients in experimental group 2, and 30 patients in control group.PaCO 2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1, 46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group. The peak airway pressure (Ppeak) , lung dynamic compliance (Cdyn) and oxygenation index (OI) were observed and compared among the three groups after endotracheal intubation (T1) , 30 min after right artificial pneumothorax (T2) and 30 min after right lung recruitment (T3) ;The clinical pulmonary infection score (CPIS) , serum procalcitonin (PCT) on the 1st, 4th and 7th day after operation were analyzed and compared. Results:At T2, observation group A had the highest dynamic lung compliance (25.13 ± 5.70 vs 22.28 ± 4.26 vs 19.99 ± 4.36), the fastest heart rate (102.04 ± 10.91 vs 96.46 ± 9.91 vs 92.28 ± 8.08) and the lowest airway pressure (17.62 ± 1.79 vs 18.96 ± 1.90 vs 20.39 ± 1.71) ( P < 0.05). Observation group A had the lowest CPIS on the 1st, 4th and 7th day after operation compared with observation group B and control group (1.12±0.77 vs 1.71±0.90 vs 2.64±1.07) (6.08±1.20 vs 7.43±1.10 vs 8.31±1.55) (1.69±1.12 vs 2.32±0.98 vs 3.44±1.25) ( P<0.05) . Conclusion:Permissive hypercapnia can reduce airway resistance, improve lung compliance and reduce the risk of postoperative pulmonary infection.

Objective To investigate the prognostic influence factors of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion. Methods From March 2015 to March 2017,222 consecutive patients with acute anterior circulation macrovascular occlusion admitted to the Department of Neurosurgery,the 101stHospital of People′s Liberation Army and the Nanjing Jinling Hospital were enrolled retrospectively.They were all confirmed by DSA and were treated with Solitaire stent thrombectomy. According to the modified Rankin Scale(mRS) scores at 90 d after treatment,they were divided into a good prognosis group (0-2,n=120) and a poor prognosis group (3-6,n =102). The baseline data and clinical data of the two groups of patients were analyzed,including the risk factors for cardiocerebrovascular diseases,baseline National Institutes of Health Stroke Scale (NIHSS) score,occlusion sites (internal carotid artery or middle cerebral artery occlusion),collateral compensatory,onset to puncture time, operation time,onset to recanalization median time,recanalization status,preoperative Alberta stroke programme early CT score(ASPECTS),and symptomatic cerebral hemorrhage,and then further multivariate logistic regression analysis was conducted for the prognostic factors of patients. Results (1) The rate of good prognosis was 54.1% (120/222).There were no significant differences in patients′ age,NIHSS at admission,ASPECTS at admission,sex,hypertension,occlusion site,and rate of good collateral branches in both groups(all P<0.05).There were no significant differences in other baseline data (all P >0. 05). (2) Onset to puncture time and onset to successful recanalization median time of the patients in good prognosis group was lower than that of the poor prognosis group (182 [138,230]min vs.236[170,305]min, 237[175,269]min vs.288[223,367]min).The proportion of successful recanalization was higher than that of the poor prognosis group (98.3% [118/120] vs.78.4% [80/102]).The proportion of postoperative symptomatic intracerebral hemorrhage was lower than that of the poor prognosis group (2.5% [3/120] vs.21.6% [22/102]).There was significant difference between the two groups (all P <0.01). There was no significant difference in operative time between the two groups (P >0.05). (3)In the single factor analysis,the parameter of P <0.05 was used as an independent variable,and prognosis was used as a dependent variable,multivariate logistic regression analysis showed that the increased age (OR,1.096,95% CI 1.050-1.144),history of hypertension (OR,8.401,95% CI 2.960-23.845),increased baseline NIHSS score (OR,1.071,95% CI 1.007-1.138),prolonged onset to successful recanalization time (OR,1.019,95% CI 1.003-1.035),symptomatic intracerebral hemorrhage after procedure (OR,18.110,95% CI 4.656-70.434) were all the risk factors for poor prognosis(all P<0.05);higher ASPECTS score at admission(OR,0.641,95% CI 0.451-0.911) and successful recanalization (OR,0.127,95% CI 0.024-0.664) were all the protective factors of good prognosis (all P<0.05). Conclusions Higher ASPECTS at admission and successful recanalization were the protective factors of poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.Increased age,history of hypertension,increased baseline NIHSS score,prolonged onset to successful recanalization time,and symptomatic intracerebral hemorrhage after procedure were the risk factors for poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.

Objective To analyze the epidemiological and clinical characteristics of 5 patients with importing yellow fever ,and to explore the preventive and control strategies of infection in hospital .Methods The epidemiological and clinical characteristics of 5 cases of importing yellow fever in Infectious Disease Hospital of Fujian Medical University from March 18th to April 6th in 2016 were retrospectively reviewed and analyzed .Results Five patients were all from Angola Luanda .One of them was vaccinated before going aboard ,and the others were vaccinated 1—10 days before disease onset in Angola .All of them were bitten by mosquitoes ,and their onset date ranged from March 11th to March 27th ,before returned to Fujian .The main clinical symptoms were fever ,chilly ,shivering ,fatigue ,arthrodynia ,headache ,and liver and kidney injury .At manifestations ,two patients had positive nuclear acid of yellow fever virus in serum samples and 3 patients were positive in urine samples .All of these patients were negative for dengue virus and Zika virus testing ,meanwhile no plasmodium was found in blood smears .All patients were cured and discharged . Conclusions There is risk of yellow fever transmission in Fujian Province . Prevention and control of the disease should be focus on improving the ability of finding and coping with the importing cases .Vaccination and hygiene knowledge propagation should be given for those who are going to epidemic country/area .Emergency monitoring and control of mosquitoes are necessary .

A novel high performance liquid chromatographic method was developed for the determination of 4-O- methylhonokiol in rabbit plasma and was applied to its pharmacokinetic investigation. Plasma samples were treated by one-fold volume of methanol and acetonitrile to remove the interference proteins. A reverse phase column of SHIM- PACK VP-ODS （150 mm ×4.6 mm, 5.0 μm） was used to separate 4-O-methylhonokiol in the plasma samples. The detection limit of 4-O-methylhonokiol was 0.2 μg/L and the linear range was 0. 012 - 1. 536 mg/L. The good extraction recoveries were obtained for the spiked samples （84.7%, 89.3% and 87.7% for low, middle and high concentrations of added standards, respectively）. The relative standard deviation of intra-day and inter-day precisions was in the range from 0.6% to 13.5%. The pharmacokinetic study of 4-O-methylhonokiol was made and the results from the plasmaconcentration curve of 4-0-methylhonokiol showed a two-apartment open model. This work developed a sensitive, stable and rapid HPLC method for the determination of 4-O-methylhonokiol and the developed method has been successfully applied to a pharmacokinetic study of 4-O-methylhonokiol.

OBJECTIVE: Strengthen realization of pulmonary infection and perform follow-up plays a key role in preventing severe pulmonary infection following kidney transplantation. The aim of this study is to analyze the diagnosis and pathogens distribution in patients with pulmonary infection following kidney transplantation. METHODS: Totally 14 patients with severe pulmonary infection following kidney transplantation, who received treatment at The Department of Urology Center, Lanzhou General Hospital of Lanzhou Military Area Command of Chinese PLA, from May 2004 to September 2008, were analyzed. Including 10 males and 4 females, aged from 20 to 65 (37.3±11.4) years. Six patients suffered pulmonary infection within 3 months, 7 patients occurred pulmonary infection occurred during 3-6 months, and pulmonary infection occurred in 1 patient at 6 months after kidney transplantation. The infection rate was 93% during 6 months after kidney transplantation. The diagnosis of pulmonary infection was according to the clinical manifestation of respiratory system, and combined with specificity display of sternum, CT or detection of pathogen. Oxygen inhale and mechanical ventilation were employed for admitted patients. And electrolytes, acid-base equilibrium was daily detected. Twelve patients accepted "three-medicine" treatment and 2 cases accepted "four-medicine" treatment. The therapeutic drugs could be regulated individually. The dose of immunosuppressive agent was adjusted due to ciclosporin, CD4~+/CD8~+, and C-reactive protein levels. RESULTS: The pathogens of pulmonary infection were bacteria (5 patients), fungi (4 patients), and mixed infection (3 patients). No pathogen was found in 2 patients. Four patients died of acute respiratory distress syndrome, 1 patient died for quitting treatment. The remained 9 patients were cured. The mortality was 36%, and the recovery rate was 64%, CONCLUSION: The cure rate of patients with severe pulmonary infection following kidney transplantation can be increased by early combining antibiotics treatment, regulating immunosuppressive agents, early identifying pathogens, taking respiratory support therapy, as weii as adding nutritional supplement.

OBJECTIVE To comprehend the mycoetiology of recurrent vulvovaginal candidiasis(RVVC),and to analyze the drug resistance of pathogens.METHODS Vaginal secretion samples extracted from the cases which were diagnosed RVVC were inoculated and identified by coloration medium.Susceptibility test was carried out by Rosco scrip diffusion method.RESULTS Totally 178 monilias were isolated from 159 RVVC samples.From them 122(68.5%) were Candida albicans,49(27.5%)C.glabrata.The susceptibility test result of C.albicans was as follows: to amphotericin B(100.0%),clotrimazole(100.0%),mycostatin(99.2%),ketoconazole(KCZ)(99.2%),and miconazole(36.9%).That of non-C.albicans was to mycostatin(100.0%),amphotericin B(98.2%),econazole(96.4%),fluconazole(60.7%),and terbinafine(0).CONCLUSIONS C.albicans and C.glabrata are the main pathogenic fungsi which induce RVVC,non-C.albicans infection is upgraded manifestly,so fungus culture and susceptibility test must be done.Mycostatin,KCZ,and clotrimazole are the first selection for treatment of RVVC.

OBJECTIVE To investigate mechanisms of sulfamethoxazolel trimethoprim(SMZco) resistance in multi-drug-resistant strains of Shigella.METHODS The strains of multi-resistant Shigella were selected with K-B susceptibility method.The genes(sul1,dfrA1,dfrA5,dfrA12 and dfrA17) of SMZco resistance were detected by polymerase chain reaction(PCR).And using the DNA sequencing determined that bears the genotype.RESULTS In 20 Shigella strains the drug-resistance rate of Shigella to SMZco was 95.0%.Sul1,dfrA1,dfrA12 and dfrA17-positive rate was 15.0%,100.0%,5.0% and 0,DfrA1 positive gene sequencing showed highly homology with the sequence of GenBank.CONCLUSIONS There is a close relation of the SMZco resistance in Shigella to sul1 and dfrA1 existing.

OBJECTIVE To investigate mechanisms of chloramphenicol resistance in multi-drug-resistant strains of Shigella.METHODS The strains of multi-resistant Shigella were detected with K-B susceptibility method.The genes(catB,cmlA)of chloramphenicol resistance were detected by polymerase chain reaction(PCR)and the DNA sequencing.RESULTS In 20 strains,the drug-resistance rate of Shigella to chloramphenicol was 70.0%.Two strains carried cmlA but no catB detected was out.The cmlA gene product sequence showed it was cmlA1.CONCLUSIONS The multiple-drug resistante cmlA1 is detected out.This is the first report in China.