Objective:To compare the efficacy of forceful reduction percutaneous pedicle screw and ordinary percutaneous pedicle screw in the treatment of osteoporotic thoracolumbar burst fracture with kyphosis.Methods:A retrospective cohort study was conducted to analyze the clinical data of 566 patients with osteoporotic thoracolumbar burst fracture with kyphosis admitted to Honghui Hospital, Xi ′an Jiaotong University from January 2015 to December 2018, including 191 males and 375 females, with age range of 48-79 years [(61.7±10.7)years]. Fracture segments were located at T 11 in 134 patients, T 12 in 154, L 1 in 160, and L 2 in 118. All fractures were type IIIA according to the acute symptomatic osteoporotic thoracolumbar fracture classification (ASOTLF). The thoracolumbar osteoporotic fracture severity score assessment system (TLOFSAS) score was ≥5 points. A total of 275 patients underwent forceful reduction and percutaneous pedicle screw internal fixation (forceful reduction screw group), and 291 patients underwent common percutaneous pedicle screw internal fixation (common screw group). The operation time, intraoperative blood loss, times of X-ray exposure on patients and measures documented before operation, at 3 days after operation and at 2 years after operation including anterior height ratio of the injured vertebrae, sagittal Cobb angle of the injured vertebrae, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) were compared between the two groups. Moreover, degree of correction of Cobb angle at 3 days after operation, loss of correction of Cobb angle at 2 years after operation and postoperative complications were observed. Results:All patients were followed up for 25-34 months [(29.9±3.4)months]. The operation time, intraoperative blood loss and times of X-ray exposure on patients in forceful reduction screw group were (69.4±10.2)minutes, (60.3±13.1)ml and (26.8±3.7)times, less than (80.6±11.9)minutes, (80.7±15.4)ml and (30.4±3.4)times in common screw group (all P<0.01). There was no significant difference in anterior height ratio of the injured vertebrae between the two groups before operation and at 3 days after operation (all P>0.05). The anterior height ratio of the injured vertebrae in forceful reduction screw group was (95.5±2.3)% at 2 years after operation, significantly higher than (85.4±1.7)% in common screw group ( P<0.01). There was no significant difference in sagittal Cobb angle of the injured vertebrae between the two groups before operation ( P>0.05). The sagittal Cobb of the injured vertebrae in forceful reduction screw group at 3 days and 2 years after operation were (7.9±1.6)° and (8.8±1.5)°, lower than (10.6±1.1)° and (12.3±1.2)° in common screw group ( P<0.05 or 0.01). There were no significant difference in JOA score and VAS between the two groups before operation, at 3 days and at 2 years after operation (all P>0.05). The degree of correction of Cobb angle in forceful reduction screw group was (19.4±2.5)°, higher than (17.3±2.6)° in common screw group ( P<0.05). The loss of correction of Cobb angle in forceful reduction group was less than that in common screw group at 2 years after operation, but the difference was not statistically significant ( P>0.05). The incidence of postoperative complications in forceful reduction screw group was 12.4% (34/275), compared to 14.1% (41/291) in common screw group ( P>0.05). There were no complications such as iatrogenic nerve injury, fracture or loosening of internal fixator or leakage of bone cement in the spinal canal in both groups. Conclusions:For osteoporotic thoracolumbar burst fracture with kyphosis, forceful reduction and percutaneous pedicle screw internal fixation can significantly shorten operation time, reduce intraoperative blood loss and times of X-ray exposure on patients, restore height of the injured vertebrae, correct kyphosis and maintain reduction height of the injured vertebrae in contrast with conventional percutaneous pedicle screw internal fixation.

OBJECTIVE To investigate the mechanism of Fuke duanhongyin capsule in improving dysfunctional uterine bleeding （DUB） in rats. METHODS Pregnant SD rats were randomly divided into blank control group （distilled water）， model control group （distilled water） and Fuke duanghongyin capsule group （1.296 g/kg）， with 6 rats in each group. Except for blank control group， DUB model was established in other groups. After modeling， they were given relevant medicine/distilled water 10 mL/kg intragastrically， once a day， for consecutive 14 d. After medication， uterine index， ovary index and hemorheology indexes （whole blood high shear relative index， whole blood low shear relative index， erythrocyte aggregation index， Carson viscosity） of rats were all determined. The pathological changes of uterus and ovary tissues were observed； mRNA relative expression levels of epidermal growth factor （EGF）， hypoxia-inducible factor 1α （HIF-1α）， epidermal growth factor receptor （EGFR） and serine/ threonine-protein kinase 1（AKT1）， and protein relative expression levels of EGF and EGFR in uterine tissue were all measured. RESULTS Compared with model control group， the uterine index， ovary index， erythrocyte aggregation index were all decreased significantly in Fuke duanghongyin capsule group （P＜0.05 or P＜0.01）； whole blood high shear relative indexes， mRNA relative expression levels of EGF， HIF-1α and EGFR and protein relative expression levels of EGF and EGFR in uterine tissue were all increased significantly （P＜0.05 or P＜0.01）. The pathological changes of ovary and uterus were improved. CONCLUSIONS Fuke duanhongyin capsule can improve DUB in rat， the mechanism of which may be related to the activation of EGF-EGFR signaling pathway.

Objective:To explore the effect of closed-loop nursing on self-efficacy and nursing satisfaction in children with nephrotic syndrome (NS) .Methods:From March 2019 to January 2021, convenience sampling was used to select 104 children with NS and their accompanying parents in Henan Provincial People's Hospital as the research object. The children were divided into the control group and the observation group by random number table method, 52 cases in each group. The control group received routine nursing, and the observation group carried out closed-loop nursing on the basis of the control group. The scores of the General Self-efficacy Scale and Satisfaction Scale were compared between the two groups.Results:After three months of intervention, the children's self-efficacy score in the observation group was higher than that in the control group, and the parents' satisfaction with nursing was 94.23% (49/52) , which was higher than 78.85% (41/52) in the control group. The differences were all statistically significant ( P<0.05) . Conclusions:The closed-loop nursing can improve the self-efficacy of children with NS and the satisfaction of their parents, which is worthy of clinical promotion.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Objective:To evaluate the relationship between postoperative acute kidney injury (AKI) and preoperative dehydration in the patients undergoing surgery for gastrointestinal tumor.Methods:A total of 231 patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged≥18 yr, undergoing elective surgery for gastrointestinal tumor with general anesthesia, were enrolled.Preoperative dehydration index was calculated according to preoperative urine color, specific gravity, osmotic pressure and creatinine.Preoperative dehydration was defined as dehydration index≥3.5.AKI was defined according to the Kidney Disease Improving Global Outcomes criteria.Logistic regression analysis was conducted to assess the association between preoperative dehydration and postoperative AKI.Results:Of the 231 patients who met our inclusion criteria, 27 (11.7%) developed postoperative AKI, and 13 patients (48.1%) had preoperative dehydration among the patients developed postoperative AKI.The results of logistic analysis showed that preoperative dehydration was an independent risk factor for postoperative AKI in the patients undergoing surgery for gastrointestinal tumor ( OR=4.03, 95% confidence interval 1.72-9.39). Conclusion:Preoperative dehydration is an independent risk factor for postoperative AKI in the patients undergoing surgery for gastrointestinal tumor.

The delivery of exogenous insulin is very important for the treatment of type 1 and advanced type 2 diabetes.Traditional injectable administration is prone to cause hypoglycemia, while the intelligent insulin system has the advantages of safety, long-term effectiveness, and high responsiveness.Glucose oxidase (GOx) can consume O2 and catalyze glucose to produce gluconic acid and H2O2.Therefore, the O2 level, H2O2 content and pH of GOx system are closely related to the glucose level in the system.This review introduces the application of GOx in closed-loop insulin delivery systems at home and abroad in recent years, which can be divided into single response and multiple response of pH-response, hypoxia-response, and H2O2-response according to the mechanism.It also discusses the opportunities and challenge facing by the application of GOx in the future.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective: To explore the significance of minimal residual disease (MRD) in predicting prognosis and guiding therapy of adults with Philadelphia-chromosome negative acute lymphoblastic leukemia (Ph^- ALL) in high-risk. Methods: Data of newly diagnosed adults with Ph^- ALL in high-risk who achieved CR were reviewed. Variables associated with outcome were identified by COX regression model and Landmark analysis. Results: A total of 177 patients, 99 (56%) cases male with a median age of 40 years (range, 16-65 years) were included in this study. Of them, 95 (54%) patients received allo-HSCT in CR₁. Multivariate analyses showed that MRD negativity after the first cycle of consolidation (HR=0.52, 95%CI 0.30-0.89, P=0.017) and achieving CR within 4 weeks (HR=0.43, 95%CI 0.24-0.79, P=0.006) were the factors significantly-associated with longer DFS, and allo-HSCT was associated with both longer DFS (HR=0.13, 95%CI 0.08-0.22, P<0.001) and OS (HR=0.24, 95%CI 0.15-0.41, P<0.001) . Landmark analysis was performed on 121 patients, of 85 patients achieving MRD negativity after the first cycle of consolidation, multivariate analyses showed that MRD negativity after the third cycle of consolidation was significantly-associated with longer DFS (HR=0.18, 95%CI 0.05-0.64, P=0.008) and OS (HR=0.14, 95%CI 0.04-0.50, P=0.003) . For the patients achieving MRD negativity after both the first and the third cycles of consolidation, the 3-year DFS rate in the allo-HSCT cohort had a higher trend compared with that in the chemotherapy cohort (75.2% vs 51.3%, P=0.082) , however, the 3-year OS rates in the 2 cohorts were similar (72.7% vs 68.7%, P=0.992) . In those with MRD positivity after the first and/or the third cycle of consolidation, 3-year DFS (64.8% vs 33.3%, P=0.006) and OS (77.0% vs 33.3%, P=0.028) rates in the allo-HSCT cohort were significantly higher than those in the chemotherapy cohort, and similar to those in the cohort achieving MRD negativity after both the first and the third cycles of consolidation and receiving allo-HSCT. Conclusions MRD negativity after the first cycle of consolidation was a predictor for better outcome in adults with Ph^- ALL in high-risk. The survival advantage of the allo-HSCT cohort was not pronounced compared with that in the chemotherapy cohort even in those with high-risk features but achieving MDR negativity after both the first and third cycles of consolidation. However, allo-HSCT could be a good option for the patients with MRD positivity after the first and/or the third cycle of consolidation.

Objective: To investigate the status quo of surgical instrument maintenance at 549 hospitals nationwide and analyze the existing problems, so as to lay a foundation for further development of relevant standards. Methods: In January 2019, 549 hospitals of different grades in 33 provinces, autonomous regions and municipalities were surveyed by a convenience sampling. The survey covered the basic information, the cognition of the management personnel on instrument maintenance, and the status quo of surgical instrument maintenances of the hospitals. Descriptive analysis was carried out on the data, and the number and percentage of counting data were described. Results: 368(59.74%)hospitals were manned with special post for cleaning precision surgical instruments, 426(69.16%) were manned with special post for cleaning quality inspection, and 382(62.01%) were manned with special post for assembly and packaging. 347(56.33%)for manufacturers training, 299(48.53%)for self-study manufacturers instruction, 420(68.18%)by department internal training; 116(18.83%)for manual cleaning, 413(67.05%)for manual and ultrasonic cleaning, 87(14.12%)for mechanical cleaning; High pressure steam sterilization was used in 518(84.10%), hydrogen peroxide plasma sterilization was used in 398(64.61%), and ethylene oxide sterilization was used in 222(36.04%) hospitals. Conclusions The maintenance of surgical instruments should be carried out by professional personnel, relevant training should be carried out, management personnel should strengthen the inspection, and relevant standards and norms should be formulated to unify the management of surgical instruments.

Objective: To analyze the variations of procalcitionin (PCT) and red blood cell distribution width (RDW) in premature infants with septicemia and to investigate their values in evaluating the severity and prognosis of septicemia. Methods: A retrospective study was conducted to analyze the medical records of 96 premature infants diagnosed with septicemia and admitted to the First Affiliated Hospital of Anhui Medical University from December 1, 2014 to December 1, 2018. According to the severity of the disease and neonatal shock score, there were 42 cases selected to the severe septicemia group (severe clinical condition with shock, shock score >6 points) and 54 in the mild septicemia group (mild clinical condition without shock or shock score ≤6 points). Moreover, after three days' treatment, they were divided into two groups: death group (n=10) and survival group (n=86, survived during hospitalization). Peripheral venous blood samples were collected before and on the first and third day after treatment to detect PCT and RDW. Dynamic changes of the two indexes were compared between different groups. Mann-Whitney U test, Wilcoxon rank sum test, Friedman test or receiver operating characteristic (ROC) curve was used for statistical analysis. Results: (1) Before and on the first and third day after treatment, the severe septicemia group had a higher level of PCT than the mild group [3.7 (0.4-37.3) vs 1.4 (0.2-5.0) ng/ml, 43.1 (18.7-83.0) vs 17.1 (4.1-34.6) ng/ml, 26.1 (3.8-67.3) vs 4.8 (0.3-32.9) ng/ml; Z=-2.017, -3.350 and -2.932; all P<0.05]. In both groups, PCT level on the first day after treatment was the highest, and that on the third day after treatment was higher than that before treatment (all P<0.05). On the first and third day after treatment, RDW in the severe group was higher than that in the mild group [16.5% (16.2%-18.6%) vs 16.3% (15.5%-17.3%), 16.1% (15.5%-19.4%) vs 15.7% (15.1%-16.5%); Z=-1.992 and -2.165; both P<0.05]. In the severe and mild groups, RDW on the first day after treatment was higher than that before and on the third day after treatment; in the mild group, RDW on the third day after treatment was lower than that before treatment, while in the severe group, RDW on the third day after treatment was higher than that before treatment (all P<0.05). (2) On the first and third day after treatment, PCT and RDW in the death group were higher than those in the survival group [PCT: 162.0 (62.9-187.2) vs 19.9 (4.3-46.1) ng/ml, 122.6 (65.0-180.8) vs 6.2 (0.5-32.9) ng/ml; Z=-4.114 and -4.594; RDW: 18.4% (16.9%-21.2%) vs 16.3% (15.7%-17.2%), 21.8% (20.6%-22.2%) vs 15.8% (15.2%-16.5%); Z=-3.307 and -4.831; all P<0.05]. In both groups, PCT on the first day after treatment was higher than that before and on the third day after treatment, and the level on the third day after treatment was higher than that before treatment (all P<0.05). In the death group, RDW on the first and third day after treatment were higher than that before treatment, and RDW on the third day after treatment was higher than that on the first day; in the survival group, RDW on the first day after treatment was higher than that before treatment, but on the third day after treatment, it was lower than that before and on the first day after treatment (all P<0.05). (3) The cut-off values of PCT for predicting severe septicemia in premature infants before and on the first and third day after treatment were 3.475, 29.765 and 3.460 ng/ml, respectively, and the sensitivity and specificity were 54.8% and 75.9%, 69.0% and 72.2%, and 83.3% and 46.3%, respectively. The cut-off values of PCT for predicting the death of premature infants with septicemia on the first and third day after treatment were 40.595 and 64.855 ng/ml, respectively, with the specificity of 73.3% and 87.2% and sensitivity of both 100.0%. The predictive thresholds of RDW for severe septicemia on the first and third day after treatment were 15.650% and 18.300%, respectively, and the sensitivity and specificity were 95.2% and 29.6%, 33.3% and 92.6%, respectively. The predictive thresholds for death were 16.650% and 18.450%, and the sensitivity and specificity were 100.0% and 68.6%, 100.0% and 91.9%, respectively. Conclusions Dynamic monitoring of PCT and RDW levels may help with early diagnosis, determination of severity and prognosis prediction of severe septicemia in premature infants.