Methods: Sixty-two patients (2014–2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed. Results: Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05). Conclusions Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.

Objective: To analyze the demographic characteristics of patients with red blood cell transfusion reactions, the usage of red blood cell preparations, and the differences in the composition ratio of adverse reactions based on multi-center data from the Haemovigilance Network, in order to reveal the clinical characteristics of red blood cell transfusion and its underlying issues. Methods: Clinical data of patients who experienced transfusion reactions after red blood cell transfusion in the Haemovigilance Network from 2018 to 2023 were collected. The demographic characteristics of patients who experienced transfusion reactions with different types of red blood cell preparations, the utilization of these preparations, and the differences of the composition ratios of transfusion reactions were analyzed. Count data were expressed as numbers (n) or percentages (%), and comparisons between groups were performed using the Chi-square test. Results: Red blood cell transfusion reactions were more common in females (53.56%), with the majority of patients aged 50-69 years (35.54%). The Han polulation accounted for the vast majority of patients (92.77%), and patients in the hematology and obstetrics/gynecology departments had a relatively high proportion of transfusion reactions (13.26% and 14.26%, respectively). Leukocyte-reduced red blood cells and suspended red blood cells were the most common types of transfusion reactions reported among red blood cell preparations. Allergic reactions and non-hemolytic febrile reactions were the most common transfusion reactions, and there were significant differences in the composition ratios of allergic reactions (χ =869.89, P<0.05) and non-hemolytic febrile reactions (χ =812.75, P<0.05) across various types of red blood cell preparations. Conclusion: There are differences in the demographic characteristics and composition ratio of transfusion reactions among different red blood cell preparations. The management of red blood cell transfusion reactions should be tailored to patient characteristics and conditions, and the selection and use of blood products should be optimized to reduce or avoid the occurrence of transfusion reactions, such as considering the use of washed red blood cells for patients with a history of transfusion allergies or those prone to allergies.

Objective:To analyze the results of detection and determinants of thyroid nodules among civil pilots, and to provide evidence for health management and aeromedical support.Methods:The results of health examination and flight data of 2 451 pilots at Xiamen Airlines Co., Ltd. collected between July 1, 2021 and June 30, 2022 was retrospectively analyzed. These pilots were divided into a non-nodule group and a nodule group based on thyroid ultrasound findings. Gender,age, flying hours, body mass index, prevalence of hypertension, blood routine parameters, lipid profiles, liver and kidney function, fasting plasma glucose, and long-haul flight frequency were compared between the 2 groups. Multivariate Logistic regression was performed to identify risk factors for thyroid nodules.Results:Among the 2 397 civil pilots, 2 301 were in the non-nodule group and 96 in the nodule group, with a detection rate of 4.01%. Most of these nodules were solitary and small (<1 cm in diameter, 52.08%), and classified as Chinese Thyroid Imaging Reporting and Data System 3 (likely benign, 53.13%). Detection rates of nodules were significantly higher among clivil pilots of older age or with longer flying hours ( χ2=25.17,36.86,both P<0.001). Overweight/obesity, hypertension, hypertriglyceridemia, hyperuricemia, and frequent long-haul flights were also associated with higher prevalence of thyroid nodules ( χ2=14.81, 6.17, 10.86, 11.57, 4.12, P<0.001,=0.013, 0.001, 0.001,0.042). Multivariate Logistic regression analysis pointed to the following independent risk factors: flying hours of 10 001-15 000 ( OR=4.005, 95% CI: 1.952-8.216) and over 15 000 ( OR=5.220, 95% CI: 2.415-11.285), overweight/obesity ( OR=1.646, 95% CI: 1.052-2.576) and hyperuricaemia ( OR=1.838, 95% CI: 1.204-2.804). Conclusions:The detection rate of thyroid nodules among civil pilots is relatively low. The occurrence is linked to advanced age, hypertension, hypertriglyceridemia and long-haul flight frequency, with cumulative flying hours, overweight/obesity and hyperuricemia as key risk factors. Aviation healthcare providers and medical examiners should provide targeted guidance and interventions related to modifiable risk factors to safeguard clivil pilots′ occupational health.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To investigate the relationship between macrophage activation related factors and clini-cal symptoms of schizophrenia(SCZ).Methods:Outpatient or inpatient SCZ patients(n=166)and normal con-trols(n=71)meeting the diagnostic criteria of DSM 4th edition were selected as subjects.The psychopathological symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS),and the concentrations of α-Na-Galases,MAF and IL-18 were determined by enzyme-linked immunosorbent assay(ELISA).The correlation be-tween biological indicators and clinical symptoms was analyzed and the mediation effect was tested.Results:The concentrations of α-NaGalases(P＜0.001)and MAF(P＜0.01)in SCZ group were lower than those in normal control group.In SCZ group,IL-18 was negatively correlated with α-NaGalases concentration(r=-0.24,P＜0.01).α-NaGalases was positively correlated with MAF concentration(r=0.67,P＜0.001),and the total score of PANSS positive symptom scale was positively correlated with IL-18(r=0.21,P＜0.05)and MAF concentration(r=0.22,P＜0.01).The mediating effect of α-NaGalases and MAF was statistically significant,and the relative mediating effect accounted for 25.47％.Conclusion:The increase of IL-18 level may indicate the occurrence of positive symptoms of schizophrenia,and α-NaGalases and MAF may negatively regulate the inflammatory damage effect of IL-18 on SCZ,thereby reducing the positive symptoms.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To investigate the relationship between macrophage activation related factors and clini-cal symptoms of schizophrenia(SCZ).Methods:Outpatient or inpatient SCZ patients(n=166)and normal con-trols(n=71)meeting the diagnostic criteria of DSM 4th edition were selected as subjects.The psychopathological symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS),and the concentrations of α-Na-Galases,MAF and IL-18 were determined by enzyme-linked immunosorbent assay(ELISA).The correlation be-tween biological indicators and clinical symptoms was analyzed and the mediation effect was tested.Results:The concentrations of α-NaGalases(P＜0.001)and MAF(P＜0.01)in SCZ group were lower than those in normal control group.In SCZ group,IL-18 was negatively correlated with α-NaGalases concentration(r=-0.24,P＜0.01).α-NaGalases was positively correlated with MAF concentration(r=0.67,P＜0.001),and the total score of PANSS positive symptom scale was positively correlated with IL-18(r=0.21,P＜0.05)and MAF concentration(r=0.22,P＜0.01).The mediating effect of α-NaGalases and MAF was statistically significant,and the relative mediating effect accounted for 25.47％.Conclusion:The increase of IL-18 level may indicate the occurrence of positive symptoms of schizophrenia,and α-NaGalases and MAF may negatively regulate the inflammatory damage effect of IL-18 on SCZ,thereby reducing the positive symptoms.

Objective:To analyze the results of detection and determinants of thyroid nodules among civil pilots, and to provide evidence for health management and aeromedical support.Methods:The results of health examination and flight data of 2 451 pilots at Xiamen Airlines Co., Ltd. collected between July 1, 2021 and June 30, 2022 was retrospectively analyzed. These pilots were divided into a non-nodule group and a nodule group based on thyroid ultrasound findings. Gender,age, flying hours, body mass index, prevalence of hypertension, blood routine parameters, lipid profiles, liver and kidney function, fasting plasma glucose, and long-haul flight frequency were compared between the 2 groups. Multivariate Logistic regression was performed to identify risk factors for thyroid nodules.Results:Among the 2 397 civil pilots, 2 301 were in the non-nodule group and 96 in the nodule group, with a detection rate of 4.01%. Most of these nodules were solitary and small (<1 cm in diameter, 52.08%), and classified as Chinese Thyroid Imaging Reporting and Data System 3 (likely benign, 53.13%). Detection rates of nodules were significantly higher among clivil pilots of older age or with longer flying hours ( χ2=25.17,36.86,both P<0.001). Overweight/obesity, hypertension, hypertriglyceridemia, hyperuricemia, and frequent long-haul flights were also associated with higher prevalence of thyroid nodules ( χ2=14.81, 6.17, 10.86, 11.57, 4.12, P<0.001,=0.013, 0.001, 0.001,0.042). Multivariate Logistic regression analysis pointed to the following independent risk factors: flying hours of 10 001-15 000 ( OR=4.005, 95% CI: 1.952-8.216) and over 15 000 ( OR=5.220, 95% CI: 2.415-11.285), overweight/obesity ( OR=1.646, 95% CI: 1.052-2.576) and hyperuricaemia ( OR=1.838, 95% CI: 1.204-2.804). Conclusions:The detection rate of thyroid nodules among civil pilots is relatively low. The occurrence is linked to advanced age, hypertension, hypertriglyceridemia and long-haul flight frequency, with cumulative flying hours, overweight/obesity and hyperuricemia as key risk factors. Aviation healthcare providers and medical examiners should provide targeted guidance and interventions related to modifiable risk factors to safeguard clivil pilots′ occupational health.

Objective:To investigate the effects of free triiodothyronine/free thyroxine(FT3/FT4) and one carbon metabolites on metabolic syndrome(MetS) in patients with severe mental illness(SMI).Methods:Retrospective case-control study was conducted to select 328 patients with SMI who were hospitalized in Beijing Huilongguan Hospital from January 2022 to August 2023 as the study subjects, including 180 patients with schizophrenia (SZ), 74 patients with bipolar disorder (BD), and 74 patients with major depression (MDD). Another 74 healthy subjects in the same period were selected as the control group. The levels of thyroid hormones and one-carbon metabolites [ folic acid, vitamin B12 (VitB12) and homocysteine (HCY) ] were compared between the two groups. At the same time, clinical data and MetS related information of SMI patients were collected. Partial correlation analysis and Logistic regression analysis were used to study the relationship between FT3/FT4 and one-carbon metabolites and MetS risk factors and insulin resistance in SMI patients, respectively.Results:There were statistically significant differences in gender, age, course of disease, smoking rate, body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG)/HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), antipsychotic drug use rate, mood stabilizer use rate, antidepressant drug use rate and hypoglycemic treatment among SZ, BD and MDD groups in SMI patients (all P<0.05).Compared with the control group, FT3/FT4, folic acid and VitB12 in patients with SMI were significantly lower ( Z=-4.315, P<0.001; Z=-8.216, P<0.001; Z=-6.021, P<0.001), HCY increased significantly ( Z=-8.789, P<0.001);Partial correlation analysis showed that FT3/FT4 in patients with SMI was positively correlated with TG( r=0.303, P<0.001), TG/HDL-C( r=0.228, P<0.001), insulin resistance index(HOMA-IR)( r=0.204, P<0.001), triglyceride glucose index(TyG)( r=0.284, P<0.001), triglyceride glucose body mass index(TyG-BMI)( r=0.211, P<0.001) and body mass index(BMI)( r=0.154, P=0.005), and negatively correlated with insulin sensitivity index(QUICKI)( r=-0.205, P<0.001). VitB12 was positively correlated with HDL-C( r=0.144, P=0.009) and QUICKI( r=0.115, P=0.038), and negatively correlated with TyG-BMI ( r=-0.122, P=0.028) and BMI ( r=-0.127, P=0.022). HCY was positively correlated with TyG ( r=0.114, P=0.039) and TyG-BMI ( r=0.188, P=0.001). Multivariate ordinal logistic regression analysis showed that smoking( OR=1.602,95% CI=1.004-2.558), female( OR=1.736,95% CI=1.041-2.895), FT3/FT4( OR=17.811,95% CI=1.596-198.764), HCY ( OR=1.026,95% CI=1.009-1.043) and BD ( OR=2.150,95% CI=1.092-4.232) were the influencing factors of the number of risk factors for MetS in patients with SMI, while VitB12 ( OR=0.997,95% CI=0.995-0.998) was a protective factor; binary Logistic regression analysis showed that patients with SMI with long course of disease( OR=1.024,95% CI=1.008-1.041) and high level of HCY ( OR=1.033,95% CI=1.014-1.052) were more likely to have MetS. Conclusion:Dynamic monitoring of FT3/FT4 and one-carbon metabolites levels is helpful to identify the risk of MetS in patients with SMI and provide reference for prevention and treatment.

Objective:To investigate the effects of free triiodothyronine/free thyroxine(FT3/FT4) and one carbon metabolites on metabolic syndrome(MetS) in patients with severe mental illness(SMI).Methods:Retrospective case-control study was conducted to select 328 patients with SMI who were hospitalized in Beijing Huilongguan Hospital from January 2022 to August 2023 as the study subjects, including 180 patients with schizophrenia (SZ), 74 patients with bipolar disorder (BD), and 74 patients with major depression (MDD). Another 74 healthy subjects in the same period were selected as the control group. The levels of thyroid hormones and one-carbon metabolites [ folic acid, vitamin B12 (VitB12) and homocysteine (HCY) ] were compared between the two groups. At the same time, clinical data and MetS related information of SMI patients were collected. Partial correlation analysis and Logistic regression analysis were used to study the relationship between FT3/FT4 and one-carbon metabolites and MetS risk factors and insulin resistance in SMI patients, respectively.Results:There were statistically significant differences in gender, age, course of disease, smoking rate, body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG)/HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), antipsychotic drug use rate, mood stabilizer use rate, antidepressant drug use rate and hypoglycemic treatment among SZ, BD and MDD groups in SMI patients (all P<0.05).Compared with the control group, FT3/FT4, folic acid and VitB12 in patients with SMI were significantly lower ( Z=-4.315, P<0.001; Z=-8.216, P<0.001; Z=-6.021, P<0.001), HCY increased significantly ( Z=-8.789, P<0.001);Partial correlation analysis showed that FT3/FT4 in patients with SMI was positively correlated with TG( r=0.303, P<0.001), TG/HDL-C( r=0.228, P<0.001), insulin resistance index(HOMA-IR)( r=0.204, P<0.001), triglyceride glucose index(TyG)( r=0.284, P<0.001), triglyceride glucose body mass index(TyG-BMI)( r=0.211, P<0.001) and body mass index(BMI)( r=0.154, P=0.005), and negatively correlated with insulin sensitivity index(QUICKI)( r=-0.205, P<0.001). VitB12 was positively correlated with HDL-C( r=0.144, P=0.009) and QUICKI( r=0.115, P=0.038), and negatively correlated with TyG-BMI ( r=-0.122, P=0.028) and BMI ( r=-0.127, P=0.022). HCY was positively correlated with TyG ( r=0.114, P=0.039) and TyG-BMI ( r=0.188, P=0.001). Multivariate ordinal logistic regression analysis showed that smoking( OR=1.602,95% CI=1.004-2.558), female( OR=1.736,95% CI=1.041-2.895), FT3/FT4( OR=17.811,95% CI=1.596-198.764), HCY ( OR=1.026,95% CI=1.009-1.043) and BD ( OR=2.150,95% CI=1.092-4.232) were the influencing factors of the number of risk factors for MetS in patients with SMI, while VitB12 ( OR=0.997,95% CI=0.995-0.998) was a protective factor; binary Logistic regression analysis showed that patients with SMI with long course of disease( OR=1.024,95% CI=1.008-1.041) and high level of HCY ( OR=1.033,95% CI=1.014-1.052) were more likely to have MetS. Conclusion:Dynamic monitoring of FT3/FT4 and one-carbon metabolites levels is helpful to identify the risk of MetS in patients with SMI and provide reference for prevention and treatment.