Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

OBJECTIVE: To explore the molecular mechanism of curcumin in inhibiting the nucleotide-binding oligomerization domain like receptor family pyrin domain-containing(NLRP3) inflammatory bodies induced by silica(SiO_2) in mouse alveolar macrophages(AM). METHODS: AMs were isolated from the bronchoalveolar lavage fluid of specific pathogen free C57 BL/6 mice and divided into 6 groups. Among them, the AM of the control group received no stimulation; the AM in the SiO_2 stimulation group was stimulated with SiO_2 suspension at the final mass concentration of 50 mg/L; the AM in nuclear factor(NF-κB)inhibition group was pretreated with 5-(4-fluorophenyl)-2-urea-thiophene-3-formamide with a final concentration of 200 nmoL/L for 1 hour, the AM in the low-, medium-and high-dose curcumin groups were pretreated with curcumin with the final concentrations of 20, 40 and 50 μmol/L for 1 hour, respectively, and then stimulated with SiO_(2 )suspension with a final concentration of 50 mg/L. Samples were collected after 6 hours of incubation. The mRNA expression of NLRP3 inflammasome related genes such as NLRP3, Caspase-1 and interleukin(IL)-1β was detected by real-time fluorescence quantitative polymerase chain reaction. The secretion level of maturation IL-1β(mIL-1β) and IL-18 in AM was detected by enzyme-linked immunosorbent assay. The protein expression and secretion level of cleaved Caspase-1, precursor-IL-1β(pro-IL-1β) and mIL-1β were analyzed by Western blotting. RESULTS: The mRNA relative expression of NLRP3, Caspase-1 and IL-1β, and the secretion levels of mIL-1β and IL-18, and the protein relative expression of Caspase-1, pro-IL-1β and mIL-1β, as well as the secretion levels of cleaved Caspase-1 and mIL-1β increased in the SiO_2 stimulated group compared with the control group(P<0.05). Except for the relative expression and the secretion level of cleaved Caspase-1, the other 8 indexes in the NF-κB inhibition group were lower than that in the SiO_2 stimulation group(P<0.05). Except for the relative expression of cleaved Caspase-1 and mIL-1β proteins in the low-dose curcumin group, the relative expression of all the above 10 indexes was lower in the three curcumin treated groups than that in the SiO_2 stimulation group(P<0.05). In addition, all the above indexes decreased with the increase of curcumin intervention dose(P<0.05). The mRNA relative expression of NLRP3 and IL-1β, and the protein relative expression of pro-IL-1β increased in the medium-dose curcumin group(P<0.05), the secretion levels of mIL-1β and IL-18, as well as the protein relative expression and secretion levels of cleaved Caspase-1 and mIL-1β decreased(P<0.05), compared with the NF-κB inhibition group. CONCLUSION: Curcumin can inhibit SiO_2-induced AM NLRP3 inflammasome activation in a dose-response relationship. This process may be related to the inhibition of NF-κB signaling pathway by curcumin and the down-regulating NLRP3 inflammasome-related genes at the transcriptional level. The important mechanism may be that curcumin directly blocks the activation, assembly, and downstream shearing of NLRP3 in inflammasomes.

Ferroptosis is a new programmed cell death characterized by iron dependent and intracellular oxidative accumulation. Current studies have confirmed that ferroptosis is involved in the occurrence and development of neurotoxicity injury, tumors, cardiovascular diseases and other diseases. This paper reviews the mechanisms of ferroptosis and its role in related diseases based on recent studies.

Pyroptosis is a programmed death mode dependent on Caspase-1/4/5/11, which is caused by activation of inflammasome, accompanied by cell membrane rupture, pore formation and cell content release. As a new type of cell death, it is widely involved in respiratory diseases, such as pulmonary fibrosis, acute lung injury, bronchopulmonary dysplasia, chronic obstructive pulmonary disease and asthma. This article reviews the mechanism of pyroptosis and its role in different respiratory diseases, in order to provide new ideas for the treatment of respiratory diseases.

Objective:To construct sensitive indexes for postoperative pain nursing in adult inpatients so as to provide a scientific, objective and quantifiable basis for dynamic monitoring and evaluation of postoperative pain nursing quality.Methods:The sensitivity indexes for postoperative pain nursing in adult inpatients were preliminarily determined by literature study and expert group discussion. From July to September 2019, Delphi method was used to carry out two rounds of expert consultations to establish a sensitive index system for postoperative pain in adult inpatients.Results:This study constructed a sensitive index system for postoperative pain in adult inpatients with 3 structural indexes, 3 process indexes and 4 result indexes. The expert authority coefficient ( Cr) was 0.87. The expert coordination coefficients of 2 rounds of consultation were respectively 0.27 and 0.32 ( P<0.01) . Conclusions:The established sensitive indexes for postoperative pain nursing in adult inpatients is scientific and practical, which is conducive to the continuous improvement of postoperative pain nursing quality and increase patients' satisfaction with pain nursing.

Ferroptosis is a new programmed cell death characterized by iron dependent and intracellular oxidative accumulation. Current studies have confirmed that ferroptosis is involved in the occurrence and development of neurotoxicity injury, tumors, cardiovascular diseases and other diseases. This paper reviews the mechanisms of ferroptosis and its role in related diseases based on recent studies.

Pyroptosis is a programmed death mode dependent on Caspase-1/4/5/11, which is caused by activation of inflammasome, accompanied by cell membrane rupture, pore formation and cell content release. As a new type of cell death, it is widely involved in respiratory diseases, such as pulmonary fibrosis, acute lung injury, bronchopulmonary dysplasia, chronic obstructive pulmonary disease and asthma. This article reviews the mechanism of pyroptosis and its role in different respiratory diseases, in order to provide new ideas for the treatment of respiratory diseases.

Objective To evaluate the relationship between perioperative peripheral blood Type 17 helper (Th17) cells and Th17-related cytokines and postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia.Methods Ninety-six patients of both sexes,aged 65-86 yr,of American Society of Anesthesiologists physical status Ⅱ or m,scheduled for elective hip replacement under general anesthesia,were selected.At 3 days before operation and 1,2,3 and 7 days after operation,Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function,and fasting venous blood samples were taken for determination of the percentage of Th17 cells and serum interleukin-17 (IL-17) and IL-22 concentrations.The patients were divided into POCD group and non-POCD group according to whether the patients developed POCD at day 7 after operation or not.Pearson linear correlation of the percentage of Th17 cells and serum IL-17 and IL-22 concentrations with MoCA scores was analyzed.Results Twenty-six patients developed POCD (27.1％).The percentage of peripheral blood Th17 cells and serum IL-17 and IL-22 concentrations were significantly higher at each time point after operation than before operation in POCD group and at 1 and 2 days after operation than before operation in non-POCD group (P＜0.05).The percentage of peripheral blood Th17 cells and serum IL-17 and IL-22 concentrations were significantly higher at each time point after operation in POCD group than in non-POCD group (P＜0.05).The percentage of peripheral blood Thl7 cells was negatively correlated with MoCA scores (r =-0.867,P＜0.01) and serum IL-17 and IL-22 concentrations were negatively correlated with MoCA scores (r=-0.662 and-0.638,P＜0.01) in group POCD.Conclusion The development of POCD is related to the increase in the percentage of peripheral blood Th17 cells and concentrations of Th17-related cytokines IL-17 and IL-22 in elderly patients undergoing general anesthesia.

Objective: To observe the repairing effect of adipose mesenchymal stem cells (ADSCs) on lung injury induced by silica in rats. Methods: Primary ADSCs-GFP was obtained from rats. ADSCs-GFP was injected into tail vein of silicosis model rats. The expression of green fluorescence in lungs was observed regularly to determine the homing ability of ADSCs. Primary ADSCs of rats were obtained and randomly divided into control group, exposure group, vehicle group and ADSCs group. Silicosis rat model was established by non-exposed tracheal drip method. 24 hours after silica exposure, rats in ADSCs group were injected with ADSCs of 1×10⁶/kg body weight through tail vein, and the pathological changes of lung tissue were observed and evaluated 28 days after intervention. To explore the early intervention mechanism of ADSCs on pulmonary fibrosis in silicosis model rats, apoptosis-related proteins were detected by immunohistochemistry. Results: 28 days after exposure to silica, rats in the exposure group showed obvious pulmonary fibrosis. Compared with exposure group and vehicle group, ADSCs group showed less pulmonary inflammation, less silica nodules and less collagen deposition area. Immunohistochemical results showed that the expression of Caspase-3 and cytochrome C protein decreased and Bcl-2 protein increased after ADSCs transplantation. Conclusion ADSCs infusion has an obvious intervention effect on postponing early silicosis fibrosis in rats exposed to silica, and its mechanism is related to the regulation of apoptotic process.