Objective:To compare and analyze the differences in the measurement of intra-abdominal pressure in different positions of critically ill patients treated with extracorporeal membrane oxygenation (ECMO) combined with prone position integration, with a view to finding a more optimal intra-abdominal pressure monitoring strategy, which can provide a theoretical basis for clinical diagnosis and treatment.Methods:Forty critically ill patients who underwent ECMO combined with prone position integrated treatment in the department of Intensive Care Medicine of the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2023 were selected by convenience sampling method using an own-control trial. The differences in intra-abdominal pressure between supine position with head elevated at 0°, 15°and 30°and prone position with head high and foot low slopes at 0°, 15°and 30°were compared and analyzed. Heart rate, respiration, mean arterial pressure and oxygen saturation were also compared in patients in different positions.Results:There were 29 males and 11 females in 40 patients with the age of (62.58 ± 17.99) years.The intra-abdominal pressure in supine position with head elevated at 30° was (12.45 ± 3.43) mmHg(1 mmHg=0.133 kPa), which was higher than that of 0° and 15° of (9.38 ± 2.52) and (10.70 ± 2.95) mmHg, and the differences were statistically significant ( t=4.56, 2.45, both P<0.05);the difference in intra-abdominal pressure between 0° and 15° was not statistically significant ( P>0.05); the intra-abdominal pressure in prone position with head-high-foot-low slope of 30° was (12.92 ± 4.19) mmHg, which was higher than that of 0°and 15°of (9.67 ± 2.80), and (11.01 ± 3.10) mmHg, and the differences were statistically significant ( t=4.08, 2.32, both P<0.05); the difference in intra-abdominal pressure between 0° and 15° was not statistically significant ( P>0.05).The differences in intra-abdominal pressure between groups of supine bed head elevation 0°, 15°, 30°and prone position with head high and foot low slopes 0°, 15°, 30°were not statistically significant (all P>0.05). The differences in heart rate, respiration, mean arterial pressure and oxygen saturation in the supine position with head elevated at 0°, 15°and 30° were not statistically significant when compared within groups (all P>0.05); the differences in heart rate, respiration, mean arterial pressure and oxygen saturation in the prone position with head elevated with feet and feet on low slopes at 0°, 15°and 30°were not statistically significant when compared within groups (all P>0.05); and the differences in supine position with head elevated at 0°, 15°, 30°and prone head-height-foot-low slope 0°, 15°, 30°of heart rate, respiration, mean arterial pressure were not statistically significant (all P>0.05); supine bed head elevation 0°, 15°, 30°and prone head-height-foot-low slope 0°, 15°, 30°of oxygen saturation between the groups, the differences were statistically significant ( Z=6.85, 6.82, 6.68, all P<0.05). Conclusions:Intra-abdominal pressure can be measured in the 15° prone position in critically ill patients treated with ECMO combined with prone position integration; the different positions have little effect on vital signs, but the prone position significantly improves oxygen saturation.

Objective:To observe the clinical efficacy of Mahuang Fuzi Xixin Decoction combined with balanced acupuncture in the treatment of migraine with yang deficiency and cold congealing syndrome.Methods:Randomized controlled trial. Totally 91 cases of migraine with yang deficiency and cold congealing syndrome in our hospital from March 2021 to May 2022 were selected and divided into 45 cases in the Western medicine group and 46 cases in the integrated Chinese and Western medicine group according to random number table method. The Western medicine group took flunarizine hydrochloride capsules orally, and the integrated Chinese and Western medicine group combined ephedrine and aconiti asarum decoction + balanced acupuncture treatment on the basis of the Western medicine group. Both groups were treated for 1 month. Traditional Chinese Medicine syndrome score was performed before and after treatment, the degree of headache was assessed by VAS scale, and the impact of headache on life was assessed by Headache Impact Test-6 (HIT-6); the levels of 5-hydroxytryptamine (5-HT) and calcitonin gene related peptide (CGRP) were determined by radioimmunoassay. The adverse reactions during treatment were observed and recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 82.22% (37/45) in the Western medicine group and 95.65% (44/46) in the integrated Chinese and Western medicine group, with statistical significance ( χ2=4.20, P=0.041). After treatment, the scores of headache, hair, urine and cold limbs in the integrated Chinese and Western medicine group were lower than those in the Western medicine group ( t values were 18.49, 22.29, 21.31, 27.49, P<0.01), and the scores of VAS and HIT-6 were lower than those in the Western medicine group ( t values were 23.20, 9.33, P<0.01). After treatment, the level of 5-HT in the integrated Chinese and Western medicine group [(98.34±6.23) μg/L vs. (85.23±4.21) μg/L, t=11.74] was higher than that of the Western medicine group ( P<0.01); CGRP [(11.24±1.99) ng/L vs. (15.22±2.52) ng/L, t=8.37] was lower than that of the Western medicine group ( P<0.01). During treatment, the incidence of adverse reactions was 2.22% (1/45) in the Western medicine group and 2.17% (1/46) in the integrated Chinese and Western medicine group, without statistical significance ( P>0.05). Conclusion:Mahuang Fuzi Xixin Decoction combined with balanced acupuncture can effectively improve the clinical symptoms and life quality of patients of migraine with yang deficiency and cold congealing, and the clinical efficacy can be promoted.

Objective:To evaluate the volume changes of cervical longus and cervical extensor after anterior cervical discectomy and fusion (ACDF), and the correlation with the clinical efficacy of patients.Methods:All of 57 patients with cervical spondylotic myelopathy who underwent single-segment ACDF surgery from January 2013 to December 2018 were analyzed. The follow-up time was 23.0±4.8 months (range 16-34 months). All included subjects underwent MR examination within 1 week before operation and 3rd, 12th months after operation and at the last follow-up. The axial section cross section area (AxCSA) of the cervical longus and the ratio of length to short diameter line (RLS) at the level of each disc of C 2-C 7 were measured on the axial T2WI. Calculate the volume of the cervical longus based on the layer thickness. At the same time, measure the cervical extensor cross-sectional area (CESA) of the same level including the multifidus, cervical semispinous muscle, semispinous head, splinter head, and cervical splinter muscles, and compare CESA with the corresponding vertebral cross-sectional area (VBA). The ratio is analyzed as the volume of the neck extensor muscle, namely CESA/VBA. At the 3rd and 12th months after operation and at the last follow-up, the axial pain was assessed by visual analogue scale (VAS) for assessing pain, and the modified Japanese Orthopedic Association score (mJOA) and the neck dysfunction index (NDI) were used to assess the functional status of the cervical spine. Analyze the morphological changes of thecervical longus and extensor cervical muscles before and after the operation and during the follow-up period, and analyze the correlation with VAS, mJOA, and NDI. Results:Compared with the preoperative period, the average AxCSA of the surgical segment decreased at the 3rd and 12th months after the operation and at the last follow-up. The difference was statistically significant ( F=24.113, P<0.05), which was changed from 140.84±19.51 mm 2 respectively reduce to 117.74±17.15 mm 2 ( t=6.714, P<0.05), 116.37±18.67 mm 2 ( t=6.841, P<0.05) and 116.27±18.65 mm 2 ( t=6.873, P<0.05). Compared with preoperatively, they were reduced by 16.40%, 17.37% and 17.45%, respectively, while the average RLS of surgical segments increased slightly, and the difference was statistically significant ( F=22.612, P<0.05), which increased from preoperative 1.97±0.67 to 2.73±0.60 (38.58% increased, t=6.380, P<0.05), 2.82±0.64 (43.15% increased, t=6.926, P<0.05) and 2.74±0.62 (39.09% increased, t=6.368, P<0.05). The volume of thecervical longus of the patients decreased after the operation, and the difference was statistically significant ( F=64.511, P<0.05), which decreased from 8853.48±458.65 mm 3 before the operation to 7834.53±461.59 mm 3 (11.51% decreased, t=11.822, P<0.05), 7926.42±456.24 mm 3 (10.47% decreased, t=10.819, P<0.05), 7892.38±450.78 mm 3 (10.86% decreased, t=11.283, P<0.05). There were no statistically significant differences in the non-surgical segment AxCSA, RLS and the volume of thecervical longus at the 3rd and 12th months after surgery and the last follow-up ( P>0.05). There was no statistically significant difference of CESA and CESA/VBA compared to preoperative in the surgical segment and non-surgical segment ( P>0.05). Pearson correlation analysis showed that the volume of cervical longus and VAS at the 3rd month ( r=-0.308, P<0.05), the 12th month ( r=-0.210, P<0.05) and the last follow-up ( r=-0.404, P<0.05) were negatively correlated; Among the volume of cervical longus and NDI in the 3rd month ( r=-0.511, P<0.05), 12th month ( r=-0.518, P<0.05) and the last follow-up ( r=-0.352, P<0.05), there was a negative correlation; However, there was no statistically significant correlation between the cervical longus muscle volume and mJOA at each follow-up time point ( P>0.05); There was no significant correlation between CESA/VBA and VAS, NDI, and mJOA at the 3rd, 12th and last follow-up ( P>0.05). Conclusion:The volume and morphology of cervical longus after ACDF was significantly reduced compared with that before the operation, but the volume and morphology of the cervical extensor muscle did not change significantly. ACDF surgery mainly affects the cervical longus corresponding to the surgical segment, and the volume is negatively correlated with the VAS and NDI during follow-up.

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.

Exosomes are vesicles with a double globular membrane of lipids that can be secreted by a variety of cells, including stem cells. Exosomes have unique biological characteristics and irreplaceable powerful functions which play an important role in intercellular communication. The various cytokines, signal proteins, lipids and regulatory nucleic acids contained in stem cell exosomes can play a protective role against the injury of kidney, liver, heart, blood vessels and nerves. Stem cell exosomes delay the process of intervertebral disc degeneration by inhibiting the apoptosis of nucleus pulposus cells and increasing the synthesis of extracellular matrix, etc. The mechanism of its role is mainly through miRNA and related signaling pathways. Exosomes contain complex components. Although the mechanism of action of exosomes in intervertebral discs has been preliminarily explored, the components contained in exosomes are complex and the specific situation has not been fully understood, which still needs further study. In this review, the characteristics and functions of stem cell exosomes, extraction, identification and storage methods, the impacttovarious other tissues, as well as the effects on intervertebral discs and their mechanisms were elaborated in order to provide a basis for the study of intervertebral disc degenerative diseases.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective To observe the clinical features and evaluate the risk factors affecting prognosis in patients with secondary sepsis of gastrointestinal perforation (GIP). Methods A retrospective cohort study was conducted, and the patients with GIP admitted to the Department of General Surgery of Affiliated Shuyang People's Hospital of Xuzhou Medical University from January 1, 2014 to April 30, 2017 were enrolled, according to the presence or absence of sepsis occurrence, they were divided into GIP with and GIP without sepsis groups. The difference of gender, age, the time between the onset of GIP and the occurrence of sepsis, infection situation, body temperature, heart rate, respiratory frequency, white blood cell count (WBC), systemic inflammatory response syndrome (SIRS) in accord with standard, C-reactive protein (CRP), blood sugar, mean arterial pressure (MAP), lactic acid, number of cases having undergone laparoscopic surgery, sequential organ failure score (SOFA) and quick sequential organ failure score (qSOFA), Glasgow coma score(GCS), length of stay in intensive care unit (ICU), the total length of stay in hospital were compared;the status of survival and prognosis was assessed on day 30 by the Glasgow Outcome Scale (GOS). The indicators with statistical significance in the two groups were brought into the Cox regression model to analyze the independent risk factors affecting the prognosis of the patients. Results Fifty-eight patients with GIP were enrolled in this study. Among them, 22 cases developed secondary sepsis (GIP with sepsis group, there were 50.0% cases with single organ failure and 50.0% cases with multiple-organ failure, cases only in accord with 0-1 SIRS criteria accounting for 81.8%, and the mortality of secondary sepsis being 31.8%). No sepsis occurred in 36 patients (GIP without sepsis group). In GIP with sepsis group, the age, blood glucose, lactic acid, SOFA score, qSOFA, and the length of stay in ICU were significantly higher than those of GIP without sepsis group [age (years): 68.7±15.9 vs. 56.1±17.2, blood glucose (mmol/L): 6.9±2.3 vs. 5.9±1.2, lactic acid (mmol/L): 2.9±1.3 vs. 1.2±0.7, SOFA score: 5.6±3.2 vs. 0.5±0.4, qSOFA score: 1.0±0.9 vs. 0.3±0.1, the length of stay in ICU (days): 1.0 (0-4.0) vs. 0.1 (0-2.0), all P < 0.05], while MAP, GCS, and GOS scores in GIP with sepsis group were significantly lower than those in GIP without sepsis group [MAP (mmHg, 1 mmHg =0.133 kPa): 83.6±18.7 vs. 100.0±14.3, GCS score: 12.8±3.5 vs. 14.5±0.5, GOS score: 3.5±1.9 vs. 4.9±0.2, all P < 0.01]. Cox multivariable regression analysis showed: only low MAP and low GCS score were the independent risk predictors of death outcome for GIP with sepsis, the relative risk (RR) was 0.896 [95% confidence interval (CI) = 0.815-0.984, P = 0.022] and 0.585 (95%CI = 0.395-0.866, P = 0.007) respectively. Conclusion Patients with secondary sepsis following GIP have relatively high morbidity and much more risk factors, but only low MAP and low GCS score are closely associated with its high risk of death.

Objective To investigate the expressions of Pokemon and c-myc in colorectal cancer,colorectal adenomas and normal colorectal mucosa tissues,and demonstrate its relationship with clinicopathological features and prognosis in patients with colorectal cancer.Methods The specimens were taken from colorectal cancer tissue of 86 patients,colorectal adenomas tissue of 60 patients,and 40 normal colorectal mucosa tissue.The expressions of Pokemon and c-myc protein were detected by immunohistochemistry,and the expressions of Pokemon and c-myc gene were detected by reverse transcription polymerase chain reaction (RT-PCR).The correlation between the expressions of Pokemon and c-myc,and clinicopathological features was analyzed.Results The positive expression rates of Pokemon and c-myc protein in colorectal cancer tissue were significantly higher than those in colorectal adenomas tissue and normal colorectal mucosa tissue:69.8％ (60/86) vs.13.3％ (8/60) and 5.0％ (2/40),73.3％ (63/86) vs.15.0％ (9/60) and 2.5％(1/40),and the expression levels of Pokemon and c-myc gene in colorectal cancer tissue were significantly higher than those in colorectal adenomas tissue and normal colorectal mucosa tissue:0.915 ±0.247 vs.0.358 ±0.102 and 0.277 ±0.085,1.272 ±0.360 vs.0.398 ± 0.153 and 0.255 ±0.097,there were statistical differences (P ＜ 0.05).The expression levels of Pokemon and c-myc gene in colorectal cancer tissue had a close correlation with the degree of infiltration,histological differentiation,lymph node metastasis,distant metastasis and Dukes stage,there were statistical differences (P ＜ 0.05),but had no correlation with the sex,age,and tumor diameter (P ＞ 0.05).Conclusions The expression levels of Pokemon and c-myc are higher in colorectal cancer tissue,and the expressions are related to the clinicopathological features of colorectal cancer.The expression levels of Pokemon and c-myc may predict the prognosis in patients with colorectal cancer.

This study was aimed to discuss the external treatment of diabetic foot ulcer with traditional Chinese medicine (TCM) Yin-Huang-San (YHS) and to observe its promoting healing effect. Analysis was made on AGEs correlated with inflammatory factors and growth factors. A total of 60 patients with damp-heat-toxin pattern standard diabetic foot ulcer patients were randomly divided into the treatment group and control group. External application of YHS was given in the treatment group. And external application of metronidazole and glucose injection was given in the control group. The dressing was changed once a day. Blood was drawn 1 d before the treatment, and 7 d, 14 d, 21 d, 28 d after the medication. Improvements of patients’ clinical symptoms were observed. Dynamic monitoring was given on changes of hs-CRP, TNF-α, IL-1, VEGF, EGF, bFGF, PDGF and AGEs. The results showed that the total efficiency of the treatment group was 96.7%; and the total efficiency of the control group was 83.3%. Compared with the control group, external treatment with YHS can obviously improve clinical symptoms of diabetic foot ulcer (P<0.01), reduce AGEs and inflammatory factor, and increase the number of growth factors. AGEs had significant positive correlation with inflammatory factor; it had significant negative correlation with growth factors. It was concluded that YHS was effective in the treatment of diabetic foot ulcer patients with damp-heat-toxin pattern.