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.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

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 distinguish lung adenocarcinoma (ADC) from squamous cell carcinoma (SCC) using 18F-fluorodeoxyglucose (FDG) PET-based radiomic features. Methods:A retrospective analysis was performed in 182 patients (109 males, 73 females, age (59.0±8.3) years) with non-small cell lung cancer (NSCLC) who underwent 18F-FDG PET/CT scan between January 2018 and December 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All patients had been diagnosed pathologically with lung ADC or SCC. The patients were divided into a training set ( n=91) and a validation set ( n=91) using simple random sampling method. Radiomic features were extracted from the PET images of segmented tumors using the Python package. The minimum redundancy maximum relevance feature selection algorithm and least absolute shrinkage and selection operator were employed to select informative and non-redundant features, and a radiomics signature score (rad-score) was developed. Differences of rad-score between groups were compared by Mann-Whitney U test. Multivariate logistic regression was applied to select the important factors. A combined model was constructed based on the clinical variable and radiomics signature. The predictive performance of models was analyzed and compared using receiver operating characteristic (ROC) curves and Delong test. Results:Four radiomic features, namely HHL_first order_maximum, LHL_first order_entropy, HHH_ gray level dependence matrix_large dependence high gray level emphasis (GLDM_LDHGLE), HHL_GLDM_LDHGLE (H/L represent the high/low pass filter) were selected to build the rad-score. The rad-score showed a significant ability to discriminate between different histological subtypes in the two sets(training set: -1.30(-1.70, -1.04) vs -0.60 (-1.11, 0.20), z=-4.61, P<0.001); validation set: -1.31(-1.66, -0.96) vs -0.73(-1.02, -0.24), z=-4.76, P<0.001). The area under the curve (AUC) of the rad-score were equal to 0.815 (95% CI: 0.723-0.906) in the training set, and 0.813 (95% CI: 0.726-0.901) in the validation set, respectively, which were larger than those of the clinical variables (smoking had the best prediction performance, training set: 0.721 (95% CI: 0.617-0.810), validation set: 0.726 (95% CI: 0.623-0.814)), however, the difference was not significant ( z values: 1.319, 1.324, both P>0.05). When the clinical variable (smoking) and radiomics signature were combined, the complex model showed a better performance in the classification of histological subtypes, with the AUC increased to 0.862 (95% CI: 0.785-0.940; sensitivity: 88.00%(22/25), specificity: 72.73%(48/66)) in the training set and 0.854 (95% CI: 0.776-0.933; sensitivity: 75.00%(21/28), specificity: 84.13%(53/63)) in the validation set. The AUC values were significantly higher than those of the clinical variable (smoking; training set: z=3.257, P<0.001; validation set: z=3.872, P<0.001). Conclusion:Individualized diagnosis model incorporating with smoking and radiomics signature can help differentiate lung cancer subtypes in a non-invasive, repeatable modality.

Objective:To compare the performance of 68Ga-prostate specific membrane antigen (PSMA) PET/CT and MRI in preoperative diagnosis and staging of primary prostate cancer. Methods:Twenty-four patients with prostate cancer, who underwent preoperative 68Ga-PSMA PET/CT and prostate MRI in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between April 2018 and December 2019, were retrospectively enrolled. The pathological and follow-up results were considered as the gold standard, and diagnostic efficiencies of the 2 imaging methods were compared per patient and per type of lesions (seminal vesicle invasion, bladder neck invasion, lymph node metastasis and bone metastasis). The χ2 test was used for data analysis. Results:Prostate cancer was confirmed by pathology in 24 patients, including 6 cases with both seminal vesicle and bladder neck invasion, 5 cases with seminal vesicle invasion and 3 cases with invasion of bladder neck. Gleason scores in patients were as follow: 7 in 9 patients, 8-9 in 15 patients. The detection rates of 68Ga-PSMA PET/CT and MRI for primary prostate cancer were both 100%(24/24). The sensitivity, specificity and accuracy of 68Ga-PSMA PET/CT and MRI for detecting seminal vesicle invasion were 10/11, 13/13, 95.8%(23/24) and 9/11, 11/13, 83.3%(20/24), respectively. The specificity and accuracy were significantly different ( χ2 values: 6.231, 13.470, both P<0.05). The sensitivity, specificity and accuracy of 68Ga-PSMA PET/CT and MRI for detecting bladder invasion, which were 7/9, 13/15, 83.3%(20/24) and 3/9, 14/15, 70.8%(17/24), respectively, were not significantly different( χ2 values: 1.285, 0.164, 2.880, all P>0.05). Furthermore, the sensitivity, specificity and accuracy of 68Ga-PSMA PET/CT for detecting pelvic lymph node metastasis were 11/11, 13/13 and 100%(24/24), respectively, and those of MRI for evaluating pelvic lymph node metastasis were 6/11, 11/13 and 70.8%(17/24), and the specificity of the 2 methods were significantly different ( χ2=6.231, P<0.05). All the 5 patients with pelvic bone metastasis were positive on 68Ga-PSMA PET/CT imaging, but only 2 of them were positive on MRI. Information from 68Ga-PSMA PET/CT changed pelvic TNM stage in 41.7%(10/24) patients who underwent MRI for initial staging. Conclusions:68Ga-PSMA PET/CT imaging and MRI can both accurately detect intermediate- to high-risk primary prostate cancer and seminal vesicle invasion. 68Ga-PSMA PET/CT imaging is superior to MRI for evaluating lymph nodes and bone metastasis. 68Ga-PSMA PET/CT provides high accuracy for preoperative diagnosing and staging intermediate- to high-risk prostate cancer.

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.

Human immunodeficiency virus (HIV)-1 infection changes transcriptional profiles and regulates. the factors and machinery of the host that facilitate viral replication. Our previous study suggested that the serine/threonine kinase citron kinase (citK) promotes HIV-1 egress. To ascertain if HIV-1 infection affects citK expression in primary cells, peripheral blood mononuclear cells were infected with vesicular stomatitis virus G protein (VSV-G)-pseudotyped HIV-1 vector NL4-3-luc viruses, which resulted in remarkably increased expression of citK. citK overexpression led to a more than two-fold increase in HIV-1 production, whereas a significant decrease was observed when citK was depleted in CD4+ T cells. Infection with HIV-1 pseudoviruses induced increases in the mRNA and protein levels of citK by 2. 5- and 2. 7-fold in HEK293T cells, respectively. By cloning the 5-kb promoter of citK into a luciferase reporter system and transfecting the construct into HEK293T cells, enhanced luciferase activity was observed during HIV-1 infection. Taken together, these data demonstrate that HIV-1 infection upregulates citK expression at the transcriptional level, and thereby renders the host more susceptible to invasion by HIV-1.
CD4-Positive T-Lymphocytes ; virology ; Cloning, Molecular ; Gene Expression Regulation, Enzymologic ; HEK293 Cells ; HIV-1 ; physiology ; Humans ; Intracellular Signaling Peptides and Proteins ; genetics ; Protein-Serine-Threonine Kinases ; genetics ; Up-Regulation ; Virus Replication

Yersinia enterocolitica infection in humans and animals was investigated in this study to explore the source of infection .We collected samples from patients and pigs ,and then the strains were conducted to undergo serotyping ,virulence gene detection and PFGE molecular typing .Of the 150 patients samples ,3 were tested positive for Yersinia enterocolitica ,and one of them was O∶3 .Of the 222 pigs samples ,14 were tested positive for Yersinia enterocolitica ,and all of them were O∶3 .PFGE molecular typing showed that the Yersinia enterocolitica from patient and pig had high homology .Our study con-firmed that Yersinia enterocolitica from pigs could infect people and find that it could exist in the cured patient for at least two months .

Objective To estimate heart function among patients with diabetic foot ulcer,and to investigate the characteristics of heart failure(HF) before and after treatment of ulcer. Methods Items associated with diabetes and some physiological and biochemical indicators were observed in patients with diabetic foot ulcer(162 cases) and with high risk factors of ulcer(75 cases). Heart function was evaluated at patients′ admission, during ulcer related treatment, and prior to discharge. Left ventricular ejection fraction and other cardiac assessment were measured with ultrasonic scan.Results During hospitalization, 23.6%(56/237) patients underwent HF with normal left ventricular ejection fraction, and it was 27.2%(44/162) in patients with foot ulcers. The prevalence of HF was 8.9%(21/237) in all patients studied on admission, and that was 10.5%(17/162) in patients with foot ulcer, more than that without foot ulcer(P＜0.01). More patients with HF were found, being 14.8%(35/237) during 2-7 days after ulcer related treatment initiated, and peak was on the 4th day. There was statistical difference among different Wagner grades(P＜0.05) about the morbidity rate of HF. All patients with HF were improved and tolerant to ulcer related treatment. Conclusion The prevalence of HF with normal left ventricular ejection fraction was relatively high in patients with diabetic foot ulcer, especially after ulcer treatment.