Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).

It is believed that the key pathogenesis of endometriosis combined with infertility is spleen and kidney yang deficiency and binding of dampness and stasis， for which the method of warming yang and removing turbidity is advocated， and self-made Wenyang Huazhuo Formula （温阳化浊方） is recommended with flexibility by stages in accordance with the rules of the changes of yin and yang in the menstrual cycle and the storing and drainage of uterus. Specifically， during the menstruation， it is suggested to warm channels and invigorate blood， drain dampness and remove dampness； during the late menstruation， the method of warming yang and replenishing yin， regulating and supplementing the chong mai （冲脉） and ren mai （任脉）； for inter-menstruation period， it is advised to warm yang and replenish qi， rectify qi and harmonize blood； in terms of premenstrual period， the method of warming and supplementing spleen and kidney， warming uterus and assisting in fertility can be used. Accordingly， Formulas at the menstruation stage， follicular stage， ovulation stage， and luteal stage to warm yang and remove turbidity are recommended in their modifications， respectively.

Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58％) and in the lumbar spine in females (23.38％). The age-standardized prevalence of osteoporosis at any site was 6.46％ in males and 29.13％ in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46％ in males and 29.13％ in females aged 50 years and older.

Objective To fabricate an antibacterial controlled drug delivery system with PEG-hydrogel and gentamicin-loaded-CSt on titanium surface,and to investigate its surface characteristics,swelling behavior,drug release behavior in vitro,antiinfection performance in vivo,and tissue biocompatibility.Methods Cross-linked starch (CSt) was synthesized first and then CSt was loaded with gentamicin (GEN) as a carrier (GEN@CSt),then 4-arm-polyethylene glycol (PEG) was added to it which was mixed by ultrasound.The surface of titanium (Ti) was covered with a layer of poly dopamine (PDA).The drug-loaded hydrogel was fixed to the titanium surface,subsequently capped by poly lactic-co-glycolic acid (PLGA) membranes,and then the Ti-PDA-PEG (GEN@CSt)-PLGA composite coating was fabricated finally.Surface morphology of the system was observed,while the swelling behavior was characterized;release behavior of the composite coating was detected;the bacteriostatic experiments were carried out with staphylococcus aureus (SAU),staphylococcus epidermidis (SEP) and escherichia coli (ECO) in vitro.The animal models of infected bone defect was established in 36 New Zealand white rabbits.These animals were randomly divided into three groups.Group 1 animals were implanted with drug-loaded composite coatings.Group 2 animals were implanted with drug-free composite coatings.Group 3 animals were implanted with bare titanium rods.The infection data were collected periodically to carry out antiinfection experiments in vivo.Another 12 rabbits were divided into the experimental group and the control group randomly.Biocompatibility of the materials was observed by histopathology after implantation of the corresponding materials into the femoral condyle.Results The composite coating adhered to the titanium surface firmly,presenting a smooth and translucent shape.The ratio of CSt/PEG affects swelling behavior varied,starch-free gels maintained an equilibrium swelling of 7.4,after the ratio reached 1 ∶ 1,the equilibrium swelling ratio remained at 3.0.In-vitro the release rate of the first 8 h was fast,and the cumulative release amount accounted for 83％ of the total in the first 7 days,lasting more than 13 d.In vitro antibacterial test,the average diameter of the inhibition ring was 3.6±0.13 cm (SAU),3.4±0.11 cm (SEP),3.7±0.10 cm (ECO).In-vivo anti-infection experiment,the infection situation of the group 1 was better than the control groups 2 and 3.The pathological results indicated that inflammatory reaction in the experimental group was basically the same as the control group.Conclusion The study successfully fabricated the antibacterial controlled drug delivery system with PEG-hydrogel and gentamicin-loaded-CSt on titanium surface.The system has a reasonable drug release behavior,and effectively inhibited the growth of bacteria in vivo and in vitro.It also has good biocompatibility to stand a promising strategy to improve the orthopedics anti-infection.

Objective To evaluate the feasibility and clinical outcomes of second sacral alar-iliac (S2AI) technique utilized in patients with tuberculosis of Lumbosacral spine.Methods 24 cases (15 male,9 female,aged 36-73 years old,average 47.1 years) of tuberculosis of Lumbosacral spine were collected for surgery using spinal and pelvic fixation system (S2AI or IS) between January 2014 and May 2016.Lumbosacral pain and restricted movement were noticed in all cases,of which 9 cases with radiating pain of lower limb and 7 cases with intermittent claudication,2 cases with saddle anesthesia.Formal anti-tuberculosis medicine treatment was given for at least 2-3 weeks before operation.All patients with lumbosacropelvic fixation were compared by recording with ESR/CRP,preoperatively,postoperatively and the last following-up.The clinical effect oswestry disability index (ODI) score,visual analogue scale (VAS),ambulatory status,SF-36 scale and related complications of 2 groups were also compared.Results The average follow-up period was average 23.4 months in the two groups.The results show that operative time,blood loss,drainage time,hospitalization days and fusion time were not statistically significant;the recording of ESR,CRP,ODI,VAS scores and ambulatory status scores between S2AI and IS groups showed no significantly different,preoperatively,postoperatively and the last following-up.Comparisons within each group were improved at postoperatively and the last following-up related to preoperatively;The difference of the SF-36 scales in each group was statistically significant between preoperatively and the last following-up;There was no statistically difference in recurrence,sinus,pseudarthrosis between two groups,but The S2AI technique was associated with lower rates of symptomatic screw prominence compared to the IS technique.Conclusion Application of S2AI screw technique in the treatment of lumbosacral tuberculosis can achieve solid fixation and satisfactory clinical effect,and reduce the complications of traditional IS screws,which is an alternative method of posterior structure reconstruction of lumbosacral tuberculosis.

Objective To investigate the causes of spinal tuberculosis retreatment and its surgical treatment strategy.Methods Between May 2010 and May 2014,96 patients with spinal tuberculosis who had been operated before were retreated.The dates of them were reviewed.There were 51 males and 45 females with mean age of 39.7 years.Deciding upon the revision surgical procedure should be determined by last operation approach,the direction of compression of spinal cord,the position of sinus and extent of foci.The retreated patients were compared with 481 unretreated patients in the following index including sex,age,duration of disease,focus range,nutrition,drug resistant tuberculosis,debridement,stability of instrumentation,postoperative regular chemotherapy,associated tuberculosis.Results The surgery duration time was 160-280 min,average 210 min,and the blood loss was 400-1500 ml,average 600 ml.The VAS score before the operation was 6-9 (average 7.5) and 1-3 (average 1.5) at the last follow-up,the difference was statistically significant.Neurological deficits in 21 patients clinically improved at least one grade according to the ASIA grading system at last follow-up.Kyphosis and scoliosis degrees were corrected significantly postoperatively and the correction was 9.5°±3.6° at the final follow-up.The average angle loss was 3.5°±1.1°.There was significant difference between the kyphosis angles preoperatively,postoperatively and final follow-up.Kirkaldy-Willis function score showed that the total fine rate was 88％.There were 35 patients whose tuberculosis bacterial culture and drug sensitive experiments suggested drug resistance.Wound healing delayed in 7 patients.24 cases had sinus formation,13 cases in which were healed after wound dressing,and 11 cases undertook operation again.Conclusion The causes of spinal tuberculosis retreatment include uncompleted debridement,drug resistant strains of tuberculosis,irregular postoperative anti-tubercular treatment,poor preoperative nutritional status and failure of spinal stability reconstruction.The key of successful revision surgery includes radical debridement,strut grafting with autologous iliac bone block,proper reconstruction of spinal stability,individualized chemotherapy according to the drug-resistance,and the appropriate use of irrigation and drainage postoperatively.

BACKGROUND:Tissue-engineered bone can be obtained by the combination of chondrocytes and polyglycolic acid scaffold. OBJECTIVE:To investigate the effect of alogeneic chondrocytes/polyglycolic acid scaffold compound in the repair of thyroid cartilage defects in rabbits. METHODS: Twenty New Zealand adult rabbits were randomly divided into experimental group with implantation of alogeneic chondrocytes/polyglycolic acid scaffold compound and control group with implantation of polyglycolic acid scaffold. Gross and histological observations were done at 4 and 8 weeks after implantation. RESULTS AND CONCLUSION: (1) Gross observation results: 4 weeks after surgery, cartilage defects in the experimental group were repaired certainly, and no necrosis appeared in the repair area; in the control group, the defects were filed with muscle and connective tissues. At 8 weeks after implantation, cartilage defects in the experimental group were further repaired, with unclear repair boundaries, and in the control group, cartilage defects were no repaired and showed a notable boundary with the surrounding normal cartilage tissues. (2) Immunohistochemical staining results: the expression of type II colagen in the experimental group was higher than that in the control group (P < 0.05) at 4 and 8 weeks after implantation. These findings indicate that the alogeneic chondrocytes/polyglycolic acid scaffold compound can promote the repair of thyroid cartilage defects in rabbits.

Objective To fabricate an anti?tuberculosis controlled drug release coating with Ti?PDA?PEG?PLGA?INH and to investigate its surface characteristics, in vivo and in vitro drug release behavior, and tissue biocompatibility. Methods 4?arm?polyethylene glycol (PEG) was synthesized first. Then cover the surface of titanium (Ti) with a layer of poly dopamine (PDA) by Michael addition reaction. Use porous starch and 4?arm?PEG as a carrier, load with isoniazid (INH), then attach to the surface of titanium by casting or sol?gel dip coating methods, and then cover with a layer of poly lactic?co?glycolic acid (PLGA) by the same method, to fabricate the Ti?PDA?PEG?PLGA?INH composite coating finally. The functional group of 4?arm?PEG was charac?terized by proton nuclear resonance spectroscopy (HNMR). The surface characteristics of Ti?PDA?PEG?PLGA?INH were evaluated by scanning electron microscope (SEM), while drug release behaviors were detected by high performance liquid chromatography (HPLC) and the cumulative release rate was calculated, and carry out the antibacterial performance in vitro. The animal model of femoral condyle bone defect was established in 25 New Zealand white rabbits. Titanium rods covered with PDA?PEG?PLGA?INH coating were implanted into defect area. INH concentrations were detected by HPLC in venous blood, muscle and bone tissue at each time point postoperatively. Another 12 rabbits were randomly divided into experimental group and control group, the experi?mental group was implanted with titanium tablets and titanium rods coated with PDA?PEG?PLGA?INH in the paraspinous muscle and left femoral condyles respectively, while the control group was implanted with a blank sheet of titanium tablets and titanium rods in the same place. Hematoxylin and Eosin Staining were used to observe the biocompatibility of the composite system in vivo at 28 and 56 days postoperatively. Results Ti?PDA?PEG?PLGA?INH controlled drug release coating uniformly distributed on the surface of plates and rods, with translucent form and smooth surface. In vitro INH release kinetics exhibited a short?burst release during the first 8h, and the cumulative release of the INH was about 65%. On the 9th day, the cumulative release of the INH was about 90%, and then the release tended to be flat, and the drug release behavior in vitro continued more than 20d. In vivo release test showed that the concentration of INH in vein blood, muscle and bone tissue around the composite system was increased steadi?ly postoperatively. On about the 28th day, the concentration reached the max. However, the INH concentrations in muscle and bone tissue around the composite system were still higher than the minimum inhibitory concentration (MIC) on the 56th day. The antibacterial test in vitro showed that the titanium tablets coated with PDA?PEG?PLGA?INH formed obvious bacterial inhibition zones. The pathological results indicated that mild inflammatory reaction was seen in the 4th week postoperatively, and the reac?tive capsule formed with loose connective tissue. In the 8th week postoperatively, there's no obvious inflammation occurred, and the reactive capsule became more dense and thicker. Conclusion The study successfully fabricated the Ti?PDA?PEG?PLGA?INH anti?tuberculosis controlled drug release coating, with reasonable release behavior both in vivo and in vitro, effective antibac?terial effect of Mycobacterium tuberculosis in vitro and good tissue biocompatibility, which is a potentially effective drug delivery system for spinal tuberculosis.

Objective To explore a biodegradable drug?loaded composite scaffold and determine its bone regeneration and local long?term drug release ability. Methods In this study, RFP?loaded a novel poly (caprolactone)?b?poly (lactide?co?gly?colide)/β?TCP composite scaffold was produced using particle?leaching/freeze?drying technique. And the obtained composite scaffold was characterized by SEM, TGA, UV spectrophotometer, universal testing machine and so on. New Zealand rabbits were used to prepare bone defects, which was treated by the implantation of active artificial bone loaded with or without RFP. The blank group was untreated. Then the repairing effects of the materials were examined. Results The obtained porous scaf?fold has inter?connected and uniformly distributed pores, and the diameters of pores range from 200 μm to 300 μm. Many mi?cropores (10 μm to 50 μm) can be observed on the wall of macropores. The total porosity of the porous composite scaffold can reach as high as 83.4%; the β?TCP content of the scaffolds is 51.2%. Meanwhile, the addition of β?TCP avoided volume shrinkage compared with b?PLGC scaffold; Additionally, the porous composite scaffold has good compressive strength ( 240 kPa) and compressive modulus (1.0 MPa); And the drug loading of the scaffold was 3.2%,which could smoothly release drug for 63 days after a period of burst release for a week. All defects in the experimental groups were radiographically repaired. There were significant differences between the experimental groups and the control group. Conclusion RFP?loaded poly (cap?rolactone)?b?poly (lactide?co?glycolide)/β?TCP composite scaffold is expected to benefit in drug therapy and bone repair in the treatment of bone tuberculosis.

BACKGROUND:Anterior cervical discectomy and intervertebral disc replacement have been extensively used in treatment of cervical degenerative disease. Its short-term therapeutic effects are encouraging, but it lacks of long-term and comprehensive evaluation.
OBJECTIVE:To observe the folow-up results of a group of cases of anterior cervical discectomy and Mobi-C intervertebral disc replacement for more than 5 years.
METHODS:A total of 25 cases of cervical spondylosis were treated in the 309 Hospital of Chinese PLA from January to September 2009. 19 of them were folowed up. Al patients received anterior cervical discectomy and Mobi-C intervertebral disc replacement. Twenty-three Mobi-C intervertebral disc prostheses were implanted. The range of motion was measured using lateral X-ray films during extension and flexion. Ectopic ossification was assessed by McAfee method. According to the cervical vertebra MRI images, the degeneration of adjacent segments was determined using Pearce classification. NDI score was used to evaluate the function of cervical spine. Pain improvement was evaluated using visual analogue scale score.
RESULTS AND CONCLUSION: A total of 19 patients were folowed up for 59-65 months, averagely 62 months. No significant difference in range of motion was detected before surgery and during final folow-up (P > 0.05). Ectopic ossification in two cases and the degeneration of adjacent segments in one case were found during final folow-up. No prosthesis loosening or displacement appeared. Visual analogue scale score and NDI score were significantly lower during final folow-up compared with that before surgery (P < 0.05). These results indicate that under the premise of reasonable choice of indications, the therapeutic effect of Mobi-C intervertebral disc replacement for degenerative cervical spondylosis was satisfactory in five-year folow-up. The range of motion was good, and the incidences of ectopic ossification and the degeneration of adjacent segments were low.