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.

Humans ; Asthma/drug therapy* ; Biological Therapy

Objective:To survey the knowledge levels about diagnosis and management of asthma among general practitioners in community health centers in Shanghai and to analyze influencing factors.Methods:A questionnaire survey was conducted from May to June 2022 among general practitioners from 80 community health care centers in Shanghai. The questionnaire contained the basic information of the responders; knowledge about the diagnosis of asthma (symptoms, diagnostic methods, interpretation of bronchodilation and fractional exhaled nitric oxide, FeNO tests); and treatment of asthma (choosing and usage of therapeutic drugs). Logistic regression was used to analyze.Results:A total 324 general practitioners completed the questionnaire survey. Among them 221 (68.21%) had bachelor degree; 200 (61.73%) were attending doctors; the median working duration was 11 years; 174 (53.70%) had training on asthma knowledge in last 3 years. The survey results showed that 55 (16.98%) responders misinterpreted results of bronchodilation test, and 90(5.86%)misinterpreted results of FeNO test for diagnosis of asthma; 244 responders (75.31%) suspected implication of long-term cough for diagnosis of asthma; 277(85.49%)would order bronchodilation text to suspected patients; 273(84.26%)prescribed inhaled corticosteroid plus long-acting beta-2 agonist to asthma patients. For mild asthma patients, 144 responders(44.44%)suggested to use budesonide formoterol as needed; for moderate to severe asthma, 174(53.70%)suggested to use budesonide formoterol regularly and as needed, 100(30.86%)suggested to use salmeterol fluticasone regularly and salbutamol as needed. Logistic analysis showed that longer working duration was correlated with higher misinterpretation rate of bronchodilation and FeNO tests( OR=0.798,95% CI:0.694-0.918, P=0.002; OR=0.859,95% CI:0.739-0.998, P=0.047). The accuracy rate of all the questions was significantly higher in general practitioners who had training on asthma knowledge than those who didn′t receive training in last 3 years(all P<0.05). Conclusions:Most general practitioners in community health service centers in Shanghai have relatively high levels of knowledge about diagnosis and treatment of asthma. Years of work experience and training experience can affect the levels of asthma knowledge among community general practitioners.

Objective:To investigate the expression changes of lncRNAs and mRNAs in human umbilical vein endothelial cells(HUVEC) treated by tritiated water.Methods:HUVEC cells were divided into two groups, the control group cultured in DMEM medium, and the tritiated water exposure group cultured in a medium containing tritiated water with a final concentraion of 3.7×10 3 Bq/ml. After culture for 48 h, cells were collected for RNA extract.The differentially expressed lncRNAs and mRNAs were screened by high-through put chip technology and then analyzed. Results:Compared with the control group, 1 717 lncRNAs were significantly up-regulated and 3 994 lncRNAs significantly down-regulated, and 4 562 mRNAs were significantly up-regulated and 1 433 mRNAs down-regulated. Through co-expression analysis of differential mRNAs and lncRNAs, some key genes including SQSTM1, CXCL8, ITPR1, GADD45A, NF-kB1 and VDAC1 were obtained.Conclusions:Tritiated water exposure can induce multiple changes of mRNAs and lncRNAs in vascular endothelial cells, which may lead to toxic effects through signaling pathways including some key genes such as SQSTM1, CXCL8, and ITPR1.

Objective:To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation.Methods:Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software.Results:According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage ( n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage ( n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant ( P<0.001). There were no significant differences between the two stages of patients in terms of other aspects ( P>0.05). Conclusions:CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.

Objective:To explore the learning curve of central pancreatectomy (CP) and provide an excellent reference for surgeons to get the point of this operation.Methods:Clinical data of 73 patients who underwent CP in the same operation team from January 2006 to January 2018 were collected and retrospectively analyzed by the moving average method (MAM) and the cumulative sum method (CUSUM). Data was analyzed by statistical package for social science (SPSS) software.Results:According to the MAM and CUSUM curves, the learning process of CP could be divided into two stages. At the first stage ( n=1-11), the median operation time was 340 minutes and the median intraoperative hemorrhage was 400 ml. In the second stage ( n=12-73), the median operation time was 213 minutes and the median intraoperative hemorrhage was 100 ml. The difference was statistically significant ( P<0.001). There were no significant differences between the two stages of patients in terms of other aspects ( P>0.05). Conclusions:CP can be mastered after 11 cases of exercises. In the first 11 operations, surgeons should get familiar with the operation process, respond actively to emergencies and accumulate experience to gain this surgical technique fast.

Objective To evaluate the clinical value and effect of biofeedback training therapy for functional constipation in elderly patients.Methods A total of 78 elderly patients with functional constipation were treated at the People's Hospital of Pudong New Area,and were divided randomly into two groups.The control group (n =39) received routine treatment plus oral polyethylene glycol,while the experimental group (n=39) received biofeedback training treatment in addition to what was offered to the control group.After treatment,constipation symptom scores,anorectal dynamic parameters and clinical effects were compared between the two groups.Results The scores on excrement characteristics,defecation difficulty,and time and frequency of defecation were better in the experimental group than those in the control group (t=5.670,4.740,4.170,5.530;P=0.016,0.034,0.039,0.022,respectively).The overall effectiveness rate was 94.9 ％ (37/39) in the experimental group,which was higher than that (71.8 ％,2 8/3 9) in the control group (x2 =4.493,P=0.030).Meanwhile,the levels of 3 SC and 10 SC in the two groups were higher than those before treatment,but the level of 10SR was lower than that before treatment (all P＜0.05).Moreover,improvement in 3SC,10SC and 10SR were more significant in the experiment group than in the control group (all P＜ 0.05).Conclusions Biofeedback training therapy is safe and effective for elderly patients with constipation to relieve constipation symptoms,enhance control of defecation and promote defecation.

Background and purpose:Long non-coding RNA (lncRNA) could be an important player in cancer biology. Recent studies showed that lncRNA PCGEM1 might be important in the regulation of androgen recep-tor (AR) signaling pathway. We tried to observe the expressions of lncRNA PCGEM1 and AR in prostate cancer, and investigate their role and signiifcance in prostate cancer genesis and progress.Methods:The expression of lncRNA PCGEM1 was observed in prostate cancer by lfuorescencein situ hybridization (FISH) technique. Then detection of AR was performed by immunolfuorescence histochemistry methods. Their co-effective role was checked by RNA pull-down technique.Results:Compared with the AR-independent cell line such as PC3 or DU145, AR-dependent cell line such as LNCaP showed much higher expression of lncRNA PCGEM1 (P<0.01). PCGEM1 and AR could be co-localized in most of these prostate cancer samples, especially in the metastasis samples. Moreover, androgen deprivation promoted the translocation of PCGEM1 into nucleus. RNA pull-down results also proved the co-effective role of PCGEM1 and AR.Conclusion:This study showed that lncRNA PCGEM1 was highly expressed in metastatic prostate cancer. It was related to the progress and malignant behavior of the prostate cancer. Its co-localization with AR may play an important role in prostate cancer genesis and progress.

BACKGROUNDThe efficacy of montelukast (MONT), a cysteinyl leukotriene receptor antagonist, in nonasthmatic eosinophilic bronchitis (NAEB), especially its influence on cough associated life quality is still indefinite. We evaluated the efficacy of MONT combined with budesonide (BUD) as compared to BUD monotherapy in improving life quality, suppressing airway eosinophilia and cough remission in NAEB.

METHODSA prospective, open-labeled, multicenter, randomized controlled trial was conducted. Patients with NAEB (aged 18-75 years) were randomized to inhaled BUD (200 μg, bid) or BUD plus oral MONT (10 μg, qn) for 4 weeks. Leicester cough questionnaire (LCQ) life quality scores, cough visual analog scale (CVAS) scores, eosinophil differential ratio (Eos), and eosinophil cationic protein (ECP) in induced sputum were monitored and compared.

RESULTSThe control and MONT groups contained 33 and 32 patients, respectively, with similar baseline characteristics. Significant with-in group improvement in CVAS, LCQ scores, Eos, and ECP was observed in both groups during treatment. After 2-week treatment, add-on treatment of MONT was significantly more effective than BUD monotherapy for CVAS decrease and LCQ scores improvement (both P < 0.05). Similar results were seen at 4-week assessment (both P < 0.05). 4-week add-on therapy of MONT also resulted in a higher percentage of patients with normal sputum Eos (<2.5%) and greater decrease of ECP (both P < 0.05).

CONCLUSIONSMONT combined with BUD was demonstrated cooperative effects in improvement of life quality, suppression of eosinophilic inflammation, and cough remission in patients with NAEB.

Acetates ; therapeutic use ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bronchitis ; drug therapy ; immunology ; Budesonide ; therapeutic use ; Cough ; drug therapy ; Female ; Humans ; Inflammation ; drug therapy ; Male ; Middle Aged ; Quality of Life ; Quinolines ; therapeutic use ; Young Adult

Objective To explore the diagnostic value and optimal cut-off point of symptom index (SI) in gastroesophageal reflux-induced chronic cough (GERC).Methods The recordings of multichannel intraluminal esophageal impedance and pH monitoring were retrospectively analyzed in 118 patients with suspicious GERC.SI for all the refluxes,acid reflux and non-acid reflux was calculated respectively by analyzing the temporal association between detected reflux and cough recorded on diary card.Based on the favorable response to the anti-reflux therapy,the diagnostic value for GERC of SI was evaluated and compared with that of the symptom association probability (SAP).Results GERC was definitely determined in 100 patients (84.7％).When SI for all the refluxes was used for the diagnosis of GERC,the cut-off point of ≥45％ had the highest diagnostic efficacy,with the sensitivity of 56.0％,the specificity of 83.3％and Youden index of 0.393.SI for acid or non-acid reflux had the same optimal cut-off point of ≥30％ and presented with the similar efficacy in the diagnosis of acid or non-acid GERC.Compared with SAP of ≥75％,SIforall the refluxes of ≥45％ had a lower sensitivity (56.0％ vs 75.0％,x2 =7.988,P=0.005),a higher specificity (83.3％ vs 44.4％,x2 =5.900,P =0.015) and the comparable positive or negative predictive value in the diagnosis of GERC.The diagnostic accuracy for GERC was further improved when combining SI for all the refluxes with SAP.Conclusion SI for all the refluxes has a diagnostic value similar to SAP and its optimal cut-off point for GERC may be ≥45％.