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.

Aim To explore the role of the ten-eleven translocation 2(TET2)/ubiquinol-cytochrome C reductase hinge protein(UQCRH)axis in the inhibition of vascular smooth muscle cell(VSMC)apoptosis by fibroblast growth fac-tor-2(FGF-2).Methods Cultured VSMCs were divided into control group,FGF-2 group,and FGF-2+fibroblast growth factor receptor(FGFR)pan-inhibitor LY2874455 group.VSMCs overexpressing TET2(OETET2)or UQCRH(OEUQCRH)were divided into control group,FGF-2 group,and OETET2+FGF-2 or OEUQCRH+FGF-2 group.Ho-echst33342 and PI staining were used to detect cell apoptosis,CCK-8 assay was employed to measure cell proliferation,and Western blot was used to examine the expression levels of apoptosis-related proteins pro-Caspase-3,cleaved Caspase-3,Bax,Bcl-2,as well as TET2 and UQCRH.The NCBI and methprimer websites were utilized for predicting and analyzing CpG island sites in the UQCRH gene promoter.Results FGF-2 could inhibit VSMC apoptosis,promote proliferation,downregulate apoptosis-related proteins cleaved Caspase-3,Bax,TET2,and UQCRH expression,and upregulate anti-ap-optotic protein Bcl-2 expression(compared with control group,P＜0.05).However,it did not affect pro-Caspase-3 ex-pression(compared with control group,P＞0.05).LY2874455 could counteract the effects of FGF-2(compared with FGF-2 group,P＜0.05).Overexpression of TET2 or UQCRH could reverse the anti-apoptotic and pro-proliferative effects of FGF-2 on VSMC,with upregulation of apoptosis-related protein expression and downregulation of anti-apoptotic protein expression(compared with FGF-2 group,P＜0.05).The UQCRH gene promoter region contained three CpG islands.Overexpression of TET2 could upregulate UQCRH expression in VSMC treated with FGF-2(compared with FGF-2 group,P＜0.05).Conclusion FGF-2,by inhibiting TET2 expression and UQCRH expression,reduces VSMC apoptosis and promotes its proliferation.

Objective To explore the predictive value of gait and balance on the frailty in community-dwelling older adults aged 65 years and older in Shanghai. Methods A total of 414 community-dwelling older adults aged 65 years or older were recruited from Shanghai,from De-cember,2022 to April,2023.They were investigated with Fried's Frailty Phenotype Scale,Timed Up and Go Test(TUGT),one leg standing test(OLST)and self-designed questionnaire.The factors related to frailty were ana-lyzed using multivariate Logistic regression. Results The prevalence of pre-frailty and frailty were 62.8%and 10.9%,respectively.Living in rural residence,older age,low income,smoking,sedentary lifestyle and no regular exercise were the risk factors for frailty among com-munity-dwelling older adults.Time of TUGT increased,and time of closed eyes OLST descreased respectively in the frail older adults(P<0.05).The area under curve was 0.846(95%CI 0.808 to 0.884,P<0.001)as prediction for frailty using the combination of TUGT and closed eye OLST,with a sensitivity of 0.726 and a specificity of 0.817 at the optimal threshold. Conclusion Gait and balance may be a valuable predictor of frailty in community-dwelling older adults in Shanghai.

Although percutaneous nephrolithotomy (PCNL) is widely applied, there are also some serious complications, and the regional application in is uneven. In order to standardize the development and promotion of PCNL, the International Alliance of Urolithiasis(IAU) has developed the first professional guideline on PCNL. IAU-PCNL guideline covers all aspects of the whole PCNL procedure, including preoperative preparation, operation process, observation and prevention of complications, etc. The present paper would like to interpret the key contents of the IAU-PCNL guideline.

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 construct a clinical predictive model of severe adenovirus pneumonia(SAP)in children using random forest and verify it.Methods:The clinical, laboratory and imaging data of 542 children with adenovirus pneumonia treated in Tianjin Children′s Hospital from January 2019 to January 2021 were analyzed retrospectively.The research object was randomly divided into training dataset and validation dataset(8∶2).The training dataset screened the predictors of SAP of pneumonia through random forest and established a prediction model, and the prediction model was expressed visually by the nomogram.In the validation dataset, the receiver operating characteristic curve(ROC)and sensitivity, specificity, error rate and confusion matrix were used to validate it.Results:A total of 439 children were in the training dataset, and 187 cases(42.60%)of the training data was divided as severe type.A total of 103 children were in validation dataset, and 44 cases(42.71%)of the validation dataset was divided as severe type.The percentage of monocytes(M%), PLT, AST, IL-6, the peak of body temperature, pulmonary inflammation of the consolidation and patchy shadowing were independent predictors of SAP in children.The area under the ROC curve of the training dataset and the validation dataset was 0.95(95% CI: 0.92~0.98)and 0.92(95% CI: 0.82~0.99), respectively.The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the training dataset were 0.994, 1.000, 0.987, 0.998, 1.000 and in validation dataset were 0.752, 0.990, 0.514, 0.945 and 0.857, respectively. Conclusion:The predictive model has good discriminant ability, and the early clinical and hematological indexes are helpful to improve the identification and screening of SAP in children.

Objective:To investigate the clinical effect of remote injection device assisted percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures.Methods:Using retrospective research and analysis methods, 168 patients with osteoporotic vertebral compression fractures admitted to Heze Municipal Hospital from September 2019 to August 2020 were selected. A total of 139 cases were followed up, with a follow-up rate of 82.7%, including 22 males and 117 females, with an average age of 74.17 years. According to the different equipment used, they were divided into two groups. Seventy-two cases used remote injection device to assist percutaneous vertebroplasty (observation group), 67 cases used traditional puncture needle puncture percutaneous vertebroplasty (control group). All patients were completed follow-up at 3 months after surgery. The operation time, intraoperative blood loss, bone cement injection volume, bone cement leakage rate, VAS score and ODI score of 1 day, 1 month and 3 months after operation were observed. Measurement data were expressed as ( Mean± SD), using t test, counting data were expressed as percentage [ n(%)], using χ2 test. Results:Both groups of patients successfully completed the operation without complications such as paraplegia, pulmonary embolism, or infection. There was no statistically significant difference between the two groups in operation time of two groups[(47.71±6.05) min vs (47.61±5.66) min, t=0.100, P=0.920]. The intraoperative blood loss of the two groups was no statistically significant difference [(7.08±3.00) mL vs (8.06±3.48) mL, t=1.782, P=0.079]. The difference between two groups of the amount of bone cement injected was statistically significant, [(6.44±1.03) mL vs (5.73±1.41) mL, t=3.369, P=0.001]. The bone cement leakage rate of the observation group was 27.78% (19/72), and the control group was 43.28% (29/67), and there was statistically significant( χ2=4.382, P=0.036). The preoperative VAS score of the observation group was (6.75±1.14) , and the control group was (6.64±1.08), and there was no significant difference between two groups( t=0.583, P=0.561) The VAS scores of the observation group and the control group were (1.28±0.75) and (1.21±0.77) respectively at 1 day after surgery. There was no statistically significant difference between two groups( t=0.583, P=0.588). The VAS scores of the observation group and the control group were (0.89±0.76) and (1.09±0.67) respectively at 1 month after operation. There was no statistically significant difference between two groups( t=1.641, P=0.103). The VAS scores of the observation group and the control group were (0.74±0.63) and (0.87±0.74) respectively at 3 months after operation. There was no statistically significant difference between two groups( t=1.118, P=0.266). The preoperative ODI scores of the observation group and the control group were (60.32±7.46) and (61.96±9.76) respectively, and there was no statistically significant difference between two groups( t=1.121, P=0.264). The ODI scores of the observation group and the control group were (14.93±6.01) and (15.10±6.43) respectively at 1 day after operation, there was no statistically significant difference between two groups( t=0.161, P=0.872). The ODI scores of the observation group and the control group were (10.54±4.24) and (11.31±3.71) respectively at 1 month after operation, and there was no statistically significant difference between two groups( t=1.136, P=0.258). The ODI scores of the observation group and the control group were (10.64±3.70) and (10.39±3.74) respectively at 3 months after operation, and there was no statistically significant difference between two groups( t=0.396, P=0.693). Conclusion:Compared with traditional puncture needle puncture percutaneous vertebroplasty, the remote injection device assisted percutaneous vertebroplasty has a definite clinical effect in the treatment of osteoporotic vertebral compression fractures, and the bone cement leakage rate is low.

This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076-0.418; P < 0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023-1.084; P < 0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028-0.143; P < 0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
Age Factors ; Aged ; COVID-19/therapy* ; China ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Survival Rate

Objective To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods The data of 45 cases with cervical posterior longitudinal ligament ossification treated by ACAF from March 2017 to October 2017 were retrospectively analyzed,including 25 males and 20 females,age 45-68 years,average 57.5 years.There were 18 cases involving C3 vertebral body,30 cases involving C4 vertebral body,40 cases involving C5 vertebral body,34 cases involving C6 vertebral body,and 7 cases involving C7 vertebral body.The function of the neural function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system at preoperation and latest follow-up.The curvature of the cervical spine was measured on the lateral X-ray film of the cervical spine,the maximum occupying ratio of the spinal canal was measured on the cross section of the CT scan,and compression of the cervical spinal cord was evaluated by the cervical MRI.Results Patients were followed up for 3 to 6 months (average,3.9 months).The improvement of neurological function was obtained in all the patients.The JOA score improvement rate at the latest follow-up was 71.3％±9.6％.The cervical lordosis was improved from preoperative 4.5°±3.8° to 10.3°±4.8° at the latest follow-up.The canal stenosis ratio was decreased from preoperative 54.3％±8.2％ to 12.5％±5.3％ at the latest follow-up.MRI showed that the cervical spinal cord was adequately decompressed in situ.No specific complications were identified that were associated with this technique.Conclusion The present study elaborates the surgical tips and demonstrates the satisfactory outcome of ACAF for the treatment of OPLL.This novel technique has the potential to serve as an alternative surgical technique for the treatment of cervical OPLL.