Objective:To understand the composition of respiratory virus spectrum in hospitalized children with acute respiratory infections in Guilin City from 2021 to 2022, and to explore the epidemic characteristics of different respiratory viruses.Methods:Information of a total of 638 hospitalized children with acute respiratory infections (ARI) syndrome under the age of 14 years in Guilin city, Guangxi from September 2021 to October 2022 was collected as research data. The collected pharyngeal swabs from pediatric patients were subjected to real-time fluorescence reverse transcription polymerase chain reaction for nucleic acid testing, screening for 15 common respiratory viruses, and analyzing the virus spectrum characteristics of hospitalized pediatric patients with acute respiratory infections.Results:Among the 638 specimens, 365 were tested positive for at least one virus, with a positive rate of 57.21% (365/638). The detection rate for two or more viruses was 12.85% (82/638). There were 12 types of viruses detected, and the difference in virus detection rates among different seasons was statistically significant (P<0.002). The virus positive detection rate of samples from different age groups was the highest in the 0-2-year old group (40.66%), followed by the 3-5-year old group (34.80%) and the 6-year and older group (24.54%).Conclusions:During the period from September 2021 to October 2022, all 12 respiratory viruses were prevalent in Guilin area, with obvious summer peak as characteristics. It is suggested that corresponding prevention and control measures should be focused on pathogens that may cause acute respiratory infections in children during the local summer to prevent and control the spread and prevalence of respiratory infections.

Objective:To investigate the impact of various mutations in the gD protein of PRV-2022 strain on its binding to the Nectin-1 receptor.Methods:We employed PCR, RT-qPCR and gene sequencing techniques for identification of the PRV-2022 strain. Furthermore, bioinformatics method were utilized to analyze the genetic evolution of the gD gene in PRV-2022 strain. Recombinant expression plasmid containing mutations at amino acids positions 69 and 82 within the extracellular domain of gD protein from PRV-2022 strain was constructed and expressed in vitro. The binding ability between different mutant forms of recombinant gD protein and Nectin-1 receptor was compared using His-pull down and biolayer interference techniques. Results:The gD gene of the PRV-2022 strain was obtained, and genetic evolution analysis revealed that the PRV-2022 strain belonged to the same branch as strains isolated prior to 2011, with a close genetic distance. The expression plasmids for gD extracellular domain containing A69V and S82N amino acid mutations were successfully constructed, enabling the expression and purification of recombinant PRV gD extracellular domain protein. Interaction studies demonstrated that gD-69, gD-82, gD-2022, and gD-Bartha proteins interacted with human Nectin-1. Notably, compared to the classical PRV vaccine strain Bartha, double mutation of amino acids 69 and 82 in the gD protein exhibited the highest affinity to human Nectin-1 receptor, whereas individual mutations at either site decreased this affinity.Conclusions:Introduction of A69V and S82N mutations in the gD protein significantly affected its binding ability to human Nectin-1 receptor. Simultaneous occurrence of A69V and S82N mutations resulted in the highest affinity towards human Nectin-1 receptor.

Pseudorabies virus (PRV) is a porcine herpesvirus that exhibits cross-species infectivity, primarily affecting pigs as its natural host. Since its initial discovery, PRV has rapidly disseminated worldwide and inflicted substantial economic losses on the swine industry. In recent years, sporadic cases of human infections with PRV have been reported, highlighting the potential risk of interspecies transmission to humans. With further analysis of the pathogenic characteristics of PRV and a deeper understanding of its pathogenic mechanism, preventing PRV from becoming a human infectious disease has become a focus of current research and prevention and control work. To comprehensively understand the variant characteristics of PRV, this study presents an overview of cutting-edge advancements in terms of its genetic variations and epidemiological characteristics, aiming to establish a foundation for more effective implementation of relevant prevention and control work.

Pseudorabies virus (PRV) is a porcine herpesvirus that exhibits cross-species infectivity, primarily affecting pigs as its natural host. Since its initial discovery, PRV has rapidly disseminated worldwide and inflicted substantial economic losses on the swine industry. In recent years, sporadic cases of human infections with PRV have been reported, highlighting the potential risk of interspecies transmission to humans. With further analysis of the pathogenic characteristics of PRV and a deeper understanding of its pathogenic mechanism, preventing PRV from becoming a human infectious disease has become a focus of current research and prevention and control work. To comprehensively understand the variant characteristics of PRV, this study presents an overview of cutting-edge advancements in terms of its genetic variations and epidemiological characteristics, aiming to establish a foundation for more effective implementation of relevant prevention and control work.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

Objective:To screen plasma exosomal protein molecular markers in patients with spinal cord injury (SCI) by applying Label-Free quantification and bioinformatics analysis.Methods:Fifty plasma specimens from the First Affiliated Hospital of Nanjing Medical University (from January 2021 to June 2022) were collected from SCI patients and healthy people, respectively. Plasma exosomes were isolated using ultracentrifugation and identified by transmission electron microscopy, nanoparticle tracking analysis and western blot. Plasma exosomal differentially expressed proteins (DEPs) were analyzed using Label-Free quantitative proteomics, and DEPs were characterized, annotated, and enriched based on Gene Ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) databases. The screened DEPs were validated by western blot and enzyme linked immunosorbent assay (ELISA) using plasma exosomal specimens.Results:According to the spinal cord injury classification of the American Spinal Injury Association, 14 cases were grade A, 19 cases were grade B, 12 cases were grade C, and 5 cases were grade D. Plasma exosomes of SCI patients and control groups showed typical cup-like morphology, with diameters mainly ranging from 30-200 nm. A total of 493 exosomal proteins were identified by Label-Free quantification, and 126 proteins were screened for differential expression, of which 38 were up-regulated and 88 were down-regulated. GO annotation revealed that DEPs were mainly involved in functions such as protein activation cascade, complement activation and immune response. KEGG pathway analysis revealed that DEPs were involved in biological pathways such as complement and coagulation cascade reactions, proteasome and neurodegenerative disease pathways. Two candidate proteins, APOB and S100A9, were initially screened based on quantitative results from proteomics and bioinformatics analyses. Western blot results showed that the relative expression of S100A9 protein in plasma exosomes of 30 SCI patients (1.62±0.19) was elevated compared with that of 30 control groups (0.86±0.24), and the difference was statistically significant ( t=8.55, P<0.001), while the relative expression of APOB protein (1.06±0.13 and 1.02±0.23) were not statistically significant ( t=0.46, P=0.653). The results of ELISA analysis showed that the expression of S100A9 in plasma exosomes of patients with different degrees of SCI (grade A 197.7±11.7 pg/ml, grade B 151.7±15.2 pg/ml, grade C 136.3±14.7 pg/ml) had statistical significance ( F=69.94, P<0.001), the higher the severity of SCI, the higher the expression of S100A9 in plasma exosomes (A vs. B, q=13.11, P<0.001; A vs. C, q=15.66, P<0.001; B vs. C, q=4.19, P=0.005). Conclusion:S100A9 is a potentially valid plasma exosomal molecular marker for assessing the severity of SCI.

Objective:To evaluate the accuracy and safety of cervical pedicle screw (CPS) placement under orthopaedic robot navigation system guidance.Methods:From March 2019 to February 2021, the data of 33 patients (19 males and 14 females, aged from 26 to 75 years, with an average age of 50.5 years) treated with pedicle screw fixation with the assistance of orthopaedic surgery robot through the posterior cervical spine were retrospectively analyzed. In clinical diagnosis, there was upper cervical fracture with instability in 14 patients (fracture nonunion in 2 patients), upper & subaxial cervical fracture in 1 patient, cervical spinal cord injury with spinal stenosis in 2 patients, cervical spinal stenosis in 9 patients, occipitocervical deformity in 2 patients, post-operative revision of cervical spondylosis in 2 patients, cervical intraspinal tumor in 3 patients. A total of 151 CPSs were inserted in C 1-C 7 using robot navigation system based on intraoperative three-dimensional C-arm fluoroscopy to assist in screw placement in posterior cervical surgery. Among them, 74 screws were implanted into upper cervical spine; 77 screws were implanted in the lower cervical spine. CT was used to obtain image data within 7 days after operation, and Neo classification was used to evaluate the accuracy of cervical pedicle screw placement. The patients were followed up for 2 weeks to observe the clinical symptoms and signs, and to determine whether there were surgical complications such as nerve and blood vessel injury and incision infection. Results:According to Neo classification, 91.4% (138/151) screws were completely contained in the pedicle without breaking through the pedicle cortex (grade 0). Among them, the accuracy of C 1 screws was 97.1% (34/35), C 2 screws was 92.3% (36/39), C 3 screws was 88.2% (15/17), C 4 screws was 71.4% (10/14), C 5 screws was 85.7% (12/14), C 6 screws was 93.3% (14/15), C 7 screws was 100.0% (17/17). The screw accuracy was highest in C 7, the lowest in C 4. The Kruskal-Wallis H test was performed on the accuracy of screw placement in different cervical level, and the results showed that there was no statistical difference (χ 2=1.31, P=0.971). However, a total of 13 screws were found to perforate the cortex of pedicle, although any neural or vascular complications associated with CPS placement were not encountered. Among them, 9 screws were found to perforate laterally, and 4 screws were found to perforate medially. No postoperative incision infection occurred in all cases. Conclusion:The safety of CPS placement can be effectively guaranteed with the assistance of the orthopaedic robot system.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective: To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle. Methods: The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs, Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018. They were 9 males and 7 females, aged from 27 to 78 years (average, 51.5 years). By the Schatzker classification, there were 2 cases of type Ⅰ, 8 cases of type Ⅱ, 3 cases of type Ⅲ and one case of type Ⅳ; by the cross classification, there were 10 cases of type Ⅰe, one case of type Ⅱe and 2 cases of type Ⅲe and 3 cases of type Ⅰv. The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015. The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution; the widened distance of the lateral tibial plateau, collapse depth of the tibial plateau, separation of avulsion fracture of medial femoral condyle, maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e and Ⅰv in the observation group. Results: In the observation group, the widened distance of the lateral tibial plateau averaged 7.18 mm, the collapse depth of the tibial plateau 8.74 mm, the separation of avulsion fracture of medial femoral condyle 3.44 mm, the maximum clearance of the medial knee 7.77 mm, and the eversion angle of the tibial plateau 87.03°. There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups (P=0.002). In the observation group, the average widened distance of the lateral tibial platea for the 13 type e patients (8.49±4.26 mm)was significantly larger than that for the 3 type Ⅰv patients (1.51±2.11 mm) (t=2.706, P=0.017). Conclusion The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and type Ⅰv. The widened distance of lateral tibial plateau helps distinction between types e and type Ⅰv.