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.

OBJECTIVE: To review the research progress of rapid surgery for hip fracture in elderly patients. METHODS: The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice. RESULTS: Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients. CONCLUSION In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.
Humans ; Aged ; Hip Fractures/epidemiology* ; Hospitalization ; Length of Stay ; Incidence ; Anemia ; Retrospective Studies

Objective:To measure the crown conical degree of the remaining maxillary incisors in patients with congenital tooth agenesis, and to analyze the influence of different gene mutations on the crown conical degree of patients.Methods:Whole exome sequencing was performed on 85 patients with congenital tooth agenesis (50 males, 35 females, median age 19 years old) who visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2019 to January 2023. The pathogenic gene was identified. The width of the crowns of the maxillary central and lateral incisors at the incisal 1/3 and gingival 1/3 were measured on the panoramic radiograph, and the ratio was defined as the crown conical degree. The smaller the ratio is, the more likely is the crown to be peg shaped teeth. The control group was matched by age and gender with 85 other patients with intact maxillary permanent incisors who were treated in the Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2019 to January 2023. The conical degree of the tooth agenesis group was compared with the control group by t-test, and the differences in the crown conical degree in different gene mutation groups were compared using one-way analysis of variance, and the multiple comparisons among gene groups were carried out using the LSD method.Results:Among the 85 tooth agenesis patients, the numbers of patients in each gene mutation group were 20 in ectodysplasin A (EDA) group, 8 in ectodysplasin A receptor (EDAR) group, 15 in wingless-type MMTV integration site family, member 10A (WNT10A) group, 16 in paired box 9 (PAX9) group, 10 in Msh homeobox 1 (MSX1) group, 10 in low-density lipoprotein receptor related protein 6 (LRP6) group, and 6 in bone morphogenetic protein4 (BMP4) group. The number of missing teeth were 1-27, median number 15 among the tooth agenesis patients. There was no significant difference in the conical degree between the left and right homonymous teeth in the congenital tooth agenesis group and the control group ( P>0.05). The crown conical degree of maxillary central incisor and lateral incisor in the congenital missing teeth group (0.95±0.24, 0.90±0.22) was significantly smaller than that in the control group (1.12±0.09, 1.13±0.09) ( t=-8.50, P<0.001; t=-11.47, P<0.001). In WNT10A mutants, the conical degree of lateral incisors (0.89±0.18) was less than that of central incisors (1.07±0.15)( t=3.68, P<0.001). The conical degree of central incisors and lateral incisors (0.70±0.23, 0.57±0.15) of EDA mutants was significantly lower than that in patients with other gene mutations ( P>0.05). Conclusions:Compared with the normal control group, the remaining maxillary central and lateral incisors of the seven gene mutation groups of patients with congenital tooth agenesis all had different degrees of conical crown. Among them, the crown conical degree of maxillary central and lateral incisors of the EDA mutation was the most severe, and the WNT10A mutation affected the maxillary lateral incisors more specifically.

Objective:To compare the efficacy of stereotactic body radiotherapy(SBRT) and surgery in treating intrapulmonary recurrence of non-small cell lung cancer (NSCLC) after radical surgery.Methods:A retrospective analysis was conducted on NSCLC patients, who underwent radical surgery at the Cancer Hospital Affiliated to University of Chinese Academy of Sciences from November 2012 to December 2018 and then received SBRT or secondary surgery because of postoperative intrapulmonary recurrence. The survival rates of these patients were calculated using the Kaplan-Meier method. The comparison between the two groups was made using the Log-rank method, and the univariate and multivariate analysis was made using the Cox regression method.Results:Among 62 eligible patients, 33 received SBRT and 29 received secondary surgery, and they were divided into the SBRT group and the surgery group accordingly. For the SBRT and surgery groups, the median follow-up time was 45.8 months and 37.4 months, the 3-year locoregional control rate (LRCR) 79.8% and 90.2%, respectively ( P > 0.05), the progression-free-survival (PFS) 58.5% and 42.3%, respectively ( P >0.05), and the overall survival (OS) 78.0% and 85.5%, respectively ( P >0.05). The multivariate analysis suggested that treatment method, Charlson comorbidity index (CCI), and adjuvant drug therapy were independent prognostic factors for PFS ( P = 0.027, 0.013, 0.001). Conclusions:The efficacy of SBRT and surgery is comparable for patients with intrapulmonary recurrence of NSCLC after radical surgery.

Objective:To evaluate the value of systematic education for primiparas undergoing epidural labor analgesia.Methods:A total of 240 primiparas who were suitable and voluntarily requested epidural labor analgesia, aged 20-35 yr, at 37-41 + 6 weeks gestation, with a singleton fetus, in vertex presentation without fetal abnormality, were selected.According to whether the primiparas and their accompanying family members had received systematic education on epidural labor analgesia during pregnancy, the primiparas were divided into 2 groups ( n=120 each): education group and control group.When the uterine contraction was regular and the diameter of the uterine orifice reached 2 cm or more, epidural labor analgesia was carried out.Before the begining of epidural puncture, the degree of anxiety of pregnant women was evaluated using the self-rating anxiety scale.The time of communication before analgesia, time of placing body position, and satisfaction of puerperae and their family members with labor analgesia were observed and recorded. Results:Compared with control group, the self-rating anxiety scale score was significantly decreased, the time of communication before analgesia and time of placing body position were shortened, and the rate of satisfaction of puerperae and their family members with labor analgesia was increased in education group ( P<0.05). Conclusions:Systematic education is helpful in relieving the anxiety of primiparas during epidural labor analgesia, increasing the efficiency of analgesia implementation and improving the delivery experience of puerperae.

This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.

Objective To analyze the epidemiological characteristics of mumps in Guangxi from 2011 to 2019, and to provide a scientific basis for formulating effective prevention and control strategies. Methods Descriptive epidemiological method was used to analyze the incidence data of mumps in Guangxi from 2011 to 2019. Results From 2011 to 2019, a total of 146,132 cases of mumps were reported in Guangxi, with an average annual incidence rate of 34.23 /100 000. There were 88,919 male cases (60.85%) and 57,213 female cases (39.15%). The incidence rate decreased from 62.26/100 000 in 2011 to 16.46/100 000 in 2015, and increased from 18.60/100 000 in 2016 to 46.90/100 000 in 2019. There were seasonal variations in the incidence, with the incidence peaks occurring from April to July and from October to the following January. 85.39% of cases were under 15 years of age, and 76.82% of cases were among kindergarteners or school children. A total of 228 mumps outbreaks were reported during 2011-2019，including 5,347 cases, accounting for 3.66% of the total cases. The incidence rates of mumps in Nanning (56.09/100 000), Hechi (48.26/100 000), Liuzhou (46.77/100 000), Baise (46.34/100 000) and Fangchenggang (40.68/100,000) were relatively higher than other places. Conclusion The mumps incidence is on an upward trend in Guangxi since 2015-2019, occurring mainly in older children or students. It is suggested to adhere to the second dose of mumps containing vaccine for kindergarten and school children and strengthen the surveillance and outbreak control of mumps in schools.

Objective: To explore the effect of the new vaginal douche device on vaginal irrigation before ovulation extraction in vitro fertilization-embryo transfer. Methods: From August 2017 to April 2018, 100 cases of infertility patients admitted to the first hospital of reproductive and gynecology of Jilin University who had to undergo ovulectomy were selected and divided into 50 cases in the experimental group and 50 cases in the control group according to the random number table. In the test group, a new type of vaginal irrigator was used for vaginal irrigation one day before the operation, while in the control group, a disposable enema was used for vaginal irrigation. The vaginal cleanliness and comfort of the two groups were compared after washing. Results: Vaginal cleanliness was compared between the two groups. Bacterial culture of vaginal secretions was positive in 2 patients in the experimental group, with a positive rate of 4%. In the control group, bacterial culture of vaginal secretions was positive in 14 patients, with a positive rate of 28%. Vaginal cleanliness was better in the experimental group than in the control group (χ²=10.714, P=0.001). In the experimental group, there were 2 cases of discomfort, 10 cases of discomfort, 29 cases of comfort, and 9 cases of comfort. In the control group, there were 8 cases of discomfort and 17 cases of discomfort. The comfort level of the experimental group was higher than that of the control group, and the difference was statistically significant (Z=-2.271, P=0.023). Conclusions The operation method of the new vaginal douche is simple and soft, which can not only effectively and thoroughly clean the vagina, reduce the incidence of infection, but also increase the comfort level of patients, alleviate psychological fear and improve patient satisfaction.

Objective: To investigate the effect of PM2.5 exposure on the thyroid function in male SD rats. Methods: Adult Sprague-Dawley rats were divided into " filtered air" (FA) and " PM2.5" groups. These rats exposed to the 2 kinds of air for 12 weeks were killed and their plasma and thyroid tissues were taken for investigation. The morphological status and pathological changes of thyroid tissue were observed after H&E staining. The levels of triiodothyronine (T₃), free triiodothyronine (FT₃), thyroxine(T₄), free thyroxine (FT₄), anti-thyroglobulin antibody (TGAb), anti-thyroid peroxidase antibody (TPOAb), thyrotropin (TSH), tumor necrosis factor α (TNF-α), and interleukin-6 (IL-6) in rats were measured by ELISA. Results: The results showed that there was no significant difference in body weight between two groups after 12 weeks of exposure to either filtered air or PM2.5. No pathological changes and significant differences were observed in the thyroid tissues of two groups after HE staining. There were no significant differences in plasma levels of T₄, T₃, FT₃, TNF-α, and IL-6 between two groups. However, compared with rats exposed to filtered air, rats exposed to PM2.5 had significantly lower plasma FT₄[(3.81±1.23) vs (6.02±2.40)pmol/L, P<0.01] and higher TSH [(5.63±1.74) vs (4.29±1.37) mU/L, P<0.05] levels. Conclusion The exposure to PM2.5 for a period of 12 weeks may lead to the decrease of FT₄ and increase of TSH in rats.

Di-(2-ethylhexyl) phthalate (DEHP) is an ubiquitous environmental contaminant because of its extensive use in plastics and its persistence. As an environmental endocrine disruptor, it is suspected to interfere with neurodevelopment in people. However, evidence of the effects of maternal DEHP exposure on cerebellar development in offspring is scarce. The objective of this study was to investigate maternal exposure to DEHP and its effect on apoptosis of cerebellar granule cells (CGCs) and related mechanisms. Pregnant Wistar rats were administrated DEHP (0, 30, 300 and 750 mg/kg/d) by gavage from gestational day (GD) 0 to postnatal day (PN) 21. Primary CGCs were also exposed to mono-(2-ethylhexyl) phthalate (MEHP), the main metabolite of DEHP, for 24 h with concentrations of 0, 25, 100 and 250 µM. The CGCs of male offspring from 300 and 750 mg/kg/d DEHP exposure groups showed significantly increased apoptosis. In addition, the PI3K/AKT signaling pathway was inhibited in the male offspring of the 300 and 750 mg/kg/d DEHP exposure groups. However, effects on female pups were not obvious. Apoptosis was also elevated and the PI3K/AKT signaling pathway was inhibited after primary CGCs were exposed to MEHP. Furthermore, apoptosis was reduced after treatment with the PI3K/AKT signaling pathway activator, insulin-like growth factor (IGF) 1, and increased after treatment with LY294002, an inhibitor of the PI3K/AKT signaling pathway. These results suggested that maternal DEHP exposure induced apoptosis in the CGCs of male pups via the PI3K/AKT signaling pathway, and the apoptosis could be rescued by IGF1 and aggravated by LY294002.
Apoptosis* ; Diethylhexyl Phthalate ; Female ; Humans ; Male ; Maternal Exposure ; Plastics ; Rats, Wistar