Objective To observe value of thin slice CT multiple signs combined with multiplanar reformation(MPR)for diagnosing tracheobronchial tuberculosis(TBTB).Methods Data of 234 TBTB patients who underwent chest thin slice CT scanning were retrospectively analyzed.MPR was performed,the direct signs and indirect signs of TBTB were observed.The diagnostic efficacy of axial plain CT images(direct observation)and of MPR combined with the former(combined observation)were compared.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of direct observation was 38.88％(201/517),98.13％(1 789/1 823),85.53％(201/235),84.99％(1 789/2 105)and 85.04％(1 990/2 340),respectively,of combined observation was 91.10％(471/517),98.85％(1 802/1 823),95.54％(471/493),97.51％(1 802/1 848)and 97.14％(2 273/2 340),respectively.Significant differences of sensitivity,positive predictive value,negative predictive value and accuracy were found(all P＜0.001),whereas no significant difference of specificity was found between 2 methods(P＞0.05).Conclusion Thin slice CT multiple signs combined with MPR could be used to effectively diagnose TBTB.

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.

Detection of serum biomarkers is an important strategy for the diagnosis of cardiovascular diseases. The roles of serum biomarker detection have become increasingly valuable in the baseline risk stratification among cancer patients in recent years. The Cardio-oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology newly proposed the “role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies”. By evaluating the characteristics of cardiac biomarkers in cancer patients receiving cardiotoxic cancer therapy, this statement discussed the mechanism, clinical application, value on monitoring and prognosis of the two main biomarkers,cardiac troponin and natriuretic peptide on chemotherapy induced cardiac toxic responses. The purpose of this statement is to help establish the multidisciplinary collaborative diagnosis and treatment strategies and provide a clinical framework, and guide clinicians to select appropriate serum biomarker monitoring programs based on risk stratification to prevent cardiovascular disease in cancer patients.

Objective:To investigate the contamination status of SARS-CoV-2 in imported frozen seafood from a Russia cargo ship in Qingdao and to analyze the risk factors for infection in local stevedores.Methods:The method of "two-stage, full coverage and mixed sampling" was used to collect the seafood packaging samples for the nucleic acid detection of SARS-CoV-2 by real-time fluorescent quantitative RT-PCR. A unified questionnaire was designed to investigate 71 stevedores in two shifts through telephone interview. The stevedores were divided into two groups, with 23 in the shit with two infections was group A and 48 in the shift without infection was group B. Software Epi Info7.2 was used to identify the risk factors for SARS-CoV-2 infections in the stevedores.Results:In the frozen seafood from a Russia cargo ship, the total positive rate of SARS-CoV-2 nucleic acid in the frozen seafood was 11.53% (106/919). The positive rate of SARS-CoV-2 nucleic acid in the frozen seafood unloaded by group A (14.29%,70/490) was significantly higher than that in the frozen seafood unloaded by group B (8.39%,36/429)( χ2=7.79, P=0.01) and the viral loads detected in the frozen seafood unloaded by group A were higher than those detected in the frozen seafood unloaded by group B. The scores of personal protection and behaviors in the stevedores in group A were significantly lower than those in group B ( P<0.05), and toilet use, smoking and improper hand washing before meals were the risk factors for the infection. Conclusions:The imported frozen seafood was contaminated by SARS-CoV-2 and the contamination distribution was uneven. Supervision and management of personal occupational protection and behaviors of workers engaged in imported frozen food transportation should be strengthened. It is suggested that a closed-loop monitoring and management system for the whole process of "fishing-transport- loading/unloading" should be established by marine fishery authority.

Cardio-oncology has developed into a new subspecialty of modern cardiology, and the clinical mentors usually need to guide students to focus on this frontier field. However, there are many deficiencies in the field of cardio-oncology training in China, and there is a lack of perfect teaching and training objectives and evaluation system. In order to adapt to the goal and orientation of talent training in cardio-oncology, the First Affiliated Hospital of Dalian Medical University adopts a multi-disciplinary teaching mode. Corresponding teaching contents and training objectives are set according to the trainees at different levels of training, and various teaching methods and assessment forms are cooperated to explore and establish the training and assessment system of cardio-oncology for doctors at different levels. The system is put into practice, and the teaching effect is outstanding which has been widely recognized by teachers and students.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objectives:To observe the anatomical location and mechanism of axis ring fractures (ARF) using 3-D CT scans, and propose a new classification for such fractures.Methods:By reviewing prospectively maintained database collecting ARF from 7 medical centers in China, 202 patients were included in this study. According to anatomical location, ARFs were classified into axis arthrosis fracture (AAF) and axis bony damage (ABD). The axis ring was divided into anterior, middle, and posterior rings, based on the border of the pars interarticularis (or pedicle) of axis. According to the features of ARF and previous study, a new classification was proposed based on the anatomical features of different fracture patterns, which was divided into three types and six subtypes (A1, A2, B1, B2, C1 and C2). The incidence of AAF and ABD and their distribution in different location of axis ring and the new classification, were observed.Results:In 202 patients with ARF, 501 anatomical structures were involved. 288 AAFs were found in 178 patients (288/501, 57%), while 213 ABDs were found in 149 patients (213/501, 43%). In anterior ring, 304 structures (304/501, 61%) were involved in injury, with 225 AAF and 79 ABD. In middle ring, 99 structures (99/501, 20%) were involved in injury, and all of them were ABD. In posterior ring, 98 structures (98/501, 19%) were involved in injury, with 63 AAF and 35 ABD. The anterior ring injuries (61%) were more common than middle (20%) or posterior ring (19%). In anterior ring, AAF (84%) were morecommon than ABD (16%); In middle ring, all the injuries were ABD; In posterior ring, AAFs (64%) were more common than ABD (36%). Type A fractures were featured with pedicle fractures and were identified in 30 patients (30/202, 15%). Type A1 fractures were bilateral pedicle fracture lines symmetrically or asymmetrically and identified in 12 (6%) patients; Type A2 fractures were pedicle fracture lineson one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 18 (9%) patients. Type B fractures were featured with superior articular facet injuries or posterior wall of C2 body fractures on one side and identified in 136 patients (67%). Type B1 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and pedicle fracture on the other side and identified in 57 (28%) patients; Type B2 fractures were superior articular facet injuries or posterior wall of C2 body fractures on one side and inferior articular facet injuries or lamina fractures on the otherside and identified in 79 (39%) patients. Type C fractures were featured with bilateral superior articular facet injuries or posterior wall of C2 body fractures and identified in 36 patients (18%). Type C1 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures symmetrically and identified in 22 (11%) patients; Type C2 fractures were bilateral superior articular facet injuries or posterior wall of C2 body fractures asymmetrically and identified in 14 (7%) patients.Conclusion:ARF could occur in different anatomical locations, and most of these fractures were caused by hyperextension and axial load on superior articular facet on one or two sides. The new CT classification of ARF with three types and six subtypes might provide all fracture patterns, which could be useful for the choice of proper diagnosis and treatment for such fractures.

Objective To investigate the experience in management of the high risk benign prostatic hyperplasia (BPH) patients in order to improve the safety of the operation.Methods The high-risk factors of 115 patients with BPH who had been treated with transurethral resection of prostate (TURP) were analyzed.The blood pressure of hypertensive patients should be controlled below 140/90 mm Hg.The patients with myocardial infarction should be in stable condition for more than 6 months.Smoking cessation,oxygen inhalation,and pulmonary function training should be carried out during the perioperative period in patients with chronic obstructive pulmonary disease,correct expectoration methods and rational use of antibiotics were also needed to improve the maximum amount of pulmonary ventilation to more than 70％.The blood-glucose of diabetic patients should be controlled below 8 mmol/L by insulin.Catheter was indwelled in patients with chronic obstructive renal insufficiency for more than 2 weeks so that the blood Cr could be below 130 μmol/L.Anticoagulant therapy should stop at least 5 days before surgery.Patients were encouraged to have physical training early after surgery and to have ankle stretch movement when they recovered form anesthesia,and pressure cycle drive therapeutic apparatus were also used to prevent deep venous thrombosis.Results All the patients tolerated TURP safely.Operation time was 30 to 60 min,the weight of the resection prostate tissue was 12 to 37 g,blood loss was 80 to 150 ml,and catheterization time was 3 to 7 days.The overall incidence of complications was 1.7％.There were 2 cases with deep venous thrombosis,who recovered after anticoagulant therapy.There were no pulmonary infection,bleeding,TUR syndrome,and other complications.Conclusion Correct analysis and effective management of the perioperative risk factors in high-risk BPH patients treated with TURP can improve the safety of the operation and reduce the complications.

Objective To discuss the diagnosis,therapy and prognosis of primary ureter transitional cell carcinoma with low stage and grade.Methods Retrospective review of 18 cases surgery to treat the primary ureter carcinoma of G1-2 Ta-2 was carried out.There were 12 males and 6 females with the mean age of 67 years.Of the 18 cases with the size of tumor were from 0.5 to 1.5 cm.13 cases had the tumors on the left and 5 cases on the right.The tumors were located at middle parts of the ureter in 3 cases,and at the lower part in 15 cases.The course of the disease was from 5 days to 3 months.10 cases had gross hematuria and 8 cases renal hydronephrosis were found incidentally by B-ultrasound.B-ultrasound was performed in all cases.15 cases were indicated pyelic separation from 1.0-1.5 cm and ureteral separation from 0.8-1.0 cm.8 cases were indicated the low-echo space-occupying disease of ureter.IVU indicated mild hydronephrosis in 12 cases of 15 cases,of whom 5 cases were demonstrated a filling defect.CT indicated the mass of ureter in 10 cases of 15 cases.Cystoscope were performed in 18 cases,of whom 5 cases were found the tumor in the ureter-bladder cuff.Retrograde pyelogram showed filling defect of the diseased ureter in 10 of 11 cases(2 cases had failure of intubation).4 cases ureteroscopy with biopsy were used and demonstrated the diagnosis.Results 8 cases were treated surgically of radical nephroureterectomy with a bladder cuff excision.7 cases were performed ureteral segmental resection,of which 2 cases anastomosis and 5 cases ureterocystostomy with bladder cuff excision.3 cases tumors were resected by ureteroscopy postoperative pathological findings confirmed the diagnosis of transitional cell carcinoma.Pathological staging showed Ta(1 case);T1 (8),T2(9),and grading showed G1(8);G2(10).16 cases(88.9％)were followed up form 6-132 months.The overall 5-year survival rate was 87.5％.Of the 25％ patient showed bladder recurrence in post-operation 6-24 months.2 cases died of tumor recurrence and metastasis in post-operation 36-48 months.Conclusions The primary transitional cell carcinoma of ureter was uncommon and has poor prognosis.Ureter carcinoma with lower stage and grade might have better prognosis.Kidney-sparing surgery is a feasible treatment option in patients with lower stage and grade.The long-term follow up is meticulous.

Objective To observe the efficacy of extensive decompression through transforaminal lumbar interbody fusion (TLIF) pathway combined with pedicle screw fixation on treating degenerative lumbar stenosis in the dderly.Methods Seventy-five elderly patients (28 males and 47 females) with degenerative lumbar stenosis were treated with extensive decompression through transforaminal pathway at our hospital from Jan.2007 to Aug.2010.The operation is through the TLIF pathway to resect part of the articular facet,and expose unilaterally the intervertebral vertebral foramen.Decompression of the vertebral canal was conducted by removing the disc.In the end,we performed posterolateral fixation with pedicle screw and placement of bone graft in posterolateral part of the lumbar or did the interbody fusion.JOA scores were obtained before and 1 day after operation and in 3 month follow-up consultation.The intervertebral height and bone fusion were observed by X ray.Results The follow-up period of the 75 patients was 6-36 months with an average of 12 months.There was significant difference (t =20.79,P ＜ 0.05 ;t =25.89,P ＜ 20.05) in JOA score between 3 month follow-up (21.08 ± 3.60) and preoperation (10.91 ± 2.23),between 1 d follow-up (22.72 ± 3.26) and preoperation (10.91 ±2.23),respectively.The rate of improvement was (88.6 ± 10.8)％,with 98％ of excellent or good in 3-month follow-up.Lumbar plane films showed neither instability or internal fixation loosening,breakage or distortion in follow-up consultation.There were 2 cases in whom Cage dislocation occurred without any neurological symptoms.Conclusion Extensive decompression through TLIF pathway combined with pedicle screw fixation is an efficacious method of treating degenerative lumbar stenosis in elderly patients.This method can retain the structure of lumbar posterior complex,reduce the risk of low back pain.It is a safe choice for treatment of degenerative lumbar stenosis in the elderly.