Objectives:To introduce the definition of the spinal cord(SC)line,and its clinical classification and application strategies in posterior cervical open-door laminoplasty,and to examine and analyze the credibility and repeatability of this classification.Methods:The clinical data of a total of 86 patients who underwent cervical open-door laminoplasty via posterior approach in The Second Affiliated Hospital of Wen-zhou Medical University from January 2018 to December 2020 were analyzed retrospectively.There were 51 males and 35 females,aged 34-77 years old,with postoperative follow-up period ranging from 12 to 36 months.The patients were classified into three types based on the location relationships between the SC line and compressor in the preoperative MRI:Type Ⅰ,the compressor at compression level did not exceed the SC line;Type Ⅱ,the compressor contacted the SC line;Type Ⅲ,the compressor exceeded the SC line.Five spinal surgeons independently evaluated and classified the MRI images of the patients,and Kappa consistency tests were performed to analyze the credibility and repeatability.50 patients with multilevelcervical spinal cord compression diseases(cervical spondylotic myelopathy,ossification of the posterior longitudinal ligament,and developmental cervical spinal canal stenosis)were recruited and treated for a prospective study from January 2021 to December 2022,and the range of open-door segments was determined under the principle of improv-ing the SC line classification as much as possible.The patients were followed up for 12 to 34 months.The modified anterior spinal cord compression score,neck pain visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score and recovery rates of the patients were recorded pre-operatively and at final follow-up in both retrospective and prospective studies.Paired samples t test was used to compare the scores before and after surgery in each type of patients,and one-way ANOVA was used to compare the scores between the three groups,to assess the postoperative spinal cord decompression and clinical outcomes of the different SC line types.Results:Among the 86 patients analyzed retrospectively,38 were Type Ⅰ,31 were Type Ⅱand 17 were Type Ⅲ.The Kappa coefficient was 0.817-0.945 for inter-observer consistency,which was 0.891-0.963 for intra-observer consistency,indicating satisfactory credibility and repeatability.There was no significant difference in modified anterior spinal cord compression score and VAS score between the three types of patients before surgery(P＞0.05),and all of them were statistically different at the final follow-up compared with the preoperative period(P＜0.05).The modified anterior spinal cord compression score and VAS score were the lowest at the final follow-up in Type Ⅰ,which were the highest in Type Ⅲ(P＜0.05).The JOA recovery rate was(73.49±11.26)％in Type Ⅰ,(67.08±9.01)％in Type Ⅱ,and(53.74±7.93)％in TypeⅢ,with statistically significant differences between the three types(P＜0.05).Among the 50 patients analyzed prospectively,27 were Type Ⅰ,15 were Type Ⅱ and 8 were Type Ⅲ.The preoperative spinal cord com-pression score was 3.67±0.47 in Type Ⅰ,3.84±0.37 in Type Ⅱ,and 4.00±0.00 in Type Ⅲ,which was 1.24±0.62 in Type Ⅰ,2.60±0.58 in Type Ⅱ,and 3.40±0.52 in Type Ⅲ at the final follow-up,respectively.The VAS score decreased from 6.48±0.85 preoperatively to 1.11±0.51 at final follow-up in Type Ⅰ.Type Ⅱcases exhibited a decrease in VAS score from 6.67±0.90 preoperatively to 1.73±0.59 at final follow-up.And the VAS score decreased from a preoperative value of 7.13±0.64 to 2.38±0.52 at final follow-up in Type Ⅲ(P＜0.05).The modified anterior spinal cord compression score and VAS score were the lowest in Type Ⅰand the highest in Type Ⅲ at final follow-up(P＜0.05).The JOA score improved from 12.07±1.17 preopera-tively to 15.59±0.69 at final follow-up in Type Ⅰ.Type Ⅱ cases exhibited an improvement in JOA score from 10.93±0.80 preoperatively to 14.67±0.72 at final follow-up.And the JOA score improved from a preop-erative value of 10.13±1.13 to 13.63±0.74 at final follow-up in Type Ⅲ(P＜0.05).The JOA recovery rate was(72.50±12.38)％in Type Ⅰ,(61.99±9.78)％in Type Ⅱ,and(51.25±5.19)％in Type Ⅲ,which was statisti-cally different between the three groups(P＜0.05).Conclusions:The SC line and its classification are practical and reliable,demonstrating good credibility and repeatability.Suitable open-door segment in posterior open-door laminoplasty in patients of Type Ⅰ SC line can make anterior spinal cord compression relieved;And anterior surgery needs to be considered when anterior compression remained after posterior surgery in patients of Type Ⅲ SC line.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Background: Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. Methods: Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. Results: The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. Conclusion The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Objective:To investigate the epidemiology and clinical characteristics of adenovirus (ADV)-caused acute respiratory tract infection among hospitalized children in Kunming, China.Methods:Clinical and laboratory data were collected from 467 children with adenovirus infection who were hospitalized from January 1, 2019 to December 31, 2019 in 6 grade A class Ⅲ hospitals in Kunming area. The basic characteristics, epidemiology, mixed infection and adenovirus genotypes of the patients were retrospectively analyzed. The patients diagnosed with adenovirus pneumonia (AP) were divided into two groups, severe AP (SAP) group and general AP(GAP) group according to the severity of illness. Mann-Whitney U test or χ 2 test was used for comparison between groups, while multivariate regression was applied to analyze the risk factors of SAP. Results:Among 15 635 hospitalized children with respiratory tract infection, 467 cases were adenovirus positive, with a detection rate of 2.99%. Of the 467 patients with adenovirus infection, 284 were male and 183 female, the age was 2.4 (1.1,3.9) years, including 44 cases (9.4%) < 0.5 years, 59 cases (12.6%) of 0.5 to<1.0 years, 176 cases (37.7%) of 1.0 to <3.0 years, 150 cases (32.1%) of 3.0 to <7.0 years, and 38 cases (8.1%) of 7.0 to 14.0 years. Adenovirus infection was common in autumn and winter, and the high incidence months were October to December, which accounted for 51.6% (241/467) of the whole year cases. Co-infection was detected in 226 cases (48.4%) out of 467 patients, in which one pathogen co-infection was the most frequent form (172 cases, 76.1%). Of the 262 pathogen detected 108 (41.2%) were Mycoplasma pneumoniae. In 144 of ADV-positve cases (30.8%) were taken geno-typing was done by PCR amplification, the results showed that 74 cases (51.4%) were ADV 3, 7 subtypes and 65 cases (45.1%) of ADV 1, 2,6 subtypes. Of the 467 cases of ADV infection, 320 (68.5%) were diagnosed with pneumonia, 82 (17.6%) with upper respiratory tract infection and pharyngeal tonsillitis, and 65 (13.9%) with bronchitis, laryngeal bronchitis, and asthmatic bronchitis. Among the 320 patients with AP, 56 cases were severe and 264 cases were general. Two cases (3.6%) in severe group died. Compared with the GAP group, the age was young [17 (11,42) months vs. 24 (14,44) months, Z=2.222, P=0.026], the fever duration was long [8 (5,14) days vs. 6 (3,9) days, Z=3.380, P<0.01], and the proportions of preterm birth and having underlying diseases were high [respectively 19.6% (11/56) vs. 6.1% (16/264), 26.8% (15/56) vs. 10.2% (27/264), χ 2=8.965,11.109, P<0.05] in SAP group. Referring to laboratory markers, white blood cell count, C-reactive protein, creatine kinase-MB and lactate dehydrogenase were significantly increased in SAP group as compared to GAP group(all P<0.05). Multivariate Logistic regression analysis showed that preterm birth ( OR=3.284, 95% CI 1.079-9.993, P=0.036), underlying disease ( OR=3.284, 95% CI 1.079-9.993, P=0.036), fever duration ≥10 d ( OR=2.523,95% CI 1.195-5.328, P=0.015) and C-reactive protein ≥50 mg/L ( OR=3.156, 95% CI 1.324-7.524, P=0.010) were positively correlated with the risk of SAP. Conclusions:The incidence of adenovirus infection among hospitalized children in Kunming was lower than the national level, and no outbreak occurred in 2019. Subtype 3 and 7 of ADV are the predominant strains for infection, which usually occurs in autumn and winter and mainly causes pneumonia. Premature birth, underlining diseases, long fever duration and markedly increased C-reactive protein are the risk factors for developing into severe pneumonia. This paper presents the prevalence and clinical characteristics of adenovirus infection in children at high altitude area.

Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury.Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked.The animal model of iatrogenic splenic injury was established by general anesthesia.Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding.The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 rmin if still bleeding.Then hemostatic effect after removing blocking and oppression was observed.Control group was only treated with gelatin sponge compression to stop bleeding.Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group,and before compression and relieving the compression for 2 hours in control group.IL-1 (interleukin),SOD (superoxide disproportionation enzyme),MPO (myeloperoxidase),MDA (malondialdehyde) and caspase-3 (aspartame acid cysteine protease) were detected.Results The control group still had bleeding,while the experimental group had successfully stopped bleeding.Serum markers before and after occlusion in the experinental group were IL-1 (124.4 ± 106.8 vs.121.2 ± 105.1),SOD (4.7 ± 2.7 vs.5.2 ± 1.8) and MDA (8.8 ±6.5 vs10.8 ±7.5).There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 (121.2 ± 105.1 vs.162.8 ± 73.8),SOD (5.2 ± 1.8 vs.4.7 ± 2.8) and MDA (10.8 ±7.5 vs.9.6 ±6.6) (P＞0.05).Histological indicators before and after occlusion in the experimental group included MPO (0.62 ±0.23 vs.0.68 ±0.21) and Caspase-3 (0.90 ±0.29 vs.0.86 ± 0.26),and there was no statistical difference on MPO (0.68 ±0.21 vs.0.86 ±0.23 after two sets of experiments) and Caspase-3 level (0.86 ± 0.26 vs.1.21 ± 0.18) (P ＞ 0.05) in two groups after occlusion/ oppression.Conclusion The therapeutic effect of intermittent splenic artery occlusion combined with gelatin sponge compression hemostasis is safe and effective and without obvious ischemia reperfusion injury.

Objective To measure the present situation of medical students' learning adaptability and find the influencing factors in order to revise Learning Adaptability Scale for medical students.Methods A stratified sampling method was used to collect 1 180 medical students from Harbin Medical University.Using the internal consistency reliability test,the reliability of the revised student learning adaptability scale was verified.Five common factors were extracted by the exploratory factor analysis of the principal analysis method,and Logistic regression was used to analyze the influencing factors of medical student learning adaptability.Results The revised Student Learning Adaptability Scale (Cronbach's Alpha=0.914) consists of 27 measurement items.It includes five dimensions,namely self-directed learning,information utilization,environment choice,stresses response and goal orientation.The results showed that the adaptability of medical students was moderate (3.28 ± 0.52),and the influencing factors included job position (OR =1.496,95％ CI=1.114-2.009),academic achievement (OR =1.638,95 ％ CI=1.386-1.936),satisfaction with learning (OR=2.160,95％CI=1.745-2.673),professional satisfaction (OR=1.369,95％CI=1.092-1.718),professional interest (OR =1.426,95％ CI=1.186-1.715) and employment prospects (OR =1.526,95％ CI=1.251-1.862).Conclusion The reliability and validity of the Student Learning Adaptability Scale is appropriate.Medical students' learning adaptability is influenced by many factors.

Objective:To investigate the effect of early enteral nutrition combined with Bacillus in the treatment of patients with digestive tract perforation.Methods:59 patients with emergency digestive tract perforation were randomly divided into experimental group (EN plus Bacillus,n =31) and control group (TPN,n =28).The patients in the experimental group were given enteral nutrition plus Bacillus after first days (＜ 24 h),and the control group was treated with parenteral nutrition support on the first day after surgery.The average hospitalization time,length of ICU stay,incidence of complications,and serum C-reactive protein in the two groups were analyzed.Results:The average length of hospitalization time,ICU stay,recovery of bowel function and eating time were significantly shorter in the experimental group than in the control group(P ＜ 0.05).There was no significant difference in nutrition index between the two groups during the perioperative period (P ＞ 0.05).The C-reactive protein in the experimental group was significantly lower than that in the control group fourth days after operation (P ＜ 0.05).The incidence of postoperative wound infection in the experimental group was significantly lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of other complications.Conclusion:Early administration of enteral nutrition combined with Bacillus can significantly shorten the intestinal function recovery time,decreasethe average hospitalization days,reduce the postoperative wound infection rate and thus improve the outcome of patients with digestive tract perforation.

OBJECTIVE:To investigate therapeutic efficacy and safety of Salviae miltiorrhizae and ligustrazine hydrochloride injection in the treatment of vertebro-basilar artery insufficiency(VBI)after cerebral infraction. METHODS:128 patients with VBI after cerebral infraction were divided into observation group and control group according to random number table,with 64 cases in each group. Both group received general treatment. Control group was additionally given Shuxuetong injection 6 ml added into 0.9%Sodium chloride injection 250 ml,ivgtt,qd. Observation group was additionally given Salviae miltiorrhizae and ligustrazine hy-drochloride injection 10 ml into 0.9% Sodium chloride injection 250 ml,ivgtt,qd. Both groups received treatment for consecutive 2 weeks. Clinical efficacies of 2 groups were observed as well as blood lipid,vertebro-basilar artery blood velocity and blood viscosity before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:The total effective rate of observa-tion group was 95.31%,which was significantly higher than 79.69% of control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in blood lipid,vertebro-basilar artery blood velocity and blood viscosity between 2 groups(P>0.05). After treatment,above indexes of 2 groups were improved significantly,and blood lipid and vertebro-basilar ar-tery blood velocity of observation group were significantly better than control group,with statistical significance(P<0.05). No obvi-ous ADR was found in 2 groups. CONCLUSIONS:Salviae miltiorrhizae and ligustrazine hydrochloride injection shows significant therapeutic efficacy for VBI after cerebral infraction,can significantly improve blood lipid,vertebro-basilar artery blood velocity and blood viscosity with good safety.

Objective To build a multi‐level hierarchical structure model of the influencing factors for hierarchical medical system ,to identify the role relationship between all the factors and transmission pathways ,and to recommend on developing China′s hierarchical medical system . Methods Thirty influencing factors were identified in a screening based on literature review for the hierarchical medical system .On such basis ,16 influencing factors were identified by three health policy experts ,which affect operations of the current system .Interpretative structural modeling was called into play in the end to analyze the hierarchy relationship between various influencing factors and the conduction loops .Results There exist among the 16 factors a 3‐level hierarchical structureand two conduction loops .The factor directly limiting the hierarchical medical system is two‐way referral,and most internal core drivers arehuman resources development and governance mechanism.By means of self‐growth and external constraints ,they exert their influence on the operation of hierarchical medical system .Conclusions There are interactive hierarchical effects among the factors ,merging into three node elements of functional role,inter‐entity relationshipand patient participation.