Objective:To evaluate the prevalence and distribution of ossification of ligamentum flavum (OLF) at the segments adjacent to the apex in patients with degenerative kyphosis.Methods:All of 74 patients with degenerative kyphosis from January 2018 to December 2021 were retrospective reviewed. All patients were taken anteroposterior and lateral radiographs, CT scan and magnetic resonance imaging (MRI) of the entire spine. Global kyphosis, the morphology of kyphosis and the occurrence of OLF at three segments adjacent to the kyphosis apex were recorded.Results:Of the 74 patients, 54 patients (73%) developed OLF in three segments adjacent to the kyphotic apex. The mean age of the 54 patients was 61.4±6.8 years, and the mean global kyphosis was 49.5°±21.2°. Among other 20 patients without OLF, the mean age was 56.1±7.5 years, and the mean kyphosis angle was 52.1°±19.1°. There was a statistically significant difference in ages ( t=2.92, P=0.005), but no statistically significant difference was observed regarding global kyphosis ( t=0.48, P=0.634). In these 74 patients, 9 patients had angular kyphosis, of which 8 (89%) developed OLF; of the 65 patients without angular kyphosis, 46 patients (71%) developed OLF. There was no significant difference between them (χ 2=1.32, P=0.251). Among the 54 patients diagnosed with OLF, 5 patients (9%) suffered ossification of the posterior longitudinal ligament (OPLL) and 20 patients (37%) suffered dural ossification; 43 patients (80%) developed OLF at proximal segments of apex, 6 patient (11%) developed OLF at distal segments of apex, and 5 patients (9%) developed OLF both at proximal and distal segments of apex. Thirty-two patients (59%) developed OLF at the first segment adjacent to the kyphotic apex, 27 patients (50%) developed OLF at the second segment, and 15 patients (28%) developed OLF at the third segment. Conclusion:Among patients with degenerative kyphosis, about 73% may development OLF within three segments adjacent to the kyphotic apex, and it mostly occurred within two segments adjacent to the apex proximally.

Objective:To evaluate the clinical outcomes and complications of second sacral alar-iliac (S 2AI) technique utilized in degenerative spinal deformity patients, and to analyze the potential risk factors for postoperative sagittal imbalance. Methods:From January 2014 to October 2020, a consecutive cohort of 39 degenerative spinal deformity patients who were treated with S 2AI were retrospectively reviewed, including 4 males and 35 females, aged 63.1±6.7 years (range, 43-73 years). All of the patients had a minimum of 2-year follow-up. According to the sagittal vertical axis (SVA) at the final follow-up, patients were divided into 2 groups. Sagittal balance group (SVA≤50 mm) and sagittal imbalance group (SVA>50 mm). Radiographic parameters including the Cobb's angle, coronal balance distance (CBD), thoracic kyphosis (TK), lumbar lordosis (LL), SVA, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS) were measured in the standing radiographs before and after operation and at the latest follow up. Comparison was made between the two groups and the differences with statistical significance were analyzed with binary logistic regression analysis. Intraoperative and postoperative complications were recorded. The Scoliosis Research Society-22 (SRS-22) score were employed to evaluate the quality of life. Results:The average follow-up period was 30.3±9.1 months (range, 43-73 months). Eighteen patients (46%) were identified with sagittal imbalance at the last follow-up. Compared with the patients in the sagittal balance group, the preoperative SVA was significantly larger (83.1±56.2 mm vs. 48.1±51.1 mm, t=2.04, P=0.049) and the postoperative TK was significantly greater (27.8°±9.6° vs. 18.9°±13.4°, t=2.36, P=0.024) for patients in the sagittal imbalance group. Scores of pain domain (3.2±0.5 vs. 3.7±0.6) and self-image domain (3.4±0.8 vs. 3.8±0.6) in sagittal imbalance group were significantly lower than those of sagittal balance group ( P<0.05). Logistic regression analysis showed that larger preoperative SVA ( OR=1.02, P=0.028) and greater postoperative TK ( OR=1.09, P=0.022) were independent risk factors for the occurrence of sagittal imbalance during the follow-up periods. Conclusion:S 2AI screw fixation can achieve satisfying coronal deformity correction and great sagittal reconstruction after surgery in patients with degenerative spinal deformity. However, sagittal imbalance may still occur during the follow-up periods. Larger preoperative SVA and greater postoperative TK are independent risk factors for the occurrence of sagittal imbalance.

Objective:To investigate the clinical outcomes and complication of posterior surgery for Scheuermann kyphosis fusing to different distal fusion levels.Methods:From January 2012 to December 2017, a consecutive cohort of 34 patients who were treated with posterior spinal instrumented correction and satisfied the inclusion criteria were retrospectively reviewed, including 29 males and 5 females, aged 17.1±4.3 years (range, 12-30 years). All of the patients had a minimum follow-up of 2 years. According to the distal fusion level, patients were divided into 2 groups. Group sagittal stable vertebra (SSV) (22 cases) included patients whose lowest instrumented vertebra (LIV) was SSV; Group SSV-1 (12 cases) included patients who had a LIV one level above the SSV. Radiographic parameters including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in the standing radiographs before and after operation and at the latest follow up. Intraoperative and postoperative complications were recorded. The Scoliosis Research Society-22 questionnaire (SRS-22) were conducted at pre-operation and the final follow up to evaluate the clinical outcomes. The sagittal radiographic parameters and the incidence of distal junctional kyphosis (DJK) were compared between the two groups.Results:There were no significant differences in terms of age, sex, radiographic measurements and scores of SRS-22 between two groups preoperatively ( P>0.05). The correction rates of GK in the SSV group and the SSV-1 group were 42.8%±7.6% and 43.2%±8.4% ( t=0.151, P=0.881) respectively. While the correction rates loss were 1.2%±5.2% and 3.9%±7.2% ( t=0.767, P=0.449) at the latest follow up. No significant difference was observed in terms of other radiographic parameters ( P>0.05). During the postoperative follow up period, 3 patients (16.7%) in SSV group and 2 patients (13.6%) in SSV-1 group developed DJK. The incidence of DJK did not show any significant difference between two groups ( χ2=0.057, P=0.812). At the final follow-up, the function scores of SRS-22 in SSV-1 group (4.1±0.6) was significantly higher than SSV group (3.7±0.5) ( t=2.300, P=0.028) and there was no significant difference in the rest of the domain ( P>0.05). Conclusion:Compared with stopping at SSV, fusion to SSV-1 could achieve comparable curve correction with the preservation of more lumbar motility. Moreover, it would not increase the risk of DJK. As a result, we recommend selecting SSV-1 as the ideal LIV for SK patients.

Objective:To establish age- and gender-based normative values of sagittal spinal-pelvic alignment in Chinese adult population, and to investigate influence of age, gender and ethnicity on sagittal spinal-pelvic alignment in Chinese normal adults.Methods:A total of 786 asymptomatic Chinese adult volunteers aged between 20 and 89 years were prospectively recruited from different spine centers. The inclusion criteria were: 1) age between 20 to 89 years old; and 2) Oswestry disability index (ODI) scored lower than 20. The exclusion criteria were: 1) previous history of spinal, pelvic or lower limb pathologies that could affect the spine; 2) presence of recent and/or regular back pain; 3) previous surgeries on spine, pelvic and/or lower limb; and 4) pregnancy. Demographic characteristics of these subjects including age, gender, body weight and height were recorded. During the enrollment of volunteers, 16 groups were defined based on the age (20 s, 30 s, 40 s, 50 s, 60 s, 70 s and 80 s) and gender. Whole body biplanar standing EOS X-ray radiographs were acquired to evaluate the sagittal alignment. Spinal-pelvic parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (T 5-T 12, TK), lumbar lordosis (L 1-S 1, LL), lower lumbar lordosis (L 4-S 1, LLL), global tilt (GT), T1 pelvic angle (TPA) and sagittal vertical axis (SVA) were measured. Values of PI-LL and lordosis distribution index (LLL/LL, LDI) were calculated. Radiographic measurements of 100 subjects were randomly selected to determine the intra- and inter-observer reliabilities using inter- and intra-class correlation coefficients (ICC). The spinal-pelvic parameters were compared among volunteers between different age and gender groups. The comparison was also made among various ethnic population. Results:The mean value was 23.7±7.1 kg/m 2 for BMI and 6.9%±2.5% (range, 0-18%) for ODI score. Each sagittal spinal-pelvic parameter was presented with mean value and standard deviationbased on age and gender. The ICCs of radiographic measurements ranged from 0.89 to 0.95, suggesting good to excellent intra- and inter-observer reliabilities. Significant differences were observed between males and females in multiple sagittal parameters (all P values <0.05). Compared to the male subjects, significantly higher values of PI (41.4° for male vs. 45.0° for female, P<0.001), PT (10.7° for male vs. 13.9° for female, P<0.001), PI-LL (-0.5° for male vs. 1.8° for female, P<0.001), and GT (10.9° for male vs. 13.5° for female, P<0.001) were documented in female subjects. Males had significantly higher values of LLL (28.6° for male vs. 26.6° for female, P<0.001) and LDI (0.68 for male vs. 0.63 for female, P<0.001). PI-LL, SVA, GT and TPA increased with aging from Group 40 s to Group 80 s, while LL, LLL and LDI decreased gradually, and TK decreased slowly with aging. Comparison of sagittal spinal-pelvic parameters between different ethnic subjects showed that Chinese adult population presented lower PI, SS, TK and LL as compared with American population; lower PI, SS and LL as compared with Japanese population. But the variation trend with aging tended to be consistent among different ethnic populations. Conclusion:Age- and gender-based normative values of sagittal spinal-pelvic alignment were established in asymptomatic Chinese adult population. Sagittal spinal-pelvic alignment varies with age and gender, and presented different compensation mechanism among different ethnic populations. Therefore, to achieve balanced sagittal alignment, age, gender and ethnicity should be take intoconsideration when planning spine correction surgery.

Patients in acute myocardial infarction (AMI) with serious complications such as malignant ventricular arrhythmia and cardiogenic shock couldn't receive emergency percutaneous coronary intervention (PCI) procedures and had high perioperative mortality. A case of AMI patients who suffered cardiac arrest and long-term cardiopulmonary resuscitation (CPR) was admitted to the department of critical care medicine of the First People's Hospital of Foshan. With the assistance of extracorporeal membrane oxygenation (ECMO), PCI and intra-aortic balloon counterpulsation (IABP) were performed. ECMO and ventilator were successfully weaned after anti-shock, mechanical ventilation, organ support treatment. The patient was successfully treated and discharged. After 6 months of follow-up, the patient recovered well in heart function.

Patients in acute myocardial infarction (AMI) with serious complications such as malignant ventricular arrhythmia and cardiogenic shock couldn't receive emergency percutaneous coronary intervention (PCI) procedures and had high perioperative mortality. A case of AMI patients who suffered cardiac arrest and long-term cardiopulmonary resuscitation (CPR) was admitted to the department of critical care medicine of the First People's Hospital of Foshan. With the assistance of extracorporeal membrane oxygenation (ECMO), PCI and intra-aortic balloon counterpulsation (IABP) were performed. ECMO and ventilator were successfully weaned after anti-shock, mechanical ventilation, organ support treatment. The patient was successfully treated and discharged. After 6 months of follow-up, the patient recovered well in heart function.
Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Intra-Aortic Balloon Pumping ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Shock, Cardiogenic ; Treatment Outcome

Objective To investigate the distribution of pathogens and their drug resistance in elderly patients with community-acquired pneumonia. Methods A total of 222 elderly patients with community-acquired pneumonia admitted to our hospital from February 2017 to January 2018 were enrolled in this study.Lower respiratory tract secretions or morning sputum were collected by using the sterile culture method. According to the clinical microbiological examination procedures ,pathogenic bacteria were cultured and identified. The pathogenic bacteria strains and the drug resistance were analyzed. Results The bacteria examination rate of the patients was 100.0% (222/222 patients) , and the rate of positive cultures was 64.9% (144/222 ).216 strains of pathogenic bacteria were identified ,and 75 strains(34.7% )were Gram-positive bacteria ,of which the most common pathogenic bacteria were Staphylococcus aureus ,Streptococcus pneumoniae and Staphylococcus epidermidis. And 127 strains(58.8% )were Gram-negative bacteria ,of which the most common pathogenic bacteria were Klebsiella pneumoniae ,patina Pseudomonas ,Escherichia coli ,Stenotrophomonas maltophilia and Haemophilus influenza. The drug susceptibility test showed that Gram-positive bacteria were sensitive to nitrofurantoin ,cotrimoxazole ,vancomycin and teicoplanin ,and Gram-negative bacteria were sensitive to piperacillin ,tazobactam ,cefepime ,amikacin ,levofloxacin and imipenem cilastatin. Conclusions The pathogenic bacteria are mainly Gram-negative bacteria in the elderly patients with community-acquired pneumonia ,but the majority of pathogenic bacteria have higher resistance to antibacterial drugs. The analyses of distribution of pathogens and their drug resistance are of great significance for the reasonable selection of antimicrobial agents and for the obvious decrease of lung infection and mortality rate.

Objective To investigate the effect of tigecycline on serum procalcitonin and its efficacy in the treatment of elderly chronic obstructive pulmonary disease (COPD) and nosocomial infection. Methods 82 elderly patients with COPD with nosocomial infection were selected and randomly divided into two groups with 41 cases of each group, the control group received routine treatment combined with cefoperazone and sulbactam, and the experimental group received routine treatment combined with tigecycline, 2 weeks for a course of treatment. The serum inflammatory factors and laboratory related indexes, clinical efficacy and bacterial clearance were compared after the treatment. Results Compared with control group, the levels of serum high-sensitivity C-reactive protein (hs-CRP), interluekin 6(IL-6) and tumor necrosis factorα(TNF-α) were significantly lower, and the serum levels of PCT and NO were lower(P < 0.05). The total efficacy of experimental group was 90.24%, which was higher than 70.73% in control group (P<0.05). The bacterial clearance rate in the control group was 63.42%, which was lower than the experimental group of 87.80% (P < 0.05). Conclusion Tigecycline in the treatment of COPD and nosocomial infection in elderly patients is curative effective and it can reduce the serum levels of PCT, NO and inflammatory factors with high safety.

Objective To compare the changes of plasma lipid indexes and coronary artery atherosclerotic plaque in TaqI B genotypes in CHD patients with impaired glucose tolerance (IGT) before and after statin therapy. Methods A total of 196 CHD with IGT and 160 controls were included. The changes of plasma lipid indexes and coronary artery atherosclerotic plaque in TaqI B genotypes were analyzed before and after Rosovastatin therapy. Sequenom Mass ARRAY platform was used to detect the CETP TaqI B SNPs. Results The genotype frequency of the B1B1, B1B2 and B2B2 in CHD with IGT group was 35.7%, 48.0% and 16.3% respectively, while in control group was 31.3%, 53.1% and 15.6% respectively. HDL-C, PA and MLA levels increased after Rosuvastatin therapy, while LDL-C, TG, TCH, Lpa, PA, EEMA and PB levels decreased. Conclusions CETP gene polymorphisms TaqI B would have association with the effects of Rosuvastatin therapy in the CHD with IGT.

ObjectiveTo explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema.Methods A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment.Results Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa·s·L-1·m-2):148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8,P< 0.05 orP< 0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL·s-1·m-2): 75.0±8.0 vs. 55.5±8.5, bothP< 0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae.Conclusions Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.