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 explore the etiology and characteristics of chronic wet cough in children in Qingdao.Methods:Patients with chronic wet cough treated at respiratory clinic of the Women and Children′s Hospital Affiliated to Qingdao University from July 2018 to June 2019 were included in this study.After three-month follow-up, the etiological data was analyzed.Results:(1)A total of 213 children were included, ranging in age from 1 month to 14 years old, including 38 cases of 1 month~1 year old, 47 cases of 1~3 years old, 87 cases of 3~6 years old, and 41 cases of 6~14 years old.The median age was 4.7 years.The top four causes of chronic wet cough in children were upper airway cough syndrome(33.8%), protracted bacterial bronchitis(20.7%), asthma with upper airway cough syndrome(15.5%), and asthma with infection(10.8%). Other causes were postinfection cough, pertussis syndrome, bronchiectasis, gastroesophageal reflux, bronchial foreign body, abnormal airway development, cystic fibrosis and so on.(2)The first cause of chronic wet cough in different age groups: 1 month to 3 years old group was protracted bacterial bronchitis; 3 to 14 years old group was upper airway cough syndrome.(3)The causes of chronic wet cough showed seasonal differences.Upper airway cough syndrome and cough after infection had a more balanced incidence throughout the year; protracted bacterial bronchitis and pertussis syndrome were common in winter; asthma with upper airway cough syndrome and asthma with infection were common in spring and autumn.Conclusion:Upper airway cough syndrome, protracted bacterial bronchitis, asthma with upper airway cough syndrome, and asthma with infection are the 4 leading causes for children with chronic wet cough in Qingdao.The causes of chronic wet cough have age and seasonal differences.

OBJECTIVE: To analyze the inter-laboratory comparison results of occupational hygiene laboratories of Guangdong Province. METHODS: The 42 laboratories that continuously participated in the inter-laboratory comparison of occupational hygiene technical service institutions in Guangdong Province from 2014 to 2018 were selected as the research subjects Guangdong Occupational Health Test Center from 2014 to 2018 were selected by convenient sampling method. The data of detection of organic compounds, metal element, non-metal element in the workplace air, detection of metal element in biological materials, and the detection of free silica in dust were analyzed. The results were statistically analyzed by four-point robust statistical technique. RESULTS: From 2014 to 2018, a total of 1 205 items of sample detection results were submitted in these 5 years. The qualified rate of sample test was 92.4%(1 114/1 205) in these laboratories. The qualified rate of test of organics in workplace air, metals in workplace air, inorganic non-metals in workplace air, metals in biological materials and free silica in dust were 93.3%, 94.4%, 91.6%, 84.4% and 91.8% respectively. There was no significant difference in the qualified rate of sample test between the laboratories in the Pearl River delta in Guangdong Province and the laboratories in other regions the laboratories in other regions(92.8% vs 89.6%, P>0.05). There was no significant difference in the qualified rate of sample test among the occupational disease prevention and treatment institute, center for disease control and prevention and private laboratories(93.1% vs 93.6% vs 89.0%, P>0.05). Among the 91 unqualified items, 35 items were │z score of inter-laboratory(z_B)│≥ 3(38.5%), 40 items were │z score of within-laboratory(z_w)│≥ 3(44.0%), and 16 items were│z_B│≥ 3 and │z_w│≥ 3(17.6%). CONCLUSION: The laboratories in Guangdong Province that participated in the inter-laboratory comparison of occupational health test for 5 consecutive years have a relatively high level of occupational health testing, and the test results are accurate.

Objective:To investigate the clinical features and outcome of treatment for novel coronavirus pneumonia.Methods:Literature on novel coronavirus pneumonia was retrieved from PubMed and EMBASE databases. The relevant data was extracted and a meta-analysis was performed using StatsDirect statistical software V.2.8.0 to calculate the combined odds ratio.Results:Seven studies were included, consisting of 1594 cases. The meta-analysis result showed that the most common clinical symptoms of the novel coronavirus pneumonia were fever (91.6%) and cough (64.5%), followed by dyspnea (32.8%) and sputum (28.1%). Headache (10.5%), sore throat (11.2%), hemoptysis (3.2%), diarrhea (6.6%) and the other symptoms were relatively rare. Aspartate aminotransferase (29%), alanine transaminase (22.7%), and total bilirubin (11.7%) levels were elevated, except for serum albumin levels (80.4%). The common therapeutic agents used were antibiotics (87.7%), antiviral drugs (75.5%), and glucocorticoids (26.6%), while antifungal agents (7.7%) were used in few. Mechanical ventilation (13.4%), extracorporeal membrane oxygenation (1.9%), and continuous renal replacement therapy (3.8%) were used in severe cases. The rate of mortality in hospital was 7.7%, respectively. Heterogeneity between studies was significant; however, subgroup and sensitivity analysis had failed to identify clear sources of heterogeneity.Conclusion:Fever, cough and liver dysfunction are the main clinical manifestations of this disease and the mortality rate is low.

Objective: To study the effects of half marathon loading on the T₂* mapping assessment of knee joint cartilage. Methods: Twenty male amateur marathon runners with more than three years of running age were enrolled. The T₁WI, PDWI, 3D-DESS, and T₂* mapping were performed on right knee joint before and after the half marathon within 3h and after a period of approximately 1 week. Cartilage was divided into 6 regions: medial and lateral femoral cartilage, medial and lateral tibial cartilage and patella and trochlea cartilage. Femoral cartilage was partitioned into central weight-bearing regions, posterior cartilage nonweight-bearing regions with the posterior boundary of the meniscus as the dividing mark. All cartilage was further divided into deep and superficial layers according to the thickness 1/2, and the ROI was delineated to obtain the T₂* value of the corresponding area. One-way repeated measures analysis was performed to test the difference of T₂* values pre- and post-marathon. LSD tests were used to estimate the different influences of physiological activities on each articular cartilage area. Results: All cartilage areas of the knee joint did not show cartilage injury during the examination. The differences in the global T₂* values of the superficial layers of the knee cartilage before and after the half-marathon marathon were statistically significant (t=5.145, P<0.05), but the global T₂* value of the deep region were not (t=1.864, P>0.05). After a week, the T₂* values of all cartilage areas were not statistically different from those before running (t=1.062, 0.309; P>0.05). Conclusion After a single half marathon, the changes of knee cartilage composition in male amateur marathon runners are reversible. In the absence of positive findings in conventional MRI, T₂* mapping can indirectly reflect changes in biochemical composition of the articular cartilage during exercise.

Objective To explore the effect of nanow-band imaging (NBI) combined with magnifying endoscopy (ME) in early diagnosis of gastric cancer,and to observe whether it is helpful for inexperienced endoscopists to diagnose.Methods From April 2015 to October 2017,a total of 480 lesions were selected as research objects which were detected in the normal white light endoscopy (WLE).Pathological examination was used as the gold standard for diagnosis.3 experienced doctors were selected to read the endoscopy films.40 intern endoscopy doctors were selected to read the endoscopy filins at the same time after simple training.80 WLE images and narrowband imaging technology combined with magnifying endoscopy (ME-NBI) images were randomly selected to hold a film reading meeting.Real-time voting was used to judge the nature of lesions.Results The accuracy,sensitivity,specificity false positive rate and false negative rate of ME-NBI were 97.9％ (470/480),96.8％ (120/124),98.3％ (350/356),1.7％ (6/356),3.2％(4/124).And WLE values were 91.7％ (440/480),80.6％ (100/124),89.9％ (320/356),10.1％ (36/356),19.4％ (24/124),respectively.The diagnostic accuracy,sensitivity and specificity of ME-NBI were significantly higher than those of WLE (x2 =18.989,16.104,15.859,P≤0.05),and the false positive rate and false negative rate were significantly lower than those of WLE (x2 =22.772,16.104,P ≤ 0.05).The diagnostic results of ME-NBI of 40 endoscopy interns were significantly better than those of WLE (t =11.467,16.188,P ≤0.05).The diagnostic results of NBI by 40 interns were significantly better than that of WLE (t =11.467,16.188,P ≤ 0.05).Conclusions The accuracy of ME-NBI in screening early gastric cancer is satisfactory,and it has certain diagnostic value for inexperienced doctors.

Objective To study the effects of cystic fibrosis transmembrane conductance regulator (CFTR) on neonatal rats with bronchopulmonary dysplasia (BPD).Method The hyperoxia (FiO2＞ 90％)-induced neonatal BPD rat models were established and assigned into three groups:the model group,the agonist group and the antagonist group.Room air (FiO2 21％) was inhaled by the rats in the control group.50 μl of phosphate buffered saline (PBS),genistein (50 mg/kg),arachidonic acid (500 mg/kg) and PBS were injected intraperitoneally respectively in the model group,the agonist group,the antagonist group and the control group at 24,48 and 72 h after birth.The survival rates of the neonatal rats were calculated,the survival curves were drawn,the pathological changes of the lung tissues were examined (the control group and the model group:3,14 and 21 d after birth;the agonist group and antagonist group:14 and 21 d after birth),and the expression of CFTR were studied using western blot method.The acute lung injury scores of the model group,the agonist group and the antagonist group were compared and the gray value was analyzed using Graphpad software.Result (1) The survival rates in the control group,the model group,the agonist group and the antagonist group were 96.8％,93.3％,100％ and 34.5％ respectively.The antagonist group had significantly lower survival rate than the other three groups (P＜0.001).(2)The alveoli developed gradually with age in the control group.The pulmonary pathology of the model group showed:alveolar congestion,hemorrhage,infiltration or aggregation of neutrophils in airspace or vessel wall,thickness of alveolar wall,with some enlarged alveolar spaces and reduced alveolar cavities.As the inflammation gradually decreased,some alveolar spaces significantly enlarged and the numbers of alveolar cavities significantly reduced.No significant differences existed of the acute lung injury scores among the agonist group,the antagonist group and the model group at 14 and 21 d after birth (P＞0.05).(3) The expressions of CFTR in the lungs were lower in the model group than the control group 3 d after birth (P＜0.01).No significant differences existed of the CFTR expression between the model group and the control group 14 d after birth(P＞0.05).The CFTR expression was much higher in the agonist group than the model group (P＜0.01) and also higher in the antagonist group than the model group (P＜0.05) 14 d after birth.The CFTR expression was lower in the model group than the control group,and higher in the agonist group than the model group 21 d after birth (P＜ 0.05).No significant differences existed of CFTR expression between the antagonist group and the model group 21 d after birth (P＞0.05).Conclusion CFTR may play a protective role in the pathogenesis of BPD.

Objective To study the effects of half marathon loading on the T2* mapping assessment of knee joint cartilage. Methods Twenty male amateur marathon runners with more than three years of running age were enrolled. The T1WI, PDWI, 3D?DESS, and T2*mapping were performed on right knee joint before and after the half marathon within 3h and after a period of approximately 1 week. Cartilage was divided into 6 regions: medial and lateral femoral cartilage, medial and lateral tibial cartilage and patella and trochlea cartilage. Femoral cartilage was partitioned into central weight?bearing regions, posterior cartilage nonweight?bearing regions with the posterior boundary of the meniscus as the dividing mark. All cartilage was further divided into deep and superficial layers according to the thickness 1/2, and the ROI was delineated to obtain the T2* value of the corresponding area. One?way repeated measures analysis was performed to test the difference of T2*values pre?and post?marathon. LSD tests were used to estimate the different influences of physiological activities on each articular cartilage area. Results All cartilage areas of the knee joint did not show cartilage injury during the examination. The differences in the global T2*values of the superficial layers of the knee cartilage before and after the half?marathon marathon were statistically significant (t=5.145, P<0.05), but the global T2*value of the deep region were not (t=1.864, P>0.05). After a week, the T2* values of all cartilage areas were not statistically different from those before running (t=1.062, 0.309; P>0.05). Conclusion After a single half marathon, the changes of knee cartilage composition in male amateur marathon runners are reversible. In the absence of positive findings in conventional MRI, T2* mapping can indirectly reflect changes in biochemical composition of the articular cartilage during exercise.

OBJECTIVE: To investigate the individual external dose level of medical radiation staffs in Guangzhou City.METHODS: The medical radiation staffs of Guangzhou City who conducted individual dose monitoring at Guangdong Province Hospital Center for Occupational Diseases Prevention and Treatment from 2008 to 2014 were selected as study subjects by convenient sampling method.Their individual dosage monitoring data were analyzed.RESULTS: A total of 17 754 person-times were monitored in 7 years.The annual collective effective dose was 10 621.1 person·mSv and the median per capita annual effective dose was 0.21 mSv/a.The per capita annual effective dose in 2008-2012 showed an increasing trend each year( P < 0.05),peaked in 2012,and then decreased in 2013 and 2014( P < 0.05).The per capita annual effective dose of radiology staffs in level Ⅱ medical institutions was higher than that of level Ⅲ medical institutions,level Ⅰ medical institutions and those below level Ⅰ( P < 0.01).The per capita annual effective dose of radiation staffs in level Ⅲ medical institutions was higher than level Ⅰ medical institutions and those below level Ⅰ( P <0.01).The effective monitoring rates of radiation staffs monitored for 4 cycles every year increased with time from 2008 to 2014( P < 0.01).The effective monitoring rate increased with the hospital level( P < 0.01).The per capita annual effective dose of the staffs in radiological diagnosis department was lower than that of clinical nuclear medicine,radiotherapy and interventional radiology( P < 0.01).CONCLUSION: The radiation dose of medical radiation staffs in Guangzhou City was within the national standard limit.Protection should be focused on the the staffs in secondary hospitals,clinical nuclear medicine,radiotherapy and interventional radiology.

BACKGROUND:Insulin-like growth factor-1(IGF-1) is an important regulator in osteoblasts proliferation,differentiation and matrix synthesis,which participates in the process of fracture healing and repairing. OBJECTIVE:To investigate the potential bone regeneration effect of human bone marrow mesenchymal stem cells(MSCs) transfected into IGF-1 retroviruses vector on bone defects repairing. DESIGN,TIME AND SETTING:A controlled observation experiment was performed between March 2004 and May 2005 at the Laboratory Animal Center of Soochow University. MATERIALS:MSCs were transfected into IGF-1 retroviruses vector in vitro and combined with demineralized bone matrix(DBM) . METHODS:Fifteen BalB/C nude mice were prepared for 8 mm calvarial defects models and divided into 3 groups by number table method,with 5 animals in each group. DBM transfected with IGF-1 and DBM transfected with vector were implanted into the defect in MSCs cells transduced with IGF-1 and vector groups,respectively. There was no other intervention in the blank control group. The implants were harvested and evaluated by histological examination at 4 weeks after model preparation. MAIN OUTCOME MEASURES:①The mRNA expression of IGF-1 was analyzed by RT-PCR and Western Blot. ②The complexes of cells and DBM were analyzed by scanning electron microscope(SEM) at days 3 and 6 after co-culture. ③Gross observation of the calvarial defects models. ④Osteogenic activity of the implants was evaluated by hematoxylin-eosin staining at weeks 4 after model preparation. RESULTS:①There were mRNA and protein expression of IGF-1 in MSCs cells transduced with IGF-1 vector. ②SEM showed that there were plenty of cells adhered to surface of DBM,and grew into inner part at the 3 days after co-culture with IGF-1,which secreted much collagen fibers at days 6. The count of adherent cells and collagen fiber was smaller in the vector group at each time points. ③No obvious inflammatory reaction could be seen in each group at 4 weeks after model preparation. Compared with vector control,abundant new bone and blood vessel formation occurred in the calvarial defects treated with DBM/IGF-1,and no new bone formation in the blank control groups. ④Results of hematoxylin-eosin staining showed that grafts in the MSCs cells transduced with IGF-1 group was combined closely with calvarial defects,new bone and vessel could be found. There were few bone-like materials formation in vector group,and no defects in control group were repaired. CONCLUSION:The composites of IGF-1 transfected MSCs and DBM has good effect in repairing calvarial defects.