Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective:To explore the measurement method and its diagnostic performance based on MRI and CT measurement of vertebral bone density in patients to predict proximal junctional kyphosis after degenerative scoliosis surgery.Methods:Retrospectively included patients who underwent long-segment fixation and fusion surgery at the Department of Orthopedics, West China Hospital of Sichuan University from January 2010 to December 2020 and had complete preoperative whole-spine X-rays, CT, MRI and other imaging examination results, and were followed up on schedule. 68 cases of adult degenerative scoliosis, 16 male, 52 women, aged 66.87±6.65 years (range, 54-80 years). The patients were measured based on preoperative lumbar spine MRI T 1WI bone quality score (vertebral bone quality score, VBQ) and CT-based Hounsfield (HU) value, and the patients were divided into postoperative proximal junction kyphosis group or non-proximal junction kyphosis group based on the results of postoperative imaging examinations. The age, gender, BMI, comorbidities, lumbar spine VBQ score, L 1 CT HU value and various imaging parameters before and after surgery were compared between the two groups of patients, including pelvic incident, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope, pelvic incidence-lumbar lordosis, T 1 pelvic angle, Upper instrumented vertebrae screw angle, etc. The receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic efficacy, sensitivity and specificity of VBQ score, HU value and their combined indicators. Results:Seventeen cases were included in the PJK group and 51 cases in the non-PJK group. The preoperative VBQ and HU values of the PJK group were 3.10±0.43 and 99.76±16.34 respectively, while those of the non-PJK group were 2.62±0.37 and 115.27±13.46 respectively. The differences were statistically significant ( t=3.896, P<0.001; t=4.482, P<0.001). The area under curve (AUC) of VBQ was 0.773 [95% CI(0.633, 0.914)], the sensitivity and specificity are 82.4% and 70.6% respectively, the AUC of HU value was 0.814 [95% CI(0.680, 0.949)], the sensitivity and specificity are 76.5% and 76.5% respectively. The AUC of the two combined indicators was 0.895 [95% CI(0.795, 0.995)], and the sensitivity and specificity were 94.1% and 82.4% respectively. The maximum Youden index and the critical value were respectively, VBQ value 0.530, 2.895, HU value 0.530, 110.0, the combined index 0.765, 0.734. Conclusion:Both VBQ and L 1 HU value can accurately predict proximal junctional kyphosis after degenerative scoliosis surgery. The accuracy of HU value was slightly higher than that of VBQ value. The diagnosis accuracy of the combined index was the highest.

Humans ; COVID-19 ; HIV Infections/drug therapy* ; Risk Factors

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.

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.

Abstract Plant exocrine-like nanovesicles(PELNs) is a new nano-therapeutic agent and delivery platform, which not only has the potential for disease treatment, but also can be used as a drug carrier to target disease sites and play a dual role in treatment and delivery. More importantly, PELNs has the characteristics of green nature and low immunogenicity. This review systematically introduced several secretory mechanisms of PELNs:Outer capsule positive organelle, polyvesicular body, vacuole and autophagosome; three components such as lipid, protein and nucleic acid; centrifugation, ultrafiltration, size exclusion chromatography, flow field-flow fractionation, immunomagnetic beads, polymer precipitation and other separation methods and their biological functions such as anti-inflammation, anti-tumor, protection of regeneration, antivirus, liver protection, etc.; sorted out the potential mechanism of PELNs as a therapeutic agent and molecular delivery platform, and put forward the problems existing in the research process of PELNs, such as quantification, mechanism research and few clinical trials. And its development potential in the future is discussed.

To investigate the distribution and clinical significance of nuclear dense fine speckled (DFS) pattern in various diseases. A total of 95 289 patients who received DFS tests at Peking Union Medical College Hospital from January 2019 to December 2020 were included in this study. The results of indirect immunofluorescence assay (IIF) for detection of antinuclear antibody (ANA) were evaluated. The positive rates of ANA and DFS were 39.60% (37 733/95 289) and 1.19% (1 139/95 289) respectively. The positive rate of DFS in ANA-positive patients was 3.02% (1 139/37 733). DFS and ANA positivity were significantly different among different age groups rather than gender. The positivity rate of DFS reached the peak (55.57%, 633/1 139) in young patients between 21-40 years, while positive ANA with negative DFS was mainly observed in patients between 41-60 years (37.26%, 13 636/36 594). Additionally, single ANA-positivity were mainly detected in rheumatology department (59.23%, 18 402/31 066), whereas positive DFS was more common in obstetrics and gynecology department (3.08%, 49/1 593). There were 82.88% (944/1 139) patients with positive DFS diagnosed with non-autoimmune disease (non-AID), and 19.49%(222/1 139) with dermatosis. Positive DFS with higher titer (≥1∶320) was detected more frequently in autoimmune disease (AID) patients (5.13%, 10/195) than in non-AID patients (1.69%, 16/944) ( P<0.05). The DFS pattern is rare in ANA positive patients, which is mainly observed in women between 21-49 years. High titer of DFS is prevalent in AID patients, but positive DFS is detected more in non-AID patients, especially those with dermatosis.

Objective:To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods:Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions，9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018. National and regional incidence rates were calculated. The data of cause of injury，injury level，severity of injury，segment and type of fracture，complications，death and other data were collected by medical record questionnaire，and analyzed according to geographical region，age and gender.Results:Medical records of 4，134 patients were included in this study，with a male-to-female ratio of 2.99∶1. The incidence of traumatic spinal cord injury in China in 2018 was 50.484 / 1 million （95% CI 50.122-50.846）. The highest incidence in the Eastern region was 53.791 / 1 million （95% CI 53.217-54.365）. In the whole country，the main causes of injury were high falls （29.58%），as well as in the Western region （40.68%），while the main causes of injury in the Eastern and Central regions were traffic injuries （31.22%，30.10%）. The main injury level was cervical spinal cord in the whole country （64.49%），and the proportion of cervical spinal cord injury in the Central region was the highest （74.68%），and the proportion of lumbosacral spinal cord injury in the Western region was the highest （32.30%）. The highest proportion of degree of injury was incomplete quadriplegia （55.20%），and the distribution pattern was the same in each region. A total of 65.87% of the patients were complicated with fracture or dislocation，77.95% in the Western region and only 54.77% in the Central region. In the whole country，the head was the main combined injury （37.87%），as well as in the Eastern and Central regions，while the proportion of chest combined injury in the Western region was the highest （38.57%）. A total of 32.90% of the patients were complicated with respiratory complications. There were 23 patients （0.56%） died in hospital，of which 17（73.91%） died of respiratory dysfunction. Conclusions:The Eastern region of China has a high incidence of traumatic spinal cord injury. Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level，incomplete quadriplegia as the main degree of injury，head as the main combined injury，and respiratory complications as the main complication.

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.