Since the concept of patient versions of guidelines （PVGs） was introduced into China， several PVGs have been published in China， but we found that there is a big difference between the concept of PVG at home and abroad， and the reason for this difference has not been reasonably explained， which has led to ambiguity and even misapplication of the PVG concept by guideline developers. By analyzing the background and purpose of PVGs， and the understanding of the PVG concept by domestic scholars， we proposed the term patient guidelines （PGs）. This refers to guidelines developed under the principles of evidence-based medicine， centered on health issues that concern patients， and based on the best available evidence， intended for patient use. Except for the general attribute of providing information or education， which is typical of common health education materials， PGs also provide recommendations and assist in decision-making， so PGs include both the patient versions of guidelines （PVG） as defined by the Guidelines International Network （GIN） and "patient-directed guidelines"， i.e. clinical practice guidelines resulting from the adaptation or reformulation of recommendations through clinical practice guidelines.

Lumbar interbody fusion is a surgical method for treating lumbar degenerative diseases. By establishing the stability of the lumbar segment, it solves the related symptoms caused by lumbar degenerative diseases. Minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) is a mature technology for treating lumbar degenerative diseases and improving the stability of the lumbar segment. In recent years, the emergence of lumbar interbody fusion under the small-channel working tube has made it have more minimally invasive characteristics compared to MIS-TLIF, with smaller incisions, less bleeding, and shorter recovery time. However, due to its long operation time, low efficiency of endplate treatment, and high complications incidence rate, it has not been widely popularized. At present, the large-channel endoscopic system, because of its larger field of view under the endoscope and more efficient endoscopic operation tools, reduces the operation time, improves the efficiency of endplate treatment, and reduces the postoperative related complications incidence rate. According to the surgical approach, it can be divided into transforaminal approach, posterior approach, oblique anterior approach, etc. According to the channel mode, it can also be divided into uniaxial endoscopy and unilateral dual-channel endoscopy, and each has its own advantages and disadvantages. Nowadays, the safety and effectiveness of spinal endoscopic posterior lumbar interbody fusion(Endo-PLIF) under the large-channel have achieved satisfactory results. This article reviews the research progress of Endo-PLIF under the large-channel, including surgical indications and contraindications, anatomical basis, surgical techniques, the choice of cages, the choice of fixation methods, safety and effectiveness, advantages and disadvantages, and explores its clinical application and prospects.

Objective:To develop a nomogram predictive model on the basis of identification of the risk factors associated with failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction.Methods:A retrospective study was conducted of the clinical data of the patients who had been treated for dislocation of the subaxial cervical spine with locked facets at Department of Orthopaedic Trauma, The Hospital Affiliated to Guizhou Medical University and Department of Spine Surgery, The People's Hospital of Guizhou Province from January 2014 to December 2022. The clinical data from The Hospital Affiliated to Guizhou Medical University were used as a training set (156 cases) and those from The People's Hospital of Guizhou Province as an external validation set (54 cases). Univariate analysis and multi-variate logistic regression analysis of the training set were conducted to screen out independent risk factors associated with the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction. A nomogram predictive model was thus constructed and assessed by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve. Internal validation of the training set and external validation set was used to evaluate and validate the model.Results:The multivariate logistic regression analysis revealed that cervical Ⅰ grade dislocation ( P=0.002), cervical Ⅱ grade dislocation ( P=0.007), low segment affected ( P=0.042), unilateral facet locked ( P=0.027), and the ASIA grading of spinal cord injury ( P=0.008) were the independent risk factors associated with the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction, based on which the nomogram model with a C-index of 0.88 was constructed to predict the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction. Analysis of the ROC curve of the training set showed an area under the curve (AUC) of 0.88, indicating good accuracy of the nomogram model. Analysis of the calibration curve showed high consistency between the probability of the nomogram model predicting the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction and the actual probability of traction reposition failure. Analysis of the decision curve showed that application of the nomogram model led to good benefits when the net benefit threshold for the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction was 0.03 to 0.84. Analysis of the ROC curve of external validation set showed an AUC of 0.79, indicating good accuracy of the nomogram model. The training set showed a C-index of 0.87 after 1,000 internal verifications by the Bootstrap method, indicating good discrimination of the nomogram model. Conclusions:Cervical Ⅰ grade dislocation, cervical Ⅱ grade dislocation, low segment affected, unilateral facet locked, and incomplete spinal cord injury are independent risk factors associated with failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction. A nomogram model has been successfully constructed which can predict the failure in repositioning the dislocation of the subaxial cervical spine with locked facets by skull traction. Validation and evaluation of the nomogram model have demonstrated its good predictive value.

Objective:To explore the clinical features and risk factors of severe mycoplasma pneumoniae pneumonia(SMPP) in children, and to provide guidance for early identification of SMPP.Methods:The clinical data of 263 children with mycoplasma pneumoniae pneumonia admitted to the Respiratory Department at Anhui Children′s Hospital from January 2019 to December 2021 were analyzed retrospectively.According to the severity of the disease, the patients were divided into severe group( n=88) and mild group( n=175). The general conditions, clinical manifestations, laboratory examination, imaging features and bronchoscopic findings between two groups were compared and statistically analyzed. Results:There was no significant difference in sex and onset season between two groups( P>0.05). The age of severe group was older than that of mild group( P<0.05). According to the age group, the incidence of SMPP in the infant group(14.10%) was lower than that in the preschool group (45.00%) and the school age group (37.65%) ( P<0.05), but there was no significant difference between preschool group and school age group ( P>0.05). The degree of fever and the proportion of extrapulmonary complications in severe group were higher than those in mild group, and the duration of fever, length of hospital stay and use of macrolides in severe group were longer than those in mild group ( P<0.05). There were significant differences in white blood cell count/lymphocyte count, C-reactive protein (CRP), prealbumin, glutamic pyruvic transaminase, lactate dehydrogenase (LDH), immunoglobulin G, immunoglobulin A, procalcitonin, erythrocyte sedimentation rate (ESR) and D-dimer between two groups(all P<0.05). There was significant difference in the copies of mycoplasma pneumoniae DNA in bronchoalveolar lavage fluid between two groups ( P<0.05). The proportion of large shadow, pleural thickening, atelectasis, pleural effusion, bronchoalveolar lavage and airway mucus thrombus blockage in severe group were higher than those in mild group ( P<0.05). Multivariate Logistic regression analysis showed that hot course ( OR=1.294, 95% CI: 1.127-1.485), CRP level( OR=1.027, 95% CI: 1.003-1.052), LDH level( OR=1.006, 95% CI: 1.002~1.011), D-dimer level( OR=1.406, 95% CI: 1.065~1.875), ESR( OR=1.042, 95% CI: 1.008-1.077), large shadow( OR=21.811, 95% CI: 6.205~76.664) and pleural effusion( OR=5.495, 95% CI: 1.604-18.826) were independent risk factors for SMPP.ROC curve analysis showed that thermal path, CRP level, LDH level, D-dimer level and ESR had high predictive value in the diagnosis of SMPP, and the best thresholds were 8.50 d, 25.625 mg/L, 412.50 IU/L, 0.98 mg/L and 36.5 mm/h, respectively. Conclusion:Children with SMPP had high degree of fever, long duration of fever, length of hospital stay, long use of macrolides, significantly increased inflammatory indexes, and severe changes in pulmonary imaging and bronchoscopy.Hot course, CRP level, LDH level, D-dimer level, ESR, large shadow and pleural effusion are risk factors for SMPP.It is helpful for early identification of SMPP when the hot course is >8.50 d, CRP>25.625 mg/L, LDH > 412.50 IU/L, D-dimer > 0.98 mg/L, ESR > 36.5 mm/h.

FTY720 and IMMH002, prodrugs for sphingosine-1-phosphate receptor 1 (S1P) agonists, show inadequate and inconsistent levels of phosphorylation in humans compared to that in rats. In this study, FTY720 or IMMH002 analogues (-) were designed and synthesized with modified head pieces to improve the biotransformation of the prodrugs to the active phosphorylated forms. Target compounds were synthesized a convergent route using the key and optically pure building block , which was first synthesized asymmetrically catalyzed amination. The phosphorylation rates of these analogues in rat or human blood were compared. The new methyl-substituted analogue compound showed higher phosphorylation rates in both rats and humans than the parent compound, whereas compound showed improvements in rats, but not in humans. In pharmacokinetics studies of rats, compounds and both had higher levels of phosphorylation than FTY720 and IMMH002. Thus, our study not only yielded new compounds with therapeutic potential, but also showed species differences between rats and humans in response to the structural modifications, which might be useful for predicting the biotransformation behavior and efficacy of this class of prodrugs in the clinic.

Objective To evaluate the feasibility and efficacy of twin grasper combined with endoloops on closing acute stomach perforation.Methods Two experimental porcines of stomach perforation underwent endoscopic closure by twin grasper combined with endoloops.Survival conditions and closure of perforating were observed.Results Mild infection and abdominal adhesions were observed in one week after operation.The nylon rope fell off and an ulcer-like lesion was presented in the closed position.The methylene blue leak test was negative.Histologic examination revealed chronic inflammatory cells infiltration,granulation,fibroplasias,and regenerative mucous membrane crawling toward the center of perforation.Conclusion The technique of twin grasper combined with nylon ropes in closing the acute stomach perforation is feasible and effective.