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ObjectiveTo assess the capacity of health emergency drills for poisoning emergencies at the municipal level in Guangdong Province. Methods A total of 21 municipal teams from cities in Guangdong Province participated in the health emergency drill competition, which included comprehensive tests and practical assessments. Results The pass rate for the total score, comprehensive tests, practical assessments of 21 municipal teams was 66.7%, 33.3%, 66.7%, respectively. The pass rate of the comprehensive tests was lower than that of practical assessments (P<0.01). The pass rate for the total score, comprehensive tests, and practical assessments of team from the Pearl River Delta region was higher than those in non-Pearl River Delta regions (88.9% vs 50.0%, 55.5% vs 16.7%, 88.9% vs 50.0%). For the four comprehensive test items, the highest pass rate was for personal protective principles against chemical poisoning (57.1%). For the five practical assessment items, the highest pass rate was for the selection and matching of personal protective equipment and practice of poisoning detection (both 71.4%). Conclusion It is urgent to improve the capacity of health emergency drills at the municipal level in Guangdong Province. Emphasis should be placed on strengthening capacity building in teams from non-Pearl River Delta regions.
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Background/Aims@#Data on the natural course of Chinese patients with ulcerative colitis (UC) was lacking. This study aimed to evaluate the natural history and prognosis of patients with UC in the past 15 years in China. @*Methods@#This cohort study included patients with UC in a tertiary hospital in southern China from 2007 to 2021 (cohort I: 2007–2011, cohort II: 2012–2016, cohort III: 2017–2021). Patients’ clinical characteristics and natural history were analyzed retrospectively. @*Results@#Of 1,139 included patients, 683 patients presented with proctitis or left-sided colitis at diagnosis and 38.5% of them (263/683) developed proximal disease extension. Fifty-eight percent of patients experienced relapse, chronic continuous and intermittent active course. Five patients (0.4%) developed colorectal tumors/dysplasia. The overall surgery rate was 8.6%, and the rates were 14.2%, 7.8%, and 8.0% in the 3 cohorts, respectively (P= 0.059). Average time from diagnosis to surgery decreased from cohorts I to III (144 months vs. 36 months, P< 0.001), so did the use of glucocorticoids (58.2% vs. 43.5%, P< 0.001) and immunosuppressants (14.1% vs. 13.4%, P= 0.016), and days of hospitalization (13 days vs. 9 days, P< 0.001). Biologics were used more frequently during the first year (0.8%, 2.1%, and 13.7% for cohorts I to III, respectively; P< 0.001). The rate of mucosal healing increased over time. @*Conclusions@#In Chinese UC patients, one-third of patients experienced proximal disease extension. The rates of malignancy and mortality were low. More biologics were used, while use of immunosuppressants and glucocorticoids were reduced over time. Early biologics use seemed to promote mucosal healing, but the rate of colectomy has not dramatically decreased.
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The process of establishing and improving the Employee Health Insurance Outpatient Co-payment Protection Mecha-nism is one of the major livelihood projects to deepen the reform of China's medical insurance system.The implementation of the mu-tual-aid mechanism for covering outpatient bills in each coordinating region is accompanied by the risks of squeezing outpatient medi-cal resources,the prevalence of fraud and deception,the increase of the government s economic burden and the lack of public ac-ceptance.In this regard,suggestions are made to improve the policy:open source and cut costs to make up for the shortage of funds,linkage of three medical institutions to build a medical security pattem,coordinated supervision to maintain the stability of medical insurance funds,and optimized policies to promote the reform of medical insurance payment methods.
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Autoimmune diseases of the nervous system are a group of diseases caused by the body′s immune system attacking its own nervous system, resulting in structural damage and functional impairment of the corresponding tissues. Interventional clearance of pathogenic auto-antibodies has been shown to be effective in reducing immune damage, inhibiting disease progression and improving prognosis through extensive basic research and long-term clinical practice. The neonatal Fc receptor (FcRn)-mediated circulating protection mechanism of IgG contributes to the long half-life and high plasma levels of IgG. FcRn inhibitors are able to target and block the binding of FcRn to IgG, accelerating IgG clearance and reducing IgG levels. Therefore, the use of FcRn inhibitors in the treatment of autoimmune diseases of the nervous system could theoretically help to accelerate the clearance of pathogenic IgG, achieve good clinical efficacy and have promising applications. Research in this area has made considerable progress in recent years and this article will review this.
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ObjectiveTo investigate the mediating role of loneliness and social anxiety in the relationship between basic psychological needs satisfaction and smartphone addiction among high school students， and to provide references for the intervention to smartphone addiction for high school students. MethodsIn April 2022， a total of 14 666 high school students from 5 middle schools in a county of Sichuan Province were included by random sampling method. Basic Psychological Needs Scales （BPNS）， the UCLA Loneliness Scale-3 edition （UCLA-3）， Interaction Anxiousness Scale （IAS） and the Mobile Phone Addiction Index （MPAI） were used for cross-sectional investigation. Bootstrap method was used to analyze the mediating role of loneliness and social anxiety in the relationship between the basic psychological needs satisfaction and smartphone addiction. Results① In this study， 14 036 valid questionnaires were returned， and 1 752 （12.48%， 95% CI： 0.114~0.136） high school students were found to be addicted to smartphone phone. The BPNS score was negatively correlated with UCLA-3， IAS and MPAI scores （r=-0.771， -0.486， -0.417， P<0.01）. And MPAI score was positively correlated with IAS and UCLA-3 scores （r=0.403， 0.424， P<0.01）. IAS score was positively correlated with UCLA-3 score （r=0.458， P<0.01）. ②The degree of basic psychological needs satisfaction in high school students can directly negatively predict smartphone addiction （β=-0.383， P<0.05）， and can also indirectly affect smartphone addiction through loneliness and social anxiety （β=-0.130， P<0.05）. ③Loneliness （indirect effect value was -0.145） and social anxiety （indirect effect value was -0.074） partially mediate between the basic psychological needs satisfaction and smartphone addiction. Loneliness-social anxiety also has significant chain mediating effect （indirect effect value was -0.034）， which accounted for 8.88%. ConclusionThe basic psychological needs satisfaction can not only directly affect the occurrence of smartphone addiction， but also indirectly affect the occurrence of smartphone addiction through the chain mediation of loneliness and social anxiety.
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Objective:To investigate the effect and mechanism of local gastric hypothermia in rats with pancreatitis based on a GC?MS and LC?MS dual metabolomics strategy.Methods:Eighteen SD rats were randomly divided into the sham operation (SO), acute pancreatitis (AP) and acute pancreatitis hypothermia (APH) groups. The AP model was established by retrograde injection of 3.5% sodium taurocholate solution into the pancreaticobiliary duct in the AP and APH groups. In the APH group, gastrotomy was performed near the cardia, and a cooling balloon with 2 silicone catheters was placed in the stomach. After the successful establishment of the rat pancreatitis model in the APH group, the speed of ice water circulation was controlled and the output power of the heating pad was adjusted to achieve pancreatic surface temperature reduction while avoiding systemic hypothermia. Temperatures were not monitored and controlled in the SO and AP groups. Serum amylase was detected by ELISA. Pancreatic tissues were stained with HE and histopathologically scored. The expression of NF-κB, IL-6, TNF-α and IκBα in pancreatic tissue was detected by Western blotting. The AP and APH groups were compared by full-scan analysis, and the serum differential metabolites and metabolic pathways were detected by GC?MS- and LC?MS-based metabolomics strategies.Results:Compared with the SO group, the serum amylase level in the AP group and APH group were increased (all P<0.05). Compared with the AP group, the amylase levels at 3 h and 5 h after the operation were decreased in the APH group (both P<0.05). The pathological scores of the AP and APH groups were higher than those of the SO group (both P<0.05), and the pathological damage to pancreatic tissue in the APH group was less than that in the AP group ( P<0.05). IL-6, TNF-α and NF-κB were decreased and IκBα was increased in the APH group compared with the AP group by Western blotting (all P<0.05). A total of 53 differential metabolites were identified by GC?MS, and 236 differential metabolites were identified by LC?MS in the serum samples of the APH group compared with the AP group. The differential metabolites obtained from the blood samples of the APH group and AP group were imported into MetaboAnalyst 4.0 software for analysis, and the root data-log ( P value)>2, P<0.05, three major metabolic pathways were obtained, including ascorbate and aldarate metabolism, pentose and glucuronate interconversions and tryptophan metabolism. Conclusions:Local gastric hypothermia has a protective effect on the expression of inflammatory factors and alleviates pathological damage in rats with acute pancreatitis, which may be related to ascorbate and aldarate metabolism, pentose and glucuronate interconversions and tryptophan metabolism.
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Objective To investigate the protective effect and mechanism of piperazine ferulate(PF)on acute kidney injury of rats with sepsis.Methods Twenty-four male Sprague Dawley rats were randomly divided into sham operation group,model group,low-dose PF group and high-dose PF group,with 6 rats in each group.The rats in the low-dose PF group and high-dose PF group were given 50 and 100 mg·kg-1 PF suspension by gavage every day for 7 days,respectively.The rats in the sham operation group and model group were given 9 g·L-1 sodium chloride solution(0.1 mL·kg-1)by gavage every day for 7 days.The rats in the sham operation group underwent cecal exploration and closed their stomachs without undergoing cecal ligation and perforation surgery.The rats in the model group,low-dose PF group and high-dose PF group underwent cecal ligation and perforation surgery to prepare the acute kidney injury models.At 24 hours after modeling,carotid artery blood of rats in each group was collected and the serum was separated.The levels of serum creatinine(Scr)and blood urea nitrogen(BUN)were measured by biochemical methods,and the levels of neutrophil gelatinase related lipid transport protein(NGAL),interleukin-6(IL-6),and procalcitonin(PCT)were measured by enzyme-linked immunosorbent assay.The rats in each group were executed by decapitation,then the kidneys were taken.The pathological changes of the kidney tissues were observed by hematoxylin-eosin(HE)staining.The relative expression levels of nuclear factor-κB(NF-κB),Toll-like receptor 4(TLR4)and NOD-like receptor thermal protein domain associated protein 3(NLRP3)in renal tissues were detected by Western blot method.Results The levels of Scr,BUN and serum NGAL,IL-6 and PCT of rats in the model group and low-dose PF group were significantly higher than those in the sham operation group(P＜0.05).The levels of Scr and serum PCT of rats in the high-dose PF group were significantly higher than those in the sham operation group(P＜0.05);there was no statistically significant difference in the levels of BUN and serum NGAL and IL-6 of rats between the high-dose PF group and the sham operation group(P＞0.05).The levels of Scr,BUN and serum NGAL,IL-6 and PCT of rats in the low-dose PF group and high-dose PF group were significantly lower than those in the model group(P＜0.05).The levels of Scr,BUN and serum NGAL,IL-6 and PCT of rats in the high-dose PF group were significantly lower than those in the low-dose PF group(P＜0.05).HE staining showed that there were no significant abnormal changes in the renal tissues of rats in the sham operation group.The renal tubular epithelial cells of rats in the model group showed significant swelling and degeneration,with a large amountof red staining in the cytoplasm;the renal tubular had congestion,degeneration,and necrosis,with a large number of inflammatory cells infiltrating the lumen,and cell proliferation in the mesangial-capillaries space.In the low dose PF group,some renal tubular epithelial cells of rats showed mild to moderate swelling,some renal tubular epithelial cells showed degenera-tion and necrosis,and no significant infiltration of inflammatory cells was observed.The renal tubular epithelial cells of rats in the high-dose PF group showed mild swelling,without significant degeneration,necrosis and inflammatory cell infiltration.The levels of TLR4,NF-κB and NLRP3 protein in renal tissues of rats in the model group and low-dose PF group were significantly higher than those in the sham operation group(P＜0.05).The level of TLR4 protein in renal tissues of rats in the high-dose PF group was significantly higher than that in the sham operation group(P＜0.05);there was no statistically significant difference in the levels of NF-κB and NLRP3 protein in the renal tissues of rats between the high-dose PF group and sham operation group(P＞0.05).The levels of TLR4 and NLRP3 proteins in the renal tissues of rats in the low-dose PF group and high-dose PF group were significantly lower than those in the model group(P＜0.05);the level of NF-κB in renal tissues of rats in the high-dose PF group was significantly lower than that in the model group(P＜0.05);there was no statistically significant difference in the level of NF-κB in renal tissues of rats between the low-dose PF group and model group(P＞0.05).The levels of TLR4 and NLRP3 proteins in tissues of rats in the high-dose PF group were significantly lower than those in the low-dose PF group(P＜0.05);there was no statistically significant difference in the level of NF-κB in renal tissues of rats between the high-dose PF group and low-dose PF group(P＞0.05).Conclusion PF intervention can effectively reduce the levels of Scr,BUN and serum NGAL,IL-6 and PCT of rats with septic acute kidney injury,and play a certain protective role on the kidneys of rats with septic acute kidney injury;its mechanism may be related to inhibiting the expression levels of TLR4,NF-κB and NLRP3,thereby regulating TLR4/NF-κB/NLRP3 signaling pathway.
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Objective:To investigate the change and clinical significance of macrophange inflammtory protein-1α (MIP-1α) and human cartilage glycoprotein 39 (YKL-40) levels in serum and cerebrospinal fluid of children with mycoplasma pneumonia complicated with encephalitis.Methods:A total of 108 children with mycoplasma pneumonia treated in Shishou People′s Hospital from July 2018 to May 2020 were retrospectively selected as the study objects, including 66 patients with encephalitis and 42 patients without encephalitis. Fifty-three healthy children who participated in physical examination during the same period were selected as the normal control group. The levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid were detected by enzyme-linked immunosorbent assay (ELISA). Pearson test was used for correlation analysis. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MIP-1α and YKL-40 levels in serum and cerebrospinal fluid for mycoplasma pneumonia complicated with encephalitis.Results:The serum levels of MIP-1α and YKL-40 in the encephalitis group and without encephalitis group were higher than those in the normal control group: (84.82 ± 12.85) and (63.46 ± 9.23) mg/L vs. (24.12 ± 2.45) mg/L, (53.46 ± 9.25) and (31.45 ± 7.35) ng/L vs. (23.95 ± 6.38) ng/L, and the serum levels of MIP-1α and YKL-40 in the encephalitis group were higher than those in the without encephalitis group, there were statistical differences ( P<0.05). The cerebrospinal fluid levels of MIP-1α and YKL-40 in the encephalitis group were higher than those in the without encephalitis group: (124.82 ± 20.85) mg/L vs. (113.46 ± 18.23)mg/L, (46.46 ± 10.25) ng/L vs.(22.95 ± 5.38) ng/L, there were statistical differences ( P<0.05). The results of Pearson test showed that the levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid had positively correlated ( r = 0.697, 0.403, P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of serum YKL-40 and MIP-1α levels in the diagnosis of children with mycoplasma pneumonia complicated with encephalitis was 0.845 and 0.885, respectively, and the AUC of combined YKL-40 and MIP-1α levels in the diagnosis of children with mycoplasma pneumonia complicated with encephalitis was 0.943, higher than the level of single index detection. Conclusions:The levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid of children with mycoplasma pneumonia are increased. The combined detection of MIP-1α and YKL-40 can be used as serum markers to predict encephalitis in children with mycoplasma pneumonia.
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Objective:To observe the clinical characteristics and surgical outcomes in patients with retinal detachment associated with atopic dermatitis (AD-RD).Methods:A retrospective case series. From January 2015 to April 2023, 8 patients (12 eyes) with AD-RD at Zhongshan Ophthalmic Center of Sun Yat-sen University were included. All patients underwent best-corrected visual acuity (BCVA), ultra-wide-field fundus photography, B-mode ultrasound, ultrasound biomicroscopy (UBM), and wide-field optical coherence tomography (OCT). BCVA was examined by standard logarithmic visual acuity chart and was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical purposes. In the primary surgery, 9 eyes underwent scleral buckling; 1 eye underwent pars plana vitrectomy (PPV) combined with silicone oil tamponade; 1 eye underwent PPV combined with C 3F 8 tamponade; 1 eye underwent C 3F 8 tamponade combined with retinal laser photocoagulation. The follow-up time was (29.1±40.9) months. BCVA before and after surgery was compared using paired t test. Results:Among the 8 patients, 6 were male and 2 were female. The mean age was (23.38±7.95) years old. Among them, 4 patients had bilateral affliction while the remaining 4 had unilateral involvement. The logMAR BCVA was 0.86±0.86. All 12 eyes were with a history of uveitis. Among 8 eyes with bilateral involvement, 6 of them were misdiagnosed as uveitis with exudative retinal detachment; 11 eyes had anterior uveitis at presentation; 9 eyes had a history of cataract, with 4 eyes having concurrent cataract and 5 eyes with intraocular lens. All affected eyes displayed as focal retinal detachment. UBM revealed ciliary epithelial detachment in 9 eyes, and no definite ciliary epithelial break was found in any case. Retinal breaks were observed in only 2 eyes in the pre-surgery retina examination, while ciliary epithelial holes were discovered in other 10 eyes during surgery. The retina was successfully reattached in 10 eyes after one surgery, including 9 eyes received scleral buckling. During the final follow-up, the logMAR BCVA of the affected eye improved significantly to 0.30±0.25 compared to pre-surgery values ( t=2.43, P=0.03). Conclusions:AD-RD is a challenging complication of AD with a high rate of young onset, bilateral involvement, associated with concurrent cataracts, and shallow temporal retinal detachment associated with ciliary epithelial detachment. Scleral buckling is an effective treatment for AD-RD.
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The neural stimulator is a core component of animal robots. While the control effect of animal robots is influenced by various factors, the performance of the neural stimulator plays a decisive role in regulating animal robots. In order to optimize animal robots, embedded neural stimulators had been developed using flexible printed circuit board technology. This innovation not only enabled the stimulator to generate parameter-adjustable biphasic current pulses through control signals, but also optimized its carrying mode, material, and size, overcoming the disadvantages of traditional backpack or head-inserted stimulators, which have poor concealment and are prone to infection. Static, in vitro, and in vivo performance tests of the stimulator demonstrated that it not only had precise pulse waveform output capability, but also was lightweight and small in size. It had excellent in vivo performance in both laboratory and outdoor environments. Our study has high practical significance for the application of animal robots.
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Animals , RoboticsABSTRACT
Objective:To simulate the placement of percutaneous cortical bone trajectory (CBT) screws on reconstructed CT images and three-dimensional lumbar model and to measure the morphometric parameters for guiding the placement of percutaneous CBT screws.Methods:The CT images of 100 adult patients with lumbar spine diseases were studied. The CT images were reconstructed using Mimics software. Taking the projection point on the lamina at the junction of the inner and lower edge of the smallest coronal section of lumbar pedicle as the entry point, the cephalad angle, lateral angle, maximum screw length, maximum screw diameter, distance between trajectory and spinous process were measured. At the same time, the relationship between the trajectory and spinous process was observed by using the reconstructed three-dimensional image.Results:The lateral angle of the trajectory from L 1 to L 5 were 9.3° (8.9°, 9.8°), 9.6° (8.9°, 9.8°), 10.4° (9.5°, 11.3°), 11.81°±1.24° and 13.6° (12.5°, 14.5°), respectively. The cephalad angle from L 1 to L 5 were 26.6° (26.0°, 27.0°), 26.2° (25.7°, 26.5°), 26.9° (26.5°, 27.4°), 25.94°±0.92° and 24.3° (22.7°, 25.4°), respectively. Significant statistic differences were found among all levels in the cephalad angles and lateral angles. The mean diameters of the trajectory from L 1 to L 5 were 5.65±0.49 mm, 6.38±0.60 mm, 6.91±0.67 mm, 7.42±0.76 mm and 8.33 (7.59, 9.01) mm, respectively. Except L 1 and L 5, there were significant differences among all levels in the maximum screw diameters. The mean length of the trajectory from L 1 to L 5 were 36.4 (35.4, 37.0) mm, 36.7 (35.8, 37.3) mm, 37.6 (37.1, 38.1) mm, 37.8 (37.3, 38.1) mm and 36.2 (35.2, 36.9) mm, respectively, and there were also significant differences among all levels. The ration in superior endplate for each segment were 41.08% (34.36%, 45.60%), 37.94% (32.97%, 43.63%), 40.18% (34.56%, 44.49%), 38.61% (34.80%, 46.24%) and 40.9% (35.32%, 46.02%), respectively and statistical differences were significant between L 1 and L 2 and L 2 and L 5. The mean distance between the trajectory and the spinous process from L 1 to L 5 were 7.27±1.23 mm, 7.19 (5.97, 8.28) mm, 7.32 (6.01, 8.28) mm, 7.31±1.36 mm and 7.45 (6.32, 8.23) mm, respectively. In the sagittal CT image, the tip of the trajectory located near the posterior two-fifths of the superior end plate, and the extended line of the trajectory located at the inferior edge of spinous process. In the three-dimensional reconstruction model, no obstruction was found between the simulated screws and the spinous process. Conclusion:Lumbar CBT screw can be implanted percutaneously, and spinous process will not hinder the implantation process. Spinous process and upper endplate can be used as a sign to guide the percutaneous CBT screw implantation. Digital analog screw placement can offer a useful reference for the clinical application of percutaneous cortical bone trajectory screw.
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The Fukushima Daiichi Nuclear Power Plant accident in Japan resulted in the release of large amounts of radioactive substances into the surrounding environment and caused contamination. In the accident recovery process, Japan had made great efforts in public communication, including the government’s promotion of organization and planning the popularization and publicity of scientific knowledge in various forms, multi-channel information disclosure, and all-round communication and exchange, which can provide a reference for the development of relevant work in China. The nuclear-related public communication work in China can get four enlightenments. Firstly, the public communication system should be improved, and corresponding policies and mechanisms should be clarified. Secondly the popularization of nuclear science knowledge should be taken as the foundation for early and long-term development. Thirdly, the operators of nuclear facilities shall disclose relevant information according to the law and confront the curiosity or doubts of the public. Finally, multi-channel, multi-level and multi-frequency exchanges and interactions should be conducted to seek unity of understanding and balance of interests between the two sides.
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Posterior lumbar fusion is one of the effective methods for the treatment of lumbar degenerative diseases, which have been recognized by the majority of spine surgeons. However, it is found that lumbar fusion brings some problems with application, research and understanding move on. Adjacent segments degeneration (ASD) is one of the main reasons for reoperation after lumbar fixation and fusion. Therefore, dynamic stabilization system used in lumbar diseases has become a research hotspot in spinal surgery. Regarded as an alternative instead of rigid fusion, lumbar transpedicular dynamic stabilization system is gradually applied in clinical practice. It has become one of the most widely used non-fusion methods due to its advantages on maintaining the stability of surgical segments and on retaining intervertebral mobility. However, an emergence of new technique often meets conflicts from traditional concepts. Scholars have explored and evaluated the lumbar dynamic fixation technology in the aspects of biomechanics, clinical efficacy and prognosis. Some studies have explored the application and its related complications of lumbar transpedicular dynamic stabilization in common lumbar degenerative diseases. Comprehensively, the clinical effects of this technology have been confirmed by many studies. It can be used as an alternative instead of rigid fusion in the treatment of unstable segments after nerve decompression. There are still some limitations of this technique. It is necessary to conduct more multi-center randomized controlled trials according to the indications, contraindications, advantages, disadvantages and related risks. Further studies could improve the device in line with the anatomical characteristics of Chinese people and serve patients better.
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Objective:To investigate CT classification of diffuse idiopathic skeletal hyperostosis (DISH), and to analyze the correlation between the position of ossification in the anterolateral spine and the sagittal configuration of the spine.Methods:The medical records of 109 patients (70 male and 39 female) who underwent whole spine computerized tomography (CT) from October 2018 to October 2020 were retrospectively analyzed. The average age was 68.4±6.9 years old, ranging from 60 to 88 years old. High resolution CT volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each vertebral space, and a CT grading system was established. Sagittal parameters such as thoracic kyphosis (TK), lumbar lordosis(LL), cervical lordosis (CL), sacral slope (SS), and thoracolumbar junction angle (TLJ) of the patients were measured. The sagittal morphology of the spine was divided into four types using the modified Abelin-Genevois (AG) sagittal classification. In AG type 1 patients, the kyphotic vertex was located in the middle of the thoracic spine (T 4-T 11). In AG type 2 patients, there was no significant kyphotic vertex. In AG type 3 patients, the kyphotic vertex was located in the thoracolumbar segment (T 12-L 2). In AG type 4 patients, the kyphotic vertex was located in the upper thoracic segment (T 1-T 3). Inter-observer and intra-observer reliability were calculated by intra-group correlation coefficient ( ICC). Statistical analysis was conducted to investigate the correlation between different AG types and ossification location and severity. Results:The new DISH grading system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer ICC value of 0.871 and inter-observer ICC value of 0.874. Combined with Resnick's DISH diagnostic criteria, 97 patients (89.0%) in this study had four consecutive intervertebral spaces with ossification grade 1 or above. For these patients, in T 4-T 11, the standardized ossification grade of AG type 1 was 1.24±0.69, greater than that of AG type 2 (0.84±0.71) and AG type 3 (1.00±0.70), and the differences were statistically significant ( F=23.101, P<0.001). In T 12-L 2, the standardized ossification grade of AG type 3 was 1.44±0.87, which was higher than AG type 1 (1.06±0.84) and AG type 2 (0.72±0.63), the differences were statistically significant ( F=14.008, P<0.001). In this study, no patients with kyphosis apex in the cervicothoracic region (AG type4) were found. In T 1-T 3, there was no statistical difference between the three groups ( F=0.303, P=0.738); in the whole thoracic and lumbar spine (T 1-L 5), there was statistically significant difference in the total ossification grade ( F=14.374, P<0.001), there was no statistical difference between AG type 1 and AG type 3 ( P=0.254), both of which were higher than AG type 2 ( P<0.001). Conclusion:The new DISH ossification grading system proposed in this study has high credibility, which can be used in DISH's study. This study confirmed that the region where the apex of kyphosis is located is prone to anterolateral ossification of the spine.
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In order to provide scientific basis for health education and patient timely seeking behavior, this article summarizes the definition, the status quo and influencing factors of delayed on health seeking behavior of patients with obstructive sleep apnea hypopnea syndrome. Influencing factors mainly include clinical character, individual and environment.
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Objective:To explore the impact of emotional valences on the risk decision performance in college students with or without early life stress.Methods:The child psychological abuse and neglect scale was used to select 30 subjects with early life stress and 30 subjects without early life stress from college students.Iowa game task was conducted under different emotional valences(positive, negative, neutral). Data were analyzed by SPSS 23.0 in the manner of MANOVA of repeated measuring, and the posthoc tests were carried out by the way of Sidak or Dunnett T3.Results:(1)The main effect of early life stress was statistically significant( F(1, 58)=4.35, P=0.04, partial η2=0.07), which meant the early life stressors tended to be more risk-averse than the non-early life stressors ((27.20±6.95) vs (23.53±9.18)). (2)The main effect of emotional valence was statistically significant( F(2, 116)=3.45, P=0.04, partial η2=0.06)), which meant all participants developed a greater risk preference in negative emotions than positive emotions ((26.38±9.09) vs (23.88±7.58)). (3)The interaction between early life stress and emotional valence was not statistically significant( F(2, 116)=0.72, P=0.49, partial η2=0.01), and the influence trend and degree of emotion valence on early life stressors and non-early life stressors were basically same. Conclusion:Both emotion and early life stress have an impact on individual risk decision, but the effect of emotion with different emotional valence on risk decision-making performance of the early life stressors and the non-early life stressors has no significant difference.
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The study showed a case of missed diagnosis of Leriche syndrome.Patients with intermittent claudication were diagnosed as lumbar spinal stenosis by local hospital with lumbar MRI.When conservative treatment was ineffective,the patients were treated in our spine clinic.However,the lumbar MRI showed no significant stenosis,and arteriovenous ultrasound also showed no abnormality.Vascular surgeons believed that patient's symptoms had little correlation with vascular lesions.After careful reading of lumbar spine MRI,we found that the signal intensity of abdominal aorta increased unevenly below L2 vertebral level.CTA examination of abdominal aorta revealed sclerosis of abdominal aorta and common iliac artery,stenosis and occlusion of abdominal aorta and common iliac artery lumen below the level of renal artery orifice.The patient was finally diagnosed as Leriche syndrome.
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Objective:To investigate and compare the biomechanical strength of paravertebral foramen screws (PVFS), lateral mass screws (LMS) and pedicle screws (PS).Methods:A total of 30 human cervical spine vertebrae (C 3-C 6) were harvested from 8 fresh-frozen cadaver specimens whose mean age was 45.3±11.2 years at death. The vertebrae were randomly divided into three groups for specific screws. For each vertebra, one side was randomly chosen for direct pullout strength test (speed 5 mm/s), and the other side for fatigue test (displacement ±1.0 mm, frequency 1 Hz, 500 cycles) and residual pullout strength test. 4.5 mm × 12 mm screws were used for PVFS, 3.5 mm × 14 mm screws for LMS, and 3.5 mm × 24 mm screws for PS. Results:The direct pullout strength was 327.10±17.07 N for PVFS, 305.71 ± 11.63 N for LMS, and 635.67 ± 22.82 N for PS. The residual pullout strength was 265.62 ±18.19 N for PVFS, 192.80 ±17.10 N for LMS, and 494.89 ±41.79 N for PS. The residual pullout strength of PVFS, LMS and PS respectively, compared with the direct pullout strength, decreased by 18.8%, 36.93% and 22.15% ( tPVFS=7.795 , tLMS=17.267 , tPS=9.349 , P<0.001). The direct pullout strength of PS was higher than that of PVFS and LMS( t=34.245, t=40.741, P< 0.001), as well as PVFS was slightly higher than LMS ( t=3.275, P=0.004). The residual pullout strength of PS was the highest, PVFS was the second, and LMS was the smallest ( F=314.619, P<0.001). For the fatigue test, the load at the first cycle and the first time when the set position was reached of PVFS were higher than those of LMS ( t=3.625, P=0.002; t=5.388, P<0.001) and PS ( t=2.575, P=0.019; t=2.680, P=0.015), but there was no difference between those of LMS and PS ( t=0.609 , P=0.550; t=1.953 , P=0.067). The load at the last cycle of PVFS and PS was higher than that of LMS ( t=5.341 , P<0.001 ; t=3.439 , P=0.003), while there was no difference between PVFS and PS ( t=1.606, P=0.126). Conclusion:The direct pullout strength of PVFS was slightly higher than that of LMS, and the residual pullout strength was significantly higher than LMS. The property of fatigue resistance of PVFS was similar to PS and obviously better than LMS. In summary, PVFS can be used as an effective substitute for LMS and PS.
ABSTRACT
Objective:To measure and compare the length and angle parameters of the screw paths of paravertebral foramen screws (PVFS), pedicle screws (PS) and lateral mass screws (LMS) of subaxial cervical spine.Methods:This study included the cervical computerized tomography (CT) scans of 50 healthy volunteers (25 males and 25 females) in our hospitalfrom January 2018 to June 2018. The average age of the volunteers was 56.00±15.90 years (range, 29-89 years). After three-dimensional reconstruction of CT data, the screw starting points, length of screw paths,optimal medial angles, maximum medial angles and minimum medial angles of PVFS, PS and LMS (Magerl technique) on C 3-C 7 segments were designed and measured on the reconstructed 3D model, and the pedicle widths at various segments of cervical vertebrae were measured. All parameters were measured twice in an interval of two weeks by one orthopaedic surgeons with experience in spine surgery, and the average values of the two measurements were used. Results:In general, the optimum length and medial angle of the PVFS in Chinese population were 10.65 mm and 21.12° at C 3; 10.12 mm, 22.62° at C 4; 9.82 mm, 23.66° at C 5; 9.19 mm, 24.13° at C 6; and 9.10 mm, 27.54° at C 7. The C 3 segment had the longest general optimal length, and the C 7 segment had the shortest general optimal length of PVFS ( F=19.287, P<0.001). However, there was no significant difference in optimal length of PVFS between C 6 and C 7 vertebrae ( P=0.674). The C 7 vertebra had the largest general medial angle, meanwhile the C 3 vertebra had the smallest general medial angle ( F=19.752, P<0.001). The optimum lengths of screw path of PVFS in males at the segments of C 4, C 6 and C 7 vertebrae were longer than those in females (C 4t=2.912, C 6t=3.884, C 7t=5.468, P<0.05), and the optimal medial angle at C 4, C 6 and C 7 segments were smaller than those in females (C 4t=3.560, C 6t=4.370, C 7t=4.738, P<0.05). The optimum length and medial angle of PS in Chinese population were 30.94 mm, 33.92° at C 3; 30.50 mm, 34.95° at C 4; 31.92 mm, 33.42° at C 5; 30.50 mm, 31.94° at C 6; and 29.87 mm, 31.01° at C 7. The general pedicle widths were 5.35 mm at C 3; 5.56 mm at C 4; 5.99 mm at C 5; 6.34 mm at C 6; and 6.86 mm at C 7. The optimum lengths of LMS paths in Chinese population were C 3, 14.84 mm; C 4, 15.33 mm; C 5, 15.44 mm; C 6, 14.74 mm; and C 7, 14.06 mm. In Chinese population, the optimal length of PVFS was 9.10-10.65 mm, and the optimal medial angle was 21.12°-27.54°. The general optimal length of PVFS path were shorter than those of LMS and PS at C 3-C 7 segments ( P<0.05), and the general optimal medial angles were smaller than those of PS at C 3-C 7 segments ( P<0.05). Conclusion:Because of the length of screw path of PVFS is limited, it does not have the risk of direct vertebral artery injury. The insert angle of PVFS is steeper and safer than that of PS. In summary, cervical PVFS can be used as an effective supplement to PS and LMS.
ABSTRACT
The study showed a case of missed diagnosis of Leriche syndrome. Patients with intermittent claudication were diagnosed as lumbar spinal stenosis by local hospital with lumbar MRI. When conservative treatment was ineffective, the patients were treated in our spine clinic. However, the lumbar MRI showed no significant stenosis, and arteriovenous ultrasound also showed no abnormality. Vascular surgeons believed that patient’s symptoms had little correlation with vascular lesions. After careful reading of lumbar spine MRI, we found that the signal intensity of abdominal aorta increased unevenly below L2 vertebral level. CTA examination of abdominal aorta revealed sclerosis of abdominal aorta and common iliac artery, stenosis and occlusion of abdominal aorta and common iliac artery lumen below the level of renal artery orifice. The patient was finally diagnosed as Leriche syndrome.