ABSTRACT Objective Early diagnosis of spinal tuberculosis remains challenging, and inappropriate percutaneous vertebral augmentation can aggravate lesions and worsen clinical symptoms. Relevant clinical evidence on subsequent standardized management remains limited. This study aimed to investigate the clinical efficacy and prognostic outcomes of different treatment strategies in patients with spinal tuberculosis following inappropriate percutaneous vertebral augmentation, and to analyze the clinical characteristics of the patients and provide clinical data for the differential diagnosis of spinal tuberculosis. Methods The clinical data of 53 patients with spinal tuberculosis who underwent vertebral augmentation between January 2012 and January 2024 were retrospectively analyzed. There were 26 males and 27 females, with a mean age of 70.33 ± 5.88 years (range 53–86 years). Thirty‐one patients had thoracic tuberculosis, and 22 had lumbar tuberculosis. According to the ASIA Impairment Scale, 7 patients were grade B, 15 were grade C, 24 were grade D, and 7 were grade E. At admission, 52 patients had elevated erythrocyte sedimentation rates (ESRs) and C‐reactive protein (CRP) levels, 36 had positive T‐SPOT results, and 1 patient had a normal ESR and CRP level and negative T‐SPOT result. Twenty‐seven patients had single‐vertebral involvement, and 26 had multiple‐vertebral involvement. Patients were divided into two groups, and a retrospective cohort comparative analysis was conducted: Surgical group (35 patients) received posterior spinal canal decompression, bone graft fusion, and internal fixation; conservative group (18 patients) received non‐surgical treatment. Outcomes included ESR, CRP level, VAS score, ASIA grade, and MBI score. Enumeration data were analyzed with the χ 2 test for intergroup differences in proportions. Normally distributed continuous data were compared using the independent samples t‐test. Non‐normally distributed continuous data were analyzed using the Mann–Whitney U test. Paired comparisons were performed using the Wilcoxon signed‐rank test. Repeated measures data were analyzed using the rank‐sum test. Results The follow‐up period ranged from 18 to 36 months. Early postoperative increases in the ESR and CRP level were significantly greater in the surgical group than in the conservative group, but inflammatory marker levels normalized within 3–6 months in both groups. Before treatment, there were no significant differences in the ESR, CRP level, VAS score, MBI, or ASIA grade between the groups (all p > 0.05). At 3 months and at the final follow‐up, the ESR, CRP level, and VAS score decreased significantly and the MBI and ASIA grades improved significantly in both groups (all p < 0.05). The MBI was significantly better in the surgical group at 3 months ( p < 0.05). At the final follow‐up, no significant differences were found between the groups in any index (all p > 0.05). Conclusion This retrospective cohort study shows that compared with conservative treatment, surgical treatment results in faster symptomatic and functional recovery in patients with neurological compression after mismanaged vertebral augmentation for spinal tuberculosis. For patients without significant neurological compression or those who are unfit for surgery, conservative treatment achieves satisfactory long‐term efficacy, although the recovery time is longer. Long‐term outcomes are comparable between the two strategies.

Neutrophil extracellular traps (NETs) are crucial innate immune components that ensnare and neutralize pathogens. Inspired by this, we engineered a novel peptide, RFC, designed to mimic NETs' "trap-and-kill" strategy against Staphylococcus aureus infections. RFC integrates an antimicrobial peptide (KR12), a self-assembling motif (KLVFF), and a Staphylococcus-targeting sequence (CARGGLKSC). In vitro, RFC exhibited potent broad-spectrum activity (minimum inhibitory concentration (MIC) as low as 4 μM), fast bactericidal kinetics (>3-log10 reduction within 2 h at 1× MIC), inhibited biofilm formation (>92% at 2× MIC), and eradicated persister cells, while showing high biocompatibility. RFC self-assembles into nanofibrillar networks for bacterial entrapment and disrupts membranes. In vivo, RFC potently treated murine polymicrobial skin infections (99.3% wound closure) and lethal sepsis, improving survival from 16.6% to 66.7%, clearing bacteremia, and suppressing cytokines without toxicity. These findings highlight RFC as a promising antimicrobial agent, combining bacterial targeting, killing, and aggregation with tissue healing and immune activation capabilities, offering a novel strategy against challenging S. aureus infections.

When a nanodrug enters the human body, it will inevitably encounter the blood and form a protein corona, which causes an immune response, decreasing efficacy and losing targetability. In order to address this issue, we screened anti-adhesion peptides (AAPs) against the plasma using a One-Bead One-Compound (OBOC) peptide library and validated the advantages of the AAPs through modification of asparaginase (ASP) as a representative nanodrug. The highly plasma-stable and anti-adhesive peptides NLSNSPQ (AAP4) and KTENSPQ (AAP8) were optimized for modification of ASP to reduce immune response. For ASP modified with one-layer AAP4 (ASP-AAP4-1), 50.0% enzymatic activity remained at 72 h after the third injection in mice, but for ASP without modification, less than 10.0% activity remained. Additionally, the IgG titer of anti-ASP antibodies for ASP-AAP4-1 was decreased 21 times, and the IgM titer was decreased 34 times. The screened peptide materials provide a promising anti-adhesion option for the efficient delivery of nanodrugs or medical implants.

OBJECTIVE:The treatment of tuberculosis at the craniovertebral junction (CVJ) remains challenging, with significant debate surrounding therapeutic approaches. Halo vest (HV) therapy provides a non-invasive immobilization alternative, while occipitocervical fusion (OCF) offers a surgical option. However, limited evidence exists comparing the efficacy of HV therapy with OCF for CVJ tuberculosis. This study aimed to evaluate the clinical outcomes and safety of HV immobilization in treating CVJ tuberculosis, compared with OCF. METHODS:This retrospective cohort study was conducted from January 2012 to December 2022 and included 43 patients diagnosed with CVJ tuberculosis. Radiographic and treatment data were meticulously analyzed to compare outcomes between patients treated with HV immobilization (Group H, n = 22) and those undergoing OCF (Group O, n = 21). Interventions comprised at least 28 weeks of HV immobilization for Group H and OCF supplemented with postoperative external fixation for Group O. Outcomes were evaluated using the Visual Analog Scale (VAS-neck), erythrocyte sedimentation rate (ESR), and radiographic stability (assessed via X-ray and CT). Statistical analyses included the Student's t-test (parametric data), Mann-Whitney U test (nonparametric data), and chi-square test (categorical variables), with a significance level set at p < 0.05. RESULTS:Over a 24-month follow-up, all patients exhibited successful healing of tuberculosis lesions. Group H demonstrated greater improvements in cervical flexion-extension and rotation function compared with Group O. Both groups showed statistically significant decreases in Visual Analog Scale (VAS-neck) and Neck Disability Index (NDI) scores, as well as in ESR and C-reactive protein (CRP) values from pre-surgery levels (p < 0.01). Notably, differences in VAS-neck (1 month) and NDI (24 months) between the groups were statistically significant (p < 0.05), while no significant differences were observed in other follow-up periods (p > 0.05). Additionally, there were no significant differences in ESR and CRP values at any time point between the treatment groups (p > 0.05). CONCLUSIONS:The study yielded satisfactory outcomes for all patients. Short-term differences in pain relief did not significantly impact the healing of CVJ tuberculosis. Patients receiving HV treatment showed greater improvement in neck function compared with those undergoing occipitocervical fusion. Given the substantial costs and risks associated with open surgery, we advocate for conservative treatment utilizing HV.

An innate immune system intricately leverages unique mechanisms to inhibit colonization of external invasive Bacteria, for example human defensin-6, through responsive encapsulation of bacteria. Infection and accompanying antibiotic resistance stemming from Gram-negative bacteria aggregation represent an emerging public health crisis, which calls for research into novel anti-bacterial therapeutics. Herein, inspired by naturally found host-defense peptides, we design a defensin-like peptide ligand, bacteria extracellular trap (BET) peptide, with modular design composed of targeting, assembly, and hydrophobic motifs with an aggregation-induced emission feature. The ligand specifically recognizes Gram-negative bacteria via targeting cell wall conserved lipopolysaccharides (LPS) and transforms from nanoparticles to nanofibrous networks in situ to trap bacteria and induce aggregation. Importantly, treatment of the BET peptide was found to have an antibacterial effect on the Pseudomonas aeruginosa strain, which is comparable to neomycin. Animal studies further demonstrate its ability to trigger aggregation of bacteria in vivo. This biomimetic self-assembling BET peptide provides a novel approach to fight against pathogenic Gram-negative bacteria.

Surgical site infections (SSIs) related to implants have always been a major challenge for clinical doctors and patients. Clinically, doctors may directly apply antibiotics into the wound to prevent SSIs. However, this strategy is strongly associated with experience of doctors on the amount and the location of antibiotics. Herein, an in situ constructable sol-gel system is developed containing antibiotics during surgical process and validated the efficacy against SSIs in beagles. The system involves chitosan (CS), β-glycerophosphate (β-GP) and vancomycin (VAN), which can be adsorbed onto porous hydroxyapatite (HA) and form VAN-CS/β-GP@HA hydrogel in a short time. The VAN concentration from VAN-CS/β-GP@HA hydrogel is higher than minimum inhibitory concentration (MIC) against Staphylococcus aureus (S. aureus) at the 21st day in vitro. In an in vivo canine model for the prevention of SSIs in the femoral condyle, VAN-CS/β-GP@HA exhibits excellent biocompatibility, antimicrobial properties, and promotion of bone healing. In all, the CS/β-GP instant sol-gel system is able to in situ encapsulate antibiotics and adhere on artificial bone implants during the surgery, effectively preventing SSIs related to implants.

Osteoporosis is primarily driven by an imbalance between bone resorption and formation, stemming from enhanced osteoclast activity during bone remodeling. At the crux of this mechanism lies the pivotal RANK-RANKL-OPG axis. In our study, we designed two binding-induced fibrillogenesis (BIF) peptides, namely BIFP and BIFY, targeting RANK and RANKL, respectively. These BIF peptides, with distinct hydrophilic and hydrophobic characteristics, assemble into nanoparticles (NPs) in aqueous solution. Through specific ligand-receptor interactions, these NPs efficiently target and bind to specific proteins, resulting in the formation of fibrous networks that effectively inhibit the RANK-RANKL associations. Experiments have confirmed the potent inhibitory effects of peptides on both osteoclast differentiation and function. Compared with the +RANKL controls, BIFP and BIFY demonstrated a more remarkable reduction in tartrate resistant acid phosphatase (TRAP)-positive cells, achieving an impressive decline of 82.8% and 70.7%, respectively. Remarkably, the administration of BIFP led to a substantial reduction in bone resorption pit area by 17.4%, compared to a significant increase of 92.4% in the +RANKL groups. In vivo experiments on an ovariectomized mouse model demonstrated that the BIFP treated group exhibited an impressive 2.6-fold elevation in bone mineral density and an astounding 4.0-fold enhancement in bone volume/total volume as against those of the PBS-treated group. Overall, BIF peptides demonstrate remarkable abilities to impede osteoclast differentiation, presenting promising prospects for the treatment of osteoporosis.

Fungal infections contribute substantially to human morbidity and mortality. A particular concern is the high rate of mortality associated with invasive fungal infections, which often exceeds 50.0% despite the availability of several antifungal drugs. Herein, we show a self-assembling antifungal peptide (AFP), which is able to bind to chitin on the fungal cell wall and in situ form AFP nanofibers, wrapping fungi. As a result, AFP limits the proliferation of fungi, slows down the morphological transformation of biphasic fungi, and inhibits the adhesion of fungi to host cells and the formation of biofilms. Compared to the broad-spectrum antifungal fluconazole, AFP achieved a comparable inhibitory effect (MIC50 = 3.5 mu M) on fungal proliferation. In addition, AFP significantly inhibited the formation of fungal biofilms with the inhibition rate of 69.6% at 1 mu M, better than fluconazole (17.2% at 1 mu M). In a skin infection model of mice, it was demonstrated that AFP showed significantly superior efficacy to fluconazole. In the systemic candidiasis mouse model, AFP showed similar efficacy to first-line antifungal amphotericin B (AmpB) and anidulafungin (AFG). This study provides a promising wrapping strategy for anti-fungal infection.

Background and Objectives:Anterior cervical discectomy and fusion (ACDF), which is widely used in the treatment of cervical spondylosis, may cause complications such as adjacent segment degeneration (ASD). However, such studies on complications are limited, and quantitative evidence is still lacking. To evaluate the clinical value of cervical discometry combined with adjacent intraoperative intradiscal pressure in cervical vertebral surgery through clinical explorations. Materials and Methods:In this retrospective study, 100 patients who were treated with anterior decompression, reconstruction, and internal fixation, were enrolled. Among them, 50 patients received ACDF combined with perioperative pressure adjustment of the adjacent segments to ensure that the pressure difference was less than 5 mmHg. The other 50 patients who had only simple ACDF were considered as the control group. Patient information, radiographic changes, axial symptoms (AS), and the occurrence of ASD were recorded in the study. Results:The degree of lordosis (D values) at postoperative of all cases were positive. The D value of the two groups of patients immediately after the operation and at the last follow-up were significantly higher than that before the operation (P < 0.05). The incidence of AS was significantly lower in the experimental group than that in the control group (P < 0.05). Besides, there were only 10 patients in the experimental group during the five-year follow-up period, which was significantly lower than the 19 patients in the control group (P < 0.05). Conclusions:The intraoperative intervertebral disc pressure measurement could effectively monitor the vertebral body distraction strength and reduce the incidence of postoperative AS and ASD.

Uncontrolled hemorrhage is a major problem both in surgical intervention and after trauma. Herein, we design an in situ constructable peptide network, mimicking and participating in the native coagulation process for enhanced hemostasis and wound healing. The network consists of two peptides including C6KL, mimicking platelets and C6KG, mimicking fibrin. The C6KL nanoparticles could bind to the collagen at the wound site and transform into C6KL nanofibers. The C6KG nanoparticles could bind to GPIIb/IIIa receptors on the surface of activated platelets and transform into C6KG nanofibers. The in situ formed peptide network could interwind platelets, fibrin and red blood cells, causing embolism at the wound site. In a lethal femoral artery, vein, and nerve cut model of rats, the amount of bleeding was reduced to 32.8% by C6KL and C6KG with chitosan/alginate. The biomimetic peptides show great clinical potential as trauma hemostatic agents.

The objective of this study was to evaluate the feasibility and clinical outcomes of S2-alar-iliac (S2AI) and iliac screw (IS) techniques in the lumbopelvic reconstruction of lumbosacral tuberculosis patients. From January 2014 to August 2016, 26 patients with lumbosacral tuberculosis attending the 8th Medical Centre of Chinese PLA General Hospital were included in this retrospective study. The subjects were divided into two groups based on the lumbopelvic fixation type (16 patients in the S2AI group, 10 patients in the IS group). The operation time, blood loss, length of hospitalisation, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analogue scale (VAS), Oswestry Disability Index (ODI), ambulatory status, and 36-Item Short-Form Health Survey (SF-36) scores of the patients in two groups were recorded and compared. In addition, surgical complications were collected and analysed. The operation time and intraoperative blood loss were significantly lower in the S2AI group than that in the IS group (P < .05). Compared with preoperative data, postoperative data showed significant improvement in ESR, CRP level, ODI scores, VAS scores, ambulatory status, and SF-36 (P < .05), but there was no significant difference in remission degree between the two groups. Compared with IS group, The S2AI group had significantly lower rates of symptomatic screw prominence (P < .05). Both the IS and S2AI fixation techniques can achieve satisfactory outcomes for the restoration of lumbosacral stability of lumbosacral tuberculosis. Furthermore, compared to the traditional IS fixation technique, the S2AI fixation technique can shorten operation time and reduce surgical trauma for the treatment of lumbosacral tuberculosis.

Lidocaine, a potent local anesthetic, is clinically used in nerve block and pain management. However, due to its short half-life, repeated administration is required. For this reason, here we designed and prepared a lidocaine-encapsulated polylactic acid-glycolic acid (Lidocaine@PLGA) microcapsule with ultrasound responsiveness to relieve the sciatica nerve pain. With a premixed membrane emulsification strategy, the fabricated lidocaine-embedded microcapsules possessed uniform particle size, good stability, injectability, and long-term sustained release both in vitro and in vivo. More importantly, Lidocaine@PLGA microcapsules had the function of ultrasonic responsive release, which made the drug release controllable with the effect of on-off administration. Our research showed that using ultrasound as a trigger switch could promote the rapid release of lidocaine from the microcapsules, achieving the dual effects of long-term sustained release and short-term ultrasound-triggered rapid release, which can enable the application of ultrasound-responsive Lidocaine@PLGA microcapsules to nerve root block and postoperative pain relief.

[目的]探讨胸椎结核伴截瘫患者手术后神经恢复的影响因素.[方法]回顾性分析2014年4月～2019年4月本中心收治的45例胸椎结核伴截瘫患者的临床资料.其中男23例,女22例,年龄17～80岁,平均(57.33±15.12)岁.术前脊髓损伤美国脊髓损伤协会分级(American Spinal Injuy Association,ASIA)A级1例,B级30例,C级4例,D级10.所有患者均行胸椎后路手术治疗.[结果]术后随访18～48个月,平均(31.80±8.12)个月.至末次随访时,23例神经功能完全恢复(complete recov-ery,CR),22例神经功能未完全恢复(incomplete recovery,IR).单项因素比较表明:CR组年龄显著小于IR组(P＜0.05),CR组术前瘫痪时间显著短于IR组(P＜0.05),CR组术前ASIA分级轻于IR组(P＜0.05),CR组影像学脊髓压迫程度显著轻于IR组(P＜0.05).二元多因素逻辑回归分析结果表明,神经功能不完全恢复的独立危险因素是高龄(OR=1.262,P=0.009)、术前瘫痪时间长(OR=1.122,P=0.014)、ASIA分级重(OR=11.494,P=0.010)、术前脊髓压迫程度重(OR=14.087,P=0.038).[结论]影响胸椎结核伴截瘫患者术后截瘫恢复的危险因素包括术前瘫痪时间长、术前ASIA分级低、影像学脊髓压迫程度重、耐药结核.尽早手术、充分减压、矫正后凸畸形、基于药敏试验的个体化化疗对截瘫恢复具有重要意义.

Osteoarticular Tuberculosis (TB) is a challenging issue because of its chronicity and recurrence. Many drug delivery systems (DDSs) have been developed for general chemotherapy. Herein, we take advantage of instant hydrogelation to in situ encapsulate drugs onto implants intraoperatively, optimizing the drug release profile against osteoarticular TB. First-line chemodrugs, i.e. rifampicin (RFP) and isoniazid (INH) are firstly loaded on tricalcium phosphate (TCP). Then, the encapsulating hydrogel is fabricated by dipping in chitosan (CS) and β-glycerophosphate (β-GP) solution and heating at 80 °C for 40 min. The hydrogel encapsulation inhibits explosive drug release initially, but maintains long-term drug release (INH, 158 days; RFP, 53 days) in vitro. Therefore, this technique could inhibit bone destruction and inflammation from TB effectively in vivo, better than our previous ex situ prepared DDSs. The encapsulating technology, i.e. instant hydrogelation of drug-loaded implants, shows potential for regulating the type and ratio of drugs, elastic and viscous modulus of the hydrogel according to the state of illness intraoperatively for optimal drug release.

[目的]评价Xpert MTB/RIF指导的个体化化疗治疗耐利福平/耐多药脊柱结核的初步临床疗效.[方法]回顾分析2017年6月～2018年6月120例接受手术治疗的脊柱结核患者,术后参照既往抗结核化疗史及Xpert MTB/RIF检测结果,制定个体化化疗方案,待表型药敏结果回示后根据药敏结果再次调整化疗方案.[结果]120例患者中,Xpert MTB/RIF检测结核分枝杆菌阳性79例(65.83％),BACTECMGIT960系统培养阳性48例(40.00％),差异具有统计学意义(P＜0.05).Xpert MTB/RIF检出11例发生rpoB基因突变,其中6例表型药敏证明利福平耐药,但1例Xpert MTB/RIF检测阴性患者表型药敏证明利福平耐药.术后各随访时间点,11例患者的红细胞沉降率、C反应蛋白逐渐下降至正常水平.3例出现肝功能损害,5例出现高尿酸血症,对症治疗后上述指标均恢复正常.末次随访骨融合良好,平均融合时间(5.66±2.57)个月.无窦道、冷脓肿、内固定失效、假关节形成等并发症.[结论]基于XpertMTB/RIF指导的个体化化疗方案有利于尽早治愈耐利福平/耐多药脊柱结核,避免治疗失败及其他严重并发症.

Macrophages (Mφs) are master regulators of the immune response and may serve as therapeutic targets in aging societies. This study aimed to determine the function of M1Mφ-exosomes (Exos) in the development of osteoporosis (OP) and the involvement of microRNA (miR)-98 and dual specificity phosphatase 1 (DUSP1). A murine model of OP was established using ovariectomies (OVX). Bone loss was observed in OVX-treated mice, as manifested by reduced bone mineral density and decreased number of bone trabecula. The bone loss was further aggravated by treatment with M1Mφ-Exos. Exos also suppressed osteogenic differentiation of MC3T3-E1 cells. miRNA microarray analysis revealed that the miR-98 level was notably upregulated in cells after Exo treatment, and DUSP1 was confirmed as a target of miR-98. Meanwhile, downregulation of miR-98 or upregulation of DUSP1 restored the osteogenic differentiation ability of MC3T3-E1 cells. In addition, upregulation of DUSP1 reduced bone loss in murine bone tissues and suppressed JNK phosphorylation. In summary, M1Mφ-derived exosomal miR-98 exacerbates bone loss and OP by downregulating DUSP1 and activating the JNK signaling pathway. miR-98 may therefore serve as a therapeutic target in OP management.

Preventing surgical site infections (SSIs) of implants has drawn significant attention in both basic and clinical research. Implants with convenient preparation methods and intelligent drug release capabilities are highly needed to resist bacterial infection. Herein, we designed an intelligent drug-release system, which can be instantly incorporated with implants during the surgical process. The drug-release system involves β-glycerophosphate (β-GP) and chitosan (CS) as a thermosensitive hydrogel for instant construction onto implants and hyaluronic acid (HA) as a trigger to release vancomycin hydrochloride (VH) on demand. Tertiary calcium phosphate (TCP) scaffolds (implants) are vacuum-adsorbed in a solution of the intelligent vancomycin-release system (VH-HA-CS/β-GP), followed by heating for 40 min at 80 °C to form VH-HA-CS/β-GP@TCP. The drug-release hydrogel intelligently releases vancomycin depending on the concentration of hyaluronidase, which is secreted by Staphylococcus aureus (S. aureus) in infection sites. Furthermore, VH-HA-CS/β-GP@TCP showed effective antibacterial properties in vitro and in vivo. The VH-HA-CS/β-GP drug-release system can be conveniently prepared during surgery for intelligently preventing SSIs in bone tissue.

Many coating materials have been studied to prevent surgical site infections (SSIs). However, antibacterial coating on surfaces show weak adhesion using the traditional titanium (Ti) cage, resulting in low efficacy for preventing SSIs after spinal surgery. Herein, a 3D-printed Ti cage combined with a drug-releasing system is developed for in situ drug release and bacteria killing, leading to prevention of SSIs in vitro and in vivo. First, a 3D-printed Ti cage is designed and prepared by the Electron Beam Melting (EBM) method. Second, polyvinyl alcohol (PVA) containing hydrophilic vancomycin hydrochloride (VH) is scattered across the surface of 3D-printed porous Ti (Ti-VH@PVA) cages. Ti-VH@PVA cages show an efficient drug-releasing profile and excellent bactericidal effect for three common bacteria after more than seven days in vitro. In addition, Ti-VH@PVA cages exhibit reliable inhibition of inflammation associated with Staphylococcus aureus and effective bone regeneration capacity in a rabbit model of SSIs. The results indicate that Ti-VH@PVA cages have potential advantages for preventing SSIs after spinal surgery.

[目的]总结经肋横突病灶清除植骨融合矫形内固定术治疗活动期胸椎结核伴后凸畸形的疗效.[方法]回顾分析2010年5月～2017年5月采用经肋横突病灶清除固定融合术治疗活动期胸椎结核伴后凸畸形患者.其中符合纳入标准的共76例,男性35例,女性41例;年龄21～74岁,平均(42.62±3.64)岁.胸椎节段性后凸角度为20°～76°.合并脊髓压迫症状者15例.[结果]76例患者均成功完成手术,术中胸膜撕裂5例,2例患者术后发生脑脊液漏,3例术后胸腔积液,经相应处理均未引发不良后果.76例患者随访18～72个月,2例窦道形成、3例切口浅表感染,均经换药等处理后愈合.1例术后18个月时连接棒断裂,行翻修术后治愈.所有患者末次随访时结核治愈,VAS评分较术前显著减小(P＜0.05).15例伴脊髓压迫症状者的ASIA分级由术前B级2例,C级3例,D级10,改进为末次随访时D级2,E级13例,差异有统计学意义(P＜0.05).末次随访时平均后凸Cobb角矫正率(68.36±6.12)％.至末次随访影像学显示所有患者植骨融合良好,结核无复发.后凸畸形矫正角度无明显丢失.术后3个月ESR和CRP均逐渐恢复正常,末次随访ESR和CRP与术前比较差异均有统计学意义(P＜0.05).[结论]经肋横突入路病灶清除植骨融合矫形内固定术治疗3个节段以内的非跳跃性活动期胸椎结核伴后凸畸形,是一种创伤小、疗效满意的手术方式.

Objective: The current risk model for long-term prediction in coronary artery disease (CAD) is complicated, while a simple useful model is still lacking. We aim to investigate if CHADS(2) and R(2)CHADS(2) scores could predict long-term outcome for patients with CAD. Patients and methods: We enrolled 3,700 patients with CAD between November 2010 and September 2014 at the Department of Cardiology from Chinese PLA General Hospital. The CHADS(2) and R(2)CHADS(2) scores were calculated. All cases were followed to track the incidence of composite end point consisting of cardiovascular (CV) death, myocardial infarction (MI), stroke, heart failure, and all-cause death. Results: During a median 2.9-year follow-up, 443 patients experienced at least one element of the composite end point of CV death (n=168 [4.6%]), MI (n=59 [1.6%]), stroke (n=96 [2.6%]), heart failure (n=101 [2.8%]), and all-cause death (n=240 [6.6%]). Multivariate Cox regression analyses showed that the CHADS2 score (hazard ratio [HR]: 2.18, 95% CI: 2.00-2.38, p<0.0001) and the R(2)CHADS(2) score (HR: 1.93, 95% CI: 1.83-2.04, p<0.0001) were independently associated with composite outcome. Receiver-operating characteristic analysis showed that compared with the CHADS(2) score, the R(2)CHADS(2) score had better discrimination for the prediction of long-term combined outcome (0.772 vs 0.791, p=0.0013). Conclusion: CHADS(2) and R(2)CHADS(2) scores provide a quick and useful tool in predicting long-term outcome for patients with CAD.