简介：AbstractPurpose:The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel.Conclusion:In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

简介：AbstractChemotherapy is often used for female malignancies, but it can increase the risk of premature ovarian failure in women of reproductive age through different mechanisms. Therefore, how to protect ovarian function and preserve fertility has attracted great attention of oncologists and gynecologists. Recently, umbilical cord mesenchymal stem cells (UCMSCs) have been extensively studied in the field of regenerative medicine. Compared with mesenchymal stem cells (MSCs) from other sources, UCMSCs have a broader application potential due to their properties of lower immunogenicity, fewer ethical issues, and non-invasive collection. Paracrine is one of the most important therapeutic mechanisms of UCMSCs, which can exert anti-inflammatory, anti-fibrosis, anti-oxidative stress, immune regulation, and other therapeutic effects. Studies in animal models have shown that UCMSCs can restore ovarian function after chemotherapy injury. However, most of the relevant researches are still in the preclinical stage. In this article, the mechanism of chemotherapy-induced ovarian failure will be overviewed, and the clinical application potential of UCMSCs in chemotherapeutic ovarian injury will be discussed.

简介：AbstractObjective:To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas (aUCBG).Methods:A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan, China, and 360 aUCBG samples were collected. The average age of pregnant women was (29.50±4.42) years, range from 19 to 48 years old. The gestational age range from 28+4 weeks to 41+3 weeks at admission. Logistic regression and area under the curve (AUC) from Receiver operating characteristic curves were used to identify risk factors, such as, premature rupture of membranes (PROM), high blood pressure, premature delivery (PD), low 1-minute Apgar scores (Apgar 1), low 5-minute Apgar scores (Apgar 5), pH, base excess, bicarbonate, neonatal blood sugar (NBS), and so on, to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters.Results:In all cases, PROM, PD, Apgar 1, Apgar 5, pH, base excess, bicarbonate, total carbon dioxide, and neonatal blood sugar were risk factors and were associated with poor condition of neonate. Apgar 1 were an independent risk factor. Combined traditional and aUCBG parameters had higher AUC of 0.895 (95% confidence interval (CI): 0.830-0.960, P<0.001). In cesarean section subgroup, high blood pressure, PD, and Apgar 1 were risk factors and were associated with poor condition of neonate. Apgar 1 and low pH were the independent risk factors. Combined traditional and aUCBG parameters had highest AUC of 0.940 (95% CI: 0.886-0.993, P<0.001). In vaginal delivery subgroup, maternal age above 35 years, PROM, PD, Apgar 1, Apgar 5, and male newborn were risk factors and were associated with poor condition of neonate. Maternal age above 35 years was an independent risk factor. Combined traditional and aUCBG parameters had highest AUC of 0.897 (95% CI: 0.828-0.965, P<0.001). For pregnant women without comorbidities and complications of pregnancy, aUCBG may not be necessary.Conclusion:In high-risk pregnancies, especially lower Apgar scores, PD, and maternal age above 35-year old, aUCBG is recommended. Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.

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简介：AbstractPurpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.

简介：[摘要]目的：分析下颈椎骨折脱位合并脊髓损伤早期急救治疗对预后的影响。方法：选取我中心2019年3月~2021年5月收治的下颈椎骨折脱位合并脊髓损伤患者182例实施回顾性分析研究，分析患者的一般资料，根据四肢瘫痪不同程度，通过Frankel分级课氛围四个不同的等级：A级89例，B级30例，C级21例，D级42例。受伤类型包括高空坠落患者38例，车祸受伤患者144例。评估患者的脊髓损伤水平：C2患者5例，C3患者12例，C4患者30例，C5患者88例，C6患者35例，C7患者12例。结果：为患者采取日本顾客学会的评估标准，手术前的JOA评分为（4.21±1.81）分，患者手术治疗一周后的评分为（7.95±2.23）分，最后一次随访调查评分为（10.25±2.13）分，患者术后一周后和最后一次随访调查评分较手术前评分对比具有极大差异表示统计学有意义。患者实施8小时内开展甲强龙冲击治疗的患者有68例，开展早期气管切开治疗的患者有40例。实施前路手术治疗的患者有111例，实施后路手术治疗的患者有40例，实施前后路联合手术治疗的患者有31例，患者治疗后出现4例死亡，发生肺感染的患者有5例，低蛋白血症患者有22例，发生深静脉血栓患者有3例。结论：为下颈椎骨折脱位合并脊髓损伤喊着开展早期急救治疗，能够有效促进患者机体康复，降低并发症的发生，不仅保证了治疗效果也保证了治疗安全性，提高患者治疗后的生活质量评分。