This study meets the requirements of the Chinese “Code of Ethical Review of Human Biomedical Research” (DB31/T899) and was given official approval by the Ethics Committee of the Nantong First People's Hospital, and all the patients were informed and signed a paper informed consent form for scientific research. The experimental group in this study was patients with both vertebral fractures and SCI because patients with only SCI are relatively rare and much more common are patients with both vertebral fractures and SCI caused by violence in the clinic. To exclude the constitutive influence on the expression of exosomes, we choose patients with only vertebral fractures as the control group, not the healthy ones. The control group has no other comorbidities, including neurological dysfunction, numbness, and dyskinesia of lower limbs, difficulty urinating, or sexual dysfunction. According to the imaging data of the patient (MRI, CT, and X-ray), clinical symptoms (Limb movement and skin sensation), and professional scoring standards (SCI: ISNCSCI and ASIA; Vertebral fracture: TLICS), two spine surgeons and two radiologists will divide the patients into experimental or control groups. Experimental groups (Marked as Sbef48h):43 persons in total, 13 females and 30 males, average age 58 ± 13.0 years. Control groups (Marked as Cbef48h): 71 persons in total, 24 females and 47 males, average age 45 ± 10.5 years.

All enrolled patients underwent surgery and had no history of long-term use of any drugs before the injury. All patients were not diagnosed with any diseases by professional doctors, including dyslipidemia, osteoporosis, nervous system diseases, tumors, and cardiovascular diseases. In both the experimental group and the control group, blood samples were taken immediately after hospitalization. The time limitation for collecting the blood samples was within 48 h after the injury, without any treatment or medication. One part of the blood samples (5 ml) was sent to the laboratory within 30 min to detect the plasma lipid composition, and the other part (20 ml) was centrifuged (9,000 rpm, 4°C, 5 min) for the supernatant (plasma), and then was stored in a deep freezer at −80°C.

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