BACKGROUND:Distinct risk factors for new adjacent vertebral fractures following percutaneous vertebroplasty in the elderly patients with osteoporotic vertebral compression fractures and underlying diseases may be different,yet there is a scarcity of pertinent research on this topic.OBJECTIVE:To investigate the high-risk factors for refracture in patients with osteoporotic vertebral compression fractures following percutaneous vertebroplasty and to delve deeper into the correlation between these risk factors and the recurrence of fractures in the operated vertebra as well as its adjacent vertebrae post-percutaneous vertebroplasty.METHODS:According to the inclusion criteria,412 patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty at the Sixth Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2023 were retrospectively screened.According to whether re-fracture occurred during the follow-up period,the patients were divided into a re-fracture group(n=75)and a non-re-fracture group(n=337).The following variables of the two groups of patients were reviewed:age,gender,body mass index,cement leakage,bone density T value,cement dosage,occupation,smoking,drinking,adverse reactions,medical insurance,hypertension,type 2 diabetes,chronic obstructive pulmonary disease,cerebral hemorrhage,coronary heart disease,psychological trauma,psychiatric treatment,osteoarthritis,gout,scoliosis,spinal surgery,chronic kidney,anti-osteoporosis treatment,previous fracture history(fracture caused by osteoporosis)and fracture injury plane.The above factors were analyzed using univariate analysis.The factors with P＜0.05 were subjected to binary logistic analysis to explore the related factors of postoperative vertebral recompression fracture.RESULTS AND CONCLUSION:(1)Univariate analysis showed that after percutaneous vertebroplasty,vertebral refracture was associated with age,smoking history of＞10 years,cement leakage,hypertension,type 2 diabetes,scoliosis,spinal surgery,and chronic kidney disease,with statistically significant differences(P＜0.05).(2)By binary Logistic regression,bone cement leakage condition(OR=2.547,95％CI:1.283-5.048,P＜0.05),smoking history＞10 years(OR=2.336,95％CI:1.157-4.701,P＜0.05),a history of hypertension(OR=4.657,95％CI:2.137-10.242,P＜0.05),a history of type 2 diabetes mellitus(OR=8.956,95％CI:3.941-21.301,P＜0.05),and a medical history of scoliosis(OR=3.754,95％CI:1.755-8.619,P＜0.05),medical history of spinal surgery(OR=2.700,95％CI:1.058-6.725,P＜0.05),and a history of chronic kidney disease(OR=2.812,95％CI:1.078-7.739,P＜0.05)were risk factors for refracture of the operated vertebral body and adjacent vertebrae.(3)The results showed that cement leakage,smoking for＞10 years,hypertension,type 2 diabetes mellitus,scoliosis,spinal surgery,and chronic kidney were risk factors for recurrent fractures of the operated vertebrae and adjacent vertebrae in patients with osteoporotic vertebral compression fractures.Surgeons should conduct a comprehensive assessment of patients before percutaneous vertebroplasty in order to more accurately predict the possibility of re-fracture and provide a basis for the formulation of personalized treatment plans to reduce the risk of future recurrent fractures.

BACKGROUND:Distinct risk factors for new adjacent vertebral fractures following percutaneous vertebroplasty in the elderly patients with osteoporotic vertebral compression fractures and underlying diseases may be different,yet there is a scarcity of pertinent research on this topic.OBJECTIVE:To investigate the high-risk factors for refracture in patients with osteoporotic vertebral compression fractures following percutaneous vertebroplasty and to delve deeper into the correlation between these risk factors and the recurrence of fractures in the operated vertebra as well as its adjacent vertebrae post-percutaneous vertebroplasty.METHODS:According to the inclusion criteria,412 patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty at the Sixth Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2023 were retrospectively screened.According to whether re-fracture occurred during the follow-up period,the patients were divided into a re-fracture group(n=75)and a non-re-fracture group(n=337).The following variables of the two groups of patients were reviewed:age,gender,body mass index,cement leakage,bone density T value,cement dosage,occupation,smoking,drinking,adverse reactions,medical insurance,hypertension,type 2 diabetes,chronic obstructive pulmonary disease,cerebral hemorrhage,coronary heart disease,psychological trauma,psychiatric treatment,osteoarthritis,gout,scoliosis,spinal surgery,chronic kidney,anti-osteoporosis treatment,previous fracture history(fracture caused by osteoporosis)and fracture injury plane.The above factors were analyzed using univariate analysis.The factors with P＜0.05 were subjected to binary logistic analysis to explore the related factors of postoperative vertebral recompression fracture.RESULTS AND CONCLUSION:(1)Univariate analysis showed that after percutaneous vertebroplasty,vertebral refracture was associated with age,smoking history of＞10 years,cement leakage,hypertension,type 2 diabetes,scoliosis,spinal surgery,and chronic kidney disease,with statistically significant differences(P＜0.05).(2)By binary Logistic regression,bone cement leakage condition(OR=2.547,95％CI:1.283-5.048,P＜0.05),smoking history＞10 years(OR=2.336,95％CI:1.157-4.701,P＜0.05),a history of hypertension(OR=4.657,95％CI:2.137-10.242,P＜0.05),a history of type 2 diabetes mellitus(OR=8.956,95％CI:3.941-21.301,P＜0.05),and a medical history of scoliosis(OR=3.754,95％CI:1.755-8.619,P＜0.05),medical history of spinal surgery(OR=2.700,95％CI:1.058-6.725,P＜0.05),and a history of chronic kidney disease(OR=2.812,95％CI:1.078-7.739,P＜0.05)were risk factors for refracture of the operated vertebral body and adjacent vertebrae.(3)The results showed that cement leakage,smoking for＞10 years,hypertension,type 2 diabetes mellitus,scoliosis,spinal surgery,and chronic kidney were risk factors for recurrent fractures of the operated vertebrae and adjacent vertebrae in patients with osteoporotic vertebral compression fractures.Surgeons should conduct a comprehensive assessment of patients before percutaneous vertebroplasty in order to more accurately predict the possibility of re-fracture and provide a basis for the formulation of personalized treatment plans to reduce the risk of future recurrent fractures.

BACKGROUND:Both calorie restriction and time-restricted feeding,as two common dietary patterns,have been shown to improve health by regulating metabolism.However,the difference between these dietary patterns,metabolic indices,as well as the gut microbiota still requires further attention.OBJECTIVE:To explore the differences of calorie restriction and time-restricted feeding on the metabolic indices and gut microbiota of mice.METHODS:The C57BL/6J mice were randomly divided into three groups of ad libitum,calorie restriction,and time-restricted feeding(n=6 per group)for 28 weeks of dietary intervention.Various parameters such as body weight,food intake,glucose tolerance,serum fasting insulin,Homeostasis Model Assessment of Insulin Resistance,and leptin were measured.The impact of different interventions on the gut microbiota structure in mice was explored using 16S rRNA sequence analysis.Key operational taxonomic units responsive to dietary interventions were identified through LEfSe analysis.RESULTS AND CONCLUSION:(1)Compared with the ad libitum group,the body weight,food intake,area under the glucose tolerance curve of the calorie restriction and time-restricted feeding groups were decreased(P＜0.01),and the serum leptin was decreased(P＜0.05).The fasting insulin level and serum leptin level of the calorie restriction group were decreased(P＜0.05)and were significantly lower than those of the time-restricted feeding group(P＜0.05);homeostasis model assessment of insulin resistance decreased in the calorie restriction group(P＜0.01).(2)Compared with the ad libitum group,the αdiversity of gut microbiota in the calorie restriction group and the time-restricted feeding group was decreased(P＜0.05),but the diversity of the time-restricted feeding group was slightly lower than that in the calorie restriction group.(3)There were 15 key operational taxonomic units related to calorie restriction and the time-restricted feeding intervention,of which 8 were positively correlated with metabolic phenotypes and their abundance decreased,and 3 were negatively correlated with metabolic phenotypes and their abundance increased(P＜0.05).OTU819 Lachnospiraceae_UCG-006 was positively correlated with body weight,area under the glucose tolerance curve,homeostasis model assessment of insulin resistance,and fasting insulin,while OTU1397 Muribaculaceae was negatively correlated with these indicators.The results show that both calorie restriction and the time-restricted feeding intervention can improve the weight and glucose metabolism of mice,and both intervention modes caused the remodeling of the gut microbiota,which helped to improve the metabolic disorders.

BACKGROUND:Femoral neck fracture is a kind of unsolved fracture.Although cannulated screw,dynamic hip screw,and femoral neck dynamic cross screw have emerged,the best internal fixation scheme for femoral neck fracture with large Pauwels angle and shear force has not been unified.OBJECTIVE:To investigate biomechanical properties of femoral neck dynamic cross screw combined with cannulated screw in the treatment of Pauwels Ⅱ type middle-aged and young femoral neck fractures using finite element analysis.METHODS:According to the extracted CT data of volunteers'femur,the model of femoral neck fracture with Pauwels angle of 50° was established,and the femoral neck was divided into three equal parts.Four groups of models were constructed:In group A,main nail of femoral neck dynamic cross screw was located in the middle 1/3.In group B,main nail of femoral neck dynamic cross screw was located in the lower 1/3.In group C,main nail of femoral neck dynamic cross screw was located at the lower 1/3+cannulated screw at the upper 1/3.In group D,main nail of femoral neck dynamic cross screw was located in the anterior medial part of the middle 1/3+cannulated screw was located in the medial posterior medial part of the middle 1/3.The stress distribution,peak value,maximum deformation,and stress distribution of fracture section of four groups of femur and internal fixation models were measured under 1 200 N load.RESULTS AND CONCLUSION:(1)The finite element analysis showed that the stress distribution and peak value,the maximum deformation and the stress of the fracture section of the femur and internal fixation model in group C were less than those in the other three groups.(2)Compared with group A,group B had smaller stress and displacement of femoral bone,internal fixation,and fracture section,indicating that the placement of head nail of femoral neck dynamic cross screw at the lower 1/3 of the femoral neck was more stable than that of middle 1/3.(3)The results show that the head nail of femoral neck dynamic cross screw located at the lower 1/3 of the femoral neck and 1/3 parallel screws on the femoral neck is more stable for Pauwels Ⅱ femoral neck fracture in young adults,and it is a good choice for the treatment of this type of fracture.

BACKGROUND:Although studies have shown that symmetrical distribution of bone cement can reduce postoperative vertebral refractures and help improve prognosis.However,achieving better bone cement distribution during percutaneous vertebroplasty remains an important issue for surgeons. OBJECTIVE:To explore the effect of cement distribution on the efficacy of unilateral percutaneous vertebroplasty to provide effective preventive and therapeutic measures to prevent postoperative vertebral fracture. METHODS:The 193 patients who underwent unilateral percutaneous vertebroplasty in Sixth Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2022 were selected and divided into group I(bone cement not touching the upper and distal end plates;n=59),group II(bone cement only touching the upper or lower end plate;n=80),and group III(bone cement touching both the upper and distal end plates;n=54).Basic data,operation-related indicators,including operation time,total hospital cost,postoperative hospital time,cement injection,visual analog scale and Oswestry disability index scores of low back pain,postoperative vertebral height recovery rate,local kyphosis angle,incidence of injured vertebral body and adjacent vertebrae were compared among the three groups.Follow-up results of all patients were recorded. RESULTS AND CONCLUSION:(1)In group III,the visual analog scale and Oswestry disability index scores were significantly lower than those in groups I and II,and the difference was statistically significant(P<0.05).(2)The incidence of injured vertebral refracture and incidence of total vertebral fractures in groups I and II were significantly higher than that in group III,and the differences were all statistically significant(P<0.05).(3)There were no significant differences in other indicators of patients of the three groups,such as bone cement leakage,Oswestry disability index,and visual analog scale score at 1 week,1 month after surgery,and during last follow-up,postoperative vertebral height recovery rate,local kyphosis angle,operation time,total hospital cost,and postoperative hospital stay(P>0.05).(4)It is indicated that compared with groups I and II,patients of group III get better long-term prognosis,and bone cement touching both the upper and distal end plates can significantly reduce the incidence of injured vertebral and total vertebral fractures.Surgeons should fully grasp the diffusion of bone cement,and develop targeted prevention and treatment strategies,so as to reduce the risk of further fracture in the future.

BACKGROUND:Both calorie restriction and time-restricted feeding,as two common dietary patterns,have been shown to improve health by regulating metabolism.However,the difference between these dietary patterns,metabolic indices,as well as the gut microbiota still requires further attention.OBJECTIVE:To explore the differences of calorie restriction and time-restricted feeding on the metabolic indices and gut microbiota of mice.METHODS:The C57BL/6J mice were randomly divided into three groups of ad libitum,calorie restriction,and time-restricted feeding(n=6 per group)for 28 weeks of dietary intervention.Various parameters such as body weight,food intake,glucose tolerance,serum fasting insulin,Homeostasis Model Assessment of Insulin Resistance,and leptin were measured.The impact of different interventions on the gut microbiota structure in mice was explored using 16S rRNA sequence analysis.Key operational taxonomic units responsive to dietary interventions were identified through LEfSe analysis.RESULTS AND CONCLUSION:(1)Compared with the ad libitum group,the body weight,food intake,area under the glucose tolerance curve of the calorie restriction and time-restricted feeding groups were decreased(P＜0.01),and the serum leptin was decreased(P＜0.05).The fasting insulin level and serum leptin level of the calorie restriction group were decreased(P＜0.05)and were significantly lower than those of the time-restricted feeding group(P＜0.05);homeostasis model assessment of insulin resistance decreased in the calorie restriction group(P＜0.01).(2)Compared with the ad libitum group,the αdiversity of gut microbiota in the calorie restriction group and the time-restricted feeding group was decreased(P＜0.05),but the diversity of the time-restricted feeding group was slightly lower than that in the calorie restriction group.(3)There were 15 key operational taxonomic units related to calorie restriction and the time-restricted feeding intervention,of which 8 were positively correlated with metabolic phenotypes and their abundance decreased,and 3 were negatively correlated with metabolic phenotypes and their abundance increased(P＜0.05).OTU819 Lachnospiraceae_UCG-006 was positively correlated with body weight,area under the glucose tolerance curve,homeostasis model assessment of insulin resistance,and fasting insulin,while OTU1397 Muribaculaceae was negatively correlated with these indicators.The results show that both calorie restriction and the time-restricted feeding intervention can improve the weight and glucose metabolism of mice,and both intervention modes caused the remodeling of the gut microbiota,which helped to improve the metabolic disorders.

BACKGROUND:Femoral neck fracture is a kind of unsolved fracture.Although cannulated screw,dynamic hip screw,and femoral neck dynamic cross screw have emerged,the best internal fixation scheme for femoral neck fracture with large Pauwels angle and shear force has not been unified.OBJECTIVE:To investigate biomechanical properties of femoral neck dynamic cross screw combined with cannulated screw in the treatment of Pauwels Ⅱ type middle-aged and young femoral neck fractures using finite element analysis.METHODS:According to the extracted CT data of volunteers'femur,the model of femoral neck fracture with Pauwels angle of 50° was established,and the femoral neck was divided into three equal parts.Four groups of models were constructed:In group A,main nail of femoral neck dynamic cross screw was located in the middle 1/3.In group B,main nail of femoral neck dynamic cross screw was located in the lower 1/3.In group C,main nail of femoral neck dynamic cross screw was located at the lower 1/3+cannulated screw at the upper 1/3.In group D,main nail of femoral neck dynamic cross screw was located in the anterior medial part of the middle 1/3+cannulated screw was located in the medial posterior medial part of the middle 1/3.The stress distribution,peak value,maximum deformation,and stress distribution of fracture section of four groups of femur and internal fixation models were measured under 1 200 N load.RESULTS AND CONCLUSION:(1)The finite element analysis showed that the stress distribution and peak value,the maximum deformation and the stress of the fracture section of the femur and internal fixation model in group C were less than those in the other three groups.(2)Compared with group A,group B had smaller stress and displacement of femoral bone,internal fixation,and fracture section,indicating that the placement of head nail of femoral neck dynamic cross screw at the lower 1/3 of the femoral neck was more stable than that of middle 1/3.(3)The results show that the head nail of femoral neck dynamic cross screw located at the lower 1/3 of the femoral neck and 1/3 parallel screws on the femoral neck is more stable for Pauwels Ⅱ femoral neck fracture in young adults,and it is a good choice for the treatment of this type of fracture.