Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective To enhance CT radiation dose management in radiology department via applying Six Sigma management method.Methods The radiation quality control processes in the radiology department were optimized according to the Six Sigma quality management DMAIC pattern.The volume CT dose index(CTDIvol),dose length product(DLP),radiation quality control problems of adult and pediatric CT scans from January 2022 to February 2022 were collected as baseline data,and data collected from August 2022 to September 2022 were taken as the control group for analysis via Six Sigma management method.All data of the dose values and problem rates were compared and analyzed between before and after Six Sigma management methods.Results The DLP in the adult group was decreased by 65.5％in computed tomography urography(CTU),decreased by 25.5％in neck enhancement,decreased by 9.8％in head,decreased by 24％in facial cranial,and decreased by 27.7％in chest enhancement,with a statistical difference(P＜0.05).While DLP in the adult group was decreased by 9.7％in abdominal enhancement,with no significant difference(P＞0.05).The DLP in the pediatric(＜1 year)group was increased by 35％in head scans,with no significant difference(P＞0.05).While the DLP was decreased by 30.2％in 1 to 5 years group,decreased by 21.8％in 6 to 10 years group,decreased by 27.6％in 11 to 15 years group,with statistical difference(P＜0.05).The DLP of facial cranial was decreased by 43.3％in 6 to 10 years group,decreased by 29.1％in 11 to 15 years group,with statistical difference(P＜0.05).The DLP of chest was decreased by 13％in＜1 year group(P＞0.05),increased by 2.2％in 1 to 5 years group(P＞0.05),decreased by 42.6％in 6 to 10 years group,decreased by 54.2％in 11 to 15 years group(P＜0.05).The incidence of radiological quality control problems of after Six Sigma management was significantly lower than that of before Six Sigma management(P＜0.05).Conclusion Six Sigma management method can identify problems in the clinical practice and enhance the ability of radiation quality control through optimization.

Objective To analyze the radiation dose in low-dose chest CT examination of pediatric patients with mycoplasma pneumoniae pneumonia(MPP)by using size-specific dose estimation(SSDE).Methods A total of 95 patients who were scanned with low-dose chest CT were prospectively selected,65 patients with weight ≤50 kg,using 80 kV and DoseRight Z-DOM(30-50 mAs);30 patients with weight＞50 kg,using 100 kV and DoseRight Z-DOM(50-100 mAs).A total of 65 patients who were scanned with conventional chest CT were retrospectively collected,40 patients with weight ≤50 kg,25 patients with weight＞50 kg,using 120 kV,DoseRight Z-DOM(50-100 mAs)and fixed mAs.Image noise,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were used to objectively evaluate image quality.The subjective evaluation of image quality was performed by two radiologists using a 5-score system and a double-blind method.The volume CT dose index(CTDIvol)and dose length product(DLP)were collected,the SSDE and effective dose(ED)were measured,respectively.Results Compared with conventional scan,CTDIvol,DLP,SSDE,and ED values of 80 kV scan was decreased by 81.3％,80.3％,81.5％,and 82.4％,respectively,with a statistical difference(Z=-8.433,-8.137,-8.146,-8.142,P＜0.05).There were statistically significant differences in image noise,SNR,and CNR between 80 kV scan and conventional scan in patients with weight ≤50 kg(Z=-6.762,-5.075,-3.430,P＜0.05).In 100 kV scan,CTDIvol,DLP,SSDE,and ED values was decreased by 75.7％,76.3％,75.3％,and 75.3％,respectively,with a statistical difference(Z=-6.301,-6.173,-6.347,-6.308,P＜0.05).There were statistically significant differences in image noise and SNR between 100 kV scan and conventional scan in patients with weight＞50 kg(Z=-5.367,-4.650,P＜0.05).The subjective evaluation scores of the two groups images were all greater than 3 points,all images could be used for clinical diagnosis.SSDE was 45.3％and 29.9％higher than CTDIvol for 80 kV and 100 kV scans,respectively,SSDE was 45.7％and 28.8％higher than CTDIvol for conventional scans with weight ≤50 kg and weight＞50 kg,respectively.Conclusion Low kV combined with DoseRight Z-DOM effectively reduces radiation dose to pediatric patients with MPP;SSDE more accurately assesses radiation dose than CTDIvol in children.

Objective: To understand levels of various foods and nutrients in school lunch based on digital platform and to provide reference for food preparation and serving. Methods: A total of 13 018 school lunch recipes in Binhai New Area of 96 schools in Tianjin from November 2020 to April 2021 were collected by using digital management platform for food safety and nutritional health.Food types including cereals and tubers, vegetables, fruits, livestock and poultry meat, fish and shrimp, eggs, milk and dairy products, legumes and their products/nuts and others energy, and nutrients including protein, fat, carbohydrate, calcium, iron, zinc, selenium, vitamin A, vitamin B 1, vitamin B 2, vitamin C and dietary fiber were evaluated. Results: The qualified rate of all kinds of food for students lunch from high to low were 96.8% (116.4 g) of livestock and poultry meat, 92.3% (179.5 g) of cereal and potato, 65.0% (170.6 g) of vegetables, 47.7% (21.4 g) of soybeans and their products/nuts, 33.4% (18.0 g) of eggs, 14.4% (8.5 g) of fish and shrimp, 14.1% (19.6 g) of fruits, 0.3% (35.4 g) of milk and dairy products. There were significant differences in the qualified rate of various food intake among different grades( P <0.05). The qualified rate of students lunch energy was 76.9%(932.6 kcal). The qualified rates of various nutrients from high to low were iron 96.9%(9.7 mg), zinc 96.8%(5.9 mg), protein 96.4%(43.8 g), carbohydrate 87.6%(130.8 g) and selenium 82.9%(23.5 μg), vitamin C 78.5%(48.8 mg), vitamin B 1 75.9%(0.5 mg), fat 74.3%(28.5 g), vitamin A 74.1%(327.1 μ g) vitamin B 2 49.9%(0.5 mg), dietary fiber 19.5%(5.9 g) and calcium 13.4%(246.1 mg). There were significant differences in the qualified rates of energy and nutrients among different grades( P <0.05). Conclusion The digital platform basically meets school lunch requirments on food types and nutrients, but still with problems regarding insufficient fish and shrimp, fruits, milk and dairy products, vitamin B 2, dietary fiber and calcium. It is suggested to optimize school lunch recipes or increase corresponding nutrients content in other meals.

Objective:To analyze the effect of integrated care model on relocation stress and sense of coherence in caregivers of severe multiple injuries patients after ICU transfer.Methods:From January 2017 to October 2019, 102 caregivers of severe multiple injuries patients in ICU of Liuzhou Worker′s Hospital were selected and divided into control group and observation group by random digits table method,with 51 cases in each group. In the process of ICU transfer the control group received routine nursing, while the observation group carried out integrated care model based on the control group scheme. Before and after ICU transfer, the degree of relocation stress and sense of coherence of caregivers in two groups were evaluated by Family Relocation Stress Scale (FRSS) and Sense of Coherence Scale (SOCS) respectively.Results:The scores of migration preparation dimension, migration satisfaction dimension,caregiver stress dimension and the total scores of FRSS were 17.51 ± 3.46, 4.81 ± 0.48, 11.69 ± 1.82 and 49.91 ± 4.51 in the observation group, which were significantly higher than those in the control group after transfer (13.61 ± 2.83, 3.32 ± 0.53, 9.42 ± 2.17, 39.25 ± 4.01)( t values were 5.12-7.64, all P<0.05). The scores of manage ability dimension, comprehensibility dimension, meaningfulness dimension and the total scores of SOCS were 29.58 ± 4.96, 24.07 ± 2.72, 22.04 ± 3.64 and 75.52 ± 6.80 in the observation group, which were significantly higher than those in the control group (24.34 ± 4.13, 20.50 ± 2.99, 17.19 ± 3.96, 64.80 ± 6.12) after transfer ( t values were 4.51-7.01, all P<0.05). Conclusions:The integrated care model can significantly alleviate relocation stress and promote sense of coherence in caregivers of severemultiple injuriespatients after ICU transfer.

Objective TostudythevalueofquantitativeparametersofDCE-MRIandthreedimensionalarterialspinlabeling(3D-ASL) inpreoperativegliomagrading.Methods 70patientsdiagnosedpathologicallywithinitialgliomawereassessedretrospectively,including 32caseswithlow-gradeglioma(LGG)and38caseswithhigh-gradeglioma(HGG).Allpatientsunderwentconventional,enhanced, DCEand3D-ASL MRIat3.0Tbeforesurgery.TheparametricvaluesofDCEsuchasvolumetransferconstant(Ktrans),extravascular extracellularspacevolumefraction(Ve),therateconstant(Kep),fractionalplasmavolume(Vp),cerebralbloodflow (CBF)andcerebral bloodvolume(CBV)wereobtainedbycorrespondingpost-processingsoftware.ThecerebralbloodflowofASL (ASL-CBF)wasalso obtained.Ttestoftwoindependentsampleswasusedtoanalyzewhetherthemaximumandaveragevaluesofeachparameterwere statisticallydifferentbetweenLGGand HGG.Thediagnosticaccuracyofdifferenttechniqueforgliomagradingwasdeterminedby ROCcurveanalysis.Results ThemaximumvaluesofDCE-Ktrans,Ve,rCBVandmaximumvalueofASL-rCBFwerestatisticallydifferent betweentheHGGandLGG (P＜0.05).AlltheparametricaveragevalueswerestatisticallydifferentbetweentheHGGandLGG (P＜0.05).ThemaximumandaveragevaluesofKtranshadarelativelyhighestdiagnosticefficiencyinallparameters,withtheAUCwere0.986 and0.971,theoptimumthresholdwere0.264and0.068,thesensitivitywere93.3%and94.1%,andthespecificitywere100%and 100%,respectively.ThemaximumvaluesofVe,rCBV,ASL-rCBFandtheaveragevaluesofallparametershadarelativelyhigher diagnosticefficiency.Conclusion ThemaximumvaluesofKtrans,VeandrCBFofDCE,themaximumvalueofASL-rCBFandtheaverage valueofeachparameterwereusefultodistinguishbetweenLGGand HGG.ThemaximumandaveragevaluesofKtransarethebest parametersforidentifyingHGGandLGG.

Objective To analyze the correlation between coronary artery lesion complexity and left ventricular funotion index of patients.Methods A total of 69 patients with coronary heart disease were selected in the study and were divided into low- risk(27 cases),medium-risk(23 cases) and high-risk (19 cases) groups according to the SYNTAX score.The difference in left ventricular function among the three groups were compared by ANOVA, and the correlation between coronary artery SYNTAX score and left ventricular function index was evaluated by Spearman rank correlation analysis.Results The differences in left ventricular end-diastolic volume(EDV),end-systolic volume(ESV),stroke volume(SV),ejection fraction(EF) and muscle mass(MM) among the groups were statistically signifcant (F=7.254,9.181, 13.004, 7.544 and 5.276,P<0.05).The coronary SYNTAX score was negatively corelated with the EF (r=-0.702,P<0.05),but positively correlated with the MM (r=0.638, P<0.05).Conclusion Coronary SYNTAX score is negatively correlated with left ventricular EF, but positively correlated with MM.

Objective To explore the correlation between serum uric acid level and coronary artery SYNTAX score of coronary heart disease.Methods A total of 69 patients of coronary heart disease were enrolled according to SYNTAX score.The patients were divided into the low risk group (27 cases),medium risk group (23 cases) and high risk group (19 cases).The differences of serum uric acid concentrations among the three groups were compared by ANOVA.Spearman rank correlation analysis was used to analyze the correlation between serum uric acid concentrations and coronary artery SYNTAX scores.Results ANOVA analysis showed that the differences of serum uric acid concentrations among the groups were statistical significant (F=4.74,P＜0.05).The Spearman correlation analysis showed that serum uric acid concentrations were positively correlated with coronary SYNTAX score (r =0.58,P ＜0.05).Conclusion Serum uric acid level and severity of coronary artery disease are positively correlative.

Objective To study clinical application value of 128-slice spiral CT imaging post-processing technique in knee joint trauma.Methods 75 cases of knee traumatic patients were examined by ordinary X-ray and 128-slice spiral CT imaging post-process-ing technique,and retrospectively analysed.Results For 75 cases of knee trauma patients,on X-ray examination 64 cases of fracture patients(78 fractures),6 patients of possible fractures,5 cases of missed diagnosis and misdiagnosis in were found,the detection rate was 88.6%;all patients underwent 128-slice spiral CT imaging post-processing technique-MPR/VR,and definite diagnosis of knee joint bone fracture was found in 75 cases (88 fractures),the detection rate was 100.0%,which was significantly higher than that on the X-ray examination (χ2 =6.1 1 7 2,P <0.05).The MPR reconstruction of knee joint fracture is of the highest detection rate.Con-clusion MSCT imaging post-processing technique can directly,clearly and comprehensive display knee joint trauma cases,and help doctors understand the relationship between fractures,soft tissue and joint space,in order to develop accurate and reasonable clinical treatment plan.