Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective To analyze the prognostic value of thrombin generation assay(TGA)and coagulation factor testing in postoperative deep venous thrombosis(DVT)of lower extremities in elderly patients with traumatic fracture.Methods A retrospective case-control study was conducted to collect traumatic patients older than 60 years old who underwent surgery in our department from March 2019 to March 2022.The number of patients was 104.According to the ultrasonic examination of DVT 5 days after operation,the patients were divided into DVT group and non-DVT group.The differences of general demographic data,previous chronic diseases,time from trauma to operation,related indexes of TGA and TF coagulation factors(F)between the two groups were analyzed.The indexes with statistical significance were analyzed by receiver operating curve(ROC);the indexes with statistically significant differences were analyzed by Logistic regression and the prediction probability was calculated by ROC curve analysis.Results The incidence of postoperative DVT was 21.12％.Compared with the non-DVT group,the time from trauma to operation was longer in the DVT group,and the peak value under 5 pmol/L TF activation was lower(258.13±40.88 vs 209.58±30.09).F V,F Ⅷ and Fib were higher(141.25(125.38,158.18)vs 176.12(150.65,186.34),145.49(133.36,147.48)vs 165.96(153.07,180.65),3.25± 0.55 vs 3.92±0.72,respectively).The differences were statistically significant(all P＜0.01).ROC curve analysis showed that the time from trauma to operation,the peak value of 5 pmol/L TF activation,F V,FⅧ and Fib combined had more predictive value for postoperative DVT,the AUC was 0.91(P＜0.01),the sensitivity was 0.82 and the specificity 0.92.Conclusion The time from trauma to operation,the peak value of TGA under the condition of 5 pmol/L TF activation,F V,F Ⅷ and Fib have excellent prognostic value for the postoperative DVT of lower extremities in elderly patients with traumatic fracture,and the combined detection is more significative.

This article reported the clinical features of a rare patient with anti-metabotropic glutamate receptor 5 （mGluR5） encephalitis with mental disorders as the initial symptom， so as to provide references for clinical diagnosis and treatment. The patient was a 38-year-old male， developed pharyngeal pain as prodromal symptoms， and the main clinical manifestations included rapidly progressive memory loss， anxiety and depression， and psychomotor excitement symptoms including irritability and impulsive behaviors. The disease had a progressive deterioration. In the most severe state， the patient became unconscious in a shallow coma， with further cognitive decline， hallucinations and delusions， and lack of self-awareness. Both cerebrospinal fluid and serum anti-mGluR5 antibody were strongly positive （1∶100）. After two sessions of hormone shock therapy， the patient showed significantly improvement in consciousness， cognitive， emotional and psychiatric dimensions.

Objective To investigate the correlation between serum adiponectin levels and post-stroke cognitive impairment (PSCI). Methods From January 2018 to December 2018, consecutive patients with ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Dongguan Changping Hospital, and Jiangsu Provincial Second Chinese Medicine Hospital were enrolled. Serum adiponectin concentration was detected by radioimmunoassay. The cognitive function assessment was performed 1 month after the onset of stroke using the Montreal Cognitive Assessment (MoCA). The total score of MoCA <22 was defined as PSCI. Univariate analysis was used to compare the baseline data between groups, and multivariate logistic regression analysis was used to determine the association between serum adiponectin levels and PSCI. Results A total of 257 patients with acute ischemic stroke were enrolled, with age 66.5 ± 9.9 years, 139 (54.1% ) males, and 91 (35.4% ) with PSCI. Age (68.2 ± 8.1 years vs. 65.6 ± 10.8 years; t=2.007, P=0.046 ), homocysteine (16.0 ± 6.2 μmol/L vs. 14.5 ± 4.5 μmol/L; t= 2.208, P= 0.028 ), and high-sensitivity C-reactive protein ( 7.0 [3.3-9.9] mg/L vs. 4.7 [2.2-9.6] mg/L; Z=2.346, P=0.019 ) as well as the proportion of hypertension (64.8% vs. 50.6% ; χ2 =4.824, P=0.028), diabetes (33.0% vs. 21.1% ; χ2 =4.392, P=0.036), leuko-araiosis (47.2% vs. 32.5% ; χ2 =5.422, P=0.020) and diffusion weighting imaging-Alberta Stroke Project early CT score 0-7 (59.3% vs. 41.4% ; χ2 =6.942, P=0.008) in the PSCI group was significantly higher than that of the non-PSCI group, while the adiponectin level was significantly lower than that of the non-PS-CI group (5.4 [3.5-8.4] mg/L vs. 7.0 [5.3-9.3] mg/L; Z=3.624, P=0.001 ). Multivariate logistic regression analysis showed that after adjusting for the confounding factors, the lower serum adiponectin level was an independent risk factors for PSCI (the 1st quartile group vs. the 4th quartile group: odds ratio 2.152, 95% confidence interval 1.119-5.039; P=0.047). Conclusions Low serum adiponectin level might be an independent risk factor for PSCI in patients with ischemic stroke.

Objective To explore the prognostic factors of intensive care unit (ICU) patients. Methods A retrospective cohort study was conducted. The clinical data of patients admitted to ICU of Beijing Geriatric Hospital from January 2005 to December 2016 were collected. According to the prognosis, the patients were divided into death group and survival group, and the mortality trend with time and age was observed. Survival and death were treated as dependent variables, while the gender, age, reason of ICU admission, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, whether undergoing invasive mechanical ventilation (MV), invasive MV reason, duration of invasive MV, whether successful weaning, whether ICU nosocomial infection, hospital acquired pneumonia (HAP), central line-associated bloodstream infection (CLABSI), acute kidney injury (AKI) occurred, whether undergoing continuous blood purification (CBP), whether septic shock occurred, whether undergoing invasive hemodynamic monitoring or blood transfusion and length of ICU stay were used as the independent variables. First, the clinical data was analyzed by univariate analysis. Second, the independent variables influencing the dependent variable were analyzed by logistic regression analysis to screen out prognostic factors of ICU patients. Results During the study period, 1325 patients were treated, 26 patients with missing data, 1299 patients in final group, 865 patients in survival group, and 434 in death group. The proportion of men in the patients was larger (67.7%), and the age span was larger (16-105 years old). The mortality rate in different years showed no significant difference (χ2 = 16.712, P = 0.117), and with the increase of age, the mortality rate of ICU showed an upward trend (χ2 = 16.399, P = 0.022). The univariate analysis showed that ICU deaths were unrelated to gender, but associated with age, APACHE Ⅱ score, invasive MV, invasive MV reason, duration of invasive MV, successful weaning, ICU nosocomial infection, HAP, CLABSI, AKI, septic shock, whether CBP or invasive hemodynamic monitoring, blood transfusion, the reason of ICU admission and the length of ICU stay (all P < 0.05). The relevant factors with statistical difference found in univariate analysis were analyzed in logistic regression analysis, which showed that whether successful weaning [odds ratio (OR) = 0.016, 95% confidence interval (95%CI) = 0.010-0.025], and whether AKI (OR = 3.917, 95%CI = 2.331-6.582) or septic shock occurred (OR = 2.808, 95%CI = 1.604-4.915) were the dependent variables of death or survival (all P = 0.000). Regression coefficient (β value) of successful weaning was -4.155, suggesting that unsuccessful weaning patients were likely to die. The β value of AKI and septic shock was 1.365 and 1.033, suggesting that the patients with AKI or septic shock were more likely to die. Conclusions Whether the success of weaning, whether the occurrence of AKI or septic shock are independent prognostic factors for the prognosis of ICU patients. Measures for the prevention of the above three aspects could improve the prognosis of ICU patients.