Peptide receptor radionuclide therapy (PRRT) with radiolabeled SSTR2 agonists is a treatment option that is highly effective in controlling metastatic and progressive neuroendocrine tumors (NETs). Previous studies have shown that an SSTR2 agonist combined with albumin binding moiety Evans blue (denoted as ¹⁷⁷Lu-EB-TATE) is characterized by a higher tumor uptake and residence time in preclinical models and in patients with metastatic NETs. This study aimed to enhance the in vivo stability, pharmacokinetics, and pharmacodynamics of ¹⁷⁷Lu-EB-TATE by replacing the maleimide-thiol group with a polyethylene glycol chain, resulting in a novel EB conjugated SSTR2-targeting radiopharmaceutical, ¹⁷⁷Lu-LNC1010, for PRRT. In preclinical studies, ¹⁷⁷Lu-LNC1010 exhibited good stability and SSTR2-binding affinity in AR42J tumor cells and enhanced uptake and prolonged retention in AR42J tumor xenografts. Thereafter, we presented the first-in-human dose escalation study of ¹⁷⁷Lu-LNC1010 in patients with advanced/metastatic NETs. ¹⁷⁷Lu-LNC1010 was well-tolerated by all patients, with minor adverse effects, and exhibited significant uptake and prolonged retention in tumor lesions, with higher tumor radiation doses than those of ¹⁷⁷Lu-EB-TATE. Preliminary PRRT efficacy results showed an 83% disease control rate and a 42% overall response rate after two ¹⁷⁷Lu-LNC1010 treatment cycles. These encouraging findings warrant further investigations through multicenter, prospective, and randomized controlled trials.

Objective:To observe the effect of robot-assisted gait training (RAGT) supplemented with intermittent theta burst stimulation (iTBS) of the cerebellum in restoring lower limb function after anterior cruciate ligament reconstruction (ACLR).Methods:Eighty ACLR patients were randomly divided into a control group, a magnetic stimulation group, a robot group and a combined group, each with 20 members. The robot and magnetic stimulation groups underwent RAGT and cerebellar iTBS before conventional training, while the combined group received iTBS followed by RAGT and then conventional training. The treatments were administered once a day, three days per week for four weeks. Before and after the intervention, the peak torque ratio of the knee flexors and extensors (H/Q), peak torque of the knee extensors (PT), and knee repositioning angle difference were measured. Knee function and balance (using the Berg Balance Scale (BBS)) were also assessed.Results:The combined group demonstrated significantly better quadriceps PT and H/Q% than the other 3 groups. Knee repositioning angle difference improved significantly in all of the groups after the treatment, with the combined group showing the smallest difference (5.00±1.21)°, significantly better than the other three groups. Lysholm and BBS scores had also improved significantly in all of the groups, with the combined group′s improvements again significantly better than those of the other groups.Conclusion:Intermittent theta burst stimulation of the cerebellum combined with robot-assisted gait training can significantly improve knee function and balance after ACLR.

Objective:To explore the effect of combining repeated peripheral (rPMS) and central transcranial magnetic stimulation (rTMS) in treating upper limb motor dysfunction after a stroke.Methods:Seventy-eight patients with upper limb motor dysfunction after a stroke were randomly divided into a control group, an rTMS group and a combined magnetic stimulation group, each of 26. All three groups underwent routine rehabilitation, while the rTMS group was repeatedly given low frequency transcranial magnetic stimulation of the M1 region on the unaffected side, and the combined group also received repeated peripheral magnetic stimulation at Erb′s point on the affected upper limb. There was one treatment session a day, 5 days a week for 3 weeks. Before and after the treatment, everyone′s upper limb motor function was quantified using the Fugl-Meyer upper extremity assessment (FMA-UE) and the Wolf motor function test (WMFT). Skill in the activities of daily living was quantified in terms of a Barthel index (BI). Motor recovery of the upper limbs and hands was assessed using Brunnstrom staging. The latency and amplitude of the motor evoked potentials (MEPs) in the subjects′ affected abductor pollicis brevis muscles were also recorded before and after the treatment. Pearson correlation coefficients quantified the correlation between the changes in FMA-UE scores and MEP amplitudes before and after the treatment in the three groups.Results:There were no significant differences among the three groups before the treatment. Afterward, however, the average FMA-UE, WMFT and BI scores, as well as the upper limb and hand Brunnstrom stages and the average MEP latencies and amplitudes of all the three groups had improved significantly. The combined group′s average results were then significantly better than the other two groups′ averages, except for the upper limb Brunnstrom stages. The increases in MEP amplitude were positively correlated with the increases in FMA-UE scores among the rTMS and the combined group, but there was no significant correlation between them in the control group.Conclusions:The combined application of rPMS and contralateral low frequency rTMS can effectively relieve motor dysfunction in the upper limbs in the early stages after a stroke.

BACKGROUND:The adjustment of force lines in open wedge high tibial osteotomy can affect the retroversion of the knee joint and the height of the patella.In addition,the adjustment of force lines in open wedge high tibial osteotomy is also different according to different varus deformity.At present,the difference of weight bearing line adjustment is still controversial for the correlation index of knee joint and the function of knee joint after surgery.OBJECTIVE:To investigate the effect of line adjustment area on postoperative knee function and joint kinematics during open wedge high tibial osteotomy.METHODS:Totally 76 patients with knee osteoarthritis who received open wedge high tibial osteotomy in Binzhou People's Hospital Affiliated to Shandong First Medical University from March 2022 to March 2023 were selected,including 33 males and 43 females,all on one knee.The lateral border of the tibial plateau was considered as 100％.The position of the central intercondylar ridge of the knee joint was 0％.The weight bearing line of the affected limb was divided into two groups according to the difference of the lateral plateau area of the affected limb:the area of the force line passing through the lateral plateau of the tibial plateau(0-29％)was classified as group A(n=39),and the area of the lateral plateau of the tibial plateau was classified as group B(n=37)by 30％to 40％.The changes of tibiofemoral angle,medial proximal tibial angle,posterior inclination of tibia,and patellar height before and after operation were analyzed.The symptoms and function of the knee were evaluated by the Numeric Rating Scale score and the Hospital for Special Surgery knee score.RESULTS AND CONCLUSION:(1)At 1 year after surgery,the posterior inclination of tibia and the medial angle of proximal tibia were increased in both groups(P＜0.05),and the tibiofemoral angle was reduced and patellar height was decreased in both groups(P＜0.05).The posterior inclination of tibia,medial proximal tibial angle,tibiofemoral angle,and patellar height were significantly different between the two groups at 1 year after surgery(P＜0.05).(2)The Hospital for Special Surgery knee scores of the two groups of patients at all times after surgery were better than those before surgery,and showed a gradually increasing trend(P＜0.05).There was no significant difference in the Hospital for Special Surgery knee scores 1 week and 3 months after surgery between the two groups(P＞0.05).Hospital for Special Surgery knee score of group B at 6 and 12 months after surgery was better than that of group A(P＜0.05).(3)The Numeric Rating Scale score after surgery showed a gradual downward trend(P＜0.05).No significant difference was detected between the two groups(P＞0.05).(4)The results show that the knee function and symptoms were significantly improved in the early and middle period after open wedge high tibial osteotomy,and the knee joint related parameters changed with the outward shift of weight bearing line.At 1-year follow-up,the functional recovery of knee joint in group B was better than that in group A.Long-term knee function and clinical differences after surgery need further follow-up study.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

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.

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.

BACKGROUND:The adjustment of force lines in open wedge high tibial osteotomy can affect the retroversion of the knee joint and the height of the patella.In addition,the adjustment of force lines in open wedge high tibial osteotomy is also different according to different varus deformity.At present,the difference of weight bearing line adjustment is still controversial for the correlation index of knee joint and the function of knee joint after surgery.OBJECTIVE:To investigate the effect of line adjustment area on postoperative knee function and joint kinematics during open wedge high tibial osteotomy.METHODS:Totally 76 patients with knee osteoarthritis who received open wedge high tibial osteotomy in Binzhou People's Hospital Affiliated to Shandong First Medical University from March 2022 to March 2023 were selected,including 33 males and 43 females,all on one knee.The lateral border of the tibial plateau was considered as 100％.The position of the central intercondylar ridge of the knee joint was 0％.The weight bearing line of the affected limb was divided into two groups according to the difference of the lateral plateau area of the affected limb:the area of the force line passing through the lateral plateau of the tibial plateau(0-29％)was classified as group A(n=39),and the area of the lateral plateau of the tibial plateau was classified as group B(n=37)by 30％to 40％.The changes of tibiofemoral angle,medial proximal tibial angle,posterior inclination of tibia,and patellar height before and after operation were analyzed.The symptoms and function of the knee were evaluated by the Numeric Rating Scale score and the Hospital for Special Surgery knee score.RESULTS AND CONCLUSION:(1)At 1 year after surgery,the posterior inclination of tibia and the medial angle of proximal tibia were increased in both groups(P＜0.05),and the tibiofemoral angle was reduced and patellar height was decreased in both groups(P＜0.05).The posterior inclination of tibia,medial proximal tibial angle,tibiofemoral angle,and patellar height were significantly different between the two groups at 1 year after surgery(P＜0.05).(2)The Hospital for Special Surgery knee scores of the two groups of patients at all times after surgery were better than those before surgery,and showed a gradually increasing trend(P＜0.05).There was no significant difference in the Hospital for Special Surgery knee scores 1 week and 3 months after surgery between the two groups(P＞0.05).Hospital for Special Surgery knee score of group B at 6 and 12 months after surgery was better than that of group A(P＜0.05).(3)The Numeric Rating Scale score after surgery showed a gradual downward trend(P＜0.05).No significant difference was detected between the two groups(P＞0.05).(4)The results show that the knee function and symptoms were significantly improved in the early and middle period after open wedge high tibial osteotomy,and the knee joint related parameters changed with the outward shift of weight bearing line.At 1-year follow-up,the functional recovery of knee joint in group B was better than that in group A.Long-term knee function and clinical differences after surgery need further follow-up study.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

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.