Background Platelet parameters are important indicators of cardiovascular risk, and environmental pollutants such as polychlorinated biphenyls (PCBs) may impair platelet function through oxidative stress. Objective To investigate the differential effects of single and mixed exposure to PCBs on platelet parameters among individuals with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM), and to evaluate the potential modifying role of a healthy lifestyle. Methods This study included 2249 participants (including 707 with NGT, 759 with IFG, and 783 with T2DM). Plasma PCB concentrations were measured using triple quadrupole gaschromatography-tandem mass spectrometry. Generalized linear regression was used to assess the associations between individual PCB congeners and platelet parameters. Quantile g-computation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the overall effects of PCBs mixture exposure on platelet parameters across different glycemic states, as well as its interaction with healthy lifestyle score (HLS). Results Generalized linear regression analyses showed significant differences in the effects of PCBs on platelet parameters across different glycemic states (P<0.05). After adjusting for confounders, PCBs mixture exposure was significantly associated with lower platelet counts (PLT) in individuals with NGT (b=−10.60, 95%CI: −16.48, −4.71) and IFG (b=−12.91, 95%CI: −18.90, −6.92), whereas no significant association was observed in individuals with T2DM (P=0.051). Mean platelet volume (MPV) and platelet-large cell ratio (P-LCR) increased significantly with higher PCBs exposure levels across all three groups (P<0.05). BKMR analysis showed a positive association between PCBs mixture exposure and P-LCR, with the strongest association observed in the NGT group. Furthermore, a significant interaction was observed between HLS and PCBs mixture exposure, and a higher HLS attenuated the effects of PCBs on P-LCR. Conclusion Glycemic glycemic states may modify the effects of PCBs on platelets. Individuals with NGT appear more sensitive to PCBs exposure, whereas the T2DM state may attenuate this effect. Moreover, healthy lifestyles, including not smoking, moderate alcohol consumption, maintaining moderate-to-high physical activity, a healthy diet, and an appropriate body mass index (BMI), may mitigate the adverse effects of most PCBs on platelet parameters.

Background Platelet parameters are important indicators of cardiovascular risk, and environmental pollutants such as polychlorinated biphenyls (PCBs) may impair platelet function through oxidative stress. Objective To investigate the differential effects of single and mixed exposure to PCBs on platelet parameters among individuals with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM), and to evaluate the potential modifying role of a healthy lifestyle. Methods This study included 2249 participants (including 707 with NGT, 759 with IFG, and 783 with T2DM). Plasma PCB concentrations were measured using triple quadrupole gaschromatography-tandem mass spectrometry. Generalized linear regression was used to assess the associations between individual PCB congeners and platelet parameters. Quantile g-computation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the overall effects of PCBs mixture exposure on platelet parameters across different glycemic states, as well as its interaction with healthy lifestyle score (HLS). Results Generalized linear regression analyses showed significant differences in the effects of PCBs on platelet parameters across different glycemic states (P<0.05). After adjusting for confounders, PCBs mixture exposure was significantly associated with lower platelet counts (PLT) in individuals with NGT (b=−10.60, 95%CI: −16.48, −4.71) and IFG (b=−12.91, 95%CI: −18.90, −6.92), whereas no significant association was observed in individuals with T2DM (P=0.051). Mean platelet volume (MPV) and platelet-large cell ratio (P-LCR) increased significantly with higher PCBs exposure levels across all three groups (P<0.05). BKMR analysis showed a positive association between PCBs mixture exposure and P-LCR, with the strongest association observed in the NGT group. Furthermore, a significant interaction was observed between HLS and PCBs mixture exposure, and a higher HLS attenuated the effects of PCBs on P-LCR. Conclusion Glycemic glycemic states may modify the effects of PCBs on platelets. Individuals with NGT appear more sensitive to PCBs exposure, whereas the T2DM state may attenuate this effect. Moreover, healthy lifestyles, including not smoking, moderate alcohol consumption, maintaining moderate-to-high physical activity, a healthy diet, and an appropriate body mass index (BMI), may mitigate the adverse effects of most PCBs on platelet parameters.

Objective To investigate the prevalence and influencing factors of work-related musculoskeletal disorders (WMSDs) in neck, shoulders and lower back among power grid workers. Methods A total of 371 workers from a power grid enterprise in Guangdong Province were selected as the research subjects using the convenience sampling method. A cross-sectional survey of WMSDs in the neck, shoulders and waist of the workers was conducted using the modified Musculoskeletal Disorders Questionnaire. Results The overall prevalence of WMSDs among the power grid workers was 62.8%, with prevalence of 37.2%, 33.7% and 32.1% for WMSDs in neck, shoulders and lower back, respectively. Binary logistic regression analysis showed that power grid workers who did not maintain a good sitting posture or were unable to maintain good sitting posture over prolonged periods had a higher risk of neck WMSDs than those who maintained a good sitting posture (both P<0.01). A higher frequency of head-down posture during work was associated with an increased risk of neck WMSDs (both P<0.05). Female workers had a higher risk of shoulder WMSDs than male workers (P<0.05). A higher frequency of early awakening with inability to fall back asleep, as well as a higher frequency of head-down posture during work, were both associated with an increased risk of shoulder WMSDs (all P<0.05). Workers with a sedentary habit had a higher risk of shoulder WMSDs than those without (P<0.01). Workers with insufficient rest time had a higher risk of shoulder WMSDs than those with sufficient rest time (P<0.01). Both maintenance workers and managers had a higher risk of lower back WMSDs than workers in other occupational categories (all P<0.05). Workers who experienced nocturnal awakening with difficulty falling back asleep at frequency of several times per year, ≥1 time /month, ≥1 time /week, had higher risk of lower back WMSDs than those who never experienced such problem (all P<0.05). Workers with a sedentary habit and those uncertain about having a sedentary habit both had a higher risk of lower back WMSDs than those without (both P<0.05). Greater forward neck flexion during work was associated with an increased risk of lower back WMSDs (both P<0.05). Workers who occasionally tilted their necks to the side while working had a higher risk of lower back WMSDs than those who did not (P<0.05). Conclusion WMSDs are highly prevalent among power grid workers, particularly affecting the neck, shoulder, and waist. Influencing factors include individual characteristics, behavioral habits, work organization, work posture, and workload. Maintaining proper posture and adequate rest may reduce the risk of WMSDs.

[Objective]To quantify lesion parameters in different retinal regions on ultra-widefield fluorescein angiography(UWFA)images of patients with diabetic retinopathy(DR)and to explore their association with center-involved diabetic macular edema(CI-DME).[Methods]We retrospectively analyzed UWFA and optical coherence tomography(OCT)images from 76 DR patients(101 eyes)initially diagnosed at Guangdong Provincial People's Hospital between June 2022 and June 2024.All images were captured on the same day.Eyes were classified into CI-DME and non-CI-DME groups based on central subfield thickness(CST)measured by OCT.Manual annotations of microaneurysms,non-perfusion areas,leakage areas,optic discs,and foveae were performed on UWFA images.Lesion parameters,including microaneurysm count,ischemic index,and leakage index,were quantified in the macular area,posterior area,mid-periphery,peripheral retina,and entire UWFA field.Differences in parameters between groups were compared,and their associations with CI-DME and diagnostic performance were assessed.[Results]The CI-DME group exhibited significantly higher microaneurysm count,ischemic index and leakage index in the macular area than those in the non-CI-DME eyes(all P<0.05).No significant differences were observed in these parameters in the peripheral retina between the two groups(all P＞0.05).ROC curve analysis showed that the leakage index could distinguish CI-DME better than the microaneurysm count and ischemia index.The macular leakage index had the highest discriminative ability,with an AUC of 0.80(95%CI:0.71,0.89).[Conclusion]This study found no significant association between peripheral lesion parameters on UWFA and CI-DME.However,macular lesion parameters,particularly the leakage index,were closely linked to CI-DME pathology.These findings highlight the importance of monitoring macular vascular stability to optimize clinical management for DME patients.

Objective To explore the impact of seasonal and temperature variations on fasting blood glucose(FPG)in patients with type 2 diabetes(T2DM).Methods A retrospective analysis was conducted on clinical data of 31 994 T2DM patients managed by community health service center in Minhang District,Shanghai,from January 1,2020 to October 31,2023.The effect of seasonal and temperature variations on FPG levels and blood glucose control was investigated in T2DM patients.Results A total of 72 334 FPG tests were conducted in 31 994 T2DM patients,with an average of 2.26 tests per person.The number of tests conducted in spring,summer,autumn and winter were 15 558,34 018,21 929 and 829,respectively.The FPG levels of T2DM patients were lower in summer and autumn compared to those of winter and spring(P<0.05),while the FPG control rates were higher in summer and autumn compared to those of winter and spring(Bonferroni-corrected,P<0.008).There were no significant differences in FPG levels and blood glucose control rates between spring and winter,or between summer and autumn.The results of the multilevel mixed-effect Logistic model analysis with FPG control status as the dependent variable revealed that the risk of uncontrolled FPG in T2DM patients during winter and spring was 47%(aOR=1.465,95%CI:1.156-1.855)and 51%(aOR=1.510,95%CI:1.384-1.645),respectively,which was higher than that of autumn.The levels of FPG and the incidence of FPG abnormalities reached peak in February and reached the trough in September.Both the FPG levels and the incidence of FPG abnormal exhibited a trend of increasing with the decrease of temperature,and with a lag effect observed.Spearman rank correlation test indicated that there was a negative correlation between FPG levels and incidence of abnormal FPG and the monthly average daily temperature one month lagged(rs=-0.951,P＜0.001 and rs=-0.944,P＜0.001).Conclusion FPG levels of T2DM patients exhibit a pronounced seasonal pattern of elevation during winter and spring,accompanied by a reduction in blood glucose control rates.FPG levels and the prevalence of abnormal FPG exhibit a negative correlation with the monthly average daily temperature,and there is a lag effect.

Objective To explore the impact of seasonal and temperature variations on fasting blood glucose(FPG)in patients with type 2 diabetes(T2DM).Methods A retrospective analysis was conducted on clinical data of 31 994 T2DM patients managed by community health service center in Minhang District,Shanghai,from January 1,2020 to October 31,2023.The effect of seasonal and temperature variations on FPG levels and blood glucose control was investigated in T2DM patients.Results A total of 72 334 FPG tests were conducted in 31 994 T2DM patients,with an average of 2.26 tests per person.The number of tests conducted in spring,summer,autumn and winter were 15 558,34 018,21 929 and 829,respectively.The FPG levels of T2DM patients were lower in summer and autumn compared to those of winter and spring(P<0.05),while the FPG control rates were higher in summer and autumn compared to those of winter and spring(Bonferroni-corrected,P<0.008).There were no significant differences in FPG levels and blood glucose control rates between spring and winter,or between summer and autumn.The results of the multilevel mixed-effect Logistic model analysis with FPG control status as the dependent variable revealed that the risk of uncontrolled FPG in T2DM patients during winter and spring was 47%(aOR=1.465,95%CI:1.156-1.855)and 51%(aOR=1.510,95%CI:1.384-1.645),respectively,which was higher than that of autumn.The levels of FPG and the incidence of FPG abnormalities reached peak in February and reached the trough in September.Both the FPG levels and the incidence of FPG abnormal exhibited a trend of increasing with the decrease of temperature,and with a lag effect observed.Spearman rank correlation test indicated that there was a negative correlation between FPG levels and incidence of abnormal FPG and the monthly average daily temperature one month lagged(rs=-0.951,P＜0.001 and rs=-0.944,P＜0.001).Conclusion FPG levels of T2DM patients exhibit a pronounced seasonal pattern of elevation during winter and spring,accompanied by a reduction in blood glucose control rates.FPG levels and the prevalence of abnormal FPG exhibit a negative correlation with the monthly average daily temperature,and there is a lag effect.

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.

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 investigate the impact of preoperative sarcopenia on chronic postsurgical pain(CPSP)after cardiac surgery in elderly patients.Methods:Elderly patients undergoing elective open-chest cardiac surgery at the Affiliated Hospital of Xuzhou Medical University from September 2022 to May 2024 were collected.According to the updated diagnostic criteria and revised by the Asian Working Group for Sarcopenia(AWGS2019)in 2019, patients were classified into sarcopenia and non-sarcopenia groups Elderly patients were divided into two groups based on the occurrence of chronic pain at 3 months postoperatively: CPSP group and non-CPSP group.Indicators with statistically significant differences in univariate regression analysis were included in multifactorial regression to analyze the influencing factors of chronic pain after cardiac surgery in elderly patients.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was calculated to compare the predictive efficacy of sarcopenia, commonly used clinical pain assessment tools(gender+ acute postoperative pain), and(gender+ acute postoperative pain+ sarcopenia)in predicting CPSP after cardiac surgery in elderly patients.Results:The study ultimately included 379 patients, consisting of 238 males(62.8%), with an average age of(66.6 ± 5.3)years.Among them, 83 patients had sarcopenia, and 119 patients developed CPSP.Univariate regression analysis showed that gender, history of atrial fibrillation, acute postoperative pain, American Society of Anesthesiologists(ASA)Physical Status Classification System, New York Heart Association(NYHA)Classification of Cardia Function, sarcopenia, and duration of extracorporeal circulation were associated with the occurrence of CPSP after cardiac surgery in elderly patients.However, after adjusting for all possible confounders, multifactorial regression analysis showed that gender, acute postoperative pain, and sarcopenia were independent risk factors for CPSP after cardiac surgery in elderly patients(all P<0.05), with sarcopenia patients having a 2.913-fold risk of developing CPSP compared with non-sarcopenia patients.The AUCs of the ROC curves for commonly used clinical perioperative pain assessment tools and those with the addition of sarcopenia determination were 0.731 and 0.802, respectively. Conclusions:Preoperative sarcopenia is an independent risk factor for the development of chronic pain after cardiac surgery in elderly patients, and the inclusion of sarcopenia determination in commonly used clinical pain assessment tools can significantly improve the predictive efficacy for chronic pain.

[Objective]To quantify lesion parameters in different retinal regions on ultra-widefield fluorescein angiography(UWFA)images of patients with diabetic retinopathy(DR)and to explore their association with center-involved diabetic macular edema(CI-DME).[Methods]We retrospectively analyzed UWFA and optical coherence tomography(OCT)images from 76 DR patients(101 eyes)initially diagnosed at Guangdong Provincial People's Hospital between June 2022 and June 2024.All images were captured on the same day.Eyes were classified into CI-DME and non-CI-DME groups based on central subfield thickness(CST)measured by OCT.Manual annotations of microaneurysms,non-perfusion areas,leakage areas,optic discs,and foveae were performed on UWFA images.Lesion parameters,including microaneurysm count,ischemic index,and leakage index,were quantified in the macular area,posterior area,mid-periphery,peripheral retina,and entire UWFA field.Differences in parameters between groups were compared,and their associations with CI-DME and diagnostic performance were assessed.[Results]The CI-DME group exhibited significantly higher microaneurysm count,ischemic index and leakage index in the macular area than those in the non-CI-DME eyes(all P<0.05).No significant differences were observed in these parameters in the peripheral retina between the two groups(all P＞0.05).ROC curve analysis showed that the leakage index could distinguish CI-DME better than the microaneurysm count and ischemia index.The macular leakage index had the highest discriminative ability,with an AUC of 0.80(95%CI:0.71,0.89).[Conclusion]This study found no significant association between peripheral lesion parameters on UWFA and CI-DME.However,macular lesion parameters,particularly the leakage index,were closely linked to CI-DME pathology.These findings highlight the importance of monitoring macular vascular stability to optimize clinical management for DME patients.