[Purpose]To analyze the disease burden of malignant tumors and its changing trends in Chinese and global non-smoking female population from 1990 to 2021.[Methods]Data of mortality and disability-adjusted life year(DALY)due to malignant tumors for Chinese and global non-smoking female malignant tumors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021(GBD 2021),and the average annual percentage change(AAPC)were calculated using Joinpoint regression model.[Results]From 1990 to 2021,the number of deaths for malignant tu-mors in Chinese non-smoking female population increased from 13.7 1×104 to 26.8 1×104,with a higher increased trend compared with the global(China:AAPC=2.19％,95％CI:2.06％～2.33％;Global:AAPC=1.92％,95％CI:1.80％～2.04％,P=0.003);the age-standardized mortality rate decreased from 32.42/105 to 24.58/105,with a higher decreased trend compared with the global(China:AAPC=-0.88％,95％CI:-1.00％～-0.76％;Global:AAPC=-0.59％,95％CI:-0.68％～-0.51％,P＜0.001).From 1990 to 2021,the DALY for malignant tumors in Chinese non-smoking female population increased from 412.96×104 to 691.20×104 person-years,with a similar changing trend compared with the global(China:AAPC=1.68％,95％CI:1.56％～1.81％,Global:AAPC=1.63％,95％CI:1.52％～1.75％,P=0.536);the age-standardized DALY rate in Chinese non-smoking female population decreased from 889.58/105 to 642.65/105,with a higher decreased trend compared with the global(China:AAPC=-1.04％,95％CI:-1.15％～-0.92％;Global:AAPC=-0.69％,95％CI:-0.78％～-0.61％,P＜0.001).The top five malignant tumors of high age-standardized mor-tality rate in Chinese non-smoking female population in 2021 were tracheal,bronchus and lung cancer,colon and rectum cancer,cervical cancer,breast cancer,and liver cancer.The top five malignant tumors of high age-standardized mortality rate globally in 2021 were cervical cancer,colon and rectum cancer,breast cancer,tracheal,bronchus and lung cancer,and pancreatic cancer.The age-standardized mortality rate and DALY rate of breast cancer,liver cancer,pan-creatic cancer and corpus cancer showed overall upward trends(all P＜0.05).[Conclusion]From 1990 to 2021,the number of deaths and DALY of malignant tumors in Chinese and global non-smoking female population showed overall increased trends,and age-standardized mortality rate and DALY rate showed overall decreased trends.In future,more targeted cancer prevention measures are needed to reduce the disease burden of malignant tumors in non-smoking female population.

Objective:To observe the effect of different exercise methods on the prevention and treatment of senile sarcopenia.Methods:A cross-sectional investigation was carried out to select the elderly who visited the First Affiliated Hospital of Zhejiang University School of Medicine and Tongxiang Hospital of Traditional Chinese Medicine from October 2016 to December 2023 for medical check-ups at the geriatrics department and physical examination center.General information was collected, and the Hologic Discovery-Wi bone density scanner(Hologic, USA)was used to measure appendicular lean mass(ALM).Walking speed over 6 meters and grip strength were measured, and the appendicular skeletal muscle index(ASMI=limb muscle mass/height 2)was calculated.The subjects were divided into three groups aged 60-69, 70-79, and 80-89 years and the relevant information was obtained through standard questionnaires.Based on the exercise methods and time, each age group was categorized into three groups: non-exercise, aerobic exercise, and resistance exercise.Differences in related indicators of sarcopenia among the elderly in different age groups with different exercise methods were analyzed. Results:In all three age groups, the ASMI of the resistance exercise group was higher compared to the aerobic exercise and non-exercise groups: In the 60-69 years old group, (7.50±0.31)kg/m 2vs.(6.93±0.37)kg/m 2 and (6.81±0.27)kg/m 2, F=38.146, P<0.001; In the 70-79 years old group, (7.26±0.30)kg/m 2vs.(6.82±0.38)kg/m 2 and (6.50±0.36)kg/m 2, F=35.784, P<0.001; In the 80-89 years old group, (7.00±0.59)kg/m 2vs.(6.53±0.63)kg/m 2 and (5.89±0.66)kg/m 2, F=23.380, P<0.001.The resistance exercise group also had higher grip strength than the aerobic and non-exercise groups: In the 60-69 years old group, (39.23±1.78) kg vs.(26.21±4.79) kg and (24.68±3.55) kg, F=127.806, P<0.001; In the 70-79 years old group, (37.78±2.50) kg vs.(27.21±5.47) kg and (24.43±3.49) kg, F=75.265, P<0.001; In the 80-89 years old group, (28.75±4.71) kg vs.(21.37±5.57) kg and (17.08±4.50) kg, F=33.148, P<0.001; Both the resistance and aerobic exercise groups had a faster walking speed compared to the non-exercise group: 60-69 years old group (1.30±0.14) m/s and (1.31±0.15) m/s compared to (1.20±0.14) m/s, F=5.905, P=0.003; 70-79 years old group (1.26±0.13) m/s and (1.24±0.17) m/s compared to (1.16±0.16) m/s, F=4.931, P=0.009; and (1.00±0.20) m/s and (1.02±0.27) m/s over (0.84±0.24) m/s in the group of 80-89 years old, F=6.913, P=0.001.The results of two-by-two comparisons showed that among the older adults in the 70-79 and 80-89 age groups, ASMI was higher in the aerobic exercise group than in the non-exercise group ( t=0.070, 0.048, both P<0.001), and grip strength was higher in the aerobic exercise group than in the non-exercise group ( t=0.885, 0.976, P=0.002, <0.001); however, there was no difference in step speed between the resistance exercise group and the aerobic exercise group among older adults in the three age groups ( t=0.031, 0.035, 0.701, P=0.605, 0.593, 0.841). Conclusions:Compared with non-exercise and aerobic exercise, resistance exercise has a clear effect on the prevention and treatment of sarcopenia in the elderly.As age increases, aerobic exercise can also prevent and treat sarcopenia in the elderly aged 70-89 years.Both resistance exercise and aerobic exercise have obvious effect on maintaining the pace of the elderly.

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 risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures. Methods:A retrospective study was conducted to analyze the 118 patients with thoracolumbar single-segment fracture who had been treated at Department of Orthopaedic Surgery, The First Hospital Affiliated to Soochow University between January 2020 and January 2023. The patients were divided into a case group (47 cases) and a control group (71 cases) according to whether an eggshell vertebral body developed in the injured vertebra after internal fixation with posterior screw-rod system. The 2 groups were compared in terms of gender, age, follow-up time, body mass index, history of primary hypertension, history of diabetes mellitus, vertebral bone quality (VBQ) score, local Cobb angle correction, presence or absence of screwing at the injured vertebra, fracture site, fracture type, presence or absence of injury to the posterior ligamentous complex, presence or absence of injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rates of the anterior, middle, and posterior heights of the injured vertebra, and preoperative and postoperative visual analog scale (VAS) for pain. After positive indicators were screened by univariate analysis ( P<0.05), they were included in a multivariate logistic regression model and receiver operating characteristic curve (ROC) to analyze the risk factors for the formation of eggshell vertebral body after posterior screw-rod internal fixation of thoracolumbar spine fractures. Results:Of the 118 patients, 47 developed an eggshell vertebral body after surgery. Univariate analysis showed that VBQ score, presence or absence of screwing at the injured vertebra, burst fracture type, injury to the posterior ligamentous complex, injury to the upper and lower discs/endplate complex in the injured vertebrae, recovery rate of the anterior height of the injured vertebra, recovery rate of the middle height of the injured vertebra were statistically significant ( P<0.05). The multivariate logistic regression analysis and ROC curve analysis showed that a VBQ score ≥ 2.95 points( OR=6.216, 95% CI: 1.890 to 20.441, P=0.003), a recovery rate of the anterior height of the injured vertebra ≥ 25.26% ( OR=1.097, 95% CI: 1.046 to 1.149, P<0.001), a burst fracture type ( OR=6.397, 95% CI: 1.733 to 23.617, P=0.005), and injury to the upper and lower discs/endplate complex in the injured vertebrae ( OR=7.581, 95% CI: 1.827 to 31.461, P=0.005) were significantly associated with the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures ( P<0.05). Conclusion:A VBQ score ≥ 2.95 points, a recovery rate of the anterior height of the injured vertebra ≥ 25.26%, a burst fracture type, and injury to the disc/endplate complex in the injured vertebrae are the independent risk factors for the formation of eggshell vertebral body after open reduction and internal fixation with posterior screw-rod system for thoracolumbar spine fractures.

[Purpose]To analyze the disease burden of malignant tumors and its changing trends in Chinese and global non-smoking female population from 1990 to 2021.[Methods]Data of mortality and disability-adjusted life year(DALY)due to malignant tumors for Chinese and global non-smoking female malignant tumors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021(GBD 2021),and the average annual percentage change(AAPC)were calculated using Joinpoint regression model.[Results]From 1990 to 2021,the number of deaths for malignant tu-mors in Chinese non-smoking female population increased from 13.7 1×104 to 26.8 1×104,with a higher increased trend compared with the global(China:AAPC=2.19％,95％CI:2.06％～2.33％;Global:AAPC=1.92％,95％CI:1.80％～2.04％,P=0.003);the age-standardized mortality rate decreased from 32.42/105 to 24.58/105,with a higher decreased trend compared with the global(China:AAPC=-0.88％,95％CI:-1.00％～-0.76％;Global:AAPC=-0.59％,95％CI:-0.68％～-0.51％,P＜0.001).From 1990 to 2021,the DALY for malignant tumors in Chinese non-smoking female population increased from 412.96×104 to 691.20×104 person-years,with a similar changing trend compared with the global(China:AAPC=1.68％,95％CI:1.56％～1.81％,Global:AAPC=1.63％,95％CI:1.52％～1.75％,P=0.536);the age-standardized DALY rate in Chinese non-smoking female population decreased from 889.58/105 to 642.65/105,with a higher decreased trend compared with the global(China:AAPC=-1.04％,95％CI:-1.15％～-0.92％;Global:AAPC=-0.69％,95％CI:-0.78％～-0.61％,P＜0.001).The top five malignant tumors of high age-standardized mor-tality rate in Chinese non-smoking female population in 2021 were tracheal,bronchus and lung cancer,colon and rectum cancer,cervical cancer,breast cancer,and liver cancer.The top five malignant tumors of high age-standardized mortality rate globally in 2021 were cervical cancer,colon and rectum cancer,breast cancer,tracheal,bronchus and lung cancer,and pancreatic cancer.The age-standardized mortality rate and DALY rate of breast cancer,liver cancer,pan-creatic cancer and corpus cancer showed overall upward trends(all P＜0.05).[Conclusion]From 1990 to 2021,the number of deaths and DALY of malignant tumors in Chinese and global non-smoking female population showed overall increased trends,and age-standardized mortality rate and DALY rate showed overall decreased trends.In future,more targeted cancer prevention measures are needed to reduce the disease burden of malignant tumors in non-smoking female population.

Objective: To examine the relationship between self-management behaviors and time perspective among patients with comorbid diabetes, so as to provide the evidence for improving self-management behaviors among patients with comorbid diabetes. Methods: The patients with comorbid diabetes who were registered in the chronic disease health management system of Minhang District, Shanghai Municipality in 2021, followed up regularly, and lived in Meilong Town were recruited. Demographic information and family history of diabetes were collected through questionnaire surveys. Time perspective and self-management behaviors were assessed using the Zimbardo Time Perspective Inventory and Diabetes Self-Management Behavior Scale, respectively. The relationship between self-management behaviors and time perspective was analyzed using a multivariable ordinal logistic regression model. Results: A total of 907 patients with comorbid diabetes were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged 65 years and above, accounting for 71.89%. In terms of the types of time perspective, 280 patients were future-oriented (30.87%), 236 were balanced (26.02%), 162 were sensation-seeking (17.86%), 123 were fatalistic (13.56%), and 106 were negative (11.69%). In terms of the self-management behaviors, 46 patients were good (5.07%), 643 were moderate (70.89%), and 218 were poor (24.04%). Multivariable ordinal logistic regression analysis showed that after adjusting for age, gender, educational level, marital status, occupation status, monthly income, and family history of diabetes, the patients with comorbid diabetes who had a future-oriented time perspective had better self-management behaviors (OR=1.874, 95%CI: 1.204-2.915). Conclusion The self-management behaviors among patients with comorbid diabetes are moderate to poor, and patients with a future-oriented time perspective can better engage in self-management behaviors.

Objective: To investigate the trajectories of fasting blood glucose fluctuations and their influencing factors among patients with comorbidity of type 2 diabetes mellitus (T2DM), so as to provide the basis for strengthening blood glucose management in this population. Methods: In October 2023, data of patients diagnosed with comorbid T2DM from January to October 2021, including demographic information, lifestyle, health status and fasting blood glucose were collected through the chronic disease health management system of Minhang District, Shanghai Municipality. Fasting blood glucose fluctuation trajectories were analyzed by group-based trajectory model established based on fasting blood glucose values from January 2021 to October 2023. Influencing factors of fasting blood glucose fluctuation trajectories among patients with comorbidity of T2DM were analyzed using a multinomial logistic regression model. Results: A total of 907 patients with comorbidity of T2DM were enrolled, including 472 males (52.04%) and 435 females (47.96%). There were 652 cases aged ≥65 years, accounting for 71.89%. The group-based trajectory model analysis identified three trajectory groups: a low-level stable group (492 cases, 54.24%), a medium-level stable group (287 cases, 31.64%), and a high-level decreasing group (128 cases, 14.11%). Multinomial logistic regression analysis showed that, compared with the low-level stable group, patients with comorbidity of T2DM who had an education level of junior high school or below (OR=1.420, 95%CI: 1.011-1.995) or college degree or above (OR=2.109, 95%CI: 1.249-3.560), as well as those who engaged in regular exercise (OR=1.387, 95%CI: 1.017-1.893), were more likely to be in the medium-level stable group. Patients with comorbidity of T2DM who were overweight or obese (OR=1.675, 95%CI: 1.116-2.513) or had dyslipidemia (OR=3.195, 95%CI: 1.642-6.216) were more likely to be in the high-level decreasing group. Conclusions From January 2021 to October 2023, the fasting blood glucose levels of patients with comorbidity of T2DM exhibited three fluctuating trajectories: low-level stability, medium-level stability, and high-level decline. Compared with the low-level stable group, the medium-level stable group was mainly influenced by educational level and regular exercise. The high-level decline group was primarily affected by overweight/obesity and dyslipidemia.

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.

Objective:To observe the effect of different exercise methods on the prevention and treatment of senile sarcopenia.Methods:A cross-sectional investigation was carried out to select the elderly who visited the First Affiliated Hospital of Zhejiang University School of Medicine and Tongxiang Hospital of Traditional Chinese Medicine from October 2016 to December 2023 for medical check-ups at the geriatrics department and physical examination center.General information was collected, and the Hologic Discovery-Wi bone density scanner(Hologic, USA)was used to measure appendicular lean mass(ALM).Walking speed over 6 meters and grip strength were measured, and the appendicular skeletal muscle index(ASMI=limb muscle mass/height 2)was calculated.The subjects were divided into three groups aged 60-69, 70-79, and 80-89 years and the relevant information was obtained through standard questionnaires.Based on the exercise methods and time, each age group was categorized into three groups: non-exercise, aerobic exercise, and resistance exercise.Differences in related indicators of sarcopenia among the elderly in different age groups with different exercise methods were analyzed. Results:In all three age groups, the ASMI of the resistance exercise group was higher compared to the aerobic exercise and non-exercise groups: In the 60-69 years old group, (7.50±0.31)kg/m 2vs.(6.93±0.37)kg/m 2 and (6.81±0.27)kg/m 2, F=38.146, P<0.001; In the 70-79 years old group, (7.26±0.30)kg/m 2vs.(6.82±0.38)kg/m 2 and (6.50±0.36)kg/m 2, F=35.784, P<0.001; In the 80-89 years old group, (7.00±0.59)kg/m 2vs.(6.53±0.63)kg/m 2 and (5.89±0.66)kg/m 2, F=23.380, P<0.001.The resistance exercise group also had higher grip strength than the aerobic and non-exercise groups: In the 60-69 years old group, (39.23±1.78) kg vs.(26.21±4.79) kg and (24.68±3.55) kg, F=127.806, P<0.001; In the 70-79 years old group, (37.78±2.50) kg vs.(27.21±5.47) kg and (24.43±3.49) kg, F=75.265, P<0.001; In the 80-89 years old group, (28.75±4.71) kg vs.(21.37±5.57) kg and (17.08±4.50) kg, F=33.148, P<0.001; Both the resistance and aerobic exercise groups had a faster walking speed compared to the non-exercise group: 60-69 years old group (1.30±0.14) m/s and (1.31±0.15) m/s compared to (1.20±0.14) m/s, F=5.905, P=0.003; 70-79 years old group (1.26±0.13) m/s and (1.24±0.17) m/s compared to (1.16±0.16) m/s, F=4.931, P=0.009; and (1.00±0.20) m/s and (1.02±0.27) m/s over (0.84±0.24) m/s in the group of 80-89 years old, F=6.913, P=0.001.The results of two-by-two comparisons showed that among the older adults in the 70-79 and 80-89 age groups, ASMI was higher in the aerobic exercise group than in the non-exercise group ( t=0.070, 0.048, both P<0.001), and grip strength was higher in the aerobic exercise group than in the non-exercise group ( t=0.885, 0.976, P=0.002, <0.001); however, there was no difference in step speed between the resistance exercise group and the aerobic exercise group among older adults in the three age groups ( t=0.031, 0.035, 0.701, P=0.605, 0.593, 0.841). Conclusions:Compared with non-exercise and aerobic exercise, resistance exercise has a clear effect on the prevention and treatment of sarcopenia in the elderly.As age increases, aerobic exercise can also prevent and treat sarcopenia in the elderly aged 70-89 years.Both resistance exercise and aerobic exercise have obvious effect on maintaining the pace of the elderly.