Objective:To analyze the mediating effect of the inflammation on the sex differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Methods:This cross-sectional study consecutively collected data from 757 middle-aged and elderly individuals receiving health checkups at Beijing Tiantan Hospital, Capital Medical University between January 1, 2023 and December 31, 2023. The gender, age, body mass index (BMI), waist to hip ratio (WHR), educational years, medical history and personal history were collected. The Montreal Cognitive Assessment (MoCA) were performed to assess the cognitive function. Inflammation indicators included the single blood inflammatory markers [white blood cell (WBC), high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and erythrocyte sedimentation rate (ESR)], inflammatory markers derived from blood cell counts, including neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI); and inflammatory markers derived from blood cell counts and high-density lipoprotein cholesterol (HDL-C), including neutrophil to HDL-C ratio (NHR), monocyte to HDL-C ratio (MHR), lymphocyte to HDL-C ratio (LHR), and platelet to HDL-C ratio (PHR) were all recorded. The simple mediation effect model in the SPSS 29.0 PROCESS macro was used to analyze the mediation effects of the inflammation indicators on the gender differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Results:Among the 757 health checkup population in the final analysis, 466 were male (61.56%), and 291 were female (38.44%), with a mean age of (54.24±8.42) years. The male had higher BMI, WHR, educational years, frequency of hypertension and diabetes mellitus, MoCA scores, and inflammation indicators, including hs-CRP, WBC, NLR, MLR, NMLR, SIRI, AISI, NHR, MHR, LHR and PHR than those in the female [(26.41±3.20) vs (24.32±3.06) kg/m 2, (0.93±0.05) vs (0.83±0.06), 12 (9, 16) vs 11 (8, 15) years, 37.77% vs 21.31%, 16.52% vs 8.93%, 26 (24, 28) vs 26 (22, 28) points, 0.81 (0.38, 1.61) vs 0.63 (0.27, 1.63) mg/L, 5.75 (4.96, 6.78) vs 5.08 (4.27, 6.05)×10 9/L, 2.06 (1.67, 2.64) vs 1.87 (1.50, 2.37), 0.21 (0.17, 0.25) vs 0.17 (0.13, 0.21), 2.26 (1.84, 2.88) vs 2.02 (1.68, 2.55), 0.71 (0.51, 1.01) vs 0.49 (0.35, 0.67), 153.43 (108.91, 220.63) vs 113.34 (78.06, 164.27), 0.16 (0.12, 0.20) vs 0.11 (0.08, 0.14), 0.02 (0.01, 0.02) vs 0.01 (0.01, 0.01), 0.08 (0.06, 0.01) vs 0.06 (0.04, 0.07), 9.33 (7.82, 11.33) vs 8.36 (6.37, 10.21)] (all P<0.05). ESR and dNLR levels in the male were both lower than those in the female [6 (2, 11) vs 11 (6, 18) mm/h, 0.87 (0.85, 0.89) vs 0.89 (0.87, 0.91)] (both P<0.05). The MoCA score was negatively correlated with age, WHR, hs-CRP, IL-6, NLR, dNLR, NMLR, SIRI, NHR ( r=-0.355, -0.103, -0.115, -0.085, -0.094, -0.078, -0.093, -0.074, -0.108), and positively correlated with educational years ( r=0.512) (all P<0.05). After adjustment for confounding factors, including age, BMI, WHR, educational years, hypertension, and diabetes mellitus, dNLR and NHR mediated 13.11% and 12.80% association between gender and MoCA scores, respectively; after adjustment for above-mentioned confounders adding hs-CRP and IL-6, dNLR mediated 13.07% association between gender and MoCA score (all P<0.05), whereas no significant mediating effect was found of NHR on this association. Conclusions:Inflammation performed potential mediating effect on the association between sex difference and cognitive function among middle-to-old aged health checkup population, and the sex difference in cognitive function was partly mediated by the dNLR and NHR.

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.

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 mediating effect of the inflammation on the sex differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Methods:This cross-sectional study consecutively collected data from 757 middle-aged and elderly individuals receiving health checkups at Beijing Tiantan Hospital, Capital Medical University between January 1, 2023 and December 31, 2023. The gender, age, body mass index (BMI), waist to hip ratio (WHR), educational years, medical history and personal history were collected. The Montreal Cognitive Assessment (MoCA) were performed to assess the cognitive function. Inflammation indicators included the single blood inflammatory markers [white blood cell (WBC), high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and erythrocyte sedimentation rate (ESR)], inflammatory markers derived from blood cell counts, including neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI); and inflammatory markers derived from blood cell counts and high-density lipoprotein cholesterol (HDL-C), including neutrophil to HDL-C ratio (NHR), monocyte to HDL-C ratio (MHR), lymphocyte to HDL-C ratio (LHR), and platelet to HDL-C ratio (PHR) were all recorded. The simple mediation effect model in the SPSS 29.0 PROCESS macro was used to analyze the mediation effects of the inflammation indicators on the gender differences in cognitive function among middle-aged and elderly individuals receiving health checkups.Results:Among the 757 health checkup population in the final analysis, 466 were male (61.56%), and 291 were female (38.44%), with a mean age of (54.24±8.42) years. The male had higher BMI, WHR, educational years, frequency of hypertension and diabetes mellitus, MoCA scores, and inflammation indicators, including hs-CRP, WBC, NLR, MLR, NMLR, SIRI, AISI, NHR, MHR, LHR and PHR than those in the female [(26.41±3.20) vs (24.32±3.06) kg/m 2, (0.93±0.05) vs (0.83±0.06), 12 (9, 16) vs 11 (8, 15) years, 37.77% vs 21.31%, 16.52% vs 8.93%, 26 (24, 28) vs 26 (22, 28) points, 0.81 (0.38, 1.61) vs 0.63 (0.27, 1.63) mg/L, 5.75 (4.96, 6.78) vs 5.08 (4.27, 6.05)×10 9/L, 2.06 (1.67, 2.64) vs 1.87 (1.50, 2.37), 0.21 (0.17, 0.25) vs 0.17 (0.13, 0.21), 2.26 (1.84, 2.88) vs 2.02 (1.68, 2.55), 0.71 (0.51, 1.01) vs 0.49 (0.35, 0.67), 153.43 (108.91, 220.63) vs 113.34 (78.06, 164.27), 0.16 (0.12, 0.20) vs 0.11 (0.08, 0.14), 0.02 (0.01, 0.02) vs 0.01 (0.01, 0.01), 0.08 (0.06, 0.01) vs 0.06 (0.04, 0.07), 9.33 (7.82, 11.33) vs 8.36 (6.37, 10.21)] (all P<0.05). ESR and dNLR levels in the male were both lower than those in the female [6 (2, 11) vs 11 (6, 18) mm/h, 0.87 (0.85, 0.89) vs 0.89 (0.87, 0.91)] (both P<0.05). The MoCA score was negatively correlated with age, WHR, hs-CRP, IL-6, NLR, dNLR, NMLR, SIRI, NHR ( r=-0.355, -0.103, -0.115, -0.085, -0.094, -0.078, -0.093, -0.074, -0.108), and positively correlated with educational years ( r=0.512) (all P<0.05). After adjustment for confounding factors, including age, BMI, WHR, educational years, hypertension, and diabetes mellitus, dNLR and NHR mediated 13.11% and 12.80% association between gender and MoCA scores, respectively; after adjustment for above-mentioned confounders adding hs-CRP and IL-6, dNLR mediated 13.07% association between gender and MoCA score (all P<0.05), whereas no significant mediating effect was found of NHR on this association. Conclusions:Inflammation performed potential mediating effect on the association between sex difference and cognitive function among middle-to-old aged health checkup population, and the sex difference in cognitive function was partly mediated by the dNLR and NHR.

The incidence of gastrointestinal malignancies is high in the population, and 40%?80% of gastrointestinal tumor patients suffer from malnutrition. The metabolic mechanism of tumor disease itself, and the perioperative stress reaction caused by surgical treatment can further aggravate malnutrition. Therefore, nutritional support should be routinely provided during the perioperative period in tumor patients with nutritional risk or malnutrition. For a long time, immunonutrients such as glutamine, ω-3 fatty acids, arginine and nucleotides have attracted much attention in the treatment of perioperative tumor patients. Most studies have shown that perioperative immunonutrition therapy not only improve nutritional deficiency and correct malnutrition, but also maintain immune function, reduce inflammation and maintain intestinal barrier integrity, to reduce postopera-tive complications and short postoperative duration of hospital stay. However, with the extensive clinical application and in-depth study of immunonutrition in recent years, there are still many doubts and controversies about its application in the perioperative gastrointestinal malignancies. The authors review the pharmacological mechanism and clinical application of perioperative immunonutrients, perioperative combined application of immunonutrients, and application timing and approach of immunonutrition in patients with gastrointestinal malignancies, so as to provide some clues for its subsequent clinical application.

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.