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.

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 investigate the efficacy of arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon in the treatment of irreparable massive rotator cuff tears (IMRCT).Methods:A retrospective case series study was performed on 11 IMRCT patients who were admitted to Affiliated Fuyang Hospital of Bengbu Medical University (Fuyang People′s Hospital) from May 2020 to June 2022, including 7 males and 4 females, aged 54-74 years [(62.6±7.3)years]. All the patients were treated with arthroscopic superior capsular reconstruction using composite patch graft combined with tenodesis of the long head of the biceps tendon. The Visual Analogue Scale (VAS), Acromiohumeral Distance (AHD), Constant-Murley score and University of California Los Angeles (UCLA) score and active range of motion of the shoulder joint before, at 6 months after surgery and at the last follow-up were compared. At the last follow-up, the integrity of reconstructed superior capsule and the long head of the biceps tendon was evaluated using MRI of the shoulder joint. Postoperative complications were observed.Results:All the patients were followed up for 13-39 months [16(13, 36)months]. The VAS score, AHD, Constant-Murley score, and UCLA score were 2(2, 3)points, (9.1±1.1)mm, (56.1±5.4)points, and (19.7±2.8)points respectively at 6 months after surgery, which were all significantly improved from those before surgery [6(5, 7)points, (5.1±1.2)mm, (37.9±2.2)points, and (11.8±1.2)points] ( P<0.05). The VAS score, AHD, Constant-Murley score, and UCLA score were 0(0, 1)points, (8.4±0.9)mm, (83.6±3.8)points, and (28.2±2.3)points respectively at the last follow-up, which were all significantly improved from those before surgery ( P<0.05). At the last follow-up, the VAS score or AHD were not significantly improved from those at 6 months after surgery ( P>0.05); Constant-Murley score and UCLA score were both significantly improved from those at 6 months after surgery ( P<0.05). At 6 months after surgery, shoulder active ranges of motion in forward flexion, abduction and external rotation were (134.6±13.5)°, (124.6±18.6)° and 45(40, 50)° respectively, which were all significantly improved compared with those before surgery [(63.2±36.1)°, (65.0±23.1)°, and [30(20, 40)°] ( P<0.05). At the last follow-up, shoulder active ranges of motion in forward flexion, abduction and external rotation were (144.1±12.6)°, (139.6±15.4)° and 60(45, 65)° respectively, which were all significantly improved compared with those before surgery ( P<0.05). There were no significant differences in active range of motion of the shoulder in forward flexion, abduction and external rotation between 6 months after surgery and the last follow-up ( P>0.05). At the last follow-up, MRI revealed integrity of the reconstructed superior joint capsule and the long head of the biceps tendon in 10 patients. One patient developed resorption of the greater tuberosity and 1 showed a partial tear of the supraspinatus tendon at 1 year after surgery. Conclusion:Arthroscopic superior capsular reconstruction using composite autologous patch graft combined with tenodesis of the long head of the biceps tendon can relieve shoulder pain, decrease upward displacement of the humerus head, improve the function and range of motion of the shoulder joint, and reduce complications in the treatment of IMRCT.

For wild natural medicine, unanticipated biodiversity as species or varieties with similar morphological characteristics and sympatric distribution may co-exist in a single batch of medical materials, which affects the efficacy and safety of clinical medication. DNA barcoding as an effective species identification tool is limited by its low sample throughput nature. In this study, combining DNA mini-barcode, DNA metabarcoding and species delimitation method, a novel biological sources consistency evaluation strategy was proposed, and high level of interspecific and intraspecific variations were observed and validated among 5376 Amynthas samples from 19 sampling points regarded as "Guang Dilong" and 25 batches of proprietary Chinese medicines. Besides Amynthas aspergillum as the authentic source, 8 other Molecular Operational Taxonomic Units (MOTUs) were elucidated. Significantly, even the subgroups within A. aspergillum revealed here differ significantly on chemical compositions and biological activity. Fortunately, this biodiversity could be controlled when the collection was limited to designated areas, as proved by 2796 "decoction pieces" samples. This batch biological identification method should be introduced as a novel concept regarding natural medicine quality control, and to offer guidelines for in-situ conservation and breeding bases construction of wild natural medicine.

Objective:To construct a combined diet and exercise program for puerperal women with Yin-deficiency constitution based on traditional Chinese medicine (TCM) constitution identification, and evaluate the effect of this program.Methods:This study was guided by the complex intervention development framework of the UK Research Council, and based on the TCM constitution identification, and determined the combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification through literature review, case analysis, group discussion, and Delphi method. From October to December 2022, convenience sampling was used to select 76 delivery women with Yin-deficiency constitution who delivered at Shenzhen Hospital of Southern Medical University as the research subject. According to the delivery time, the delivery women were divided into a control group ( n=37) and an experimental group ( n=39). The control group adopted routine postpartum nursing. On this basis, the experimental group implemented the combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification. We compared the Yin-deficiency constitution score, duration of lochia, and incidence of puerperium complications between two groups of delivery women before and after intervention. Results:The final constructed program included 6 primary indicators, 20 secondary indicators, and 50 tertiary indicators. In the two rounds of consultation, the positivity coefficients of experts were all 100%, the authority coefficients of experts were 0.827 and 0.843, and the Kendall harmony coefficients were 0.419 and 0.502, respectively with a statistical difference ( P<0.01). After intervention, the score of Yin-deficiency constitution, duration of lochia, and incidence of puerperium complications in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification is scientific, comprehensive, and feasible, which can provide reference for future development of TCM constitution management during the puerperium.

Objective:To evaluate the effects of different doses of ulinastatin on lung function in patients undergoing total aortic arch replacement.Methods:One hundred and thirty five patients with acute Stanford type A aortic dissection of both sexes, aged 20-70 yr, with body mass index of 16.2-33.3 kg/m 2, of American Society of Anesthesiologist physical status Ⅳ, were divided into 3 groups ( n=45 each) using a random number table method: high-dose ulinastatin group (group H with total dose of 30 000 U/kg), low-dose ulinastatin group (group L with total dose of 20 000 U/kg) and control group (group C). In group H and group L, half of the total dose of ulinastatin was given after induction of anesthesia, the rest of the total dose was primed after being added to cardiopulmonary bypass (CPB) circuit, while normal saline 100 ml was given at the same time point in group C. After induction of anesthesia (T 0), and at 3, 6, 12, 24 and 48 h after the beginning of CPB (T 1-5), blood samples from the central vein were collected for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The oxygenation index (OI) and alveolar-arterial partial pressure of oxygen difference (P A-aO 2) at T 0 and T 2-T 5, intraoperative blood loss and blood transfusion, postoperative mechanical ventilation time, length of intensive care unit (ICU) stay and the incidence of complications within 30 days after surgery were collected. Results:Compared with group C, the plasma concentrations of TNF-α and IL-6 were significantly at T 1-T 5, OI was increased, and P A-aO 2 was decreased at T 2, 3 in H and L groups ( P<0.05). There was no significant difference in the mechanical ventilation time, length of ICU stay and incidence of complications within 30 days after surgery among the 3 groups ( P>0.05). Conclusion:Ulinastatin can inhibit inflammatory responses and improve lung function in patients undergoing total aortic arch replacement, but it has no value for clinical outcomes.

Objective: To evaluate the effect of autologous platelet-rich plasma (aPRP) on postoperative outcomes in the patients undergoing Sun′s procedure. Methods: One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes, aged 18-64 yr, with body mass index of 19-34 kg/m², of American Society of Anesthesiologist physical status Ⅳ, were divided into aPRP group (group A) and control group (group C) by a random number table method, with 58 cases in each group.After anesthesia induction and intubation, aPRP preparation was completed before surgery in group A, and surgery began in group C. After heparin neutralization, group A received retransfusion of platelet-rich plasma, while group C received conventional fluid management.Thromboelastography was performed on all patients, and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were recorded after anesthesia induction (T₀), immediately after completion of aPRP preparation (T₁), 3 h after heparin neutralization (T₂), and at 24 and 48 h after surgery (T_{3, 4}). The volume of postoperative chest drainage and amount of allogeneic blood products, mechanical ventilation time, lengths of intensive care unit and hospital stay, incidence of important complications and fatality rate within 30 days after surgery were also collected. Results: Compared with group C, the intraoperative amount of allogeneic blood products and blood loss were significantly reduced, α angle and MA values of thromboelastograph were larger, plasma concentrations of TNF-α and IL-6 were reduced at T_{2, 3}, postoperative chest drainage volume and allogeneic blood transfusion were reduced, the postoperative mechanical ventilation time and length of hospital stay were shortened, and the incidence of pulmonary complications was reduced in group A(P<0.05). There was no significant difference in the length of intensive care unit stay, incidence of other complications or fatality rate within 30 days after surgery between the two groups (P>0.05). Conclusion aPRP can improve postoperative outcomes in the patients undergoing Sun′s procedure.

Objective To evaluate the effect of autologous platelet-rich plasma(aPRP)on postop-erative outcomes in the patients undergoing Sun's procedure.Methods One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes,aged 18-64 yr,with body mass index of 19-34 kg/m2,of American Society of Anesthesiologist physical status Ⅳ,were divided into aPRP group(group A)and control group(group C)by a random number table method,with 58 cases in each group.After an-esthesia induction and intubation,aPRP preparation was completed before surgery in group A,and surgery began in group C.After heparin neutralization,group A received retransfusion of platelet-rich plasma,while group C received conventional fluid management.Thromboelastography was performed on all patients,and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)were recorded after anesthesia induction(T0),immediately after completion of aPRP preparation(T1),3 h after heparin neutralization(T2),and at 24 and 48 h after surgery(T3,4).The volume of post-operative chest drainage and amount of allogeneic blood products,mechanical ventilation time,lengths of intensive care unit and hospital stay,incidence of important complications and fatality rate within 30 days after surgery were also collected.Results Compared with group C,the intraoperative amount of allogeneic blood products and blood loss were significantly reduced,α angle and MA values of thromboelastograph were larger,plasma concentrations of TNF-α and IL-6 were reduced at T2,3,postoperative chest drainage volume and allogeneic blood transfusion were reduced,the postoperative mechanical ventilation time and length of hospital stay were shortened,and the incidence of pulmonary complications was reduced in group A(P＜0.05).There was no significant difference in the length of intensive care unit stay,incidence of other complications or fatality rate within 30 days after surgery between the two groups(P>0.05).Conclu-sion aPRP can improve postoperative outcomes in the patients undergoing Sun's procedure.

Objective To investigate fatigue in children with acute lymphoblastic leukemia (ALL) during chemotherapy,and influencing factors.Methods From Feburary 2014 to August 2016, 216 children with ALL,from 5 to 15 years old,treated in a Grade III,Level A children's hospital in Zhengzhou,were surveyed by Peds QLTM multidimensional fatigue scale (Chinese version) and Questionnaire on discomfort in ALL children during chemotherapy.Results During chemotherapy,total scores of fatigue in the ALL children were (31.71±16.66) ,with fatigue of the whole body (11.67±6.29),of sleeping (10.99±5.57),and of cognition (9.10±6.84);during chemotherapy,incidence of fatigue of the whole body was 90.74%,of sleeping 95.83%, and of cognition 81.94%. Main influencing factors of fatigue of the whole body were weight loss,appetite loss and lack of energy,accounting for 72.8% of fatigue variation;that of sleeping were weight loss and irritability, accounting for 51.2% of fatigue variation;and that of cognition were difficulty in concentration and oral ulcer, accounting for 44.2% of fatigue variation.Conclusions During chemotherapy,fatigue in ALL children is common and is below average level. When managing fatigue symptoms in ALL children,nurses should actively treat the symptoms,so as to reduce the level of fatigue.

Objective To observe the effect of acupuncture and massage on tiptoe in children with spastic cerebral palsy. Methods 49 children with spastic cerebral palsy were divided into treatment group (n=24) and control group (n=25) in accordance with the order of visiting. The control group accepted routine rehabilitation, and the treatment group accepted acupuncture and massage in addition. They were assessed with Composite Spasticity Scale (CSS), the angle of ankle passive dorsiflexion before and after treatment. Results The scores of CSS and the angle of ankle passive dorsiflexion improved in both groups after treatment (P<0.001), and improved more in the treatment group than in the control group (P<0.001). The rate of improvement was 95.6% in the treatment group, and 78.26% in the control group (P<0.05). Conclusion Acupuncture and massage may further improve the correcting of the tiptoe in children with spastic cerebral palsy.