Glioma is difficult to treat due to the unique tumor microenvironment and blood-brain barrier. (13aS)-3-Hydroxyl-6,7-dimethoxyphenanthro[9,10-b] indolizidine (PF403), a phenanthroindolizidine alkaloid, has been identified as a promising therapeutic agent for the treatment of glioma. However, the anti-glioma mechanism of PF403 in vivo has not been conclusively verified and must be further elucidated. Hence, a strategy without chemical modification was applied to identify the target of PF403. In this study, we identified nicotinamide phosphoribosyl transferase (NAMPT) as the target of PF403 by using thermal proteome profiling (TPP). Moreover, microscale thermophoresis (MST), surface plasmon resonance (SPR), and isothermal titration calorimetry (ITC) experiments confirmed that NAMPT exhibits good affinity for PF403. Direct and indirect enzyme activity assays revealed that PF403 inhibited the catalytic activity of NAMPT, leading to a decrease in the concentration of nicotinamide adenine dinucleotide (NAD⁺) in U87 cells. X-ray diffraction and amino acid spot mutation experiments revealed that PF403 primarily relies on the formation of pi-pi interactions with residue Tyr188 to maintain binding with NAMPT (PDB code 8Y55). After NAMPT was knocked down with lentivirus, PF403 lost or partially lost its antitumor activity at the cellular and animal levels. These findings suggest that PF403 exerts antitumor activity by directly targeting NAMPT.

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.

The incidence of tumors among the elderly is notably high, presenting significant challenges in terms of harm, complexity, and treatment.The processes of diagnosis and treatment often lack a precise clinical foundation and robust experimental evidence, resulting in numerous difficulties and dilemmas.A collaborative approach that integrates traditional Chinese and Western medicine, leveraging the strengths of both, can substantially alleviate these challenges and ensure that elderly cancer patients can undergo systematic, comprehensive, and intensive cancer treatments.Traditional Chinese medicine can play a vital role throughout the entire continuum of diagnosis and treatment for elderly cancer patients, whether by leading, assisting, or complementing other treatment modalities.This article employs the concepts of ′righteousness′and ′evil′from traditional Chinese medicine, where ′righteousness′signifies the ′state of a person′and ′evil ′denotes the ′state of a tumor′.We systematically explore collaborative diagnosis and treatment strategies that integrate traditional Chinese and Western medicine for tumor management in the elderly, categorizing the approaches into four conditions: strong righteousness with strong evil, strong righteousness with weak evil, weak righteousness with strong evil, and weak righteousness with weak evil.In cases where both righteousness and evil are strong, the treatment strategy is primarily dominated by Western medicine, with support from traditional Chinese medicine.Conversely, when righteousness is strong and evil is weak, the strategy entails a combination of both Chinese and Western medicine.In situations characterized by weak righteousness and strong evil, the treatment approach is largely guided by traditional Chinese medicine, while also considering equal attention to both modalities.Finally, when both righteousness and evil are weak, the coordinated diagnosis and treatment strategy is primarily based on Chinese medicine, with Western medicine adapting to the circumstances and intervening appropriately throughout the process.By accurately assessing the concepts of ′righteousness′and ′evil′and implementing collaborative diagnostic and treatment strategies that integrate both traditional Chinese and Western medicine, we can significantly enhance the physical condition of elderly cancer patients.This comprehensive approach not only boosts immunity and improves organ function but also increases tolerance to tumor treatments, alleviates complications, reduces adverse reactions, and ensures that elderly cancer patients can undergo systemic cancer treatment to its fullest extent.Ultimately, this strategy aims to improve prognosis, enhance quality of life, and extend the effective survival period.

BACKGROUND:With the aging of the population,the incidence of osteoporosis is increasing year by year,and osteoporotic spinal fracture,as one of the common complications,brings great pain and inconvenience to patients.As an effective treatment,percutaneous vertebroplasty has been widely used in clinical practice.However,cement leakage as a potential risk of this procedure has been the focus of researchers.OBJECTIVE:To investigate the causes and management strategies of cement leakage after percutaneous vertebroplasty for osteoporotic vertebral compression fractures.METHODS:A total of 100 osteoporotic vertebral compression fractures patients who underwent percutaneous vertebroplasty in the Department of Orthopedics of Beijing Pinggu District Hospital from March 2017 to February 2021 were selected as the study subjects.According to the 12-month follow-up results,the patients were divided into bone cement leakage group(n=27)and non-bone cement leakage group(n=73).Cox proportional risk regression analysis was used to screen the influencing factors of bone cement leakage after surgery,so as to construct and evaluate the nomogram model for predicting the risk of bone cement leakage after surgery.Visual analog scale score and Oswesry dysfunction index of 27 patients were observed before surgery,3 days and 12 months after surgery following bone cement leakage treatment.RESULTS AND CONCLUSION:(1)Among the 27 patients with bone cement leakage,24 patients had internal leakage of intervertebral disc endplate,no obvious symptoms or discomfort,and no special treatment.Pulmonary embolism occurred in 1 case,and the patient was treated with the help of respiratory department.Two patients with symptoms underwent percutaneous intervertebral foramen endoscopic bone cement removal.(2)CT value,fracture severity,bone cement viscosity,cortical fracture,and injection amount of bone cement were the independent influencing factors for postoperative bone cement leakage(P<0.05).(3)The calibration degree and differentiation degree of the nomogram model were good,and it had good clinical practicability.(4)For 27 patients with external bone cement leakage after surgery,visual analog scale score at 3 days and 12 months after surgery was significantly lower than that before surgery,and the difference was statistically significant(P<0.05).Oswesry dysfunction index score at 12 months after surgery was significantly lower than that at 3 days after surgery,and the difference was statistically significant(P<0.05).(5)The results show that the amount of bone cement injection,bone cement viscosity,cortical fracture,CT value,and fracture severity are the risk factors of bone cement leakage after percutaneous vertebroplasty.

Objective To study the clinical value of stroboscopic laryngoscope combined with narrow band imaging endoscope in the diagnosis of benign and malignant glottic lesions.Methods A total of 60 patients(84 sides of vocal cord)who visited our department from June 2022 to January 2023 with hoarseness as the main complaint and were found to have glottic lesions by electronic nasopharyngoscopy were selected.In all 60 patients with 84 sides of vocal cord degenerative lesions,stroboscopic laryngoscopy and narrow band imaging(NBI)endoscopy were com-pleted.The examination results were evaluated and graded separately.The same operative group performed the re-section biopsy of vocal cord lesions under general anesthesia and laryngoscope respectively,and the pathological re-sults were used as the diagnostic gold standard.With sensitivity,specificity,accuracy,false negative rate,and false positive rate as the main evaluation indexes,the differences in diagnostic accuracy between single test technique and combined application of the two techniques were analyzed.Results Pathological results showed squamous cell carci-noma on 18 sides,carcinoma in situ on 4 sides,severe dysplasia on 4 sides,mild and moderate dysplasia on 13 sides,and papilloma,chronic,mucosal,nflammation,hyperplasia,hypokeratosis,hyperkeratosis on 45 sides.The sensitivity of strobe laryngoscopy detection was 53.06％and specificity was 60.34％.The sensitivity of NBI endo-scopic detection was 88.46％,and the specificity was 89.66％.The sensitivity of strobe laryngoscopy combined with NBI endoscopy was 96.15％,and the specificity was 94.83％.The areas under the ROC curve of strobe laryn-goscopy,NBI endoscopy and white light imaging combined with narrowband imaging were 0.888(95％CI:0.820～0.957),0.943(95％CI:0.885～1),0.970(95％CI:0.942～0.999),respectively.The area under the curve of the combined method was higher than that of the single method,and the difference was statistically significant(P＜0.05).Conclusion Stroboscopic laryngoscope combined with NBI endoscope can improve the diagnostic accuracy of benign and malignant glottic lesions.

Objective To evaluate the therapeutic effects of different intracranial pressure lower-ing regimens in patients with acute large-area cerebral infarction based on electrical impedance tomo-graphy(EIT)technology.Methods A total of 75 patients with acute large-area cerebral infarction were selected as the study subjects and randomly divided into study group(n=40,using mannitol combined with albumin to decrease intracranial pressure)and control group(n=35,using mannitol alone to decrease intracranial pressure).EIT technology was used to continuously monitor the changes in intracranial pressure within 48 hours in the patients.Clinical data of the two groups were collected,and the 24-hour intracranial pressure change rate,48-hour intracranial pressure change rate,ICU stay duration,hospitalization duration,antibiotic use duration,and National Institutes of Health Stroke Scale(NIHSS)score at discharge were observed and compared between the two groups.A 90-day sur-vival follow-up was also conducted.Results There was no statistically significant difference in the 24-hour intracranial pressure change rate between the two groups(P＞0.05).The 48-hour intracrani-al pressure change rate in the study group was higher than that in the control group,and the difference was statistically significant(P＜0.05).The ICU stay duration,hospitalization duration,and antibiotic use duration in the study group were all shorter than those in the control group,and the NIHSS score at discharge in the study group was lower than that in the control group,with statistically significant differences(P＜0.05).The follow-up results showed that the survival duration in the study group was longer than that in the control group,and the 90-day cumulative survival rate in the study group was higher than that in the control group,but the differences were not statistically significant(P＞0.05).The modified Rankin Scale score in the study group was lower than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion Compared with the use of mannitol alone,early use of mannitol combined with albumin can effectively decrease the in-tracranial pressure within 48 hours,shorten the hospitalization duration,and improve neurological function in patients with acute large-area cerebral infarction.

Diffuse pediatric-type high-grade glioma (pHGG), H3- and isocitrate dehydrogenase (IDH)-wild-type, is a World Health Organization (WHO) grade 4 diffuse glioma with malignant histological features, which typically affects in children and adolescents. This multidisciplinary treatment case involves a 24-year-old young female patient initially diagnosed via biopsy. After concurrent chemoradiotherapy reduced the tumor size, complete resection was achieved, followed by adjuvant therapy with temozolomide and regorafenib. After recurrence, the tumor was resected again, and a second course of radiotherapy was administered, but the disease ultimately progressed rapidly, with an overall survival exceeding 32 months. pHGGs are highly malignant, aggressive, and associated with poor prognosis. Accurate diagnosis and targeted intervention require close collaboration among a multidisciplinary team, which highlights the critical value of multidisciplinary manage-ment in clinical practice.

Ischemic stroke is one of the leading causes of mortality and disability,and it particularly inflicts brain damage through various mechanisms.However,there is a significant gap in the availability of specific drugs for the treatment of ischemic stroke.Numerous studies have demonstrated that exercise preconditioning can provide protective ef-fects against ischemic stroke through complex mechanisms.In this review,we aim to summarize the amount of exercise re-quired to induce exercise preconditioning and its potential mechanisms for improving outcomes in ischemic stroke.The fol-lowing benefits of exercise preconditioning have been identified in relation to ischemic stroke:(1)reduction of cerebral edema and infarct size,while promoting angiogenesis;(2)preservation of the integrity of the blood-brain barrier,reduc-tion of apoptosis,and mitigation of neurological damage;(3)inhibition of glutamate overactivation,alleviation of oxida-tive stress,and improvement of the inflammatory response.Ultimately,exercise preconditioning mitigates the damage caused by ischemic stroke through these pathways.

Objective:To investigate the efficacy and safety of lenvatinib plus drug-eluting bead transarterial chemoembolization (DEB-TACE) and FOLFOX-based hepatic arterial infusion chemotherapy (Len+DEB-TACE+HAIC) versus lenvatinib plus DEB-TACE (Len+DEB-TACE) for hepatocellular carcinoma (HCC) larger than 7 cm with portal vein tumor thrombosis (PVTT).Methods:The data from patients diagnosed with HCC (>7 cm) and PVTT who received either Len+DEB-TACE+HAIC ( n=99) or Len+DEB-TACE ( n=102) between July 2019 and June 2021 at six institutions in China were collected and retrospectively analyzed. Tumor responses were evaluated based on modified Response Evaluation Criteria in Solid Tumors. Objective response rate (ORR), disease control rate (DCR), time to progression (TTP), overall survival (OS), and treatment-related adverse event (TRAE) were compared between the two groups by propensity score matching. Subgroup analyses were performed for TTP and OS. Results:After propensity score matching, 83 pairs of patients were included in the study cohorts. The ORR for the Len+DEB-TACE+HAIC group and the Len+DEB-TACE group was 66.3% and 38.6% ( χ2=12.78, P<0.001), respectively. The DCR for the Len+DEB-TACE+HAIC group and the Len+DEB-TACE group was 91.6% and 79.5% ( χ2=4.87, P=0.027), respectively. The median TTP and median OS for the Len+DEB-TACE+HAIC group were significantly longer than those for the Len+DEB-TACE group (TTP, 10.1 months vs. 6.1 months, χ2=35.28, P<0.001; OS, 17.3 months vs. 12.9 months, χ2=16.84, P<0.001). The incidence of ≥grade 3 TRAEs was 38.6% in the Len+DEB-TACE+HAIC group and 33.7% in the Len+DEB-TACE group ( χ2=0.42, P=0.518). Conclusion:Compared with Len+DEB-TACE, Len+DEB-TACE+HAIC led to improved tumor response, TTP and OS with an acceptable safety profile in patients with large HCC and PVTT.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.