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.

Objective To explore the influence of cardiac electrophysiological(EP)mode on image quality and radiation dose in performing hysterosalpingography(HSG)with digital subtraction angiography(DSA).Methods The clinical data of 97 infertility patients,who were admitted to the Jinhua Municipal People's Hospital of China from October to November of 2024,were prospectively collected.Among them,50 patients who received treatment in October of 2024 by using DSA abdominal acquisition mode were collected as the control group,and other 47 patients who received treatment in November of 2024 by using EP acquisition mode were collected as the study group.The image quality and radiation dose of the two groups were analyzed.Results The patients' image quality of both groups met the diagnostic requirements,and the diagnostic conclusions made by two physicians were consistent.No statistically significant differences in the positive rate,number of spot shot films,radiation dose of spot shot films,and continuous exposure time existed between the two groups(P＞0.05).Compared with the control group,in the study group the number of images increased by 8.3 times,the continuous exposure radiation dose was decreased by 90.0％,and the total radiation dose was decreased by 83.0％.The differences in the above indexes between the two groups were statistically significant(P＜0.05).Conclusion In performing HSG with DSA,the use of EP mode for image acquisition can meet the diagnostic requirements,besides it can effectively reduce the radiation dose while increasing the number of image frames,therefore,this technique is worthy of clinical promotion.

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.

Objective:To investigate the clinicopathological features and prognosis of patients with penile cancer.Methods:The clinical data of 362 patients with penile cancer who underwent surgery in Fudan University Shanghai Cancer Center from January 2005 to December 2020 were retrospectively analyzed. The mean age was (57.0±0.7) years. According to the clinical N stage classification, 239 patients were in N 0 stage, 57 patients in N 1 stage, 37 patients in N 2 stage, and 29 patients in N 3 stage. All these patients had no metastasis. Based on tumor size and location, 50 patients underwent extended circumcision, 283 patients underwent partial penectomy, and 29 patients underwent total penectomy. One hundred and eighty-three patients underwent inguinal lymphadenectomy and 47 patients underwent pelvic lymphadenectomy. Tumor pathology, tumor size, HPV subtype, postoperative pathological stage, overall survival (OS) and prognosis were analyzed. The Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyse the factors which could affect the survival of patients. 5-year OS rate of these patients were also calculated. Results:In the pathological T classification, 137 cases were in T 1a stage, 24 cases in T 1b stage, 51 cases in T 2 stage, 136 cases in T 3 stage, and 14 cases in T 4 stage. In the pathological N classification, 235 cases were in N 0 stage, 54 cases in N 1 stage, 31 cases in N 2 stage and 42 cases in N 3 stage. The most common tumor type was squamous cell carcinoma (300 cases, 83%), followed by verrucous carcinoma (40 cases, 11%), sarcomatoid carcinoma(7 cases), carcinoma in situ (6 cases), basal-like carcinoma (6 cases), and adenosquamous carcinoma (3 cases). The most common tumor grade was mild (160 cases, 44%), followed by moderate differentiation (130 cases, 36%), poor differentiation (46 cases, 13%), and unclear differentiation (26 cases). The tumor sizes were < 3 cm in 135 patients and ≥ 3 cm in 142 patients. The tumor size was unclear in 85 patients. 173 cases (48%) were HPV positive and 189 cases (52%) were HPV negative. The Kaplan-Meier analysis showed the 5-year OS rate of HPV-positive group was higher than that of HPV-negative group (79% vs. 72%) but no significant difference was found ( P=0.09). The 5-year OS rate of patients whose tumor ≥ 3 cm (69%) was lower than those tumor < 3 cm (85%) and significant difference could be found ( P = 0.02). The 5-year OS rate of wild and moderate and poor grade were 85%, 70% and 58%, and significant difference could be found in the three groups ( P<0.01). The 5-year OS rates of patients with stage T 1a, T 1b, T 2, T 3and T 4 were 90%, 67%, 71%, 68% and 37% respectively( P<0.01). The 5-year OS rates of patients with stage N 0, N 1, N 2, and N 3 were 91%, 62%, 57%, and 30%, respectively( P<0.01). N stage could significantly affect the prognosis. The 5-year OS rate of T 1b patients was lower than that of T 1a and T 2 stage (67% vs. 90% vs. 71%, P=0.003). Of the 24 patients with T 1b stage, 17 cases received inguinal lymphadenectomy and 7 cases not. The 5-year OS rate of T 1b who received lymphadenectomy, who not and T 2 group were 73%, 57% and 71% respectively ( P=0.22). Multivariate Cox analysis showed that N stage ( HR =4.55, 95% CI 2.64-7.85, P<0.01) and tumor grade ( HR =2.09, 95% CI 1.09-4.02, P=0.03) were independent factors which could affect the prognosis. Conclusions:N stage and tumor grade were independent factors which could affect the prognosis. The poorer the tumor grade, the worse the prognosis. Inguinal lymphadenectomy could improve the prognosis of patients with T 1b stage.

Objective:To investigate the clinicopathological features and prognosis of patients with penile cancer.Methods:The clinical data of 362 patients with penile cancer who underwent surgery in Fudan University Shanghai Cancer Center from January 2005 to December 2020 were retrospectively analyzed. The mean age was (57.0±0.7) years. According to the clinical N stage classification, 239 patients were in N 0 stage, 57 patients in N 1 stage, 37 patients in N 2 stage, and 29 patients in N 3 stage. All these patients had no metastasis. Based on tumor size and location, 50 patients underwent extended circumcision, 283 patients underwent partial penectomy, and 29 patients underwent total penectomy. One hundred and eighty-three patients underwent inguinal lymphadenectomy and 47 patients underwent pelvic lymphadenectomy. Tumor pathology, tumor size, HPV subtype, postoperative pathological stage, overall survival (OS) and prognosis were analyzed. The Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyse the factors which could affect the survival of patients. 5-year OS rate of these patients were also calculated. Results:In the pathological T classification, 137 cases were in T 1a stage, 24 cases in T 1b stage, 51 cases in T 2 stage, 136 cases in T 3 stage, and 14 cases in T 4 stage. In the pathological N classification, 235 cases were in N 0 stage, 54 cases in N 1 stage, 31 cases in N 2 stage and 42 cases in N 3 stage. The most common tumor type was squamous cell carcinoma (300 cases, 83%), followed by verrucous carcinoma (40 cases, 11%), sarcomatoid carcinoma(7 cases), carcinoma in situ (6 cases), basal-like carcinoma (6 cases), and adenosquamous carcinoma (3 cases). The most common tumor grade was mild (160 cases, 44%), followed by moderate differentiation (130 cases, 36%), poor differentiation (46 cases, 13%), and unclear differentiation (26 cases). The tumor sizes were < 3 cm in 135 patients and ≥ 3 cm in 142 patients. The tumor size was unclear in 85 patients. 173 cases (48%) were HPV positive and 189 cases (52%) were HPV negative. The Kaplan-Meier analysis showed the 5-year OS rate of HPV-positive group was higher than that of HPV-negative group (79% vs. 72%) but no significant difference was found ( P=0.09). The 5-year OS rate of patients whose tumor ≥ 3 cm (69%) was lower than those tumor < 3 cm (85%) and significant difference could be found ( P = 0.02). The 5-year OS rate of wild and moderate and poor grade were 85%, 70% and 58%, and significant difference could be found in the three groups ( P<0.01). The 5-year OS rates of patients with stage T 1a, T 1b, T 2, T 3and T 4 were 90%, 67%, 71%, 68% and 37% respectively( P<0.01). The 5-year OS rates of patients with stage N 0, N 1, N 2, and N 3 were 91%, 62%, 57%, and 30%, respectively( P<0.01). N stage could significantly affect the prognosis. The 5-year OS rate of T 1b patients was lower than that of T 1a and T 2 stage (67% vs. 90% vs. 71%, P=0.003). Of the 24 patients with T 1b stage, 17 cases received inguinal lymphadenectomy and 7 cases not. The 5-year OS rate of T 1b who received lymphadenectomy, who not and T 2 group were 73%, 57% and 71% respectively ( P=0.22). Multivariate Cox analysis showed that N stage ( HR =4.55, 95% CI 2.64-7.85, P<0.01) and tumor grade ( HR =2.09, 95% CI 1.09-4.02, P=0.03) were independent factors which could affect the prognosis. Conclusions:N stage and tumor grade were independent factors which could affect the prognosis. The poorer the tumor grade, the worse the prognosis. Inguinal lymphadenectomy could improve the prognosis of patients with T 1b stage.

Objective To investigate the characteristics of adverse drug reactions(ADRs)induced by tislelizumab and to provide reference for clinic drug safety.Methods The ADR of tislelizumab in Beijing Friendship Hospital Affiliated to Capital Medical Univeristy from July 2021 to December 2022 were retrospectively analyzed.The case reports of ADR induced by tislelizumab from January 2019 to December 2022 in PubMed,ScienceDirect,Embase,Wanfang,VIP databases were searched.Age,sex,original diseases,adverse reaction time,clinical manifestation,treatment measures and clinical outcome were analyzed.Results A total of 30 patients including 8 cases in hospital and 22 cases in literature were collected.Among these patients,male accounted for 83.33%(25/30),and the highest proportion was from patients over 60 years old(21 patients,70.00%).Most ADRs occurred in 1-2 dose cycles of medication,mainly including skin toxicity in 8 patients,digestive disease in 6 patients and kidney injury in 4 patients.After the symptomatic treatment,29 patients improved and 1 patient died.Conclusion During the medication with tislelizumab,ADRs of skin,gastrointestinal tract and renal should be vigilant,and the changes of relevant indicators should be closely monitored.

Objective:To explore clinical value of prostate target biopsy guided by multiparametric magnetic resonance imaging (mpMRI) and 68Ga-labeled prostate specific membrane antigen ligand imaging positron emission tomography/X-ray computed tomography ( 68Ga-PSMA PET/CT) image fusion. Methods:The data of 50 patients admitted to Fudan University Shanghai Cancer Center from January 2021 to February 2022 who underwent mpMRI and 68Ga-PSMA PET/CT to guide prostate biopsy were retrospectively analyzed. The median age was 70 (63-79) years, the median serum tPSA value was 8.1 (6.8-83.0) ng/ml, and the prostate volume was 45.5 (30-80) ml. 36 cases were positive by mpMRI, including PI-RADS score 3 in 5 cases, 4 score in 19 cases, 5 score in 12 cases. 32 cases were positive by 68Ga-PSMA PET/CT examination, of which 30 cases were double positive and the fusion of both imaging techniques was positive, referred to as PET/CT-MRI. The patient's mpMRI and 68Ga-PSMA PET/CT images were imported into the MIM fusion software, and the outline of the prostate and the target area were outlined respectively. When PET/CT and MRI double positive cases were biopsied, the two images were alternately fused, calibrated and locked with the real-time prostate ultrasound interface(PET/CT-MRI). Single-positive cases were guided by positive images to complete targeted biopsy, and 12-needle systematic biopsies were completed after targeted biopsy and double-negative cases. The advantages of targeted biopsy and systematic biopsy was evaluated, and the diagnostic performance (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed. Results:Among the 50 biopsy patients in this group, 31 (62%) had prostate cancer, of which 22 (44%) were CsPCa. There was no significant difference in the detection rate of prostate cancer between targeted biopsy and systematic biopsy [78.9% (30/38) and 62.0% (31/50), P=0.088], and there was no significant difference in the detection rate of CsPCa [57.9% (22/38) and 40.0% (20/50), P=0.096]. The positive rate of the biopsy needles number was significantly different [86.3% (69/80) and 19.0% (114/ 600), P<0.001]. The detection rates of prostate cancer in mpMRI positive, PET/CT positive and PET/CT-MRI positive cases were 83.3% (30/36), 90.6% (29/32) and 96.6% (29/30) respectively, the detection rates of CsPCa were 61.1% (22/36), 68.8% (22/32) and 73.3% (22/30) respectively.The sensitivity, specificity, positive predictive value and negative predictive value of mpMRI in the diagnosis of prostate cancer were 96.8%(30/31), 68.4%(13/19), 83.3%(30/36)and 92.9%(13/14), respectively.Those values in 68Ga-PSMA PET/CT were 93.5%(29/31), 84.2%(16/19), 90.6%(29/32)and 88.9%(16/18), respectively.Those values in PET/CT-MRI were 93.8%(29/31), 94.7%(18/19), 96.7%(29/30)and 90.0%(18/20), respectively. The above four indicators of mpMRI diagnosis of CsPCa were 100.0%(22/22), 50.0%(14/28), 61.1%(22/36)and 100.0%(14/14), respectively.Those indicators in 68Ga-PSMA PET/CT were 100.0%(22/22), 64.3%(18/28), 68.8%(22/32)and 100.0%(18/18), respectively.Those indicators in PET/CT-MRI was 100.0%(22/22), 71.4%(20/28), 73.2%(22/30)and 100.0%(20/20), respectively. The detection efficiency of PET/CT-MRI was better than that of mpMRI (Kappa value was 0.737, P=0.031). Conclusions:PET/CT-MRI image fusion-guided targeted prostate biopsy can effectively improve the detection efficiency of prostate cancer and clinically significant prostate cancer, and increase the positive rate.

Objective:To observe the efficacy and safety of radium-223 in metastatic castration resistant prostate cancer (mCRPC) with bone metastasis.Methods:The clinical data of 48 patients with mCRPC treated with radium-223(55 kBq/kg, once every 4 weeks, planned to use for 6 cycles)from February 2021 to May 2022 were analyzed retrospectively. All patients had symptomatic bone metastasis without visceral metastasis, which the number of bone metastasis was more than one site.They were all classified as IVb stage. The average age was 70.5 (ranging 49-90) years. The median PSA was 44.70(ranging 0.15-1 864.00) ng/ml. The median ALP was 162 (ranging 43-1 589) U/L. The median time from mCRPC diagnosis to radium-223 use was 10 (ranging 3-47) months. 9, 18 and 11 patients had received first-line, second-line and third-line treatment for mCRPC before enrollment respectively, 10 patients had received at least fourth-line treatment. 38 (79.1%), 31 (64.5%), 30 (62.5%) and 7 (14.6%) patients had used abiraterone, enzalutamide, docetaxel and olaparib before enrollment. The probability of PSA level decrease >30%, ALP level decrease >30%, symptom improvement rate, median overall survival (OS), as well as the occurrence of treatment-related adverse reactions and the reasons for withdraw treatment were analyzed.Results:The median follow-up time was 8 (ranging 1-16) months. 11 patients completed all 6 courses of treatment. The median number of completed courses was 4 (ranging 1-6). 27 patients (56.2%) received radium-223 and bone protection drugs (Bisphosphate/ Denosumab). PSA decreased by >30% was recorded in 10 patients (20.8%) and ALP decreased by >30% was recorded in 25 patients (52.1%). 23 cases (47.9%) reported bone pain relief during treatment. Among the 9 patients who had received first-line of mCRPC previously, 6 cases (66%) had relief of bone pain symptoms, and 4 cases (44%) had a decrease of PSA >30%. Among the 18 patients who had previously received second-line mCRPC treatment, 11 cases (61%) had relief of bone pain symptoms, and 4 cases (22%) had a decrease of PSA >30%. Among the 21 patients who had received third-line or more mCRPC treatment in the past, 6 (28.5%) had symptom relief, and 2 (9.5%) had PSA decrease >30%. The median overall survival (OS) was not reached, and the OS was estimated to be 12.5 months using the Kaplan-Meier method. The most common hematological adverse effects were thrombocytopenia (15 cases, 31.2%; grade 3 in 6 cases and grade 4 in 0), followed by leucopenia (11 cases, 22.9%; grade 3 in 4 cases and grade 4 in 1 case) and anemia (8 cases, 16.7%; grade 3 in 3 cases and grade 4 in 0). Non-hematological adverse reactions included fever in 1 case (2.1%), constipation in 4 cases (8.3%), nausea and vomiting in 10 cases (20.8%), diarrhea in 7 cases (14.6%), dizziness in 1 case (2.1%) and fatigue in 11 cases (22.9%). Seven cases were discontinued due to intolerable adverse reactions (median 2 courses), 14 cases were discontinued due to disease progression or death (median 2 courses), and 5 cases were discontinued due to other reasons (median 1 course).Conclusions:Radium-223 has a good performance in symptom control for mCRPC patients who have previously received first-line or second-line therapy. Due to the high incidence of hematological adverse reactions, more attention should be paid to the changes of hemogram during the treatment, and timely treatment should be carried out to improve the drug tolerance of patients.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To explore the clinical value of cryoablation technology in the treatment of patients with primary tumor recurrence after radical radiotherapy for prostate cancer.Methods:The clinical data of 21 patients with prostate cancer recurrence after radical radiotherapy in the Fudan University Affiliated Cancer Hospital from August 2017 to February 2021 was retrospectively analyzed. The average age was 73.1 (57.3-85.0) years old, and the Gleason score was 6 in 5 cases, 7 in 8 cases, and ≥8 in 8 cases. The clinical stage of the first diagnosis: 13 cases of cT 2 stage; 8 cases of cT 3 stage. The baseline PSA before radiotherapy was 35.3 (6.4-78.5) ng/ml, and the lowest PSA after radiotherapy was 1.8 ng/ml. After a median follow-up of 8 (3-12) months, all patients were detected with persistently elevated PSA. Pelvic MRI and PSMA SPECT showed that the primary prostate lesion had recurred. PSA before cryoablation was 4.1 (1.8-14.4) ng/ml. Comprehensive assessment of preoperative examination showed that the patient only had a recurrence of the primary tumor, and no lymph node or distant metastasis was seen. An argon-helium cryogenic surgical treatment system was used to place 1 to 3 cryo-needles for recurring lesions, and cryoablation was performed using two cold and hot cycles. Observation indicators include prognostic indicators such as PSA, recurrence and metastasis, and the occurrence of adverse reactions. Results:Complications after cryoablation include: 2 cases of urinary retention, 1 case of urinary tract infection, and 2 cases of urination with tissue shedding. The PSA of 11 cases decreased rapidly 2 to 3 months after operation, and dropped to the lowest median value of 0.4 (0.003 to 2.8) ng/ml. After cryoablation, the median follow-up was 18 (6-51) months. Imaging examinations in 1 case showed that the prostate still had limited diffusion or increased PSMA uptake, and 4 cases had PSA progression but no recurrence or metastasis. The median recurrence time for advanced patients was 13 (4-36) months. Larger prostate volume ( P<0.001) and higher blood PSA before ablation( P=0.021) were related to biochemical recurrence. Conclusions:Prostate cryoablation could delay the progression of the primary tumor after radical radiotherapy for prostate cancer. The incidence of complications such as urinary retention and urinary tract infection is not high, and it is generally safe and controllable.