This study investigated the regulatory potential of salidroside (SAL), a primary active compound in Rhodiola rosea L., on osteoclast differentiation by modulating the hypoxia-inducible factor 1-alpha (HIF-1a) pathway in osteoblasts. Luciferase reporter assay and chromatin immunoprecipitation (ChIP) assay were employed to validate whether the receptor activator of nuclear factor-?B ligand (RANKL) is the downstream target gene of HIF-1a in osteoblasts. The study also utilized lipopolysaccharide (LPS)-induced mouse osteolysis to examine the impact of SAL on osteolysis in vivo. Furthermore, conditioned medium (CM) from SAL-pretreated osteoblasts was used to investigate the paracrine effects on osteoclastogenesis through the HIF-1a pathway. Hypoxic condition-induced overexpression of HIF-1a upregulated RANKL levels by binding to the RANKL promoter and enhancing transcription in osteoblastic cells. In vivo, SAL significantly alleviated bone tissue hypoxia and decreased the expression of HIF-1a by downregulating the expression of RANKL, vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), and angiopoietin-like 4 (ANGPTL4). In the paracrine experiment, conditioned media from SAL-pretreated osteoblasts inhibited differentiation through the HIF-1a/RANKL, VEGF, IL-6, and ANGPTL4 pathways. RANKL emerges as the downstream target gene regulated by HIF-1a in osteoblasts. SAL significantly alleviates bone tissue hypoxia and bone loss in LPS-induced osteolysis through the HIF-1a/RANKL, VEGF, IL-6, and ANGPTL4 pathways. SAL inhibits osteoclast differentiation by regulating osteoblast paracrine secretion.
Animals ; Osteoblasts/cytology* ; Hypoxia-Inducible Factor 1, alpha Subunit/genetics* ; Glucosides/administration & dosage* ; Cell Differentiation/drug effects* ; Phenols/administration & dosage* ; Mice ; Osteoclasts/metabolism* ; RANK Ligand/genetics* ; Rhodiola/chemistry* ; Osteogenesis/drug effects* ; Signal Transduction/drug effects* ; Interleukin-6/genetics* ; Male ; RAW 264.7 Cells ; Osteolysis/genetics* ; Humans ; Mice, Inbred C57BL

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 association between serum 25-hydroxyvitamin D [25(OH)D] levels and 24-h urinary calcium excretion (24-h UCaE) and hypercalciuria in Chinese adults.Methods:This cross-sectional study was conducted from March 2022 to March 2023 in nine cities in China and included 1 239 residents. Demographic characteristics were collected through questionnaires and physical examinations, fasting blood samples were assessed for bone metabolism indicators, and 24-h urine samples were used to determine the 24-h UCaE. Multiple linear regression analysis was used to explore the relationship between serum 25(OH)D and 24-h UCaE and bone metabolism indexes. The relationship between serum 25(OH)D and hypercalciuria was analyzed using a multiple logistic regression model combined with restricted cubic spline modeling.Results:The mean participant age was (47.9±18.1) years, of which 453 (36.6%) were male. The percentages of vitamin D sufficiency, insufficiency, and deficiency were 7.6% (94/1 239), 29.0% (359/1 239), and 63.4% (786/1 239), respectively. The multiple linear regression model showed that after adjusting for the covariates the 24-h UCaE gradually increased with higher levels of 25(OH)D ( P overall <0.001, P nonlinear <0.001). The logistic regression analysis revealed that compared with the vitamin D deficient group, the OR for the prevalence of hypercalciuria in the vitamin D sufficient and vitamin D insufficient groups were 3.290 (95% CI 1.745 to 6.202) and 3.742 (95% CI 2.458 to 5.697), respectively. The results of the restricted cubic spline modeling showed a positive nonlinear relationship between 25(OH)D and the prevalence of hypercalciuria ( P overall <0.001, P nonlinear <0.001). The prevalence of hypercalciuria increased when 25(OH)D was >17.00 μg/L and peaked at 26.71 μg/L, after which there was a decreasing trend in the prevalence of hypercalciuria with increasing 25(OH)D. Conclusion:Associations between serum 25(OH)D levels and urinary calcium excretion and the prevalence of hypercalciuria were observed in the Chinese adult population.

Objective:To investigate the effect of preoperative systemic inflammatory response index (SIRI) on prognosis in patients with resectable colorectal cancer.Methods:The clinical data of 355 colorectal cancer patients underwent radical resection from January 2018 to December 2022 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. The basic information, pathological data and laboratory test results were recorded, and SIRI was calculated. The patients followed up to December 2023 or death, and the overall survival (OS) and disease-free survival (DFS) were recorded. The receiver operating characteristic (ROC) curve was drawn, the optimal critical value of SIRI in patients with colorectal cancer was determined according to the maximum Yoden index, and the patients were grouped based on this. Multivariate Cox regression analysis was used to analyze the independent risk factors of prognosis in patients with colorectal cancer. Kaplan-Meier survival curve was drawn, and the log-rank test was used for comparison.Results:ROC curve analysis result showed that the optimal critical value of SIRI was 0.99, and the area under the curve was 0.556. Among the 355 patients with colorectal cancer, SIRI<0.99 was in 229 cases (low SIRI group), and SIRI≥0.99 was in 126 cases (high SIRI group). There were no statistical difference in gender composition, age, body mass index (BMI), preoperative carcinoembryonic antigen, preoperative cancer antigen 19-9 (CA19-9), tumor location, T stage, N stage, tumor stage, degree of differentiation, tumor long diameter, lymphatic invasion, vascular invasion, operating time and intraoperative blood loss between two groups ( P>0.05). The incidence of anastomotic leakage in high SIRI group was significantly higher than that in low SIRI group: 20.6% (26/126) vs. 12.2% (28/229), and there was statistical difference ( P<0.05). The median follow-up time of 355 patients was 21.7 months. The mortality and recurrence rate in high SIRI group were significantly higher than those in low SIRI group: 28.6% (36/126) vs. 19.2% (44/229) and 13.5% (17/126) vs. 6.1% (14/229), and there were statistical differences ( P<0.05). Kaplan-Meier survival curve analysis result showed that the median OS and DFS in high SIRI group were significantly lower than those in low SIRI group (17.3 months vs. 23.3 months and 15.1 months vs. 21.9 months), and there were statistical differences ( P<0.05). Multivariate Cox regression analysis result showed that the tumor stage Ⅲ to Ⅳ, preoperative CEA>5 μg/L and SIRI>0.99 were independent risk factors of OS and DFS in patients with colorectal cancer (OS: HR = 2.447, 1.951 and 1.923; 95% CI 1.461 to 4.099, 1.266 to 3.456 and 1.003 to 2.655; P<0.05. DFS: HR = 2.982, 1.782 and 1.529; 95% CI 1.663 to 4.754, 1.147 to 2.651 and 1.198 to 2.021; P<0.05). Conclusions:The preoperative SIRI is an independent risk factor of prognosis in patients with colorectal cancer. The patients with low SIRI have longer postoperative OS and DFS. The preoperative SIRI has guiding value in the prognosis assessment and treatment selection in patients with colorectal cancer.

Objective:To investigate the effect of preoperative systemic inflammatory response index (SIRI) on prognosis in patients with resectable colorectal cancer.Methods:The clinical data of 355 colorectal cancer patients underwent radical resection from January 2018 to December 2022 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. The basic information, pathological data and laboratory test results were recorded, and SIRI was calculated. The patients followed up to December 2023 or death, and the overall survival (OS) and disease-free survival (DFS) were recorded. The receiver operating characteristic (ROC) curve was drawn, the optimal critical value of SIRI in patients with colorectal cancer was determined according to the maximum Yoden index, and the patients were grouped based on this. Multivariate Cox regression analysis was used to analyze the independent risk factors of prognosis in patients with colorectal cancer. Kaplan-Meier survival curve was drawn, and the log-rank test was used for comparison.Results:ROC curve analysis result showed that the optimal critical value of SIRI was 0.99, and the area under the curve was 0.556. Among the 355 patients with colorectal cancer, SIRI<0.99 was in 229 cases (low SIRI group), and SIRI≥0.99 was in 126 cases (high SIRI group). There were no statistical difference in gender composition, age, body mass index (BMI), preoperative carcinoembryonic antigen, preoperative cancer antigen 19-9 (CA19-9), tumor location, T stage, N stage, tumor stage, degree of differentiation, tumor long diameter, lymphatic invasion, vascular invasion, operating time and intraoperative blood loss between two groups ( P>0.05). The incidence of anastomotic leakage in high SIRI group was significantly higher than that in low SIRI group: 20.6% (26/126) vs. 12.2% (28/229), and there was statistical difference ( P<0.05). The median follow-up time of 355 patients was 21.7 months. The mortality and recurrence rate in high SIRI group were significantly higher than those in low SIRI group: 28.6% (36/126) vs. 19.2% (44/229) and 13.5% (17/126) vs. 6.1% (14/229), and there were statistical differences ( P<0.05). Kaplan-Meier survival curve analysis result showed that the median OS and DFS in high SIRI group were significantly lower than those in low SIRI group (17.3 months vs. 23.3 months and 15.1 months vs. 21.9 months), and there were statistical differences ( P<0.05). Multivariate Cox regression analysis result showed that the tumor stage Ⅲ to Ⅳ, preoperative CEA>5 μg/L and SIRI>0.99 were independent risk factors of OS and DFS in patients with colorectal cancer (OS: HR = 2.447, 1.951 and 1.923; 95% CI 1.461 to 4.099, 1.266 to 3.456 and 1.003 to 2.655; P<0.05. DFS: HR = 2.982, 1.782 and 1.529; 95% CI 1.663 to 4.754, 1.147 to 2.651 and 1.198 to 2.021; P<0.05). Conclusions:The preoperative SIRI is an independent risk factor of prognosis in patients with colorectal cancer. The patients with low SIRI have longer postoperative OS and DFS. The preoperative SIRI has guiding value in the prognosis assessment and treatment selection in patients with colorectal cancer.

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 association between serum 25-hydroxyvitamin D [25(OH)D] levels and 24-h urinary calcium excretion (24-h UCaE) and hypercalciuria in Chinese adults.Methods:This cross-sectional study was conducted from March 2022 to March 2023 in nine cities in China and included 1 239 residents. Demographic characteristics were collected through questionnaires and physical examinations, fasting blood samples were assessed for bone metabolism indicators, and 24-h urine samples were used to determine the 24-h UCaE. Multiple linear regression analysis was used to explore the relationship between serum 25(OH)D and 24-h UCaE and bone metabolism indexes. The relationship between serum 25(OH)D and hypercalciuria was analyzed using a multiple logistic regression model combined with restricted cubic spline modeling.Results:The mean participant age was (47.9±18.1) years, of which 453 (36.6%) were male. The percentages of vitamin D sufficiency, insufficiency, and deficiency were 7.6% (94/1 239), 29.0% (359/1 239), and 63.4% (786/1 239), respectively. The multiple linear regression model showed that after adjusting for the covariates the 24-h UCaE gradually increased with higher levels of 25(OH)D ( P overall <0.001, P nonlinear <0.001). The logistic regression analysis revealed that compared with the vitamin D deficient group, the OR for the prevalence of hypercalciuria in the vitamin D sufficient and vitamin D insufficient groups were 3.290 (95% CI 1.745 to 6.202) and 3.742 (95% CI 2.458 to 5.697), respectively. The results of the restricted cubic spline modeling showed a positive nonlinear relationship between 25(OH)D and the prevalence of hypercalciuria ( P overall <0.001, P nonlinear <0.001). The prevalence of hypercalciuria increased when 25(OH)D was >17.00 μg/L and peaked at 26.71 μg/L, after which there was a decreasing trend in the prevalence of hypercalciuria with increasing 25(OH)D. Conclusion:Associations between serum 25(OH)D levels and urinary calcium excretion and the prevalence of hypercalciuria were observed in the Chinese adult population.

Objective:To evaluate the current status of alpha-fetoprotein (AFP) detection, a comparability analysis was conducted on the results measured by eight automated immunoassay systems, incorporating external quality assessment (EQA) data from the Beijing Center for Clinical Laboratories (BCCL) for the years 2020, 2021, and 2023.Methods:Methodological evaluation. Abbott Architect i2000, Beckman DxI 800, Roche Cobas E601, Diasorin Liaison XL, Maccura IS1200, Autolumo A2000, Leadman CI1000, and Mindray CL-2000i were used to detect 40 individual AFP serum samples that were collected from the laboratory of Beijing Chaoyang Hospital in 2019. The AFP results from eight different systems were compared with the median cohort. Passing-Bablok regression was used to evaluate the correlation between methods, and the concordance correlation coefficient was used to analyse the consistency between methods. Taking the optimal biological variability (±5.90%) as the criterion for bias evaluation, the bias between systems was evaluated using Bland-Altman analysis. The EQA results for AFP from BCCL over the past three years were statistically analysed to calculate the robust mean, robust coefficient of variation ( CV), and standard uncertainty within groups. The acceptance limit is based on the requirement of desirable biological variability (±21.87%) of allowable total error, and the pass rates were calculated for instrument or method groups, respectively. Results:The CVs of the eight detection systems were all≤1/3 allowable total error (±8.3%), passing the precision verification. The average relative biases between two detection systems (Roche Cobas E601 and Maccura IS1200) and the median cohort were>±5.90%, while the other six detection systems were<±5.90%. The eight detection systems showed good correlation and consistency with the median cohort (both R2 and concordance correlation coefficients>0.95). The results of EQA showed that there were no statistically significant differences in the robust means within each instrument or method group ( P>0.05). In the instrument group, except for Siemens and two other groups, the robust CVs of other groups were within 9%. The pass rates of most instruments and methods after being grouped were higher than the total pass rate, but that of the enzyme immunoassay chemiluminescence method was relatively low. Conclusions:The eight automated AFP immunoassay systems show a good correlation with the median cohort, and the consistency of AFP detection results is satisfactory among most detection systems. However, the comparability of AFP detection results for certain systems needs further improvement.

Objective:To systematically evaluate the recurrence risk prediction model of diabetic foot ulcers (DFU) .Methods:Research on DFU recurrence risk prediction models was electronically searched in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and China Biomedical Service System. The search period was from database establishment to July 20, 2023. Two researchers independently screened literature and conducted data extraction and quality evaluation using the prediction model research data extraction table and the Prediction Model Risk of Bias Assessment Tool (PROBAST) .Results:A total of 8 articles were included, including 14 models. The area under the receiver operating characteristic (ROC) curve included in the model ranged from 0.660 to 0.940. The most common five predictors in the model were ulcers location, glycosylated hemoglobin, smoking, combined peripheral neuropathy and diabetes course. All 8 articles had a high risk of bias, mainly due to insufficient sample size, improper handling and reporting of missing data, and a lack of internal validation, which might lead to overfitting of the model. Only one article was subjected to external validation.Conclusions:The research on DFU recurrence risk prediction models is still in the development stage, and the predictive performance of various studies is still acceptable, but there is a high risk of bias. Future research still needs to use rigorous statistical analysis methods to construct new risk prediction models and improve internal and external validation.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment.However,irrigant selection or irrigation procedures are far from clear.The vapor lock effect in the apical region has yet to be solved,impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes.Additionally,ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified.Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes.Indeed,clinicians have been aware of these concerns for years.Based on the current evidence of studies,this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions.The evolution of different kinetic irrigation methods,their effects,limitations,the paradigm shift,current indications,and effective operational procedures regarding intracanal medication are also discussed.This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication,thus facilitating a better understanding of infection control,standardizing clinical practice,and ultimately improving the success of endodontic therapy.