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.

Diabetic neurogenic bladder(DNB)is an autonomic neuropathy,which is a common complication of diabetes mellitus(DM)with a high disability rate.Emphysematous cystitis(EC)is a rare and life-threatening urological disease.A patient with DNB and EC was admitted to our hospital,who was complicated with bilateral hydronephrosis and double ureters.After comprehensive treatment with indwelling catheterization,intravenous application of broad-spectrum antibiotics,and Ins hypoglycemic therapy,the re-examination of urinary CT showed that bilateral hydronephrosis,double ureters,and bladder gas disappeared,and the indicators were improved compared with before.Due to the severe condition of the patient with DNB,the residual urine volume of the bladder increased day by day after the catheter was removed,which led to long-term indwelling catheter after discharge.

Diabetic neurogenic bladder(DNB)is an autonomic neuropathy,which is a common complication of diabetes mellitus(DM)with a high disability rate.Emphysematous cystitis(EC)is a rare and life-threatening urological disease.A patient with DNB and EC was admitted to our hospital,who was complicated with bilateral hydronephrosis and double ureters.After comprehensive treatment with indwelling catheterization,intravenous application of broad-spectrum antibiotics,and Ins hypoglycemic therapy,the re-examination of urinary CT showed that bilateral hydronephrosis,double ureters,and bladder gas disappeared,and the indicators were improved compared with before.Due to the severe condition of the patient with DNB,the residual urine volume of the bladder increased day by day after the catheter was removed,which led to long-term indwelling catheter after discharge.

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.

Colorectal cancer is one of the common malignant tumors of the digestive tract.With the popularization of screening methods and advancement of endoscopic technology,an increasing number of T1 stage colorectal cancers can be discovered.Accurately predicting lymph node metastasis risk is significantly important for guiding clinical treatment decisions,reducing complications and mortality.Current research on risk factors for lymph node metastasis in T1 stage colorectal cancer covers multiple aspects including clinical pathological features,molecular phenotypes and genetic characteristics.Some studies have built prediction models by integrating these factors,which show higher sensitivity,specificity and accuracy compared to current clinical guidelines.These models provide valuable experience for clinical practice.

Endoscopic resection(ER)and laparoscopic surgery are the main methods for treatment of early gastric cancer(EGC).Radical gastrectomy(RG)and lymph node dissection are required for the patients who don't meet the indications of ER,but it may cause postoperative stomach dysfunction and reduce quality of life(QOL).Pylorus-preserving gastrectomy(PPG)is one of the function-preserving gastrectomy for EGC.The short-term complications of PPG are equal to that of RG and it is also beneficial to long-term nutritional status and QOL.The 5-year survival rate of PPG is similar to that of distal subtotal gastrectomy(DSG)according to a retrospective study of the matched cohort.But delayed gastric emptying(DGE)is a common problem in the short and long term after PPG.The limited lymph node dissection of PPG makes its application not widely promoted.Sentinel node navigation surgery(SNNS)may provide more personalized and minimally invasive surgery,in order to preserve the gastric function to the maximum extent.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To investigate the influencing factors of delayed methotrexate (MTX) elimination after high-dose methotrexate (HD-MTX) treatment in children with acute lymphoblastic leukemia (ALL) and the effects of delayed MTX elimination and HD-MTX reduction on the prognosis of children with ALL.Methods:The clinical data of 242 children with ALL diagnosed and treated in Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2015 to June 2020 in accordance with the Chinese Children's Cancer Group study ALL 2015 (CCCG-ALL 2015) were retrospectively analyzed. Low risk and intermediate/high risk children respectively received 3 g/m 2 and 5 g/m 2 HD-MTX for 4 times, and the serum MTX concentration was monitored. The serum MTX concentration > 1 μmol/L at 44 h of administration was considered as the delayed elimination, which was divided into mild (> 1 μmol/L and ≤ 5 μmol/L), moderate (> 5 μmol/L and ≤ 10 μmol/L) and severe (> 10 μmol/L) delayed elimination. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of delayed MTX elimination, and univariate Cox proportional hazards model was used to analyze the related factors of ALL relapse. Results:The 242 children with ALL completed 962 times of HD-MTX chemotherapy. The median serum MTX concentration [ M ( Q1, Q3)] at 44 h of administration was 0.45 μmol/L (0.33 μmol/L, 0.72 μmol/L). The total incidence of delayed MTX elimination was 17.7% (170/962). The incidence of mild, moderate and severe delayed elimination was 13.8% (133/962), 2.6% (25/962) and 1.2% (12/962), respectively. Logistic regression analysis showed that age ≥ 7 years old ( OR = 1.68, 95% CI 1.17-2.41, P = 0.005), MTX dose >3 g/m 2 at each course ( OR = 2.14, 95% CI 1.52-3.03, P < 0.001) and the first course of HD-MTX chemotherapy ( OR = 2.05, 95% CI 1.43-2.93, P < 0.001) were independent risk factors for delayed MTX elimination. The median follow-up time was 50 months (34 months, 68 months), 12.8% (31/242) of the children relapsed, and the median relapse time was 30 months (30 months, 39 months). Univariate Cox regression analysis showed that there were no significant differences in the relapse rates among children with different gender, immunophenotype, risk, the number of delayed MTX elimination, and the completion of HD-MTX chemotherapy (the ratio of MTX average dose to initial planned dose) (all P > 0.05). Conclusions:The independent risk factors of delayed elimination of MTX in children with ALL are age ≥ 7 years old, MTX dose > 3 g/m 2 at each course and the first course of HD-MTX chemotherapy. Delayed elimination of MTX and reduction of HD-MTX have no significant effect on ALL relapse.

Objective:To evaluate the biplane osteotomy assisted by 3D printing for malunion of tibial plateau fracture of Schatzker type Ⅳ.Methods:A retrospective study was conducted of the 19 patients with malunion of tibial plateau fracture of Schatzker type Ⅳ who had been treated at Department of Orthopaedics, Jiaozuo People's Hospital and Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital from February 2014 to May 2018. They were 11 males and 8 females, aged from 20 to 55 years (average, 37.6 years). The interval from injury to operation ranged from 3 to 8 months. All patients were treated with biplane osteotomy assisted by 3D printing. The tibiofemoral angle, tibial plateau varus angle, posterior tilt angle and Lysholm scores of knee joint were recorded before and after treatment. Postoperative complications were observed.Results:All patients were followed up for 12 to 28 months (average, 18.5 months).The fracture healing time ranged from 12 to 24 weeks (average, 15.5 weeks).At the last follow-up, the patient's tibiofemoral angle was 173.2°±2.0°, tibial plateau varus angle was 85.6°±1.3 °, and posterior tilt angle was 11.9°± 1.1 °, which were higher than the preoperative ones (154.1°±5.0°, 76.0°±1.8°, 18.9 °±1.6°), and the differences were statistically significant ( P<0.05).The Lysholm scores at the last follow-up (89.8 ± 1.2) were significantly higher than the preoperative ones (52.0±4.4) ( P<0.05).One patient had to receive total knee arthroplasty because of difficult walking 6 months after operation. Conclusion:Biplane osteotomy assisted by 3D printing can delay development of traumatic arthritis, relieve pain and restore knee function in the treatment of malunion of tibial plateau fracture of Schatzker type Ⅳ.

Objective: To investigate the effect of Toll-like receptor 9 (TLR9) on high glucose-induced retinal ganglion cells-5 (RGC-5) apoptosis and the inhibitory effects of small interfering RNA-TLR9 (si-TLR9) on apoptosis. Methods: RGC-5 cells were divided into normal control group, high glucose group, high glucose+ negative control group and high glucose+ si-TLR9 group which cells were respectively dealt with normal culture medium, high glucose medium, transfection of non-specific siRNA under high glucose and transfection of siRNA-TLR9 under high glucose.The expression of TLR9 mRNA was detected by real time PCR; the survival rate of the cells was evaluated by MTT assay; the apoptotic rate of the cells was detected by flow cytometry; the caspase-3 activity in the cells was detected by related kit, and the expressions of TLR9, B cell lymphoma (bcl-2), bcl-2 associated X protein (bax), p38 mitogen-activated protein kinases (p38MAPK) and phosphorylated (p)-p38MAPK proteins were detected by Western blot. Results: The expressions of TLR9 mRNA and protein in the high glucose+ si-TLR9 group were significantly decreased in comparison with the high glucose+ negative control group (both at P<0.05). The cell survival rate of the high glucose group and high glucose+ negative control group was (78.36±5.13)% and (75.12±4.25)%, respectively, which was significantly lower than (95.48±7.25)% in the normal control group, and that in the high glucose+ si-TLR9 group was (86.58±5.32)%, which was significantly reduced in comparison with the high glucose+ negative control group (all at P<0.05). The apoptotic rate of the cells in the high glucose group and high glucose+ negative control group was (13.23±1.22)% and (12.52±1.38)%, respectively, which was significantly higher than (2.26±0.15)% of the normal control group, and apoptotic rate in the high glucose+ si-TLR9 group was (7.15±0.24)%, which was significantly lower than that in high glucose+ negative control group (all at P<0.05). The expression of bax in the cells of the high glucose+ si-TLR9 group was significantly decreased, and the expression of bcl-2 in the cells of the high glucose+ si-TLR9 group was significantly increased in comparison with the high glucose+ negative control group (both at P<0.05). Caspase-3 activity in the cells was significantly decreased in the high glucose+ si-TLR9 group compared with the high glucose+ negative control group (P<0.05). The relative expression of p-p38MAPK in the cells was significantly decreased in the high glucose+ si-TLR9 group compared with the high glucose+ negative control group (P<0.05). Conclusions Down-regulation of TLR9 expression in the RGC-5 cells can inhibit the apoptosis induced by high glucose probablely by suppressing p38MAPK signaling pathway.