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.

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 clinical outcomes of anterolateral thigh flap combined with great saphenous vein transplantations for the treatment of extensive elbow soft tissue defects accompanied by brachial artery embolism.Methods:A retrospective case series study was carried out to investigate the clinical data of 19 patients with extensive elbow soft tissue defects accompanied by brachial artery embolism admitted to Fuyang People's Hospital of Anhui Medical University from March 2017 to March 2020. There were 15 males and 4 females，aged 14-59 years［（37.6±14.1）years］. The areas of elbow soft tissue defects ranged from 7 cm×3 cm to 12 cm×5 cm. Before operation，angiography test was performed to confirm brachial artery embolism of the affected upper limb. The length of embolization ranged from 5 to 12 cm［（7.3±1.6）cm］. All patients were treated using the anterolateral thigh flap combined with great saphenous vein transplantation. The operation time and intraoperative blood loss were recorded. Angiography test was re-examined one week after operation. The degree of flap swelling，elbow Broberg-Morrey functional score and scar contracture were evaluated at postoperative 3，6，and 12 months. Healing of donor site and postoperative complications were observed.Results:All patients were followed up for 12-24 months［（18.1±3.0）months］. The operation duration was 3.5-6.4 hours［（4.9±0.8）hours］，with intraoperative blood loss of 200-600 ml［（338.7±101.6）ml］. The blood flow of repaired brachial artery was unobstructed in all patients one week after operation，with all flaps survived. The degree of flap swelling was（0.9±0.3）cm at postoperative 12 months，significantly reduced from that at postoperative 3 and 6 months［（1.2±0.3）cm，（1.1±0.3）cm］（ P<0.05）. The elbow Broberg-Morrey functional score was（87.8±4.8）points，significantly higher than those at postoperative 3 and 6 months［（71.4±7.0）points，（80.2±4.8）points］（ P<0.05）. The rating of elbow function score was excellent in 9 patients，good in 8 and fair in 2 at postoperative 12 months，with the excellent and good rate of 90%. The rate of scar contracture was 63%（12/19）at postoperative 12 months，significantly higher than that at postoperative 3［11%（2/19）］（ P<0.05），while not different from that at postoperative 6 months［42%（8/19）］（ P>0.05）. The donor site was healed in all patients，without complications related to blood vessels or flaps. Conclusions:For extensive elbow soft tissue defect accompanied by brachial artery embolism，the anterolateral thigh flap combined with great saphenous vein transplantations can successfully restore the blood supply of the distal site of the affected limb with a high survival rate of the flap and well recovered limb function，and hence is a feasible method for severe elbow trauma. However，due to various factors such as elbow joint immobilization during perioperative period，scar contracture is prone to occur in the area of the flap.

Objective To investigate the role of B cell lymphoma/leukemia-2 and adenovirus E1B 19 000 interacting protein 3 (BNIP3) in oligodendrocyte cell apoptosis induced by carbon monoxide poisoning (CO poisoning) and the potential signal pathways.Methods Twenty-five male C57BL/6 mice were randomly divided into control group and CO poisoning group.Mice were left to breathe room air (control group) or subjected to 40-minute exposure to 2 500-3 000 ppm CO (CO poisoning group).The mice were sacrificed at 1,3,7 d and 14 d following CO poisoning.We examined the damage of myelin sheath and oligodendrocytes by observing the expression of myelin basic protein (MBP) and oligodendrocyte transcription factor 2 (Olig2) in corpus callosum.Furthermore,we explored the role of BNIP3 and potential signal pathways in the oligodendrocyte cell death following CO poisoning by observing the expression of BNIP3,Bcl-2 associated X protein (Bax) and cysteinyl aspartate specific proteinase 9 (caspase 9).Results Immunohistochemistry showed that the expression of MBP decreased significantly in the corpus callosum from 1 d (0.12±0.02,t=3.357,P＜0.05) to7 d (0.05±0.02,t=9.730,P＜0.01) and increased from 7 d to 14 d (0.13 ± 0.02,t =2.897,P ＜ 0.05) to some degree after CO poisoning compared with the control group (0.16 ± 0.02) and that Olig2 expression increased markedly in 3 d CO poisoning group (72.2 ± 5.45,t =12.211,P ＜ 0.01) compared with the control group (36.6 ± 3.58).The results of MBP and Olig2 in Western blotting revealed that MBP began to decrease from 1 d (0.39 ± 0.02,t =10.391,P＜0.01)to 7 d(0.09 ±0.01,t =34.767,P＜0.01)and increased in 14 d (0.45 ±0.03,t =6.146,P ＜ 0.01) compared with the control group (0.55 ± 0.03),and that O1ig2 increased obviously in 3 d (0.52 ± 0.02,t =16.651,P ＜ 0.01) compared with the control group (0.31 ± 0.02).Western blotting analysis showed that the levels of BNIP3 were increased in 1 d (2.49 ±0.40,t =15.342,P ＜0.01),started to decrease in 3 d (1.90 ± 0.24,t =12.417,P ＜ 0.01) and finally recovered in 14 d (0.24 ± 0.02,t =0.798,P ＞0.05),as compared with the control group(0.25 ±0.03).Moreover,compared with the control group(0.44 ±0.03),Bax was also upregulated in the corpus callosum from 1 d (1.09 ± 0.15,t =9.427,P ＜ 0.01) to 7 d (0.64 ± 0.09,t =4.540,P ＜ 0.05) after CO poisoning.The expression of caspase 9 showed the similar tendency that increased in 1 d (1.10 ± 0.17,t =7.137,P ＜ 0.01),decreased in 3 d (0.79 ± 0.10,t =5.051,P ＜ 0.01)and recovered in 7 d (0.55 ± 0.05,t =0.910,P ＞ 0.05) compared with the control group (0.51 ± 0.08).BNIP3 expression was positively correlated with Bax (r =0.995,P ＜0.01) and caspase 9 (r =0.950,P ＜ 0.01).Conclusion BNIP3 may play an important role in the apoptosis of oligodendrocytes induced by CO poisoning via the pathway of caspase dependent mitochondrial apoptosis.

Objectives:To evaluate the long-term complications of percutaneous kyphoplasty(PKP) for osteoporotic vertebral compression fractures (OVCF),and to provide evidence for clinical procedure.Methods:Databases including CNK1,CBM,PubMed,The Cochrane Library(lssue 2,2017),Wiley Online Library,ELSEVIER Science Direct(SDOS) were used to collect the randomized controlled trials(RCTs) which compared PKP with conservative treatment in the treatment of OVCF from inception to February 2017.The diagnosis of thoracolumbar vertebral compression fracture was confirmed by X-ray,CT and MRI.The presence of thoracolumbar osteoporotic T which was less than or equal to-2.5,was confirmed by bone mineral density measurement.All the patients were 50 years or older,and disease duration was less than 6 months;postoperative outcomes included at least one of the following indicators:new vertebral fractures,adjacent fractures,serious adverse events,visual analogue score.Cochrane system evaluation manual 5.0.1 was referred to evaluate the quality of the included literatures.Results:Five RCT studies included four English literatures and one Chinese literature.Methodological quality assessment of 4 articles were more than or equal to 4 points,one article scored 3 points.PKP group consisted of 417 cases,conservative treatment group of 458 cases.The results of meta-analysis showed that there was statistical difference in VAS between the two groups after 3 to 6 months' treatment(mean difference=-0.36;95％CI-0.07 to-0.65;P=0.02).However,there was no statistical difference in new vertebral fractures,adjacent fractures or serious adverse events.Conclusions:Application of PKP in OVCF can reduce the patients' long-term (3-6 months) VAS pain score and does not increase the risks of new vertebral fractures,adjacent fractures and serious adverse events.

Objective To explore the association between C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene and susceptibility to hyperuricemia and gout.Methods The case-control studies from Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang,Weipu,PubMed,Cochrane Library,OvidSP,Wiley Online Library,EBSCO,Elsevier Science Direct,Springer Link and Google scholar databases for the association of C677T polymorphism of MTHFR gene with hyperuricemia and gout.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from randomeffects or fixed-effects models to assess the association strength by RevMan 5.3 and Stata 12.0 software.Results Ten references enrolled 1 899 hyperuricemia patients and 5 403 controls,and 3 references enrolled 209 gout patients and 194 controls in total.The meta analysis showed that carriers of genotype CC [OR=0.42,95％CI (0.29,0.63),P＜0.01] and allele C [OR=0.54,95％CI (0.42,0.71),P＜0.01] had lower risk of hyperuricemia;genotype TT [OR=1.55,95％CI (1.32,1.83),P＜0.01] and allele T [OR=1.84,95％CI (1.38,2.45),P＜0.01] had higher risk of hyperuricemia,carriers of genotype CC [OR=0.32,95％CI (0.15,0.68),P=0.003] and allele C [OR=0.35,95％CI (0.17,0.70),P=0.003] hadlower risk of gout;genotype TT [OR=2.92,95％CI (1.74,4.92),P＜0.01] allele T [OR=2.69,95％CI(1.50,4.84),P=0.0009] had higher risk of gout.Conclusion The meta analysis reveals that C677T polymorphism of MTHFR gene is associated with the susceptibility to hyperuricemia and gout.

Objective To explore the association between the polymorphism in-308 site of tumor necrosis factor (TNF)-α promoter region and ankylosing spondylitis (AS).Methods The case-control studies from PubMed,Cochrane Library,Ovid,Chinese Biomedical Database,Chinese National Knowledge Infrastructure,Wanfang and Weipu databases for the association polymorphism in-308 site of TNF-α promoter region with AS.The pooled odds ratios (OR) with 95％ confidence intervals (CI) were appropriately derived from random-effects models or fixed-effects models to assess the association strength by RevMan 5.2 and Stata 12.0 software.Results Nineteen references enrolled 2 155 AS patients and 2 367 controls in total.The meta analysis showed that the frequencies of GG vs (AA +GA) genotypes was not statistically different between AS group and the control group in total populations [OR=1.20,95％CI (0.85,1.70),P=0.30],in the populations of Asian origin [OR=1.29,,95％CI (0.66,2.52),P=0.45] and in the populations of non-Asian origin [OR=1.16,95％CI (0.78,1.72),P=0.46].The analysis also showed that the frequencies of AA vs (GG +GA) genotypes was not statisticalLY differenT between AS group and the control group in total populations[OR=0.78,95％CI (0.53,1.15),P=0.21],in the populations of Asian origin [OR=1.15,95％CI (0.33,4.00),P=0.82] and in the populations of non-Asian origin[OR=0.69,95％CI (0.42,1.13),P=0.14].The analysis also showed that the frequencies of allele G vs A was not statistically different between AS group and the control group in total populations [OR=1.09,95％CI (0.79,1.50),P=0.61],in the populations of Asian origin [OR=1.17,95％CI (0.65,2.09),P=0.60] and in the populations of non-Asian origin [OR=1.05,95％CI (0.71,1.54),P=0.81].Conclusion The Meta-analysis reveales that all genotypes and alleles of-308 site of TNF-α promoter region may not be associated with AS.

Objectives: To explore the association between the polymorphism in -857 site of tumor necrosis factor (TNF)-α promoter region and the susceptibility to ankylosing spondylitis (AS). Methods: Case-control studies Pubmed, Cochrane Library, Ovid, Chinese Biomedical Database(CBM), Chinese National Knowledge In-frastructure(CNKI), Wanfang and Weipu data bases from inception to October 2013 for the association between TNF-α-857 C/T polymorphism and the susceptibility to AS were collected. Meta-analysis was performed by Revman 5.2 and Stata 12.0 software. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were de-rived from random-effects or fixed-effects models to assess the strength of the association. Results: Nine case-control studies were included in the final meta-analysis, including a total of 933 AS patients and 1094 controls. Statistically significant differences between AS and control groups were observed in the susceptibility to AS and TNF-α-857 genotype CC [OR=0.46, 95%CI (0.26, 0.81), P=0.007], allele C [OR=0.61, 95%CI (0.41, 0.91), P=0.02] and T [OR=1.64, 95%CI (1.10, 2.43), P=0.02]. But, no statistical difference in the fre-quency of genotype TT [OR=1.49, 95%CI (0.95, 2.34), P=0.08] was observed between AS and control groups. There were obvious heterogeneities among the studies of genotype CC(P<0.00001, I2=87%), allele C(P<0.00001, I2=84%) and allele T(P<0.00001, I2 =84%), except genotype TT(P=0.09, I2=42%). Sensitivity analysis was per-formed by leaving out one study at a time, but the heterogeneity remained obvious. It was symmetric of the funnel plots of genotype CC, allele C and T with AS, but genotype TT. There was no statistical significance in genotype CC[Begg′s test(z=0.52, P=0.602), Egger′s test(t=0.23, P=0.825)], genotype TT[Begg′s test(z=0.94, P=0.348), Egger′s test(t=1.26, P=0.248)], allele C[Begg′s test(z=0.31, P=0.754), Egger′s test(t=0.72, P=0.494)] or allele T[Begg′s test(z=0.31, P=0.754), Egger′s test(t=-0.72, P=0.494)]. Conclusions: Genotype CC, allele C and T of TNF-α-857 are associated with the susceptibility to AS, and T-allele carriers have higher risk of AS.