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 function of FAK / Twist1 signaling pathway during craniosynostosis closure. Methods: Ten days old rats were divided into a control group (n = 50) and a rotation group (n = 50) . Both of them were made a approximately 0. 5 cm circle bone window at the midpoint of the lambdoid suture of the rat.The bone flaps were left free without damaging the dura mater. The bone flaps in the control group were repositioned in situ , and the bone flaps in the rotation group were rotated 180 ° and repositioned 3 weeks later. Then the experiments were performance as followed :open field test , measurement of body weight , head circumference , bone flap area , and thickness of bone flap in the two groups , observation of cranial suture closure by microscopy and HE staining , FAK / Twist1 expression determined by Western blot , real⁃time PCR , and immunohistochemical staining in the bone flap and dure , respectively. Results: The cranial sutures was completely closed in the rotation groupand that was open in the control group through detecting by microscopic examination and HE staining. The thickness of the bone flap in the derotation group was greater than that in the control group , with statistical significance (P < 0. 01) . There were no significant differences between two groups in head circumference , weight , bone flap area , and operative area. The results of behavioral test showed that after the closure of cranial suture , the acsion of FAK was significantly increased in the calvaria and dura as well as Twsit1 was significantly decreased in the dura in rotating group measuring by Western blot , real⁃time PCR , and immunohistochemical staining (P < 0. 05) . Conclusion FAK/Twist1 may play an important role in craniosynostosis after rotation.

This article aims to study the factors affecting the flexibility of the tip of an epidural anesthesia catheter. The flexibility of the tip of the epidural anesthesia catheter was tested with a softness tester from four aspects:raw materials, tip structure, tip processing technology, and the outer diameter of the catheter. Highly flexible and malleable polymer material with a smooth tip, the tip softening process and the proper outer diameter can effectively improve the tip flexibility of the epidural anesthesia catheter.
Anesthesia, Epidural ; Catheterization ; Catheters ; Epidural Space

Objective To investigate the interaction between homocysteine (HCY) and uric acid (UA) on the atherosclerosis (AS) of the fishing crew.Methods Research data were recruited from the special AS survey of 3 671 fishing workers (＞ 35 years old)of 11 large fishing companies,who had health checks from December 2014 to December 2016.Levels of homocysteine (HCY),uric acid (UA),carotid artery intimamedia thickness (CIMT) and carotid femoral pulse wave velocity (cfPWV) were detected in the 3 081 eligible subjects.According to the detected HCY and UA data,they were divided into 4 groups:the HCY and UA normal group (or the control group,n =1 486),the HCY high and UA normal group (or the HHCY group,n =979),the normal HCY and high UA group (or the HUA,n =370) and the increased HCY and UA group (or the HHCY group,n =979).The interaction of AS was assessed with 2 × 2 factorial analysis.Results Compared with those of the control group[(1.23 ±0.30) mm,(10.45 ±0.86) m/s],the levels of CIMT [(1.32±0.28),(1.30±0.30),(1.49 ±0.24) mm] and cfPWV[(10.63±0.99),(10.81 ±1.11),(11.40 ± 1.36) m/s] in the HHCY,HUA and HHCY + HUA groups all significantly elevated,and statistical significance could be seen,when comparisons were made between them (P ＜ 0.05).Compared with those of the HHCY group,the level of cfPWV in the HUA group and the level of CIMT in the HHCY + HUA group were significantly increased (P ＜ 0.05).In comparison with those of the HUA group,the levels of CIMT and cfPWV in the HHCY + HUA group all significantly elevated (P ＜ 0.05).The levels of HCY and UA were positively correlated with the levels of CIMT (r =0.375,r =0.285) and cfPWV (r =-0.342,r =0.399) (P ＜ 0.01).After correction of the confounding factors,HCY and UA were all independent factors of CIMT and cfPWV.The results of the 2 × 2 factorial analysis showed that HCY and UA had significant synergistic effect on IMT and cfPWV (P ＜ 0.01).Conclusions Both HCY and UA were independent influential factors of AS in fishing workers,and at the same time,they displayed synergistic interaction.

Objective To investigate the interaction between homocysteine (HCY) and uric acid (UA) on the atherosclerosis (AS) of the fishing crew.Methods Research data were recruited from the special AS survey of 3 671 fishing workers (＞ 35 years old)of 11 large fishing companies,who had health checks from December 2014 to December 2016.Levels of homocysteine (HCY),uric acid (UA),carotid artery intimamedia thickness (CIMT) and carotid femoral pulse wave velocity (cfPWV) were detected in the 3 081 eligible subjects.According to the detected HCY and UA data,they were divided into 4 groups:the HCY and UA normal group (or the control group,n =1 486),the HCY high and UA normal group (or the HHCY group,n =979),the normal HCY and high UA group (or the HUA,n =370) and the increased HCY and UA group (or the HHCY group,n =979).The interaction of AS was assessed with 2 × 2 factorial analysis.Results Compared with those of the control group[(1.23 ±0.30) mm,(10.45 ±0.86) m/s],the levels of CIMT [(1.32±0.28),(1.30±0.30),(1.49 ±0.24) mm] and cfPWV[(10.63±0.99),(10.81 ±1.11),(11.40 ± 1.36) m/s] in the HHCY,HUA and HHCY + HUA groups all significantly elevated,and statistical significance could be seen,when comparisons were made between them (P ＜ 0.05).Compared with those of the HHCY group,the level of cfPWV in the HUA group and the level of CIMT in the HHCY + HUA group were significantly increased (P ＜ 0.05).In comparison with those of the HUA group,the levels of CIMT and cfPWV in the HHCY + HUA group all significantly elevated (P ＜ 0.05).The levels of HCY and UA were positively correlated with the levels of CIMT (r =0.375,r =0.285) and cfPWV (r =-0.342,r =0.399) (P ＜ 0.01).After correction of the confounding factors,HCY and UA were all independent factors of CIMT and cfPWV.The results of the 2 × 2 factorial analysis showed that HCY and UA had significant synergistic effect on IMT and cfPWV (P ＜ 0.01).Conclusions Both HCY and UA were independent influential factors of AS in fishing workers,and at the same time,they displayed synergistic interaction.

A neuroinflammatory response is commonly involved in the progression of many neurodegenerative diseases. Potassium 2-(1-hydroxypentyl)-benzoate (PHPB), a novel neuroprotective compound, has shown promising effects in the treatment of ischemic stroke and Alzheimer׳s disease (AD). In the present study, the anti-inflammatory effects of PHPB were investigated in the plasma and brain of C57BL/6 mice administered a single intraperitoneal (i.p.) injection of lipopolysaccharide (LPS). Levels of iNOS and the cytokines TNF, IL-1and IL-10 were elevated in plasma, cerebral cortex and hippocampus after LPS injection and the number of microglia and astrocytes in cortex and hippocampus were increased. LPS also upregulated the expression of heme oxygenase-1 (HO-1) in the cortex and hippocampus. PHPB reduced the levels of iNOS and cytokines in the plasma and brain, decreased the number of microglia and astrocytes and further enhanced the upregulation of HO-1. In addition, PHPB inhibited the LPS-induced phosphorylation of ERK, P38 and JNK. These results suggest that PHPB is a potential candidate in the treatment of neurodegenerative diseases through inhibiting neuroinflammation.

OBJECTIVETo explore the efficacy and prognostic factors of induction therapy combined with autogenetic peripheral blood stem cells transplantation (APBSCT)in patients with multiple myeloma (MM).

METHODSFrom January 1998 to May 2015, 201 patients with MM were enrolled. All patients received APBSCT after induction therapy. With the follow up to 20 June 2015, the overall survival (OS), progression free survival (PFS)and prognostic factor were analyzed.

RESULTS① With a media follow up of 36.67 months, the median PFS and OS were 22.87 (17.48- 28.26)and 69.63 (63.57- 75.69)months, 5-year PFS and OS were 17% and 49%, respectively. ②After APBSCT, when the subgroup (n= 112) achieved complete response (CR)compared with the subgroup (n=89) not achieved CR, the median PFS were 32.93 (21.03-44.83) and 18.13 (14.46-21.80) months (P<0.001), respectively; And the media OS were 96.77 (71.79- 121.75)and 54.70 (49.53- 59.87) months (P=0.004), respectively. The risks for disease progression and death declined in CR subgroup. ③ Two subgroups included or not included bortezomib/thalidomide at induction therapy (123 patientsvs 21 patients), the media PFS were 31.67 (24.36- 38.98)and 15.20 (10.11- 20.29) months (P=0.013), respectively; And the media OS were 76.30 (55.44- 97.15)and 52.03 (33.76- 70.30) months (P=0.014), respectively. ④According to the ISS stage, the media OS of stageⅠ, Ⅱ, Ⅲ were 99.47 (59.58-139.36), 66.77 (52.17-81.37), 53.97 (28.71-79.23) (P< 0.001), respectively. The risk for death of stage Ⅱ, Ⅲ were 2.16 and 3.04 times higher than stage Ⅰ, with no difference in terms of PFS. ⑤ The media PFS in IgD (n=22) and IgG (n=101) type MM were 11.17 (10.27- 13.13)and 35.43 (22.69- 48.17)months (P=0.007) , respectively; The media OS were 30.83 (0.24-61.42)and 70.70 (53.52-87.88) months (P=0.039), respectively. The risk for disease progression of IgD type was 2.47 times higher than IgG type. ⑥ Patients received 1 line induction therapy (n=132) compared with more than 1 line (n=69), the media PFS were 25.43 (16.09- 34.77)and 20.27 (15.04- 25.50) months (P=0.042). ⑦Cox analysis showed that CR after APBSCT and ISS stage were independent prognostic factors for OS. IgD type MM and CR after APBSCT were independent prognosis factor for PFS.

CONCLUSIONCR after APBSCT and ISS stage were independent prognostic factors for OS in MM. CR after APBSCT was independent prognostic factor for PFS in MM. However, disease progression more likely occurred in IgD type MM, which was independent negative prognostic factor for PFS in MM.

Antineoplastic Combined Chemotherapy Protocols ; Bortezomib ; therapeutic use ; Disease-Free Survival ; Humans ; Multiple Myeloma ; diagnosis ; therapy ; Neoadjuvant Therapy ; Peripheral Blood Stem Cell Transplantation ; Prognosis ; Remission Induction ; Survival Rate ; Thalidomide ; therapeutic use ; Transplantation, Autologous ; Treatment Outcome

Objective:To evaluate the benefit of autologous stem cell transplantation (ASCT) as a consolidation therapy in the survival of multiple myeloma (MM) patients at different risks. Methods:A total of 67 MM patients who received ASCT as consolida-tion therapy between August 2006 and July 2011 were enrolled in the retrospective study. The cases were divided into three risk groups on the basis of the International Staging System and fluorescence in situ hybridization. Another 67 patients who accepted consolidation chemotherapy at the same period were selected as case-paired controls matched in terms of age, sex, optimal response after induction, and risk stratifications. All the patients received bortezomib-and/or thalidomide-based induction therapies. Results:No statistical differ-ences in non-complete remission (nCR)/complete remission (CR) rate were observed between the ASCT and chemotherapy groups (44.8%vs. 37.3%, P=0.380) after the induction therapy. The progression-free survival (PFS) was longer in the ASCT group than in the chemotherapy group (32.4 months vs. 15.1 months, P<0.001). The overall survival (OS) was longer in the ASCT group than in the che-motherapy group (58.8 months vs. 42.1 months, P=0.009). both the PFS (median:30.5 months vs. 11.2 months, P<0.001) and the OS (median:85.5 months vs. 34 months, P=0.015) rates were significantly prolonged in the high-risk subgroup after ASCT. In the interme-diate-risk subgroup, neither PFS nor OS showed any significance after ASCT (P>0.05). In the low-risk subgroup, only PFS was extend-ed (median: 34.8 months vs. 17.6 months, P=0.012) after ASCT, without significant improvements in the OS (P>0.05). Conclusion:The MM patients obtained cytogenetic high-risk benefits mostly from ASCT consolidation after inductions based on novel agents.

Purpose To investigate the expression of Axin, β-catenin and p53 in the pleural fluid and to discuss their relationships and significances. Methods The expression of Axin, β-catenin and p53 was detected using immunocytochemistry in adenocarinoma cells of the pleural fluid from 40 patients with primary lung adenocarcinomas or reactive mesothelial cells of the pleural fluid from 40 pa-tients with benign lung diseases. Results Axin positive expression rate was 30% (12/40) in cases with primary lung adenocarcino-mas. The positive expression rate of β-catenin was 15% (6/40) on cell membrane and 60%(24/40) in cytoplasm. The expression rate of p53 was 57. 5% (23/40) in cases of primary lung adenocarcinomas. The expression of Axin was positively correlated with the membranous expression of β-catenin, and negatively correlated with p53 in cancer cells of the pleural fluids. The positive expression rate of Axin was 77. 5% (31/40), but the expression rate of p53 was 1. 25% (5/40). There was no expression ofβ-catenin in reac-tive mesothelial cells from benign lung diseases. Conclusions The expression of Axin is significantly reduced in adenocarcinoma cells. The expression rate ofβ-catenin in cytoplasm is higher than that in membrane of cancer cells. It has a certain value to detect the expression of Axin,β-catenin and p53 for diagnosis and differential diagnosis of lung adenocaicinomas from benign lung diseases.