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 evaluate the clinical efficacy of comprehensive treatment for synchronous primary advanced gastric and esophageal cancer by propensity score matching(PSM).Methods A total of 2 551 patients with advanced gastric cancer admitted to Jiangsu Province Hospital of Chinese Medicine from January 2013 to December 2022 were retrospectively analyzed.Among them,45 patients with synchronous primary esophageal cancer were distributed to the observation group,and 2 506 patients without esophageal cancer were distributed to the control group.Through the PSM method,the control group was matched with the observation group and the equilibrium samples of covariates between two groups were obtained.The overall survival(OS)between the two groups were compared.Results Both observation and control group contained 45 patients in this study.According to the treatment regimen,the patients in the observation group was divided into radical resection treatment subgroup(n=22)and chemoradiotherapy(CRT)subgroup(n=23).In the radical resection subgroup,4 patients underwent the simultaneous surgical resection of gastric and esophageal tumors through proximal gastrectomy with the Ivor Lewis operation.Eighteen patients underwent endoscopic submucosal dissection(ESD)of their esophageal tumors and gastric cancer radical resection.Radical resection of gastric cancer combined with preoperative chemoradiotherapy of esophageal cancer was performed in the CRT subgroup.Survival analysis showed that OS in the observation group was significantly shorter than that in the control group(P=0.042)and there was no significant difference in OS between the radical resection subgroup and the control group(P=0.799).The 1-,3-,and 5-year survival rates of the patients in the CRT subgroup were significantly lower than those of the control group(P=0.003).While the 1-,3-,and 5-year survival rates of the patients in the radical resection subgroup were not statistically significant,compared to those of the CRT subgroup(P=0.071).Conclusions Multidisciplinary and comprehensive treatment can significantly improve the prognosis of patients with synchronous primary advanced gastric and esophageal cancer.Radical resection of gastric cancer combined with ESD of esophageal cancer is an optional treatment for patients with gastric cancer complicated with early esophageal cancer.Radical resection of gastric cancer combined with CRT of esophageal cancer can improve the prognosis of patients with advanced gastric cancer complicated with unresectable esophageal cancer.

Background With the change of the national energy development layout, Qingyang has seen a situation where oil exploitation and agriculture go hand in hand, which may lead to local soil pollution if not taken seriously. Objective To evaluate the distribution characteristics, possible sources, and ecological risks of heavy metals in farmland soils around the main production areas of Changqing Oilfield. Methods A total of 60 farmland soil samples were collected from Zhengning County, Zhenyuan County, and Qingcheng County of Qingyang City, and the contents of heavy metals such lead (Pb), mercury (Hg), chromium (Cr), cadmium (Cd), and arsenic (As) in farmland soil were detected according to GB 15618-2018 Soil environmental quality—Risk control standard for soil contamination of agricultural land (on trial). The soil background value of Gansu Province was used as the denominator in the calculation of pollution index, and the pollution characteristics and ecological characteristics of selected five heavy metals in farmland soil were evaluated by single-factor pollution index (P_i), Nemerow comprehensive pollution index (P_N), and potential ecological risk index. Results The levels of Pb, As, and Hg in farmland soils around Changqing Oilfield, the levels of Cr and Cd in Qingcheng County, and the level of Cd in Zhengning County were higher than the corresponding soil background values of Gansu Province, but lower than the national soil environmental quality standard. The single-factor pollution indexes (P_i) were: Hg, 2.14; Pb, 1.24; As, 1.13; Cr, 0.78; Cd, 0.67, which indicated that Hg were graded as moderate pollution, Pb and As were slight pollution, and Cd and Cr were not polluted. The Nemerow comprehensive pollution indexes (P_N) were: Cr, 0.92; Cd, 1.08; As, 1.20; Pb, 1.68; Hg, 3.85, which indicated that Cr was graded as no pollution, Cd, Pb and As were mild pollution, and Hg was severe pollution. The variation coefficients of Hg and Cd in Zhenyuan County and that of Hg in Qingcheng County were 60.00%, 50.00%, and 50.00%, respectively, which were all greater than 50%, indicating that the pollution of above heavy metals in the location was subject to human activities. The potential ecological risk indexes (E_r) of Pb, Cr, Cd, As, and Hg were 6.20, 1.55, 20.05, 11.28, and 81.64, respectively, indicating that Hg was graded as strong ecological risk, and the other four heavy metals were mild ecological risk. The comprehensive potential ecological risk index (R_RI) was 124.48. Combined with the potential ecological risk index of Hg, the comprehensive potential ecological risk of the five heavy metals in local farmland soils was considered to be at a strong ecological risk level. Conclusion Although the average values of selected five heavy metals in farmland soils surrounding the main production areas of Changqing Oilfield are qualified with the national soil environmental quality standards, they exceed corresponding soil background values of Gansu Province, and there are signs of human influence and potential ecological risks of different degrees.

Objective:A new type of bio-ink and polycaprolactone (PCL) were used to construct an integrated osteochon-dral composite tissue block by multi-nozzle 3D bioprinter. And the repair results to osteochondral defects were evaluated.Methods:In freeze-drying group: Freeze-dried composite scaffold made by silk fibroin (SF) and β-tricalcium phosphate was used to repair osteochondral defects, as control. In the 3D printing group: PCL was used to printed a hollow multi-layer cylinder frame by 3D biological printer. Extracellular matrix, SF and bone marrow mesenchymal stem cells were used as chondral bio-ink. Then, chon-dral bio-ink was used to print tissue-engineered cartilage on top of PCL frame. Before implantation of cartilage defect, autogenous cancellous bone was filled in PCL frame, then the tissue-engineered osteochondral composite was used to repair osteochondral defects. In mosaic group: Autologous osteochondral transplantation was performed. The repair results of the above three groups were compared by histological score, biochemical analysis and biomechanical test to evaluate the effect of repairing rabbit cartilage defects.Results:The compression modulus of neo-cartilage in the 3D print group 2.56±0.30 MPa was close to that of the mosaic group 2.51±0.13 MPa ( P>0.05), and significantly higher than that of freeze-dried group 1.37±0.14 MPa ( F=11.058, P<0.05). The sGAG contents in the 3D print group 14.49±0.7 μg/mg was close to that of the mosaic group 14.98±0.81 μg/mg ( P>0.05), and significantly higher than that of freeze-dried group 8.72±0.73 μg/mg ( F=20.973, P<0.05). However, there was no significant difference in collagen content between the three groups ( P>0.05). The results of ICRS cartilage repair histology score showed that the scores of the 3D print group were close to those of the mosaic group in the matrix, cell distribution, cell viability and subchondral bone ( P>0.05), and were significantly higher than those of freeze-dried group in the surface and cartilage mineralization scores ( F=19.544, P<0.05). Conclusion:Using the new bio-ink to make bone cartilage composite scaffold by 3D bio printing can simplify the construction of tissue-engineered bone cartilage composite tissue in vitro, and can repair cartilage defects in vivo.

Objective:To repair the articular cartilage defects of animal models with cartilage tissue block made by multi-nozzle three-dimensional bio-printer and observe its effect.Methods:Bio-ink was made by adding silk fibroin, polyethylene glycol and bone mesenchymal stem cells into extracellular matrix (ECM) solution. Rheological properties of biological ink were evaluated by rheometer, the protein secondary structure of biological ink was identified by Fourier transform infrared spectroscopy, and a tissue engineering scaffold with thickness of 2mm and diameter of 6mm was printed by using a pressure sprinkler loaded with cartilage biological ink. The compression modulus of tissue engineering scaffold was measured by tension machine. The degradation rate of each scaffold was evaluated by dry weight loss method, and the viability and proliferation of cells on the scaffold were evaluated by CCK-8 and live&dead cell staining. The differentiation of cellular cartilage on the scaffold was evaluated by real-time fluorescence quantitative PCR. The scaffold was embedded into the defect area of animal articular cartilage to repair articular cartilage defect according to the principle of autogenous cartilage transplantation. The effect of cartilage repair after 3 months was evaluated by histological staining and biochemical detection.Results:We found that all biological inks showed the flow characteristics of shear thinning. The absorption peak of biological ink amide I region containing silk fibroin moved to 1 623 cm -1. With the increase of silk fibroin content, the mechanical strength and degradability of biological ink were improved, and the compression modulus of 10% and 15% printing stand reached 19.96±5.66 kpa and 26.87±10.68 kpa, respectively. All biological inks had no obvious cytotoxicity. Real-time quantitative PCR showed that when the content of silk fibroin reached 10%-15%, the bone marrow mesenchymal stem cells in the tissue mass had stronger ability to differentiate into cartilage. In vivo studies showed that after 3 months, the sGAG/DNA content of 10% and 15% silk fibroin scaffolds reached 0.25±0.01 μg/ng and 0.24±0.02 μg/ng, respectively, and the collagen/DNA content reached 17.71±0.83 ng/ng and 16.69±2.39 ng/ng, respectively. Tissue engineered cartilage printed with high concentration silk fibroin can better repair articular cartilage defects. Conclusion:TThe chondrogenic differentiation and extracellular matrix (collagen and glycosaminoglycan) secretion of BMSCs were superior to those of the other two scaffolds when the content of silk fibroin reaches 10%-15%. The changes of chondrogenic differentiation ability and extracellular matrix secretion of stem cells from different scaffolds, as well as the repair effect on articular cartilage defects are caused by the differences of mechanical properties of scaffolds, which can be produced by the changes of silk fibroin concentration.

OBJECTIVE: Patients with chronic neuropathic pain (CNP) have a higher incidence to develop depression. However, its pathogenesis has not yet been fully elucidated. Here we aimed to investigate the role of inflammatory cytokines in CNP-related anhedonia, which is a core symptom of depression, and to explore the effects of ketamine and parecoxib on pain and anhedonia. METHODS: A rat model of spared nerve injury (SNI) was constructed to mimic CNP. Hierarchical cluster analysis of sucrose preference test (SPT) was applied to classify the SNI rats into anhedonia susceptible and unsusceptible. Inflammatory cytokines in medial prefrontal cortex (mPFC) of brain, serum and L2–5 spinal cord were measured. Moreover, effects of ketamine or parecoxib on mechanical withdrawal test (MWT) and SPT in anhedonia susceptible rats were detected. RESULTS: Tumor necrosis factor (TNF)-α was increased in mPFC, serum and and spinal cord of anhedonia susceptible rats. Furthermore, anhedonia susceptible and unsusceptible rats both increased the interleukin (IL)-1β level in mPFC, serum and spinal cord. IL-6 was altered in serum and spinal cord, but not in mPFC. IL-10 was significantly altered in mPFC and serum, but not in spinal cord. Additionally, ketamine treatment significantly attenuated the decreased results of MWT and SPT in anhedonia susceptible rats, and that parecoxib significantly improved the MWT score, but failed to alter the result of SPT. CONCLUSION: These findings suggest that abnormalities in inflammatory cytokines confer susceptible to anhedonia in a rat model of SNI. Ketamine, a fast-acting antidepressant, has pharmacological benefits to alleviate pain and anhedonia symptoms.
Anhedonia ; Animals ; Brain ; Cytokines ; Depression ; Humans ; Incidence ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Ketamine ; Models, Animal ; Neuralgia ; Neurogenic Inflammation ; Prefrontal Cortex ; Rats ; Spinal Cord ; Sucrose ; Tumor Necrosis Factor-alpha

Objective To explore the association,consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke.Methods A retrospective cohort survey of 240 patients,admitted to our hospital from September 2012 to December 2017,was performed.All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time,K time,α angle,maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT],activated partial thromboplastin time [APTT],fibrinogen [FIB],international normalized ratio [INR],blood platelet count).The association,consistency,and sensitivity,specificity,positive predictive value,negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed.Results (1) R time and APTT,K time and APTT,α angle and FIB,and α angle and PLT were positively correlated;K time and FIB,R time and PLT,and α angle and APTT were negatively correlated.(2) R time and APTT (κ=0.266,P=0.000),K time and APTT (κ=0.134,P=0.024),and α angle and FIB (κ=0.162,P=0.007) had agreement in identifying hypercoagulability;R time and APTT (κ=0.211,P=0.001),K time and APTT (κ=0.198,P=0.002),and blood platelet count and K (κ=0.388,P=0.000),and α angle and PLT (κ=0.099,P=0.041) had agreement in identifying hypocoagulability.(3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65％ and 58.82％,and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68％ and 47.39％.Conclusions Some parameters has correlations in peroperative period,and has agreement in identifying hypercoagulability and hypocoagulability.Accordingly,routine coagulation tests might be superior in evaluating early neurological deterioration,and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke.

Objective To compare the National Aeronautics and Space Administration-task load index (NASA-TLX) scores and the heart rate variability (HRV) of the female pilot cadets under different task conditions and to preliminarily investigate the characteristics of flight mental workload in females . Methods Two factors repeated measurement design was applied in this study .Twenty female pilot cadets of a flight college were chosen as subjects .Their ECG data was collected under the baseline status that they were in theoretical education and the states of preflight , taking off , approaching and landing in simulated and real flying tasks by KF1 physiological parameter recorder . The NASA-TLX scores were used to evaluate the subjective mental workload of the female cadets under baseline status and in all flying stages .The collected data are analyzed by repeated measurement ANOVA and the trends of changes in different flight stages were analyzed by Spearman's non-parameter correlation test . Results Eighteen subjects'NASA-TLX scores and 10 subjects'HR and HRV data were valid .① In analysis of the main effects of task type factors ,18 female pilot cadets'NASA-TLX scores showed significant variance between different tasks (F＝ 8 .294 , P＜0 .01) .The grand average scores both in simulated flight task (49 .47 ± 22 .69) and in real flight task (49 .68 ± 16.85)weresignificantlyhigherthanthatofbaselinestatus [(30.85±13.97);t＝3.506,3.547,P＜0 .05] .The heart rates of 10 female pilot cadets showed statistical significance between different tasks (F＝14 .615 , P＜0 .01) .The average heart rate in simulated flight task [(84 .70 ± 6 .89)beats/min] and in real flight task [(87 .73 ± 8 .79)beats/min] was also significantly higher than that of baseline status [(73 .70 ± 6 .15)beats/min ;t＝4 .029 ,5 .137 ,P＜0 .05] .②At the stage of landing ,NASA-TLX scores of 18 female flight cadets in real flight task (61 .70 ± 13 .15) and in simulated task (60 .54 ± 21.05)weresignificantlyhigherthanthatofbaselinestatus [(30.85±13.97);t＝3.506,3.547,P＜0 .05] .The HRV indexes of 10 female cadets ,including normalized unit low frequency (LFnu) , normalized unit high frequency (HFnu) ,ratio of low and high frequency bands (LF/HF) ,varied significantly in different types of task at the landing stage (F＝9 .015～12 .275 , P＜0 .01) .The LFnu in simulated flight [(90 .88 ± 4 .44)% ] and real flight tasks [(77 .22 ± 12 .04)% ] was higher than that of baseline status [(63 .75 ± 16 .87)% ;] (t＝4 .957 ,2 .462 ,P＜0 .05) ,and the HFnu of the two flight tasks [(9 .11 ± 4 .52)% ,(22 .78 ± 12 .04)% ] was lower than that of baseline status [(36 .25 ± 16 .87)% ;t＝4 .955 ,2 .460 ,P＜0 .05] .The LF/HF in this flight stage showed significant difference between simulated task (13 .51 ± 9 .51) and baseline status [(2 .40 ± 1 .66) ; t＝ 4 .088 , P＜ 0 .05] .③Both in the simulated and real flight tasks ,the NASA-TLX scores of 18 female flight cadets showed rising trend with the flight stage progress (ρ＝0 .328 ,0 .537 ,P＜0 .01) .The rising trends were also found on the LFnu and LF/HF of 10 female flight cadets (ρ＝ 0 .450～0 .631 , P＜ 0 .01) while the descending trends with flight stage progress were found on HFnu in both tasks (ρ＝ - 0 .631 ,-0 .450 ,P＜0 .01) . Conclusions The mental workload of female pilot cadets significantly increases in flight tasks as comparing to the baseline status and is significantly higher in landing stage than before flight .The simulated flight task can provide female pilot cadets basically the same mental workload as the real flight task .It is meaningful to pilot's training and related researches .

Objective To compare the National Aeronautics and Space Administration-task load index (NASA-TLX) scores and the heart rate variability (HRV) of the female pilot cadets under different task conditions and to preliminarily investigate the characteristics of flight mental workload in females . Methods Two factors repeated measurement design was applied in this study .Twenty female pilot cadets of a flight college were chosen as subjects .Their ECG data was collected under the baseline status that they were in theoretical education and the states of preflight , taking off , approaching and landing in simulated and real flying tasks by KF1 physiological parameter recorder . The NASA-TLX scores were used to evaluate the subjective mental workload of the female cadets under baseline status and in all flying stages .The collected data are analyzed by repeated measurement ANOVA and the trends of changes in different flight stages were analyzed by Spearman's non-parameter correlation test . Results Eighteen subjects'NASA-TLX scores and 10 subjects'HR and HRV data were valid .① In analysis of the main effects of task type factors ,18 female pilot cadets'NASA-TLX scores showed significant variance between different tasks (F＝ 8 .294 , P＜0 .01) .The grand average scores both in simulated flight task (49 .47 ± 22 .69) and in real flight task (49 .68 ± 16.85)weresignificantlyhigherthanthatofbaselinestatus [(30.85±13.97);t＝3.506,3.547,P＜0 .05] .The heart rates of 10 female pilot cadets showed statistical significance between different tasks (F＝14 .615 , P＜0 .01) .The average heart rate in simulated flight task [(84 .70 ± 6 .89)beats/min] and in real flight task [(87 .73 ± 8 .79)beats/min] was also significantly higher than that of baseline status [(73 .70 ± 6 .15)beats/min ;t＝4 .029 ,5 .137 ,P＜0 .05] .②At the stage of landing ,NASA-TLX scores of 18 female flight cadets in real flight task (61 .70 ± 13 .15) and in simulated task (60 .54 ± 21.05)weresignificantlyhigherthanthatofbaselinestatus [(30.85±13.97);t＝3.506,3.547,P＜0 .05] .The HRV indexes of 10 female cadets ,including normalized unit low frequency (LFnu) , normalized unit high frequency (HFnu) ,ratio of low and high frequency bands (LF/HF) ,varied significantly in different types of task at the landing stage (F＝9 .015～12 .275 , P＜0 .01) .The LFnu in simulated flight [(90 .88 ± 4 .44)% ] and real flight tasks [(77 .22 ± 12 .04)% ] was higher than that of baseline status [(63 .75 ± 16 .87)% ;] (t＝4 .957 ,2 .462 ,P＜0 .05) ,and the HFnu of the two flight tasks [(9 .11 ± 4 .52)% ,(22 .78 ± 12 .04)% ] was lower than that of baseline status [(36 .25 ± 16 .87)% ;t＝4 .955 ,2 .460 ,P＜0 .05] .The LF/HF in this flight stage showed significant difference between simulated task (13 .51 ± 9 .51) and baseline status [(2 .40 ± 1 .66) ; t＝ 4 .088 , P＜ 0 .05] .③Both in the simulated and real flight tasks ,the NASA-TLX scores of 18 female flight cadets showed rising trend with the flight stage progress (ρ＝0 .328 ,0 .537 ,P＜0 .01) .The rising trends were also found on the LFnu and LF/HF of 10 female flight cadets (ρ＝ 0 .450～0 .631 , P＜ 0 .01) while the descending trends with flight stage progress were found on HFnu in both tasks (ρ＝ - 0 .631 ,-0 .450 ,P＜0 .01) . Conclusions The mental workload of female pilot cadets significantly increases in flight tasks as comparing to the baseline status and is significantly higher in landing stage than before flight .The simulated flight task can provide female pilot cadets basically the same mental workload as the real flight task .It is meaningful to pilot's training and related researches .