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.

Objective:To explore the effects of age and gender on the sagittal spinal-pelvic parameters during the natural aging process of healthy adults.Methods:A total of 647 Chinese healthy adults who underwent health check-ups at the Second Affiliated Hospital of Zhejiang University School of Medicine and Songyang County People's Hospital, from January 2017 to September 2024 were collected. There were 277 males and 370 females, aged 18-93 years. Anteroposterior and lateral X-ray films of the whole spine were taken to evaluate the spinal-pelvic sagittal morphology. The following parameters were measured: thoracic kyphosis (TK), lumbar lordosis(LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), global tilt (GT), T 1-pelvic angle (TPA), sagittal vertical axis (SVA), thoracic Cobb angle (T-Cobb), lower end vertebra of thoracic Cobb angle (T-LEV), apex vertebra of thoracic Cobb angle (T-Apex), lumbar Cobb angle (L-Cobb). Compare the differences in spine-pelvis parameters among patients of different genders and age groups (in this study, the subjects were subdivided into the 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-93 years groups according to the age range). Results:The results showed that GT, SVA, TPA, and PT increased with age ( P<0.05). For males aged 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-93 years, PT values were 8.58°±6.47°, 9.60°±5.63°, 12.65°±7.13°, 11.00°±6.99°, 13.01°±8.63°, 15.77°±8.02°, and 18.47°±10.03° respectively; for females in the same age groups, the PT values were 8.44°±6.83°, 9.00°±6.44°, 11.84°±7.35°, 12.07°±7.51°, 15.44°±9.39°, 19.26°±8.28°, and 18.17°±9.43° respectively. For males in these age groups, the global tilt (GT) values were 6.37°±7.20°, 8.77°±6.51°, 10.38°±9.07°, 8.80°±7.49°, 10.80°±8.62°, 16.07°±10.42°, and 21.99°±12.65° respectively; for females, the GT values were 4.46°±8.09°, 5.96°±7.83°, 8.17°±6.88°, 9.41°±8.03°, 9.96°±1.39°, 17.89°±9.39°, and 19.55°±12.34° respectively. The sagittal vertical axis (SVA) values for males in the age groups were -7.94±25.57 mm, -2.98±25.69 mm, -4.63±20.90 mm, -6.43±32.81 mm, 7.85±43.39 mm, 36.49±53.89 mm, and 55.57±51.10 mm respectively; for females, they were -24.12±31.35 mm, -17.49±25.12 mm, -17.88±22.72 mm, -8.25±30.91 mm, 8.80±27.45 mm, 28.67±38.22 mm, and 23.23±35.19 mm respectively. For males, the thoracic pelvic angle (TPA) values across the age groups were 4.46°±5.94°, 6.05°±5.38°, 9.58°±9.35°, 7.52°±7.64°, 11.23°±9.59°, 16.32°±12.38°, and 18.49°±11.70° respectively; for females, the TPA values were 2.72°±6.88°, 3.68°±6.26°, 7.30°±6.11°, 7.44°±6.75°, 12.64°±9.79°, 19.08°±10.39°, and 16.79°±13.19° respectively. T-Cobb, T-LEV, and T-Apex increased slowly with age ( P<0.05). The pelvic incidence (PI) remained relatively constant in males ( P>0.05), while it increased slowly with age in females ( P<0.05). Conclusions:Sagittal anteversion of the spinal-pelvis increases with age. Gender differences are reflected in specific changes in the fluctuation amplitude of certain parameters (such as PI), and the fluctuations of indicators like T-Cobb, T-LEV, and T-Apex are closely related to the natural aging process of the spine.

AIM:To investigate the effects of vericiguat(Ver)on inhibiting myocardial fibrosis and on myo-cardial angiotensin Ⅱ(Ang Ⅱ)type 1 receptor(AT1R)/P70 ribosomal S6 kinase(P70S6K)expression in spontaneously hypertensive rats(SHR).METHODS:Eight 3-month-old male Wistar-Kyoto(WKY)rats were used as the normal con-trol(WKY group),and 24 age-and sex-matched SHR were randomly and equally divided into SHR group,SHR+Ver1 group(Ver:1 mg·kg-1·d-1)and SHR+Ver3 group(Ver:3 mg·kg-1·d-1).Ver was administered via oral gavage at the cor-responding dose for 3 months.Blood pressure of rats was measured by tail-cuff method.Whole heart mass index(HMI)and left ventricular mass index(LVMI)were measured by weighing method.Myocardial collagen deposition was observed by Sirius red staining.Cardiac fibroblasts(CFBs)were cultured by tissue patch method and induced with angiotensin Ⅱ(Ang Ⅱ),followed by cellular intervention with Ver,nicorandil(Nic)or P70S6K inhibitor.The levels of collagen type Ⅰ(Col Ⅰ)and Col Ⅲ were determined by ELISA.The levels of Ang Ⅱ and cyclic guanylate cyclase(cGMP)were measured by radioimmunoassay.Western blot was performed to determine the protein levels of AT1R,P70S6K and p-P70S6K.RE-SULTS:Compared with WKY group,systolic blood pressure(SBP),diastolic blood pressure(DBP),HMI,LVMI,col-lagen volume fraction(CVF)and myocardial Col Ⅰ and Col Ⅲ in SHR group were increased(P<0.05).Compared with SHR group,HMI,LVMI,CVF and myocardial Col Ⅰ and Col Ⅲ in SHR+Ver1 group and SHR+Ver3 group were de-creased(P<0.05).The levels of plasma Ang Ⅱ,myocardial Ang Ⅱ,AT1R and p-P70S6K of myocardial tissue in SHR group were significantly higher than those of WKY group(P<0.05).Compared with SHR group,the p-P70S6K level in SHR+Ver1 group and SHR+Ver3 group was decreased(P<0.05).Compared with WKY group,myocardial cGMP level in SHR group was decreased(P<0.05).Compared with SHR group,cGMP level in SHR+Ver1 group and SHR+Ver3 group was increased(P<0.05).Ver(10-7～10-5 mol/L)could reduce the level of Ang Ⅱ-induced CFBs Col Ⅰ and Col Ⅲ synthesis in a concentration-dependent manner.Compared with the Ang Ⅱ(10-6 mol/L)group,the levels of Col Ⅰ and Col Ⅲ in CFBs in Ang Ⅱ(10-6 mol/L)+Ver(10-5 mol/L)group were significantly reduced(P<0.05).Ver(10-5 mol/L),Nic(10-4 mol/L)and P70S6K inhibitor(10-4 mol/L)could all significantly reduce the level of p-P70S6K,Col Ⅰ and Col Ⅲ in CFBs induced by Ang Ⅱ(10-6 mol/L)(P<0.05).CONCLUSION:Vericiguat can attenuate cardiac fibrosis by increasing cGMP,inhibiting SHR myocardial P70S6K phosphorylation and collagen synthesis in Ang Ⅱ-induced CFBs.

Objective:To explore the effects of age and gender on the sagittal spinal-pelvic parameters during the natural aging process of healthy adults.Methods:A total of 647 Chinese healthy adults who underwent health check-ups at the Second Affiliated Hospital of Zhejiang University School of Medicine and Songyang County People's Hospital, from January 2017 to September 2024 were collected. There were 277 males and 370 females, aged 18-93 years. Anteroposterior and lateral X-ray films of the whole spine were taken to evaluate the spinal-pelvic sagittal morphology. The following parameters were measured: thoracic kyphosis (TK), lumbar lordosis(LL), sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), global tilt (GT), T 1-pelvic angle (TPA), sagittal vertical axis (SVA), thoracic Cobb angle (T-Cobb), lower end vertebra of thoracic Cobb angle (T-LEV), apex vertebra of thoracic Cobb angle (T-Apex), lumbar Cobb angle (L-Cobb). Compare the differences in spine-pelvis parameters among patients of different genders and age groups (in this study, the subjects were subdivided into the 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-93 years groups according to the age range). Results:The results showed that GT, SVA, TPA, and PT increased with age ( P<0.05). For males aged 18-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-93 years, PT values were 8.58°±6.47°, 9.60°±5.63°, 12.65°±7.13°, 11.00°±6.99°, 13.01°±8.63°, 15.77°±8.02°, and 18.47°±10.03° respectively; for females in the same age groups, the PT values were 8.44°±6.83°, 9.00°±6.44°, 11.84°±7.35°, 12.07°±7.51°, 15.44°±9.39°, 19.26°±8.28°, and 18.17°±9.43° respectively. For males in these age groups, the global tilt (GT) values were 6.37°±7.20°, 8.77°±6.51°, 10.38°±9.07°, 8.80°±7.49°, 10.80°±8.62°, 16.07°±10.42°, and 21.99°±12.65° respectively; for females, the GT values were 4.46°±8.09°, 5.96°±7.83°, 8.17°±6.88°, 9.41°±8.03°, 9.96°±1.39°, 17.89°±9.39°, and 19.55°±12.34° respectively. The sagittal vertical axis (SVA) values for males in the age groups were -7.94±25.57 mm, -2.98±25.69 mm, -4.63±20.90 mm, -6.43±32.81 mm, 7.85±43.39 mm, 36.49±53.89 mm, and 55.57±51.10 mm respectively; for females, they were -24.12±31.35 mm, -17.49±25.12 mm, -17.88±22.72 mm, -8.25±30.91 mm, 8.80±27.45 mm, 28.67±38.22 mm, and 23.23±35.19 mm respectively. For males, the thoracic pelvic angle (TPA) values across the age groups were 4.46°±5.94°, 6.05°±5.38°, 9.58°±9.35°, 7.52°±7.64°, 11.23°±9.59°, 16.32°±12.38°, and 18.49°±11.70° respectively; for females, the TPA values were 2.72°±6.88°, 3.68°±6.26°, 7.30°±6.11°, 7.44°±6.75°, 12.64°±9.79°, 19.08°±10.39°, and 16.79°±13.19° respectively. T-Cobb, T-LEV, and T-Apex increased slowly with age ( P<0.05). The pelvic incidence (PI) remained relatively constant in males ( P>0.05), while it increased slowly with age in females ( P<0.05). Conclusions:Sagittal anteversion of the spinal-pelvis increases with age. Gender differences are reflected in specific changes in the fluctuation amplitude of certain parameters (such as PI), and the fluctuations of indicators like T-Cobb, T-LEV, and T-Apex are closely related to the natural aging process of the spine.

AIM:To investigate the effects of vericiguat(Ver)on inhibiting myocardial fibrosis and on myo-cardial angiotensin Ⅱ(Ang Ⅱ)type 1 receptor(AT1R)/P70 ribosomal S6 kinase(P70S6K)expression in spontaneously hypertensive rats(SHR).METHODS:Eight 3-month-old male Wistar-Kyoto(WKY)rats were used as the normal con-trol(WKY group),and 24 age-and sex-matched SHR were randomly and equally divided into SHR group,SHR+Ver1 group(Ver:1 mg·kg-1·d-1)and SHR+Ver3 group(Ver:3 mg·kg-1·d-1).Ver was administered via oral gavage at the cor-responding dose for 3 months.Blood pressure of rats was measured by tail-cuff method.Whole heart mass index(HMI)and left ventricular mass index(LVMI)were measured by weighing method.Myocardial collagen deposition was observed by Sirius red staining.Cardiac fibroblasts(CFBs)were cultured by tissue patch method and induced with angiotensin Ⅱ(Ang Ⅱ),followed by cellular intervention with Ver,nicorandil(Nic)or P70S6K inhibitor.The levels of collagen type Ⅰ(Col Ⅰ)and Col Ⅲ were determined by ELISA.The levels of Ang Ⅱ and cyclic guanylate cyclase(cGMP)were measured by radioimmunoassay.Western blot was performed to determine the protein levels of AT1R,P70S6K and p-P70S6K.RE-SULTS:Compared with WKY group,systolic blood pressure(SBP),diastolic blood pressure(DBP),HMI,LVMI,col-lagen volume fraction(CVF)and myocardial Col Ⅰ and Col Ⅲ in SHR group were increased(P<0.05).Compared with SHR group,HMI,LVMI,CVF and myocardial Col Ⅰ and Col Ⅲ in SHR+Ver1 group and SHR+Ver3 group were de-creased(P<0.05).The levels of plasma Ang Ⅱ,myocardial Ang Ⅱ,AT1R and p-P70S6K of myocardial tissue in SHR group were significantly higher than those of WKY group(P<0.05).Compared with SHR group,the p-P70S6K level in SHR+Ver1 group and SHR+Ver3 group was decreased(P<0.05).Compared with WKY group,myocardial cGMP level in SHR group was decreased(P<0.05).Compared with SHR group,cGMP level in SHR+Ver1 group and SHR+Ver3 group was increased(P<0.05).Ver(10-7～10-5 mol/L)could reduce the level of Ang Ⅱ-induced CFBs Col Ⅰ and Col Ⅲ synthesis in a concentration-dependent manner.Compared with the Ang Ⅱ(10-6 mol/L)group,the levels of Col Ⅰ and Col Ⅲ in CFBs in Ang Ⅱ(10-6 mol/L)+Ver(10-5 mol/L)group were significantly reduced(P<0.05).Ver(10-5 mol/L),Nic(10-4 mol/L)and P70S6K inhibitor(10-4 mol/L)could all significantly reduce the level of p-P70S6K,Col Ⅰ and Col Ⅲ in CFBs induced by Ang Ⅱ(10-6 mol/L)(P<0.05).CONCLUSION:Vericiguat can attenuate cardiac fibrosis by increasing cGMP,inhibiting SHR myocardial P70S6K phosphorylation and collagen synthesis in Ang Ⅱ-induced CFBs.

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.

Objective To investigate characteristics of cage migration after transforaminal lumbar interbody fusion (TLIF) and related risk factors.Methods A retrospective study was conducted to review cage migration in 512 patients who had undergone TLIF procedure from January 2010 to June 2011 in 5 spinal research centers.There were 255 males and 257 females,aged from 37 to 77 years (average,54.7 years).All patients were followed up at 3,6,12 months after operation.The clinical outcomes were evaluated using the visual analogue scores (VAS) and Oswestry disability index (ODI).X-rays and 3D CT scans were used to analyze the incidence and related risks factors of cage migration in these patients.Results Cage migration was found in 6 of 512 patients,the total incidence was 1.17％.Significant difference was found between each center.Cages with different shapes had different incidence.The analysis showed that the incidence of migration of rectangular-shaped cage (3.11％,5/161) was significantly higher than that of kidney-shaped cage (0.28％,1/351).The cage in double-segment TLIF (5.75％,5/87) was easier to migrate than that in monosegment TLIF (0.24％,1/425); furthermore,linear type endplate(3.50％,5/143) was remarkably easier to migrate than concave-concave one (0.27％,1/369).Conclusion Difference in operative skills,cage shape,number of fused segments,adjacent endplate shape,and lumbar spondylolisthesis might be risk factors for cage migration after TLIF.

Objective To evaluate the clinical value of multislice spiral CT(MSCT) reconstruction in designing the pedicle screw trajectory before operation in atlantoaxial lesions.Methods 37 patients with upper cervical abnormality treated by surgery for atlantoaxial or occipitoaxial interfixation and/or fusion were undergone MSCT scan,and the 3D anatomical data(including the length,width and height of each pedicle,the angle between the pedicle and sagittal plane,and the thickness of internal occipital crest) were measured on volume reconstruction(VR) and multi-plane reconstruction(MPR) images and used for surgeon to select advisable pedicle screws(including the proper length and diameter) and to ensure the comfortable point,depth and direction for screw position at preoperation.The patients were followed up by atlantoaxial X-ray image and/or MSCT reconstruction to estimate the veracity of the screw position.Results All the patients were operated successfully,of them,5 patients were treated by simply atlantoaxial fixation,15 by atlantoaxial fixation and fusion,4 by simply occipitoaxial fixation,11 by occipitoaxial fixation and fusion,2 by atlantoaxial fixation and occipitoaxial fusion.X-ray images and/or MSCT reconstruction revealed that atlantoaxis were reposition entirely and all the screws were at predesigned trajectory.All the patients were followed up and no screw was broken or loosen and no atlantoaxial redislocation was found.Conclusion MSCT reconstruction for designing pedicle screw trajectory in atlantoaxial lesions before operation is satisfactory and valuable for clinical application.