Varicocele (VC) is a common cause of male infertility, yet there is a lack of molecular information for VC-associated male infertility. This study investigated alterations in the seminal plasma metabolomic and lipidomic profiles of infertile male VC patients. Twenty infertile males with VC and twenty-three age-matched healthy controls (HCs) were recruited from Peking Union Medical College Hospital (Beijing, China) between October 2019 and April 2021. Untargeted metabolite and lipid profiles from seminal plasma were analyzed using mass spectrometry. Four hundred and seventy-six metabolites and seventeen lipids were significantly different in infertile male VC patients compared to HCs. The top enriched pathways among these significantly different metabolites are protein digestion and absorption, aminoacyl-transfer RNA (tRNA) biosynthesis, and biosynthesis of amino acids. Different key lipid species, including triglyceride (TG), diacylglycerol (DG), ceramides (Cer), and phosphatidylserine (PS), varied between VC and HC groups. The distinct metabolites and lipids were moderately correlated. DL-3-phenyllactic acid is a potential diagnostic biomarker for VC-related male infertility (area under the curve [AUC] = 0.893), positively correlating with sperm count, concentration, and motility. Furthermore, DL-3-phenyllactic acid is the only metabolite shared by all four comparisons (VC vs HC, VC-induced oligoasthenospermia [OAS] vs VC-induced asthenospermia [AS], OAS vs HC, and AS vs HC). DL-3-phenyllactic acid significantly decreased in OAS than AS. Metabolite-targeting gene analysis revealed carbonic anhydrase 9 (CA9) might be the strongest candidate associated with the onset and severity of VC. The seminal plasma metabolite and lipid profiles of infertile males with VC differ significantly from those of HCs. DL-3-phenyllactic acid could be a promising biomarker.
Humans ; Male ; Varicocele/complications* ; Infertility, Male/etiology* ; Semen/metabolism* ; Lipidomics ; Adult ; Metabolomics ; Case-Control Studies ; Biomarkers/metabolism*

BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

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.

Thoracolumbar spine fracture often leads to severe pain, functional impairments, and neurological deficits, for which open reduction and internal fixation can effectively restore the spinal structural stability. Open decompression and reduction with internal fixation can help relieve spinal cord compression and improve spinal function in cases of concomitant cord injury. Although spinal stability can be restored through surgery, patients often face chronic pain and functional impairments postoperatively. A postoperative rehabilitation program is critical in optimizing therapeutic outcomes, reducing complications, and minimizing the risk of secondary injuries. However, current rehabilitation methods, such as physical therapy, functional training, and pain management, are confronted with problems in clinical practice, including significant variation in efficacy, poor patient adherence, and prolonged rehabilitation period. There is an urgent need for a unified rehabilitation strategy to address these problems. To this end, the Spinal Trauma Group of the Orthopedic Physicians Branch of the Chinese Medical Association and the Spine Health Professional Committee of the Chinese Human Health Technology Promotion Association organized experts from relevant fields to formulate Evidence-based guidelines for rehabilitation treatment after internal fixation of thoracolumbar spine fracture in adults ( version 2025) by integrating evidences from clinical researches and advanced rehabilitation concepts at home and abroad. A total number of 14 recommendations concerning the rehabilitation treatment with multimodal analgesia, psychological intervention, deep vein thrombosis prevention, core muscle and extremity exercise, appropriate use of braces, early weight-bearing, device-aided rehabilitation exercise, neuroregulatory therapy, rehabilitation team were put forward, aiming to standardize the post-operative rehabilitation process following internal fixation, promote the functional recovery, and enhance patients′ quality of life.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the diagnostic value of gastroenteroscopic narrow band imaging(NBI)combine with serum amyloid A(SAA),C-reactive protein(CRP),D-Dimer(D-D)in children with abdominal henoch schonlein purpura(HSP).Methods:90 children with HSP who were admitted to our hospital from September 2022 to September 2024 were prospectively selected as the research objects,of which 50 children with abdominal HSP were included in the observation group and 40 children with other types of HSP were included in the control group.All children underwent gastroenteroscopic NBI examination and serum CRP,SAA and D-D levels were detected,and serum CRP,SAA and D-D levels were compared between the two groups,and the results of gastroenteroscopic NBI examination were analyzed in the two groups.Then the receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of gastroenteroscopic NBI and serum CRP,SAA,D-D alone or in combination in children with abdominal HSP.Results:Serum CRP,SAA and D-D levels in the observation group were significantly higher than those in the control group(P＜0.05);The results of gastroenteroscopic NBI showed that most of the children with abdominal HSP had some degree of changes in the gastric and duodenal mucosa,with mucosal congestion,edema,erosion,ulceration,and scattered bright or dark red bleeding spots as the main manifestations.Under gastroenteroscopic NBI,41 of 50 children with abdominal HSP were diagnosed as abdominal HSP,and 11 of 40 children with other types of HSP were diagnosed as abdominal HSP;the area under curve(AUC)of serum CRP,SAA,and D-D in the diagnosis of children with abdominal HSP were 0.668,0.720 and 0.771,respectively,and the AUC of the combination diagnosis of serum CRP,SAA and D-D in the diagnosis of children with abdominal HSP was 0.815;The AUC of the diagnosis of gastroenteroscopic NBI and serum CRP,SAA and D-D in children with abdominal HSP was 0.801 and 0.815,respectively,and the AUC of the combination diagnosis of gastroenteroscopic NBI in children with abdominal HSP was 0.867.Conclusion:Serum CRP,SAA and D-D in children with abdominal HSP were significantly increased,and the main manifestations under gastroenteroscopic NBI were mucosal congestion,edema,erosion,ulceration and scattered bright or dark red bleeding spots as the main manifestations.Gastroenteroscopic NBI combine with serum CRP,SAA and D-D could significantly improve the diagnostic efficiency of children with abdominal HSP.

Objective:To investigate the diagnostic value of gastroenteroscopic narrow band imaging(NBI)combine with serum amyloid A(SAA),C-reactive protein(CRP),D-Dimer(D-D)in children with abdominal henoch schonlein purpura(HSP).Methods:90 children with HSP who were admitted to our hospital from September 2022 to September 2024 were prospectively selected as the research objects,of which 50 children with abdominal HSP were included in the observation group and 40 children with other types of HSP were included in the control group.All children underwent gastroenteroscopic NBI examination and serum CRP,SAA and D-D levels were detected,and serum CRP,SAA and D-D levels were compared between the two groups,and the results of gastroenteroscopic NBI examination were analyzed in the two groups.Then the receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of gastroenteroscopic NBI and serum CRP,SAA,D-D alone or in combination in children with abdominal HSP.Results:Serum CRP,SAA and D-D levels in the observation group were significantly higher than those in the control group(P＜0.05);The results of gastroenteroscopic NBI showed that most of the children with abdominal HSP had some degree of changes in the gastric and duodenal mucosa,with mucosal congestion,edema,erosion,ulceration,and scattered bright or dark red bleeding spots as the main manifestations.Under gastroenteroscopic NBI,41 of 50 children with abdominal HSP were diagnosed as abdominal HSP,and 11 of 40 children with other types of HSP were diagnosed as abdominal HSP;the area under curve(AUC)of serum CRP,SAA,and D-D in the diagnosis of children with abdominal HSP were 0.668,0.720 and 0.771,respectively,and the AUC of the combination diagnosis of serum CRP,SAA and D-D in the diagnosis of children with abdominal HSP was 0.815;The AUC of the diagnosis of gastroenteroscopic NBI and serum CRP,SAA and D-D in children with abdominal HSP was 0.801 and 0.815,respectively,and the AUC of the combination diagnosis of gastroenteroscopic NBI in children with abdominal HSP was 0.867.Conclusion:Serum CRP,SAA and D-D in children with abdominal HSP were significantly increased,and the main manifestations under gastroenteroscopic NBI were mucosal congestion,edema,erosion,ulceration and scattered bright or dark red bleeding spots as the main manifestations.Gastroenteroscopic NBI combine with serum CRP,SAA and D-D could significantly improve the diagnostic efficiency of children with abdominal HSP.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.