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.

The prefrontal cortex (PFC) plays a pivotal role in orchestrating higher-order emotional and cognitive processes, a function that depends on the precise modulation of synaptic activity. Although pharmacological studies have demonstrated that dopamine signaling through dopamine D1 receptor (DRD1) in the PFC is essential for these functions, the cell-type-specific and molecular mechanisms underlying the neuromodulatory effects remain elusive. Using cell-type-specific knockout mice and patch-clamp recordings, we investigated the regulatory role of DRD1 on neurons and astrocytes in synaptic transmission and plasticity. Furthermore, we explored the mechanisms by which DRD1 on astrocytes regulate synaptic transmission and plasticity at the cellular level, as well as emotional and cognitive functions at the behavioral level, through two-photon imaging, microdialysis, high-performance liquid chromatography, transcriptome sequencing, and behavioral testing. We found that conditional knockout of the Drd1 in astrocytes (CKO^AST) increased glutamatergic synaptic transmission and long-term potentiation (LTP) in the medial prefrontal cortex (mPFC), whereas Drd1 deletion in pyramidal neurons did not affect synaptic transmission. The elevated level of d-serine in the mPFC of CKO^AST mice increased glutamatergic transmission and LTP through NMDA receptors. In addition, CKO^AST mice exhibited abnormal emotional and cognitive function. Notably, these behavioral changes in CKO^AST mice could be reversed through the administration of d-serine degrease to the mPFC. These results highlight the critical role of the astrocytic DRD1 in modulating mPFC synaptic transmission and plasticity, as well as higher brain functions through d-serine, and may shed light on the treatment of mental disorders.

OBJECTIVE: To observe the clinical efficacy of auricular electroacupuncture for post-stroke dysphagia in the pharyngeal phase. METHODS: Eighty-two patients with post-stroke dysphagia in the pharyngeal phase were randomized into an auricular electroacupuncture group (41 cases) and a swallowing electrical stimulation group (41 cases, 1 case dropped out). In the auricular electroacupuncture group, electroacupuncture was applied at auricular points, i.e. Xin (CO₁₅) and Yanhou (TG₃), using disperse-dense wave, in frequency of 2 Hz/10 Hz, 30 min a time. In the swallowing electrical stimulation group, swallowing electrical stimulation was delivered for 30 min a time. Both groups were treated once daily for 4 weeks. The functional oral intake scale (FOIS) grade, as well as the hyolaryngeal complex displacement, the pharyngeal constriction rate (PCR) and the pharyngeal delay time (PDT) under video fluoroscopic study of swallowing (VFSS) were observed before and after treatment, and the clinical efficacy was evaluated in the two groups. RESULTS: Compared before treatment, the FOIS grade was improved (P<0.01), the forward and upward displacement amplitude of hyoid bone and thyroid cartilage was increased (P<0.05), and the PCR and PDT were decreased (P<0.05) after treatment in the two groups. After treatment, compared with the swallowing electrical stimulation group, the FOIS grade was superior (P<0.01), the upward displacement amplitude of hyoid bone and thyroid cartilage was larger (P<0.05) and the PCR and PDT were lower (P<0.05) in the auricular electroacupuncture group. The total effective rate was 85.4% (35/41) in the auricular electroacupuncture group, which was higher than 62.5% (25/40) in the swallowing electrical stimulation group (P<0.05). CONCLUSION Auricular electroacupuncture can effectively trigger pharyngeal initiation and improve post-stroke dysphagia in the pharyngeal phase.
Humans ; Electroacupuncture ; Male ; Deglutition Disorders/etiology* ; Female ; Middle Aged ; Aged ; Stroke/physiopathology* ; Pharynx/physiopathology* ; Acupuncture, Ear ; Acupuncture Points ; Deglutition ; Treatment Outcome ; Adult

Objective:To analyze the risk factors for aspiration pneumonia m patients with post-stroke dysphagia based on quantitative analysis of videofluoroscopic swallowing study(VFSS),and to construct a prediction model and validate it in order to standardize the management of high-risk patients with post-stroke dysphagia complicating aspiration pneumonia.Method:A total of 556 patients with post-stroke dysphagia admitted to Xiamen Hospital of Beijing University of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the study and divided into a modeling group(n=436)and an external validation group(n=120).The model group was divided into pneumo-nia group(n=113,25.9％)and non-pneumonia group(n=323,74.1％)according to the occurrence of aspiration pneumonia.Clinical data and VFSS results were collected for all participants.Logistic regression identified the risk factors for aspiration pneumonia,and a nomogram predictive model was constructed.Model perfonnance was evaluated using receiver operating characteristic(ROC)curves,the area under the ROC curve(AUC),and the Hosmer-Lemeshow goodness-of-fit test.External validation was conducted to assess the sensitivity,spec-ificity and consistency of the model.Result:Logistic regression analysis showed that advanced age,poor oral hygiene,tracheotomy,Penetration-As-piration Scale(PAS)grade≥5,pharyngeal residue and prolonged pharyngeal transport time were risk factors for aspiration pneumonia,and active cough and eating instruction were protective factors(P＜0.05 for both).The predictive risk index(C-index)of the nomogram prediction model was 0.957,AUC=0.957,sensitivity was 93.8％,specificity was 86.4％,and the Hosmer-Lemeshow goodness of fit test showed P=0.6.Conclusion:The predictive model can be used to predict the occurrence of aspiration pneumonia in stroke pa-tients with dysphagia.Its use in clinical practice allows for the development of targeted and individualized inter-ventions according to patient risk levels,thereby improving the quality of nursing.

Objective:To analyze the risk factors for aspiration pneumonia m patients with post-stroke dysphagia based on quantitative analysis of videofluoroscopic swallowing study(VFSS),and to construct a prediction model and validate it in order to standardize the management of high-risk patients with post-stroke dysphagia complicating aspiration pneumonia.Method:A total of 556 patients with post-stroke dysphagia admitted to Xiamen Hospital of Beijing University of Traditional Chinese Medicine from July 2021 to June 2023 were selected for the study and divided into a modeling group(n=436)and an external validation group(n=120).The model group was divided into pneumo-nia group(n=113,25.9％)and non-pneumonia group(n=323,74.1％)according to the occurrence of aspiration pneumonia.Clinical data and VFSS results were collected for all participants.Logistic regression identified the risk factors for aspiration pneumonia,and a nomogram predictive model was constructed.Model perfonnance was evaluated using receiver operating characteristic(ROC)curves,the area under the ROC curve(AUC),and the Hosmer-Lemeshow goodness-of-fit test.External validation was conducted to assess the sensitivity,spec-ificity and consistency of the model.Result:Logistic regression analysis showed that advanced age,poor oral hygiene,tracheotomy,Penetration-As-piration Scale(PAS)grade≥5,pharyngeal residue and prolonged pharyngeal transport time were risk factors for aspiration pneumonia,and active cough and eating instruction were protective factors(P＜0.05 for both).The predictive risk index(C-index)of the nomogram prediction model was 0.957,AUC=0.957,sensitivity was 93.8％,specificity was 86.4％,and the Hosmer-Lemeshow goodness of fit test showed P=0.6.Conclusion:The predictive model can be used to predict the occurrence of aspiration pneumonia in stroke pa-tients with dysphagia.Its use in clinical practice allows for the development of targeted and individualized inter-ventions according to patient risk levels,thereby improving the quality of nursing.

Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.

Objective:To introduce the clinical application of "page-turning" superior pancreatic lymph node dissection in laparoscopic D2 radical gastrectomy for gastric cancer.Methods:Patients who were confirmed to have adenocarcinoma by preoperative gastroscopy and pathological biopsy, with tumor staging evaluated by imaging as cT1~4aN0~3M0, without neoadjuvant therapy, and without absolute surgical contraindications, underwent laparoscopic radical gastrectomy for gastric cancer with "page-turning" superior pancreatic lymph node dissection. The "page-turning" superior pancreatic lymph node dissection was performed in four steps: (1) Expose the posterior gastric mesentery and dissect No.11p lymph nodes; (2) Expose the left gastric mesentery and dissect No.7, No.8a and No.9 lymph nodes; (3) Expose the right gastric mesentery and dissect No.5 lymph nodes; (4) Expose the left edge of the portal vein and dissect No.12a lymph nodes.Results:From April 2018 to October 2024, 112 patients with gastric cancer underwent laparoscopic D2 radical gastrectomy with "page-turning" superior pancreatic lymph node dissection, including 21 cases in the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 78 cases in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, and 13 cases in the Department of Gastrointestinal Surgery, Jilin Provincial People's Hospital. The TNM staging of all patients was as follows: 31 cases in stage Ⅰ, 24 cases in stage Ⅱ, and 57 cases in stage Ⅲ; 62 cases of differentiated adenocarcinoma and 50 cases of undifferentiated adenocarcinoma; the median length of tumors was 3.8 cm. All patients successfully completed the operation without conversion to open surgery, no intraoperative massive hemorrhage or postoperative death. The median total number of lymph nodes dissected in all patients was 32, and the median number of positive lymph nodes was 4.5. The overall postoperative complication rate was 5.4% (6/112), all of which were Clavien-Dindo grade Ⅱ, including pulmonary infection, pleural effusion, and incisional infection, all cured by symptomatic treatment. The median follow-up was 41.8 (2-78) months, with 7 cases lost to follow-up. During the follow-up period, 27 cases (25.7%) had tumor recurrence and 16 cases (15.2%) died.Conclusions:The "page-turning" superior pancreatic lymph node dissection technique is safe and feasible in laparoscopic radical gastrectomy for gastric cancer.

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 study the influence of different region of interest (ROI) sketch on measurement results in the diagnosis of breast cancer by imaging technology of intravoxel incoherent motion (IVIM) .Methods:The clinical dataes of 84 patients with breast mass lesions from Apr. 2017 to Oct. 2021 were collected, all patients underwent IVIM-DWI. ROI was delineated at the maximum level of the mass by tumor contour method and fixed radius method. The apparent diffusion coefficient (ADC), real diffusion coefficient (D), perfusion fraction (f) and pseudo diffusion coefficient (D *) were recorded. IVIM-DWI parameters of patients with benign and malignant breast tumors were compared. The influence of ROI delineation by tumor contour method and fixed radius method on the results of IVIM related parameters were compared. Results:Forty-six of 84 patients were malignant and 38 benign masses. The ADC and D values of patients in the malignant group were (0.98±0.24) ×10 -3 mm 2/s, (0.79±0.22) ×10 -3 mm 2/s in the malignant group, significantly lower than those in the benign group [ (1.65±0.43) ×10 -3 mm 2/s, (1.41±0.35) ×10 -3 mm 2/s], and the f value and D * value were (5.65±1.13) %, (43.89±8.05) ×10 -3 mm 2/s, significantly higher than those in the benign group [ (3.84±1.57) %, (37.77±9.3) ×10 -3 mm 2/s]. The differences were statistically significant ( t=9.01, 9.89, 6.13, 3.23; all P<0.05). The results obtained by using the tumor fixed radius method to delineate ROI showed that the ADC and D values of (0.96±0.27) ×10 -3 mm 2/s (0.81±0.23) ×10 -3 mm 2/s in the malignant group were significantly lower than those in the benign group [ (1.66±0.39) ×10 -3 mm 2/s, 1.39±0.37) ×10 -3 mm 2/s], and the f and D * values were (5.69±1.15) %, (43.94±7.98) ×10 -3 mm 2/s, which were significantly higher than those in the benign group [ (3.86±1.49) %, (38.01±8.46) ×10 -3 mm 2/s]. The differences were statistically significant ( t=9.69, 8.78, 6.35, 3.30; all P<0.05) .The 95% consistency interval range of ADC difference, D value difference, f value difference, and D * value difference obtained by using tumor contour method to delineate ROI was smaller than that of tumor fixed radius method. Conclusions:The IVIM has high accuracy in the diagnosis of breast cancer, the IVIM parameters obtained from ROI delineation by tumor contour method have good repeatability.

OBJECTIVE: To observe the clinical effect of CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on post-stroke swallowing dysfunction (PSD) in the pharyngeal phase, and explore its biomechanical mechanism. METHODS: A total of 72 patients with PSD in the pharyngeal phase were randomly divided into a ziwu reinforcing and reducing acupuncture group (36 cases, 2 cases dropped out and 1 case was eliminated) and a conventional acupuncture group (36 cases, 1 case dropped out and 1 case was eliminated). The patients in the conventional acupuncture group were treated with conventional acupuncture at Lianquan (CV 23) and bilateral Fengchi (GB 20), Wangu (GB 12), Tongli (HT 5), Zhaohai (KI 6), Hegu (LI 4), Taichong (LR 3). The patients in the ziwu reinforcing and reducing acupuncture group were treated with CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method on the basis of the conventional acupuncture group's acupoints. Both groups were treated with acupuncture for 30 min each time, once a day, and rested for 1 day after 6 days of treatment, and the treatment lasted 4 weeks. Before and after treatment, the standardized swallowing assessment (SSA) score, Rosenbek penetration aspiration scale (PAS) grade, the shortening rate of mandibular-hyoid distance, swallowing quality of life (SWAL-QOL) score were evaluated in the two groups. The removal rate of nasogastric feeding tube was compared in the two groups, and the clinical efficacy and safety of the two groups were compared. RESULTS: After treatment, the SSA scores and PAS grade of the two groups were lower than those before treatment (P<0.001), and above indexes in the ziwu reinforcing and reducing acupuncture group were lower than those in the conventional acupuncture group (P<0.01, P<0.05). After treatment, the shortening rates of mandibular-hyoid distance and SWAL-QOL scores in the two groups were higher than those before treatment (P<0.001), and the shortening rate of mandibular-hyoid distance in the ziwu reinforcing and reducing acupuncture group was higher than that in the conventional acupuncture group (P<0.001). The removal rate of nasogastric feeding tube in the ziwu reinforcing and reducing acupuncture group was 87.9% (29/33), which was higher than 61.8% (21/34) in the conventional acupuncture group (P<0.05). The total effective rate of the ziwu reinforcing and reducing acupuncture group was 84.8% (28/33), which was higher than 61.8% (21/34) of the conventional acupuncture group (P<0.05). Neither group experienced serious adverse reactions. CONCLUSION CHEN Yinglong 's ziwu reinforcing and reducing acupuncture method can effectively improve swallowing dysfunction in the pharyngeal phase after stroke, reduce the risk of aspiration, and improve quality of life. Its therapeutic effect may be related to increasing the displacement amplitude of the hyoid bone.
Humans ; Male ; Female ; Middle Aged ; Aged ; Acupuncture Therapy ; Stroke/therapy* ; Acupuncture Points ; Deglutition Disorders/physiopathology* ; Deglutition ; Treatment Outcome ; Adult ; Pharynx/physiopathology*