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 observe the clinical efficacy of Shengdi Xiexin Decoction combined with proton pump inhibitors(PPIs)in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB)with stomach-heat congestion syndrome.Methods Sixty-two patients with ANVUGIB of stomach-heat congestion syndrome admitted to Dongguan Hospital of Guangzhou University of Chinese Medicine between January and December 2024 were randomly divided into a treatment group(n=31)and a control group(n=31)using a random number table.The control group received conventional western therapy(e.g.,Omeprazole Sodium),while the treatment group additionally received Shengdi Xiexin Decoction.Both groups were treated for 7 days,followed by 8 weeks of follow-up.The changes in traditional Chinese medicine(TCM)syndrome scores,hematological parameters[hemoglobin(Hb),red blood cells(RBC),hematocrit(Hct),albumin(ALB)],tissue perfusion and metabolic markers[blood urea nitrogen/creatinine ratio(BUN/Cr),lactate(Lac)levels],hemostasis time,time to resume oral diet,hospital stay duration,hospitalization costs,and rebleeding rates were observed to evaluate the clinical efficacy and drug safety.Results(1)After 7 days of treatment,the total effective rate was significantly higher in the treatment group(90.32％,28/31)than that in the control group(74.19％,23/31).The intergroup comparison(by chi-square test)showed that the treatment group,efficacy was superior to that of the control group(P＜0.05).(2)The treatment group showed significantly short hemostasis time,time to resume oral diet,and hospital stay duration(P＜0.05),as well as significantly low hospitalization costs(P＜0.05)compared to the control group.(3)Both groups exhibited significant reductions in the scores of epigastric burning pain,abdominal distension,acid regurgitation,restlessness,excessive thirst,scanty dark uring and dry stools,and total TCM syndrome scores(P＜0.05).The treatment group demonstrated significantly greater improvements in the scores of abdominal distension,acid regurgitation,restlessness,dark uring and dry stools,and total TCM syndrome scores(P＜0.05),while no significant differences were observed in epigastric burning pain and excessive thirst(P＞0.05).(4)Hb and Hct levels increased significantly in both groups(P＜0.05),with a greater increase in the treatment group(P＜0.05).Although RBC and ALB levels showed an upward trend,no significant differences were observed between groups(P＞0.05).Following treatment,intergroup comparisons revealed that the treatment group demonstrated significantly greater increases in Hb and Hct levels than the control group(P＜0.05).In contrast,the two groups showed comparable effects in elevating RBC and ALB levels,with no statistically significant differences(P＞0.05).(5)BUN/Cr ratio and Lac levels decreased significantly in both groups(P＜0.05),with a more pronounced reduction in the treatment group(P＜0.05).(6)No significant differences were found in early or delayed rebleeding rates between groups(P＞0.05).(7)Neither group experienced significant adverse events.Conclusion Shengdi Xiexin Decoction combined with PPIs significantly improves clinical outcomes in ANVUGIB patients with stomach-heat congestion syndrome.It is effective on enhancing hematological parameters,correcting tissue hypoperfusion,alleviating symptoms,shortening hemostasis time and hospitalization durations,and reducing medical costs,demonstrating excellent safety.

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.

ObjectiveTo identify and clarify the key issues faced by tertiary hospitals in responding to public health emergencies. MethodsA literature review index system was constructed， and key issues were identified using hierarchical analysis. ResultsAfter a systematic literature review， 20 types of problems faced by tertiary hospitals in responding to public health emergencies were identified. Three key issues were ultimately identified by prioritizing the issues that needed to be addressed. ConclusionThe key issues of tertiary hospitals in responding to public health emergencies are concentrated in the areas of emergency response capabilities and competencies of medical staff， the number of emergency response personnel， and the standardization and specificity of training and drills. Tertiary hospitals should focus on these issues in developing public health emergency response systems to improve the effectiveness of their emergency response.

Steroid-induced avascular necrosis of the femoral head (SANFH) is the death of the femoral head caused by long-term use of glucocorticoid (GC). Its pathological manifestations are mainly trabecular bone collapse and increased empty bone lacunas, osteocyte apoptosis rate and autophagy rate. Its pathogenesis is complicated, and the exact pathogenesis is still unclear. MicroRNAs (miRNAs) are a group of endogenous, non-coding small RNAs with an average length of 23 nucleotides. They are responsible for negatively regulating gene expression after transcription by inhibiting target messenger RNAs (mRNAs). MiRNAs play an important role in physiological processes, including cell development, proliferation, differentiation, metabolism, migration and apoptosis. According to bioinformatics analysis, MiRNAs play an important role in regulating gene expression, and it is estimated that more than one-third of human genes are regulated by them. In the past few years, more and more miRNAs have been found to be related to osteonecrosis, such as regulating the proliferation and differentiation of mesenchymal stem cells and osteoblasts. This article aims to review the relationship between steroid-induced femoral head necrosis and miRNAs.

Globally, more than 2 million bone grafts are performed every year for bone defects in orthopedics, neurosurgery, and dental procedures. Current treatment options include the use of grafts of human, animal or synthetic origin. In this case, autograft is the current gold standard. However, its quantity is limited, a second wound(donor site) needs to be created, and the risk of infection, pain, and morbidity increases. In recent years, the rise of tissue engineering and 3D bioprinting has provided a new idea for treating bone defects in patients. 3D bioprinting is a branch of the applications of "additive manufacturing" in biological tissue engineering. It can precisely control cells, personalize macro and micro structures as needed, and can be used in bone regeneration applications. The establishment of osteoblast scaffolds is the basis of 3D bioprinting, and hydrogels suitable for the growth of bone and cartilage are the basis of scaffold research. For this reason, domestic and foreign scholars have developed and researcheda variety of hydrogel scaffolds, and they have found that mixed hydrogels with multiple biological materials have more advantages than single-material hydrogels. For example, hydroxyapatite, alginate or hyaluronic acid is used as the main component to mix several or more bioprinting materials, and 3D printed bone scaffold formed after combining the required cells can promote bone growth and differentiation better than traditional scaffolds. As the printed structure becomes thicker, the diffusion of nutrients and oxygen becomes more and more difficult. This is especially true in the reconstruction of bone tissue and it is necessary to create an interconnected and effective vascular network. Therefore, the formation of blood vessels in the stent is indispensable. This article mainly reviews the step-by-step research progress of bone printing scaffold materials and vascular network formation in 3D bioprinting.

Objective To analyze rural doctors′ social mentality with the theory of relative deprivation.Methods 642 rural doctors from 225 villages of 1 5 counties in Shandong were selected for a questionnaire survey.The factor analysis method was used to reduce the scale dimension and simplify the scale.Analysis of rural doctors′vertical and horizontal relative deprivation was made based on different reference groups.Results Rural doctors tend to identify themselves with rural teachers and doctors in township hospitals,and 60.0% identify themselves as the low income group.39.9% of them found a higher income,while 33.5% of them found a higher social status.76.3% of them found their social contributions are higher.91.4% of them hold that villagers benefit from the new healthcare reform policies,while 65.9% of them hold themselves as benefiting from such policies.This indicates a low sense of achievement.Conclusions Compared with the reference groups,rural doctors feel an obvious sense of relative deprivation comparing both horizontally and vertically.They hold themselves as underpaid and have little sense of achievement for the policies.In this consideration,the government should increase subsidies to lift pay for rural doctors,and to identify their legitimacy,in order to stabilize these medical workers.

Grounded theory was used to summarize and analyze influencing factors and their mechanism on availability of essential medicine.Four factors which influenced the availability of essential medicine were singled out:defective top design in the essential medicine system,interactions among its policies,deviations in the policy implementation by government agencies,and deficiency of supporting policies for the system.The availability of essential medicine in rural areas was influenced by a variety of factors.The ideas and methods of the grounded theory prove helpful for this study.In the future studies,both qualitative and quantitative study should be made to perfect this model formed by the grounded theory,to identify roadblocks and underlying causes in order to provide evidence for improving availability of essential medicine in rural areas.

Objective To evaluate the township hospitals'medical service efficiency in Shandong province,and to provide references for the development in township hospitals under the background of the essential medicine system.Methods The method of data envelopment analysis(DEA)was used to analyze the township hospitals' medical service efficiency in Shandong province before and since the implementation of the essential medicine system.Results For the township hospitals in Shandong province in general,their relative efficiency ratio of the medical service efficiency dropped from 66.67% to 53.33% since the implementation of the essential medicine system.In terms of the input and output,the non-DEA effective township hospitals are found with insufficient output as measured by the output indicator,while some input indicators input were found as excessive.Conclusion The low scale efficiency has become the main factor for the low service efficiency of such hospitals since the implementation of the essential medicine system in Shandong province.In order to improve the medical service efficiency,it is important to continue to improve the essential medicine system,increase the medical staff's incentives, improve the fiscal compensation policy,and keep the policy continuity.

To study performance problems found in China's essential medicine system.The SmithModel of system implementation was called into play in a systematic collation and analysis for the ideal policies,system implementation agencies,target groups and policy environment in its performance,along with relationships among the four factors.The system is found with a number of loopholes as the system itself is highly idealized,its system objectives set inappropriately,problems found with the four factors,and tension and conflicts among these factors.Given these problems found in its performance,it is inappropriate to make drastic changes to avoid instability of the system at its early stage.Government departments in question are advised to comprehensively analyze the four factors and their relationships then taking effective measures to deal with them and the tension,conflict among them.This can ensure effectively implementation of the essential medicine system.