OBJECTIVE: To explore the relationship between the effect of acupuncture and layered localization of computed tomography (CT) in treatment of lumbar disc herniation. METHODS: Based on the CT layered localization, the herniated lumbar discs were positioned in 5 layers, A, B, C, D and E among 300 patients with lumbar disc herniation. Combined with the horizontal and the frontal planes, the three-dimensional location was formed. Acupuncture was delivered at acupoints including bilateral Shenshu (BL23), Dachangshu (BL25), and Huantiao (GB30), Weizhong (BL40) on the affected side. One intervention of acupuncture was 30 min, once daily; 1 course of treatment was composed of 10 interventions and 2 courses were required. Before and after treatment, Japanese orthopaedic association (JOA) score was recorded, and the effect was evaluated. The curative effect was classified and compared with the CT layered localization. RESULTS: Of 300 patients, 226 cases were effective and the effective rate was 75.33%. The JOA scores of all patients, and in the effective group and the non-effective group were higher compared with the scores before treatment (P<0.05). With the layered localization considered, acupuncture was more effective on the cases positioned in C layer. Regarding the horizontal plane, the effect was better on the cases with zone 1 and zone 1-2 involved. In terms of the grade of frontal plane, acupuncture was more effective on the cases graded Ⅰ and Ⅱ. CONCLUSION The clinical effect of acupuncture on lumbar disc herniation is related with the layer and the horizontal zone of herniated disc positioned, as well as to the grade of the frontal plane.
Humans ; Acupuncture Therapy ; Intervertebral Disc Displacement/diagnostic imaging* ; Male ; Female ; Middle Aged ; Adult ; Tomography, X-Ray Computed ; Lumbar Vertebrae/diagnostic imaging* ; Acupuncture Points ; Aged ; Young Adult ; Treatment Outcome

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 postoperative changes of tear cytokines in patients with advanced refractory glaucoma and their impact on ocular surface-related indicators.Methods In total,120 patients(240 eyes)with advanced refractory glaucoma admitted from January 2023 to June 2024 were selected as the observation group,all of whom underwent glaucoma drainage device(GDD)implantation.Another 85 healthy individuals(170 eyes)who underwent ophthalmic examinations during the same period were selected as the control group.The changes in tear cytokine levels[interleukin-1α(IL-1α),interleukin-2(IL-2),tumor necrosis factor-α(TNF-α),transforming growth factor-β(TGF-β),interleukin-10(IL-10),vascular endothelial growth factor(VEGF)]and ocular surface-related indicators[tear film break-up time(BUT),Schirmer I test(SIt)values,and corneal fluorescein staining(CFS)scores]were observed and recorded at 1 d before surgery and at 1,7,30,and 60 d after surgery in the observation group,and the levels of the above indicators were compared with those in the control group.Pearson correlation analysis was used to investigate the correlation between changes in IL-1α,IL-2,TNF-α,TGF-β,IL-10,VEGF levels and SIt values,CFS scores,and BUT.Results There were significant differences in the levels of IL-1α,IL-2,TNF-α,TGF-β,IL-10,and VEGF in the observation group when compared at 1 d before surgery and at 1,7,and 30 d after surgery(P<0.05).There was no significant difference in the levels of IL-1α,IL-2,TNF-α,TGF-β,IL-10,and VEGF in the observation group when compared at 1 d before surgery and at 60 d after surgery(P>0.05),nor significant difference compared with the control group(P>0.05).The differences in BUT,SIt values,and CFS scores in the observation group at 1 d before surgery and at 1,30,and 60 d after surgery were statistically significant(P<0.05),and the levels of the above indicators in the observation group were comparable to those in the control group at 60 d after surgery(P>0.05).Pearson correlation analysis showed that IL-1α,IL-2,TNF-α,TGF-β,IL-10,and VEGF in the observation group were positively correlated with SIt value and CFS score,and negatively correlated with BUT(P<0.05).Conclusion In the early postoperative period(1-30 d),the levels of IL-1α,IL-2,TNF-α,TGF-β,IL-10,and VEGF in the tears of patients with advanced refractory glaucoma are significantly increased,and returned to preoperative levels at 60 d after surgery.The above cytokines are positively correlated with SIt values and CFS scores,and negatively correlated with BUT.

Objective To develop an automated bone mineral density(BMD)assessment model based on proximal femur images from abdomen-pelvic CT scans and to analyze its application value in opportunistic osteoporosis(OP)screening.Methods A retrospective selection was conducted on 351 patients who underwent abdomen-pelvic plain CT examination.The patients were randomly divided into training set(n=245)and test set(n=106)in a ratio of 7∶3.All images were transferred to a quantitative computed tomography(QCT)post-processing workstation to measure the BMD of the left proximal femur.According to the QCT BMD T-score,the patients were divided into osteoporosis(T-score-2.5),osteopenia(-2.5＜T-score＜-1)and normal bone density(T-score≥-1).The left proximal femur was dissected using an automatic segmentation model,and two three-class BMD assessment radiomics models were constructed using random forest(RF)and logistic regression(LR)classifiers,respectively.The receiver operating characteristic(ROC)curves were generated,and the area under the curve(AUC),sensitivity,specificity and other metrics were calculated to evaluate the diagnostic performance of the two models.The DeLong test was used to compare differences between the models.Results In the test set,the AUC of the RF and LR models for identifying osteoporosis were 0.953 and 0.954,respectively.The AUC for identifying osteopenia were 0.894 and 0.870,and the AUC for identifying normal bone density were 0.975 and 0.982,respectively.The comparison of model performance showed no statistically significant differences between the RF and LR models in identifying the three bone states in both the training and test sets(P＞0.05).Conclusion Both the RF and LR radiomics models,constructed based on abdomen-pelvic plain CT scans,can be used for opportunistic BMD screening with high diagnostic efficiency.

Objective To investigate and compare the epidemiological characteristics of common respiratory viruses among influenza-like illness(ILI)and severe acute respiratory infection(SARI)cases in Huzhou,Zhejiang Province before and after the COVID-19 pandemic,so as to provide a basis for formulating and adjusting the prevention and control strategies for viral respiratory infectious diseases.Methods ILI and SARI cases at two influenza surveillance sentinel hospitals in Huzhou and had throat swab samples collected during Nov 2017 to Feb 2020(pre-COVID-19 pandemic period)and Dec 2022 to Apr 2024(post-COVID-19 mitigation phase)were selected as the participants.Seven common viral respiratory pathogens were tested,including influenza A virus(H1N1 and H3N2 subtypes),influenza B virus(Victoria lineage,FluB),respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),and severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).The positive rates of respiratory pathogens before and after the COVID-19 pandemic were compared across different age groups and different time.Results A total of 7 948 ILI samples and 2 294 SARI samples were included.The overall positive rate of ILI samples increased from 33.6%to 47.1%,primarily due to the increase in influenza and COVID-19 infections;the overall positive rate of SARI samples decreased from 31.4%to 24.8%,mainly due to the reduction in HRV and ADV infections.During the post-COVID-19 mitigation phase,SARS-CoV-2(22.1%),H3N2(12.7%),and FluB(6.0%)were the primary pathogens in ILI samples,while RSV(7.1%),H3N2(5.3%),and HRV(4.5%)dominated in SARI samples.During the post-COVID-19 mitigation phase,the influenza virus circulation period was shortened.Before the COVID-19 pandemic,RSV was mainly detected in autumn and winter,while during the post-COVID-19 mitigation phase,out-of-season RSV epidemics were observed in spring and summer.Co-infection rate in ILI cases increased significantly in the post-COVID-19 mitigation phase,predominantly consisting of co-infections of COVID-19 and influenza A virus,while co-infection rate in SARI cases showed a decline.Conclusion We found important epidemiological changes in respiratory viruses in Huzhou during the post-COVID-19 mitigation phase compared to pre-COVID-19 period,including increased positive rates of influenza and COVID-19,and disruptions to the seasonal patterns of influenza and RSV.The prevention and control strategies should be adjusted in a timely manner based on the monitoring data.

With the aging of the population,the disease burden of heart valve disease in China has significantly increased.In recent years,the interventional treatment for heart valve disease has flourished,among which transcatheter aortic valve replacement(TAVR)has become the first-line treatment for elderly patients with aortic valve stenosis.China started relatively late in the field of interventional treatment for heart valve disease.The construction of heart valve centers helps to standardize the diagnosis and interventional treatment of heart valve disease in China and improve the management of prognosis for patients.Up to December 2024,a total of 453 centers have participated in the construction of heart valve centers,including 100 construction centers and 40 certification centers.The National Transcatheter Valve Therapeutics Registry(NTCVR)database has reported a total of 28 594 cases,with approximately 50％of Chinese TAVR cases recorded in NTCVR database.The construction of the heart valve centers has shown initial results,significantly optimizing the process of diagnosis and treatment of heart valve disease and improving the prognosis.At present,there are still many shortcomings in the construction of heart valve centers.For example,the follow-up rate of patients after discharge is low,and long-term management after discharge needs to be further improved.There is still a gap in some indicators between construction centers and certification centers,and the promotion of high-quality management of interventional treatment of heart valve disease in China is still a long way to go.

As an important endocrine organ of human body,adipose tissue secrets a large amount of endocrine fac-tors that regulate a variety of physiological functions,and role of adiponectin in cardiovascular system is especially important.At the cellular and molecular level,adiponectin possesses profound anti-inflammatory,anti-oxidative and anti-apoptotic effects,which can reduce various pathogenic factors of cardiovascular diseases(CVD).In ad-vanced stage of CVD,the expression of adiponectin in adipose tissue as well as its circulating level compensatively increased.Therefore,adiponectin has a protective effect on the cardiovascular system,and increased adiponectin level may suggest severe CVD.In this review article,we systematically introduced the role of adiponectin in CVD and discussed its application prospects as a clinical biomarker.