Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.

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 correlations of diaphragm function parameters,hy-poalbuminemia,decoy receptor 3(DcR3)and D-dimer(D-D)with disease severity and treatment outcomes of elderly patients with chronic obstructive pulmonary disease(COPD)complicated by re-spiratory failure.Methods A total of 118 elderly COPD patients with respiratory failure were select-ed as study subjects.Patients were divided into mild(n=27),moderate(n=51)and severe(n=40)groups based on arterial oxygen partial pressure[pa(O2)].Diaphragm function parameters,DcR3,D-D and hypoalbuminemia were compared among the three groups.Based on the treatment outcomes at 28 days,patients were further divided into treatment success group(n=87)and treatment failure group(n=31).Univariate and multivariate analyses were performed to assess the correlations of dia-phragm function parameters,hypoalbuminemia,DcR3,and D-D with adverse outcomes.Results The diaphragm mobility and diaphragm movement area of patients in the severe group were significantly lower or smaller than those in the moderate group and the mild group(P＜0.05);the diaphragm mobility and diaphragm movement area of patients in the moderate group were significantly lower or smaller than those in the mild group(P＜0.05).The proportions of patients with DcR3,D-D and hypoproteinemia in the severe group were significantly higher than those in the moderate and mild groups,and the DcR3 and D-D in the moderate group were significantly higher than those in the mild group(P＜0.05).The age,Acute Physiological Function and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,N-terminal pro-brain natriuretic peptide(NT-proBNP)and the proportion of patients with coronary heart disease in the treatment failure group were significantly higher than those in the treatment success group(P＜0.05).The diaphragm mobility in the treatment failure group was significantly lower than that in the treatment success group,and the diaphragm movement area was smaller than that in the treatment success group(P＜0.05).The proportions of patients with DcR3,D-D and hypoproteinemia in the treatment failure group were significantly higher than those in the treatment success group(P＜0.001).Older age,higher APACHE Ⅱ score,higher NT-proBNP,combined with coronary heart disease,higher DcR3,higher D-D level,hypoproteinemia,decreased diaphragm mobility and reduced diaphragm motor area were independent risk factors for adverse treatment outcomes in elderly patients with COPD complicated with respiratory failure(P＜0.05).Conclusion In elderly COPD patients with respiratory failure,reduced diaphragm mobility,de-creased diaphragm motion area,elevated DcR3 and D-D levels and the presence of hypoalbumine-mia are associated with more severe disease conditions.

Objective: To investigate the potential efficacy and safety of Lutai Danshen Baishao granules (LDBG) for treating female melasma associated with kidney deficiency and blood stasis patterns. Methods: A randomized, double-blind, placebo-controlled trial was conducted at the Third Central Hospital of Tianjin, China from March to December 2023. A total of 110 female patients with melasma linked to kidney deficiency and blood stasis were enrolled and treated with either LDBG or a placebo twice daily for 60 days. Efficacy was assessed through measures such as the total melasma area, reduced melasma area, reduction rate of melasma area, melasma color score, Melasma Area and Severity Index (MASI) score, and traditional Chinese medicine (TCM) symptom score scale. Safety assessments included routine blood and biochemical tests. Results: Participants in both groups were aged 52–63 years, with no significant differences. After the 2-month intervention, the total melasma area decreased in both groups; however, a greater reduction was observed in the test group [462.50 mm2 (12.81%) vs. 100.00 mm2 (3.11%), P < .001]. Moreover, LDBG treatment significantly reduced the MASI and melasma color scores in the test group (P < .05). The total TCM symptom evaluation score significantly decreased (test group: 6.00 vs. placebo group: 7.00, P = .001), with significant relief in symptoms such as improvement in dark lips, nails, and waist soreness in the test group, compared with that in the placebo group (P < .05). Within-group comparisons revealed that TCM syndrome was significantly alleviated in the test group (P < .05). Conclusion LDBG intervention shows promising effectiveness in reducing female melasma and alleviating TCM syndromes.

Objective:To compare the dosimetric characteristics of three fractionated stereotactic radiotherapy techniques,i.e.,tomo-therapy(TOMO),volumetric-modulated arc therapy(VMAT),and CyberKnife(CK),in the treatment of intracranial oligometastases,and to assess their dose distribution,treatment efficiency,and difference in dose delivered to organs at risk(OARs).Methods:A retro-spective analysis was performed for the clinical data of 54 patients with intracranial oligometastases who underwent fractionated stereo-tactic radiotherapy in The First Affiliated Hospital of Army Medical University in 2021-2023.Varian Eclipse 16.1 Physician Worksta-tion was used to perform tumor target volume delineation,and MANTEIA AccContour 3.2 software was used to perform the delineation of OARs,such as brainstem,spinal cord,and optical nerves.The delineated structures and images were transmitted to TOMO,CK,and Eclipse treatment planning systems to design three different radiotherapy treatment plans.Related key parameters were analyzed using the dose-volume histogram to evaluate the dosimetric characteristics of these three radiotherapy techniques,including conformity index(CI)of the target,dose homogeneity index(HI),beam-on time,the number of monitor units(MU),and the exposure dose of OARs.Results:All three treatment plans(TOMO,VMAT,and CK)met the requirements for prescribed dose.TOMO had a slightly better CI than VMAT and CK(1.05 vs.1.09 and 1.17,P<0.001).VMAT had a better HI than CK and TOMO(1.15 vs.1.28 and 1.46,P<0.001).In terms of execution efficiency,VMAT had a significantly shorter beam-on time than TOMO and CK(5 minutes,1 633 MU vs.10 minutes,8 932 MU and 39 minutes,5 191 MU,P<0.001).In terms of the exposure dose of OARs,CK provided the best protection for the lens,with a maximum dose of 15 cGy for the right lens and 17 cGy for the left lens,and TOMO had an advantage in dose control for the right cochlea,with a mean dose of 88 cGy,while VMAT had the best performance in limiting the dose for the spinal cord,with a maximum dose of 31 cGy(P<0.05).Conclusion:This study shows that TOMO,VMAT,and CK all meet the requirements for the prescribed dose and can effectively protect OARs in the treatment of in-tracranial oligometastases.In clinical practice,the most appropriate technique should be selected based on the features of lesions and treatment goals to achieve individualized treatment.

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 construct an evaluation index system of internal control medical equipment based on the internal control theory of The Committee of Sponsoring Organizations of the Treadway Commission(COSO)and combined with the current situation of medical equipment internal management in public hospitals,so as to provide reference and suggestions for the evaluation of internal control of medical equipment in public hospitals.Methods:Through literature research and expert consultation,the evaluation index system of internal control of medical equipment was preliminarily determined.Using the Delphi method,15 experts from 1 medical college and 3 tertiary hospitals in Beijing who were engaged in the use and management of medical equipment were selected to conduct two rounds of consultation on the evaluation index system of internal control of medical equipment,and the evaluation indicators were scored and screened.The analytic hierarchy process(AHP)was used to determine the index weights,and the internal control evaluation index system of medical equipment in public hospitals based on COSO was constructed.Results:The coefficient of the two rounds of expert consultation was 100%.The authority degree of consulting experts was 0.867.Finally,the evaluation index system of internal control of medical equipment in tertiary public hospitals was formed,which included 5 first-level indicators,17 second-level indicators and 50 third-level indicators.Conclusion:The evaluation index of internal control of medical equipment in public hospitals based on COSO has high expert enthusiasm,authority and coordination.The evaluation index system includes the unit level and the business level of internal control,with a wide coverage,which makes up for the limitations of traditional internal evaluation of medical equipment,which can make up for the limitations of the internal evaluation of traditional medical equipment,improve the internal control system of medical equipment in public hospitals,and optimize the medical equipment management system.

Objective:To construct an effectiveness evaluation model of internal control of medical equipment in public hospitals based on fuzzy analytic network process(F-ANP),and to improve the level of internal control management of medical equipment in hospitals.Methods:Through literature research and analysis,based on the internal control theory system of The Committee of Sponsoring Organizations of the Treadway Commission(COSO),combined with the characteristics of medical equipment management in public hospitals,the effectiveness evaluation model of internal control of medical equipment in public hospitals was established by F-ANP,which was combining analytic network process(ANP)and fuzzy comprehensive evaluation.An empirical analysis was carried out on the internal control of medical equipment in Beijing Friendship Hospital,Capital Medical University.Results:The index system for model evaluation included 5 first-level indicators of control environment,risk evaluation,control activities,information exchange,and supervision mechanism,17 second-level indicators,and 50 third-level indicators.The model was used to evaluate the effectiveness of internal control of medical equipment in the hospital,its maximum membership value was 0.133 7,and the result was"relatively effective",indicating that the construction and implementation of internal control of medical equipment in the hospital were relatively perfect,while the management of scrapping of medical equipment,cost control and equipment informatization construction still need to be improved.Conclusion:The effectiveness evaluation model of internal control of medical equipment of public hospitals based on F-ANP can provide certain reference value for evaluation of the effectiveness of internal control of medical equipment in public hospitals,which is conducive to standardizing internal control of medical equipment,promoting the fine management of medical equipment and ensuring the safety of medical equipment assets.

Osteonecrosis of the femoral head （ONFH） is a painful and debilitating disease caused by impaired blood supply to the femoral head and cellular and tissue degeneration， leading to gradual destruction of the bone structure and progressive collapse of the femoral head. The main pathological mechanism of ONFH is the disruption of the balance between bone absorption and the reconstruction of new bone， resulting from microcirculation damage and decreased cellular tissue ability. This imbalance leads to biomechanical changes and accelerates the pathological progression of ONFH. In the early stages， clinical manifestations may not be obvious， mainly presenting as pain or discomfort in the hip or groin area， which can be relieved after rest. In the later stage of the disease， pain intensifies， and limb shortening， lower limb weakness， difficulty walking， or limping may occur. Currently， western medicine commonly uses osteogenic agents， anticoagulants， and artificial joint replacement for treatment， but there are also many issues such as prosthesis loosening and infection. Research has shown that traditional Chinese medicine （TCM） treatment of ONFH takes a holistic approach and employs multi-functional， multi-target， and multi-system Chinese medicine therapies， ensuring the safety and effectiveness of the treatment. The osteoprotegerin （OPG）/receptor activator of nuclear factor-κB （RANK）/RANK ligand （RANKL） signaling pathway plays a crucial role in maintaining the dynamic balance of bone remodeling. TCM treatments utilize this pathway to promote apoptosis of osteoclasts， reduce bone resorption， and accelerate bone formation， thereby playing an important role in the prevention and treatment of ONFH. This paper reviewed the role of OPG/RANK/RANKL signaling pathway and related cytokine expression in ONFH by reviewing relevant literature in China and abroad and research status of Chinese medicinal monomers， Chinese medicinal formulations， and combinations with physical therapy in increasing osteoblast secretion， promoting OPG expression， enhancing cytokine expression levels， and inhibiting osteoclast activity for the prevention and treatment of ONFH. This paper is expected to provide new ideas and directions for TCM in the prevention and treatment of ONFH.

ObjectivesTo introduce the progress in neurological classification of spinal cord injury (SCI) with complications. MethodsThe literatures in recent ten years were reviewed and summarized. ResultsIn January, 2022, a new neurological classification of SCI with complications in the International Standards for Neurological Classification of SCI (ISNCSCI) was published by the focus group of the American Spinal Injury Association (ASIA) International Standards Committee, with the extended "*"-tag concept, sensory and motor examination results impacted by SCI complication above, at, or below the neurological level of injury (NLI) could be consistently documented, scored, and classified. ConclusionThis new taxonomy in neurological classification of SCI with complications has overcome the shortcomings of the previous ISNCSCI versions and benefits the accuracy of ISNCSCI classifications, it could be tried in the clinical application.