Traditional Chinese medicines (TCMs) possess a rich historical background, unique theoretical framework, remarkable therapeutic efficacy, and abundant resources. However, the modernization and internationalization of TCMs have faced significant obstacles due to their diverse ingredients and unknown mechanisms. To gain deeper insights into the phytochemicals and ensure the quality control of TCMs, there is an urgent need to enhance analytical techniques. Currently, two-dimensional (2D) chromatography, which incorporates two independent separation mechanisms, demonstrates superior separation capabilities compared to the traditional one-dimensional (1D) separation system when analyzing TCMs samples. Over the past decade, new techniques have been continuously developed to gain actionable insights from complex samples. This review presents the recent advancements in the application of multidimensional chromatography for the quality evaluation of TCMs, encompassing 2D-gas chromatography (GC), 2D-liquid chromatography (LC), as well as emerging three-dimensional (3D)-GC, 3D-LC, and their associated data-processing approaches. These studies highlight the promising potential of multidimensional chromatographic separation for future phytochemical analysis. Nevertheless, the increased separation capability has resulted in higher-order data sets and greater demands for data-processing tools. Considering that multidimensional chromatography is still a relatively nascent research field, further hardware enhancements and the implementation of chemometric methods are necessary to foster its robust development.

Objective:To explore our self-designed classification system of irreducible intertrochanteric fractures based on reduction stage and bone block position and to evaluate the reduction techniques guided by the classification system.Methods:A retrospective study was conducted to analyze the data of 115 patients with irreducible intertrochanteric fracture who had been admitted to Department of Orthopedics, Beijing Hospital from September 2014 to November 2022. There were 24 males and 91 females with a mean age of (80.9±11.0) years. The reduction for the fractures was divided into a diaphysis reduction stage (Phase Ⅰ) and a cortical reduction stage (Phase Ⅱ). Based on the relative positions of the intraoperative bone blocks, Phase Ⅰ was divided into an anterior and posterior interlocking type (Phase Ⅰa) and a distal bone block sinking displacement type (Phase Ⅰb) while Phase Ⅱ into a proximal lifting type (Phase Ⅱa), a posterior angulation type (Phase Ⅱb), a positive support type (Phase Ⅱc), and a negative support type (Phase Ⅱd). Depending on the difficulties encountered in different reduction stages, corresponding close reduction strategies (such as top rod support, percutaneous prying, and Joystick technique) were adopted to restore the proximal femoral neck shaft angle, anteversion angle, anterior medial cortex, and length of the affected limb before fixation with intramedullary nails. Recorded were the patient's surgical time, intraoperative bleeding, quality of postoperative reduction, fracture union time, and complications.Results:The surgical time for this group of patients was 70.0(60.0, 92.0) minutes, and the intraoperative blood loss 200.0 (170.0, 200.0) mL. According to the standards by Baumgaertner et al., the quality of postoperative reduction was evaluated as excellent in 103 cases and as good in 12 cases, with an excellent and good rate of 100.0% (115/115). Of the 115 patients, 86 were followed up for more than 6 months to reveal fracture union in all after a duration of 6.0 (4.0, 8.0) months. One patient died of an acute cardiovascular event in the hospital 5 days after surgery. Two patients lost their mobility within 3 months after surgery due to acute cerebral infarction. There was no internal fixation failure requiring secondary surgery or no incision infection.Conclusion:Guided by our self-designed classification system of irreducible intertrochanteric fractures based on the intraoperative reduction stage and the relative position of bone block, real time intraoperative fluoroscopy images can be used to effectively clarify the difficulty of fracture reduction in stages so that corresponding reduction strategies can be adopted, leading to fine clinical efficacy.

Objective:To establish a visualized nomogram which can predict the rate of 30-day complications in the elderly patients after hip fracture.Methods:A retrospective study was conducted to analyze the clinical data of 1,074 patients with hip fracture aged 60 years and over who had been admitted to Department of Orthopedics, Beijing Hospital from January 2010 to December 2017. There were 335 males and 739 females with an average age of (80.3±7.3) yeas, 529 intertrochanteric fractures of the femur (all fixed with intramedullary nails after closed reduction), and 545 femoral neck fractures (including 470 ones treated with artificial femoral head replacement and 75 ones treated with artificial total hip replacement). The duration between injury to operation was (6.2±3.7) d. After the complications within 30 days after surgery were recorded, the risk factors for postoperative complications were screened using the binary multi-factor logistic regression analysis. The visualized nomogram and calibration graph were established with the risk factors screened.Results:Of the 1,074 patients, 28.49% (306/1,074) suffered from 30-day complications. The multivariate regression analysis showed that age ( OR=1.050, 95% CI: 1.022 to 1.080, P=0.001), time from injury to surgery ( OR=1.043, 95% CI: 1.005 to 1.083, P=0.027), white blood cell count ( OR=1.093, 95% CI: 1.033 to 1.158, P=0.002), serum albumin level ( OR=0.930, 95% CI: 0.883 to 0.980, P=0.007), troponin I ( OR=195.983, 95% CI: 2.224 to 17,268.296, P=0.021), respiratory system comorbidities ( OR=2.020, 95% CI: 1.287 to 3.170, P=0.002),cardiovascular comorbidities ( OR=1.388, 95% CI: 1.098 to 1.754, P=0.006), and neurological system comorbidities ( OR=1.778, 95% CI: 1.346 to 2.349, P<0.001) were the risk factors for 30-day complications after surgery in elderly patients with hip fracture. Based on these risk factors, a nomogram was created, with an area under the curve of 0.714. The calibration graph showed that the incidence predicted was close to that measured. Conclusion:The present study has established a visualized nomogram which can predict the rate of 30-day complications in the elderly patients after hip fracture based on age, time from injury to surgery, white blood cell count, serum albumin levels, troponin I, and cardiovascular, respiratory and neurological complications.

Objective:To explore the epidemiological characteristics of geriatric hip fractures in Beijing so as to provide evidence for effective prevention and control measures.Methods:This multicenter study was conducted in 3 urban (Beijing Jishuitan Hospital, Beijing Hospital and Beijing Anzhen Hospital) and 3 suburban hospitals (Beijing Shunyi District Hospital, Beijing Changping District Hospital and Beijing Liangxiang Hospital) in Beijing from November 2018 to November 2019. Eligible patients were those aged ≥ 65 years with hip fracture confirmed by X-ray and being admitted to hospital within 21 days of injury. To explore the epidemiological characteristics of geriatric hip fractures in Beijing, such data were collected as patients' age, gender, comorbidities, as well as type, site, time and cause of the fracture.Results:① A total of 2,071 patients were included in this suevey. They were 653 males and 1,418 females (M∶F=1∶2.17). Their age ranged from 65 to 102 years (average, 79.8 years). The patients aged from 75 to 84 years were the most common, accounting for 44.81% (928/2,071). ② Femoral neck fractures accounted for 43.41% (899/2,071), and intertrochanteric fractures accounted for 56.59% (1,172/2,071). The age of the patients with femoral neck fracture was (78.6±7.7) years, which was significantly younger than that of those with intertrochanteric fracture [(80.7±7.4) years] ( P<0.05). ③ 94.69% of the hip fractures (1,961/2,071) were caused by falling, and 71.27% fractures (1,476/2,071) happened at home. ④ Approximately 83.00% of the patients (1,719/2,071) had one or more comorbid conditions. Hypertension was the most prevalent disease (57.89%, 1,199/2,071), followed by diabetes (27.09%, 561/2,071), and coronary atherosclerotic heart disease (22.02%, 456/2,071). Conclusions:In Beijing, significantly more geriatric females sustain a hip fracture than males, and the proportion of those aged from 75 to 84 year is the largest. The proportion of intertrochanteric fractures increases with age. Falls are the leading cause for geriatric hip fractures. Most of the patients have one or more chronic comorbid conditions. Corresponding prevention and intervention measures should be formulated according to the distribution characteristics of elderly hip fractures in Beijing.

Objective:To analyze the epidemiological characteristics of geriatric hip fractures.Methods:This study retrospectively analyzed the clinical characteristics of 2 054 elderly patients with hip fracture aged 60 years and over who were admitted to Beijing Hospital from January 2011 to December 2020.The epidemiological characteristics of geriatric hip fractures were analyzed from the aspects of age, gender, fracture type, length of stay, surgical method and surgical complications.Results:The total number of hip fractures patients admitted from 2011 to 2020 showed a general upward trend in quantity.Among them, there were 1 177 femoral neck fractures(57.3%, 1 177/2 054), and 877 intertrochanteric femoral fractures(42.7%, 877/2 054)with statistical differences in the distribution of fracture types between patients at different ages( χ2=61.727, P<0.001). A total of 1 839 patients chose surgical treatment, accounting for 89.5% of the total number of patients.Artificial femoral head arthroplasty was the most common operation mode for patients with femoral neck fractures(783 cases, 75.4%).534 patients with intertrochanteric femoral fractures(66.8%)were treated with closed reduction and femoral intramedullary nailing.There was a statistically significant difference in operation modes among different fracture types( χ2=1 480.800, P<0.001). The length of hospital stay in patients with femoral neck fracture was(14.2±8.3)days, which was significantly longer than in patients with femoral neck fracture(13.2±10.9)days( t=2.417, P=0.016). There was no significant difference in the time from admission to operation between the two groups[(5.7±3.5)days vs.(5.4±3.3)days]( t=1.954, P=0.051). Among all the comorbidities of hip fracture patients, the top 5 diseases were cardiovascular system diseases(2 001 cases, 97.4%), nervous system diseases(1 105 cases, 53.8%), endocrine system diseases(814 cases, 39.6%), skeletal and muscular system diseases(623 cases, 30.3%), digestive system diseases(472 cases, 23.0%).1 485 patients(72.3%)had 3 or more comorbidities. Conclusions:Hip fractures in the elderly have some epidemiological distribution characteristics in terms of age, gender, length of hospitalization, injury mechanism and comorbidities, which is conducive to further improve the prevention and treatment strategies for hip fractures and promote the rational allocation of medical resources.

Objective:To evaluate the effects of percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)operation in elderly patients with osteoporotic vertebral compression fracture(OVCF).Methods:From June 2019 to June 2020, a total of 58 patients with OVCF aged over 60 and under 80 years who had a loss of more than one-third of the anterior margin height of vertebral and agreed to participate in the study were randomly divided into PKP group and PVP group.The visual analogue pain scale(VAS)score, SF-36 quality of life score, anterior height of fractured vertebral body, leakage of bone cement, refracture and cost of high-value consumables were observed at the time point before operation, 1 day, 1 month, 3 month, 6 month, 12 month after operation.Results:VAS scores in PKP and PVP groups were decreased after operation as compared with preoperation( F=115.380, 175.010, both P<0.001). VAS score was lower in the PKP group than in the PVP group at 6 months after operation with statistically significant difference( t=2.219, P=0.031), and no statistically significant difference at other time points between the two groups(all P>0.05). In the PKP and PVP groups, the height of the anterior edge of the vertebral body recovered significantly on the first day after operation, and there was a significant difference in the height compared with that before operation( F=43.020, 51.010, both P<0.001). The SF-36 scores at the latter time point in PKP and PVP groups were increased as compared with the previous time point.The increment of the SF-36 scores was statistically significant at 1 month after operation than pre-operation, and also at 3 months after operation than at 1 month after operation.The leakage rate of bone cement was 37.0%(10/27)in PKP group and 25.0%(7/28)in PVP group, with no significant difference between the two groups( χ2=0.930, P=0.391). The refracture rate was 3.7%(1/27)in PKP group and 7.1%(2/28)in PVP group, with no significant difference between the two groups( χ2=0.000, P=1.000). The cost of high-value consumables for single segment fracture was 46 490 yuan in PKP group, and 36 700 yuan in PVP group.The cost of PKP group was higher than that of PVP group. Conclusions:PKP and PVP operation in the treatment of osteoporotic vertebral compression fractures have good effects in aspect of analgesia, restoring vertebral height and improving patients' quality of life.The analgesic effect is slightly better in PKP group than in PVP group.PVP group has more advantages in health economics.

Objective:To investigate the clinical characteristics and prognosis of hip fractures in patients aged 90 and over.Methods:Clinical data of hip fracture patients aged 90 years and older admitted to Beijing Hospital from January 2016 to June 2020 were retrospectively analyzed.Patients were divided into a surgical treatment group and a conservative treatment group according to treatment received.Mortality and walking function 30 days and 1 year after injury were followed up.The mortality and walking function 1 year after injury in the two groups of patients were compared and analyzed, and related factors affecting the 1-year mortality rate of the surgical treatment group were analyzed.Results:Eventually 114 cases were included, with 18 in the conservative treatment group and 96 in the surgical treatment group.There were no significant differences in age, sex, American Society of Anesthesiologists(ASA)score, comorbidities, fracture type, hemoglobin, total protein, albumin and coagulation function at admission, walking ability before injury, and length of stay between the two groups(all P>0.05). Of the 18 conservatively treated patients, 9 died within 1 year(50.0%). Among 96 surgically treated patients, 20 died within 1 year(20.8%). The difference between the two groups was statistically significant( χ2=6.789, P=0.016). Among the 9 patients who survived 1 year after injury under conservative treatment, 1(11.1%)was able to walk independently, 2(22.2%)were able to walk with a walker, and 6(66.7%)were unable to walk; Among the 76 surviving patients 1 year after injury under surgical treatment, 16(21.1%)were able to walk independently, 50(65.8%)were able to walk with a walker, and 10(13.1%)were unable to walk.There was a statistically significant difference in walking ability between the two groups( χ2=20.030, P<0.001). Univariate analysis results showed that ASA score, walking ability before injury and total protein were correlated with 1-year mortality after injury( χ2 or t=5.803, -2.176, 29.400, all P<0.05). Multivariate logistic regression results showed that the inability to walk independently before injury was an independent risk factor for death within 1 year after injury[ HR(95% CI)=15.95(4.42-57.55), P<0.001]. Conclusions:The prognosis of surgical treatment of hip fractures in patients aged 90 and over is better than that of conservative treatment.The inability to walk independently before injury is an independent risk factor for death within 1 year after injury.

Objective:To investigate the clinical effect of Infix combined with hollow screws for the treatment of pelvic injuries with pubic symphysis separation in middle-aged and elderly patients.Methods:Data of 8 middle-aged and elderly patients with pelvic injuries due to pubic symphysis separation undergone treatment from January 2017 to December 2020 were retrospectively analyzed.Results:The average operating time of 8 patients was (46.0±6.2)min(range: 40-62min); the average intraoperative blood loss was (32.0±5.6)ml(range: 25-50 ml); the average length of incisions at the iliac screw was(2.6±0.4)cm(range: 2.0-3.5 cm); the average length of incisions at the hollow screw was (1.1±0.3)cm(range: 0.8-1.5 cm); and the average times of fluoroscopy were (36.0±6.0)times(range: 28-52 times). Postoperative X-ray and CT examinations showed that the reduction of the pubic symphysis was good, the inserted iliac screws and cannulated screws were positioned accurately, and the incision healed well.Based on Matta's criteria, postoperative radiological outcomes were evaluated, with 7 cases rated as excellent and 1 as good, giving an excellent to good rate of 100%(8/8). The average followed up time for all 8 patients was (15.0±4.2)months(range: 6-24 months). Pelvic X-ray and CT examinations at the last follow-up showed that the fractures healed well and the pubic symphysis reduction did not fail.Infix and cannulated screws in the pubic symphysis were removed 10-12 weeks after surgery[average: (10.5±0.5)weeks]. According to the Majeed Pelvic Score, 5 cases were rated as excellent, 2 cases as good and 1 as fair, with an excellent to good rate of 87.5%(7/8). One patient had symptoms related to the lateral femoral cutaneous nerve that disappeared after 3 months.One patient developed deep venous thrombosis after surgery, and the filter was placed and removed 10 weeks later.Conclusions:Using Infix plus cannulated screws for the treatment of pelvic injuries in middle-aged and elderly patients with pubic symphysis separation has the advantages of limited trauma and intraoperative blood loss, good fixation and few complications.

Objective:To analyze the risk factor of postoperative delirium in the elderly hip fracture patients.Methods:A total of 1051 patients with hip fracture aged 60 years and over, admitted to Beijing Hospital from January 2010 to December 2017 were retrospectively analyzed.They were divided into a postoperative delirium group(n=156)with 56 males and 100 females, 81 femoral neck fractures and 75 intertrochanteric fractures, and the control group(n=895)with no delirium, receiving the corresponding treatment in the same period.The complications, laboratory tests, fracture types, operation methods, the time from fracture to operation, operation time, intraoperative blood loss, intraoperative blood transfusion were compared between the two groups.Risk factors of postoperative delirium in the elderly hip fracture patients were screened using the binary multi-factor logistic regression analysis.Results:Of the 1 051 patients, 156 cases(14.8%)delirium occurred.There was no significant difference in fracture type and operation methods( P>0.05)between the 2 groups.The age was significantly older in the observation group(82.9±6.6)years than in the control group(79.9±7.2)years.The serum albumin before operation(37.1±2.9)g/L, creatinine clearance rate(52.4±22.2)ml·min -1·(1.73 m 2) -1in the observation group were significantly lower than in the control group[(37.8±3.8)g/L, (59.0±30.0)ml·min -1·(1.73 m 2) -1]( P<0.05). The past dementia rate was higher in delirium group[19.8%(31 cases)]than in control group[2.2%(20 cases)], with statistically significant difference( χ2=89.503, P<0.01). The proportion of patients with more than two medical diseases was higher in delirium group[51.9%(81 cases)]than in control group[40.3%(361)]( χ2=7.320, P<0.01). There were no significant differences(all P>0.05)between.the two groups in hemoglobin, white blood cell, serum K and Na, American Society of Anesthesiologists(ASA)grade, and the incidences of Parkinson's disease, pulmonary diseases and cardiovascular diseases(all P>0.05). The binary multi-factor Logistic regression analysis showed that the age, past dementia and kidney dysfunction were the risk factors for the postoperative delirium in the elderly hip fracture patients(all P>0.05). Conclusions:The incidence of postoperative delirium in the elderly hip fractures patients is high.Age, past dementia and kidney dysfunction are the risk factors for postoperative delirium in the elderly hip fracture patients, which should be prevented and improved preoperatively.

Objective:To investigate the clinical effectiveness of vertebroplasty for osteoporotic vertebral compression fractures in the elderly aged 90 years and over.Methods:Clinical data of 64 elderly patients aged 90 years and over who had undergone percutaneous vertebroplasty for vertebral compression fractures between January 2015 and January 2021 were retrospectively analyzed.Changes in preoperative and postoperative pain, intraoperative bone cement leakage, postoperative pneumonia, bedsores, urinary tract infections, lower extremity venous thrombosis and changes in preoperative and postoperative physical mobility were evaluated.Pain scores, physical mobility scores, bone cement extravasation and complications such as re-fractures of the vertebral body, postoperative pneumonia, bedsores, urinary tract infections and thrombosis were recorded before surgery, 3 and 30 days after surgery.Results:The visual analogue scale(VAS)scores of 64 patients before surgery, 3 and 30 days after the procedure were 8.34±1.12, 2.17±1.45 and 1.83±1.15, retrospectively( F=540.876, P<0.01). The physical mobility scores before surgery, 3 and 30 days after the procedure were 2.83±0.94, 1.59±0.70 and 1.39±0.60, retrospectively( F=65.492, P<0.01). There were 18 cases(28.13%)of bone cement leakage during surgery, 4 cases(6.25%)of pneumonia within 30 days after surgery, 9 cases(14.06%)of urinary tract infections, 3 cases(4.69%)of lower extremity venous thrombosis, 1 case(1.56%)of bedsores, and 2 cases(3.13%)of vertebral re-fractures after surgery.No patient died during the 30-day follow-up. Conclusions:Percutaneous vertebroplasty can reduce pain and improve physical mobility and is an effective and safe minimally invasive treatment for elderly patients with spinal compression fractures aged 90 years and over.