Objective: To investigate the association between edentulism and the risk of social isolation in middle-aged and elderly populations, provide empirical evidence for formulating social isolation prevention and intervention policies targeting edentulous middle-aged and elderly populations. Methods: Data were derived from the baseline survey (2011) and three follow-ups (2013, 2015, 2018) of the China Health and Retirement Longitudinal Study (CHARLS). Participants were enrolled in the follow-up from the baseline. Those identified as socially isolated in any of the follow-up surveys conducted in 2013, 2015, or 2018 were considered to have reached the endpoint; otherwise, the follow-up was continued until the end of the 2018 survey; 9 870 individuals were ultimately included. Subjects were grouped by edentulism status. Chi-square test and multivariate Cox regression analysis were performed using Stata 17.0. Results: During a median follow-up of 6.54 years, 1 800 cases of social isolation occurred, with an incidence rate of 18.23%（17.47%~18.99%）. Multivariate Cox regression showed that edentulism was associated with an increased risk of social isolation (HR=1.21, 95% CI: 1.03-1.42) after adjusting for confounders. Subgroup analysis revealed population heterogeneity. Sensitivity analyses confirmed the stability of the results. Conclusion Edentulism is associated with an increased risk of social isolation in middle-aged and elderly adults.

Objective:To construct a whole course management and follow-up platform, named Care Plan, for patients undergoing breast reconstruction surgery, and to evaluate its initial clinical applications.Methods:From June 2023 to January 2024, patients who underwent breast reconstruction surgery at Peking Union Medical College Hospital were selected as the study subjects and enrolled in the Care Plan platform for whole course management. The platform comprised five modules: patient education, self-assessment, medical assessment, medical follow-up, and doctor-patient dialogue, each with corresponding sub-modules and specific components. Each patient was assigned to a case manager who provided one-on-one assessment, sent patient education materials, and conducted follow-ups. The preliminary application of the Care Plan platform was evaluated based on the completeness of patient data, patient education material reading status, doctor-patient dialogue topics, and follow-up responses. At 3 months postoperatively, patients were followed up and further divided into patient education group(reading at least an article on patient educational materials) and control group based on their reading status of educational materials. Patients rated their satisfaction with the surgery using a 5-point questionnaire, including five indicators: expected breast reconstruction outcome, expected surgical type, completeness of information acquisition, breast symmetry, and breast softness. Statistical analysis was performed using SPSS 27.0.1 software, with count data expressed as frequencies and (or) percentages, normally distributed measurement data expressed as Mean±SD, intergroup comparisons conducted using t-test, and P<0.05 indicating statistical significance. Results:A total of 147 female patients aged 16 to 63 years with a body mass index of 16.6 to 31.3 kg/m 2 were ultimately included. All 147 patients completed the content of the self-assessment and medical assessment modules, with relatively complete data. Of the 133 patients who received patient education materials sent through the platform, 38 (28.6%) read the materials, with the sub-module on the introduction and choices of the reconstruction surgery (37.3%, 94/252 ) being the most frequently viewed. A total of 24 patients (16.3%, 24/147 ) raised 45 questions using the doctor-patient dialogue module, with the highest proportion related to consultation issues and complications, each accounting for 22.2% (10/45). Twenty-three patients completed the 3-month follow-up, with 12 in the patient education group and 11 in the control group. The patient education group scored higher than the control group in terms of completeness of information acquisition [(4.58±0.51) points vs. (3.91±0.70) points, t=-2.65, P=0.015], while scoring lower in breast symmetry [(3.92±0.79) points vs. (4.63±0.67) points, t=2.33, P=0.030]. There was no significant difference between the two groups in terms of expected breast reconstruction outcome, expected surgical type, and breast softness scores ( P>0.05 for all). Conclusion:The Care Plan platform for whole course management and follow-up of breast reconstruction can assist medical staff in formulating patient-centered management plans, improve patients’ understanding of surgical information, and aid patients in making decisions regarding breast reconstruction methods.

Objective:To construct a whole course management and follow-up platform, named Care Plan, for patients undergoing breast reconstruction surgery, and to evaluate its initial clinical applications.Methods:From June 2023 to January 2024, patients who underwent breast reconstruction surgery at Peking Union Medical College Hospital were selected as the study subjects and enrolled in the Care Plan platform for whole course management. The platform comprised five modules: patient education, self-assessment, medical assessment, medical follow-up, and doctor-patient dialogue, each with corresponding sub-modules and specific components. Each patient was assigned to a case manager who provided one-on-one assessment, sent patient education materials, and conducted follow-ups. The preliminary application of the Care Plan platform was evaluated based on the completeness of patient data, patient education material reading status, doctor-patient dialogue topics, and follow-up responses. At 3 months postoperatively, patients were followed up and further divided into patient education group(reading at least an article on patient educational materials) and control group based on their reading status of educational materials. Patients rated their satisfaction with the surgery using a 5-point questionnaire, including five indicators: expected breast reconstruction outcome, expected surgical type, completeness of information acquisition, breast symmetry, and breast softness. Statistical analysis was performed using SPSS 27.0.1 software, with count data expressed as frequencies and (or) percentages, normally distributed measurement data expressed as Mean±SD, intergroup comparisons conducted using t-test, and P<0.05 indicating statistical significance. Results:A total of 147 female patients aged 16 to 63 years with a body mass index of 16.6 to 31.3 kg/m 2 were ultimately included. All 147 patients completed the content of the self-assessment and medical assessment modules, with relatively complete data. Of the 133 patients who received patient education materials sent through the platform, 38 (28.6%) read the materials, with the sub-module on the introduction and choices of the reconstruction surgery (37.3%, 94/252 ) being the most frequently viewed. A total of 24 patients (16.3%, 24/147 ) raised 45 questions using the doctor-patient dialogue module, with the highest proportion related to consultation issues and complications, each accounting for 22.2% (10/45). Twenty-three patients completed the 3-month follow-up, with 12 in the patient education group and 11 in the control group. The patient education group scored higher than the control group in terms of completeness of information acquisition [(4.58±0.51) points vs. (3.91±0.70) points, t=-2.65, P=0.015], while scoring lower in breast symmetry [(3.92±0.79) points vs. (4.63±0.67) points, t=2.33, P=0.030]. There was no significant difference between the two groups in terms of expected breast reconstruction outcome, expected surgical type, and breast softness scores ( P>0.05 for all). Conclusion:The Care Plan platform for whole course management and follow-up of breast reconstruction can assist medical staff in formulating patient-centered management plans, improve patients’ understanding of surgical information, and aid patients in making decisions regarding breast reconstruction methods.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Abstract OBJECTIVE To study the effect of berberine(BBR) on autophagy of human breast cancer HCC1937 cells under hypoxia condition. METHODS Cultured human breast cancer HCC1937 cells, CCK-8 method was used to determine the effects of different concentrations of BBR(0, 5, 10, 20, 40, 80, 160 μmol·L-1) on cell viability under normoxia and hypoxia conditions, and select the drug concentration for further experiments. Cultured HCC1937 cells were randomly divided into 4 groups: control group, 20 μmol·L-1 BBR group, hypoxia group, hypoxia+20 μmol·L-1 BBR group. LIVE/DEAD cell viability/cytotoxicity kits were used to measure the cell death rate. The expressions of autophagy related proteins Beclin1, LC3 and P62 in each group were determined by Western blotting. The cells were infected with mCherry-GFP-LC3 adenovirus, and the number of autophagosomes and autophagolysosomes in each group were counted by laser confocal microscopy to determine the effect of BBR on the autophagy flow of HCC1937 cells. RESULTS BBR decreased the cell viability of human breast cancer HCC1937 cells in a concentration-dependent manner. After hypoxia treatment, the cell death rate of HCC1937 cells was not significantly changed, and the intracellular Beclin1, LC3-II and LC3-II/LC3-I ratio were significantly increased, while P62 without significant changes, and the autophagy flow was increased. BBR significantly increased cell death rate, decreased Beclin1 and LC3II/LC3-I ratio, increased intracellular P62, significantly reduced the number of autophagosomes and autophagolysosomes, and inhibited the formation and clearance of autophagosomes under both normal and hypoxia conditions. CONCLUSION BBR increases the death rate of human breast cancer HCC1937 cells under hypoxia condition, and its effect is related to the inhibitory effect of berberine on autophagy under hypoxia condition.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Spinal cord injury is a common clinical disease secondary to spinal cord fractures that causes patients with motor and sensory dysfunction or even paralysis. In recent years, exosomes have participated in the occurrence and development of various diseases as nanometer-sized cell particles, and have received extensive attention. Exosomes derived from spinal cord tissue cells during spinal cord injury affect the injury process and tissue repair. In addition, exosomes as a new treatment for spinal cord injury have been widely studied. The authors document the mechanisms of various exosomes from spinal cord tissue and the repair effects of various cell-derived exosomes in spinal cord injury, in order to deepen the understanding of the role of exosomes in spinal cord injury and provide new ideas for studying the course and treatment of spinal cord injury.

Objective:To investigate the effect of N-trimethyl chitosan-recombinant tissue factor pathway inhibitor (rTFPI) complex on avulsion flap with roll compaction in rat.Methods:The experimental methods were adopted. The N-trimethyl chitosan-rTFPI complex solution was prepared by ion cross-linking method. The morphology of the complex was observed by scanning electron microscope, and its diameter was measured. The encapsulation rate of rTFPI in the complex and drug loading rate of the complex was determined and calculated by enzyme-linked immunosorbent assay (ELISA) method ( n=3). The concentration of rTFPI in the solution at 0, 10, 30, 45, 60, 90, 120, 240 minutes of storage was measured by ELISA method to observe the release of rTFPI, and its half-life was calculated ( n=3). Twenty-four 6-week-old male Sprague-Dawley rats were divided into phosphate buffered saline (PBS) group, N-trimethyl chitosan alone group, rTFPI alone group, and N-trimethyl chitosan-rTFPI group according to the random number table, with 6 rats in each group. The avulsion flaps with roll compaction were prepared on the backs of rats with pedicles located on the line of the bilateral iliac spine and lifted from the surface of the muscle membrane. One injection of corresponding reagents was carried out immediately after in-situ suture and on post operation day (POD) 1, 2, and 3. General changes of the flap were observed on POD 1, 3, and 7. On POD 7, the survival area of the flap was measured and the survival rate of the flap was calculated; the flaps were divided into pedicle, proximal, middle, and distal segments, and the blood perfusion in the proximal, middle, and distal segment tissue of the flap was detected by the laser speckle blood flow imager; tissue samples in the middle of the flap were cut and stained with hematoxylin and eosin to observe the changes in tissue structure and the infiltration of inflammatory cells, and the numbers of embolized blood vessels and new blood vessels per 100 times visual field were counted. Data were statistically analyzed with one-way analysis of variance and least significant difference test. Results:The N-trimethyl chitosan-rTFPI complex had an irregular spherical structure with a diameter of 150-200 nm. The encapsulation rate of rTFPI in the complex and drug loading rate of the complex were (88.7±2.1)% and (2.83±0.09)%, respectively. The concentration of rTFPI in the solution of the N-trimethyl chitosan-rTFPI complex gradually increased with prolonged storage time, and the release was basically stable at 90 min, with half-life of (651±36) min. On POD 1, the distal parts of flaps of rats in N-trimethyl chitosan alone group darkened significantly. On POD 3, scabs and necrosis were relatively mild on the distal segment of the flaps of rats in rTFPI alone group and N-trimethyl chitosan-rTFPI group as compared with those of the other two groups. On POD 7, the necrosis boundaries of the flaps of rats in each group were clear. On POD 7, the flap survival rates of rats in rTFPI alone group and N-trimethyl chitosan-rTFPI group were (63±7)% and (73±5)%, respectively, which were significantly higher than (41±3)% in PBS group and (52±7)% in N-trimethyl chitosan alone group. Moreover, the flap survival rate of rats in N-trimethyl chitosan-rTFPI group was significantly higher than that in rTFPI alone group ( P<0.05). On POD 7, the flaps of rats in each group had blood perfusion; the blood perfusion values in the proximal segment tissue of the rat flaps in N-trimethyl chitosan alone group and the blood perfusion values in the proximal, middle, and distal segment tissue of the rat flaps in rTFPI alone group and N-trimethyl chitosan-rTFPI group were significantly higher than those in PBS group ( P<0.05 or P<0.01); the blood perfusion values in the distal segment tissue of the rat flaps in rTFPI alone group and the blood perfusion values in the middle and distal segment tissue of the rat flaps in N-trimethyl chitosan-rTFPI group were significantly higher than those in N-trimethyl chitosan alone group ( P<0.05 or P<0.01); the blood perfusion value in the middle segment tissue of the rat flaps in N-trimethyl chitosan-rTFPI group was significantly higher than that in rTFPI alone group ( P<0.01). On POD 7, inflammatory cells infiltrated more and cell edema was obvious in the middle segment tissue of the rat flaps in PBS group and N-trimethyl chitosan alone group. Compared with those of the previous two groups, the inflammation degrees in the middle segment tissue of the rat flaps in rTFPI alone group and N-trimethyl chitosan-rTFPI group were significantly milder, the number of embolized blood vessels was significantly decreased ( P<0.05 or P<0.01), and the number of new blood vessels was significantly increased ( P<0.05 or P<0.01). Compared with that of rTFPI alone group, the number of new blood vessels in the middle segment tissue of the rat flaps in N-trimethyl chitosan-rTFPI group increased significantly ( P<0.05). Conclusions:The effect of sustained release of rTFPI can be achieved by loading rTFPI with N-trimethyl chitosan. Compared with rTFPI alone, the N-trimethyl chitosan-rTFPI complex can further improve the blood perfusion of the avulsion flaps with roll compaction in rat and improve the survival rate of the flap.

Objective To investigate the prevalence of nutritional risk and malnutrition in hospitalized lung cancer patients in a tertiary A hospital in Chongqing.Methods From December 2013 to July 2017,2 735 consecutive lung cancer patients were admitted to the Department of Pneumology at Daping Hospital for planned anti-cancer treatment.Patients who did not complete a nutritional status assessment and who had repeated admission wcrc excluded from the study.The demographic and tumor characteristics were investigated in the 548 lung cancer inpatients who completed the study.The nutritional risk screening 2002 (NRS 2002) was used to evaluate the nutritional risk.The individual nutritional status was also evaluated using the patient-generated subjective global assessment (PG-SGA) questionnaire,anthropometry measurements and hematological measurements.The physical status was assessed by the Karnofsky performance status (KPS).Results According to the NRS 2002 score,29.56％ (162/548) of the cancer patients had nutritional risk (score ≥3).The prevalence of nutritional risk was 17.39％,15.00％,22.00％ and 36.86％,respectively,for patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ lung cancer.Forty-four patients (9.67％) had a body mass index＜ 18.5 kg/m2 and poor general condition,and the prevalence was 6.52％,5.00％,8.67％ and 11.22％,respectively,for stages I,Ⅱ,Ⅲ and Ⅳ.A total of 107 cases (19.53％) had impaired nutritional status (indicated by a severity score of 3 in the NRS 2002).The prevalence by different stages was 10.87％ (stage Ⅰ),5.00％ (stage Ⅱ),14.67％ (stage Ⅲ) and 25.00％ (stage Ⅳ).One hundred and twenty-five patients (22.81％) had PG-SGA scores ≥ 9,with 2.19％,2.50％,12.67％,and 33.33％ of patients in stages Ⅰ,Ⅱ,Ⅲ and Ⅳ having these high scores.The KPS scores were lower in the patients with nutritional risk and malnutrition than in the patients with a normal nutritional status.Conclusions The prevalence of nutritional risk and malnutrition in patients with lung cancer were mediom.Nutritional risk screening and nutritional status assessment should be considered at the time of admission for lung cancer patients in order to ensure better outcomes of treatment.