Background: and Purpose Vertebrobasilar fusiform aneurysms (VBFAs) carry substantial morbidity and mortality, but optimal management for unruptured VBFAs remains unclear. We compared the safety and efficacy of conservative management (CM), stent-assisted coiling (SAC), and flow diverters (FDs) in patients with unruptured VBFAs, focusing on long-term prognosis. Methods: This study included data from a nationwide Chinese cohort of patients with vertebrobasilar dissecting aneurysms. Inverse probability of treatment weighting (IPTW) balanced confounders across groups. The primary outcome was poor prognosis (modified Rankin Scale score >2). Secondary outcomes included aneurysm rupture, ischemic stroke, compression symptoms, and VBFA-related deaths. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Among 1,115 patients with unruptured VBFAs, 838 (median age, 54 years; 655 men) were included. After IPTW, baseline characteristics were balanced. Median follow-up was 54 months. FD was associated with a lower risk of poor prognosis than CM (OR, 0.48 [95% CI, 0.30 to 0.77]; p=0.002), with no difference between CM and SAC. FD also reduced aneurysm rupture (OR, 0.20 [95% CI, 0.07 to 0.60]; p=0.004) and compression symptoms (OR, 0.30 [95% CI, 0.13 to 0.68]; p=0.004) versus CM. Time-to-event analyses further revealed significant differences in vertebral artery lesions and Type I–II VBFAs, whereas no significant differences were observed in basilar or vertebrobasilar junction lesions or in Type III–IV VBFAs. Conclusions Compared with CM, FD was associated with improved long-term outcomes in unruptured VBFAs, particularly in vertebral artery lesions and Type I–II VBFAs, although residual confounding cannot be excluded.

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 explore the value of the albumin-to-alkaline phosphatase ratio(AAPR)with modified Glasgow prognostic score(mGPS)in assessing the response to and prognosis of intravesical Bacillus Calmette-Guérin(BCG)therapy in patients with non-muscle invasive bladder cancer(NMIBC).Methods A total of 153 high-risk NMIBC patients treated with intravesical BCG in our hospital during Jan.2018 and Oct.2021 were enrolled.Patients were divided into response and non-response groups based on the treatment efficacy,and into good and poor prognosis groups based on the clinical outcomes.AAPR and mGPS were calculated.The relationship between AAPR,mGPS and BCG treatment non-response was analyzed with multivariate logistic regression.Clinical data and scores were compared between prognosis groups.The associations between AAPR,mGPS,and poor prognosis after BCG treatment were assessed with a Cox proportional hazards model.Patients were stratified into high-and low-A APR groups,and into mGPS 0,1,and 2 groups.Kaplan-Meier survival curves were plotted for progression-free survival(PFS)across different AAPR and mGPS strata.The diagnostic performance of AAPR combined with mGPS in predicting treatment non-response and poor prognosis was evaluated using receiver operating characteristic(ROC)curves.Results Among the 153 patients,the response rate to BCG treatment was 71.90％(110/153),the 3-year poor prognosis rate was 45.75％(70/153),and the 3-year PFS rate was 54.25％(83/153).Increased AAPR was identified as an independent protective factor for both treatment response and good prognosis,while higher mGPS was an independent risk factor(P＜0.05).The 3-year PFS rate was significantly higher in the high-AAPR group than in the low-A APR group(P＜0.001).Among the mGPS groups,the 3-year PFS rate was lowest in the mGPS 2 group,followed by mGPS 1 and mGPS 0 groups(P＜0.001).The area under the ROC curve(AUC)for AAPR with mGPS in predicting BCG treatment non-response and poor prognosis was 0.864 and 0.901,respectively,significantly higher than using AAPR(0.774,0.781)or mGPS alone(0.798,0.809)(P＜0.05).Conclusion Lower AAPR and higher mGPS are associated with non-response and poor prognosis in NMIBC patients undergoing intravesical BCG therapy.The combination of AAPR and mGPS has high predictive value.

Objective To explore the value of the albumin-to-alkaline phosphatase ratio(AAPR)with modified Glasgow prognostic score(mGPS)in assessing the response to and prognosis of intravesical Bacillus Calmette-Guérin(BCG)therapy in patients with non-muscle invasive bladder cancer(NMIBC).Methods A total of 153 high-risk NMIBC patients treated with intravesical BCG in our hospital during Jan.2018 and Oct.2021 were enrolled.Patients were divided into response and non-response groups based on the treatment efficacy,and into good and poor prognosis groups based on the clinical outcomes.AAPR and mGPS were calculated.The relationship between AAPR,mGPS and BCG treatment non-response was analyzed with multivariate logistic regression.Clinical data and scores were compared between prognosis groups.The associations between AAPR,mGPS,and poor prognosis after BCG treatment were assessed with a Cox proportional hazards model.Patients were stratified into high-and low-A APR groups,and into mGPS 0,1,and 2 groups.Kaplan-Meier survival curves were plotted for progression-free survival(PFS)across different AAPR and mGPS strata.The diagnostic performance of AAPR combined with mGPS in predicting treatment non-response and poor prognosis was evaluated using receiver operating characteristic(ROC)curves.Results Among the 153 patients,the response rate to BCG treatment was 71.90％(110/153),the 3-year poor prognosis rate was 45.75％(70/153),and the 3-year PFS rate was 54.25％(83/153).Increased AAPR was identified as an independent protective factor for both treatment response and good prognosis,while higher mGPS was an independent risk factor(P＜0.05).The 3-year PFS rate was significantly higher in the high-AAPR group than in the low-A APR group(P＜0.001).Among the mGPS groups,the 3-year PFS rate was lowest in the mGPS 2 group,followed by mGPS 1 and mGPS 0 groups(P＜0.001).The area under the ROC curve(AUC)for AAPR with mGPS in predicting BCG treatment non-response and poor prognosis was 0.864 and 0.901,respectively,significantly higher than using AAPR(0.774,0.781)or mGPS alone(0.798,0.809)(P＜0.05).Conclusion Lower AAPR and higher mGPS are associated with non-response and poor prognosis in NMIBC patients undergoing intravesical BCG therapy.The combination of AAPR and mGPS has high predictive value.

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 explore the effect of Annexin A1(ANXA1)peptidomimetic Ac2-26 on acute kidney injury(AKI)and neutrophil apoptosis in septic rats.Methods:Experimental groups included control group,Ac2-26 group,AKI group,AKI+Ac2-26 group,with 15 rats in each group.After cecal ligation and perforation were used to establish a sepsis-induced AKI model,Ac2-26 was intravenously infused for treatment,once a day for 14 days;after the end,ELISA was used to detect levels of serum creatinine(Scr),urea nitrogen(BUN),IL-1β,IL-6 and TNF-α;HE staining and periodic acid Schiff(PAS)staining were used to observe the pathological changes of rat kidney tissues in each group;immunohistochemical staining was used to detect expression of ANXA1 in kidney tissue of each group of rats;neutrophils were isolated from rat peripheral blood,Giemsa staining and trypan blue staining were used to detect cell purity and viability;Annexin V-FITC/PI double staining method and TUNEL staining were used to determine apop-tosis level of neutrophils in each group.Results:Compared with control group,levels of Scr and BUN in serum of rats in AKI group were increased(P<0.05),levels of IL-1β,IL-6 and TNF-α also increased(P<0.05),renal tubules and glomeruli in kidney tissue were both significantly damaged,accompanied by a large number of inflammatory cell infiltration,and pathological score increased(P<0.05),while proportion of ANXA1 positive staining area was decreased(P<0.05);neutrophils identified by Giemsa staining and trypan blue staining had complete morphology and high activity;compared with control group,apoptosis rate of neutrophils in AKI group was decreased(P<0.05),and the positive rate of TUNEL was decreased(P<0.05).Compared with AKI group,levels of Scr and BUN in serum of rats in AKI+Ac2-26 group were decreased(P<0.05),levels of IL-1β,IL-6 and TNF-α also decreased(P<0.05),pathological manifestations of renal tubules and glomeruli in renal tissue were significantly reduced,and pathological score was reduced(P<0.05),while the proportion of ANXA1 positive staining area was increased(P<0.05),at the same time,apoptosis rate of rat neu-trophils was increased(P<0.05),positive rate of TUNEL was also increased(P<0.05).Conclusion:ANXA1 peptidomimetic Ac2-26 can increase expression of ANXA1 in kidney tissue of AKI in septic rats,promote neutrophil apoptosis,and have a protective effect on kidney tissue damage in rats caused by sepsis.

OBJECTIVE To reveal the role of the basal forebrain(BF)GABAergic neurons in the regulation of isoflurane anesthesia and to elucidate the underlying neural pathways.METHODS The activity of BF GABAer-gic neurons was monitored during isoflurane anesthesia using a genetically encoded calcium indicator in Vgat-Cre mice of both sexes.The activity of BF GABAer-gic neurons was manipulated by chemogenetic and opto-genetic approaches.Sensitivity,induction time and emer-gence time of isoflurane anesthesia were estimated by righting reflex.The electroencephalogram(EEG)power and burst-suppression were monitored by EEG recording.The effects of activation of GABAergic BF-thalamic reticu-lar nucleus(TRN)pathway on isoflurane anesthesia were investigated with optogenetics.RESULTS The activity of BF GABAergic neurons was generally inhibited during isoflurane anesthesia,obviously decreased during the induction of anesthesia and gradually restored during the emergence from anesthesia.Activation of BF GABAergic neurons with chemogenetics and optogenetics promoted behavioral emergence from isoflurane anesthesia,with decreased sensitivity to isoflurane,delayed induction and accelerated emergence from isoflurane anesthesia.Optogenetic activation of BF GABAergic neurons prom-oted cortical activity during isoflurane anesthesia,with decreased EEG delta power and burst suppression ratio during 0.8%and 1.4%isoflurane anesthesia,respectively.Similar to the effects of activating BF GABAergic cell bod-ies,photostimulation of BF GABAergic terminals in the TRN also strongly promoted cortical activation and behav-ioral emergence from isoflurane anesthesia.CONCLU-SION The GABAergic neurons in the BF is a key neural substrate for general anesthesia regulation that facilitates behavioral and cortical emergence from general anesthe-sia via the BF-TRN pathway.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.