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.

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.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Gastrointestinal stromal tumor(GIST)is the most prevalent mesenchymal tumor of the gastrointestinal tract,with imatinib serving as the first-line drug for metastatic GIST due to its good clinical efficacy.However,the majority of patients exhibit tumor progression within several years of drug therapy,primarily due to the high rate of drug resistance,which significantly impedes drug therapeutic outcome and patient prognosis.Traditional approaches to counteract resistance,including dosage increase and subsequent line therapy yielded suboptimal results.As a research hotspot,intestinal flora has been proven to be closely related to drug resistance of various tumors.In recent years,it has been observed that specific intestinal flora could serve as biomarkers for early GIST patient screening or as potential drug targets,and modulating the intestinal flora through interventions may delay or even reverse the progression of imatinib secondary drug resistance in GIST.This review delineates the drug resistance of GIST,correlations between intestinal flora and drug resistance of tumors,as well as the relationship between intestinal flora and drug resistance of GIST,aiming to provide novel perspectives and methodologies for clinical application.

Objective To investigate the clinical and pathological characteristics of adrenal cortical carcinoma(ACC),compare differences between hypercortisolism and non-functional ACC,and assess the diagnostic value of indicators such as Ki-67 index.Methods The clinical data of 57 ACC patients admitted to the First Medical Center of Chinese PLA General Hospital from January 2015 to March 2025 were retrospectively analyzed.According to the results of endocrine function assessment,47 of these patients were divided into hypercortisolism group(n=19)and non-functional group(n=28).The differences in clinical and pathological characteristics between the two groups were compared,and non-parametric tests and Spearman correlation analysis were used to explore the relationship between Ki-67 index and tumor stage as well as imaging features.Results Among the 57 patients,there were 20 males and 37 females,with a male-to-female ratio of 1:1.85.The age ranged from 16 to 76 years,and the age at diagnosis was(48.7±13.3)years.The tumor diameter was(10.53±4.14)cm.The tumors were located on the right side in 12 cases(21.1%),on the left side in 34 cases(59.6%),and bilaterally in 11 cases(19.3%).Among them,16 cases(28.1%)were complicated with glucose metabolism disorders,31 cases(54.3%)had hypertension,and 20 cases(35.1%)had hypokalemia.According to ENSAT staging,there were 0 cases in stage Ⅰ,15 cases(26.3%)in stage Ⅱ,24 cases(42.1%)in stage Ⅲ,and 18 cases(31.6%)in stage Ⅳ.Endocrine function assessment was completed in 47 of the 57 patients,including 28 cases(59.6%)of non-functional ACC and 19 cases(40.4%)of hypercortisolism(including 1 case of hypercortisolism combined with increased sex hormone secretion).Compared with non-functional group,hypercortisolism group had a significantly higher prevalence of hypertension(P=0.014),later ENSAT stage(P=0.010),and a higher proportion of hypervascularization(P=0.048).The median Ki-67 index was 20%(10%-40%),showing no significant correlation with either the maximum tumor diameter or SUVmax value,but it was related to ENSAT staging,with Ki-67 index in stageⅣ patients being significantly higher than that in stage Ⅱ(P=0.032).Immunohistochemistry results showed that the positive rate of Inhibin-α was 84.8%,and the positive rate of Melan-A was 40.9%.Conclusions ACC is a rare malignant endocrine tumor.ACC patients with hypercortisolism are more likely to be complicated with hypertension,have later staging,and more common hypervascular manifestations.Clinically,their endocrine function should be prioritized for assessment,and more active treatment strategies should be adopted.Diagnosis should be combined with imaging characteristics(such as hypervascularization)and immunohistochemical indicators(Ki-67,Inhibin-α,Melan-A).The significant increase in Ki-67 is in the advanced stage can serve as an important prognostic indicator to guide individualized treatment.

Objective To analyze the relationship between frailty and acute kidney injury(AKI)after hip fracture surgery in the elderly.Methods A total of 405 elderly patients who underwent hip fracture surgery in Jieyang People's Hospital from August 2021 to January 2023 were retrospectively analysed.According to the modified frailty index(mFI),they were divided into frail group(mFI≥0.27,n=112)and non-frail group(mFI<0.27,n=293).Postoperative AKI was defined according to the Kidney Disease:Improving Global Outcomes(KDIGO)criteria.After 1:1 propensity score matching(PSM),100 cases in each group were successfully matched.Univariable and multivariable logistic regression models,propensity score adjustment,PSM,inverse probability of treatment weighting(IPTW),standardized mortality ratio weighting(SMRW),pairwise algorithm(PA)weighting,and overlap weighting(OW)methods were used to analyze the relationship between frailty and postoperative AKI.Stratified analyses were performed according to age(≥80 or<80 years),gender,whether angiotensin-converting enzyme inhibitors(ACEI)/angiotensin Ⅱreceptor antagonists(ARB)were used,and whether intraoperative hypotension occurred.Results After PSM,there were no significant differences between the two groups in age,sex,surgical type,ACEI/ARB,blood urea nitrogen,serum creatinine,intraoperative blood loss,and intraoperative hypotension[standardized mean difference(SMD)<0.1].In both the original cohort and the matched cohort,the incidence of AKI was higher in frail group than in non-frail group(25.9%vs.8.9%,P<0.001;28.0%vs.11.0%,P=0.002).Analysis of the risk of postoperative AKI in elderly hip fracture patients in frail group found that compared with the non-frail group,in the univariate logistic regression model the odds ratio(OR)and a 95%confidence interval(CI)for the frail group was 3.59(2.00-6.43),P<0.001,and in the multivariable logistic regression model,the OR(95%CI)for frail group was 3.04(1.55-5.95),P=0.001.After adjustment for propensity score,the OR(95%CI)for frail group was 2.85(1.52-5.34),P=0.001,and the OR(95%CI)for frail group after PSM was 3.15(1.47-6.75),P=0.003.After IPTW,SMRW,PA weighting,and OW,the OR(95%CI)for frail group were 2.48(1.37-4.50),2.43(1.41-4.19),2.63(1.25-5.54),and 2.69(1.07-6.78),respectively,with P<0.05.The interaction tests were not statistically significant for age,sex,use of ACEI/ARB,and intraoperative hypotension(P>0.05).Conclusion In elderly patients with hip fractures,preoperative frailty may be a risk factor for postoperative AKI.

Objectives:To retrospectively review the clinical data from multiple centers of patients diagnosed with spinal tuberculosis,and identify key indicators that reflect the disease's characteristics and clinical man-agement to propose a novel classification system for spinal tuberculosis;To summarize the surgical treatment methods and outcomes of patients with complete data who were followed up for more than 1 year for surgical efficacy evaluation.Methods:The clinical data of 358 spinal tuberculosis patients diagnosed and treated at multiple centers between January 2007 and December 2022 were collected and analyzed.The patients aged 35.5±28.9 years old,and were consisted of 189 males and 169 females.There were 346 cases of active spinal tuberculosis and 12 cases of inactive tuberculosis.The distribution of lesion sites included cervical spine in 37 cases,cervicothoracic spine in 24 cases,thoracic spine in 126 cases,thoracolumbar spine in 79 cases,lumbar spine in 63 cases,and lumbosacral spine in 29 cases.The number of affected vertebrae per lesion was 3.1±1.9(ranged from 1 to 12).Clinical manifestations included pain,limited mobility,fever,elevated erythrocyte sedimentation rate,destruction and absorption of vertebrae and intervertebral discs,cold abscesses,and sequestra.Among the patients,256 patients exhibited concomitant kyphotic deformities,and 66 patients presented with varying degrees of spinal cord or nerve dysfunction.Using expert panel discussions and opin-ion surveys,indicators that reflect the characteristics of spinal tuberculosis were identified and subjected to correlation analysis with the degrees of kyphosis.Based on these findings,a new comprehensive classification system(ASM classification)grounded in key indicators was designed and then re-evaluated and tested for reli-ability.In parallel,the clinical data of 117 patients with over one year of postoperative follow-up and com-plete records were collected,and the surgical efficacy was assessed according to visual analogue scale(VAS)score for pain,examination of spinal cord or nerve function,and measurement of Cobb angle of kyphosis as well as evaluation of graft fusion conditions on X-ray and CT.Results:The expert discussions confirmed that pathological stage,lesion location,number of affected vertebrae,and the presence of kyphotic deformity and spinal cord or nerve dysfunction were key indicators in the diagnosis and treatment of spinal tuberculosis;Other indicators such as the extent of vertebral destruction,segmental instability,and the number and size of sequestra and cold abscesses were found to be less specific.Correlation analysis demonstrated a significant association between kyphotic deformity and factors such as disease duration,lesion location,affected segment,and spinal cord or nerve involvement(P＜0.05).Based on the validation results,a new comprehensive classifica-tion system was proposed.The spinal tuberculosis was categorized into two main types based on lesion activi-ty,the active spinal tuberculosis(type Ⅰ)and inactive spinal tuberculosis(type Ⅱ).Type Ⅰ was further divid-ed into four subtypes:type A-early-stage spinal tuberculosis,type B-progressive spinal tuberculosis,type C-special type including skip lesions,and type D-spinal appendage tuberculosis;Type Ⅱ was divided into two subtypes:type A-deformity-stable type,type B-deformity-progressive type.Additionally,the four key indicators-lesion location,number of affected vertebrae,presence and degree of kyphotic deformity,and spinal cord or nerve impairment were included as auxiliary indicators.Reliability analysis showed that the new classification system had good consistency and reproducibility.Among the 117 patients with over one year of postoperative follow-up and complete records,12 with cervical tuberculosis underwent anterior ap-proach surgery,104 patients with lesions below the cervicothoracic junction underwent posterior-only surgery,and 1 thoracolumbar case underwent additional debridement of a cold abscess via a small contralateral ab-dominal incision during posterior surgery.Follow-up results revealed:VAS score was 1.9±0.3(1-3),kyphotic Cobb angle was 15.61°±8.44°(4°-40°);The patients with abnormal spinal cord nerve function were fully recov-ered to normal at the final follow-up,and the above-mentioned indicators were improved with statistically significant differences comparing with the preoperative values(P＜0.05);111 patients were clinically cured and bony fused on CT images;6 patients experienced tuberculosis recurrence,among which,5 failed in internal fixation due to graft non-fusion and underwent re-operation.Conclusions:The new classification system(ASM)effectively captures the clinical characteristics of spinal tuberculosis and facilitates diagnosis,treatment plan-ning,and clinical communication.For patients with spinal tuberculosis below the cervicothoracic junction,a purely posterior surgical approach also represents an advantageous treatment option.

This paper summarizes the progress of theoretical research and practice of One Health in China,and discusses the paradigm of One Health governance to improve the prevention and control of infectious diseases in China and the world,and provide an example for the improvement of the public health system.In particular,China has long history to apply the concept of One Health in the national schistosomiasis control programmes and patriotic health campaigns,which were not only focusing on human health,but also emphasizing the sustainable development of animal health and ecological environment.At the same time,the application of tools such as system dynamics model,eDNA technology,One Health economic assessment and global One Health index(GOHI)in the field of disease control and environmental health provides technical support for the concept of One Health.Despite the challenges of practical application of these tools,the One Health concept will play a greater role in providing sustainable solutions for human-animal-environmental health by strengthening interdisciplinary collaboration,improving standardization protocols and promoting inter-national cooperation.

Objective To design a centrifugal agtomization principle-based disinfection and disinsection device for plateau areas.Methods A disinfection and disinsection device was developed based on centrifugal atomization principle,which was composed of a spraying body,lifting and rotating mechanisms,an electrical control system,a spray tank and a sprayer carriage.The spraying body consisted of spraying components,a motor,an air blower,a fan and etc,and the spraying components adopted the structural form of multi-layer disc stacking to realize the atomization of liquid medicine;the lifting mechanism implemented up-and-down adjustment of the air blower through an electric actuartor,and the rotating mechanism executed left-and-right adjustment of the air blower thrgouth the worm gear motor and limit switch;the electrical control system was made up of a power source,electrical devices,a distribution system and a control system,in which a lead-acid battery pack was used for power supply and a DGUS touch screen and a DCS001 controller were involved in the control system;the spray tank was formed of a tank body,a needle valve,a water pump,float switch,etc;the sprayer carriage comprised a frame,a pusher,two sealing plates and four wheels.Some disc samples with different diameters were trial produced,and comparison experiments were carried out to investigate the relationship between disc diameter,motor speed,spray flow rate and atomization effect;a prototype was manufactured for performance testing of the device.Results The disc diameter and motor speed were inversely proportional to the droplet size;the spray flow rate was directly proportional to the droplet size,when the spray flow rate increased by 60%,the increment of the droplet size was restrained within 2%to 11%.The prototype test results indicated that the device could be used for ultra-low-volume disinfection and insecticide in plateau areas,with the D50 and D90 of the droplet size being 31 and 48 μm,respectively.Conclusion The device developed gains advantages in atomiztion,and meets the requirements for epidemic prevention,disinfection and disinsection in plateau areas.[Chinese Medical Equipment Journal,2025,46(4):35-39]