Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

ObjectiveTo investigate the status of tooth loss in people aged 50 and above, so as to understand their oral health status and provide scientific evidences for promoting oral health of middle-aged and elderly people. MethodsA total of 400 patients who visited the department of stomatology at Sijing Hospital in Songjiang District of Shanghai were performed oral health examinations and their information was collected according to the national epidemiological survey standards for oral health. ResultsThere were statistically significant differences in tooth loss among people aged 50 and above with different ages, educational levels, occupations, types of medical insurance and chronic diseases (P<0.05), but gender and monthly income had no statistically significant correlations with tooth loss (P>0.05). Among lifestyle factors, smoking, alcohol consumption and tea drinking had no statistically significant impacts on the number of remaining teeth (P>0.05), but toothbrushing frequency, flossing frequency, toothpick use frequency, toothbrush replacement frequency, and tooth loosening were statistically associated with the number of remaining teeth (P<0.05). Multiple linear regression analyses indicated that a total of 7 related factors including age, educational level, occupation, medical payment type, chronic disease, tooth loosening and toothpick use frequency were significantly associated with the number level of remaining teeth in individuals aged 50 and above. ConclusionAge, chronic disease, and tooth loosening were influencing factors affecting the number of teeth left in people aged 50 and above. It is recommended to strengthen oral health education and improve healthcare awareness to reduce the risk of tooth loss in people aged 50 and above.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.

Lymphangioleiomyomatosis (LAM) is a rare, multisystemic, low-grade neoplasm character-ized by diffuse cystic lesions in the lung.In recent years, emerging imaging examination such as ⁶⁸Ga-NEB PET-CT scan provides efficient and precise non-invasive diagnostic methods to detect lymphatic circulation abnormalities in LAM patients. The long-term efficacy and safety of sirolimus for LAM has accumulated further evidence, and genetic profiling studies have unveiled more information of genetic mechanisms. Prognosis of LAM has been much improved. We briefly reviewed the research advances of LAM in China and other countires.

Objective To investigate the effect of verapamil on chemosensitivity and apoptosis of esophageal cancer cells.Methods The IC50 values (IC501) of three kinds of chemotherapy drugs:paclitaxel,cisplatin,and 5-fluorouracil were detected by CCK-8 method in 4 kinds of esopha geal cancer cell lines (EC109,EC9706,KYSE-450,TE-1).Each cell was processed by verapamil (4.91 μg/mL) combined with the chemotherapy treatment above,IC50 (IC502) value was detected by CCK8 assay combined with chemotherapy for the verapamil of the 4 esophageal carcinoma cell lines (EC109,EC9706,KYSE-450 and TE-1).A pair of esophageal cancer cells with the most significant reversal of the resistance to chemotherapy by VER detected by the previous experiments were included as research objects,and Annexin V-PI double staining method was used to detect the apoptosis of esophageal cancer cells.Results The IC50 values of paclitaxel in KYSE-450 and EC9706 cell lines were significantly higher than that in EC109 and TE-1.The IC50 values of cisplatin in TE-1 cells were significantly less than those in the other three cells,while the IC50 values of 5-fluorouracil in EC109 were significantly higher than that in other three cell lines.After adding verapamil,the IC50 values of paclitaxel,cisplatin and 5-fluorouracil in four esophageal cancer cell lines (EC109,EC9706,KYSE-450 and TE-1) all decreased to different degrees,and the above three kinds of chemotherapeutic drugs had increased their sensitivity to varying degrees.Among them,the cisplatin group before adding verapamil had different degrees of resistance compared with EC109,EC9706,KYSE-450,TE-1.After joining verapamil,IC50 value change for the EC9706 multiplied for 15.2 times,suggesting that the reversal was sensitive;IC50 value change for EC109 was 1.6 times smaller,suggesting that the reversal was tolerant.Conclusion Verapamil reversal of EC9706 adriamycin has highest efficiency index (15.2 times),there was significant difference compared with the EC109 cells (1.6 times).Tipthe EC9706 (DDP) sensitivity to the reversal of verapamil,and EC109 (DDP) reverse resistance of verapamil.Verapamil may enhance the ability to reverse chemotherapy tolerance by promoting cell apoptosis,thereby enhancing the sensitivity of chemotherapeutic drugs.

Objective To investigate the effect of verapamil on chemosensitivity and apoptosis of esophageal cancer cells.Methods The IC50 values (IC501) of three kinds of chemotherapy drugs:paclitaxel,cisplatin,and 5-fluorouracil were detected by CCK-8 method in 4 kinds of esopha geal cancer cell lines (EC109,EC9706,KYSE-450,TE-1).Each cell was processed by verapamil (4.91 μg/mL) combined with the chemotherapy treatment above,IC50 (IC502) value was detected by CCK8 assay combined with chemotherapy for the verapamil of the 4 esophageal carcinoma cell lines (EC109,EC9706,KYSE-450 and TE-1).A pair of esophageal cancer cells with the most significant reversal of the resistance to chemotherapy by VER detected by the previous experiments were included as research objects,and Annexin V-PI double staining method was used to detect the apoptosis of esophageal cancer cells.Results The IC50 values of paclitaxel in KYSE-450 and EC9706 cell lines were significantly higher than that in EC109 and TE-1.The IC50 values of cisplatin in TE-1 cells were significantly less than those in the other three cells,while the IC50 values of 5-fluorouracil in EC109 were significantly higher than that in other three cell lines.After adding verapamil,the IC50 values of paclitaxel,cisplatin and 5-fluorouracil in four esophageal cancer cell lines (EC109,EC9706,KYSE-450 and TE-1) all decreased to different degrees,and the above three kinds of chemotherapeutic drugs had increased their sensitivity to varying degrees.Among them,the cisplatin group before adding verapamil had different degrees of resistance compared with EC109,EC9706,KYSE-450,TE-1.After joining verapamil,IC50 value change for the EC9706 multiplied for 15.2 times,suggesting that the reversal was sensitive;IC50 value change for EC109 was 1.6 times smaller,suggesting that the reversal was tolerant.Conclusion Verapamil reversal of EC9706 adriamycin has highest efficiency index (15.2 times),there was significant difference compared with the EC109 cells (1.6 times).Tipthe EC9706 (DDP) sensitivity to the reversal of verapamil,and EC109 (DDP) reverse resistance of verapamil.Verapamil may enhance the ability to reverse chemotherapy tolerance by promoting cell apoptosis,thereby enhancing the sensitivity of chemotherapeutic drugs.