Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective:To investigate the mechanism of polygonatum and astragalus compound(PA)in inhibiting the progression of lung adenocarcinoma. Methods:CCK-8 assay was used to assess the inhibitory rate of proliferation in A549 and H1299 cells treated with PA at different concentrations and to calculate the half maximal inhibitory concentration(IC50).C57BL/6 mice(KRASG12D/+;TP53flox/flox)were treated with adenovirus carrying Cre enzyme via nasal inhalation to establish a mouse model of primary lung adenocarcinoma.The model mice were fed with PA-containing diet to directly observe the effect of PA on the lung adenocarcinoma tissue.Immunohistochemical staining was used to examine the pathological status of the lung tissue.Bioinformatics analysis indicated that PA affects the progression of lung adenocarcinoma through the apelin-peroxisome proliferator-activated receptor gamma coactivator 1-alpha(PGC1α)-mitochondrial brown fat uncoupling protein 1(UCP1).Real-time quantitative PCR and Western blotting analysis were used to study the effect of PA on the mRNA and protein expression levels of apelin-PGC1α-UCP1 signaling pathway related genes.An ATP detection kit and flow cytometry were used to evaluate the effect of PA on the ATP and mitochondrial ROS production,respectively,in A549 and H1299 cells.siUCP1 was used to silent the expression of UCP1 while Z160 was used to induce UCP1 overexpression in A549 and H1299 cells,and the changes in ATP and mitochondrial ROS production were examined to further investigate whether PA acts on apelin-PGC1α-UCP1 signaling pathway to affect the progression of lung adenocarcinoma. Results:PA could obviously inhibit the proliferation of A549 and H1299 cells with the IC50 values of 10.66 mg/mL for A549 cells and 9.66 mg/mL for H1299 cells.In the mouse primary lung adenocarcinoma model,PA could effectively inhibit the growth of tumor,downregulate apelin-PGC1α-UCP1 signaling pathway and inhibit the expression of lung adenocarcinoma-promoting gene UCP1.In A549 and H1299 cells,PA could significantly inhibit the expression of apelin,PGC1α and UCP1(P＜0.05),promote the production of ATP(P＜0.000 1)and ROS,restore mitochondrial oxidative phosphorylation,and inhibit aerobic glycolysis(P＜0.01).UCP1 silencing could increase the production of ATP(P＜0.01)and mitochondrial ROS and decrease the expression of key glycolysis enzymes hexokinase 2(HK2)and pyruvate kinase isozyme type M2(PKM2)(P＜0.05).Increasing the expression of UCP1 could reduce the ATP production(P＜0.01)and mitochondrial ROS generation in cells while increase the expression of HK2 and PKM2(P＜0.05).Treating cells with PA and Z160 simultaneously(PA+Z160)could reverse the inhibitory effect of PA on the ATP production and glycolysis of tumor cells(P＜0.05). Conclusion:PA can downregulate the apelin-PGC1α-UCP1 signaling pathway,inhibit mitochondrial uncoupling,restore mitochondrial oxidative phosphorylation,inhibit aerobic glycolysis,reverse the Warburg effect,and thus inhibit lung adenocarcinoma progression.

Objective:To investigate the effects of preoperative pre-rehabilitation on early functional recovery after knee arthroplasty under the multidisciplinary collaboration mode of accelerated rehabilitation surgery.Methods:The clinical data of 51 patients who underwent total knee arthroplasty in the Department of Orthopedics, Jinjiang Hospital from September 2019 to December 2021 were retrospectively analyzed. These patients were divided into an observation group ( n = 24) and a control group ( n = 27). The observation group received pre-rehabilitation before knee replacement surgery, while the control group did not. After completing the admission procedures, patients in the observation group underwent rehabilitation evaluation in the rehabilitation clinic and received individualized rehabilitation training. The control group did not undergo preoperative pre-rehabilitation but underwent the same individualized rehabilitation training as the observation group. The rehabilitation specialist evaluated the patients' rehabilitation scores [hospital for special surgery knee (HSS) score, visual analog scale (VAS) score] at 2 and 5 days after surgery. The main outcome measures included the range of motion (ROM) of the patient's knee joint at 2 and 5 days after surgery, HSS score at 2 and 5 days after surgery, VAS score at 5 days after surgery, the number of days from surgery to discharge, the incidence of postoperative complications, and the rate of outpatient visits after surgery. Results:There was no significant difference in postoperative ROM of the knee joint between the observation and control groups at 2 days after surgery ( P > 0.05). However, there was a significant difference in score of ROM of the knee joint at 5 days after surgery between the two groups [(100.08 ± 7.75) points vs. (88.44 ± 16.09) points, t = 3.34, P = 0.002]. There was no significant difference in HSS score between the two groups at 2 days after surgery ( P > 0.05). However, there was a significant difference in HSS score between the two groups at 5 days after surgery [(62.84 ± 5.78) points vs. (57.09 ± 6.53) points, t = 3.31, P = 0.002]. There was a significant difference in VAS score (exercise) between the two groups at 5 days after surgery [(3.42 ± 1.02) points vs. (5.37 ± 1.15) points, t = -6.39, P < 0.001]. There was no significant difference in the number of days from surgery to discharge between the two groups ( P > 0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P > 0.05). However, there was a significant difference in the rate of outpatient visits between the two groups [7/17 vs. 1/26, χ2 = 4.45, P = 0.035]. Conclusion:Preoperative pre-rehabilitation in the accelerated rehabilitation surgery model under multidisciplinary collaboration can help improve the early function of patients undergoing total knee arthroplasty, reduce the pain of postoperative rehabilitation, improve the postoperative rehabilitation compliance, and ultimately enhance patient satisfaction with the surgery.

OBJECTIVE: To assess the value of using flat-sided culture tubes for preparing chromosomes through chorionic villi (CV) and amniotic fluid (AF) cell cultures during prenatal diagnosis. METHODS: From February to March 2020, 157 CV samples and 147 AF samples subjected to prenatal diagnosis at the Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region were selected as the study subjects. For each sample, one flat-sided tube and one flask culture were set up by following the standard protocols. The methods were evaluated by comparing the cell growth, experimental process, quality of chromosome preparation and costs. RESULTS: The success rates for the culturing of CV and AF samples by the flat-sided culture tube method were 97.45% (153/157) and 97.96% (144/147), respectively. By contrast, the success rates for the conventional flask method were 98.72% (155/157) for CV and 98.64% (145/147) for AF samples. No significant difference was found between the two methods (P > 0.05). The average harvest time required by the flat-sided culture tube method was 8.45 days for CV and 9.43 days for AF cultures, whilst the average harvest time for conventional flask method was 9.05 days and 9.54 days, respectively. The flat-sided culture tube method for CV had required significantly shorter average harvest time than the conventional method (P < 0.001). No statistical significant difference was found in the average harvest time for AF by the two methods (P > 0.05). The conventional culturing method had required three containers with two sample transfers. By contrast, the flat-sided culture tube method was carried out in one tube without any sample transfer. The average total amount of medium used was 3.91 mL for each flat-sided culture tube and 6.26 mL for each conventional flask. CONCLUSION The flat-sided culture tube method can provide a simple, cost-effective and error-reducing procedure for the CV and AF samples culture during prenatal diagnosis.
Child ; Female ; Pregnancy ; Humans ; China ; Prenatal Diagnosis ; Chorionic Villi Sampling ; Amniotic Fluid ; Cell Proliferation

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To provide anatomic data of the coracoclavicular (CC) ligament attachment regions in Chinese population for anatomic reconstruction of CC ligament to treat acromioclavicular dislocation.Methods:The CC ligaments were first dissected layer by layer out of the bilateral acromioclavicular joint specimens taken from 87 adult cadavers. The CC width and thickness on the attachments of the clavicle and the coracoid process were measured by an electronic digital caliper. The conoid ligament and trapezoid ligament were mapped on the surface of the clavicle and the coracoid process by transecting the ligaments close to their insertions. The distances from the ligament footprint center to the lateral, anterior and posterior margins of the clavicle were measured. The distances from the ligament footprint center to the tip, medial and lateral margin borders of the coracoid process were measured.Results:The distances from the lateral edge of the clavicle to the footprint centers of the conoid and trapezoid ligaments were (35.7 ± 3.4) mm and (21.8 ± 2.7) mm, and the ratio of the distance divided by the clavicular length was 25.5% ± 0.9% and 15.6% ± 1.1%, respectively. The distances from the tip of coracoid to the footprint centers of the conoid and trapezoid ligaments were (35.1 ± 3.2) mm and (29.7 ± 2.9) mm, and the ratio of the distances divided by the coracoidal length was 86.7% ± 1.9% and 73.3% ± 2.1%, respectively.Conclusion:Although the absolute position of the CC ligament attaching to the clavicle and the coracoid process varies greatly among Chinese individuals, the ratio of its relative position to the length and width of the clavicle and the coracoid process is a relatively stable set of data.

Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.

Background and Objectives: Bone marrow mesenchymal stem cells (BMSCs) show considerable promise in regenerative medicine. Many studies demonstrated that BMSCs cultured in vitro were highly heterogeneous and composed of diverse cell subpopulations, which may be the basis of their multiple biological characteristics. However, the exact cell subpopulations that make up BMSCs are still unknown. Methods: and Results: In this study, we used single-cell RNA sequencing (scRNA-Seq) to divide 6,514 BMSCs into three clusters. The number and corresponding proportion of cells in clusters 1 to 3 were 3,766 (57.81%), 1,720 (26.40%), and 1,028 (15.78%). The gene expression profile and function of the cells in the same cluster were similar. The vast majority of cells expressed the markers defining BMSCs by flow cytometry and gene expression analysis. Each cluster had at least 20 differentially expressed genes (DEGs). We conducted Gene Ontology enrichment analysis on the top 20 DEGs of each cluster and found that the three clusters had different functions, which were related to self-renewal, multilineage differentiation and cytokine secretion, respectively. In addition, the function of the top 20 DEGs of each cluster was checked by the National Center for Biotechnology Information gene database to further verify our hypothesis. Conclusions This study indicated that scRNA-Seq can be used to divide BMSCs into different subpopulations, demon-strating the heterogeneity of BMSCs.

Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.