Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

ObjectiveTo construct a prediction model for high responsiveness to short-term aerobic training in patients with Parkinson's disease (PD) based on dual-task gait assessment, and to provide evidence for identifying individuals who are most likely to benefit from such interventions. MethodsA total of 42 patients with PD who visited the outpatient clinic of Tianjin Huanhu Hospital between August 29, 2023 and December 19, 2024 were enrolled. All participants completed a 4-week home-based aerobic cycling training program and underwent dual-task gait assessments pre- and post-training. Patients were classified into high-response group (n = 12) and low-response group (n = 30) according to whether the improvement in gait speed reached the minimal clinically important difference of 0.1 m/s. The clinical validity of this grouping was verified by comparing differences in cardiopulmonary exercise testing parameters and dual-task gait indicators between the two groups pre- and post-training. Based on baseline characteristics, Firth's penalized maximum likelihood logistic regression was applied to construct a predictive model for high responsiveness, and the discriminative performance of the model was assessed preliminarily. ResultsThe high-response group showed significantly greater improvement in gait speed, step length, cadence and the anaerobic threshold to maximal oxygen uptake ratio after training compared with the low-response group (P < 0.05), confirming the clinical validity of the grouping. The baseline anaerobic threshold to maximal oxygen uptake ratio (OR = 3.348), body mass index (OR = 2.229) and age (OR = 0.428) demonstrated certain discriminative ability in the present sample. The area under the receiver operating characteristic curve was 0.831, with an overall prediction accuracy of 81.0%, specificity of 83.3% and sensitivity of 75.0%. Robustness of the model was confirmed via internal validation using the Bootstrap method, which suggested that the results were informative, but further validation was still required. ConclusionThe anaerobic threshold/maximal oxygen uptake ratio, body mass index and age may predict the response to short-term aerobic training in patients with PD.

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.

Objective:To observe the effect of ankle joint proprioception training on ankle joint proprioception, balance and gait in patients with thalamic infarction.Methods:Fifty-six patients with thalamic infarction were divided into a control group and a treatment group, each of 28, using a random number table. Both groups were given conventional lower limb rehabilitation training, but the treatment group was additionally provided with ankle joint proprioception training. Before and after 4 weeks of the treatment, the Tecnobody proprioception testing system was used to determine the average trajectory error rate (ATE) and the time taken in the test. The Berg Balance Scale (BBS) and a balance tester were used to assess balance. A gait analyzer was used to collect spatial-temporal measures of the patients′ walking, including the stride amplitude, stride rate, the proportion of the time spent in the swing phase, and foot dorsiflexion and plantarflexion angles.Results:After the treatment, the time used, ATE, ankle proprioception, BBS scores, static balance test scores, stability limits, stride length, stride rate, swing phase time percentage, and foot dorsiflexion and plantarflexion angles had improved in both groups compared with before the treatment ( P≤0.05). Compared with the control group, the treatment group had a smaller average ATE, spent less time on the ankle proprioception test, had higher BBS scores, had lower scores on the static balance test, had larger limits of stability, took longer strides at a faster rate, and spent a greater percentage of time in the swing phase. That group also showed greater ankle dorsiflexion and plantarflexion on average ( P≤0.05). ATE difference of the affected lower limb and the time to complete the ankle proprioception test were positively correlated with the gap in the static balance ability test, and negatively correlated with the gaps in the BBS score, the limits of stability, stride length, stride rate, and the time share of the swing phase, as well as the dorsiflexion and plantarflexion angles of the foot. Conclusions:Ankle proprioception training, in addition to effectively improving ankle proprioception, can improve the balance and gait of persons with thalamic infarction. It is worthy of clinical application and promotion.

[Purpose]To analyze the incidence and changing trends of elderly breast cancer(de-fined as diagnosis at age ≥ 60 years old)in China and globally from 1990 to 2021,and to predict its trends from 2022 to 2035.[Methods]Data on the number of new cases and crude incidence rate of elderly breast cancer in China and globally were extracted from the 2021 Global Burden of Disease Study(GBD)database.The age-standardized incidence rate(ASIR)was calculated by sex and age group.The Joinpoint regression model was used to calculate the annual percentage change(APC)and average annual percentage change(AAPC),to describe the incidence trend of elderly breast cancer from 1990 to 2021.The Bayesian age-period-cohort(BAPC)model was applied to predict the incidence of elderly breast cancer from 2022 to 2035.[Results]From 1990 to 2021,the number of new breast cancer cases among elderly individuals globally increased from 416 444 to 1 023 776,while in China,the number rose from 26 371 to 158 085.The ASIR increased from 89.04/105 to 94.73/105 globally and from 27.24/105 to 58.40/105 in China.By sex,the ASIR of el-derly females increased from 155.19/105 to 170.54/105 globally and from 49.13/105 to 106.00/105 in China;the ASIR of elderly males increased from 2.78/105 to 4.72/105 globally and from 1.69/105 to 6.81/105 in China.By age group,from 1990 to 2021,the incidence rates of breast cancer in elderly female and male both peaked in the age group of 85～89 years old globally.In China,the most significant increases in incidence rates were observed in the age group of 60～64 years old for elderly females and the age group of 70～74 years old for elderly males;these two age groups had the highest incidence rates in their respective sexes in 2021.Joinpoint analysis showed that the ASIR of elderly breast cancer in China presented a continuous upward trend from 1990 to 2021(AAPC=2.51％),with the fastest growth during 2016-2019(APC=5.14％).The global ASIR showed only a slight fluctuating upward trend(AAPC=0.20％),with significant increases only during 1990-1995 and 2003-2010.Predictions from the BAPC model indicated that by 2035,the global ASIR of elderly breast cancer would reach 107.84/105(192.26/105 for females and 6.02/105 for males),while the ASIR in China would reach 104.35/105(188.08/105 for females and 13.32/105 for males).[Conclusion]From 1990 to 2021,the incidence of elderly breast cancer showed an upward trend both in China and globally,with a particularly pronounced increase in elderly male.The disease burden of elderly breast cancer in China is expected to continue increasing in the future,necessi-tating strengthened primary and secondary prevention measures,as well as optimized screening programs for the elderly population to reduce disease risks and improve prognosis.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multi-system disease that presents significant diagnostic challenges due to its complexity and low incidence (White and Dubey, 2023). It affects males and females equally, though males may exhibit more active disease at diagnosis and often require more aggressive treatment (Liu et al., 2023). The hallmark features of EGPA include delayed-onset asthma, eosinophilia in tissues and blood, and vasculitis affecting small to medium-sized arteries (White and Dubey, 2023). EGPA falls under the category of antineutrophil cytoplasmic antibody (ANCA)‍-associated vasculitis (AAV), whereas only about half of EGPA patients test positive for ANCA (Khoury et al., 2023).
Humans ; Male ; Hemorrhage/etiology* ; Granulomatosis with Polyangiitis/complications* ; Heart Arrest/etiology* ; Early Diagnosis ; Eosinophilia/diagnosis* ; Kidney Diseases/etiology* ; Churg-Strauss Syndrome/complications* ; Middle Aged

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.

[Purpose]To analyze the incidence and changing trends of elderly breast cancer(de-fined as diagnosis at age ≥ 60 years old)in China and globally from 1990 to 2021,and to predict its trends from 2022 to 2035.[Methods]Data on the number of new cases and crude incidence rate of elderly breast cancer in China and globally were extracted from the 2021 Global Burden of Disease Study(GBD)database.The age-standardized incidence rate(ASIR)was calculated by sex and age group.The Joinpoint regression model was used to calculate the annual percentage change(APC)and average annual percentage change(AAPC),to describe the incidence trend of elderly breast cancer from 1990 to 2021.The Bayesian age-period-cohort(BAPC)model was applied to predict the incidence of elderly breast cancer from 2022 to 2035.[Results]From 1990 to 2021,the number of new breast cancer cases among elderly individuals globally increased from 416 444 to 1 023 776,while in China,the number rose from 26 371 to 158 085.The ASIR increased from 89.04/105 to 94.73/105 globally and from 27.24/105 to 58.40/105 in China.By sex,the ASIR of el-derly females increased from 155.19/105 to 170.54/105 globally and from 49.13/105 to 106.00/105 in China;the ASIR of elderly males increased from 2.78/105 to 4.72/105 globally and from 1.69/105 to 6.81/105 in China.By age group,from 1990 to 2021,the incidence rates of breast cancer in elderly female and male both peaked in the age group of 85～89 years old globally.In China,the most significant increases in incidence rates were observed in the age group of 60～64 years old for elderly females and the age group of 70～74 years old for elderly males;these two age groups had the highest incidence rates in their respective sexes in 2021.Joinpoint analysis showed that the ASIR of elderly breast cancer in China presented a continuous upward trend from 1990 to 2021(AAPC=2.51％),with the fastest growth during 2016-2019(APC=5.14％).The global ASIR showed only a slight fluctuating upward trend(AAPC=0.20％),with significant increases only during 1990-1995 and 2003-2010.Predictions from the BAPC model indicated that by 2035,the global ASIR of elderly breast cancer would reach 107.84/105(192.26/105 for females and 6.02/105 for males),while the ASIR in China would reach 104.35/105(188.08/105 for females and 13.32/105 for males).[Conclusion]From 1990 to 2021,the incidence of elderly breast cancer showed an upward trend both in China and globally,with a particularly pronounced increase in elderly male.The disease burden of elderly breast cancer in China is expected to continue increasing in the future,necessi-tating strengthened primary and secondary prevention measures,as well as optimized screening programs for the elderly population to reduce disease risks and improve prognosis.

Objective:To observe the effect of ankle joint proprioception training on ankle joint proprioception, balance and gait in patients with thalamic infarction.Methods:Fifty-six patients with thalamic infarction were divided into a control group and a treatment group, each of 28, using a random number table. Both groups were given conventional lower limb rehabilitation training, but the treatment group was additionally provided with ankle joint proprioception training. Before and after 4 weeks of the treatment, the Tecnobody proprioception testing system was used to determine the average trajectory error rate (ATE) and the time taken in the test. The Berg Balance Scale (BBS) and a balance tester were used to assess balance. A gait analyzer was used to collect spatial-temporal measures of the patients′ walking, including the stride amplitude, stride rate, the proportion of the time spent in the swing phase, and foot dorsiflexion and plantarflexion angles.Results:After the treatment, the time used, ATE, ankle proprioception, BBS scores, static balance test scores, stability limits, stride length, stride rate, swing phase time percentage, and foot dorsiflexion and plantarflexion angles had improved in both groups compared with before the treatment ( P≤0.05). Compared with the control group, the treatment group had a smaller average ATE, spent less time on the ankle proprioception test, had higher BBS scores, had lower scores on the static balance test, had larger limits of stability, took longer strides at a faster rate, and spent a greater percentage of time in the swing phase. That group also showed greater ankle dorsiflexion and plantarflexion on average ( P≤0.05). ATE difference of the affected lower limb and the time to complete the ankle proprioception test were positively correlated with the gap in the static balance ability test, and negatively correlated with the gaps in the BBS score, the limits of stability, stride length, stride rate, and the time share of the swing phase, as well as the dorsiflexion and plantarflexion angles of the foot. Conclusions:Ankle proprioception training, in addition to effectively improving ankle proprioception, can improve the balance and gait of persons with thalamic infarction. It is worthy of clinical application and promotion.

Purpose To analyze the multimodal imaging manifestations of phosphaturic mesenchymal tumor.Materials and Methods A retrospective analysis was performed on ten patients with phosphaturic mesenchymal tumor confirmed by pathology and molecular imaging from November 2012 to June 2022 in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.The imaging features of CT in four cases,of MRI in seven cases,and of nuclear medicine in ten cases were reviewed,along with the clinical characteristics of all patients.Results The main clinical symptoms of ten patients,eight cases had pain,four cases had weakness,and nine cases had multiple fractures.Laboratory tests results:ten cases showed decreased blood phosphorus,six cases showed decreased blood 25-hydroxyvitamin D and ten cases showed elevated blood alkaline phosphatase.The lesions were heterogeneous in four cases on CT scans and in six cases on MRI scans.Calcification was common,and some had cysts and fatty components.After enhancement,seven cases showed moderate to obvious uneven enhancement.99Tcm-MDP SPECT showed increased uptake of multiple bones and joints in eight cases,18F-FDG PET/CT showed no or slight increase in lesion metabolism in eight cases,68Ga-DOTATATE PET/CT showed significantly high uptake at the lesion site in ten cases.Conclusion Phosphaturic mesenchymal tumor patients typically present with pain,fractures and hypophosphatemia.The conventional imaging features are characterized by small and concealed lesions and complex components.Particularly,68Ga-DOTATATE PET/CT imaging exhibits high sensitivity for the tumor detection.