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 investigate the clinical results of gasless endoscopic thyroidectomy via posterior chest-collarbone approach (GETPCA) compared with open neck surgery for papillary thyroid carcinoma (PTC) .Mthods:Retrospective analysis of PTC patients admitted to the Department of Thyroid and Breast Surgery of the Third Affiliated Hospital of Anhui Medical University from Jan. 2022 to Dec. 2023,and randomly divided into the open group and the lumbo-scopic group according to whether or not they had a requirement for an unmarked neck, in which the open group was n=100,and the lumbo-scopic group was n=67,with 39 male cases and 128 female cases. Clinicopathological characteristics, surgery-related indexes, postoperative complications, postoperative pain scores and postoperative cosmetic satisfaction were compared between the two groups.The t-test,Wilcoxon rank-sum test, χ2 test, consecutively corrected χ2 test, or Fisher’s exact probability method were used to compare the groups. Results:No recurrence was seen during the follow-up period,and none of the cases in the luminal group was open in the middle. The differences in age, body mass index BMI, gender, relative tumor location,preoperative TSH, T stage and N stage between the two groups were not statistically significant ( P>0.05) . The total operation time [ (121.07±39.80) min vs. (93.87±26.97) min]in the luminal group was greater than that in the open group,intraoperative bleeding was less than that in the open group, and the postoperative drainage flow[ (130.69±31.01) mL vs. (105.52±32.71) mL] was greater than that in the open group in the postoperative period of 72 h, and the difference was statistically significant ( P<0.001) .There was no statistical difference between the two groups in terms of 24-h postoperative drainage volume, number of central zone lymph node dissection, number of positive central zone lymph nodes,postoperative hospitalization days or total hospitalization cost ( P>0.05) .The number of cases of neck discomfort (3 cases vs.23 cases, P<0.001) and swallowing dysfunction (2 cases vs.20 cases, P=0.003) in the luminal group was smaller than that in the open group,and the difference was statistically significant.The difference in the incidence of bleeding,incision infection,seroma,temporary recurrent laryngeal nerve injury and temporary parathyroid gland injury between the two groups was also not statistically significant ( P>0.05) .The postoperative NRS on day 1 and postoperative NRS on day 3 of the luminal group were lower than those of the open group,and the difference was statistically significant ( P>0.05) ,while there was no statistically significant difference between the postoperative NRS on day 7,the postoperative NRS on month 1 and the postoperative NRS on month 3 ( P>0.05) .Cosmetic satisfaction at 6 months postoperatively was higher in the luminal group than in the open group,and the difference was statistically significant ( P<0.001) . Conclusion:GETPCA for the treatment of the PTC is safe and feasible,with satisfactory cosmetic results and reduction of neck discomfort and swallowing dysfunction,which is worthy of clinical popularization.

Objective:To investigate the clinical results of gasless endoscopic thyroidectomy via posterior chest-collarbone approach (GETPCA) compared with open neck surgery for papillary thyroid carcinoma (PTC) .Mthods:Retrospective analysis of PTC patients admitted to the Department of Thyroid and Breast Surgery of the Third Affiliated Hospital of Anhui Medical University from Jan. 2022 to Dec. 2023,and randomly divided into the open group and the lumbo-scopic group according to whether or not they had a requirement for an unmarked neck, in which the open group was n=100,and the lumbo-scopic group was n=67,with 39 male cases and 128 female cases. Clinicopathological characteristics, surgery-related indexes, postoperative complications, postoperative pain scores and postoperative cosmetic satisfaction were compared between the two groups.The t-test,Wilcoxon rank-sum test, χ2 test, consecutively corrected χ2 test, or Fisher’s exact probability method were used to compare the groups. Results:No recurrence was seen during the follow-up period,and none of the cases in the luminal group was open in the middle. The differences in age, body mass index BMI, gender, relative tumor location,preoperative TSH, T stage and N stage between the two groups were not statistically significant ( P>0.05) . The total operation time [ (121.07±39.80) min vs. (93.87±26.97) min]in the luminal group was greater than that in the open group,intraoperative bleeding was less than that in the open group, and the postoperative drainage flow[ (130.69±31.01) mL vs. (105.52±32.71) mL] was greater than that in the open group in the postoperative period of 72 h, and the difference was statistically significant ( P<0.001) .There was no statistical difference between the two groups in terms of 24-h postoperative drainage volume, number of central zone lymph node dissection, number of positive central zone lymph nodes,postoperative hospitalization days or total hospitalization cost ( P>0.05) .The number of cases of neck discomfort (3 cases vs.23 cases, P<0.001) and swallowing dysfunction (2 cases vs.20 cases, P=0.003) in the luminal group was smaller than that in the open group,and the difference was statistically significant.The difference in the incidence of bleeding,incision infection,seroma,temporary recurrent laryngeal nerve injury and temporary parathyroid gland injury between the two groups was also not statistically significant ( P>0.05) .The postoperative NRS on day 1 and postoperative NRS on day 3 of the luminal group were lower than those of the open group,and the difference was statistically significant ( P>0.05) ,while there was no statistically significant difference between the postoperative NRS on day 7,the postoperative NRS on month 1 and the postoperative NRS on month 3 ( P>0.05) .Cosmetic satisfaction at 6 months postoperatively was higher in the luminal group than in the open group,and the difference was statistically significant ( P<0.001) . Conclusion:GETPCA for the treatment of the PTC is safe and feasible,with satisfactory cosmetic results and reduction of neck discomfort and swallowing dysfunction,which is worthy of clinical popularization.

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 Bushen Huoxue Decoction(BSHX)on PI3K/Akt/mTOR signaling pathway and explore its possible mechanism in improving synaptic plasticity in a vascular dementia(VD)rat model.Methods Sprague-Dawley rats were randomly divided into sham operation group(Sham group),model group(VD group),Bushenhuoxue decoction group(BSHXD group),nimodipine group(NMDP group),with 10 rats in each group.The VD model of rats was established by two-vessel(2-VO)occlusion method.Rats in BSHXD group were given BSHXD at a weight of 10.14 g·kg-1,while rats in the NMDP group were given nimodipine decoction at 11 mg·kg-1.The SHAM group and the VD group were given saline at a weight of 10 mL·kg-1 once a day for 4 weeks.Morris water maze was used to observe the spatial learning and memory ability of rats in each group.Nissl staining was used to observe the damage of Nissl bodies and neurons in CA1 area of hippocampus of rats.The expression of synaptophysin(SYN)and postsynaptic density protein 95(PSD-95)in hippocampal CA1 region was detected by immunohistochemistry.Golgi-Cox staining method was used to observe the number changes of dendritic branches and spines of hippocampal neurons.Transmission electron microscopy(TEM)observed the ultrastructural change of synapses.The protein and mRNA expressions of phosphatidylinositol 3-kinase(PI3K),serine-threonine kinase(AKT)and mammalian target of rapamycin(mTOR)in rat hippocampus were detected by Western blot and Reverse transcription quantitative PCR(RT-qPCR).Results Compared with the control group,the learning and memory ability of VD rats decreased.These rats showed abnormal synaptic ultrastructure of hippocampal neurons and neuronal cell damage,and this was accompanied by a decrease in the density of dendrite branches and dendritic spines of neurons.The expression of both SYN and PSD-95 proteins in the hippocampus decreased(P<0.05),and synaptic plasticity was damaged.Both mRNA and protein expression of PI3K,Akt,and mTOR in the hippocampus decreased in the VD rats(P<0.05).Also observed in VD rats was that administration of BHSX mitigated the learning and memory impairment observed in these animals,improved the morphology and synaptic ultrastructure of hippocampal neurons,increased the mRNA and protein expression levels of PI3K,Akt,mTOR,and increased the protein levels of SYN and PSD-95(P<0.05).Conclusion BSHX can alleviate the learning and memory impairment of VD rats and increase the protein expression levels of synapse-related proteins.These effects may be related to the promotion of synaptic plasticity by BSHX through activation of PI3K/Akt/mTOR signaling.

Objective:To investigate the clinical features of nontuberculous mycobacteria (NTM) disease patients with positive anti-interferon γ (IFN-γ) autoantibody.Methods:Forty-three adult human immunodeficiency virus-uninfected patients with NTM disease hospitalized in Huashan Hospital, Fudan University and Jing′an Branch, Huashan Hospital, Fudan University from July 2021 to August 2023 were included. Clinical data and NTM strain information of the patients were collected. The plasma levels of anti-IFN-γ autoantibodies were detected by enzyme-linked immunosorbent assay, and the patients were divided into antibody positive group and antibody negative group. The clinical characteristics and laboratory examination results between the two groups were compared. The independent sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis. Multivariate logistic regression analysis was used to determine the correlation factors of positive anti-IFN-γ autoantibodies. Results:Among the 43 patients, 13 cases (30.2%) were positive for anti-IFN-γ autoantibodies and 30 cases (69.8%) were negative. The proportions of patients with NTM disseminated infection (9/13 vs 30.0%(9/30))and combined bacterial infection (5/13 vs 6.7%(2/30)) in antibody positive group were both higher than those in antibody negative group, and the differences were both statistically significant ( χ2=5.74 and 6.73, respectively, both P<0.05). The white blood cell count, platelet count, the proportion of platelet count >350×10 9/L of antibody positive patients were all higher than those of antibody negative group, while the white sphere ratio was lower than that of antibody negative group, with statistical significance ( t=2.42, 3.02, χ2=9.77 and t=3.66, respectively, all P<0.05). Erythrocyte sedimentation rate, C-reactive protein, procalcitonin, globulin, immunoglobulin G, immunoglobulin A and immunoglobulin M in antibody positive patients were all higher than those in antibody negative group, and the differences were all statistically significant ( U=99.50, 112.00, 115.50, 61.50, 76.50, 99.00 and 83.00, respectively, all P<0.05). Mycobacterium abscessus complex (seven cases and 11 cases, respectively) and Mycobacterium avium complex (five cases and 13 cases, respectively) were the main isolated strains in antibody positive and antibody negative patients. Multivariate logistic regression analysis showed that combined with bacterial infection (odds ratio ( OR)=21.83, 95% confidence interval ( CI) 1.94 to 245.71), NTM disseminated infection ( OR=7.64, 95% CI 1.10 to 53.26), platelet count>350×10 9/L ( OR=14.31, 95% CI 1.91 to 107.04) were risk factors for anti-IFN-γ autoantibodies positive (all P<0.05). Conclusions:Patients with positive anti-IFN-γ autoantibodies have higher probability of having elevated levels of systemic inflammation. Anti-IFN-γ autoantibody test is recommended for patients with NTM disease who present with co-bacterial infection, NTM disseminated infection, or elevated platelet count (>350×10 9/L).

Objective: To understand the prevalence of HIV (human immunodeficiency virus) testing and associated factors among sexual active college students in Zhuhai City. Methods: From November to December, 2019, an anonymous electronic questionnaire was administered among 12 235 students in six colleges and universities in Zhuhai City by multistage sampling. A total of 1 789 college students ever had sex were selected. Pearsons Chisquare test and nonconditional Logistic regression model were applied to analyze the factors associated with uptake of HIV testing. Results: Among these students ever had sex, 7.55% (135/1 789) had been tested for HIV mainly through hospitals (71.85%). The main reasons for testing were regular testing (50.37%) and intending to know their infection status (23.70%). Multivariable Logistic regression showed that homosexual individuals (OR=4.62, 95%CI=1.07-19.95) and those who had heterosexual commercial sex in the past year (OR=3.77, 95%CI=1.96-7.26) were more likely to test for HIV, while female (OR=0.41, 95%CI=0.24-0.69) were less likely to test for HIV. Conclusion The proportion of HIV testing was low among sexual active college students in Zhuhai City. Interventions should be tailored including strengthening the HIV testing propaganda education and enhancing students awareness of HIV testing, and the influencing factors such as gender, sexual orientation and commercial sexual behavior should be taken into consideration, so as to improve the HIV testing coverage of this population.

Objective To evaluate the feasibility of modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator for foot surgery.Methods Sixty-two patients of both sexes,aged 18-60 yr,with body mass index ＜ 30 kg/m2,of ASA physical status Ⅰ-Ⅲ,scheduled for elective foot surgery,were included in the study.Anesthesia was induced with iv propofol 2-4 mg/kg and sufentanil 0.2-0.4 μg/kg.The laryngeal mask airway was inserted and the patients were mechanically ventilated.Sevoflurane was inhaled continuously.Modified lateral approach to sciatic nerve block was performed with 0.3 ％ ropivacaine 30 ml under the guidance of the ultrasound combined with nerve stimulator.Rocuronium 0.6 mg/kg and propofol 1-2 mg· kg-1 · h-1 were administered after completion of sciatic nerve block.Additional sufentanil 0.10-0.15 μg/kg was intravenously injected immediately after skin incision and rocuronium 0.15 mg/kg was injected intravenously at 1 h intervals.The depth of puncture and time for puncture and success rate of puncture were recorded.Sensory block was assessed after the patients regained consciousness completely.Nerve injury,hematoma at the puncture site and infection within 72 h after surgery were recorded.Results The time for puncture was (40 ± 17) s.The depth of puncture was (5.8 ± 0.7) cm.The success rate of puncture at first attempt was 77 ％.The rate of complete sensory block was 100％.The post-operative follow-up showed that no patients developed nerve injury,hematoma or infection.Conclusion Modified lateral approach to sciatic nerve block guided by ultrasound and nerve stimulator is safe and effective for foot surgery.