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.

Objectives:To investigate the clinical efficacy of the distal tension-offloading cosmetic suture technique in reducing hypertrophic scar formation following open thyroidectomy.Methods:Clinical data and postoperative incision appearance of 138 patients undergoing open thyroidectomy at the Department of Thyroid and Neck Oncology of Tianjin Medical University Cancer Institute and Hospital, as well as the Department of Head and Neck Oncology of Tianjin Cancer Hospital Airport Hospital, from Aug 2023 to Jan 2024 was enrolled. Patients were devided into two groups based on the incision closure method: the distal tension-offloading cosmetic suture group (tension reduction group, 37 cases) and ordinary intradermal suture group (control group A, 55 cases evaluated 3 months post-surgery; control group B, 46 cases evaluated 6 months post-surgery). The Vancouver Scar Scale (VSS) was employed to assess the appearance of the wounds at 3 and 6 months post-surgery .Results:On 3 and 6 months post-surgery, the total VSS scores for patients in the tension reduction group were 2.8 ± 2.3 and 2.5 ± 2.5, respectively,while that in control group A on 3 months was 5.2 ± 3.0, and in group B on 6 months was 5.3 ± 3.4. The differences were statistically significant (all P<0.001). On 3 and 6 months post-surgery, the proportions of hypertrophic scars in the tension reduction group were 14% (5/37) and 11% (4/37), respectively , while in control group A it was 35% (19/55) , and in control group B was 35% (16/46) at 6 months, with differences being statistically significant ( P=0.024, 0.011 ). On 6 months post-surgery, 51 % (19/37) of patients in the tension reduction group achieved 'socially invisible aesthetic incisions', while only 15% (7/46) of patients in control group B achieved the same outcome ( P<0.01). Conclusion:Distal tension-offloading cosmetic suture significantly reduces the incidence of incision hypertrophic scars in open thyroid surgery.

Objective To investigate the expression levels of serum exosomal LncRNA GAS5 in gastric cancer(GC)patients and eval-uate its clinical significance.Methods Seventy GC patients admitted to Henan Electric Power Hospital from January 2019 to Decem-ber 2020 and 70 age-and sex-matched healthy controls undergoing physical examination during the same period were enrolled.Their se-rum samples and clinicopathological data were collected.Additionally,cancer tissue and adjacent normal tissue specimens were ob-tained from 20 GC patients who underwent surgical resection.The expression levels of LncRNA GAS5 in tissues and serum exosomes were detected by real-time fluorescence quantitative PCR(qRT-PCR).The chemiluminescence method was used to detect the levels of serum carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9).The receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of different detection indicators for GC.The correlations of serum exosomal LncRNA GAS5 levels with clinicopathological parameters and prognosis of GC patients were also analyzed.Results The expression levels of serum ex-osomal LncRNA GAS5 in GC patients were significantly lower than that in healthy controls(t=10.84,P＜0.001).The expression levels of LncRNA GAS5 in GC tissues were also significantly lower than that in adjacent tissues(t=14.94,P＜0.001).The analysis results of the ROC curve showed that the area under the ROC curve(AUCROC)of serum exosomal LncRNA GAS5 for the screening of GC was 0.807.When the cut-off value was 1.96,its sensitivity was 81.43%and specificity was 67.14%.The diagnostic efficacy of serum exoso-mal LncRNA GAS5 for GC was significantly better than traditional tumor markers CEA and CA19-9,and their AUCROC were 0.664 and 0.713,respectively.The analysis results of clinicopathological parameters of GC patients showed that low serum exosomal LncRNA GAS5 levels were significantly correlated with large tumor size,advanced TNM stage,and distant metastasis(P＜0.05).The overall survival time of patients with low expression of serum exosomal LncRNA GAS5 was significantly lower than that of patients with high ex-pression(median overall survival time:23 vs 35 months,P=0.03).Conclusion Serum exosomal LncRNA GAS5 in GC patients is down-regulated,which has good diagnostic efficacy for GC and is expected to become a potential biological marker for the diagnosis and prognosis evaluation of GC patients.

ObjectiveTo investigate the analgesic effect of Tuina at the "Weizhong （BL 40）" on neuropathic pain in a rat model of chronic constriction injury （CCI） of the sciatic nerve and its potential central spinal mechanisms. MethodsThirty-two Sprague-Dawley rats were randomly divided into four groups （8 rats in each group）， sham-operated group， model group， Tuina group， and blockade group. The CCI model was established in the model group， Tuina group， and the blockade group by ligating the sciatic nerve with catgut， while the sham-operated group underwent only sciatic nerve exposure without ligation. From postoperative day 4 to day 14， rats in the Tuina group and the blockade group received Tuina manipulation at the "Weizhong （BL 40）" using a dynamic pressure distribution measurement system （5 N pressure， 2 Hz frequency， 10 min per session， once daily）. The blockade group also received intraperitoneal injections of the microglial inhibitor minocycline （10 mg/kg） once daily. The sham-operated and the model group underwent the same handling and fixation as the Tuina group without actual Tuina. Mechanical withdrawal threshold （MWT） and paw withdrawal latency （PWL） were measured before surgery and on day 3， 7， 10， and 14 post-surgery. Transmission electron microscopy was used to evaluate sciatic nerve injury and repair， measuring axon diameter and total myelinated fiber diameter to calculate the g-ratio. Western Blotting was performed to detect the protein levels of ionized calcium-binding adapter molecule 1 （Iba-1）， CD206， CD68， interleukin-10 （IL-10）， and β-endorphin （β-EP） precursor pro-opiomelanocortin （POMC） in the ipsilateral spinal dorsal horn. ResultsCompared with the sham-operated group， the model group showed significantly reduced MWT and PWL on day 3， 7， 10， and 14 （P＜0.01）. Compared with the model group， the Tuina group and the blockade group showed increased MWT and PWL on day 10 and 14 （P＜0.05）. Compared with the Tuina group， the blockade group exhibited higher MWT on day 7， 10， and 14， and higher PWL on day 10 （P＜0.05）. Sciatic nerve pathological morphology revealed intact and well-structured myelin in the sham-operated group， while the model group exhibited myelin collapse， distortion， and myelin ovoid formation. The Tuina group displayed partially irregular myelin with occasional myelin collapse， whereas the blockade group exhibited partial myelin irregularities and phospholipid shedding. Compared with the sham-operated group， the model group showed a decreased g-ratio and increased levels of Iba-1 and CD68 in the spinal dorsal horn （P＜0.05 or P＜0.01）. Compared with the model group， the Tuina group and the blockade group exhibited an increased g-ratio and reduced Iba-1 and CD68 levels. Additionally， the Tuina group showed elevated levels of CD206， IL-10， and POMC， whereas the blockade group had decreased CD206 levels （P＜0.05）. ConclusionTuina at "Weizhong （BL 40）" alleviates neuropathic pain in CCI rats， potentially by regulating microglial activation in the spinal cord， inhibiting M1 polarization while promoting M2 polarization， and activating the IL-10/β-EP pathway to exert analgesic effects.

BACKGROUND: Research has indicated that the disease burden of alopecia areata (AA) in China exceeds the global average. Therefore, accurate and updated epidemiological information is crucial for policymakers. In this study, we aimed to comprehensively assess the disease burden of AA in China. METHODS: The following four key indicators were utilized: the prevalence of cases; disability-adjusted life-years (DALYs); the age-standardized prevalence rate (ASPR); and the age-standardized DALY rate (ASDR) of AA according to the Global Burden of Disease (GBD) study 2021. We analyzed the epidemiological burden of AA in China during 2021, examined changes between 1990 and 2021, and performed a Bayesian age-period-cohort analysis to predict trends over the course of the next decade (2022-2030). Additionally, a Gaussian process regression model was applied to estimate the relationship between the gross domestic product (GDP) and the ASPR and ASDR of AA at the provincial level between 1992 and 2021. RESULTS: In 2021, the estimated number of patients with AA in China was approximately 3.49 million (95% uncertainty interval [UI], 3.37-3.62 million); of these patients, 1.20 million (95% UI, 1.16-1.25 million) were male and 2.29 million (95% UI, 2.20-2.37 million) were female. This large number of patients with AA resulted in a total of 114,431.25 DALYs (95% UI, 74,780.27-160,318.96 DALYs). Additionally, the ASPR and ASDR were 224.61 per 100,000 population (95% UI, 216.73-232.65 per 100,000 population) and 7.41 per 100,000 population (95% UI, 4.85-10.44 per 100,000 population), respectively; both of these rates were higher than the global averages. The most affected demographic groups were young and female individuals 25-39 years of age. Slight regional disparities were observed, with the northern and central regions of China bearing comparatively higher burdens. Between 1990 and 2021, the health loss and disease burden caused by AA in China remained relatively stable. The ASPR and ASDR of AA increased with the GDP when the annual GDP was less than 2 trillion Chinese yuan; however, a downward trend was observed as the GDP surpassed 2 trillion Chinese yuan. A slight upward trend in the disease burden of AA in China is predicted to occur over the next decade. CONCLUSIONS AA continues to be a public health concern in China that shows no signs of declining. Targeted efforts for young individuals and females are necessary because they experience a disproportionately high burden of AA.
Humans ; China/epidemiology* ; Alopecia Areata/epidemiology* ; Global Burden of Disease ; Female ; Male ; Adult ; Disability-Adjusted Life Years ; Middle Aged ; Prevalence ; Adolescent ; Young Adult ; Bayes Theorem ; Child ; Quality-Adjusted Life Years ; Child, Preschool

Alopecia areata (AA) is an autoimmune-mediated, hair follicle-targeting, inflammatory, non-scarring hair loss. The treatment of severe AA has long been a focus and challenge. Currently, novel therapeutic agents, such as Janus kinase (JAK) inhibitors, have been increasingly employed in the treatment of severe AA. This review provides an overview of new small-molecule targeted drugs and biologics for AA.

Objective To investigate the expression levels of serum exosomal LncRNA GAS5 in gastric cancer(GC)patients and eval-uate its clinical significance.Methods Seventy GC patients admitted to Henan Electric Power Hospital from January 2019 to Decem-ber 2020 and 70 age-and sex-matched healthy controls undergoing physical examination during the same period were enrolled.Their se-rum samples and clinicopathological data were collected.Additionally,cancer tissue and adjacent normal tissue specimens were ob-tained from 20 GC patients who underwent surgical resection.The expression levels of LncRNA GAS5 in tissues and serum exosomes were detected by real-time fluorescence quantitative PCR(qRT-PCR).The chemiluminescence method was used to detect the levels of serum carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9).The receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of different detection indicators for GC.The correlations of serum exosomal LncRNA GAS5 levels with clinicopathological parameters and prognosis of GC patients were also analyzed.Results The expression levels of serum ex-osomal LncRNA GAS5 in GC patients were significantly lower than that in healthy controls(t=10.84,P＜0.001).The expression levels of LncRNA GAS5 in GC tissues were also significantly lower than that in adjacent tissues(t=14.94,P＜0.001).The analysis results of the ROC curve showed that the area under the ROC curve(AUCROC)of serum exosomal LncRNA GAS5 for the screening of GC was 0.807.When the cut-off value was 1.96,its sensitivity was 81.43%and specificity was 67.14%.The diagnostic efficacy of serum exoso-mal LncRNA GAS5 for GC was significantly better than traditional tumor markers CEA and CA19-9,and their AUCROC were 0.664 and 0.713,respectively.The analysis results of clinicopathological parameters of GC patients showed that low serum exosomal LncRNA GAS5 levels were significantly correlated with large tumor size,advanced TNM stage,and distant metastasis(P＜0.05).The overall survival time of patients with low expression of serum exosomal LncRNA GAS5 was significantly lower than that of patients with high ex-pression(median overall survival time:23 vs 35 months,P=0.03).Conclusion Serum exosomal LncRNA GAS5 in GC patients is down-regulated,which has good diagnostic efficacy for GC and is expected to become a potential biological marker for the diagnosis and prognosis evaluation of GC patients.

Objective To analyze the practice of position setting management in a public hospital and provide sugges-tions for optimizing the hospital's position setting management.Methods The position setting plans,number of positions set,and number of positions employed from 2010 to 2023 in the hospital were reviewed,and existing problems were analyzed.Results In 2023,the proportion of non-permanent staff accounted for 51.94％of the total number of in-service employees,the number of professional and technical positions accounted for 95.95％of the in-service employees,and the number of senior professional and technical positions employed accounted for 18.00％of the total number of professional and technical positions.The"rigidi-ty"of the position setting method restricts professional development.There are issues such as the need to adjust the structure of professional and technical positions,and vacancies in management and skilled worker positions.Conclusion It is suggested to facilitate the integration of non-permanent staff into the establishment management system,dynamically adjust position setting plans,and strengthen post-employment management.

Alopecia areata (AA) is an autoimmune-mediated, hair follicle-targeting, inflammatory, non-scarring hair loss. The treatment of severe AA has long been a focus and challenge. Currently, novel therapeutic agents, such as Janus kinase (JAK) inhibitors, have been increasingly employed in the treatment of severe AA. This review provides an overview of new small-molecule targeted drugs and biologics for AA.

Objective:To investigate the preoperative risk features of skip metastasis in medullary thyroid carcinoma（MTC），and analyze the rule and the causes of missed diagnosis of skip metastasis.Methods:A retrospective study of 208 MTC patients in Tianjin Medical University Cancer Institute and Hospital between January 2013 and January 2023 were enrolled. Based on postoperative pathology，patients were classified into without lateral cervical metastasis group（ n=102），skip metastasis group（ n=21），and non-skip metastasis group（ n=85）. Prognostic outcomes were compared via Kaplan-Meier analysis in the 3 groups. Univariate and multivariate Logistic regression identified risk factors for lateral cervical metastasis and skip metastasis.The distribution patterns，clinical and sonographic features of metastatic lymph nodes were analysed. Results:Prognostic differences：The group without lateral cervical metastasis showed the highest biochemical cure rate，followed by the skip subgroupand non-skip subgroup（ P<0.001）. The results of the regression analysis showed male（ OR=2.930，95% CI=1.295-6.628），preoperative calcitonin >317 ng/L（ OR=9.820，95% CI=3.541-27.234），tumor contact with the length/perimeter ≥1/4（ OR=3.275，95% CI=1.353-7.927），a taller-than-wide shape <1（ OR=24.239，95% CI=6.319-92.983），irregular margins（ OR=3.658，95% CI=1.213-11.036），solid composition（ OR=25.639，95% CI=2.295-286.408）and calcifications（ OR=15.429，95% CI=4.090-58.202）were independent risk factors for lateral cervicalasis. Tumor size ≤ 1 cm（ OR=4.735，95% CI=0.067-0.868）and upper pole involvement（ OR=6.879，95% CI=0.069-0.679）were independent risk factors for skip metastasis. The rules of skip metastasis：Skip metastasis group could distribute to levels Ⅱ（ n=9），Ⅲ（ n=13），Ⅳ（ n=14），and Ⅴ（ n=2），the number of metastatic lymph nodes was significantly less than non-skipping group［4（8.0） vs.11（17.5）， P<0.001］. There were no statistically significant differences in size，shape，hilum，calcifications，peripheral vascularity and the number of high suspicious ultrasound features of metastatic lymph node between the two groups（all P>0.05）. Conclusions:The prognosis is best in the without lateral cervical metastasis，followed by skip metastasis，and is worst for non-skip metastasis. A small number of metastatic lymph nodes may be the reason for the missed diagnosis of skip metastasis by ultrasound. Male，calcitonin > 317 ng/L，tumor contact with the length/perimeter ≥ 1/4，a taller-than-wide shape，irregular margins，solid composition and calcifications are independent risk factors for lateral cervicalasis . Tumor size ≤ 1 cm and upper pole involvement should alert to skip metastasis.