Objectives:To develop a new type of multifunctional rectangle transoral exposure retractor(MRTER)and explore its clinical application value.Methods:From 2020 to 2025,we performed 310 cases of transoropharyngeal atlantoaxial surgery,of which 162 cases used Codman retractors[Codman group,72 males and 90 females,aged 9-67 years old,47 cases were with simple atlantoaxial dislocation(AAD),115 cases were with basilar invagination],and 148 cases used the MRTER retractor system(MRTER group,63 males and 85 females,aged 6-72 years old,39 cases were with AAD,109 cases were with basilar invagination).The main clinical symptoms of the patients included cervical pain and restricted mobility in 49 cases,torticollis in 54 cases,weak and numbness of the limbs in 259 cases,finger inflexibility in 43 cases,walking instability in 178 cases,and bladder dysfunction in 5 cases.After admission,a transoral atlantoaxial reduction and plate internal fixation(TARP)was performed.Among the patients,86 with AAD did not undergo a soft palate split,and 224 patients with basilar invagination underwent a soft palate split to expand the exposure and then un-derwent transoral release and reduction+TARP procedures.Intraoperative oral opening distance(D value)and o-ral floor field of view area(S value)were measured to evaluate the exposure ability of the retractor system.The global reduction rate of atlantoaxial dislocation was measured on the cervical sagittal CT film,and the JOA score improvement rate at the final follow-up was calculated to evaluate the effect of the operation.Re-sults:The surgical procedure of 310 patients was smooth,the operation time was 138±25min in Codman group and 118±31min in MRTER group(P＜0.05);The surgical blood loss was 105±45mL in Codman group and 113±28mL in MRTER group(P＞0.05).The intraoperative measured D value was 4.0±2.1cm in Codman group and 4.2±1.9cm in MRTER group(P＞0.05);the S value was 6.3±2.8cm2 in Codman group and 7.1±3.1cm2 in MRTER group(P＜0.05).After operation,the symptoms of headache and neck pain were significantly relieved;the symptoms of limb numbness,weakness and walking instability were improved to varying degrees.The overall reduction rate of AAD was 81.3％in Codman group,and 82.5％in MRTER group(P＞0.05);JOA improvement rate was 71％in Codman group,and 73％in MRTER group(P＞0.05).Conclusions:The new MRTER exposure system provides an effective auxiliary tool for the implementation of atlantoaxial transoropha-ryngeal surgery.

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

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.

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.

In recent years,significant breakthroughs have been achieved in the immunotherapy for Alzheimer's disease.In line with global advancements,two anti-amyloid-β monoclonal antibodies have been approved and successfully launched in China for clinical use.Lecanemab and Donanemab were officially used in June 2024 and April 2025 in China,respectively.In order to standardize the rational and safe application of anti-amyloid-β monoclonal antibodies for Alzheimer's disease in China,this article integrates recom-mendations from the clinical trials and real-world experience from the author's team and domestic peers to further update the recom-mendations for the clinical use of anti-amyloid-β monoclonal antibody based on the 2024 version.It includes indications for therapy,pre-treatment evaluation and preparation,administration protocols and safety measures during treatment,and post-treatment monitor-ing strategies.

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

Objective To investigate the pathogenesis of high-altitude cerebral edema(HACE)and develop new therapeutic strategies.Methods Male Sprague-Dawley(SD)rats of 6 weeks old were selected and placed in a hypobaric chamber.The rats were exposed to the high-altitude environment of 7000 m above sea level for 3 days for HACE modeling.Whether the HACE model was successfully established in the rats was evaluated by measuring brain water content,the degree of disruption to the blood-brain barrier(BBB),and brain tissue Nissl staining.The experimental animals were divided into four groups,with 28 rats in each group.The blank control group was exposed to a normobaric and normoxic environment simulating the conditions at 500 m above sea level for 3 d.The other groups,including a model group(the HACE group),a bumetanide group(the positive control group),and a XH-6003 treatment group,were placed at an altitude of 7 000 m above sea level and were injected with normal saline,bumetanide,and XH-6003,a new type of Na-K-2C1 cotransporter 1(NKCC1)inhibitor,via the tail vein,respectively,twice daily for 3 d.The experimental animals were taken out of the hypobaric chamber for testing after 3 d.The primary outcome measures included brain water content,BBB permeability,changes in brain tissue morphology,and the expression levels of aquaporin-4(AQP4)and NKCC1.The secondary outcome measures included behavioral changes,apoptosis,and oxidative stress markers.Results The HACE rat model was successfully established.The model group exhibited increased brain water content(P＜0.0001),BBB disruption(P＜0.0001),impairment in learning skills and memory(P＜0.001),and anxiety/depression-like behaviors(P＜0.01).qPCR results showed significantly increased expression of NKCC1 and AQP4 in the brain tissue of the model group(P＜0.01).Pathology examination revealed neuronal and glial cell damage in the hippocampus of the model group(P＜0.01).Treatment with XH-6003,the NKCC1 inhibitor,reversed brain water content,BBB disruption,and neuronal and glial cell damage to a certain degree(P＜0.05),decreased the expression of NKCC1 and AQP4 in the brain tissue(P＜0.01),and inhibited apoptosis-related proteins.Among the oxidative stress indices,only glutathione(GSH)showed improvement(P＜0.001).Rats treated with XH-6003 showed functional improvement only in the time spent exploring novel objects,while other behavioral outcomes remained unchanged.Conclusion HACE is associated with the activation of the NKCC1/AQP4 pathway.Inhibition of this pathway alleviates brain edema,BBB disruption,and neuronal and glial cell damage.These findings suggest that XH-6003 holds potential as a therapeutic strategy for HACE at the cellular and molecular levels,but its effects in improving HACE-related behavioral disorders warrant further investigation.

Objectives:To develop a new type of multifunctional rectangle transoral exposure retractor(MRTER)and explore its clinical application value.Methods:From 2020 to 2025,we performed 310 cases of transoropharyngeal atlantoaxial surgery,of which 162 cases used Codman retractors[Codman group,72 males and 90 females,aged 9-67 years old,47 cases were with simple atlantoaxial dislocation(AAD),115 cases were with basilar invagination],and 148 cases used the MRTER retractor system(MRTER group,63 males and 85 females,aged 6-72 years old,39 cases were with AAD,109 cases were with basilar invagination).The main clinical symptoms of the patients included cervical pain and restricted mobility in 49 cases,torticollis in 54 cases,weak and numbness of the limbs in 259 cases,finger inflexibility in 43 cases,walking instability in 178 cases,and bladder dysfunction in 5 cases.After admission,a transoral atlantoaxial reduction and plate internal fixation(TARP)was performed.Among the patients,86 with AAD did not undergo a soft palate split,and 224 patients with basilar invagination underwent a soft palate split to expand the exposure and then un-derwent transoral release and reduction+TARP procedures.Intraoperative oral opening distance(D value)and o-ral floor field of view area(S value)were measured to evaluate the exposure ability of the retractor system.The global reduction rate of atlantoaxial dislocation was measured on the cervical sagittal CT film,and the JOA score improvement rate at the final follow-up was calculated to evaluate the effect of the operation.Re-sults:The surgical procedure of 310 patients was smooth,the operation time was 138±25min in Codman group and 118±31min in MRTER group(P＜0.05);The surgical blood loss was 105±45mL in Codman group and 113±28mL in MRTER group(P＞0.05).The intraoperative measured D value was 4.0±2.1cm in Codman group and 4.2±1.9cm in MRTER group(P＞0.05);the S value was 6.3±2.8cm2 in Codman group and 7.1±3.1cm2 in MRTER group(P＜0.05).After operation,the symptoms of headache and neck pain were significantly relieved;the symptoms of limb numbness,weakness and walking instability were improved to varying degrees.The overall reduction rate of AAD was 81.3％in Codman group,and 82.5％in MRTER group(P＞0.05);JOA improvement rate was 71％in Codman group,and 73％in MRTER group(P＞0.05).Conclusions:The new MRTER exposure system provides an effective auxiliary tool for the implementation of atlantoaxial transoropha-ryngeal surgery.

Occipitocervical fusion (OCF) is used to treat the instability of the cranio-cervical junction due to various reasons (such as trauma, rheumatoid arthritis, infection, tumor, congenital malformations and degeneration). A satisfactory fusion rate can be obtained and the stability of the occipital neck can be reconstructed by OCF. Dysphagia is one of the most common complications after OCF, which seriously affects the quality of life of patients after surgery. This article mainly focuses on the evaluation and prediction methods of dysphagia after OCF, and summarizes related research in the past 16 years, and provides guidance and direction for how to predict the occurrence of dysphagia during OCF and the evaluation of postoperative dysphagia. The evaluation of dysphagia is mainly conducted using the Bazaz dysphagia score, swallowing quality of life scale (SWAL-QOL) and eating assessment tool-10 (EAT-10) score. However, the clinical prediction of dysphagia is mainly based on the changes of cervical curvature parameters (O-C 2 angle, O-EA angle, Oc-Ax angle, PI angle). At present, there are many methods for clinical evaluation and prediction of dysphagia, but the best evaluation method is still uncertain. We reviews the evaluation and prediction methods of postoperative dysphagia of OCF, showing that the Bazaz dysphagia score, SWAL-QOL score and EAT-10 score scale are suitable for evaluating postoperative dysphagia of OCF. During OCF operation, adjustment of O-C 2 Angle >-5°, O-EA Angle >100°, Oc-Ax Angle >65°, and increase of postoperative PI Angle from preoperative PI Angle (that is, dPI Angle) ≥0° can reduce the probability of dysphagia to a certain extent.

Environment control and life support(ECLS)system is important to living and working of the astronauts in space station.Made mission reliability assessment for ECLS system of China space station before its launch and after three years operation.In the first place,a reliability model was made in unit's reliability contribution principle.Then multiple data resources was used to evaluate component reliability based on Bayes and Weibull model and evaluate system reliability based on CMSR method.The three year mission reliability assessment made a better understanding for ECLS system reliability of China space station with the flight data accumulation and evaluate subsamples increase since flight mission details has been planned.It showed that the on-orbit non-replaceable units of ECLS system has a longer life and higher inherent reliability.Combined the assessment results with the lifetime extension and reliability demands of the on-orbit replaceable units,the weakness and the trend of change of the system life and reliability was discovered.It can provided a more accurate reference for repair maintence arrangement,on-orbit spare parts planning and supplies launching for ECLS system of China space station.The results can support mission reliability of ECLS system of China space station with on-orbit maintenance and replacement and reliability growth of the units of the system in the future.The reliability modeling and date collection methods of similar units can build a more reasonable reliability model and extend data resource for evaluation.