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.

The concept of harmony between heaven and man is an important concept in TCM. The theory of "harmful hyperactivity and responding inhibition" has been developed and perfected by medical professionals throughout history to explain physiological and pathological changes in humans based on a natural understanding. Guided by the TCM philosophy of "harmful hyperactivity and responding inhibition", it provides guidance for attention deficit hyperactivity disorder (ADHD). Sorting out the complex pathogenesis, it has been found that core pathogenesis of the disease is the excessive damage to the five organs, which leads to the overall state of yin deficiency and yang hyperactivity in the human body. The treatment mainly focuses on regulating the hyperactivity and damage of the organs, restoring the balance of yin and yang, while also taking into account the harm of pathological products. Based on clinical manifestations, the secondary selection of medication for liver and liver hyperactivity and spleen and kidney dysfunction has been determined, while improving the hyperactivity of the external environment, in order to achieve the goal of "tolerance is control", which fully embodies the TCM syndrome differentiation thinking of "unity of heaven and man, holistic concept".

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 analyze the application value of the American Society of Anesthesiologists (ASA) classification in treating patients with percutaneous nephrolithotomy (PCNL) under local anesthesia for upper urinary tract calculi. Methods A total of 80 patients with PCNL under local anesthesia for upper urinary tract calculi were divided into high-risk group (ASA Ⅲ to Ⅳ level) with 36 cases and low-risk group (ASA Ⅰ to Ⅱ level) with 44 cases according to ASA classification, and perioperative indicators (operation time, intraoperative blood loss and hospital stay), stone clearance rate, inflammatory factors[C reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], score of the Visual Analogue Scale (VAS) for pain, and the incidence of complications were compared between the two groups. Results Hospital stay in the low-risk group was significantly shorter than that in the high-risk group (P < 0.05); the stone clearance rate was 93.18% in the low-risk group, which was significantly higher than 75.00% in the high-risk group (P < 0.05). Before surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05); one day after surgery, the levels of serum CRP, IL-6 and TNF-α in the high-risk group were significantly higher than those in the low-risk group (P < 0.05). On the first, the third, and the fifth day after surgery, the VAS score in the high-risk and low-risk groups decreased significantly, and the VAS score in the low-risk group was significantly lower than that in the high-risk group (P < 0.05). Incidence rate of complications in the low-risk group was 4.54%, which was significantly lower than 19.44% in the high-risk group (P < 0.05). Conclusion Application of PCNL under local anesthesia in treating patients with upper urinary tract calculi of ASA Ⅰ to Ⅲ has milder inflammation and pain when compared to those of ASA Ⅲ to Ⅳ, and the incidence rate of complications is relatively low.

Background/Aims: The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. Methods: Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. Results: A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. Conclusions Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Objective:To evaluate the efficacy and safety of sodium hyaluronate gel in preventing adhesion after prophylactic enterostomy.Methods:One hundred and twenty four patients from 6 hospitals were enrolled in this prospective multi-center randomized controlled trial. Patients were randomized into the study group ( n=59) or the control group ( n=65).All patients underwent prophylactic enterostomy. Patients of study group received odium hyaluronate gel for adhesion-prevention,while those in control group did not receive any adhesion-prevention treatment. The incidence of moderate to severe adhesion around the incision in the stoma area were evalutated during stoma reduction surgery. Results:The incidence of moderate to severe adhesion around the incision in the stoma area was 6.3% in the study group, the difference was statistically significant ( P<0.05) compared to that of the control group (32.6%). Conclusion:Sodium hyaluronate gel can safely and effectively reduce the incidence of moderate and severe adhesions after abdominal surgery.

Objective:To investigate the changes of ocular surface microbiota in obese patients before and after dietary intervention.Methods:From November 1, 2020 to May 1, 2021, 35 obese patients in the obesity management center of the Department of Endocrinology and Metabolic Diseases of Henan Provincial People′s Hospital were selected for a 4-week low-calorie dietary intervention of 1 600-1 800 kcal/day. The body weight, body mass index(BMI), body composition(body fat, body fat percentage, visceral fat grade, total body water, and skeletal muscle) were observed before and after dietary intervention. The characteristics of ocular surface flora in obese patients before and after intervention were analyzed by 16S rRNA sequencing.Results:The body weight, BMI, body fat, percentage of body fat, visceral fat grade and total body water decreased significantly after 4 weeks( P<0.05), while there was no significant difference in skeletal muscle( P>0.05). There was no significant difference of ocular surface flora α and β in diversity( P>0.05). Opportunistic pathogens Pseudomonas and Cutibacterium decreased significantly, while Faecalibacterium, Lachnospiraceae NK4A136 group, Oscillospiraceae UCG 002, and Blautia, which producing short chain fatty acids, increased significantly( P<0.05). Functional prediction analysis showed that the metabolic pathways such as degradation related pathways and insulin signaling pathways of volatile organic compounds(VOCs) were significantly enriched. Conclusion:After dietary intervention, opportunistic pathogenic bacteria decreased and short chain fatty acid producing bacteria increased in obese patients. The altered ocular surface flora may be related to the degradation of VOCs and the improvement of insulin sensitivity.

Objective:To investigate the prevention and treatment for deviation of costal cartilage dorsal onlay grafts in rhinoplasty.Methods:From January 2010 to October 2020, a total of 588 patients (83 male cases, 505 female cases, age range from 25 years to 55 years, 32±4 years in average) accepted costal cartilage rhinoplasty in Shenzhen Mylike Medical Plastic Aesthetic Hospital. During the operation, various methods were used in the process of catilage selection, water bath, sculpture, treatment of nasal dorsal, graft fixation and fascial modification to prevent and treat the deformation and displacement of the costal cartilage dorsal onlay grafts.Results:The immediate postoperative photograph of 588 cases showed that costal cartilage dorsal onlay graft was put on the middle of dorsum. After a follow-up period of 396 cases from 6 to 60 months, the average follow-up period was 12.1 months, there were 44 cases happened with the deviation of dorsal onlay grafts, and deviation was managed after the second rhinoplasty surgery. There was no prolonged function sequela such as ventilation dysfunction, abnormal sensation, or hyposmia occured. 362 cases were satisfied with the aesthetic effect.Conclusions:It is particularly important to grasp the principles of managing costal cartilage in rhinoplasty and to learn how to prevent and treat postoperative complications of costal cartilage dorsal onlay graft.

Objective:To investigate the treatment strategies for the thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection (TBAD) accompanied with intra-or post-operational retrograde type A aortic dissection (RAAD).Methods:TBAD patients who underwent TEVAR in Henan Provincial People′s Hospital from February 2004 to January 2020 were retrospectively analyzed. Among 1 176 cases, 14 cases (1.2%) were accompanied with RAAD. Another 9 patients who received TEVAR at other hospitals with TBAD accompanied with RAAD were also collected. In total 23 patients [18 males and 5 females, age as (54±12) years old , ranging from 38 to 79] were included in this study. There were 15 cases of typical dissection, 7 cases of intramural haematoma, and 1 case of penetrating aortic ulcer. Sixteen patients received surgical operation, 1 received hybrid surgery, and the remaining 6 patients underwent conventional therapies. The clinical data and followed up data were collected and analyzed.Results:Among 23 cases, 2 RAAD cases were discovered during the TEVAR, 8 cases were discovered during the perioperative period, 5 cases were discovered within 3 months after discharge, and 8 cases were discovered at more than 1 year after TEVAR, with the longest time point of 120 months after TEVAR. The RAAD rupture was located on the greater curvature side of the aorta in 21 cases, and on the minor curvature side in 2 cases. In 13 cases, the rupture was close to the stent head, and in 10 cases, the rupture was located on the ascending aorta and more than 2 cm from the stent head. Followed up data were collected in 21 cases, with the mean follow-up time as (59±40) months, ranging from 1 to 134 months. Six patients died, with 3 cases of all-reason death and 3 cases of cardiac-reason death. Among the 16 patients receiving surgical operation, one patient died during the perioperative period, and 1 patient suffered from the cerebral infarction and mediastinal infection. Well recovery was found in 1 patient received the hybrid operation. Five of 6 patients who received the conventional treatment died.Conclusions:RAAD is a serious complication related to TEVAR, with low incidence and high mortality rate. RAAD can occur in the early or late stages of TEVAR. TEVAR-associated RAAD has poor therapeutic outcomes, and the surgical operation should be recommended as the preferred treatment for RAAD in clinical practice.

OBJECTIVE: To explore the clinical characteristics of congenital neutropenia caused by ELANE gene mutations. METHODS: Clinical manifestations, absolute blood neutrophil count, high-throughput exome sequencing for mutation screening, suspected locus Sanger sequencing verification, processes of diagnosis and treatment of two patients with congenital neutropenia caused by ELANE gene mutation were retrospectively analyzed. RESULTS: High-throughput sequencing has found that proband 1 has carried a heterozygous c.170C>T (p.Ala57Val) missense mutation in exon 2 of the ELANE gene, which was known to be pathological, and a heterozygous c.251T>G (p.Leu84Arg) mutation in exon 3 of proband 2, which was unreported previously. Sanger sequencing confirmed that neither mutation was inherited from their parents. CONCLUSION ELANE mutation is an important cause for congenital neutropenia. Detection of new pathogenic variants has enriched the mutation spectrum of the ELANE gene.