Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Background::Joint dislocations significantly impact public health. However, a comprehensive study on the incidence, distribution, and risk factors for joint dislocations in China is lacking. We conducted the China National Joint Dislocation Study, which is a part of the China National Fracture Study conducted to obtain the national incidence and risk factors for traumatic fractures, and to investigate the incidence and risk factors for joint dislocations.Methods::For this national retrospective epidemiological study, 512,187 participants were recruited using stratified random sampling and probability-proportional-to-size method from January 19 to May 16, 2015. Participants who sustained joint dislocations of the trunk, arms, or legs (skull, sternum, and ribs being excluded) in 2014 were personally interviewed to obtain data on age, educational background, ethnic origin, occupation, geographic region, and urbanization degree. The joint-dislocation incidence was calculated based on age, sex, body site, and demographic factors. The risk factors for different groups were examined using multiple logistic regression.Results::One hundred and nineteen participants sustained 121 joint dislocations in 2014. The population-weighted incidence rate of joint dislocations of the trunk, arms, or legs was 0.22 (95% confidence interval [CI]: 0.16, 0.27) per 1000 population in 2014 (men, 0.27 [0.20, 0.34]; women, 0.16 [0.10, 0.23]). For all ages, previous dislocation history (male: OR 42.33, 95% confidence interval [CI]: 12.03–148.90; female: OR 54.43, 95% CI: 17.37–170.50) and alcohol consumption (male: OR 3.50, 95% CI: 1.49–8.22; female: OR 2.65, 95% CI: 1.08–6.50) were risk factors for joint dislocation. Sleeping less than 7 h/day was a risk factor for men. Compared with children, women aged ≥15 years (female 15–64 years: OR 0.16, 95% CI: 0.04–0.61; female ≥65 years: OR 0.06, 95% CI: 0.01–0.41) were less likely to sustain joint dislocations. Women with more than three children were at higher dislocation risk than women without children (OR 6.92, 95% CI: 1.18–40.78).Conclusions::The up-to-date data on joint dislocation incidence, distribution, and risk factors can be used as a reference for national healthcare, prevention, and management in China. Specific strategies for decreasing alcohol consumption and encouraging adequate sleeping hours should be developed to prevent or reduce dislocation incidents.Trial Registration::Chinese Clinical Trial Registry, ChiCTR-EPR-15005878.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Purpose: Fibroblast growth factor receptor 4 (FGFR4) plays a critical role in cancer progression involving in tumor proliferation, invasion, and metastasis. This study clarified the role of FGFR4-Arg388 variant in gastric cancer (GC), and more importantly highlighted the possibility of this single nucleotide polymorphism (SNP) as potential therapeutic targets. Materials and Methods: FGFR4 polymorphism was characterized in advanced GC patients to perform statistical analysis. FGFR4-dependent signal pathways involving cell proliferation, invasion, migration, and resistance to oxaliplatin (OXA) in accordance with the SNP were also assessed in transfected GC cell lines. Results: Among 102 GC patients, the FGFR4-Arg388 patients showed significantly higher tumor stage (p=0.047) and worse overall survival (p=0.033) than the Gly388 patients. Immunohistochemical results showed that FGFR4-Arg388 patients were more likely to have higher vimentin (p=0.025) and p-STAT3 (p=0.009) expression compared with FGFR4-Gly388 patients. In transfected GC cells, the overexpression of FGFR4-Arg388 variant increased proliferation and invasion of GC cells, increasing resistance of GC cells to OXA compared with cells overexpressing the Gly388 allele. Conclusion The exploration mechanism may be through FGFR4-Arg388/STAT3/epithelial to mesenchymal transition axis regulating pivotal oncogenic properties of GC cells. The FGFR4-Arg388 variant may be a biomarker and a candidate target for adjuvant treatment of GC.

Objective To evaluate GIPR protein expression in predicting prognosis of appendical neuroendocrine tumors (A-NET) patients.Methods The clinical data of 40 A-NET cases surgically treated from June 2007 to June 2017 at Tianjin Police Hospital were analyzed.The expression of GIPR markers was detected by immunohistochemistry (IHC).Results There were 25 male and 15 female patients,with an median age of 59 years.Sex,tumor site,tumor size,tumor stage and lymph node metastasis were not related to prognosis (P ＞ 0.05).The expression of GIPR was positive in 18 cases and negative in 22 cases.There were 16 cases in G1 stage,20 cases in G2,4 cases in G3.The expression of GIPR protein and pathological grades were related to prognosis (P ＜ 0.05).Conclusions Symptoms of appendix neuroendocrine tumor are nonspecific.Diagnosis is dependent on pathological examination and immunohistochemistry.Positive GIPR protein expression predicts poor prognosis for A-NETs patients.

Objective To compare and analyze the epidemiological features of adult pelvic fractures between West China and East China from 2010 to 2011.Methods The data of adult pelvic fractures treated from January 2010 to December 2011 in 63 hospitals in West China and East China were collected through the PACS system and case reports checking system.The data from the 35 hospitals in East China were assigned into group A and those from the 28 hospitals in West China into group B.The analytic items included gender,age,age distribution and type of AO classification.Results A total of 7,896 cases were collected.In group A of 5,683 cases,there were 2,829 males and 2,854 females,with a male to female ratio of 0.99∶1 and a median age of 42 years (interquartile range,from 30 to 55 years).In group B of 2,213 cases,there were 1,123 males and 1,090 females,with a male to female ratio of 1.03∶1 and a median age of 41 years (interquartile range,from 31 to 54 years).There was no significant difference in the male to female ratio between the 2 groups (x2 =0.594,P =0.441) but there was a significant difference in the median age (Z =-4.344,P =0.000).The age distribution showed that the peak range was from 31 to 40 years in group A (with a proportion of 21.50％) and from 41 to 50 years in group B (with a proportion of 23.41％),showing no significant difference between the 2 groups (P ＞ 0.05).In both groups,type 61-A was the high risk type of fracture (82.23％ in group A and 86.08％ in group B),and type 61-A2 the high risk subtype of fracture (41.47％ in group A and 54.36％ in group B),showing significant differences (P ＜ 0.05).Conclusions East China and West China had similar male to female ratios in pelvic fractures.Generally,the patients in West China were younger,for the most patients in East China were aged from 31 to 40 years and those in West China from 41 to 50 years.In both East China and West China,type 61-A2 and subtype 61-A2 were the most common,but the proportions of type 61-A2 and subtype 61-A2 were higher in West China than in East China.

Objective To compare and analyze the epidemiological features of adult patients with distal humerus fractures between the east and west China from 2010 to 2011.Methods The data of adult patients with distal humerus fracture treated from January 2010 to December 2011 in 63 hospitals in the east and west China were collected through the PACS system and case reports checking system.The data from 35 hospitals in the east China were classified as group A,and those from 28 hospitals in the west China as group B.The analytic items included gender,age and AO/OTA classification.Results A total of 2,668 cases were collected.The median age of the 1,852 cases in group A was 42 (IQR:33) years old.The high peak age ranged from 21 to 30 years old;the gender ratio of group A was 1.18:1.The median age of the 816 cases in group B was 37 (IQR:27) years old.The high peak age ranged from 31 to 40 years old;the gender ratio of group B was 1.80:1.Group A had a significantly lower gender ratio but a significantly higher median age than group B (P ＜ 0.05).The proportions of patients from 16 to 20 and from 31 to 40 years old in group A were significantly lower than those in group B but the proportion of patients aged above 61 years old in group A was significantly higher than that in group B (P ＜ 0.05).According to the AO/OTA classification,1,399 cases (52.44％) were type 13-A,682 ones (25.56％) type 13-B and 587 ones (22.00％) type 13-C.The proportions of type 13-A and type 13-A1 in group A were significantly lower than in group B (P ＜ 0.05).Conclusions Fractures of the distal humerus mostly occurred in the age range from 21 to 40 years old and in males.Type 13-A fractures were the most common.The east China had a significantly higher proportion of female patients,an older median age and a lower proportion of type 13-A1 fracture than the west China.

Objective To compare and analyze the epidemiological features of adult talus fractures between East China and West China from 2010 to 2011.Methods The data of adult talus fractures from January 2010 to December 2011 in 63 hospitals in East China and West China were collected through the PACS system and medical records systems.The data of 35 hospitals in East China were assigned into group A while the data of 28 hospitals in West China into group B.The analytic items included gender,age,and type of AO classification.Results A total of 1,014 cases were collected.In group A of 825 cases,there were 624 (75.64％) males and 201 (24.36％) females;in group B of 189 cases,there were 130 (68.78％)males and 59 (31.22％) females.There was no significant difference between groups A and B in male to female ratio (x2 =3.788,P=0.052).The mean age was 36 years old (26,47) in group A and 35 (24,48) years old in group B,showing no significant difference between the 2 groups (Z =-8.244,P ＜ 0.001).There was a significant difference between the 2 groups in the constituent ratio of age ranges (P ＜ 0.05).The peak age range was from 21 to 30 years old in group A (27.76％,229/825),and from 31 to 40 years old in group B (24.34％,46/189).The high-risk type of fracture was AO type 81-A in both groups.Conclusions There were more male talus fractures than female ones in both East China and West China.Most talus fractures happened in patients aged from 21 to 30 years in East China and in patients aged from 31 to 40 years in West China.AO Type 81-A was the most common in both West and East China.

Objective To explore the clinical pathological characteristics and prognostic factors of patients with neuroendocrine tumor of the appendix.Methods Data of 42 cases of the appendiceal neuroendocrine tumor from June 2006 to June 2016 at Tianjin Police Hospital were analyzed.Tumors were classified according to 2010 WHO classification.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test.Results There were 27 males and 15 females,with median age of 60 years.Tumors located in the head of the appendix in 37 cases,in the body in 2 cases and at the base in 3 cases.The median of tumor sizes were 1.2 cm.G1 in 17 cases,G2 in 21 cases,G3 in 4 cases.The follow-up rate was 100％.The overall 1-year survival rate was 92％.Conclusions The clinical symptoms of appendiceal neuroendocrine tumors are most often nonspecific.The diagnosis depends on pathological examination and immunohistochemistry,and prognosis varies with pathological grades.