The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

Objective To observe the clinical efficacy of Dachaihu decoction in treatment of stroke-associated pneumonia (SAP) in the elderly patients with excess-heat syndrome and acute ischemic stroke (AIS). Methods One hundred elderly patients with excess-heat syndrome and SAP admitted to the Department of Neurology of Tianjin Nankai Hospital from August 2015 to September 2016 were enrolled, and they were divided into a control group and an observation group according to the random number table, 50 cases in each group. Both groups were given conventional neurological treatment, while the observation group additionally received Dachaihu decoction (the ingredients of the decoction: bupleurum 15 g, scutellariae 10 g, pinellia 10 g, fructus aurantii immaturus 15 g, radix paeoniae alba 10 g, rhubarb 5 g, ginger 10 g, jujube 2), and according to the individual's symptoms and signs, the above ingredients can be added and/or subtracted, 1 dose per day, divided into two parts, 1 part taken in the morning and 1 part in the evening orally, 14 days as a therapeutic course. The body temperature recovery time, the duration of antibiotic treatment, the changes of Clinical Pulmonary Infection Score (CPIS) and National Institutes of Health Stroke Scale (NIHSS) score before and after treatment of the two groups were observed and the therapeutic effects in the two groups were evaluated. Results The body temperature recovery time (days: 6.56±2.70 vs. 8.08±3.23) and the duration of antibiotic treatment (days: 8.78±2.80 vs. 10.02±2.90) in the observation group were significantly shorter than those in the control group (both P ＜ 0.05); with the prolongation of treatment, after treatment, the CPIS and NIHSS score were decreased significantly in both groups, reaching the lowest levels on the 14th day, and the degrees of score descent in observation group were more significant than those of the control group (CPIS score: 0.68±0.59 vs. 1.12±0.96, NIHSS score: 6.38±2.31 vs. 7.44±2.74, both P ＜ 0.05); the total effective rate in the observation group was significantly higher than that in the control group [92% (46/50) vs. 76% (38/50), P ＜ 0.05]. Conclusion The therapeutic effect of Dachaihu decoction used for treatment of SAP in elderly patients with excess-heat syndrome is favorably effective and safe.

Objective To find the potential risk factors for pancreatic fistula after distal pancreatectomy.Methods Clinical data of 125 cases of consecutive distal pancreatectomy in Ningbo Lihuili Hospital from January 2006 to June 2013 were retrospectively analyzed.Results In all the 125 patients with distal pancreatectomy,pancreatic fistula was the most common surgical complication (43/125,34.4％),including 27 cases of grade A fistula,16 cases of grade B pancreatic fistula.Multivariate analysis showed that the texture of the pancreas and main pancreatic duct ligation were the independent risk factors for pancreatic fistula (all P ＜ 0.05).Conclusions Pancreatic fistula was the most common surgical complication of distal pancreatectomy.The texture of the pancreas and main pancreatic duct ligation effect the occurrence of postoperative pancreatic fistula.

ObjectiveTo study the efficacy of transcatheter arterial chemoembolization (TACE) after liver resection for hepatocellular carcinoma (HCC) with tumor thrombus in the main trunk and/or first branch of portal vein,and to clarify prognostic factors affecting survival.Methods From 2005 to 2009,there were 358 consecutive patients with HCC who underwent surgical resection in our Department.In 55 patients (15 ％),portal vein tumor thrombus (PVTT) was found intraoperatively or postoperatively during histopathological examinations to involve the first portal branch,main portal trunk,or contralateral portal branch.In this retrospective study,these 55 patients were divided into two groups:Group A,29 patients received postoperative TACE,and Group B,26 patients who did not receive TACE.The clinical data and survivals were compared between the two groups.Prognostic factors were indentified using univariate analysis,followed by multivariate regression analysis using the Cox proportional hazards model.ResultsThere were no significant differences in the demographic clinical data between Group A and Group B.The overall 1-,2- and 3-year survivals for the 55 patients were 63.3 ％,51.4 ％ and 43.5 ％,respectively.The accumulative 1-,2- and 3-year survivals for group A were 71.4 ％,60.1 ％ and 50.1 ％,respectively.The corresponding figures for group B were 56.7％,21.7％ and 10.4％,respectively.Multiple tumors,intrahepatic metastases,hepatic vein thrombus,and invasive type of tumor thrombus were found to be risk factors for short-term survival on univariate analysis,while the latter 3 factors were further found to be significant prognostic factors in the Cox proportional hazards model.Postoperative TACE was shown to be a significant factor in both univariate and multivariate analyses.ConclusionLiver resection was beneficial for some patients with portal vein tumor thrombus.Postoperative TACE further improved the prognosis and prolonged survivals in these patients.

OBJECTIVETo analyze the reasons and related factors of failures in the treatment of intertrochanteric fracture with dynamic hip screw (DHS) and to increase the therapeutic level of intertrochanteric fracture.

METHODSAll the 78 cases of intertrochanteric fractures were treated with dynamic hip screws from Dec. 1998 to Dec. 2007 included 42 males and 36 females with an average age of 62 years old ranging from 26 to 85 years. The disease course was from 1 to 49 hours (means 4 hours). According to Evans-Jensen classification of intertrochanteric fracture, 4 cases were type IA, 24 cases were type IB, 13 cases were type IIA, 22 cases were type IIB, 11 cases were type III, 4 cases were type IV. The fracture were fixed with dynamic hip screws following AO operative standard. To analyze the reasons and related factors of the 12 failed cases involving femur head and neck cut-off, tail pin exit, coxa vara, screw loosening, compress screw slip out of the tube, fracture displacement, respectively.

RESULTSAll the cases were followed up for 13 months to 7 years with an average of 36 months, 12 cases were failed including 4 cases of femur head and neck cut-off, 1 case of coax vara, 2 cases of compress screw slip out of the plate tube, 2 cases of screws loosening, 2 cases of tail pin displacement 1 case of great trochanter fracture displacement.

CONCLUSIONFor intertrochanteric fracture, to interfix with dynamic hip screw is an effective method, the choice of indication, the type of fracture, the bone mineral density and the manipulative technique affect the results.

Adult ; Aged ; Aged, 80 and over ; Bone Screws ; Cluster Analysis ; Female ; Follow-Up Studies ; Hip Fractures ; diagnostic imaging ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome