BACKGROUND:Percutaneous kyphoplasty was a common surgical procedure for the treatment of osteoporotic vertebral compression fracture.However,there was no research to confirm whether percutaneous kyphoplasty could effectively correct the local kyphoplasty of the spine in patients over 80 years old with osteoporotic vertebral compression fracture.OBJECTIVE:To investigate the effect of percutaneous kyphoplasty on local kyphosis in super-aging patients with osteoporotic vertebral compression fracture.METHODS:Single-segment osteoporotic vertebral compression fracture patients treated with percutaneous kyphoplasty at the Department of Spinal Surgery,Peking University People's Hospital,from March 2016 to August 2022,were selected as the research cohort,and the follow-up data of patients in hospital and out-patient were collected.According to patients'age,patients were divided into the advanced age group(60-79 years old,n=126)and the super-aged group(＞80 years old,n=52).According to gender,body mass index,basic diseases(hypertension,diabetes,and cardiovascular diseases),fracture segments and the presence or absence of preoperative intravertebral cleft,the two groups of patients were matched 1:2 by propensity score matching.The lumbar CT values,injection amount of bone cement,preoperative and postoperative vertebral height,preoperative collapse rate of the vertebral body,preoperative and postoperative Cobb angle,recovery rate of Cobb angle,distance between the bone cement and anterior edge of the vertebral body,sagittal position of cement filling,contact between the bone cement and endplate,distance between the bone cement and vertebral endplates,bone cement distribution score,bone cement leakage,and vertebral refracture were compared between the two groups.RESULTS AND CONCLUSION:(1)After matching the propensity score,115 patients were included,with 71 patients in the advanced age group and 44 patients in the super-aged group.There was no statistically significant difference in baseline data,including gender,body mass index,hypertension ratio,diabetes ratio,cardiovascular disease ratio,fracture section,and preoperative intravertebral cleft,between the two groups(P＞0.05).The postoperative Cobb angle of the super-aged patients was significantly smaller than that of the elderly patients(P＜0.05).There was no significant difference in lumbar CT values,injection amount of bone cement,preoperative and postoperative vertebral height,preoperative collapse rate of the vertebral body,preoperative Cobb angle,recovery rate of Cobb angle,postoperative distance between the bone cement and anterior edge of the vertebral body,sagittal position of cement filling,contact between the bone cement and endplate,distance between the bone cement and vertebral endplates,bone cement distribution score,bone cement leakage,and vertebral refracture ratio between the two groups(P＞0.05).(2)These findings indicate that percutaneous kyphoplasty can effectively correct local kyphosis of the spine in super-aging patients with osteoporotic vertebral compression fractures.

Objective To investigate the protective effect of cerebrospinal fluid(CSF)on the spinal cord in patients with scoliosis and evaluate its buffering effect during gravitational traction surgery and in daily life,so as to provide a theoretical guidance for surgical planning and postoperative rehabilitation of scoliosis.Methods A three-dimensional coupled spinal cord-CSF finite element model was established to simulate the biomechanical responses of the spine under two scenarios:gravitational traction surgery and daily life.Comparative analyses were conducted for conditions with and without CSF,and the buffering effect of CSF was quantitatively assessed.Results During simulated gravitational traction surgery,CSF significantly reduced the stress and deformation of the spinal cord,with the stress in spinal cord white and gray matter decreasing by 65％-90％and deformation decreasing by 70％-95％.In the daily life scenario,CSF provided greater protective effects in lateral flexion and anterior-posterior flexion directions,with stress reductions of 60％-85％.However,in torsion,the buffering effect of CSF was relatively weaker,with stress reductions of only 10％-25％.Conclusions CSF significantly reduces spinal cord stress and deformation during gravitational traction surgery and in daily life,reducing the risk of injury.

In recent years, the rapid development of artificial intelligence (AI) has revolutionized the whole-course nutritional management of elderly patients. AI technologies, including machine learning and natural language processing, are capable of efficiently processing vast amounts of multidimensional information such as clinical data, laboratory test results, and imaging findings. For instance, machine learning algorithms can efficiently identify complex nutritional metabolism patterns and accurately predict malnutrition and its trends in elderly patients. Following the standard pathway of "screening, assessment, diagnosis, treatment, and monitoring", AI technology empowers the whole-course nutritional management for elderly patients, forming a refined, data-driven management model, and shows great potential in improving the nutritional status of elderly patients, enhancing treatment outcomes, and promoting elderly health.

Objective:To evaluate the effectiveness of the Total Nutritional Therapy (TNT) course initiated by the Chinese Society for Parenteral and Enteral Nutrition (CSPEN) over the 20 years since its implementation in China.Methods:Participants who attended the CSPEN-organized TNT course between 2005 and 2024 were randomly selected as survey subjects. A four-level questionnaire (reaction, learning, behavior, and results) was developed via expert consensus, based on the Kirkpatrick model. An electronic link to the survey, created via Wenjuanxing, was distributed to invite participants to complete the questionnaire.Results:A total of 1,548 healthcare professionals from various specialties who had received TNT course participated in the online survey. Over 93% of participants reported improvements in theoretical knowledge and 94% in enhanced clinical diagnosis and treatment capabilities. Additionally, 65.4% of participants reported a "significant" or "noticeable" increase in the frequency of nutritional screening and assessments, with the frequency of nutritional support therapy utilization increased by 91.2%. Furthermore, 52.6% of respondents perceived a "significant" or "noticeable" career advancement, particularly in professional title promotion and international academic exchanges. The TNT course also positively impacted discipline development and management: 63.6% of the trainees' hospitals established clinical nutrition departments, 58.98% opened nutrition outpatient clinics, and 56.9% formed nutrition support teams. The adoption rate of standardized procedures, such as nutritional screening, exceeded 92.5% in relevant departments.Conclusions:Over the past 20 years, the CSPEN-led TNT course has successfully established a virtuous cycle of "knowledge dissemination–practice transformation–system innovation" in China. It has played a positive role in enhancing the professional competencies of healthcare workers and promoting the development of clinical nutrition as a discipline.

Objective:To investigate the relationship between dynamic alterations in serum albumin (ALB) concentrations and clinical outcomes in hospitalized surgical patients, thus providing a basis for optimizing clinical management strategies.Methods:This study utilized data from a prospective observational cohort study on nutritional status among 7 122 elderly hospitalized patients across 34 tertiary hospitals in 18 Chinese cities. A total of 1 714 surgical patients hospitalized for 7-30 days with complete data were included. Standardized protocols were used to collect demographic data, clinical outcomes, and a range of laboratory results, including nutritional and hematological parameters. Heterogeneous effects of ALB on clinical outcomes were explored. Receiver operating characteristic (ROC) curves were used to determine cutoff values for infection-related complications. Correlation analyses and multiple linear regression models were used to identify independent predictors of the absolute change in ALB (?ALB).Results:Among the surgical patients, 69.7% (1 195/1 714) experienced a decline in ALB levels during their hospital stay, which was significantly associated with the occurrence of both infection- and non-infection-related complications. Simultaneously, a marked decrease in ALB was also significantly correlated with changes in nutritional and inflammatory status during hospitalization, worsening of gastrointestinal symptoms at discharge, and functional activity abnormalities (all P<0.05). ?ALB exhibited a close association with outcome variables such as infection-related complications. Based on the incidence of infection-related complications, a cutoff value for ALB was calculated, dividing patients into a high-risk group ( n=179) and a low-risk group ( n=1 535), and a statistically significant difference in the incidence of infection-related complications was found between these two groups ( P<0.05). Correlation analysis and multiple linear regression modeling revealed that female gender, a higher baseline ALB level, a poorer baseline inflammatory status, an exacerbation of inflammatory status, larger alterations in platelet-to-lymphocyte ratio, and the presence of infection-related complications were predictive factors for a decline in ALB levels among surgical patients during their hospital stay. Conclusions:?ALB serves as a critical indicator of the inflammatory-nutritional interplay, with its magnitude of decline effectively predicting clinical outcomes and nutritional status changes and guiding multidisciplinary interventions in surgical patients.

The high prevalence of frailty in older adults and its close link to adverse outcomes make it a critical public health challenge in the aging global population. Frailty, characterized by multisystem functional decline, significantly increases the risk of falls, disability, and even death, yet its underlying mechanisms remain poorly understood. While the role of gut microbiota as the "second genome" in disease regulation has been widely recognized, its specific mechanisms in the development of frailty syndrome remain to be systematically investigated. This review synthesizes findings from the last decade of international literature to analyze the mechanisms by which gut microbiota dysbiosis contributes to frailty syndrome. We focus on pathways including metabolic disorders, chronic inflammation, oxidative stress, and the oral-gut microbiota axis, aiming to provide insights for clinical diagnosis and treatment.

Micronutrients (MNs), including vitamins and trace elements, are essential for maintaining normal human metabolism and promoting postoperative recovery. Surgical procedures, especially those involving the digestive tract, may alter the structure and function of the gastrointestinal tract, thereby affecting the digestion and absorption of MNs and leading to deficiencies in various MNs. Perioperative MN intervention is an important strategy for preventing and treating postoperative malnutrition in surgical patients. This article reviews recent domestic and international research, summarizing and analyzing the current status of perioperative MN deficiencies in surgical patients, specific deficiency manifestations after different surgeries, impact of MN supplementation on postoperative recovery, and nutritional management measures. The aim is to provide more precise and scientific nutritional intervention strategies for clinical practice, promoting comprehensive recovery of patients.

Metabolic and bariatric surgery (MBS) is an effective treatment for obesity as it can dramatically reduce body weight and improve obesity-related comorbidities. However, postoperative changes from MBS can impair gastrointestinal structure and function, leading to micronutrient (MN) deficiencies and potentially severe organ dysfunction. MNs, including vitamins and trace elements, are crucial for human metabolism and can influence disease progression and outcomes. By reviewing the domestic and international literature in the past 5 years, we summarized and analyzed MN changles and nutritional management after various MBS procedures, aiming to further inform clinical practice.

Gut microorganisms are central to the intestinal microecosystem, regulating digestive functions and related to immune regulation, metabolic disorders, and nervous system development. Recent studies reveal the multifaceted interactions between micronutrients (MNs) and gut microbiota, where MNs provide essential nutrients to the intestinal flora and influence the production and absorption of various MNs through direct or indirect pathways. This article reviews the recent advances in the effects of water-soluble vitamins, fat-soluble vitamins, and micronutrients on the intestinal microecology, aiming to provide new ideas for future research.

Objective:To evaluate the role of tubulin tyrosin ligase like-6 (TTLL6)-mediated microtubule polyglutamylation and Spastin(a microtubule cleaving protein)-induced excessive microtubule cleavage in the developmental impairment of dendritic spines in neonatal mice following repeated sevoflurane anesthesia, by utilizing TTLL6 conditional knockout mice.Methods:Fifty SPF female TTLL6 brain tissue-specific knockout (TTLL6 CKO: Camk2-Cre + ; TTLL6 f/f) and fifty control (TTLL6 CON: TTLL6 f/f) mice with C57BL/6J background, aged 6 days old were selected.TTLL6 CKO mice were divided into TTLL6 CON control group and TTLL6 CON sevoflurane group, and TTLL6 CKO mice were divided into TTLL6 CKO control group and TTLL6 CKO sevoflurane group, with 25 mice in each group by random block method.Mice in the sevoflurane groups were exposed to 3% sevoflurane with 60% O 2 for 2 hours daily on postnatal days 6, 8, and 10.The mice in control groups received only 60% O 2 under the same condition.The polyGlu-Tubulin and postsynaptic density 95(PSD95) protein expression were detected using Western blot. The expressions of TTLL6, Spastin, and α-Tubulin were assessed via immunofluorescence.Golgi staining and electron microscopy were employed to observe the density of hippocampal dendritic spines and synaptic conditions. The Morris water maze test was used to evaluate spatial memory capabilities. Statistical analysis was performed using GraphPad Prism 8.0 software. Results:(1) Behavioral results showed significant time and group interactions among the four groups in terms of latency to find the platform ( F=8.22, P<0.001).Mice in the TTLL6 CON sevoflurane group had a significantly longer escape latency on days 3-7 compared with the TTLL6 CON control group (all P<0.05), while there was no significant difference between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group (all P>0.05). The number of platform crossings differed significantly among the four groups ( H=11.95, P=0.007).The TTLL6 CON sevoflurane group had significantly fewer crossing times than the TTLL6 CON control group ( P<0.05), but no significant difference was observed between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group ( P>0.05). (2) Golgi staining and electron microscopy results revealed significant differences in dendritic spine density and synapse number among the four groups( F=29.00, 41.94, both P<0.001). The dendritic spine density ((5.83±0.40)/10 μm) and the number of synapses ((3.67±0.58)/10 μm) in the TTLL6 CON sevoflurane group were both significantly lower than those in the TTLL6 CON control group ((12.87±1.70)/10 μm, (9.33±0.57)/10 μm)(both P<0.05). In contrast, there was no statistically significant difference between the TTLL6 CKO sevoflurane group and TTLL6 CKO control group (both P>0.05). (3) Immunofluorescence results showed significant differences in the percentage of TTLL6 and Spastin and α-Tubulin co-expressed positive cells in the CA3 region of the hippocampus among the four groups of mice ( F=215.20, 26.08, both P<0.001). The percentage of TTLL6 and Spastin and α-Tubulin co-expressed positive cells in the TTLL6 CON sevoflurane group ((16.75±1.81) %, (47.98±8.42) %) were significantly higher than those in the TTLL6 CON control group ((2.44±0.58) %, (20.07±4.54) %)(both P<0.05), while there was no statistically significant difference between the TTLL6 CKO sevoflurane group and TTLL6 CKO control group ( P>0.05). (4) Western blot results indicated significant differences in the expression of polyGlu-Tubulin and PSD95 proteins in the hippocampal tissue among the four groups of mice ( F=19.66, 8.57, both P<0.001). The TTLL6 CON sevoflurane group had higher polyGlu-Tubulin expression (0.86±0.19) and lower PSD95 expression (0.61±0.13) compared to the TTLL6 CON control group (0.51±0.11, 1.01±0.07) (both P<0.05).However, there was no significant difference between the TTLL6 CKO sevoflurane group and the TTLL6 CKO control group ( P>0.05). Conclusion:The mechanism underlying long-term cognitive impairment in developing brain of neonatal mice caused by repeated sevoflurane anesthesia may relate to the upregulation of TTLL6-induced microtubule polyglutamylation and accelerated Spastin-mediated microtubule severing, which ultimately leads to abnormal dendritic spine development.