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 analyze the value of dual energy CT parameters combined with serum procollagen Ⅰ N-terminal propeptide (PⅠNP) and beta C-terminal cross-linked telopeptide of type Ⅰ collagen (β-CTX) in differential diagnosis of spinal bone metastasis from lung cancer and myeloma.Methods:The clinical data of 54 patients with spinal bone metastasis from lung cancer and 50 patients with myeloma in Jincheng People′s Hospital from October 2019 to March 2021 were analyzed retrospectively. All patients were examined by dual energy CT on the day of admission, and the CT values at the energy levels of 40 to 80 keV (energy interval of 10 keV) were recorded. The serum PⅠNP and β-CTX levels were detected by chemiluminescent assay before treatment. The pathological examination results were taken as gold standard, and the CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP and β-CTX levels were compared between 2 groups. Receiver operating characteristic (ROC) curve was used to analyze the differential diagnosis value of the CT values at the energy levels of 40 to 80 keV, serum PⅠNP and β-CTX levels alone and combination.Results:The CT values at the energy levels of 40 to 80 keV by dual energy CT and serum PⅠNP and β-CTX levels in patients with spinal bone metastasis from lung cancer were significantly higher than those in patients with myeloma: 79.86 (61.20, 116.32) HU vs. 58.29 (46.92, 64.03) HU, 64.48 (50.27, 90.08) HU vs. 45.78 (38.59, 56.75) HU, 57.35 (43.31, 78.04) HU vs. 43.62 (36.91, 54.06) HU, 52.05 (42.98, 75.79) HU vs. 41.26 (32.84, 51.76) HU, 45.52 (38.55, 63.59) HU vs. 36.68 (28.72, 49.83) HU, 66.35 (31.15, 81.97) μg/L vs. 31.38 (27.76, 34.50) μg/L and 0.61 (0.48, 0.67) μg/L vs. 0.49 (0.47, 0.52) μg/L, and there were statistical differences ( P<0.05 or <0.01). ROC curve analysis result showed that the sensitivity of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT was higher than those alone (83.33% vs. 59.26%, 61.11%, 62.96%, 64.81% and 66.67), the area under the curve (AUC) was also higher than those alone (0.882 vs. 0.798, 0.811, 0.817, 0.801 and 0.773), and there were statistical differences ( P<0.01 or <0.05); the sensitivity of the combination of serum PⅠNP and β-CTX levels was higher than those alone (81.48% vs. 57.41% and 62.96%), the AUC was higher than those alone (0.829 vs. 0.753 and 0.729), and there were statistical differences ( P<0.01 or <0.05); the sensitivity of all indexes combined in the differential diagnosis of spinal bone metastasis from lung cancer and myeloma was higher than those of the combination of the CT values at the energy levels of 40 to 80 keV by dual energy CT, the combination of serum PⅠNP and β-CTX levels (98.15% vs. 83.33% and 81.48%), the same as AUC (0.976 vs. 0.882 and 0.829), and there were statistical differences ( P<0.01); there were no significant differences in the specificity of each index alone and combination ( P>0.05). Conclusions:Compared with myeloma, the CT values at the energy levels of 40 to 80 keV by dual energy CT, serum PⅠNP and β-CTX levels in patients with spinal bone metastasis from lung cancer are increased, and the combination of the above indexes has ideal value in differential diagnosis of the two diseases.

Attention ; Memory, Short-Term ; Psychomotor Performance

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.

Objective:To explore effective schemes for improving cognitive function in patients with subjective cognitive decline (SCD) by EEG neurofeedback (NF) technique.Methods:Ten SCD patients recruited in Department of Neurology, Xuanwu Hospital, Capital Medical University from April 2019 to August 2019, were chosen in our study; all patients were subjected to neuro-regulation of mismatched negativity (MMN) for 5 times in 2 weeks by EEG NF technique. By using the midlines of frontal zone (Fz), central zone (Cz) and peak zone (Pz) as training electrodes, auditory tones (1000 Hz as standard stimulus, individual hearing discrimination threshold as deviation stimulus) were used to induce MMN characteristics of event-related potential (ERP) via Oddball paradigm. SCD patients received visual disc stimulation feedback with dynamic neural signal activity. ERP waveforms and standard MMN characteristics (amplitude and latency) before and after training were used to evaluate the changes in neural activity of these patients; nine N-Back working memory tasks (three types×three gradients) and hearing discrimination ability tests were used in these patients to evaluate the improvement of cognitive competence.Results:ERP analysis showed that the MMN waveforms in SCD patients after training were obviously different as compared with those before training; their standard stimulus and deviant stimulus in the point-by-point paired t-test analysis were significant different ( P<0.05). The MMN amplitudes at the Fz, Cz and Pz electrodes in these patients after training were significantly higher than those before training ( P<0.05). The accuracy of auditory tone 3-Back task in SCD patients was statistically significant before and after training ( P<0.05). Conclusion:NF based on MMN can significantly improve the MMN amplitude and accuracy of auditory working memory task in patients with SCD, which might provide a potentially effective cognitive intervention method for patients with early AD and the elderly with normal memory decline.

Objective:To evaluate the clinical efficacy of human-like collagen scar repair gel in the treatment of proliferative hypertrophic scar.Methods:The clinical effect of smear-like silicone ointment on patients with hypertrophic scars after prolonged injury or 4-6 months after surgery, the difference of curative effects between 3-18 years old juvenile group and 19-45 years old adult group, were analyzed by multicenter randomized controlled clinical study. Among them, 58 cases were treated with human-like collagen scar repair gel, 39 cases in adult group and 19 cases in minor group; 30 cases were using Silicone Gel, 20 cases in adult group and 10 cases in minor group. The differences in scar color, thickness, blood vessel distribution, softness, patient's self-conscious symptoms, clinical efficacy scores and adverse reactions were analyzed before and after application of the products at 4, 8, 12 and 24 weeks.Results:The scores of the two groups before treatment were slightly higher than those of the control group except the softness and thickness score test group ( P<0.05). There was no significant difference in the remaining parameters ( P>0.05). The efficacy scores at the 4th, 8th, 12th and the 24th week after application of the two groups showed that there were significant differences in the therapeutic indicators after treatment for different time ( P<0.05) and age grouping. There was no significant difference between juvenile group and adult group ( P>0.05). There was a statistically significant difference in the time points of different clinical evaluation scores ( P<0.05). There was no interaction between the evaluation time and the experimental control group and age group ( P>0.05); and not affected by group or age grouping ( P>0.05), no adverse reactions occurred in either group. Conclusions:Human-like collagen scar repair gel is safe and effective in the treatment of proliferative hypertrophic scar, and the clinical efficacy is not inferior to Silicone gel.

Objective:To evaluate the clinical efficacy of human-like collagen scar repair gel in the treatment of proliferative hypertrophic scar.Methods:The clinical effect of smear-like silicone ointment on patients with hypertrophic scars after prolonged injury or 4-6 months after surgery, the difference of curative effects between 3-18 years old juvenile group and 19-45 years old adult group, were analyzed by multicenter randomized controlled clinical study. Among them, 58 cases were treated with human-like collagen scar repair gel, 39 cases in adult group and 19 cases in minor group; 30 cases were using Silicone Gel, 20 cases in adult group and 10 cases in minor group. The differences in scar color, thickness, blood vessel distribution, softness, patient's self-conscious symptoms, clinical efficacy scores and adverse reactions were analyzed before and after application of the products at 4, 8, 12 and 24 weeks.Results:The scores of the two groups before treatment were slightly higher than those of the control group except the softness and thickness score test group ( P<0.05). There was no significant difference in the remaining parameters ( P>0.05). The efficacy scores at the 4th, 8th, 12th and the 24th week after application of the two groups showed that there were significant differences in the therapeutic indicators after treatment for different time ( P<0.05) and age grouping. There was no significant difference between juvenile group and adult group ( P>0.05). There was a statistically significant difference in the time points of different clinical evaluation scores ( P<0.05). There was no interaction between the evaluation time and the experimental control group and age group ( P>0.05); and not affected by group or age grouping ( P>0.05), no adverse reactions occurred in either group. Conclusions:Human-like collagen scar repair gel is safe and effective in the treatment of proliferative hypertrophic scar, and the clinical efficacy is not inferior to Silicone gel.

Neurofeedback may improve cognitive function and behaviour by regulating the cerebral neural activities. Neurofeedback works as a kind of therapy for patients with Parkinson's disease, primarily based on electroencephalogram signals and hemodynamic signals. It regulates abnormal neuronal rhythm oscillations in the cortical-spinal system by electroencephalogram neurofeedback and sensory motor rhythm as the main adjustment frequency band, and modulates activation in the cortical-basal ganglia-thalamic-cortical network of brain with the supplementary motor area as the target area via functional magnetic resonance imaging neurofeedback. Neurofeedback effectively improves the motor symptoms of Parkinson's patients, both dynamic and static. However, the number of samples is limited in these researches, and the assessments before and after neurofeedback training are not yet comprehensive. Neurofeedback technology might be a potential effective rehabilitation for patients with Parkinson's disease.

Objective: To investigate whether the artermisinin has beneficial efficacy to improve the learning and memory in aged mice, as well as the possible mechanisms regarding the inflammatory cytokines and monoamlne neurotransmitters. Methods: 30 aged mice(22 month old) were randomly divided into the aged mouse model control group(n=10), the artemisinin low dose group(artemisinin 0.1% in feed, n=10)and the artemisinin high dose group(artemisinin 0.3% in feed, n=10). Another 10 mice(2 month old) served as young mouse model control group. The artemisinin low dose group and the artemisinin high dose group fed artemisinin feed for 10 weeks. The aged mouse model control group and the young mouse model control group were fed standard feed.Morris water maze test was performed to assess learning and memory capacities for evaluation of the cognitive degree. Serum TNF-α and IL-6 were also detected by ELISA and dopamine, norepinephrine, serotonin in the brain were analyzed by HPLC. Results: (1) Morris water maze test showed, the retention time of the aged mouse model control group was significantly longer than that of the young mouse model control group (P<0.05). The retention time of the artemisinin low dose group and the artemisinin high dose group was significantly shorter than that of the aged mouse model control group (P<0.05). In the ninth days of the reverse recessive platform experiment, the retention time of the artemisinin low dose group ((50.1±19.9) s) and the artemisinin high dose group ((43.2±17.6) s) was significantly shorter than that of the aged mouse model control group ((66.1±29.1)s, P<0.05). (2) Serum inflammatory factors test showed, the level of IL-6 and TNF-αin the artemisinin low dose group (IL-6 : (28.4±4.3) pg/ml, TNF-α: (51.8±8.2) pg/ml) and the artemisinin high dose group(IL-6 : (17.6±2.3) pg/ml, TNF-α: (38.6±12.5) pg/ml) were significantly lower than those in aged mouse model control group(IL-6 : (36.12±7.98)pg/ml), TNF-α : (67.32±10.27) pg/ml, P<0.05). (3) Neurotransmitter content test in the brain showed, the content of DA((19.96±3.89) mmol/ml) and 5-HT((5.73±0.93)mmol/ml) in low dose artemisinin group was higher than that in aged mouth model control group. The content of DA((26.13±5.66) mmol/ml), NE((16.31±2.69) mmol/ml) and 5-HT((8.03±1.93) mmol/ml) in high dose artemisinin group was higher than that in aged mouth model group(DA(13.96±3.89) mmol/ml, NE(8.73±2.16) mmol/ml, 5-HT (3.82±1.09)mmol/ml, all P<0.05). Conclusion Artemisinin can improve the ability of learning and memory in aged mice. The mechanism may be related to inhibiting the inflammation and promoting the level of neurotransmitters in the brain of aged mice.