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 evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

A young male diagnosed with severe hemophilia A since childhood, was presented with recurrent joint and urinary bleeding. Annualized bleed rates dropped below five with low dose prophylactic medication.Bleeding in the right knee joint recently aggravated. Due to coexisting HIV infection and advanced hemophilic arthritis, the patient was managed by a multi-disciplinary team(MDT).Total knee arthroplasty was performed by an experienced surgeon using modern prosthesis design and intraoperative navigation technologies.Physical and rehabilitation therapy was provided during the postoperative period, and joint function improved. The MDT managed the young patient with HIV infection and advanced hemophilic arthritis. The patient was diagnosed with osteoporosis thought to have been caused by hemophilia, HIV infection and antiviral drugs; and he received treatment. The treatment of this patient reflects the importance of multidisciplinary cooperation in the management of difficult and rare diseases.

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.

Chinese, as a logographic language, fundamentally differs from alphabetic languages like English. Previous neuroimaging studies have mainly focused on alphabetic languages, while the exploration of Chinese reading is still an emerging and fast-growing research field. Recently, a growing number of neuroimaging studies have explored the neural circuit of Chinese reading. Here, we summarize previous research on Chinese reading from a connectomic perspective. Converging evidence indicates that the left middle frontal gyrus is a specialized hub region that connects the ventral with dorsal pathways for Chinese reading. Notably, the orthography-to-phonology and orthography-to-semantics mapping, mainly processed in the ventral pathway, are more specific during Chinese reading. Besides, in addition to the left-lateralized language-related regions, reading pathways in the right hemisphere also play an important role in Chinese reading. Throughout, we comprehensively review prior findings and emphasize several challenging issues to be explored in future work.
Brain/diagnostic imaging* ; Brain Mapping ; China ; Connectome ; Language ; Magnetic Resonance Imaging/methods* ; Reading

Objective : To construct a cell-free DNA ( cfDNA) methylation model for early screening in male pa- tients with gastric cancer by using novel cfDNA methylation detection technology． Methods : Methylation informa- tion of the whole genome of gastric cancer patients were detected by cell-free methylated DNA immunoprecipitation and highthroughput sequencing ( cfMeDIP-seq ) technology and locate gastrogenic cfDNA． Then bioinformation methods were used to extract specific methylation labels which could distinguish GC patients and establish diagnosis model by random forest algorithm. Related validation clinical researches were also conducted. Results : 63 most sig- nificant DMR were selected to construct the cfDNA methylation model based on GC samples and normal control samples，the goal sensitivity was above 85 percent while the goal specificity was above 95% ．The sensitivity and specificity of the validation set were 98. 7% and 99. 0% while the area under curve(AUC) was 0. 999． Conclusion The cfDNA methylation model constructed in this study has good performance in predicting GC.

OBJECTIVETo investigate the characteristics, treatment and outcome of patients with primary central nervous system lymphoma （PCNSL）.

METHODSA total of 37 patients with PCNSL treated in Peking Union Medical College Hospital from June 1999 to June 2012 were enrolled into this retrospective study. The clinical characteristics, results of treatment and prognostic factors were analyzed.

RESULTSThe median age of 37 patients with PCNSL at diagnosis was 57 years（range 17 to 78 years） with a male to female ratio of 2.7:1. The symptoms or signs of elevated intracranial pressure and cognitive dysfunction were the most common initial manifestations. The median time period between onset of symptoms and diagnosis was 1.5 months. The majority of lesions were located in the cerebral hemisphere. At a median follow-up of 50 months, the median overall survival for all treated patients was 36.0 months （95% CI 21.7-50.3 months）, with a progression-free survival of 18.0 months（95% CI 9.1-26.9 months）. The 3-year cumulative survival rate was 46.9%. Compared to chemotherapy alone, combined-modality regimens which did not improve outcome were associated with a greater risk of neurotoxicity.

CONCLUSIONThe prognosis of PCNSL was still poor, and the optimal treatment strategy for these patients should be explored in the future clinical trials.

Adolescent ; Adult ; Aged ; Beijing ; Central Nervous System Neoplasms ; diagnosis ; pathology ; Disease-Free Survival ; Female ; Humans ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

Objective To investigate the clinical effects of two minimally invasive surgical treatments for billary acute pancretitis.Method In this study,63 patients with billary acute pancretitis were prospectively divided into two groups.Patients in group A received laparoscopic cholecystectomy (LC) and laparoscopic transcyctic common bile duct exploration (LTCBDE) within 72 hours of onset,group B underwent endoscopic nasobiliary drainage (ENBD).The two groups were evaluated by blood amylase and urine amylase,alanine aminotransferase,aspartate aminotransferase on postoperative day 1,3,5,local complication and the recurrence rate within 6 months.Result Blood amylase was lower in group A than that in group B (P =0.04) on postoperative day 1.There were no significant differences in amylase,aminotransferase of two groups on postoperative day 3,5 (all P ＞ 0.05).The incidences of local complications and pancreatic necrosis infection were 2.7％,7.7％ respectively(P =0.13) ; the incidences of pancreatic pseudocyst were 5.4％,7.7％ (P =0.42) ; the recurrence rate within 6 months were 2.7％ and 19.2％ respectively(P =0.006).Conclusions The clinical curative effects of early LC and LTCBDE or ENBD on billary acute pancretitis showed no significant differences,but the recurrence rate of acute pancretitis within 6 months revealed that early LC and LTCBDE may be more effective.

Objective To investigate the effect of 5-hydroxytryptamine serotonin receptor-1A (5-HT1 A) agonists on micturition dysfunction in rats with chronic spinal cord injury (SCI).Methods Female SD rats weighing 175 -200 g were used.Seven of the rats were modified for a spinal cord injury model (transsection at T10).Eight weeks later,control rats and SCI rats were tested.Rats were anesthetized with urethane ( 1.3 g/kg ).A polyethylene (PE) -50 catheter was placed in the left jugular vein for intravenous drug administration.A PE-90 catheter was inserted through the bladder dome,and the other end of the bladder catheter was connected to a syringe pump for continuous infusion of saline and to a pressure transducer for intravesical pressure monitor.Dose-response curves for 8-OH-DPAT were followed by the WAY-100635 test.The capacity,residual volume,micturition volume,and EUS-EMG were measured.Results With an increasing dose of 8-OH-DPAT,the capacity of the bladder decreased from 33.2 ± 8.3 ml to 22.8 ± 2.4 ml.The micturition volume was increased from 0.14 ± 0.08 ml to 0.38 ± 0.09 ml.The residual volume decreased from 3.68 ± 1.36 ml to 1.84 ± 0.21 ml,and peak intravesical pressure changed from 27.1 ± 3.6 mm Hg to 22.8 ± 2.4 mm Hg.Control rats showed little significant change in the cystometric variable.Effects of 8-OH-DPAT were reversed by WAY-100635.That 8-OH-DPAT induced phasic relaxation occured in spinal cord-injured rats but the control group showed no significant change.ConclusionsThe 5-HTIA/7 receptor agonist 8-OH-DPAT may induce periodic EUS relaxation during voiding in urethane-anesthetized chronic spinal cordinjured rats.And this could result in an increase in micturition volume,a decrease in bladder capacity,and thus an increase in voiding efficiency.