Volume 105 · Issue 01 · 2025

Osteoporotic fracture is a special type of pathological fracture characterized by high morbidity, high disability, high mortality and low diagnosis and treatment rate. Currently, the main problem with clinical intervention for osteoporotic fractures is the lack of proper understanding by doctors (especially orthopedic surgeons) of the pathologic changes in the disease itself. Aggressive surgical treatment is very important, but it cannot fundamentally solve the serious consequences of delayed healing of osteoporotic fractures and the occurrence of re-fractures. Early treatment by anabolic agents can effectively shorten the fracture healing time, prevent postoperative implants displacement, and reduce the occurrence of re-fractures. This article emphasizes the importance of actively facing the imminent risk of osteoporotic fracture; correctly recognizing the pathological changes of osteoporotic fracture; and comprehensively paying attention to the early intervention of osteoporotic fracture.

When diagnosing and treating primary osteoporosis and various calcium-phosphorus metabolism disorders, we must pay attention to some key points: diagnosing primary osteoporosis only after excluding secondary factors; understanding the features of various calcium supplements and anti-osteoporosis drugs; and selecting appropriate medications; foreseeing the changes in calcium-phosphorus metabolism after using anti-osteoporosis drugs. This article delves into the aforementioned key issues in the diagnosis and treatment of primary osteoporosis and various disorders of calcium and phosphorus metabolism. It emphasizes the pathophysiological mechanisms, diagnostic criteria, rational drug use, and precautions for primary osteoporosis and various disorders of calcium and phosphorus metabolism, aiming to enhance the level of disease diagnosis and treatment through a holistic thinking.

After the maturity period, human bones will experience aging changes such as decreased bone mass, abnormal trabecular structure and increased bone fragility. In recent years, with the development of aging research, research on bone aging markers has increased. Primary osteoporosis, which is related to aging, also belongs to the category of bone aging. This article will review the knowledge related to aging, bone aging markers and osteoporosis to explain the interrelationships between them, and combine some research progress to propose to learn from the bone aging markers research in the field of osteoporosis research. Combining bone aging markers and osteoporosis, the discussion around aging, bone aging, and osteoporosis will provide new ideas for further research on osteoporosis.

With the population aging, the prevalence of osteoporosis is rapidly increasing, which has become serious public health problem. At present, there is a severe shortage of effective anti-osteoporotic drugs in China, making it difficult to control the growing trend of osteoporosis. The key pathological mechanism of osteoporosis is bone homeostasis imbalance. It is necessary to continuously study the bone cell biology, important pathway regulating bone homeostasis, and its regulatory network constituted by bone-muscle-vessel-immune system-nerve-gut microbiota, in order to identify key targets for new drug, and develop more novel effective drugs to increase bone mineral density, improve bone strength, reduce fracture risk and protect bone health.

Gastrointestinal dysfunction is a common clinical disease. Due to abnormal gastrointestinal digestive and absorption functions, nutrients, water, and electrolytes cannot be absorbed properly, and therefore, scientific and reasonable nutritional intervention is needed. In order to further standardize medical nutrition treatment of patients with gastrointestinal dysfunction, the Chinese Society of Parenteral and Enteral Nutrition (CSPEN) organized experts and scholars in related fields in China to elaborate on the following topics based on current evidence-based medical evidence: the standard process of medical nutrition treatment for patients with gastrointestinal dysfunction, the time and mode of enteral and parenteral nutrition application, and the nutritional intervention mode for patients with gastrointestinal dysfunction in special disease state. Finally, 29 questions and 58 recommendations were formed to provide reference for the standardized application of medical nutrition therapy for patients with gastrointestinal dysfunction.

To analyze the influence of cervical range of motion on the preferable sagittal vertical axis in ankylosis spondylitis (AS)-related thoracolumbar kyphosis following single-level pedicle subtraction osteotomy (PSO).

The clinical data of sixty-five AS patients who underwent single-level PSO from February 2012 to November 2018 in the Drum Tower Hospital of Nanjing University Medical School were retrospectively reviewed. Of the patients, 59 were males and 6 were females with a mean age of (34.2±9.2) years. Radiographic parameters including cervical range of motion (CROM), global kyphosis (GK), C₇ sagittal vertical axis (C₇SVA), thoracic kyphosis (TK), lumbar lordosis (LL), spinosacral angle (SSA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS) and chin-brow vertical angle (CBVA) were measured preoperatively, 10 days after surgery and at the last follow-up. Oswestry disability index (ODI) and visual analogue scale (VAS) of pain were recorded for all patients preoperatively and at the final follow-up. Based on preoperative CROM, patients were divided into cervical flexible group (CROM>20°, group Ⅰ) and cervical ankylosis group (CROM≤20°, group Ⅱ). The patients were further divided into four groups according to the C₇SVA at the last follow-up: group ⅠA, CROM>20°, C₇SVA<50 mm; group ⅠB, CROM>20°, C₇SVA≥50 mm; group ⅡA, CROM≤20°, C₇SVA<50 mm; and group ⅡB, CROM≤20°, C₇SVA≥50 mm. Differences among baseline data, clinical efficacy and radiographic parameters between different groups were compared, and the optimal sagittal alignment balance after PSO in AS patients with thoracolumbar kyphosis under different CROM was explored.

All patients were followed-up for (31.0±10.2) months. A total of 65 patients were included, with 31 cases in group Ⅰ, comprising 16 cases in group ⅠA and 15 cases in group ⅠB, and 34 cases in group Ⅱ, with 18 cases in group ⅡA and 16 cases in group ⅡB. There was no significant difference in the age, gender and level of osteotomy between groups ⅠA and ⅠB and groups ⅡA and ⅡB (all P>0.05). Comparing between ⅠA and ⅠB groups, no significant difference was observed in radiographic parameters(all P>0.05), excepted for C₇SVA [(14.3±27.6) mm vs (80.3±24.1) mm, P<0.001]. At the last follow-up, ODI and VAS scores were significantly lower in group ⅠA than in group ⅠB [(7.1±6.2) points vs (13.3±7.0) points and (0.9±0.9) points vs (1.9±1.3) points] (both P<0.05). Compared with group ⅡA, PT was significantly greater in group ⅡB before the operation, 10 days after surgery and at the final follow-up (all P<0.05); the SSA and CBVA were also significantly greater in group ⅡB at the last follow-up (both P<0.05). At the last follow-up, the quality-of-life scores were better in group ⅡB than those in group ⅡA [ODI: (12.6±10.7) points vs (22.9±12.5) points; VAS: (1.2±1.6) points vs (2.8±2.0) points] (both P<0.05). The complications in group ⅠA included 1 case of rod fracture, while 2 cases of osteotomized vertebral subluxation and 2 cases of intraoperative dural tear occurred in group ⅠB. The complications in group ⅡA included 1 case of rod fracture and 1 case of screw malposition, and 2 cases of postoperative postural brachial palsy and 2 cases of osteotomized vertebral subluxation occurred in group ⅡB.

The impact of CROM should be fully evaluated when developing a sagittal vertical axis reconstruction protocol for patients with AS thoracolumbar kyphosis. C₇SVA<50 mm is crucial to acquire ideal clinical outcome in AS with flexible cervical spine. However, in AS with cervical ankylosis, C₇SVA≥50 mm is a preferable choice.

To explore the quantitative value of the T2mapping sequence in evaluating the early glenohumeral joint cartilage injury.

A total of 92 patients with shoulder joint pain who underwent routine sequence and T2mapping sequence scanning in General Hospital of Ningxia Medical University from March 2023 to March 2024 were retrospectively collected as a case group. The patients were classified into tendinitis group, partial tear group and full tear group according to the degree of tendon injury. Another 25 healthy subjects of the same age were selected as the control group. Two physicians divided articular cartilage into upper, middle, and lower subregions in the T2mapping sequence and measured T2 values in each subregion. The intra-observer correlation coefficient (ICC) was employed to evaluate the inter-observer and intra-observer consistency. Independent sample t test was utilized to compare the T2 values of different subregions between the two groups. One-way analysis of variance was used to compare the T2 values of different subregions among the groups, and pairwise comparison was conducted using the Bonferroni test. Spearman correlation analysis was conducted to analyze the correlation between the T2 values in different subregions of the articular cartilage and the injury degree of the supraspinatus tendon.

There were 44 males and 48 females in the case group, with an age range of 38 to 60 (51.4±5.8) years; there were 32 cases in the tendonitis group, 33 cases in the partial tear group, and 27 cases in the full tear group. There were 11 males and 14 females in the control group, with an age range of 40 to 54 (49.1±3.9) years. The T2 values of the upper, middle, and lower subregions of the glenohumeral articular cartilage in the case group were (37.8±4.9) ms, (39.1±5.9) ms, and (42.1±5.1) ms, respectively, all of which were significantly higher than those in the control group [(29.4±3.3) ms, (31.7±5.0) ms, and (36.3±6.2) ms, respectively] (all P<0.001). Within the supraspinatus tendon full tear group, the T2 values were (40.2±5.7) ms, (41.2±5.4) ms, and (43.4±4.1) ms, respectively, all of which exceeded those in the partial tear group [(38.2±4.3) ms, (38.9±6.5) ms, (43.1±5.1) ms, respectively], which were also higher than those in the tendonitis group [(35.0±3.2) ms, (37.7±5.0) ms, (40.1±4.5) ms, respectively] and the control group [(29.4±3.3) ms, (31.7±5.0) ms, (36.3±6.2) ms, respectively] (all P<0.001). Statistically significant differences in T2 values were observed between different subregions of articular cartilage in both the tendonitis and partial tear groups (all P<0.05); however, no significant differences were found among the upper, middle, and lower subregions in the full tear group (P=0.140). Furthermore, the T2 values in the upper, middle, and lower subregions of articular cartilage exhibited a positive correlation with the degree of supraspinatus muscle injury (r=0.693, 0.515, and 0.449, respectively, all P<0.001).

The T2mapping sequence can quantitatively assess the degree of articular cartilage damage, and the degree of supraspinatus tendon damage and glenohumeral joint cartilage damage is positively correlated.

To analyze the influencing factors of toe-amputation in diabetic foot patients and construct a predictive model.

The clinical data of 437 diabetic foot patients who were hospitalized in Air Force Medical Center from January 2017 to January 2024 were retrospectively analyzed, including 327 males and 110 females, with a median age[M(Q₁,Q₃)] of 63.0 (55.0, 69.0) years.The patients were divided into amputation group(n=344) and non-amputation group (n=93) according to whether toe-amputation surgery was performed within 3 months. The differences of clinical indicators between the two groups were analyzed.The patients were randomly divided into the training set and the validation set in a 7∶3 ratio using R 4.2. Multivariate logistic regression model was used to screen the influencing factors of toe-amputation in diabetic foot patients, and the nomogram of toe amputation prediction model was drawn. The predictive ability, accuracy and clinical applicability of the model were assessed using the area under the curve (AUC) of the receiver operating, calibration curve and decision curve analysis(DCA), respectively.

The patients in the toe amputation group had higher proportions of diabetes duration, lower extremity arterial disease (LEAD), white blood cell count, total bilirubin, fibrinogen, erythrocyte sedimentation rate, C-reactive protein level, and positive bacterial cultures in wound secretions compared to those in the non-toe amputation group. Conversely, the levels of high-density lipoprotein cholesterol, blood uric acid, the internal diameter and blood flow of dorsalis pedis artery were lower in the toe amputation group than those in the non-toe amputation group (all P<0.05). Multivariate logistic regression model analysis indicated that LEAD (OR=4.19,95%CI:1.88-9.34), blood uric acid (OR=0.99,95%CI:0.99-0.99), fibrinogen (OR=1.86,95%CI:1.19-2.91), and wound secretion culture positive for staphylococcus aureus (OR=5.77,95%CI:2.72-12.25) or non-staphylococcus aureus infection (OR=4.74,95%CI:1.43-15.77), were influencing factors of diabetic foot toe-amputations (all P<0.05). The prediction model of toe amputation in patients with diabetes foot was established using the above parameters. In the training set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.86(95%CI:0.80-0.91)、90% and 72%, respectively. In the validation set, the AUC, sensitivity and specificity of the prediction model for predicting toe amputation in diabetic foot patients were 0.85(95%CI:0.78-0.92), 77% and 71%, respectively. The calibration curves of the training set and the validation set indicates that the model has good calibration ability. The DCA curve of the training set and the validation set suggests that the predictive model has good clinical applicability.

LEAD, blood uric acid, fibrinogen, and positive bacterial culture of wound secretion are the influencing factors of diabetes toe amputation. The nomogram model including the above factors can evaluate the risk of diabetic foot amputation more intuitively.

To explore the impact of gonadotropin-releasing hormone agonist (GnRH-a) on the pregnancy outcomes in frozen-thawed embryo transfer cycles for patients with recurrent implantation failure (RIF) complicated by chronic endometriti (CE).

A total of 138 patients with RIF combined with CE who underwent in vitro fertilization/intracytoplamic sperm injection treatment-embryo transfer in the Department of Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2020 to December 2023 were retrospectively included. According to the endometrial preparation protocol, they were divided into two groups: the pituitary downregulation group (n=59) and the artificial cycle group (n=79). The baseline data and pregnancy outcomes of the two groups were compared. Multivariate binary logistic regression analysis was conducted to assess the influencing factors of clinical pregnancy in patients with RIF complicated by CE.

The age of the artificial cycle group [M(Q₁, Q₃)] was 33(31, 37) years; the age of pituitary downregulation was 33(30, 36) years. No statistically significant differences were found in the baseline data of the patients, such as age, the type of infertility, duration of infertility, body mass index (BMI), anti-Müllerian hormone (AMH), and baseline endocrine parameters(all P>0.05). For patients with RIF combined with CE, compared to the artificial cycle group, the pituitary downregulation group had a higher number of previous failed attempts [M(Q₁, Q₃), 3(3, 4) vs 4(3, 4) ], and a higher clinical pregnancy rate[42.37% (25/59) vs 24.05% (19/79)](P<0.05). GnRH-a pretreatment in a pituitary downregulation cycle is a factor influencing clinical pregnancy in patients with RIF combined with CE (OR=2.229, 95%CI: 1.015-4.896, P<0.05).

GnRH-a is effective in improving the clinical pregnancy rate of patients with RIF combined with CE.

This article reports a case of a 40-year-old female patient who developed headache, runny nose, and hyposmell in 2014. It was found that the nasal cavity and right anterior cranial fossa occupied space. Olfactory neuroblastoma was diagnosed pathologically after two craniotomies. After radiotherapy and chemotherapy, there was recurrence and metastasis. Eight years after the operation, rounded face, weight gain, purple skin lines and limb weakness gradually appeared. The examination showed that the blood cortisol rhythm disappeared, the classical low-dose dexamethasone test was not inhibited, and the adrenocorticotropic hormone (ACTH) was significantly increased, which confirmed the diagnosis of ACTH-dependent Cushing syndrome. Surgical pathological ACTH staining was positive, and ectopic ACTH syndrome was considered to be caused by olfactory neuroblastoma. After ketoconazole was given to control hypercortisolemia, 5 courses of albumin paclitaxel + cisplatin + anlotinib chemotherapy were performed. The cortisol and ACTH levels of the patient were controlled, the lesions were reduced compared with before, and the symptoms improved.

The male patient was admitted to Xuanwu Hospital in June 2024 mainly because of "dizziness with unstable gait and unclear speech for 1 1/2 years". Physical examination revealed postural hypotension, cerebellar ataxia, palatal tremor, gazing nystagmus, cerebellar atrophy, hypertrophy and degeneration of the lower olive nucleus, and decreased α synuclein in cerebrospinal fluid. He was diagnosed as sporadic progressive ataxia with palatal tremor and idiopathic hypertrophic inferior olive nucleus degeneration. After symptomatic treatment, the symptoms improved slightly, suggesting that abnormal α synuclein metabolism may be an important part of the pathogenesis of sporadic progressive ataxia with palatal tremor.

Spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD), is an inherited neurodegenerative disease characterized by cerebellar atrophy. Imaging studies have shown significant changes in the structure and function of multiple brain regions in SCA3 patients, which are not limited to the cerebellum but also extend to the cerebral cortex, and are closely related to the clinical symptoms of patients. By systematically retrieving and analyzing the magnetic resonance imaging (MRI) studies applied to SCA3 in recent years, this paper expounds the research progress of structural MRI (sMRI), diffusion tensor imaging (DTI), blood oxygen level-dependent functional MRI (BOLD-fMRI) and magnetic resonance spectroscopy (MRS) in the assessment of structural, functional and metabolic changes in clinical SCA3 patients and preclinical carriers, taking the cerebellum as the entry point, and emphasizes the value of MRI technology as disease diagnosis, progression monitoring and prognosis assessment, thus providing new theoretical basis and research direction for future research.

Heart failure is the terminal stage of various cardiovascular diseases, and patients with heart failure are often complicated with one or more comorbidities. The interaction between heart failure and comorbidities not only increases the complexity of the patient's condition, but also puts forward higher requirements for diagnosis and treatment. At present, a variety of biomarkers are used in the diagnosis, risk stratification and prognosis assessment of heart failure. However, the diagnostic thresholds and comprehensive applications of biomarkers are different when heart failure is complicated with different diseases. Full use of biomarkers can help optimize the management strategy of heart failure complications. The purpose of this paper is to summarize the current status and progress of these biomarkers in clinical application, and to explore their potential research directions and application prospects.

A 20-year-old male went to the Sports Medicine Department of the Second Affiliated Hospital of Xi'an Jiaotong University for "pain in the left shoulder with mobility restriction for 6 months and aggravation for 5 days". Six months before admission, the patient had left shoulder pain and discomfort without obvious trigger, which was not paid attention to. After strenuous exercise, the pain worsened, and oral non-steroidal anti-inflammatory drugs could not relieve it. Specialist physical examination showed that the left shoulder was obviously aggravated by anterior flexion and abduction, and Job sign was positive. MRI of the left shoulder showed a large number of free bodies in the shoulder joint, supraspinatus tendon tear (panel A, arrow), biceps longhead tendonitis (panel B, arrow). After admission, the left shoulder joint was explored and cleared under arthroscopy. During the operation, a large number of free bodies were filled in the glenohumeral joint cavity and internodular sulcus, and synovial congestion and edema were found. Articular cartilage degeneration, partial tear of the supraspinatus muscle, and tendinitis of the longhead tendon of the biceps brachii (Figures C, D). Then the anterior and posterior approaches were combined with full shoulder arthroscopic free body removal + synovectomy, and double row fixation of supraspinatus tendon under microscope was performed. Synovial osteochondromatosis was further confirmed by postoperative pathology. Rehabilitation exercises were performed after operation, and the shoulder pain was significantly reduced and the functional activity returned to normal after half a year of follow-up. Primary synovial osteochondromatosis is a rare benign soft tissue tumor involving a single joint, especially the knee. The disease is characterized by extensive inflammation of the synovial membrane of the joint, resulting in ectopic chondrocyte masses, which can be shed into a large number of free bodies. At present, the etiology of the disease is still unclear, and the inflamed synovium should be completely removed during operation to reduce the risk of recurrence. It is necessary to cooperate with rehabilitation exercise to actively recover joint mobility and muscle strength after operation. The disease is insensitive to radiotherapy and chemotherapy.