Volume 105 · Issue 09 · 2025

Degenerative spinal deformity (DSD) refers to a disease in which the spine undergoes degenerative changes due to aging, gradually developing into coronal/sagittal spinal deformities. If the patient has persistent pain, progressive kyphosis, or impaired neurological function, orthopedic surgery should be considered to relieve nerve compression and restore the balance of the coronal and sagittal spine. However, the development of previous surgical plans mainly relied on spinal imaging parameters, while neglecting the importance of bone and skeletal muscle degeneration, resulting in mechanical complications even with good correction of sagittal morphology. Therefore, it is necessary to pay attention to the comprehensive evaluation of osteoporosis and paraspinal muscle degeneration in clinical practice, accurately assess the sagittal balance of the patient′s spine and predict the risk of postoperative complications, and adopt corresponding surgical strategies and preventive measures to reduce the incidence of internal fixation failure.

The importance of the ratio of pulse oxygen saturation to fraction of inspired oxygen (S/F) has been increasingly highlighted. In recent years, multiple clinical studies have confirmed the diagnostic and prognostic value of S/F and its derived parameters in patients with acute respiratory distress syndrome (ARDS). Hence, the 2023 new global definition of ARDS recommended using S/F as both diagnostic criteria and for severity stratification of ARDS. However, there is currently no established Chinese nomenclature for S/F. Considering its inherent meaning, differentiation, and clinical utility, the authors propose the Chinese nomenclature"pulse oxygen index"for S/F. Establishing this nomenclature will facilitate the promotion and application of S/F in academic communication and clinical practice, as well as the new global definition of ARDS.

Late-onset hypogonadism (LOH) refers to the decline in serum testosterone levels in middle-aged and elderly men with aging, causing symptoms such as decreased libido, erectile dysfunction, and reduced physical and mental activity, as well as metabolic abnormalities such as abdominal obesity, diabetes and myopenia. The diagnosis and treatment of LOH are closely related to the health and quality of life of middle-aged and elderly men. It has been a focus of medical attention. The clinical data over the past decade provide substantial evidence for these issues. Consequently, Growth and Development and Gonadal Diseases Committee of Chinese Aging Well Association organized 52 experts in endocrinology, andrology, urology, geriatrics, traditional Chinese medicine, nutrition, laboratory medicine, cardiology, neurology, psychiatrics, hematology, orthopedics, basic medicine, pharmacology and othe fields. Based on the Oxford Center for Evidence-Based Medicine′s level of clinical evidence and recommendation levels, the guidelines have been developed around the diagnosis of LOH, the risks and benefits of testosterone supplementation. Combined with the evaluation opinions of Delphi method, 17 recommendations were finally formulated to help clinicians cope with LOH.

Postoperative delirium is a common complication of deep brain stimulation in Parkinson′s disease, which affects the short-term and long-term prognosis of Parkinson′s disease patients.With the continuous development of deep brain stimulation for Parkinson′s disease in China, the prevention and treatment of postoperative delirium has also received increasing attention. To promote standardization and normalization of the prevention and treatment of delirium after deep brain stimulation for Parkinson′s disease, reduce the occurrence of delirium after deep brain stimulation for Parkinson′s disease in China, and achieve better prognosis. The Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association, Functional Neurosurgery Group of Chinese Congress of Neurological Surgeons and Chinese Neuromodulation Society organized experts with experience in deep brain stimulation for Parkinson′s disease to write this consensus. Based on a systematic review and summary of domestic and international literature and clinical evidence related to delirium following deep brain stimulation for Parkinson′s disease, this expert consensus was developed. It discusses six aspects: epidemiology, pathogenesis, risk factors, diagnosis, treatment, and prevention, and forms 14 recommended suggestions, providing reference and guidance for clinical diagnosis, treatment, and prevention of delirium after deep brain stimulation surgery in Parkinson′s disease.

To explore the risk factors associated with coronal imbalance following posterior short-level fixation and fusion surgery for patients with degenerative lumbar scoliosis (DLS).

A retrospective analysis was conducted on the clinical data of patients who underwent posterior short-level fixation and fusion for the treatment of DLS at Shanghai Changzheng Hospital from January 2018 to December 2022. The postoperative follow-up period was 12 months. Based on the postoperative distance between the C₇ plumb line and the central sacral vertical line (C₇-CSVL), patients were divided into an imbalance group (C₇-CSVL ≥20 mm) and a balance group (C₇-CSVL <20 mm). Demographics, radiographic and surgical factors were compared between the two groups. The cutoff values for postoperative coronal imbalance in patients with ipsilateral and contralateral DLS were determined by analyzing the main curve sizes of the thoracolumbar spine, C₇-CSVL offset, apex vertebra offset, and lumbosacral base curve size using receiver operating characteristic (ROC) curves. A logistic regression model was performed to detect the risk factors for postoperative coronal imbalance following short-level fixation and fusion in patients with DLS.

A total of 234 patients [62 males, 172 females, with a mean age of (66.90±6.93) years] who underwent short-level fixation and fusion surgery for DLS were included in this study. Of these, 44 patients progressed postoperative coronal imbalance [12 males, 32 females, with an average age of (68.50±7.06) years], 190 patients did not endure postoperative coronal imbalance [50 males, 140 females, with a mean age of (66.54±6.86) years]. There were differences between the coronal balance group and the coronal imbalance group in preoperative C₇-CSVL [(1.63±1.36)cm vs (2.51±1.66)cm], lowest instrumented vertebra(LIV) tilt (4.84°±4.65° vs 6.81°±4.94°), LIV rotation [Nash-moe grade one, 32 cases (16.84%) vs 12 cases (28.57%)], Cobb-angle of the thoracolumbar main curve (19.15°±6.85° vs 26.74°±8.02°), Cobb-angle of the fractional curve (9.64°±5.27° vs 13.83°±5.01°), apical vertebral translation [(1.95±0.92) cm vs (3.11±0.96) cm], the rigidity of the thoracolumbar major curve [62 cases (32.6%) vs 24 cases (54.5%)] (all P<0.05). The categorical variables based on the ROC curve cut-off values [the thoracolumbar main curve pattern, the C₇-CSVL pattern, the apical vertebra translation (AVT) pattern, and the fractional curve pattern], as well as the correction pattern of key curve, showed differences between the two groups with all P<0.05; subsequently, all variables with P<0.05 were included in a forward multivariate logistic regression analysis, the results revealed that the higher thoracolumbar Cobb-angle pattern (OR=11.98, 95%CI: 3.680-39.000), the higher C₇-CSVL pattern (OR=6.603, 95%CI: 2.324-18.759), the higher AVT pattern (OR=4.362, 95%CI: 1.498-12.700), the higher fractional curve pattern (OR=3.756, 95%CI: 1.191-11.847), and the inferior correction pattern of key curve (OR=20.000, 95%CI: 6.211-66.667) were the risk factors associated with postoperative coronal imbalance after short-level fixation and fusion for the DLS.

The higher thoracolumbar Cobb-angle pattern, the higher C₇-CSVL pattern, the higher AVT pattern, the higher fractional curve pattern and the inferior correction pattern of key curve were the risk factors associated with postoperative coronal imbalance after short-level fixation and fusion for the DLS.

To investigate the incidence of adjacent segment degeneration (ASD) following extreme lateral interbody fusion (XLIF) and identify risk factors for early ASD after XLIF.

A retrospective study was conducted, including patients diagnosed with lumbar spinal stenosis who underwent XLIF at Tianjin Hospital between July 2019 and December 2022 and were followed-up for at least one year. Preoperative and final follow-up lumbar MRI and X-ray examination were performed for all patients to evaluate the degeneration status of adjacent segments. According to the occurrence of ASD at the last follow-up, the patients were divided into non-ASD group and ASD group. Age, gender, age, body mass index (BMI), American Society of Anesthesiologists (ASA) grade of anesthesia, follow-up time, length of fusion, time of operation, blood loss, hospital stay, pre-operation and follow-up clinical effects scores, pre-operation and follow-up sagittal parameters, central canal stenosis grades of adjacent segment and Pfirrmann grades were analyzed and compared between the two groups. Variables with a P-value less than 0.1 in the intergroup comparisons were included in a multivariate regression analysis to identify the risk factors for early onset of ASD following XLIF.

A total of 68 patients were included in this study, including 20 males and 48 females with a mean age of (60.0±6.9) years. At the last follow-up, 20 cases (28.9%) developed ASD and were included in the ASD group, while the remaining 48 cases were included in the non-ASD group. There was no statistically significant differences in the demographic characteristics between the two groups of patients (all P>0.05), indicating comparability. Compared with those in ASD group, the preoperative lumbar lordosis angle (LL) (46.5°±12.0° vs 32.3°±15.9°, P<0.01) and the sacral slope angle (SS) (36.6°±7.1° vs 29.5°±12.6°, P=0.022) in the non-ASD group were both greater, the mismatch rate of the preoperative pelvic incidence-lumbar lordosis angle (PI-LL) was lower [25.0% (12/48) vs 60.0% (12/20), P=0.033], and the preoperative morphologic grading of adjacent segmental vertebral canals was better (grades 0/1 were 33/15 and 6/14 cases, respectively, P<0.01). Compared to preoperative values, both groups showed significant improvements in the Oswestry disability index (ODI) score, VAS (back), and VAS (leg) at the last follow-up (all P<0.01). However, there were no statistically significant differences in the preoperative clinical function scores and the clinical function improvement rates at the last follow-up between the two groups (all P>0.05). Multivariate analysis showed that the preoperative central canal stenosis grade 1 of adjacent segment was a risk factor for ASD after early XLIF (OR=13.00, 95%CI: 2.51-67.04, P<0.01).

About 28.9% of patients may experience ASD one year after XLIF surgery, preoperative adjacent segment central canal stenosis grade 1 is a risk factor for early postoperative ASD after XLIF surgery.

To evaluate the impacts of perioperative nutritional screening and management on postoperative infectious complications in geriatric degenerative spinal deformity surgery.

This retrospective cohort study included elderly patients with degenerative spinal deformity who underwent open posterior thoracolumbar fusion at Xuanwu Hospital, Capital Medical University, from February 2018 to October 2022. A total of 139 patients with malnutrition or at risk of malnutrition, as identified using the Mini Nutritional Assessment-Short Form (MNA-SF), were included. The patients were divided into an intervention group and a control group based on whether they received standardized perioperative nutritional management. Postoperative adverse events, laboratory parameters, and transfusion rates of albumin and blood products were compared between the two groups.

Among the 139 patients, 96 were male, and 43 were female, with an average age of (70.72±8.21) years. The control group included 70 patients, while the intervention group included 69 patients. There were no significant differences in preoperative baseline or intraoperative data between the two groups (all P>0.05). The incidence of postoperative infection-related complications was significantly lower in the intervention group compared to the control group [10.1%(7/69) vs 22.9%(16/70), P=0.044]. On postoperative day 3, the levels of serum albumin and prognostic nutritional index (PNI) in the intervention group were higher [(32.40±3.58) vs (30.72±3.17) g/L, 37.85±4.23 vs 35.87±4.57, both P<0.05]. The albumin transfusion rate was lower in the intervention group [31.9%(22/69) vs 48.6%(34/70), P=0.045].

Perioperative nutritional screening and management are safe and effective for elderly patients undergoing open posterior thoracolumbar fusion for degenerative spinal deformity, these measures reduce the incidence of infection-related complications in patients with malnutrition or at risk of malnutrition.

To analyze the application value of different dimensional olfactory tests in different dimensions of olfactory function in patients with Parkinson′s disease (PD), and to explore the clinical characteristics of different olfactory dimensions in PD patients with and without rapid eye movement sleep behavior disorder (RBD) and the correlation between different olfactory dimensions and RBD.

A total of 73 patients who visited the Department of Neurology, the First Affiliated Hospital of Anhui Medical University from May 2023 to June 2024 were retrospectively included. According to the Rapid Eye Movement Sleep Behavior Disorder Screening Scale (RBDSQ), PD patients were divided into 25 cases of PD with RBD (PD-RBD+) and 48 cases of PD without RBD (PD-RBD-). A total of 39 family members of patients in the same period were recruited as healthy controls. General data of all subjects were collected, and their motor symptoms, emotions, sleep status and cognitive function were evaluated. Olfactory function was evaluated by olfactory threshold, discrimination and recognition olfactory tests in three dimensions. The receiver operating characteristic (ROC) curve was used to analyze the ability of the three olfactory tests to distinguish PD patients from healthy controls.. Spearman correlation analysis was used to evaluate the correlation between different olfactory dimensions and motor and non-motor symptoms.

There were 39 males and 34 females in PD patients, aged (63±7) years old; there were 16 males and 23 females in healthy controls, aged (64±10) years old. The olfactory threshold [(6.92±4.20) vs (9.36±4.33), P=0.005], discrimination [(7.44±3.05) vs (10.44±3.04), P<0.001] and recognition [(15.38±5.80) vs (22.72±5.09), P<0.001] scores of PD patients were lower than those of healthy controls. ROC curve analysis of different olfactory tests to distinguish PD patients from healthy controls showed that among the three olfactory tests, the area under the curve (AUC) of the olfactory threshold test was 0.671 (95%CI: 0.568-0.773, P=0.003), the AUC of the olfactory discrimination test was 0.750 (95%CI: 0.655-0.844, P<0.001), and the AUC of the olfactory identification test was 0.829 (95%CI: 0.751-0.906, P<0.001). The olfactory recognition of the PD-RBD+group [(13.36±5.77) vs (16.44±5.58), P=0.030] was significantly lower than that of the PD-RBD-group. There were no significant differences in olfactory threshold [(6.58±3.49) vs (6.69±4.04), P=0.906] and discrimination [(7.00±3.39) vs (7.00±3.39), P=0.380] between the PD-RBD+group and the PD-RBD-group. Olfactory threshold was positively correlated with Montreal Cognitive Assessment (MoCA) (r=0.236, P=0.045); olfactory discrimination was negatively correlated with Pittsburgh Sleepiness Scale (PSQI) (r=-0.347, P=0.003); olfactory identification was positively correlated with MoCA (r=0.246, P=0.036), and negatively correlated with RBDSQ (r=-0.254, P=0.030) and PSQI (r=-0.335, P=0.004).

The olfactory threshold, discrimination and identification abilities of PD patients are impaired. Olfactory identification test was more capable of distinguishing PD patients from healthy controls. PD-RBD+patients have worse olfactory identification ability than PD-RBD-patients. There is a significant correlation between olfactory identification and RBDSQ.

To investigate the clinical characteristics, prognosis of different treatments and influencing factors of hepatic myelopathy (HM).

The clinical data of 134 HM patients treated in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2023 were retrospectively analyzed. The age of the patients was (53.6±9.0) years old, with 114 males and 20 females. According to different treatment methods, they were divided into drug group (n=95), intervention group (n=23) and liver transplantation group (n=16); according to the different types of shunt, they were divided into spontaneous shunt group (n=84) and manual shunt group (n=50). The clinical characteristics and complications of patients in different groups were analyzed. Kaplan-Meier method was used to draw the survival curve, and log-rank test was used to compare the difference of the overall survival rate between the groups. Multivariate Cox regression model was used to analyze the related factors affecting the survival of HM patients.

Four patients started with unilateral lower limb involvement and gradually progressed to involve both lower limbs, while the remaining 130 patients had simultaneous involvement of both lower limbs, including 9 cases with additional involvement of both upper limbs. There were statistically significant differences in the proportion of liver cancer in the drug group, intervention group and liver transplantation group [21.1% (20/95) vs 4.8%(1/23) vs 0,P=0.021], while there were no significant differences in gender, liver and kidney function and other indicators (all P>0.05). In the drug group, the follow-up time was 26 (18, 37) months. One case improved, 7 cases were stable, and 87 cases were progressive. In the intervention group, the follow-up time was 22 (14, 32) months. Among the 11 patients with stent flow restriction, 1 case improved, 2 cases were stable, and 8 cases were progressive. In 12 cases of spontaneous shunt embolization, 1 case improved, 1 case was stable, and 10 cases had no significant change. In the liver transplantation group, the follow-up time was 29 (13, 45) months. One case died 1 month after operation, 9 cases improved, 4 cases were stable, and 2 cases progressed. Compared to the drug group and the intervention group, the liver transplantation group had the lowest incidence of hepatic encephalopathy [0 vs 87 (91.6%) vs 16 (69.6%)] and the highest disease control rate [13 (81.3%)vs 8 (8.4%) vs 5 (21.7%)],all P<0.001. Log-rank test results showed that there was no significant difference in survival rate between drug group, intervention group and liver transplantation group (67.4% vs 69.6% vs 68.8%, P=0.849). There was no significant difference in survival rate between spontaneous shunt group and manual shunt group (68.0% vs 67.9%, P=0.676). The estimated 1, 3, and 5 years survival rates for HM patients were 88.8%, 65.1%, and 46.5%, respectively. Multivariate Cox regression analysis showed that Child-Pugh C class (with Child-Pugh A-B class as the reference,HR=3.39, 95%CI: 1.57-7.32) and HM 3-4 class (with HM 1-2 class as the reference, HR=2.65, 95%CI: 1.27-5.53) were risk factors that affect the survival of HM patients (assigned death as 1, survival as 0).

HM usually occurs in middle-aged male patients with liver cirrhosis,most commonly affecting both lower limbs. Liver transplantation can control the disease progression to a certain extent. Child-Pugh Class C and HM 3-4 class are risk factors for the prognosis of HM patients.

To investigate the efficacy of chemo-free regimen in treatment of patients with treatment-naive Philadelphia chromosome positive mixed phenotype acute leukemia(Ph⁺MPAL). The clinical data of patients with newly treated Ph⁺MPAL who received venetoclax (VEN), azacytidine (AZA) and tyrosine kinase inhibitors (TKIs) in the First Affiliated Hospital of Soochow University from July 1, 2021 to October 31, 2023 were retrospectively included. The last follow-up date was December 1, 2024. The complete remission/complete remission with incomplete blood count recovery (CR/CRi), measurable residual disease (MRD), survival and safety were analyzed. A total of 6 patients were included, with 1 male and 5 females, aged 40 (25-52) years. The peripheral white blood count at diagnosis was 191.4 (13.6-344.0)×10⁹/L. All 6 patients had mixed expression of B lineage and myeloid lineage. Philadelphia chromosome was detected in 5 patients, and 3 of them had additional chromosomal abnormalities. All 6 patients achieved response after 1 cycle induction therapy, including 3 patients who achieved CR and 3 patients who achieved CRi. And all 6 patients attained bone marrow MRD negativity. After treatment of 1.5 (0.4-5.9) months, 6 patients achieved molecular remission (MMR). Tow patients experienced recurrence. Five patients received allogeneic hematopoietic stem cell transplantation. The follow-up time was 31.4 (13.1-40.6) months, and all 6 patients were in disease-free survival. Severe adverse events mainly included hematological toxicity and sepsis, and no treatment-related deaths occurred. The VEN+AZA+TKIs chemo-free regimen has good efficacy in treating newly diagnosed Ph⁺MPAL patients.

Overweight or obesity refers to a state of excessive fat deposition in the body, which has a high incidence among the elderly in China. This article reviews the status of weight management of overweight or obese elderly patients in China from three aspects: the prevalence of overweight or obesity in the elderly, the complexity of overweight or obesity in the elderly, and the existing methods of weight management in the elderly. In addition, there are many factors that affect the weight management of the elderly. Based on the health ecology model, this paper divides the possible influencing factors of the weight management of the elderly into five levels: personal traits, behavior and lifestyle, interpersonal relationship network, work and living conditions, and policy and social environment, and elaborates from each level.