The preserved ratio impaired spirometry (PRISm) population is a high-risk group for chronic obstructive pulmonary disease, with different clinical characteristics and development trajectories, closely related to various systemic comorbidities and poor prognosis. Currently, researches on PRISm are still in the exploratory stage both domestically and internationally. Due to insufficient understanding of PRISm, such as the lack of standardized clinical classification, imaging evaluation, accurate diagnosis, and prevention and treatment strategies, it is easily overlooked or confused with other common respiratory and comorbidities, resulting in many patients missing the opportunity for early intervention. General practitioners should not only pay attention to the patients with PRISm, but also fully consider their clinical heterogeneity, mechanism relationship with comorbidities, early imaging features, and potential detection targets. They should also focus on community screening of PRISm population and management of comorbidities. This article provides an overview of the current status, challenges, and response strategies of PRISm.
Frailty is a geriatric syndrome associated with aging, which increases the risk of adverse events in the elderly. With the progress of population aging, the problem of frailty has been widely concerned. Previous studies mainly focused on frailty, mainly cross-sectional studies, and the studies on frailty trajectory (clustering of individuals with similar frailty over time) and its influencing factors were not clear, and the measures for early intervention of frailty through these studies were not clear. This paper summarized the latest clinical research progress of the risk factors of the frailty trajectory, in order to analyze the factors affecting the frailty trajectory from different angles, and provide new ideas for the comprehensive management of patients with frailty.
Nontraumatic osteonecrosis of the femoral head (NONFH) is a disabling orthopedic condition that predominantly affecting quality of life. Although total hip arthroplasty effectively treats end-stage lesions with significant collapse, for young and active patients, the ultimate goal is hip preservation—delaying or avoiding joint replacement and preserving native joint function. This remains a challenge in both clinical practice and basic research. In this context, a correct understanding of the clinical characteristics and pathological processes of NONFH, along with the appropriate selection of hip preservation strategies, is of great significance. Based on the current research of NONFH, this article first analyzes the correlation between its clinical features and pathological progression, proposing that the initial onset of hip pain indicates the occurrence of subchondral bone fracture or femoral head collapse. By examining the pathological course of "necrosis-repair-collapse-osteoarthritis" in NONFH, it identifies the critical role of cystic lesion in the repair and collapse processes. Targeting the microenvironment within cystic lesion to promote repair and prevent collapse is central to achieving satisfactory outcomes with non-surgical hip preservation. Secondly, the article summarizes methods for predicting collapse and introduces the concept of the anterior and lateral femoral head preservation angles based on the residual healthy bone in the anterolateral weight-bearing region. These angles enable precise assessment of collapse risk. Finally, it reviews the current application and challenges of non-surgical hip preservation, surgical hip preservation, and emerging technological therapies. It emphasizes that accurate diagnosis of NONFH, specifically predicting femoral head collapse or its arrest, is crucial for implementing precise and timely hip preservation. The choice of hip preservation strategy depends on whether the weight-bearing region of the femoral head is at risk of collapse. The anterior and lateral femoral head preservation angles not only predict collapse but also define the indications for hip preservation. Under well-defined indications, utilizing existing treatment modalities and integrating multi-technique, multi-modal approaches to develop individualized comprehensive hip preservation plans aimed at reconstructing mechanical conduction pathways represents a mature strategy in current clinical practice. With continued innovation in biotechnology and regenerative medicine, along with the optimization of treatment pathways through high-quality clinical research, the success rate of hip preservation is expected to further improve.
