Given the increasing prevalence of the high incidence of bone and joint diseases in the elderly population, and significantly associated with higher mortality, more disability, decline in functional status and lower quality of life, this creates a large disease burden. There is currently no research on the prevalence and influencing factors of this disease in Henan Province.

To provide scientific basis for understanding the epidemic characteristics and influencing factors of bone and joint diseases in the elderly population in Henan Province and implementing precise prevention and control.

The multi-stage random cluster sampling method was used to obtain the demographic characteristics, past disease history, physical activity and physical indicators of permanent residents aged≥18 years old in Henan Province in 2018 through questionnaires, medical physical examination, laboratory testing and other methods. 1 055 people aged ≥60 years old were included in this study. Multivariate Logistic regression was used to analyze the characteristics and influencing factors of bone and joint diseases in the elderly population with different characteristics in Henan Province.

The incidence rate of bone and joint diseases among the elderly population in Henan Province in 2018 was 28.13% (95%CI=28.10%-28.15%). Among them, women, urban areas, those with overweight or obesity, central obesity, dyslipidemia or hyperlipidemia, snoring history, moderate intensity activity, and non-smoking history have higher incidence rates, and the differences are statistically significant (P<0.05). Multivariate Logistic regression analysis showed that males (OR=0.717, 95%CI=0.550~0.933, P=0.013) were protective factors for bone and joint diseases in the elderly population, while overweight or obesity (OR=1.329, 95%CI=1.050-1.684, P=0.018) and central obesity (OR=1.305, 95%CI=1.047-1.626, P=0.018) were risk factors for bone and joint diseases in the elderly population.

Bone and joint diseases in the elderly population in Henan Province are related to gender, BMI, and central obesity. Targeted health education and comprehensive intervention should be carried out for women, overweight or obese individuals, and central obesity in the elderly population.

Clinical practice guidelines can standardize medical behaviors, improve the quality of medical services, rationalize resource allocation, and safeguard the rights of patients. However, all of these are achieved based on the rigorous design, scientific formulation, and standardized reporting of guidelines. With the nation's high attention to the standardization of traditional Chinese medicine, many clinical practice guidelines for traditional Chinese medicine or integrated traditional Chinese and Western medicine have been published. Traditional Chinese medicine orthopedics, as a discipline with obvious advantages in specialization in the field of traditional Chinese medicine, is witnessing a rapid increase in the number of clinical practice guidelines, prompting the discipline to gradually move towards standardization, modernization, and internationalization. However, many issues are increasingly emerging in this context, attracting widespread attention from researchers. This article systematically reviews and summarizes the current status and challenges of the development of clinical practice guidelines in orthopedics of traditional Chinese medicine, and proposes targeted strategies. Currently, the development of clinical practice guidelines in orthopedics of traditional Chinese medicine faces many challenges, including inaccurate positioning of clinical problems, a lack of high-quality clinical evidence, insufficient standardization in guideline formulation, a shortage of multidisciplinary talent development, and various issues regarding guideline updating and implementation. In future research, professional societies/associations should strengthen guidance on guideline formulation. Researchers should focus on improving the quality of original research, enhance learning and research in guideline methodology, prioritize guideline updating and adaptation, and promote the dissemination and implementation of guidelines, aiming to develop high-quality guidelines and promote the standardization of orthopedics of traditional Chinese medicine.

Establishing the advantageous diseases in the field of traditional Chinese orthopedics treated with manual therapy will promote the development of manual techniques and dominant discipline. However, the current evaluation and selection lack a quantitative evaluation process based on evidence-based medicine.

To systematically review systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy using evidence mapping methodology and explore the advantageous diseases in this field.

Computerized searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, Wanfang Data, and VIP database to collect systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy from inception to March 5, 2023. The evidence distribution characteristics were presented using a combination of charts and text.

A total of 126 systematic reviews published from 2003 to 2023 were included, showing an overall increasing trend in the quantity of relevant studies both domestically and internationally. Methodological quality assessment results indicated that 13 reviews were of moderate quality, 64 were of low quality, and 49 were of very low quality. The evidence map showed that the research evidence in the field of traditional Chinese orthopedics treated with manual therapy mainly focused on 18 clinical diseases, including cervical spondylosis, low back pain, knee osteoarthritis, lumbar disc herniation, ankle sprain, adhesive capsulitis of the shoulder, cervicogenic headache, atlantoaxial subluxation, distal radius fracture, lateral epicondylitis of the humerus, carpal tunnel syndrome, lumbar sprain, scoliosis, hip osteoarthritis, fibromyalgia syndrome, myofascial pain syndrome, rotator cuff injury, and supracondylar fracture of the humerus, demonstrating beneficial or potentially beneficial effects.

Manual therapy is widely used in the clinical practice of traditional Chinese orthopedics. However, due to methodological shortcomings and a lack of research evidence on safety and cost-effectiveness, future efforts should focus on multi-level inter-agency cooperation to establish sound evaluation standards and systems, improve research quality, update research evidence, and further explore the advantages of manual therapy in the field of traditional Chinese orthopedics.

Senescence-associated secretory phenotype (SASP) is an important feature of cellular senescence and plays an important role in regulating the disease microenvironment. At present, the role of SASP in intervening bone metabolism and inducing bone loss is very limited. Therefore, this paper discusses the regulatory mechanism of SASP in osteoporosis models and summarizes its regulatory characteristics: SASP is fully expressed in senescent bone cells and transmits aging effects to mesenchymal stem cells in an autocrine/paracrine manner, thereby interfering with osteogenic differentiation. SASP activates immune cells and promotes their aging, thus inducing the formation of inflammatory tissue microenvironment and aggravating bone loss. Mitochondrial homeostasis, pathologic hyperglycemia, and obesity-induced fat accumulation all promote SASP expression, thus disrupting microenvironmental homeostasis and transmitting aging effects to bone tissue. To sum up, understanding the role of SASP in osteoporosis lays a solid foundation for us to develop anti-SASP therapy for osteoporosis in the future.

With the gradual deepening of the comprehensive reform of community health services, the prevention and control of single diseases for the entire population in the community is also constantly being optimized, However, there is still a lack of appropriate evaluation methods in the community to reflect its prevention and control effectiveness evaluation.

By analyzing and exploring the cost effect of the existing whole-population prevention and control measures of osteoporosis in Fenglin community, from 2016 to 2022, this paper answers the initial results and possible problems of the whole-population prevention and control of single disease in the community.

This study conducted a cost-effectiveness analysis on 4 293 community residents who received osteoporosis prevention and treatment in Fenglin community from 2016 to 2022. Divide the research object into three states based on bone density values: healthy, low bone mass, and osteoporosis, and construct a Markov model to analyze the influencing factors of different state transitions. And based on the predicted values of the Markov model combined with quality adjusted life years (QALY) , the increment of quality adjusted life years (QALY) is calculated. All costs invested in prevention and control work from 2016 to 2022 are counted, and the effectiveness of prevention and control is evaluated by the cost/quality adjusted life year increment ratio. Quality adjusted life years (QALY) are obtained by calculating the health utility value and expected life determined through literature search.

The total cost of osteoporosis prevention and treatment in Fenglin community was 33 814 102.15 yuan. The total quality-adjusted life years of 4 293 community osteoporosis prevention and treatment population were 77 098.288 9 at the first diagnosis, the average per capita was 17.959, and the standard deviation was 9.34. At the second diagnosis, the total quality-adjusted life years were 79 616.936 1, the mean per capita was 18.546, the standard deviation was 9.342, and the difference between the two diagnoses was 2 518.647 2. The incremental cost-effectiveness ratio (ICER) is 2 132.907 0 yuan /QALY, and the incremental cost-effectiveness ratio (ICER) is less than 1 times (66 965.10 yuan) per capita GDP, indicating that the intervention scheme is fully cost-effective.

This study combined Markov model and quality-adjusted life years (QALY) to make a preliminary evaluation of the prevention and treatment effect of osteoporosis in Fenglin community. The results showed that the intervention program of osteoporosis prevention and treatment in Fenglin community was worth investing, and provided a certain basis for the accurate prevention and treatment decision of osteoporosis in the future.

Knee osteoarthritis (KOA) is a common clinical condition with a decades-long course. Long-term and personalised health management in community hospitals is the best way to prevent and treat KOA, and non-surgical treatment is an effective way to slow joint degeneration and postpone joint replacement surgery.

To understand the population characteristics, clinical staging and treatment modality characteristics of the population attending community hospitals for knee osteoarthritis, in order to provide a basis for optimising the treatment protocol for knee osteoarthritis at the grassroots level.

All streets in the urban area of Beijing were randomly selected for the study using the whole cluster sampling method, and Hepingli Street in Dongcheng District, Beijing was censored for all patients who attended all community hospitals (7) belonging to the street from January to June 2022, and general information, medical history, personal history, clinical staging, K-L grading and treatment modalities were collected.

A total of 3 615 KOA patients were included in this study, including 1 327 males (36.71%) and 2 288 females (63.29%), aged (71.8±13.3) years. There were 867 cases (23.98%) in the onset period, 2009 cases (55.57%) in the remission period and 739 cases (20.45%) in the rehabilitation period. Gender and age of patients with different clinical stages were not correlated with clinical stages (P>0.05), while BMI (K=0.235) and KL grading (K=0.406) were correlated with clinical stages (P<0.001). During the attack period, 4-5 kinds of treatment methods (48.67%) were combined, and the treatment methods were mainly traditional Chinese patent medicines and simple preparations for external use 598 cases (68.97%), 475 cases (54.79%) of traditional Chinese patent medicines and simple preparations for oral use, and 396 cases (45. 67%) of health education; in the remission stage, 2-3 treatment methods were used in combination (48.58%), mainly including 1 084 cases (53.96%) of traditional Chinese patent medicines and simple preparations for external use, 1 047 cases (52.12%) of health education and 790 cases (39.32%) of cupping; in the rehabilitation stage, 2-3 kinds of treatment methods were used in combination (47.23%). The main treatment methods were health education in 488 cases (66.04%), traditional exercises in 286 cases (38.70%), and external use of traditional Chinese patent medicines and simple preparations in 279 cases (37.75%). There was a correlation between clinical stage and type of combination therapy (K=0.356, P<0.05) .

KOA patients in community hospitals are mainly in remission, and treatment is often combined with various methods of traditional Chinese patent medicine and simple preparations, and traditional exercises are also widely used.

Rheumatoid arthritis interstitial lung disease (RA-ILD) is one of the most common complications of rheumatoid arthritis (RA) that severely impairs the quality of life and survival. Zang Bi Formula (ZBF) is mostly used in clinical practice for patients with recurrent occurrence of RA. However, its mechanism of action and efficacy in RA-ILD still remain unclear. Objective To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

From January 2022 to March 2023, a total of 14 tumor necrosis factor alpha-transgenic (TNF-Tg) mice were randomly divided into Saline group and ZBF group, with 7 mice in each group. At the same time, 7 wild-type (WT) mice in the same litter were randomly selected as the control group (WT group). Intragastric administration of ZBF 1.4 g/mL with 0.2 mL per time was given to mice of ZBF group once a day, and those in the WT group and Saline group were given an equal amount of normal saline via intragastric administration. After the intervention for 8 weeks, hematoxylin&eosin (H&E) staining of mouse ankle tissues was performed to observe the inflammatory cell area. Alcian blue-orange and tartrate-resistant acid phosphatase (TRAP) staining was performed to observe the cartilage area and bone area ratio, as well as the osteoclast area, respectively. The area proportion of inflammatory cells, fibrosis and T-cell/B-cell proportion in mouse lung tissues were observed by H&E staining, Masson staining and immunofluorescence staining, respectively.

Mice in the Saline group had significantly increased inflammatory cell infiltration, synovial hyperplasia, and ankle tissue destruction. Inflammation of the ankle joint was alleviated in the ZBF group. The proportion of inflammatory cells in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significant damages to the sagittal plane of the talus of the ankle joint and bone erosion. Bone damages of the ankle joint and erosion were significantly alleviated in ZBF group, showing a gradually cleared boundary of the sagittal plane of the talus and increased bone mass. The proportions of cartilage area and bone area in the Saline group were significantly lower than those of ZBF group and WT group, which were significantly lower in the ZBF group than those of WT group (P<0.05). Mice in the Saline group presented massive infiltration of red-stained osteoclasts in the ankle joint, which was significantly alleviated in mice of ZBF group. The area of osteoclasts in the ZBF group was significantly smaller than that of the Saline group (P<0.05). Mice in the Saline group had mild-to-moderate inflammatory cell infiltration diffusely around the pulmonary interstitium, blood vessels and bronchi, thickening of the walls of the middle and small arteries, reduced alveolar intervals and obvious damages to lung tissues. Inflammatory cells infiltrated in the pulmonary interstitium surrounding tissues of the trachea and blood vessels were reduced and the boundary of the lungs were cleared in mice of ZBF group, presenting an improved lung structure. The proportion of inflammatory cells area in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significantly enlarged areas of blue collagen fibers around blood vessels and trachea and thickening of the alveolar or bronchial walls. Mice in the ZBF group had reduced areas of blue collagen fibers around blood vessels and trachea and improved lung structure. Pulmonary fibrosis scores of the lung were significantly higher in the Saline group than those of ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05). T lymphocytes cells and B lymphocytes cells increased significantly in mouse lung tissue of the Saline group, and most of them surrounded the pulmonary blood vessels and bronchi, forming a follicle-like structure lacking a germinal center. The follicle-like structures were less observed in mouse lungs of the ZBF group. The area proportions of B lymphocytes cells and T lymphocytes cells in the Saline group were significantly higher than those of the ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05) .

ZBF not only reduced ankle injury in TNF-Tg mice, but also improved their lungs inflammation and fibrosis, reducing the numbers of B lymphocytes cells and CD₃⁺ T lymphocytes cells in lung tissue.

Traditionally, open reduction with Kirschner wire fixation (ORKF) is used to treat paediatric patients with significantly displaced lateral humeral condyle fractures. However, in recent years, the use of closed reduction percutaneous pinning (CRPP) to treat lateral humeral condyle fractures in children has been increasingly reported. However, there is some controversy as to which surgical technique is more effective and safe.

To evaluate the efficacy and safety of CRPP and ORKF in paediatric patients with lateral humeral condyle fractures.

Chinese databases including CNKI, Wanfang Data, VIP and CBM and English databases including PubMed, Embase, Cochrane Library and Web of Science were searched from inception to 2023-01-01 for the case-control studies of CRPP and ORKF to treat the lateral humeral condyle fractures, the quality of the literature was evaluated and data were extracted. RevMan 5.3 software was performed to conduct a meta-analysis comparing the relevant efficacy and safety indexes of the two surgical techniques.

A total of 16 studies involving 1 165 cases were included for this meta-analysis. The results of meta-analysis indicated that CRPP was superior in status of surgical time (MD=-11.81, 95%CI=-15.04 to -8.58, P<0.000 01), intraoperative bleeding (MD=-3.36, 95%CI=-4.37 to -2.36, P<0.000 01), postoperative fracture healing time (MD=-3.92, 95%CI=-6.80 to -1.03, P=0.008), Kirschner wire rtention time (MD=-3.35, 95%CI=-6.33 to -0.38, P=0.03), and postoperative functional recovery of elbow joint (OR=0.44, 95%CI=0.25 to 0.76, P=0.006). The incidence of overall postoperative complications (OR=0.33, 95%CI=0.19 to 0.56, P<0.000 1) and superficial infections (OR=0.39, 95%CI=0.21 to 0.73, P=0.003) was lower than that in the ORKF group. However, there is no statistically significant difference in the deep infections, poor fracture healing, and ischemic necrosis of the lateral condyle between the two groups (P>0.05) .

CRPP was superior to ORKF in the treatment of pediatric lateral humeral condyle fractures, both in terms of efficacy and overall complications, but more high-quality studies are needed to further validate CRPP in terms of specific complications.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) has a direct impact on patients' quality of life, hospitalization rates and fracture risk. In recent years, osteoblasts and osteoclasts have become central to the pathophysiology of CKD-MBD. Osteoblasts interact with other organs by synthesizing fibroblast growth factor-23 (FGF-23) and sclerostin (SOST), making the skeleton an endocrine organ. Therefore, dysregulation of osteoblast differentiation is an important early event in the pathogenesis of CKD. In this paper, we systematically discuss the metabolic pathways of osteoblasts and the mechanisms related to the altered metabolic reprogramming of osteoblasts in the early CKD-MBD pathology. This paper shows that abnormalities in signaling pathways and metabolites such as Wnt/β-catenin, FGF-23, uremic toxins, metabolic acidosis, can alter the metabolic activity of osteoblasts, causing impaired maturation of the osteogenic spectrum, which in turn affects bone remodeling, which will provide a new way of thinking for explaining the pathological changes in renal bone disease and developing clinical treatment options.

Isocitrate dehydrogenase (IDH) is the more mutation-prone human metabolic gene. In the presence of nicotinamide adenine dinucleotide phosphate (NADPH), mutant IDH can bind to α-ketoglutaric acid (α-KG) and reduce it to 2-hydroxyglutaric acid (2-HG), participating in various biological processes of tumorigenesis. IDH has been widely studied in glioma and acute myeloid leukemia, and rarely in chondrosarcoma. Chondrosarcoma is prone to recurrence and metastasis due to the presence of high-frequency mutations in the IDH gene, and treatment options are limited after recurrence or metastasis, resulting in a poor prognosis for patients and an urgent clinical need to find new treatment options. This article reviews the role of IDH mutations in the development, prognosis, differential diagnosis and treatment of chondrosarcoma, further elaborates the biological role of IDH gene mutation in the occurrence and development of chondrosarcoma, and provides an outlook on the development of powerful IDH inhibitors and anti-cancer drugs, in order to provide a reference for the establishment of therapeutic regimen and prognostic evaluation.

With the aging of the population, the health threat of osteoporosis (OP) has become more prominent. The prevalence of OP in postmenopausal women will further increase to three times of that in men due to the reduction of ovarian estrogen secretion. The prevalence and risk factors of OP in postmenopausal women have been widely reported and systematically summarized, however, there are few systematic reviews of relevant studies worldwide.

To systematically review the prevalence and influencing factors of OP in postmenopausal women.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched for studies on the prevalence and influencing factors of OP in postmenopausal women from 2002-11-01 to 2022-11-01; in addition to literature tracking based on the references in the included studies. Two reviewers independently conducted literature screening and information extraction, the quality was evaluated using the risk of bias assessment criteria recommended by the Agency for Healthcare Research and Quality. A Meta-analysis on the prevalence and influencing factors of OP in postmenopausal women was performed using Stata 16.0 software.

A total of 68 articles were included, with a total sample size of 112 097 cases. Meta-analysis showed that the prevalence of OP and osteopenia in postmenopausal women was 34.73% (95%CI=31.02%-38.44%) and 41.83% (95%CI=38.19%-45.47%), respectively. Subgroup analysis showed that the highest prevalence was found in the age≥80 years group (68.72%, 95%CI=59.81%-77.62%), followed by the age of 70-79 years group (57.20%, 95%CI=50.53%-63.87%) and the age of 60-69 years group (37.46%, 95%CI=28.95%-45.98%), the age of 50-59 years group (24.94%, 95%CI=15.50%-34.39%), the age of 40-49 years group (14.01%, 95%CI=6.64%-21.38%) ; the prevalence rate of <2 births (34.24%, 95%CI=24.08%-44.41%) was lower than that of ≥2 births (39.27%, 95%CI=30.10%-48.44%) ; the prevalence of age ≥10 years menopause (47.15%, 95%CI=42.27%-52.04%) was higher than that of <10 years menopause (34.18%, 95%CI=33.30%-35.06%) ; the prevalence in developing countries (35.87%, 95%CI=31.39%-40.34%) was higher than that in developed countries (30.10%, 95%CI=23.97%-36.23%). The influencing factors of OP in postmenopausal women included diabetes (OR=2.79, 95%CI=1.75-4.46, P<0.05) ; high BMI (OR=0.53, 95%CI=0.43-0.64, P<0.05) ; exercise (OR=0.43, 95%CI=0.28-0.65, P<0.05) ; number of births (OR=2.52, 95%CI=1.72-3.67, P<0.05) ; duration of menopause (OR=1.88, 95%CI=1.43-2.46, P<0.05) ; family history (OR=1.92, 95%CI=1.38-2.67, P<0.05) ; alcohol consumption (OR=1.95, 95%CI=1.54-2.47, P<0.05), menopausal hormone therapy (OR=0.34, 95%CI=0.25-0.44, P<0.05) ; non-violent fracture history (OR=3.83, 95%CI=1.88-7.98, P<0.05) ; and age (OR=1.43, 95%CI=1.29-1.59, P<0.05) .

The prevalence of OP and osteopenia in postmenopausal women is high, with about one third of postmenopausal women suffering from osteoporosis, and about half of postmenopausal women suffering from osteopenia. High BMI, regular exercise, and use of menopausal hormone therapy are protective factors for OP in postmenopausal women, while diabetes, high number of births, long years of menopause, family history of disease, alcohol consumption, non-violent fracture history, and advanced age are risk factors. The evaluation and intervention of OP should be strengthened in clinical practice, and it is also necessary to promote healthy lifestyle to postmenopausal women to improve their quality of life.

Multiple myeloma is a highly heterogeneous disease. Super-aged patients with multiple myeloma are a special group. There is a lack of evidence-based medical basis in the treatment decision and general evaluation of them, and there is also some controversy in the assessment of frailty.

To explore the clinical features and the influencing factors of survival and prognosis in newly diagnosed super-aged multiple myeloma (MM) patients with the bortezomib based regimen and to evaluate the best assessment model for the general status of patients with MM.

The clinical data of newly diagnosed super-aged patients with MM in Beijing Chao-yang Hospital, Capital Medical University from November 2013 to January 2023 were retrospectively analyzed. Survival follow-up was conducted through the medical record system of Beijing Chao-Yang Hospital, Capital Medical University until April 1, 2023, with the end points of this study of overall survival (OS) and progression-free survival (PFS) . The patients were divided into the two-drug treatment group (n=18) and three-drug treatment group (n=11) , and the clinical and genetic characteristics of the two groups were compared. The Geriatric Assessment System (GA) score, UK Myeloma Research Alliance Risk Profie (MRP) score, and Mayo score were used to evaluate the frailty status and treatment efficacy. Survival curves of OS and PFS in MM patients were plotted using the Kaplan-Meier method. Log-rank test was used to compare the survival curves of different influencing factors. Multivariate Cox hazard risk regression analysis was used to explore the influencing factors of OS and PFS in MM patients.

The median PFS was 8.70 (1.90-43.87) months and the median OS was 17.23 (2.00-72.83) months. A total of 21 (72.41%) patients experienced disease progression (PD) or relapse, and 12 (41.38%) patients died by the final follow-up. The objective remission rate (ORR) for first-line treatment was 82.76% (24/29) , the partial remission (PR) rate was 51.72% (15/29) , the very good partial remission (VGPR) rate was 24.14% (7/29) , and the complete remission (CR) rate was 6.90% (2/29) . There was no significant difference in CR rate, VGPR rate, PR rate and ORR between the two groups of newly diagnosed super-aged MM patients (P>0.05) . Multivariate Cox hazard risk regression analysis showed that MRP debilitation (HR=0.213, 95%CI=0.049-0.924, P=0.039) , elevated serum corrected calcium (HR=0.153, 95%CI=0.041-0.570, P=0.005) and maintenance therapy (HR=4.301, 95%CI=1.219-15.169, P=0.023) were independent influencing factors of PFS in newly diagnosed super-aged MM patients, while maintenance treatment (HR=4.372, 95%CI=1.049-18.221, P=0.043) was an independent influencing factor for OS in newly diagnosed super-aged MM patients.

There is no significant difference in the efficacy and prognostic impact of two-drug or three-drug Bortezomib based treatment. Serum corrected calcium elevation and maintenance therapy are independent prognostic factors for survival. MRP score can be used to assess the prognosis of newly diagnosed super-aged MM patients.

Chimeric antigen receptor (CAR) -T cell immunotherapy has achieved good therapeutic effect in multiple myeloma (MM) , and the most common target is B cell maturation antigen (BCMA) . The disadvantage of single target CAR-T cell immunotherapy is that it can lead to disease resistance and recurrence, which may be related to antigen escape. Therefore, the dual-targeted CAR-T cell therapy for refractory-relapsed multiple myeloma (RRMM) has been improved and developed, but there is still a lack of systematic clinical analysis in this field.

A meta-analysis was conducted on the efficacy and safety of dual-targeted CAR-T cell therapy for RRMM patients.

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP were searched for single-group rate studies on dual-targeted CAR-T cell therapy in patients with RRMM from inception to 2023-02-06. The data were extracted for collection by 2 investigators using a self-designed form and the quality of literature was evaluated using the methodological index for non-randomized studies (MINORS) . The data analysis was conducted using RStudio software.

A total of 9 clinical studies, involving 200 RRMM patients who had previously received multi-line therapy were included in the study. Dual-targeted CAR-T cell therapy can be mainly divided into four categories based on different targets of BCMA/CD₁₉, BCMA/CD₃₈, BCMA/TACI, and BCMA/CS1, of which the BCMA+CD₁₉ target is more studied. Dual-targeted CAR-T cell therapy also can be divided into four categories of bispecific categories, combined/sequential infusion of two different CAR-T cells, bicistronic or cotransduction according to the different forms of infusion. Meta-analysis showed that the overall response rate (ORR) of dual-targeted CAR-T cells for RRMM was 90.0% (95%CI=0.849-0.943) , and the complete response rate (CRR) was 54.6% (95%CI=0.416-0.673) , the negative rate of minimal residual disease (MRD) was 75.6% (95%CI=0.489-0.952) , the ORR of extramedullary diseases (EMD) was 55.1% (95%CI=0.234-0.851) , the recurrence rate at the last follow-up was 29.7% (95%CI=0.141-0.454) , and the survival rate was 75.6% (95%CI=0.554-0.915) . The incidence of grade 3 to 4 cytokine release syndrome (CRS) was 16.4% (95%CI=0.094-0.245) , and the incidence of immune effector cell-associated neurotoxicity syndrome (ICANS) was 4.0% (95%CI=0-0.120) . Sensitivity analysis suggested stable results. The results of Egger's test indicated a potential bias risk for ORR (P=0.03) and overall response rate of EMD (P=0.02) . Meanwhile, no publication bias was suggested for CRR (P=0.53) , MRD negative rate (P=0.79) , recurrence rate at the last follow-up (P=0.71) , survival rate (P=0.98) , incidence of grade 3-4 CRS (P=0.90) , and incidence of ICANS (P=0.30) .

Dual-targeted CAR-T cell therapy for RRMM has shown favorable efficacy and safety, and multicenter, large-sample, and longer follow-up studies are needed to further evaluate its efficacy and safety.

Traditional Chinese acupuncture has been widely applied for the treatment of knee osteoarthritis (KOA) with outstanding efficacy. However, recognized and unified outcome indicators remain to be absent, which impedes the translation of research into high-quality clinical evidence. Therefore, the establishment of core outcome indicators for acupuncture in KOA is conducive to enhance the scientific rigor, rationality, and feasibility of clinical research programs in traditional Chinese medicine (TCM) , provide higher quality evidence-based basis for clinical research.

To analyze the current status of the application of outcome indicators in randomized controlled trials (RCTs) of acupuncture for KOA, so as to provide a basis for the assessment method of clinical efficacy.

PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP and SinoMed were searched for clinical RCTs of acupuncture in the treatment of KOA from 2003 to 2022. Two researchers screened and extracted the characteristics of literature. The indicator domain, measurement tools and the time point of measurement of RCTs of acupuncture for KOA were analyzed.

A total of 131 papers were included, with a sample size of 22 726 cases and 89 outcome indicators, which were classified into 40 (44.9%) items for symptoms and signs, 22 (24.7%) items for physical and chemical examinations, 5 (5.6%) items for quality of life, 5 (5.6%) items for psychological state, 3 (3.4%) items for satisfaction evaluation, 2 (2.2%) items for safety indicators, and 12 (13.5%) items for other indicators. Among the 131 articles, 23 measurement time points were included in the 131 articles, ranging from 1 hour to 3 years after treatment, 106 (80.9%) articles used "clinical efficacy" as the outcome indicator, 23 (17.6%) articles used safety evaluation and adverse event reports.

There are some problems in the use of outcome indicators in the RCTs of acupuncture for KOA, such as large variation in the use of outcome indicators, confounding of primary and secondary indicators, abuse of index combination, irregular use of composite indexes, inadequate safety evaluation, irregular measurement time points, insufficient evaluation of long-term prognosis, and failing to reflect the characteristics of TCM intervention of acupuncture. Future research should combine treatment based on syndrome differentiation characteristics of TCM, to evaluate the efficacy of acupuncture in the treatment of KOA by using scientific and reasonable outcome indicators. It is urgent to establish the core indicators set of TCM in the treatment of KOA, and to construct a standardized and recognized COS-TCM.

The incidence of multiple myeloma has long been high, however, there are fewer studies on phosphatidylinositol 3-kinase (PI3K) /serine-threonine kinase (AKT) signaling pathway and M2 macrophage polarization promoting the progression of multiple myeloma.

To investigate the expression of M2 macrophages in patients with multiple myeloma and the mechanism of PI3K/AKT signaling pathway promoting M2 macrophage polarization.

Forty-eight multiple myeloma patients diagnosed in the Department of Hematology of the Affiliated Hospital of Guilin Medical University from October 2021 to April 2022 were selected as the test group, and thirty healthy volunteers (healthy donors of blood marrow transplantation) in the same period were selected as the control group. Peripheral blood was taken from the 2 group and mononuclear cells were isolated, the proportion of M2 macrophages was determined by flow cytometry. RPMI8226 cells were subcultured by cell passage, and mononuclear macrophages THP-1 cells were cultured as macrophages by phorbol ester differentiation. According to the experimental requirements, tumor cells were cultured and transfected with siRNA to silence phosphatase and tensin homolog (PTEN) and divided into three groups, including blank group, siRNA-PTEN experimental group, and siRNA control group; the supernatants of the above three groups were collected and added to the macrophage co-culture system and then divided into four groups including M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group. The protein expression levels of AKT, p-AKT, PI3K-p85, and p-PI3K-p85 in the blank group, siRNA-PTEN experimental group, and siRNA control group of multiple myeloma cell culture were determined by Western blot assay. The mRNA expression levels of MMP2 and MMP9 in the blank group, siRNA-PTEN experimental group and siRNA control group were determined by fluorescence quantitative polymerase chain reaction (PCR) . The expression levels of specific antibodies CD163, CD206, and F4/80 in M2 macrophages in M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group were determined by flow cytometry. The mRNA expression levels of arginase 1 (ARG-1) and interleukin 10 (IL-10) in M0 macrophage group, tumor cell supernatant group, siRNA-PTEN supernatant group, and siRNA supernatant group were determined by fluorescence quantitative PCR.

The expression level of M2 macrophages was higher in the test group than that in the control group (t=0.855, P<0.001) . The protein expression levels of p-AKT/AKT and p-PI3K-p85/PI3K-p85 in the siRNA-PTEN experimental group were higher than the blank group and siRNA control group (P<0.05) . The mRNA expression levels of MMP2 and MMP9 in the siRNA-PTEN experimental group were higher than the blank group and siRNA control group (P<0.05) . M2 macrophage specific antibody CD163+F4/80 and CD206+F4/80 in the siRNA-PTEN supernatant group were higher than the tumor cell supernatant and siRNA-PTEN supernatant group (P<0.05) . The mRNA expression levels of ARG-1 and IL-10 in the siRNA-PTEN supernatant group were higher than the tumor cell supernatant group and siRNA supernatant group (P<0.05) .

M2 macrophages are upregulated in multiple myeloma patients, and multiple myeloma cells can promote M2 macrophage polarization through activation of the PI3K/AKT signaling pathway, thereby regulating the myeloma cell microenvironment.

As China enters the period of accelerated development of population aging, the proportion of rheumatoid arthritis cases is increasing, causing a serious burden on society and families. The active ingredients in simiao decoction have improved effect, but there is a lack of relevant studies to analyze the action and mechanism of prescriptions.

To observe the intervention effect of simiao decoction on rats with rheumatoid arthritis established by collageninduced arthritis and its effect on vitamin D system and neutrophil extracellular traps (NETs) .

From November 2021 to January 2023, 70 SD female rats were selected. The rats were randomly divided into the blank group (control group), model group (model group), methotrexate group (MTX group), vitamin D group (VD group), Simiao decoction low-dose group (SMT-L group), Simiao decoction medium-dose group (SMT-M group) and Simiao decoction high-dose group (SMT-H group) by random number table method, with 10 rats in each group. The rat model of synovial arthritis was established by collagen induction method and the gavage treatment was started 7 d after modeling. The degree of ankle swelling was assessed, and the arthritis index (AI) score of rats in each group the levels of interleukin 6 (IL-6), 25-hydroxyvitamin D₃ [25 (OH) D₃], NETs in serum of rats and the expression levels of 24-hydroxylase (CYP24A1), 1-α hydroxylase (CYP27B1), MPO, vitamin D receptor (VDR) and elastase (NE) in synovial tissue of joint were measured.

The degree of ankle swelling in the control, MTX, VD, SMT-L, SMT-M and SMT-H groups was lower than that in the model group on day 7, the degree of ankle swelling in the model group was higher than the control group, the SMT-M group was higher than the model group on day 14, the degree of ankle swelling in the model group was higher than the control and MTX groups and lower than the VD, SMT-L, SMT-M and SMT-H groups on day 21, the degree of ankle swelling in the control, MTX, VD, SMT-L, SMT-M and SMT-H groups was higher than the model group, and the difference was statistically significant (P<0.05). The AI score of rats in the SMT-H group was lower than that in the model group on day 14, the AI score in the MTX, VD, SMT-L and SMT-H groups was lower than that in the model group on day 21, the score of rats in the MTX, VD, SMT-L, SMT-M, and SMT-H groups was lower than that in the model group on day 28, the difference was statistically significant (P<0.05). Immunohistochemical results showed significant differences in the expression levels of MPO and TNF-α in synovial tissue among the 7 groups (P<0.05), MPO and TNF-α in the model group were higher than those in the control group, while MPO and TNF-α in the MTX, VD and SMT-H groups were lower than those in the model group, TNF-α in the SMT-M group was lower than that in the model group, and the difference was statistically significant (P<0.05). IL-6 and NETs in the model group were higher than those in the control group, and 25 (OH) D₃ was lower than that in the control group. IL-6 and NETs in the MTX, VD and SMT-H groups were lower than those in the model group, and 25 (OH) D₃ was higher than that in the model group. NETs in the SMT-M group were lower than those in the model group, and the difference was statistically significant (P<0.05). CYP24A1 in the model group was higher than that in the control, MTX, VD, SMT-M and SMT-H groups, while CYP27B1 and VDR in the model group were lower than those in the control, MTX, VD, SMT-M and SMT-H groups, MPO was higher than that of the control, MTX, VD, SMT-L, SMT-M and SMT-H groups, and NE was higher than the control, VD, SMT-M and SMT-H groups, and the difference was statistically significant (P<0.05) .

Simiao decoction may inhibit the formation of NETs by regulating the vitamin D system, thereby treating RA.

The continuous increase in numbers of people with osteoporosis, and individuals with low bone mass in the community, brings severe challenges to the prevention and treatment of osteoporosis in the community.

To investigate the basic conditions related to the prevention and control of osteoporosis in communities, including the basic process and cost of enrolling the target population, and the prevalence and risk factors of osteoporosis in the target population, so as to provide evidence for supporting a general practice team to develop precise osteoporosis prevention and control measures.

This study selected 322 cases (including outpatient patients and older physical examinees) from Waitan Community Health Service Center, Shanghai from May to August 2021. General information, bone density test results and risk factors of osteoporosis were collected by a questionnaire.

The cost of enrolling the target population in the community was 57.344 yuan per person. Among the 322 cases, 27 (8.4%) had normal bone mass, 157 (48.8%) had low bone mass, and 138 (42.8%) had osteoporosis. The prevalence of bone density abnormalities (low bone mass and osteoporosis) reached 91.6%. There were statistically significant differences in gender ratio and BMI among normal bone mass, low bone mass and osteoporosis groups (P<0.05). The average bone mineral density (BMD) values of normal bone mass, low bone mass and osteoporosis groups were (-0.72±0.27) AU/mm³, (-1.88±0.38) AU/mm³, and (-3.17±0.53) AU/mm³, respectively. In terms of exercise habits, the prevalence of individuals doing little exercise in normal bone mass, low bone mass and osteoporosis groups was 37.0% (10/27), 49.7% (78/157) and 64.5% (89/138), respectively. In terms of exercise intensity, the prevalence of individuals exercising at moderate-intensity in normal bone mass, low bone mass and osteoporosis groups was 74.1% (20/27), 79.6% (125/157) and 80.4% (111/138), respectively. Three groups had no significant differences in the other osteoporosis risk factors, such as surgical treatment history, smoking history, allergy history and disease history. There was also no significant intergroup difference in dietary habits. Of all cases, 48.8% (157/322) never drank beer, liquor and red wine, 32.0% (103/322) drank coffee 4-6 times per week, and 31.4% (101/322) ate pickled vegetables, smoked foods, or sauces 4-6 times per week.

The community is a favorable setting for conducting prevention, treatment and clinically research programs regarding osteoporosis owing to short participant enrollment period and low cost. As the exercise and eating habits of the elderly in the community are unhealthy, the general practice team should accurately guide them to rapidly improve their dietary structure and develop a healthy exercise habit according to their own status, by which the onset and progression of osteoporosis can be proactively controlled.

Rheumatoid arthritis (RA) is a refractory autoimmune disease with chronic and systemic characteristics, however, the pathogenesis of this disease has not been fully defined. Autophagy is a metabolic process that exists in eukaryotic cells and maintains normal physiological activities and cell homeostasis. Dysregulation of autophagy is related to the occurrence and development of various diseases such as RA. The databases of CNKI, Wanfang Data, VIP, PubMed, Web of Science, Elsevier, etc. were searched for the literature related to autophagy in RA pathogenesis. The role of autophagy in the pathogenesis of RA was summarized in terms of maintaining synovial inflammation (improving anti-apoptosis rate of synovial cells and regulating the phenotype transformation of synovial cells), promoting bone destruction (participating in osteoclastogenesis and regulating chondrocyte apoptosis) and disrupting immune system homeostasis (regulating the activation and maturation of immune cells, participating in the presentation of citrullinated proteins, and inducing carbamoylation of proteins), in order to provide basis and reference for the pathogenesis research and treatment of RA.

Major hepatectomy for liver malignancies carries with large risks. Perioperative nutritional support plays a vital role for postoperative recovery. However, there are few studies focusing on predictions of postoperative complications and prognosis using postoperative loss of skeletal muscle mass (PLSMM) in acute stage after major hepatectomy.

To identify the change inskeletal muscle index (SMI), and to investigate risk factors for PLSMM, as well as its correlation with postoperative complications after major hepatectomy for liver cancer.

A total of 97 patients who received major hepatectomy for liver cancer from Department of General Surgery, the Second Affiliated Hospital of Soochow University between July 2018 and August 2022 were included. The preoperative and postoperative day 5 skeletal muscle area at the third lumbar vertebra level was measured, respectively, using computed tomographic images. The postoperative change rate of SMI was calculated. The PLSMM was defined as the lowest tertile of the percent change in SMI, according to which the patients were divided into PLSMM and Non-PLSMM group. Baseline data, surgical and postoperative indices were collected and analyzed.

SMI was decreased in 54 patients postoperatively. Thirty-two and 65 patients were assigned to the PLSMM group (SMI≤-3.59%) and Non-PLSMM groups (SMI>-3.59%), respectively. Compared with Non-PLSMM group, PLSMM group had longer operation time, more intraoperative blood loss and higher ratio of microvascular invasion (MVI) (P<0.05). Moreover, PLSMM group had longer postoperative hospital stay, higher levels of white blood cell and international normalized ratio and lower level of fibrinogen on postoperative day 5 (P<0.05). PLSMM group showed a lower incidence of overall complications (P<0.05). Multivariate Logistic regression analysis indicated that MVI〔OR=2.751, 95%CI (1.173, 6.642) 〕 and operation time >210 min〔OR=1.973, 95%CI (1.286, 4.936) 〕were risk factors associated with PLSMM (P<0.05). PLSMM〔OR=2.591, 95%CI (1.173, 6.977) 〕, preoperative myopenia〔OR=1.798, 95%CI (1.133, 3.792) 〕, operation time >210 min〔OR=2.958, 95%CI (0.918, 9.529) 〕 and blood loss >500 mL〔OR=1.003, 95%CI (1.001, 1.007) 〕 were risk factors associated with postoperative complications (P<0.05) .

MVI and operation time >210 min were risk factors associated with PLSMM. PLSMM was the independent predictor of postoperative complications, which negatively affected postoperative outcomes after major hepatectomy.

Steroid-induced osteonecrosis of the femoral head (SONFH) is common and disabling. The efficacy of Huoxue Tongluo Capsule has been consistently demonstrated in the prevention and treatment of osteonecrosis of the femoral head, but there is no research on whether the treatment can be carried out by regulating the intestinal flora.

To establish SONFH rat model intervened by Huoxue Tongluo Capsule, analyze and compare the diversity of intestinal flora in each group of rats, screen out SONFH-specific altered bacterial genera and observe the effect of Huoxue Tongluo Capsule on intestinal flora.

24 male SD rats were selected from April to October 2022 and divided into the blank group (n=8), model group (n=8) and Huoxue Tongluo group (n=8) by random number table method. The SONFH model was prepared. The Huoxue Tongluo group was given 0.63 g·kg^-1·d^-1 Huoxue Tongluo Capsule by gavage on the 3rd to 28th day of modeling. The blank group and model group were given an equal volume of 0.9% sodium chloride solution by gavage. After drug intervention, rat femurs were collected for HE staining and Micro-CT analysis. Rat feces were collected for 16S rDNA sequencing. α diversity analysis was used to evaluate species diversity, β diversity analysis was used to explore the similarity or dissimilarity of sample community composition, and linear discriminant analysis (LEfSe) was used to compare the differences of intestinal flora among the three groups. COG function was used to predict the intestinal flora function of the rats in the three groups.

There were significant differences in the rate of empty bone lacunae among the three groups, and the rate of empty bone lacunae in the model group was higher than that in the blank group, while the rate of empty bone lacunae in the Huoxue Tongluo group was lower than that in the model group (P<0.05). There were significant differences in the bone volume (BV/TV), bone trabeculae number (Tb.N), bone trabeculae thickness (Tb.Th) and bone trabeculae separation (Tb.Sp) among the three groups, and the BV/TV, Tb.N and Tb.Th of the model group were lower than those of the blank group, while the Tb.Sp of the model group was higher than that of the blank group (P<0.05). The BV/TV, Tb.N, Tb.Th of the Huoxue Tongluo group were lower than those of the blank group, while the Tb.Sp was higher than that of the blank group (P<0.05). There were significant differences in the intestinal flora structure of rats among the three groups, the number of intestinal flora ASVs in the model group was higher than the blank group, the number of intestinal flora ASVs in the Huoxue Tongluo group was lower than the model group (P<0.05). There were significant differences in the Shannon index among the three groups, and the Shannon index in the model group was higher than the blank group (P<0.05). The PCoA plot of β-diversity analysis showed that there was partial overlap among the three groups, but the community structure of the three groups could be distinguished. The results of similarity analysis showed that the differences among the groups were greater than that within groups, and the differences were statistically significant (R=2 062, P=0.01). The results of LEfSe analysis showed that the abundances of Desulfovibrio, Hafnia-Obesumbacterium, Leuconostoc and Staphylococcus were increased, the abundances of Bacteroides and Prevotella _UCG-001 were decreased (P<0.05). The abundances of Oxalobacteraceae and Ruminococcus_torques_group were increased and the abundances of Rekenella and Kineothrix were decreased in the Huoxue Tongluo group compared with the model group (P<0.05). The prediction results of COG function in the three groups of rats showed that compared with the blank group, COG function of the model group mainly focused on carbohydrate transport and metabolism, inorganic ion transport and metabolism, amino acid transport and metabolism, lipid transport and metabolism, cell wall/membrane/envelope biogenesis. The function of the Huoxue Tongluo group focused on inorganic ion transport and metabolism, carbohydrate transport and metabolism, and the levels of replication, recombination and repair, transcription, cell cycle control, cell division, chromosome division, and cell motor function were increased compared with the model group.

The bacterial diversity of SONFH rats was higher than that of normal rats, and the increased bacteria genera was mainly pathogenic bacteria, with the decrease of corresponding beneficial bacteria genera. Huoxue Tongluo Capsule may achieve the therapeutic purpose of SONFH by changing the abundance and diversity of intestinal flora and regulating the abundance of Oxalobacteraceae, Ruminococcus_torques_group and other genera.

With the aggravation of population aging in China, the number of elderly perioperative orthopedic patients is increasing, and the growing prevalence of frailty in older patients undergoing orthopedic surgery has attracted increasing attention. Early preoperative assessment and intervention of frailty are of great significance for improving postoperative prognosis and reducing the occurrence of complications in this population.

To perform a scoping review of frailty assessment tools for elderly orthopedic inpatients, and to provide a reference for the selection of frailty assessment tools for this group.

Seven databases (PubMed, CINAHL, PsycINFO, Scopus, Embase, CNKI and Wanfang Data) were searched for studies on frailty assessment tools for older orthopedic inpatients from 2006 to 2021. Two researchers independently screened the literature and extracted the basic characteristics of the literature (the flint author, publication time, country, basic information, research tools and outcome indicators) and the basic characteristics of involved frailty assessment tools (name, study country, study type, scale dimension, number of items, assessment cut-off value, assessment time, etc.) .

A total of 1733 studies were retrieved, and 25 of them with 12 frailty assessment tools were included. The analysis showed that there are a variety of assessment tools, and different studies have used different frailty assessment tools. Frailty Phenotype and Frailty Index are the two common tools. The application of accurate and effective tools for frailty screening is crucial to improving preoperative risk stratification and postoperative prognosis. Frailty assessment using the Reported Edmonton Frail Scale, FRAIL Scale, PRISMA-7 Questionnaire or the Groningen Frailty Index can be completed without the use of additional measuring equipment and surveyors with an experience of training.

The selection of an optimal frailty assessment tool for elderly orthopedic inpatients should be in accordance with patient features, clinical resources and the performance of the tool. However, there is still lack of a gold standard for frailty assessment. Future studies are needed to assess the reliability and validity of existing frailty assessment scales or to develop frailty assessment tools applicable to Chinese older orthopedic inpatients.

Osteoarthritis (OA) is a degenerative disease frequently encountered clinically, which can lead to loss of joint function in the late stage and is associated with a high disability rate. There is still no available cure for OA. Therefore, early diagnosis and precise treatment are the key to improving the therapeutic effect. Being an interdisciplinary research focus, artificial intelligence (AI) has been increasingly used in the diagnosis and treatment of OA recently, as it improves the diagnostic accuracy as well as clinical treatment and prognosis of OA. We summarized and systematically reviewed the literature on the application of AI in the diagnosis and treatment of OA, in which the application potential in assisting imaging diagnosis, surgical treatment, progression prediction and postoperative rehabilitation of OA was indicated, yet some limitations including non-standardized data collection and unstable algorithmic system were also identified. In the future, it is expected to establish a standardized clinical sample database and continuously optimize the algorithmic model, so as to better incorporate AI technologies in the diagnosis and treatment process of OA.

Diabetic foot is a serious chronic complication of diabetes, tibial transverse transport (TTT) technique can promote the regeneration of vascular tissue, improve microcirculation, achieving good results in the treatment of diabetic foot ulcers, but traditional TTT technique has many complications, which needs to be improved to reduce postoperative complications.

To investigate the efficacy of modified TTT technique, that is, bone and periosteum combined transport technique, in the treatment of patients with Wagner grade Ⅲ and Ⅳ diabetic foot.

The clinical data of 117 diabetic foot patients treated with modified TTT technique in the hand and foot surgery of Yantai Yuhuangding Hospital from January, 2018 to May, 2021 were retrospectively analyzed, and the postoperative foot preservation, functional limb preservation, large amputation, ulcer healing time, complication, foot skin temperature improvement, resting pain, preoperative and postoperative CTA results were collected. The follow-up was till to March 31, 2022.

The follow-up time ranged from 5.5 to 24.0 months, with an average of (14.21±4.06) months. The postoperative foot preservation rate (no amputation or amputation below ankle) was 95.73% (112/117) , the functional limb preservation rate (no amputation or minor amputation distal to midfoot) was 83.76% (98/117) , the major amputation rate (amputation above ankle) was 4.27% (5/117) , and the postoperative ulcers healed well in all patients except amputees, with an average time to healing of (9.07±2.02) weeks, ranging from 6 to 14.5 weeks. The postoperative foot skin temperature at 1, 2, 4, and 8 weeks of the patients were significantly improved compared with the preoperative period (P<0.01) ; The postoperative VAS scores of 35 patients with resting pain at 1, 2, 4, and 8 weeks compared with the preoperative period (P<0.01) ; the CTA results showed improved postoperative vascular condition, increased microvascular vessels number and reconstructed vascular network of the foot in 70.34% (94/117) of included patients postoperatively; The incidence of complication during bone handling was 11.97% (14/117) , among which the incidence of osteotomy area skin edge necrosis, deep vein thrombosis, and pin track infection was 5.98% (7/117) , 4.27% (5/117) , and 1.71% (2/117) , respectively.

The modified TTT technique can promote wound healing through the stimulation of lower limb microcirculation reconstruction, to alleviate resting pain and improve foot skin temperature in diabetic foot patients effectively in the short term, with low incidence of complication, providing an effective approach for the treatment of diabetic foot.

The associations of muscle and adipose tissue with bone mineral density (BMD) in perimenopausal women has been studied, but there are differences in site distribution, which lead to that the effect of muscle and adipose tissue on BMD and the site of action are still unclear.

To analyze the relationships of BMD in lumbar spine, femoral neck, total hip and adipose, muscle tissue in perimenopausal women, and provide theoretical basis for improving the quality of life of middle-aged and elderly and preventing and treatment of osteoporosis (OP) .

2 355 women aged 40-60 years who underwent medical examination in the Health Management Center, Affiliated Hospital of Guizhou Medical University from January 2018 to October 2021 were retrospectively selected and divided into pre-menopausal women (n=1 261) and post-menopausal women (n=1 094) according to whether they were menopausal or not. BMD of lumbar spine, femoral neck, and total hip were measured by Dual energy X-ray Absorptiometry (DXA) . Adipose and muscle tissue were measured by Bioelectrical Impedance Analysis (BIA) . To explore the association of adipose and muscle tissue with BMD of different site in perimenopausal women by Pearson correlation and multiple linear regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of appendicular lean mass (ALM) for postmenopausal OP.

Pearson correlation analysis showed that adipose mass, total body muscle mass, trunk muscle mass and ALM were positively correlated with BMD of lumbar spine, femoral neck and total hip in premenopausal, postmenopausal and overall women (P<0.05) .Multiple linear regression analysis showed that total body muscle mass and trunk muscle mass were the influencing factors of femoral neck BMD in overall female (β=-0.051, 0.099, P<0.05) , ALM was an influencing factor of BMD of lumbar spine, femoral neck and total hip in overall female (β=0.244, 0.199, 0.199, P<0.05) ; total body muscle mass was an influencing factor for BMD of femoral neck and total hip in postmenopausal women (β=-0.125, -0.075, P<0.05) . Trunk muscle mass was an influencing factor for BMD of femoral neck in postmenopausal women (β=0.150, P<0.05) . ALM was the influencing factor for BMD of lumbar spine, femoral neck and total hip in postmenopausal women (β=0.226, 0.216, 0.188, P<0.05) . ROC curve analysis showed that the AUC of ALM for predicting OP of total hip in postmenopausal women was 0.825〔95%CI (0.742, 0.908) 〕, with 81.82% sensitivity and 76.59% specificity when the cut-off value was 16.24 kg. The AUC of ALM for predicting OP of femoral neck in postmenopausal women was 0.760〔95%CI (0.692, 0.829) 〕, with 75.61% sensitivity and 61.89% specificity when the cut-off value was 16.68 kg. The AUC of ALM for predicting OP of lumbar spine in postmenopausal women was 0.641〔95%CI (0.603, 0.679) 〕, with 60.85% sensitivity and 60.17% specificity, when the cut-off value was 17.20 kg. The best site of ALM for predicting OP in postmenopausal women was the total hip (Z_{femoral neck}=-9.89, P<0.05) .

ALM is positively correlated with BMD of lumbar spine, femoral neck and total hip in postmenopausal women. ALM can predict the occurrence of OP at different body parts of postmenopausal women, of which the optimal site of prediction for OP is the total hip.

The diagnostic gold standard for myelodysplastic syndrome (MDS) is based on bone marrow morphology, progenitor cell count and cytogenetics. But the dysplasia is not specific for MDS. In the context of poor quality of bone marrow smear, very mildmorbid hematopoiesis, insignificant increase in blasts, especially a normal karyotype, the diagnosis of MDS is often challenging. Multiparameter flow cytometry has become a key tool for the diagnosis of MDS. Some studies have shown that integrated flow cytometric score (iFS) is the best scoring system for MDS diagnosis, but its use has not been reported in Chinese population.

To assess diagnostic and prognostic values of iFS in MDS to demine whether it is an appropriate flow cytometry scoring system for clinical diagnosis and prognosise valuation of MDS.

The immunophenotype data of 83 patients with MDS and 77 patients with non-MDS treated in Department of Hematology, the Affiliated People's Hospital of Ningbo University between January 2019 and April 2022 were analyzed retrospectively. Low-grade MDS was defined as less than 5% blasts in bone marrow, including MDS with single lineage dysplasia, MDS with multilineage dysplasia, MDS with ring sideroblasts, MDS, unclassifiable, and MDS with isolated del (5q). The results of chromosome karyotype and bone marrow morphology of MDS patients were collected. The probability of phenotypeabnormalities in each cell lineinterpreted according to the iFS was compared between MDS and non-MDS patients. ROC analysis was conducted to assess the performance of iFS and Ogata score in diagnosing MDS, with sensitivity, specificity and the area under the ROC curve (AUC) calculated. In the MDS group, the Spearman's rank correlation was adopted to analyze the correlation of iFS grade with cytogenetic risk category and Revised International Prognostic Scoring System (IPSS-R). The event-free survival curve was plotted by the Kaplan-Meier method and compared between MDS patients diagnosed by the iFS and the other MDS patients by Log-rank test.

MDS group had higher prevalence of phenotype abnormalities of myeloid progenitors (71.1% vs 1.3%), granulocytes/monocytes (73.5% vs 18.8%) and erythrocytes (60.2% vs 14.2%) than non-MDS group (P<0.05). The specificity and sensitivity of iFS for the diagnosis of MDS was 93.5% and 81.9%, with an AUC of 0.921〔95%CI (0.876, 0.967) 〕. And its sensitivities in diagnosing low-grade MDS and low-grade MDS with normal karyotype were 66.7% and 65.0%, respectively. The iFS grade was positively correlated with IPSS-R (r_s=0.411, P<0.05). The event-free survival of MDS patients diagnosed by the iFS was shorter than that of the other MDS patients (χ²=5.71, P<0.05) .

The iFS may compensate for morphological and cytogenetic limitations, effectively diagnose MDS and assess its prognosis, and provide clinicians with diagnostic and prognostic information on MDS.

Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) are jointly known as PGAD/GPD, which is a newly discovered condition in recent years, featured by spontaneous or secondary persistent genital arousal and/or dysesthesia in the genital and pelvic areas. PGAD/GPD mainly affects women, which can seriously influence the physical and mental health of the sufferers due to the specificity of its symptoms. Most patients have anxiety, depression, and even the suicidal tendency. The medical community abroad has paid attention to PGAD/GPD, and included it in the International Classification of Diseases-11th Revision (ICD-11) . Given the fact that this newly discovered condition is under-recognized among domestic health providers at present, we summarized the current research on PGAD/GPD abroad and introduced the epidemiological characteristics, pathophysiological mechanisms, diagnosis and treatment methods of PGAD/GPD based on the review of the latest expert consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) , and discussed the future research direction of PGAD/GPD and the coping strategies that should be taken by the domestic medical community, with a view to arousing medical workers' attention to the disease in China.

Multiple myeloma (MM) is a common hematologic malignancy. With the emergence of a variety of new drugs, the survival rates of patients have increased, however, further discussion on how to achieve deeper and faster remission and reduce recurrence of patients is still needed.

To investigate the efficacy and safety of daratumumab in the chemotherapy of MM.

73 MM patients treated with daletumab in Sichuan Provincial People's Hospital from January 2020 to July 2022 were included as study subjects. Baseline information of the included patients were collected through the electronic medical record system. All patients were treated with daletumab based regimen and followed up through outpatient and inpatient review and telephone once a month when it is not time for review, with the time of first use of darettuzumab since 2020-01-01 as the starting point, death, disease recurrence or end of follow-up as the ending point. Follow-up was up to 2022-07-31 with a median follow-up time of 6.5 (0.5, 26.5) months. Overall response rate (ORR) and complete response rate were used to evaluate the efficacy of the patients. Kaplan-Meier curves were plotted for different drug use, initial renal function, drug administration, cytogenetic risk stratification and M protein types, and compared by Log-rank test.

The median age of the patients was 64 (30, 86) years, including 38 males and 35 females. 28 MM patients were treated with first-line darettuzumab, 13 were switched from other regiments to darettuzumab due to adverse reactions, and 32 patients had relapsed and refractory multiple myeloma (RRMM). 18 patients were lost during follow-up, and a total of 55 patients were available for efficacy assessment. After one course of treatment with the darettuzumab-based chemotherapy regimen, ORR was 72.7% with the complete response rate of 30.9%, including 3.6% (2/55) achieved strin-gent complete response (sCR) and 27.3% (15/55) achieved complete response (CR), 10.9% (6/55) achieved very good partial response (VGPR), 30.9% (17/55) achieved partial response (PR), 9.1% (5/55) achieved minimal response (MR), 12.7% (7/55) achieved stable disease (SD), and 5.5% (3/55) achieved disease progression (PD). The median progress free survival (PFS) of the patients was 6.0 (0.5, 26.5) months, and the median overall survival was 16 (3, 103) months. There was no statistically significant difference in the PFS survival curve between patients treated first-line with darettuzumab and RRMM patients (χ²=3.676, P=0.055). The difference of PFS survival curve between patients with normal and impaired renal function was statistically significant (χ²=12.51, P=0.004). There was a statistically significant difference in the survival curve of patients treated with daletumab + bortezomib + dexamethasone and those treated with daletumab + dexamethasone (χ²=6.691, P=0.009). There was no statistically significant difference in PFS survival curves between patients with non-high risk and high-risk cytogenetic classification (χ²=0.328, P=0.567). There was no statistically significant difference in PFS survival curves among patients with M protein types of IgA, IgG, IgD, light chain, double clone and non-secretory (P>0.05). The main adverse reactions of the patients were infusion reaction and myelosuppression, of which 21 patients had adverse infusion reactions at the first infusion, 21 patients had leukopenia, 40 patients had anemia and 16 patients had thrombocytopenia.

Darettuzumab has good curative effect in MM patients, which can be used as the first-line treatment for newly diagnosed patients, improve the clinical prognosis of RRMM patients, and prolong the survival time of patients.

Diabetes and osteoporosis are common diseases in middle-aged and elderly people. Diabetes can lead to various acute and chronic complications, but its related bone changes are often neglected. Osteoporosis is more common in postmenopausal women, and those with type 2 diabetes mellitus (T2DM) have multiple risk factors for osteoporosis. Therefore, it is particularly important to early identify risk factors of osteoporosis in these women, and to provide them with targeted interventions.

To explore the associated factors of osteoporosis in Chinese postmenopausal women with T2DM through a meta-analysis.

In July 2021, databases of China National Knowledge Infrastructure, CQVIP, WanFang Data, SinoMed, PubMed, EmBase, and the Cochrane Library were searched for literature about factors associated with osteoporosis in Chinese postmenopausal women with T2DM from inception to July 2021. Two researchers independently screened literature and extracted data. RevMan 5.4 and Stata 15.0 were used to conduct a meta-analysis on the data.

Twenty-one studies were finally included, from which 11 osteoporosis-related factors were extracted. The meta-analysis showed that age〔MD (95%CI) =6.56 (5.24, 7.88) 〕, years of postmenopause〔MD (95%CI) =5.93 (4.23, 7.62) 〕, duration of diabetes〔MD (95%CI) =1.94 (0.89, 2.98) 〕, body mass index〔MD (95%CI) =-1.99 (-2.63, -1.36) 〕, serum calcium〔MD (95%CI) =0.03 (0.01, 0.06) 〕, fasting blood glucose〔MD (95%CI) =0.49 (0.09, 0.90) 〕, glycosylated hemoglobin〔MD (95%CI) =0.37 (0.02, 0.71) 〕, and fasting insulin〔MD (95%CI) =3.65 (1.24, 6.06) 〕 were associated factors for osteoporosis in postmenopausal women with T2DM. But no significant association was found between osteoporosis and serum creatinine〔MD (95%CI) =4.02 (0.00, 8.04) 〕, serum phosphorus〔MD (95%CI) =0.00 (-0.05, 0.05) 〕, or serum alkaline phosphatase〔MD (95%CI) =1.26 (-0.06, 2.57) 〕 in these women. Sensitivity analysis revealed that the association of all the above-mentioned factors (except for serum creatinine) with osteoporosis was relatively robust.

Older age, long years of postmenopause, long duration of T2DM, low levels of BMI and serum calcium, and high levels of fasting insulin, fasting blood glucose, and glycosylated hemoglobin are risk factors for osteoporosis in Chinese postmenopausal women with T2DM. But the effects of serum creatinine, phosphorus, and alkaline phosphatase on osteoporosis in this group need to be further verified.

As a chronic age-related disease known as "silent killer" in medical academic circle, osteoporosis is manifested by slow and insidious development, and obvious age-related physiological changes in muscle, bone and fat. There are few studies on the relationship of osteoporosis with muscle, bone, and fat indices.

To assess the relationship of osteoporosis with muscle, bone, and fat indices.

A total of 108 patients with primary osteoporosis were recruited from the Third Affiliated Hospital of Guangzhou University of Chinese Medicine according to the inclusion and exclusion criteria from July 19, 2019 to January 5, 2021. Data were collected, including general data (height, weight and BMI) , T-score, fat mass, muscle mass and bone mineral content measured by the dual-energy X-ray absorptiometry, bone formation indices, such as serum calcium, bone morphogenetic protein-2 (BMP2) and osteoproteintin (OPG) detected by ELISA. Height, weight, BMI, T-score, fat mass, muscle mass, fat percentage and bone mineral content were compared across three age groups. Fat mass, muscle mass, fat percentage, bone mineral contents and bone formation indices were compared across normal group (T-score≥-1.0, n=20) , bone loss group (-2.5<T-score<-1.0, n=38) and osteoporosis group (T-score ≤-2.5, n=50) divided by the T-score.

The T-score varied significantly in three age groups of 49-58, 59-68, and≥69 (P<0.05) , and it was the highest in the 49-58 age group (P<0.01) . Compared with the normal group, bone loss group had decreased bone mineral content, while osteoporosis group had decreased fat mass and bone mineral content (P<0.05) . Compared with the bone loss group, both the muscle mass and bone mineral content in the osteoporosis group were decreased (P<0.05) . Compared with normal group, a significant decrease was found in OPG and BMP2 in osteoporosis group, and in BMP2 in bone loss group (P<0.05) . Compared with bone loss group, a significant decrease was found in OPG and BCL2 in osteoporosis group (P<0.05) .

The abnormality in dynamic balance between muscular and skeletal systems and adipose tissue is closely related to the pathogenesis of osteoporosis. Bone mineral density decreases with age, decrease in serum BMP2, OPG and Bcl2 levels may be related to the failure of apoptosis-regulatory proteins to play a good role in anti-apoptosis and promoting bone formation, resulting in the decrease of osteoblast activity and the weakening of bone formation activity.

With the change of people's environment and diet structure, acute gouty arthritis (AGA) has become a common clinical disease, which is prone to recurrence, causing harm to patients' health. Pricking-bloodletting therapy combined with Zhuang-medicine-thread moxibustion (moxibustion with a threat prepared with Zhuang herbal medicine) has proven to have a definite therapeutic effect on AGA clinically, but the mechanism of action is not very clear.

To assess the effect of pricking-bloodletting therapy combined with Zhuang-medicine-thread moxibustion on toll-like receptors /myeloid differentiation factor 88 (TLRs/MyD88) signal pathway in a rat model of AGA to explore the mechanism of action of this treatment in AGA.

The experiment lasted from May 2021 to March 2022, sixty SD rats were equally randomized into 6 groups: blank group, model group, pricking-bloodletting group, medicated thread group, colchicine group and pricking-bloodletting with medicated thread group. Except for the blank group, the other groups received sodium urate suspension injected into the right ankle cavity to prepare the AGA model. Twenty-four hours after the modelling, colchicine group received intragastric administration of colchicine suspension, pricking-bloodletting group received bloodletting after pricking the Ashi acupoint with a needle, medicated thread group received Zhuang-medicine-thread moxibustion at the site of lesion, and pricking-bloodletting with medicated thread group first received bloodletting after pricking the Ashi acupoint with a needle, then Zhuang-medicine-thread moxibustion at the site of lesion. The swelling degree of the right ankle joint was observed at 6, 12, 24 h and 72 h after modeling. Hematoxylin-eosin staining was used to observe the pathological changes of the synovium of the right ankle joint. The serum levels of interleukin (IL) -10, IL-8 and cyclooxygenase-2 (COX-2) were determined by ELISA. The expressions of MyD88 and IKK-β in the synovium of the right ankle were detected by western blotting.

The transverse diameter of right lateral malleolus in model group, pricking-bloodletting group, medicated thread group or colchicine group was larger than that in blank group at 6, 12, 24, 48 h and 72 h after modeling (P<0.05). The transverse diameter of right lateral malleolus in pricking-bloodletting with medicated thread group was larger than that in blank group at 6, 12, 24 h and 48 h after modeling (P<0.05). The transverse diameter of the right lateral malleolus of the pricking-bloodletting group, medicated thread group, colchicine group or pricking-bloodletting with medicated thread group was smaller than that of the model group at 48 h and 72 h after modeling (P<0.05). Compared with model group, the inflammatory cell infiltration of right ankle in pricking-bloodletting group, medicated thread group, colchicine group and pricking-bloodletting with medicated thread group was improved. The blank group had lower levels of IL-8 and COX-2 and higher level of IL-10 than each of the other 5 groups (P<0.05). The model group had higher levels of IL-8 and COX-2 and lower level of IL-10 than colchicine group, pricking-bloodletting with medicated thread group, pricking-bloodletting group or medicated thread group (P<0.05). The colchicine group had lower levels of IL-8 and COX-2 and higher level of IL-10 than pricking-bloodletting group or medicated thread group (P<0.05). The pricking-bloodletting with medicated thread group had lower levels of IL-8 and COX-2 and higher level of IL-10 than pricking-bloodletting group or medicated thread group (P<0.05). The blank group had lower level of MyD88 than each of the other 5 groups (P<0.05). The blank group had lower level of IKK-β than model group, medicated thread group, pricking-bloodletting group or pricking-bloodletting with medicated thread group (P<0.05). The model group had higher IKK-β level than medicated thread group or colchicine group (P<0.05). The model group had higher MyD8 level than medicated thread group, colchicine group, pricking-bloodletting group or pricking-bloodletting with medicated thread group (P<0.05) .

Pricking-bloodletting with Zhuang-medicine-thread moxibustion is effective in improving the symptoms of AGA by regulating the TLRs/MyD88 signaling pathway, which may be a potential alternative therapy for AGA.

Musculoskeletal disorders are one of the most prevalent chronic diseases around the world. Additionally, they contribute significantly to the global burden of disease. Tuina manipulation played a crucial role in treating musculoskeletal diseases from ancient times to the present. However, there are no systematic investigations on the efficacy characteristics of Tuina manipulation for alleviating musculoskeletal pain.

To objective of the study was to investigate the factors that have an influence on the effectiveness of Tuina manipulation in treating musculoskeletal pain.

In October 2021, we interviewed physicians from Beijing's Tuina Department using the purpose sampling method and the snowball sampling strategy. Interviews were carried out following a semi-structured format to determine the factors influencing Tuina manipulation for musculoskeletal pain. In accordance with the study's aims, the interview outline was drafted and discussed with the research group, and the interview was ended when saturation of information had been reached. To develop a theoretical model, the interview content is organized into text using three-level coding and rooted theory using the qualitative analysis software NVivo 11.

A total of 16 interviewees were interviewed effectively. The interviews were open coded to obtain 21 initial categories. And The 21 initial categories were summarized into five main categories: "health care providers" "patients" "medical environment" "regional divergence" and "advantages of disease" . In addition to selective coding, the factors of musculoskeletal pain are summarized as the intrinsic factors of "people" ( "health care provider" and "patients" ) , the external factors of "environment" ( "medical environment" and "regional divergence" ) , and the causative factors of "disease" ( "advantages of disease" ) . By combing these factors with Tuina manipulation, it becomes a tree-like model of influencing factors in the treatment of musculoskeletal pain.

The factors affecting the treatment of musculoskeletal pain by Tuina manipulation are composed of three factors: the internal factors of "people" , the external factors of "environment" and the causative factors of "diseases" . "Health care providers" constitute the most critical factors, as their diagnosis, treatment plan, and technical level significantly affect the final result of treatment. The patient's compliance is largely a secondary factor, while external factors indicate that good doctor-patient communication leads to success. From the causative factors of "disease" , it can be seen that Tuina has a more prominent effect in the treatment of musculoskeletal diseases.

Exercise is one of inexpensive and effective interventions for the prevention and treatment of postmenopausal osteoporosis, but relevant pieces of evidence are wide-ranging and fragmented, and there is no standardized and comprehensive exercise guidance program on clinic.

To screen and assess the evidence of exercise interventions for postmenopausal osteoporosis, then summarize the best pieces.

We systematically searched clinical practice guidelines, clinical decisions, evidence summaries, expert consensuses and systematic reviews regarding exercise interventions for postmenopausal osteoporosis in databases of BMJ Best Practice, Up To Date, DynaMed, National Institute for Health and Care Excellence, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, webs of Registered Nurses' Association of Ontario, International Osteoporosis Foundation, Royal Osteoporosis Society, National Osteoporosis Foundation, Royal Australian College of General Practitioners, American College of Obstetricians and Gynecologists, Society of Obstetrics and Gynaecologists of Canada, Medlive, JBI, Cochrane Library, CINAHL, Web of Science, PubMed, Embase, CNKI and SinoMed from inception to January 2022. All relevant evidence was summarized and extracted according to the theme. Appraisal of Guidelines for Research and Evaluation (AGREEⅡ) was used to evaluate the quality of the guidelines, Critical Appraisal for Summaries of Evidence (CASE) was used to evaluate the quality of clinical decisions, the authenticity assessment tool of the expert consensus of the JBI Evidence-Based Health Care Center in Australia (2016 edition) was used to evaluate the quality of expert consensuses, the Australian JBI Evidence-based Health Care Centre System Evaluation Methodology Quality Evaluation Tool (2016 edition) was used to evaluate the quality of the systematic reviews.

A total of 18 studies were included, including seven guidelines, two clinical decisions, four expert consensuses and five systematic reviews. Twenty-two pieces of evidence were extracted, involving five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions.

This paper extracts the best evidence of exercise intervention for postmenopausal osteoporosis patients from five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions. To reduce the risks of falls and fractures and improve quality of life in postmenopausal women with osteoporosis, it is suggested to provide these women with rational exercise guidance developed based on the best evidence.

The association of sedentary behavior and physical activity with bone mineral density (BMD) in Chinese population has been rarely studied in China, and also seldom studied in Asian populations (mainly limited in young children) by foreign countries. Considering there are great discrepancies between foreign populations and Chinese populations in genetics, dietary habits and other aspects, it is necessary to carry out relevant research in China.

To assess the association of sedentary behavior and physical activity with calcaneal BMD in college students, offering a reference for understanding the bone health status of college students, and for preventing osteoporosis in middle-aged and old people.

By use of stratified cluster sampling, 781 college students aged 19-25 years (including 518 females and 263 males) of different grades were selected from a medical university in Guangzhou from January 2021 to March 2022. Demographic and anthropometric characteristics (including sex, age, height, weight, fat mass index and fat free mass index) and lifestyle information (including daily sedentary time, time spent on physical activity in one week, frequency of dairy products, carbonated drinks and tea consumption, calcium supplement, smoking status, alcohol use status) were collected. Calcaneal BMD was measured, and compared across college students by physique and lifestyle. Multiple linear regression and binary Logistic regression were used to investigate the association of sedentary behaviors and physical activity with calcaneal BMD.

The prevalence of normal and abnormal calcaneal BMD in all students was 50.3% and 49.7%, respectively. The prevalence of abnormal calcaneal BMD in female college students (59.4%) is higher than that in male college students (30.4%) (χ²=58.849, P<0.001). The prevalence of abnormal calcaneal BMD varied by daily sedentary time and time spent on physical activity in one week in female students (χ²=6.670, 6.559, P<0.05). After controlling for potential confounders, multiple linear regression analysis and test for trend showed that in female students, the T-score value of calcaneal BMD increased with the decrease of daily sedentary time (β=-0.17), and there was an obvious negative linear trend between them (P_trend=0.011). And the T-score value of calcaneal BMD increased with the increase of time spent on physical activity in one week (β=0.15), and there was an obvious positive linear trend between them (P_trend=0.004). Further analysis based on binary Logistic regression models showed that in female students, sedentary time <4 hours per day was associated with lower risk of abnormal calcaneal BMD compared with sedentary time >8 hours per day〔OR=0.17, 95%CI (0.04, 0.68), P<0.05〕, and 90-150 minutes of physical activity in one week was associated with lower risk of abnormal calcaneal BMD compared with less than 90 minutes of physical activity in one week〔OR=0.66, 95%CI (0.44, 1.00), P<0.05〕.

The prevalence of abnormal calcaneal BMD in female college students is higher than that in male college students. Both sedentary behavior and physical activity are associated with calcaneal BMD in female college students, no correlation found among male college students. Daily duration of sedentary behavior <4 hours and 90-150 minutes of physical activity in one week are associated with lower risk of abnormal calcaneal BMD. Furthermore, the shorter time spent on daily sedentary behaviors, the lower the risk of abnormal BMD.

Osteoporosis (OP) and lumbar disc herniation (LDH) are two common orthopedic diseases encountered clinically, which are closely related and often coexisted, causing great suffering to middle-aged and elderly people along with the accelerated process of population aging.

To perform a cross-sectional survey on the prevalence and associated factors of LDH in OP in community-dwelling middle-aged and elderly people in Beijing, providing a reference for clinical prevention and treatment of this disease.

From November 2017 to July 2018, 1 540 residents with complete demographics and bone mass measurement data who lived in 10 communities in Chaoyang District and Fengtai District of Beijing were selected. A survey was conducted with the residents for understanding their data collected on-site, including demographics, fracture history, fall history, history of hereditary disease, bone mineral density, EuroQol Health Utility score, then those with OP were further selected and divided into two groups by the prevalence of LDH. Multivariate Logistic regression analysis was used to explore the influencing factors of LDH in OP.

A total of 521 cases of OP attended the survey, except for one with missing information of LDH, the other 520 cases (80 with LDH, and 440 without LDH) were included for final analysis. Multivariate Logistic regression analysis indicated that after controlling for age and BMI, falls〔OR=1.96, 95%CI (1.02, 3.78) , P=0.044〕, fracture〔OR=1.80, 95%CI (1.04, 3.12) , P=0.035〕and pain/discomfort〔OR=2.43, 95%CI (1.41, 4.18) , P=0.001〕were independently associated with LDH in OP.

The coexistence of LDH and OP was common in this population. Falls, fractures, and pain/discomfort may be influencing factors of LDH in OP.

Osteoarthritis has a high rate of disability and deformity, and can be combined with several physical and mental diseases. However, the early symptoms of the disease are not obvious. At present, there are problems in the management of osteoarthritis in the community such as uncoordinated management, inadequate methods and imperfect systems.

To construct and evaluate an informatics-based multidisciplinary management model for osteoarthritis patients in community, to promote the management of community osteoarthritis patients and improve the prognosis of the patients.

First a multidisciplinary management model of osteoarthritis patients in the community was constructed, including hierarchical management process of patients based on risk factor stratification, the multidisciplinary management team and its division of diagnosis and treatment, then an informatics based multidisciplinary management process was constructed, and information software development was completed. From July 2019 to July 2020, 80 patients with knee osteoarthritis who attended the general outpatient clinics of Dinghai and Daqiao Community Health Service Centers in Shanghai, and the orthopedics outpatient clinics of Yangpu District Central Hospital were randomly assigned into multidisciplinary management groups and general management group, with 40 patients in each group. The patients in general group were given conventional treatment, while the patients in multidisciplinary group were adopted information-based multidisciplinary management. Visual analogue scale (VAS) scores, Western Ontario McMaster University (WOMAC) osteoarthritis index score, the simplified scale of Arthritis Quality Of Life Measurement Scale (AIMS2) scores, Health Literacy Management Scale (HeLMS) scores, and body mass index (BMI) were assessed before and after 12 weeks of management, respectively.

Before treatment, there were no significant differences in VAS score, WOMAC osteoarthritis index score, AIMS2 score, Helms score, and BMI between patients with knee osteoarthritis in the multidisciplinary and general groups (P>0.05) . After 12 weeks of treatment, the VAS and WOMAC score of both the multidisciplinary and general groups went down, and the health literacy AIMS2 scores and Helms total score were higher after treatment than those before. The difference was statistically significant (P<0.05) . After 12 weeks of treatment, the AIMS2 total score and Helms total score of patients in the multidisciplinary group were higher than those in the general group, and the VAS score, WOMAC osteoarthritis index, and BMI were lower than those in the general group, with significant differences (P<0.05) .

The implementation of an informatics based community multidisciplinary management model for patients with osteoarthritis of the knee can effectively reduce the patients' joint pain and control their weight, improve their ability of daily living and health literacy, improve the quality of life of patients, and delay the progress of the disease.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with bone metabolism in Western population. Chinese population manifest different development progress of OSAHS and bone metabolism owing to their own specific physiological characteristics compared to the Western population. Although the association between OSAHS and bone metabolism may be confounded by underlying diseases, the association between them among healthy Chinese people remains unknown.

To examine the relationship between OSAHS and bone metabolism in Chinese people without underlying conditions using a review and Meta-analysis, providing evidence for improving bone health.

This review was conducted following the PRISMA guidelines. Electronic databases, such as PubMed, Embase, and CINAHL, were searched from inception to December 2020 for studies regarding bone metabolism and OSAHS in Chinese adults (aged≥18 years) in which those with and without OSAHS were classified as OSAHS and control groups, respectively (OSAHS was diagnosed based on the Guidelines for the Diagnosis and Management of Obstructive Sleep Apnea Hypopnea Syndrome) . Outcome indicators include one or more bone metabolism indicators. Three researchers independently performed literature screening and data extraction. Two researchers independently performed the quality appraisal using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Data were analyzed using Stata 15.1.

Ten studies were included, with a total of 898 participants, and 653 of whom had OSAHS. Nine were cross-sectional studies and one was a quasi-experimental study. According to the JBI quality assessment tool, the nine cross-sectional studies were of high quality on items 1 to 5, and 4 of which did not control for the confounding factors. Based on the Meta-analysis, compared to the control group, OSAHS group had lower lumbar BMD 〔SMD (95%CI) =-1.758 (-2.300, -1.217) 〕, lower femoral neck BMD〔SMD (95%CI) =-1.260 (-1.949, -0.571) 〕, higher β-CTX〔SMD (95%CI) =0.803 (0.122, 1.484) 〕, and higher P1NP〔SMD (95%CI) =0.820 (0.318, 1.321) 〕. Apnea-hypopnea index had a negative correlation with lumbar BMD〔r (95%CI) =-0.36 (-0.57, -0.12) 〕 and positive correlations with β-CTX〔r (95%CI) =0.39 (0.29, 0.47) 〕and P1NP〔r (95%CI) =0.36 (0.16, 0.53) 〕.

Among Chinese adults without underlying conditions, OSAHS may reduce BMD by increasing bone resorption, thereby elevating the risk of osteoporosis or fractures.