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.

Adolescent idiopathic scoliosis (AIS) is becoming increasingly common in clinical settings, imposing a heavy burden on the family and society. At present, few treatments are available with fair effects for AIS, and there is a lack of unified and effective treatment schemes for AIS.

To explore the effect of Schroth therapy with bonesetting massage in AIS.

Forty adolescent AIS patients treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to December 2020 were selected, and equally randomly divided into treatment group and control group, 20 cases in each group. Both groups received bone setting massage once a week, and the treatment group additionally received Schroth therapy, 90 minutes per time, 3 times per week. The treatment for both groups lasted for 6 months. Pre- and post-treatment Cobb angle and angle of trunk rotation (ATR) as well as clinical efficacy were compared between the two groups.

The Cobb angle after treatment was smaller than that before treatment in both groups (P<0.05). And the treatment group had a smaller post-treatment Cobb angle than the control group (P<0.05). ATR decreased after treatment in both groups (P<0.05), and it decreased more obviously in the treatment group (P<0.05). The response rate for either control group or treatment group was 95.0% (19/20) but the marked response rate was higher in the treatment group〔85.0% (17/20) vs. 30.0% (6/20) 〕 (P<0.001) .

Compared with bonesetting massage alone, Schroth therapy with bonesetting massage had better effect on improving the Cobb angle and ATR in AIS patients, so the combination therapy is recommended for clinical use.

The prevalence of hip fractures is increasing due to increased number of aging people and availability of modern transportation. Elderly patients with hip fracture tend to have many basic diseases and poor prognosis, with 1-year postoperative mortality as high as 15%-25%. Timely screening of those at high risk of hip fractures with predictive tools and providing them with interventions can improve the prognosis. But there are rare studies and no appropriate objective indicators regarding predicted 1-year postoperative mortality in older hip fracture patients.

To assess the predictive association of Controlling Nutritional Status (CONUT) score and other possible associated factors for 1-year postoperative mortality in elderly patients with hip fracture.

A total of 399 patients with unilateral hip fracture (including femoral neck and intertrochanteric fractures) hospitalized in Xuanwu Hospital Capital Medical University from January 2013 to March 2016 were selected. General data, routine blood test results, biochemical and coagulation indices, and calculated CONUT score, geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR) were collected. All the patients received internal fixation or femoral head replacement procedure, and 1-year postoperative clinic- and telephone-based follow-up with death as an endpoint. Multivariate Logistic regression was used to identify influencing factors of 1-year postoperative mortality. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of CONUT score for 1-year postoperative mortality.

Among the 399 patients, 47 died and 352 survived at the end of follow-up. Multivariate Logistic regression analysis found that age〔OR=1.093, 95%CI (1.040, 1.148) 〕, old cerebral infarction〔OR=0.353, 95%CI (0.169, 0.737) 〕, serum creatinine〔OR=1.006, 95%CI (1.002, 1.010) 〕, CONUT score〔OR=1.261, 95%CI (1.005, 1.583) 〕 and NLR〔OR=1.049, 95%CI (1.003, 1.098) 〕 were associated with 1-year postoperative mortality (P<0.05). In predicting 1-year postoperative mortality, the area under the curve of CONUT score was 0.681〔95%CI (0.590, 0.771) 〕 with 4.5 as the optimal cutoff point, 48.9% sensitivity and 83.5% specificity. The area under the curve of NLR was 0.611〔95%CI (0.523, 0.699) 〕, with 7.055 μg/L as the optimal cutoff point, and 47.8% sensitivity and 75.9% specificity.

Age, old cerebral infarction, serum creatinine, CONUT score and NLR were associated with 1-year postoperative mortality in elderly patients with hip fracture. Preoperative CONUT score greater than 5 may be associated with worse postoperative nutritional status and higher risk of death. The CONUT score could be used for postoperative risk assessment in these patients.

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.

China is seeing increasingly osteoporosis prevalence as ageing marches on. However, the specific etiology and pathogenesis of osteoporosis are still unclear, and there are still limitations in its prevention and treatment.

To investigate osteoporosis prevalence and associated factors in older Chinese patients with stable chronic conditions.

Three hundred and two elderly inpatients with stable chronic conditions who underwent a reexamination in Department of Geriatrics, Yunnan First People's Hospital from November 2020 to September 2021 were recruited. Dual-energy X-ray absorptiometry (DXA) was used to measure lumbar spine and hip bone mineral density (BMD) . T value ≤-2.5 was defined as osteoporosis. Demographic data were collected. Comprehensive geriatric assessment was conducted via a self-developed online platform named Comprehensive Geriatric Assessment. Fasting venous blood samples were collected and measured for serum biomarkers.

Among the patients, 126 (41.7%) were found with osteoporosis, and other 176 (58.3%) without. Binary Logistic regression analysis indicated that insomnia〔OR=2.180, 95%CI (1.080, 4.443) 〕, multiple chronic conditions〔OR=1.223, 95%CI (1.101, 1.358) 〕, elevated homocysteine〔OR=1.043, 95%CI (1.000, 1.088) 〕 were associated with increased risk of osteoporosis (P<0.05) , while elevated serum uric acid level〔OR=0.996, 95%CI (0.993, 0.999) 〕 was associated with decreased risk of osteoporosis (P<0.05) .

The prevalence of osteoporosis in these older patients with stable chronic conditions was 41.7%. The probability of osteoporosis may be decreased with elevated serum uric acid level, and increased with elevated homocysteine, insomnia and multiple chronic conditions.

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.

Appropriate and effective prevention and treatment of knee osteoarthritis (KOA) has become a challenge faced by medical institutions. Clinical evidence shows that both the royal TCM-based tendon-regulation manipulation and joint mobilization are effective for KOA, but there are few comparative studies of them in KOA.

To compare the similarities and differences between the royal TCM-based tendon-regulation manipulation and joint mobilization in the treatment of KOA, promoting the normalization and standardization of manipulative medicine worldwide.

From October 2020 to June 2021, 67 KOA patients who met the requirements were recruited from the Massage Department of Dongzhimen Hospital, Beijing University of Chinese Medicine. They were randomly divided into royal TCM-based tendon-regulation manipulation (n=33) and joint mobilization (n=34) . The two groups of patients received 10 treatments for 4 weeks, 4 cases fell off midway, and 63 patients were finally included. A mixed method of quantitative and qualitative analysis was adopted. Quantitative data collected were pre- and post-treatment assessment of the clinical responses in two groups with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) . Qualitative data were collected using semi-structured individual interviews conducted in the participants based on topics of the efficacies and assessment of the two treatments for KOA, and understanding of the massage therapy. The similarities and differences between the two treatments were compared, and analyzed using thematic analysis. Parallel comparison and joint display were used for integrative analysis of the mixed data.

Efficacy evaluation: there was no statistically significant difference in the total score of WOMAC between the two groups after 4 weeks of treatment (P>0.05) , the total scores of WOMAC in both groups were lower than those before treatment (P<0.05) . According to the interview, there were no significant differences in patient-assessed efficacies (positive, neutral or negative evaluation) between the two treatments. Besides that, patients' positive, neutral and negative perceptions of massage were basically the same before and after treatment, but after treatment, patients' perception of massage inclined to be positive. The results of quantitative analysis showed that the curative effect was not related to previous hospital treatment with massage therapy. The efficacy was also not related to the success of blinding. There was no significant correlation between the success of blinding and the type of treatment or previous massage treatment. Patients' perceptions of massage were not associated with the efficacy, and the type of treatment received by them. Manipulation evaluation: There were no significant differences in the two treatments assessed by patients in terms of strength, pain degree, manipulation characteristics, onset time of curative effect and number of times with the most obvious perceived curative effect after the first or fourth week of treatment.

Quantitative and qualitative studies show that both the royal TCM-based tendon-regulation manipulation and joint mobilization are safe and effective for KOA, and they have no significant differences in patient-assessed efficacy and manipulation skills, as well as patients' perceptions of them.

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.

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.

People with diabetes mellitus are at increased risk of developing osteoporosis (OP) , especially those with postmenopausal type 2 diabetes mellitus (T2DM) . Chronic inflammation plays an important role in the development of OP.

To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for OP in postmenopausal patients with T2DM.

Two hundred and sixteen postmenopausal T2DM patients who were hospitalized in the Department of Endocrinology and Metabolism, the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were chosen. Clinical data were obtained, including blood routine and biochemical parameters (such as blood lipids and so on) in fasting venous blood, calculated NLR and MHR, and bone mineral density (BMD) of lumbar spine L_1-4, left femoral neck and left hip measured by dual-energy X-ray absorptiometry (DXA) . According to the BMD, the patients were divided into normal bone mass group (n=51) , osteopenia group (n=78) and OP group (n=87) . In addition, they were divided into 4 groups according to NLR quartiles (A1 to A4 group) and MHR quartiles (B1 to B4 group) , with 54 cases in each. Spearman correlation was used to analyze the association of NLR and MHR with BMD at lumbar spine L_1-4, left femoral neck and left hip. Multivariate Logistic regression analysis was applied to explore the influencing factors of OP. Receiver operating curve (ROC) analysis was performed to evaluate the value of NLR, MHR and their combination in predicting OP.

NLR and MHR were increased in the osteopenia group than the normal bone mass group (P<0.05) . Compared with the normal bone mass group and the osteopenia group, NLR and MHR in the OP group were statistically significant increased (P<0.05) . Compared with A1 group, A3 group had decreased BMD at lumbar spine L_1-4, left femoral neck and left hip, so did A4 group (P<0.05) . A4 group had decreased BMD at lumbar spine L_1-4, and left hip than A2 group (P<0.05) . B1 group had higher BMD at lumbar spine L_1-4, left femoral neck and left hip than did B2, B3, and B4 groups (P<0.05) . B4 group had decreased BMD at lumbar spine L_1-4, left femoral neck and left hip than did B2 group (P<0.05) . B4 group also had decreased BMD at lumbar spine L_1-4 did B3 group (P<0.05) . Spearman correlation analysis showed that both NLR and MHR were negatively correlated with BMD at lumbar spine L_1-4, left femoral neck and left hip (P<0.001) . Multivariate Logistic regression analysis showed that long menopausal duration〔OR=1.092, 95%CI (1.005, 1.186) 〕, increased NLR〔OR=2.341, 95%CI (1.453, 3.770) 〕and increased MHR〔OR=329.250, 95%CI (21.421, 5 060.810) 〕were independently associated with elevated risk of OP, while high BMI〔OR=0.806, 95%CI (0.718, 0.903) 〕was associated with decreased risk of OP (P<0.05) . ROC analysis demonstrated that in predicting OP, the area under the curve (AUC) of NLR was 0.722, with 65.5% sensitivity and 72.1% specificity, and that of MHR was 0.709 with 52.9% sensitivity and 79.8% specificity, and that of NLR with MHR was 0.787, with 81.6% sensitivity and 67.4% specificity. The AUC of NLR with MHR was greater than that of NLR or MHR alone (Z=2.418, P<0.05; Z=2.893, P<0.05) .

Either NLR or MHR could be used as a predictor of OP in postmenopausal T2DM patients, and the predictive efficiency and sensitivity of the combination of them would be higher.

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.

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.

It is sometimes difficult to distinguish osteitis condensans ilii (OCI) from other diseases, and exploring biochemical markers of bone turnover may contribute to the differential diagnosis.

To evaluate the characteristic and significance of biochemical markers of bone turnover in patients with OCI.

Participants were retrospectively selected from Beijing Jishuitan Hospital from June 2013 to February 2022, including 61 female outpatients and inpatients with OCI {observation group: 15-50 years old〔mean age of (33.8±6.6) years〕, duration of OCI of two weeks to 15 years}, and 61 healthy female physical examinees{control group: 15-48 years old〔mean age of (35.6±7.6) years〕}. The clinical data and biochemical markers of bone turnover were compared between the two groups. The correlations of biochemical markers of bone turnover with OCI-related indices were analyzed.

The serum albumin of the observation group was significantly lower than that of the control group〔 (45.4±2.9) g/L vs (46.5±2.8) g/L〕 (t=2.190, P<0.05) . In terms of biochemical markers of bone turnover, the observation group had significantly lower serum β-isomerised carboxy-terminal cross-linking telopeptide of type 1 collagen (β-CTX) 〔0.28 (0.23, 0.37) μg/L vs 0.36 (0.29, 0.48) μg/L〕, N-terminal osteocalcin (OC) 〔13.1 (11.2, 16.2) μg/L vs 15.6 (13.7, 17.3) μg/L〕, and 25- (OH) VD₃ 〔 (14.1±5.1) μg/L vs (17.5±6.6) μg/L〕 than the control group (Z=-2.983, -3.255, t=3.081, P<0.05) . OCI patients with a longer disease duration had significantly higher serum OC〔14.6 (12.4, 18.5) μg/L vs 11.7 (10.2, 14.0) μg/L〕 than those with a shorter duration (Z=-2.407, P<0.05) . OCI patients with two or more pregnancies had significantly lower serum β-CTX〔0.25 (0.22, 0.32) μg/L vs 0.33 (0.26, 0.44) μg/L〕 and OC〔12.2 (10.3, 15.0) μg/L vs 13.4 (12.0, 18.8) μg/L〕 than those with no or one pregnancy (Z=-2.486, -1.897, P<0.05) . Correlation analysis showed that, in OCI patients, the procollagen type 1 N-terminal propeptide (tP1NP) was negatively correlated with the number of pregnancies and deliveries (r_s=-0.276, -0.298, P<0.05) . Serum OC level was negatively correlated with BMI, VAS score and the number of pregnancies (r_s=-0.284, -0.374, -0.360, P<0.05) . The serum 25- (OH) VD₃ level was positively correlated with BMI (r_s=0.275, P<0.05) .

The serum levels of OC and β-CTX in female patients with OCI were significantly lowered, which could be used for distinguishing OCI and other diseases. The serum level of OC may be a predictor of the severity of OCI, which was related to the number of pregnancies. The level of tP1NP was related to the number of pregnancies and deliveries.

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.

Postmenopausal osteoporosis (PMOP) has an increasing incidence as aging advances. As the traditional Chinese medicine (TCM) constitution theory is of great significance in guiding PMOP prevention and treatment, studying the associated factors of yang-deficiency constitution, a common imbalanced constitution in PMOP patients, will contribute to the development of personalized treatment of PMOP.

To perform an analysis of the distribution of TCM constitution and associated factors of yang-deficiency constitution in PMOP patients in the community.

From November 2017 to July 2018, an interviewer-administered questionnaire survey for screening PMOP was conducted with a random sample of residents (45-80 years old) from 10 communities of Beijing's Chaoyang and Fengtai Districts. The general data collected include age, age at menopause, retirement status, types of job (mental, physical, or both) , educational level, monthly household income, height, weight, body mass index (BMI) , grip strength-weight index, history of fractures, history of falls, family history of osteoporosis, nighttime sleep duration, habits of eating leftovers, diet type (meat-based, plant-based, or meat-plant based) . TCM constitution was analyzed using the TCM Constitution Questionnaire. The associated factors of yang-deficiency constitution in PMOP cases were analyzed by multivariate Logistic regression.

Four hundred and thirty-two cases were found with PMOP, four of them were excluded due to missing data of TCM constitution, and the other 428 cases were finally included. The residents with gentleness constitution numbered the most (n=175) . Among residents with biased constitution, those with yang-deficiency constitution numbered the most (n=107) . Through multivariate Logistic regression analysis, it was found that BMI<18.5 kg/m², frequently eating leftovers, and meat-based diet were associated with increased risk of PMOP in yang-deficiency residents (P<0.05) .

This cross-sectional survey indicates that yang-deficiency constitution may be highly prevalent in PMOP residents, and was associated with BMI<18.5 kg/m² often eating leftovers, and meat-based diet.

As life expectancy increases, the number of elderly patients with osteoporosis rises as well. Many factors affect the development of osteoporosis, and good physical fitness may contribute to having better social adaptability in older people. So it is very important to pay attention to osteoporosis and ensure physical fitness in this group.

To explore the factors associated with osteoporosis, and analyze physical fitness in elderly men, providing a theoretical basis for preventing osteoporosis, improving physical fitness and developing health management programs for this group.

This study was conducted from January 2018 to December 2020. A total of 250 elderly men who underwent bone mineral density (BMD) examination were selected from Health Management Center, Inner Mongolia People's Hospital, and divided into normal BMD, osteopenia and osteoporosis groups by BMD examination results. Data were collected, including baseline information, laboratory results, physical fitness test results〔 including muscular strength (number of elbow bending within 30 seconds, 30-second sit-to-stand test results) , flexibility (shoulder and arm stretches, sitting flexion test) , balance (stand on one foot with eyes closed) , aerobic capacity (2-minute step test) , agility/mobility (timed up go test with a minimal space of 2.5 meters) 〕.

Of the 250 subjects, 76 (30.4%) had normal BMD, 123 (49.2%) had osteopenia, and 51 (20.4%) had osteoporosis. Multivariate Logistic regression analysis demonstrated that abdomen circumference〔OR=0.710, 95%CI (0.566, 0.891) 〕, body mass index 〔OR=0.685, 95%CI (0.474, 0.990) 〕, high-density lipoprotein cholesterol〔OR=74.182, 95%CI (3.738, 1 472.125) 〕, 25 (OH) D₃〔OR=0.745, 95%CI (0.619, 0.897) 〕, and estradiol〔OR=0.784, 95%CI (0.665, 0.924) 〕were associated with osteoporosis in elderly men (P<0.05) . All the subjects successfully completed physical fitness tests, without adverse events. The number of repetitions of sit-to-stands within 30 seconds, results of shoulder and arm stretches, sitting flexion test, and 2-minute step test, duration for stand on one foot with eyes closed, as well as time used for timed up go test with a minimal space of 2.5 meters differed significantly across normal BMD, osteopenia and osteoporosis groups (P<0.05) . The number of elbow bending within 30 seconds showed no significant differences across the three groups (P>0.05) .

In elderly men, abdomen circumference, body mass index, high-density lipoprotein cholesterol, 25 (OH) D₃, and estradiol may independently associated with osteoporosis. Physical fitness indices varied significantly by BMD, especially flexibility, balance, aerobic capacity and agility/mobility.

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.

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.

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.

Multiple myeloma is a malignant disease in which plasma cells abnormally proliferate in the bone marrow. Most patients may experience relapse/refractory and drug resistance with an unsatisfactory prognosis. CD38 monoclonal antibodies have been reported to achieve durable remission in patients with relapsed and refractory multiple myeloma (RRMM) . Although phase Ⅱand Ⅲclinical trials of CD38 monoclonal antibodies for MM have been initiated, a meta-analysis of these trials is lacking.

To systematically assess the efficacy and safety of CD38 monoclonal antibodies in RRMM, providing a theoretical basis for clinical treatment of this disease.

Databases including SinoMed, CQVIP, CNKI, Wanfang Data, Web of Science, PubMed, EMBase, and Cochrane Library were searched for randomized controlled trials (RCTs) of CD38 monoclonal antibodies treating RRMM published from inception to November 2021. The experimental group: the CD38 monoclonal antibody and the compatible drug were applied; the control group: only the compatible drug or CD38 monoclonal antibody (no other drug compatibility) was used. Treatment efficacy was assessed using overall response rate (ORR) , progression-free survival (PFS) , ≥very good partial response (≥VGPR) , partial response (PR) , ≥complete remission (≥CR) , and minimal residual disease (MRD) . Treatment safety was assessed using non-hematological adverse events, ≥grade 3 non-hematological adverse events, and hematological adverse events. The Cochrane Collaboration's tool for assessing risk of bias was used for quality assessment. A Meta-analysis was performed using Review Manager 5.3 and Stata 15.0.

Eight RCTs were finally included, with a total of 2 821 patients (including 1 529 in the experimental group and 1 292 in the control group) . Meta-analysis showed that: in terms of efficacy, the experimental group had higher ORR, longer mean PFS, higher prevalence of≥VGPR, MRD and ≥CR than the control group〔RR=1.28, 95%CI (1.15, 1.43) , P<0.000 01; HR=0.49, 95%CI (0.39, 0.62) , P<0.000 01; RR=1.86, 95%CI (1.53, 2.27) , P<0.000 01; RR=5.28, 95%CI (2.80, 9.96) , P<0.001; RR=2.57, 95%CI (1.89, 3.50) , P<0.001〕. The experimental group also had lower prevalence of PR〔RR=0.67, 95%CI (0.53, 0.86) , P=0.002〕. In terms of safety, among the non-hematological adverse events occurred, the incidences of upper respiratory tract infection, pneumonia, bronchitis, diarrhea, and back pain in the experimental group were higher than those in the control group〔RR=1.55, 95%CI (1.36, 1.77) , P<0.001; RR=1.34, 95%CI (1.13, 1.59) , P<0.001; RR=1.64, 95%CI (1.07, 2.51) , P=0.02; RR=1.49, 95%CI (1.33, 1.68) , P<0.001; RR=1.29, 95%CI (1.07, 1.57) , P=0.009〕. Among the non-hematological adverse events of ≥grade 3, the incidences of upper respiratory tract infection, pneumonia, diarrhea, and fatigue in the experimental group were higher〔RR=1.99, 95%CI (1.15, 3.43) , P=0.01; RR=1.30, 95%CI (1.05, 1.62) , P=0.02; RR=2.44, 95%CI (1.58, 3.76) , P<0.001; RR=1.75, 95%CI (1.19, 2.56) , P=0.004〕. Among the hematological adverse events, the incidence of thrombocytopenia in the experimental group was also higher〔RR=1.10, 95%CI (1.01, 1.20) , P=0.02〕.

CD38 monoclonal antibodies may achieve good overall efficacy in RRMM, in particular, the PFS was significantly prolonged, although risks of treatment-emergent pulmonary infection, diarrhea, and thrombocytopenia may increase, the risks are controllable. To sum up, it is feasible to apply CD38 monoclonal antibodies for RRMM patient population, but be prepared to deal with high-risk complications.

Osteoarthritis is a common chronic disease in middle-aged and elderly people, which seriously affects their quality of life. Carrying out community-based management of osteoarthritis is conducive to the optimization of healthcare resource allocation and the improvement of the overall prevention and treatment level of osteoarthritis. However, current community-based management of osteoarthritis has many problems and is not effectively.

To perform a review and comparative analysis of the developments in foreign and domestic community-based management of osteoarthritis, and strategies addressing the existing problems, providing evidence for improving strategies regarding community-based management of osteoarthritis to improve the treatment and prognosis of osteoarthritis patients in China.

From October 2020 to January 2021, Studies related to osteoarthritis management in Chinese published from January 1, 2010 to January 1, 2020 were searched from databases of CNKI, Wanfang Data and CQVIP using "骨关节炎" plus "管理", "骨关节炎" plus "模式", "骨关节炎" plus "策略" as the search terms, and those in English published during the same period were searched from databases of PubMed, Web of Science, and the Cochrane Library using osteoarthritis and management, mode or strategy as the search terms. After excluding duplicates or those about self-management of osteoarthritis, the enrolled studies about community-based management of osteoarthritis were analyzed using systematic analysis.

Altogether, 2 695 studies were retrieved, 2 642 of them were excluded, and the other 53 were included. Five studies were about surveys on the management of osteoarthritis in the community, all of which revealed the lack of coordination and purpose in community-based management of osteoarthritis at home and abroad, and the key treatments are relieving symptoms, delaying cartilage degradation, and reducing the possibility of developing deformities, but the efficacies of such treatments were unsatisfactory, and symptoms often recurred. Moreover, community-based management modes of osteoarthritis in China were undiversified, mostly were various types of health education. Six studies proposed that the management of osteoarthritis in the community may be influenced by insufficient understanding of osteoarthritis in patients and their families, insufficient understanding and undervaluing of osteoarthritis in some primary care physicians, and uncoordinated healthcare resources, and put forward that a variety of factors led to the lack of coordination and purpose in the management of osteoarthritis in the community. There were three articles referring the significance of community-based osteoarthritis management, which highlighted that community-based osteoarthritis management could relieve pain, delay disease progression, and improve the quality of life in patients, and improve patients' satisfaction with treatment and services by healthcare professionals, as well as optimize the use of healthcare resources. There were 39 studies related to the strategies for community-based osteoarthritis management, 22 of which involved systematic management strategies, including 18 studies of multi-disciplinary or integrated management models and four studies of hierarchical management. As a whole, China's successful experience of managing diabetes and hypertension in the community has provided new ideas for the prevention and treatment of osteoarthritis, but most of the strategies were in the developmental stage, and their applications in practice needed further research. The remaining 17 studies involved various non-systematic community-based management strategies of osteoarthritis, including eight centering on health education, three focusing on internet-based management approaches, two involving telephone-based management, two focusing on non-drug management, and two focusing on written guidance.

There are problems in the community-based management strategies of osteoarthritis, including uncoordinated management, unsound methods, and imperfect systems. The referential community-based management strategies for osteoarthritis include: multidisciplinary or comprehensive management, hierarchical management and other systematic management strategies; making full use of medical techniques and tools (such as e-health, remote management, and health manuals) ; optimizing resource allocation (such as adding osteoarthritis management as a national essential public health project, and increasing government policy support for osteoarthritis management) .

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.

Osteoarthritis is a chronic disease commonly seen in community settings, and the management of which is associated with numerous inter-related factors. Due to lack of appropriate healthcare-seeking perceptions and behaviors in osteoarthritis patients, it is difficult to diagnose, treat and manage osteoarthritis.

To understand healthcare-seeking perceptions and behaviors in community-living osteoarthritis patients, providing evidence for improving the diagnosis and treatment of such patients in the community.

This was a mixed-methods study. From May to June 2019, interviews for understanding osteoarthritis patients' healthcare-seeking perceptions and behavior-related factors, as well as management were conducted with a purposive sample of five orthopedic physicians and five general practitioners (GPs) from a general hospital in a regional healthcare consortium in Shanghai's Yangpu District, and a convenience sample of 12 GPs and 12 osteoarthritis patients from six community health centers (CHCs) in the same consortium. Then from June 2019 to December 2020, 425 patients with osteoarthritis were chosen from three randomly selected CHCs of the above-mentioned six ones to attend a survey using a quantitative questionnaire developed based on the themes derived from the above-mentioned interviews (excluding some highly subjective and less quantifiable indicators) for understanding their socio-demographic information, disease status, healthcare-seeking perceptions and behaviors, self-management and utilization of the APP for chronic disease management. Binary Logistic regression was used to analyze the influencing factors of healthcare-seeking behaviors in patients with osteoarthritis.

The following themes were extracted from the interviews: patients' insufficient awareness of osteoarthritis, lack of management of osteoarthritis and influencing factors of patients' healthcare-seeking behavior. Three hundred and ninety-seven of the 425 cases (93.4%) who effectively completed the questionnaire were included for quantitative analysis. One hundred and fifty-two (38.3%) respondents understood osteoarthritis, and 79 (52.0%) of them acquired relevant knowledge from the media, and other 50 (32.9%) from ward-mates. Two hundred (50.4%) respondents knew the treatments for osteoarthritis, including 91 (45.5%) knowing exercise and physical therapies, and 105 (52.5%) knowing treatment with painkillers. The healthcare-seeking behaviors in osteoarthritis patients varied significantly by sex, BMI, pain level, impact of pain on sleep quality, and previous healthcare-seeking experience (P<0.05) . The results of regression analysis demonstrated that sex, BMI, pain level, previous treatment experience and impact of pain on sleep quality were associated with healthcare-seeking behavior (P<0.05) .

Community-living patients with osteoarthritis had insufficient awareness of healthcare-seeking and weak self-management awareness, and their healthcare-seeking behaviors were affected by multiple factors. To improve these patients' healthcare-seeking perceptions and behaviors, priority should be given to take actions to enhance patients' healthcare-seeking perceptions, train patients' self-management ability, better GPs' diagnostic and therapeutic skills, improve doctors and patients' negative attitude toward osteoarthritis treatment, and promote patients seeking healthcare actively.

The pain induced by degenerative knee osteoarthritis (KOA) is common in postmenopausal women, but there is a lack of clinical evidence on whether it has an association with decreased sex hormone levels and inflammatory cytokines in the synovial fluid.

To assess the associations of degenerative KOA pain with sex hormones in the serum 〔estradiol (E₂) , testosterone (T) , prolactin, luteinizing hormone (LH) , follicle-stimulating hormone (FSH) and progesterone (P) 〕, and inflammatory cytokines in synovial fluids 〔interleukin-1 (IL-1) , IL-6, IL-10 and tumor necrosis factor-α (TNF-α) 〕 in postmenopausal women, providing a novel basis for estrogen hormone treatment of pain induced by degenerative KOA.

Ninety postmenopausal women with pain induced by degenerative KOA were recruited from the Sixth Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2021, including 30 with mild pain (VAS score ≤ 3) , 30 with moderate pain (VAS score higher than 4 but lower than 7) , and 30 with severe pain (VAS score higher than 7 but lower than 10) . They were compared to 30 postmenopausal women with knee effusion (controls) undergoing physical examination in the hospital during the same period. The levels of serum sex hormones and inflammatory cytokines in synovial fluids were measured in all cases. All subjects were tested for sex hormones in the serum and inflammatory cytokines in synovial fluids.

The BMI differed across mild, moderate, and severe pain subgroups and the controls (P<0.05) . In particular, severe pain subgroup had higher BMI than did controls and mild pain subgroup (P<0.05) . The serum levels of E₂ and T differed across mild, moderate, and severe pain subgroups and the controls (P<0.05) . Specifically, the controls had higher levels of E₂ and T than did moderate and severe pain subgroups (P<0.05) . The E₂ level in the moderate pain subgroup was lower than that of mild pain subgroup (P<0.05) . The E₂ and T levels in the severe pain subgroup were lower than those in the mild pain subgroup (P<0.05) . There were no significant differences in prolactin, LH, FSH and P between controls, and mild, moderate and severe pain subgroups (P>0.05) . The levels of IL-1, IL-6, and IL-10 as well as TNF-α varied across mild, moderate, and severe pain subgroups and the controls (P<0.05) . Compared with controls, mild pain subgroup had higher IL-1 level, and moderate and severe pain subgroups had higher IL-1, IL-6, IL-10 and TNF-α levels (P<0.05) . The levels of IL-6, IL-10 and TNF-α in severe pain subgroup were higher than those in mild pain subgroup (P<0.05) . E₂ and T levels were negatively correlated with VAS score for degenerative knee pain (r_s=-0.686, -0.454, P<0.05) ; IL-1, IL-6 and TNF-α levels were positively correlated with VAS score for degenerative knee pain (r_s=0.517, 0.665, 0.319, P<0.05) . There was no correlation between IL-10 and VAS score for degenerative knee pain (r_s=0.162, P>0.05) .

In postmenopausal women, VAS score for degenerative knee pain was negatively correlated with E₂ and T levels. There was no significant difference in prolactin, LH, FSH and P levels among degenerative KOA patients with different pain levels. The IL-1, IL-6 and TNF-α levels in synovial fluids were positively correlated with the VAS score of degenerative knee pain. So reducing the levels of IL-1, IL-6 and TNF-α could improve the tolerance of knee pain, which may be a reference for clinical treatment of degenerative knee pain.

Overweight and obesity are major risk factors for many chronic diseases, with the prevalence of overweight/obesity among Chinese adults reaching 50.7% in 2018. Bariatric surgery is one currently available treatment for obesity, but whether it increases the risk of fracture is still controversial.

To analyze whether weight-loss surgery will increase the risk of fracture.

PubMed, Embase, and Cochrane Library databases were searched for studies (cohort studies, case-control studies, and randomized controlled trial) about the risk of fracture and bariatric surgery published between January 2010 and November 2021. The Newcastle-Ottawa scale (NOS) and Jadad scale were used to evaluate the methodological quality of the studies. RevMan 5.3 and Stata 12.0 were used for data analysis. The Begg's test and Egger's test were conducted to assessing the potential publication bias. Compare the association of bariatric surgery with risk of fracture by comparing risk of fracture between patients with and without bariatric surgery.

A total of 15 studies were included, including 12 cohort studies, two case-control studies, and one randomized controlled trial, all of which were of high quality. Twelve studies compared the risk of fracture between patients with bariatric surgery and those without, 10 of which enrolled patients with bariatric surgery (surgery group, n=137 239) and obese patients without bariatric surgery (obesity group, n=159 066) with no differences in baseline BMI, showing large heterogeneity (P<0.01, I²=94%). Meta-analysis using a random-effects model showed that there was no significant intergroup difference in fracture risk between the two groups〔RR (95%CI) =1.21 (1.00, 1.46), P=0.05〕. Four studies enrolled patients with bariatric surgery (n=14 796) and non-obese patients without bariatric surgery (n=132 124) with significant differences in baseline BMI, showing slight heterogeneity (P=0.26, I²=25%), and a higher risk of fracture was found in those with bariatric surgery revealed by meta-analysis using a fixed effects model〔RR (95%CI) =1.73 (1.59, 1.89), P<0.01〕. The level of heterogeneity decreased significantly after removing 4 of the 10 studies with high heterogeneity with no intergroup difference in baseline BMI (P=0.24, I²=25%), and a higher risk of fracture was found in patients with bariatric surgery indicated by meta-analysis using a fixed effects model〔RR (95%CI) =1.38 (1.31, 1.46), P<0.01〕. Subgroup analysis showed that the risk of fracture was similar in the surgery group and the obesity group within two years〔RR (95%CI) =1.05 (0.89, 1.24), P=0.56〕 and during two to five years〔RR (95%CI) =1.16 (1.00, 1.35), P=0.05〕, but it was higher in the former group five years after surgery〔RR (95%CI) =1.50 (1.23, 1.84), P<0.001〕. The risk of fracture was higher in patients with Roux-en-Y gastric bypass than that of those with adjustable gastric banding〔RR (95%CI) =1.31 (1.15, 1.50), P<0.01〕 or with sleeve gastrectomy〔RR (95%CI) =1.77 (1.55, 2.02), P<0.01〕. The risk of fracture was lower in patients with gastric banding than that of those with gastric bypass〔RR (95%CI) =0.54 (0.41, 0.71), P<0.01〕. Both Begg's test and Egger's test showed that publication bias was less likely in the studies (P=0.631, 0.720) .

Fracture risk is increased by bariatric surgery, which is not influenced by obesity. High risk of fracture did not appear until five years after the operation, with Roux-en-Y gastric bypass and gastric bypass were associated with higher fracture risk.

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.