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.

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.

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.

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.

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.

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.