Osteoporosis is a progressive metabolic disease. In traditional Chinese medicine (TCM), deficiency of the liver, spleen and kidney and blood stasis can induce osteoporosis. The main etiology was kidney deficiency which harmed the liver and spleen and causeqi-blood deficiency and blood stasis. The insufficiency of natural endowment and postnatal malnutrition caused poor nutrition of tendons and vessels, which induced debility of bone. This article discussed the etiology and pathogenesis of TCM understanding on osteoporosis in details. Opportunities and challenges of TCM in osteoporosis treatment were explored. The homology of Chinese medicine and food as well as the long-term of osteoporosis showed that TCM had incomparable superiority in osteoporosis treatment. While, the scientific research methods and reasonable evaluation of TCM safety were important to display its advantages in osteoporosis treatment.

In this study,adults of Armillifer agkistrodontis (A.agkistrodontis) were collected from Agkistrodon acutus,and then the eggs were separated to feed mice.In the next step,when the infection model was established,blood serum of infected mice were collected after 1,2 and 3 weeks,respectively.Furthermore,ELISA and dot- ELISA were used to detect the dynamic change of specific antibodies and circulating antigens respectively.The specific antibodies increased from 8th week,reached the top at 12th week,decreased from 16th week,and then maintain at the same level constantly.Meanwhile,the specific antibodies were typed.It is evident that IgM antibody appeared first.However,it was substitute by IgG1 after 16 weeks.Moreover,the circulating antigens have been detected in the 1st week by dot-ELISA.Then,the dilution between 1:8 to 1:128were founded in 3rd week.The highest dilution with 1:256 appeared at 8th week,maintained before 11th week and then decreased gradually,which might provide a significant clinical implication for early diagnosis of circulating antigens.

Objective To discuss surgical method and clinical curative effect of the headless compression cannulated screw percutaneous minimally invasive treatment of Evans -JensenⅠ,type Ⅱ of intertrochanteric fracture. Methods The clinical data of 21 cases of Jensen Evans and type II femoral intertrochanteric fractures who were treated by headless compression cannulated screw minimally invasive treatment were retrospectively annalyzed.In all patients,male in 6 cases,female in 13 cases;63 -86 years old,average 71.79 years.According to the Evans -Jensen norm and curative effect evaluation according to the improved Harris standard.Results Follow -up time was 6 -18 months (mean 12.15 months),two of them respectively in the six months after death from acute myocardial infarc-tion (ami)and 11 months of cor pulmonale,the rest of 17 cases of bony healing.Harris,the average score (67 -95points)at the time of the last follow -up,including 14 cases of optimal good in 2 cases,fair 1,poor in 1 case,was 88.89%.Conclusion Headless compression cannulated screw percutaneous minimally invasive treatment of Evans-Jensen Ⅰ,type Ⅱ intertrochanteric fractures has the advantangtages of minimally invasive,reliable fixation,high rate of fracture healing,allowing early hip not functional exercise load conditions and obtaining ideal therapeutic effect.

Objective To investigate the safety and efficacy of three column osteotomy (3-CO) procedures through previous spinal fusion site for the revision surgical treatment in severe spinal deformity patients.Methods From Oct.2010 to May 2014 in our hospital,a total of 12 severe spinal deformity patients underwent 3-CO for the revision surgical treatment.There were 7 males and 5 females with the average age of (21.8±3.8) years,ranging from 18 to 30 years.The mean time from the initial operation to the revision surgery was (10.2±4.8) years (ranging from 3 to 17 years).The reasons for revision were:curve progression in 7 patients,neurologic deficit in 2 cases,implant failure in 1 patient and pseudarthrosis in 2 patients.The coronal parameters including major Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),and the sagittal parameters including global kyphosis curve and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at last followup,respectively.The operation time,intraoperative blood loss and complications were recorded.The paired t test was used to evaluate the difference among pre-revision,post-revision and last follow-up.Results The average operation time was (451.7±83.1) min (range,320-600 min) and the average blood loss was (4 016.7± 1 080.0) ml (range,2 700-6 000 ml).The average follow-up time after revision operation was (35.4±9.8) months (range,24-49 months).The coronal Cobb angles of pre-revision and post-revision were 83.8°±23.3°and 34.6°± 13.7°.The average correction rate was 60.1％ ±8.8％.At last follow-up,the average coronal Cobb angle was 34.9°±13.8°,there was no significant loss of correction.The pre-revision and post-revision values of global kyphosis were 99.1°±13.3°and 38.7°±7.8° with a mean correction rate of 60.8％ ±6.7％.At the last follow-up,the average global kyphosis was 39.3°±7.5°and no loss of correction was found.For the C7PL-CSVL and SVA,pre-revision (30.3± 17.1) mm and (40.1±31.1) mm were corrected to (14.3 ±7.6) mm and (19.1± 12.3) mm immediately after revision operation,respectively.At final follow-up,the average C7PL-CSVL and SVA were(14.1 ± 7.6) mm and (19.6± 12.1) mm,the correction was well maintained.Obviously,two patient's neurological status improved from Frankel C before revision surgery to Frankel E.Complications were encountered in five patients (41.7％),including SEP signal changed in 1 patient (8.3％),transient neurologic deficit after revision surgery in 1 patient (8.3％),cerebrospinal fluid leak in 1 patient (8.3％),and pleural effusion in 2 patients (16.7％).During the follow-up time,there was no patient experienced pseudarthrosis,implant failure,infection or significant loss of correction.Conclusion Based on results of this study,it was concluded that 3-CO procedures through previous spinal fusion sites could obtain satisfactory and safety results in severe spinal deformity revision surgery.However,it is a technique-demanding procedure with more blood loss,longer operative time and higher risk of perioperative complications.

Objective To develop and validate a predictive model for in-hospital mortality in elderly patients with severe acute pancreatitis (SAP). Methods A total of 368 elderly SAP hospitalized patients were selected as study objects, and were divided into mortality group (96 patients, 26.09%) and survival group (272 patients, 73.91%) based on their survival status during hospitalization. Multivariable Logistic regression analysis was performed to identify influencing factors associated with in-hospital mortality in SAP patients, and a predictive model was constructed based on these factors. Receiver operating characteristic (ROC) curves were plotted, and the predictive performance of the model was evaluated using the area under the curve (AUC), accuracy, sensitivity, and specificity. Results Univariate analysis revealed that the mortality group had a higher proportion of patients aged over 60 years, with renal insufficiency, coronary heart disease, and undergoing laparoscopic surgery. Additionally, the mortality group had significantly higher levels of red blood cell distribution width, fasting blood glucose, interleukin-6, procalcitonin, neutrophil-to-lymphocyte ratio (NLR), lactate, modified CT severity index (MCTSI) score, and bedside index for severity in acute pancreatitis (BISAP) score compared to the survival group (P < 0.05). Multivariable Logistic regression analysis identified age, renal insufficiency, MCTSI score, fasting blood glucose, and NLR as independent influencing factors of in-hospital mortality in elderly SAP patients (P < 0.05). A regression equation was constructed based on these factors: C-index=-1.569+0.258×(age)+0.334×(renal insufficiency)+0.672×(MCTSI score)+0.281×(fasting blood glucose)+0.410×(NLR). The ROC curve analysis showed that the AUC of the model for predicting in-hospital mortality in elderly SAP patients was 0.877 (95%CI, 0.840 to 0.915), with an accuracy of 84.23%, sensitivity of 75.00%, and specificity of 87.50%. Conclusion Age, renal insufficiency, MCTSI score, fasting blood glucose, and NLR are independent predictors of in-hospital mortality in elderly SAP patients. The predictive model constructed based on these factors can assist in identifying high-risk patients and predicting all-cause mortality risk in SAP.

Objective: To define radiographic features that response to serial casting and bracing for progressive early-onset scoliosis (EOS). Methods: A retrospective study of a total of 20 patients (10 females and 10 males) with complete radiographic data diagnosed as progressive early onset scoliosis treated with serial cast or brace for at least 12 months in the 306th Hospital of PLA from June 2011 to April 2018. Ages at initial diagnosis were all less than 5 years old. They were divided into two groups according to the main curve degree, those with cobbs angles more than 50 degree treated with serial cast, or else with brace. All the cases have radiographs of pretreatment, posttreatment, and last follow-up, and anteroposterior (lateral) film of the full length spine in standing position were taken to evaluate magnitudes and balance of coronal and sagittal malformations. We compared the general data of the two groups by independent sample t test and that of pretreatment, posttreatment and the last follow-up by paired-sample t test. Results: According to the effective standard of not less than 10 degrees improvement, 9 of them were effective, 4 cast and 5 brace, the effective rates were 44.44% and 45.45%, 3 cases from brace group progressed. The magnitudes of the main curve improved significantly after the first treatment of cast and brace (55.4±24.36 vs 42.35±23.62) degree (t=5.850, P=0.000), and at the last follow up, the curve decreased slightly compared of that before interventions (55.4±24.36 vs 51.8±26.33). The compensatory curves, segmental kyphosis, thoracic kyphosis, lumbar lordosis, balance of both coronal and sagittal also had no significant differences between the primal and the latest follow up. The widths 159.63±19.27 mm, 160.81±14.54 mm, 176.08±28.10 mm (t=3.942, P=0.001; t=-3.096, P=0.006) and heights 153.78±29.24 mm, 161.14±29.53 mm, 175.01±36.91 mm of the thoracic were significantly different between pre-posttreatment and the last follow up (t=-5.950, P=0.000; t=-3.997, P=0.001). Serial cast and brace application can preserve the growth of the thorax. Conclusion Serial cast and brace are viable growth friendly methods to deal with progressed EOS, Although a cure improvement cannot be always expected, they can stabilize relatively large curves in young children and may help delay eventual surgical intervention.

Objective:To evaluate the role of RhoA/ROCK2 signaling pathway in multiple exposures to sevoflurane-induced long-term cognitive impairment in neonatal rats.Methods:Sixty SPF healthy neonatal Sprague-Dawley rats of either sex, aged 6 days, weighing 12-20 g, were divided into 3 groups ( n=20 each) using a random number table method: control group (group C), multiple exposures to sevoflurane group (group S) and RhoA/ROCK2 signaling pathway inhibitor Y-27632 group (group Y). Group S and group Y inhaled 3% sevoflurane for 2 h at days 6, 7 and 8 after birth.In group Y, Y-27632 5 mg/kg was intraperitoneally injected before sevoflurane anesthesia.The spontaneous activity was evaluated by open field test on day 35 after birth.The cognitive function was detected by Morris water maze test at day 36 after birth.The rats were sacrificed after Morris water maze test, and the hippocampal tissues were isolated for determination of the apoptosis rate of hippocampal neurons and cytoplasmic calcium concentration ([Ca 2+ ] i) (by flow cytometry) and expression of phosphorylated RhoA (p-RhoA), ROCK2 and cleaved-caspase-3 (by Western blot) and for microscopic examination of the ultrastructure of hippocampal neurons (with a transmission electron microscope). Results:There was no significant difference in movement speed, distance and time of stay in the open field center in the open field test among the three groups ( P>0.05). Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the apoptosis rate of hippocampal neurons and [Ca 2+ ] i were increased, the expression of p-RhoA, ROCK2 and cleaved-caspase-3 was up-regulated ( P<0.05), and the pathological injury to hippocampal neurons was found in group S. Compared with group S, the escape latency was significantly shortened, the number of crossing the original platform was increased, the apoptosis rate of hippocampal neurons and [Ca 2+ ] i were decreased, the expression of p-RhoA, ROCK2 and cleaved-caspase-3 was down-regulated ( P<0.05), and the pathological injury to hippocampal neurons was attenuated in group Y. Conclusions:The mechanism by which multiple exposures to sevoflurane induces long-term cognitive impairment is related to activation of RhoA/Rock2 signaling pathway and induction of apoptosis rate of hippocampal neurons in neonatal rats.

This paper is based on the theory of"internal diseases will be presented externally"in Traditional Chinese Medicine, combined with the idea of syndrome differentiation and grasping the main symptoms, and proposes the concept of"virtual special disease". It is extracted from ancient books and expert experience, and it is believed that it is widespread and can be tested by clinical practice. The application of virtual syndrome to diagnosis can achieve the purpose of simplifying the complexity TCM syndrome differentiation. On the one hand, it provides a new exploration for enriching the TCM syndrome differentiation system; on the other hand, it provides new ideas for supplementing the biological research of syndromes and developing the diagnosis of integrated traditional Chinese and Western medicine.

Objective: To observe the changes of Notch signaling pathway related molecule expression in hippocampus of rats with stagnation of liver qi and spleen deficiency syndrome and to explore the regulatory effect of Xiaoyaosan. Methods: Male SD rats were randomly divided into four groups: normal group, model group, model+xiayaosan group and model+fluoxetine group, each group had 12 rats. The stagnation of liver qi and spleen deficiency model was established by chronic immobilization stress for 21 days. Detection of Nissl bodies by Nissl staining, expression of NICD, Hes1, Hes5 and Jad1 were detected by Fluorescent quantitative PCR and Western-blot method. Results: Compared with the normal group, the number of Nissl bodies in the model group decreased significantly (P ＜ 0.01), which showed that Xiaoyaosan and fluoxetine could reverse it (P ＜ 0.01). The expression of Notch signaling pathway-related protein in model group was significantly lower than that in normal group (P ＜ 0.01), which showed that Xiaoyaosan and fluoxetine could reverse the expression of NICD, Hes5 and Jag1 protein (P ＜ 0.05, P ＜ 0.01). Compared with the normal group, the expression of each gene in the model group decreased (P ＜ 0.01), which showed that Xiaoyaosan and fluoxetine could reverse the expression of NICD, Hes1 and Hes5 mRNA (P ＜ 0.05, P ＜ 0.01). Conclusion: The hippocampal neurons of rats with stagnation of liver qi and spleen deficiency syndrome were damaged and the Nissl bodies were reduced, the expression of each protein and gene in Notch signaling pathway decreased. Xiaoyaosan may play a therapeutic role by regulating the expression level of hippocampal related molecules to protect neurons.

Wuling powder, which is from Treatise on Cold Damage and Miscellaneous Diseases of Zhang Zhongjing, is a famous formula from thousand years now on. As people have a deeper understanding of Wuling powder, its application range is more extensive. In Treatise on Cold Damage and Miscellaneous Diseases and Essentials from the Golden Cabinet, there are a total of 11 articles concerning Wuling powder. Wuling powder syndrome can be classified as pulse floatation, fever, thirst, irritability, vomiting and urination, which can also occur in dehydration by sorting out and analyzing these articles. This paper talks about the relationship between Wuling powder syndrome and dehydration from the etiology, the symptom and the clinical application as well as to the thought of Wuling powder syndrome several aspects.