Objective To evaluate the midterm efficacy of prosthetic disc nucleus ( PDN) replacement for the treatment of lumbar disc herniation. Methods Twenty cases of lumbar disc herniation( including one case of recurrent lumbar disc herniation) were treated with PDN. The twenty cases were followed-up 5.4 ～6.2 years( mean 5.7 years). Functional,and radiographic follow-up examinations,MRI and follow-up records of all patients were reviewed carefully. Results Clinical evaluation at the end of follow-up,there were 10 cases in excellent,6 cases in good,2 cases in fair and 2 cases in poor,and good rate was 80%. One patient accepted the revision operation to remove the PDN because of device migration. One patient accepted the fusion because of adjacent segment disease. The others experienced pain relief, and resumed their normal life and work. The average Oswestry score and VAS get better significantly. Conclusion The PDN was effective in treating patients with lumbar disc herniation. However, the medium term complications of device subsidence should be taken seriously.

Objective　To evaluate the diagnositic value of exercise stress echocardiography (ESE) in patients with pacemaker-dependnet.Methods　Forty-six patients remained pacemaker dependent with a fixed heart rate throughout ESE and coronary angiographic studies.Results　Thirty-four of 46 patients completed the ESE. Coronary artery disease was confirmed in 28 of 34 who had coronary angiograms. ESE had a sensitivity of 75% and specificity of 83% in pacemaker-dependent patients.Conclusions　ESE has preserved diagnostic utility in pacemaker dependent patients with absolute chronotropic incompetence.

Objective: To establish a mini invasive way to evaluate endothelium function. Methods: Group 1 consisted of 10 subjects with no risk factors for coronary artery disease, group 2 consisted of 11 subjects with risk factors for coronary artery disease and angiographically normal coronary arteries. Two groups of patients underwent transesophageal echocardiography(TEE) for assessment of LAD diastolic blood flow velocity (V) and time velocity integral (VTI) at rest (B 1), 2 min after immersion of the hand in cold water (CPT), 5 min after rewarming of the extremity (B 2), and 5 min after administered nitroglycerin. The percent change in V and VTI were calculated between B 1 and CTP and B 2 and nitroglycerin. Results: After CPT the percent increase in V and VTI were significant in group 1 than group 2 ( P

The pathogenesis theory of"spleen deficiency and stasis toxin"in gastric cancer holds that spleen is the source of generation and transformation of qi and blood,that spleen deficiency is the internal basis of disease and throughout the disease.Stasis toxin is based on spleen deficiency,which is the fundamental pathogenesis of gastric cancer.In the pathological process of gastric cancer,a variety of metabolic substances in tumor cells and tumor microenvironment,mainly glucose metabolic reprogramming,undergo metabolic changes to reconstruct the phenotype and function of tumor-related macrophages,which is consistent with the pathogenesis theory of"spleen deficiency and stasis toxin".Therefore,this article focused on the reprogramming of glucose metabolism in tumor microenvironment to drive the phenotypic remodeling of tumor-related macrophages,explored the scientific connotation of the pathogenesis theory of"spleen deficiency and stasis toxin"of gastric cancer,and provided references for the theoretical and clinical research on the treatment of gastric cancer by TCM.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.