This article systematically reviews and verifies the medicinal materials of Dioscoreae Hypoglaucae Rhizoma（DHR）， Dioscoreae Spongiosae Rhizoma（DSR）， Smilacis Chinae Rhizoma（SCR） and Smilacis Glabrae Rhizoma（SGR） from the aspects of name， origin， producing area， quality， harvesting， processing and efficacy by consulting historical literature， in order to provide reference for the development and utilization of famous classical formulas containing the four medicinal materials. DHR， DSR， SCR and SGR have a long history of application as medicinal materials. However， due to their similar growth environment and medicinal properties， as well as their functions of promoting dampness， dispelling wind and removing numbness， there have been instances of homonymous foreign objects and homonymous synonyms throughout history， resulting in confusion of the origin. Therefore， it is necessary to conduct comparative analysis and systematic research for clarifying the historical development and changes of the four， in order to provide a basis for safe and effective medication. According to research， Bixie was first recorded in Shennong Bencaojing and has been historically known as Baizhi， Chijie， Zhumu， and other aliases. From ancient times to the mid-20th century， there has always been a situation where the rhizomes of Dioscorea plants and Smilax plants， and even the rhizomes of Heterosmilax plants， were mixed together to be used as medicinal herbs for Bixie. However， since the Tang dynasty， it has been clearly advocated that the rhizomes of Dioscorea plants have excellent quality and have been the mainstream throughout history. The 2020 edition of Chinese Pharmacopoeia categorized it into two types of medicinal herbs（DHR and DSR）. Among them， the origin of DHR is the dry rhizomes of Dioscorea hypoglauca， and the origins of DSR are the dry rhizomes of D. spongiosa and D. futschauensis. In ancient times， due to different types， the corresponding production areas of DHR and DSR were also different. Nowadays， They are mainly produced in the southern region of the Yangtze River. Since the Tang dynasty， the quality of Bixie has been characterized by its white color and soft nature. In modern times， it has been summarized that those with white color， large and thin pieces， powdery texture， tough and elastic texture， and neat and unbreakable are the best. The harvesting times of DHR and DSR are in spring or autumn， with the best quality harvested in autumn. The mainstream processing methods of them are slicing and then using the raw products or wine-processed products. SCR was first recorded in Mingyi Bielu and has been known as Jinganggen， Tielingjiao， Tieshuazi， and other aliases in history. The mainstream source is the dry rhizomes of Smilax china in the past dynasties， with the best quality being those that are tough and rich in powder. The harvesting time is from the late autumn to the following spring， and the main processing method throughout history has been slicing for raw use. SGR was first recorded under the item of Yuyuliang in Variorum of Shennong's Classic of Materia Medica. It was listed as an independent medicinal material from Bencao Gangmu. In history， there were such aliases as Cao Yuyuliang， Lengfantuan， Xianyiliang， Tubixie， etc. The main source of the past dynasties was dry rhizomes of S. glabra. In history， there have also been instances of multiple plants belonging to the same genus， and even cases of mixing the rhizomes of plants in the genus Heterosmilax. It is mainly produced in Guangdong， Hunan， Hubei， Zhejiang， Sichuan， Anhui and other regions， its quality has been summarized as large in size， powdery in texture， with few veins， and light brown in cross-section since modern times. The harvesting time is in spring or autumn， and the main processing method throughout history has been slicing for raw use. DHR， DSR， SCR and SGR all have the effects of promoting dampness， dispelling wind， relieving rheumatism and detoxifying. However， their detoxification abilities are ranked as follows：SGR>SCR>Bixie（DHR and DSR）. Especially for the treatment of limb spasms， arthralgia and myalgia， scrofula， and scabies caused by syphilis and mercury poisoning， SGR has a unique effect. Based on the research results， DHR is recommended to develop the famous classical formulas containing Bixie as the first choice for medicinal herbs. It should be harvested in autumn， sliced thinly while fresh， and processed according to the requirements of the famous classical formulas， without any requirements for raw use. Selecting the rhizomes of S. china， harvested in late autumn， and thinly sliced while fresh. If there are no special processing requirements in the formulas， use it raw. Selecting the rhizomes of S. glabra， it is harvested in autumn and thinly sliced while fresh. If there are no special processing requirements in the formulas， raw products can be used.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

Objective:To explore a type of teaching teeth that can highly simulate natural teeth, and to investigate its application in the practice teaching of crown preparations.Methods:A total of 44 senior students majoring in stomatology Fourth Military Medical University were selected, and each student received the training of crown preparations using interpenetrating polymer network (IPN) enamel-like teaching teeth, extracted natural teeth, and traditional composite resin teeth. Operation assessment was performed, and the operation time of each crown preparation was recorded. According to the requirements for crown preparations, scores were determined from the five aspects of axial converging, space for repair, line angle, shoulder quality, and posture, with 10 points for each aspect and 50 points in total, and the total score was calculated. A questionnaire survey on IPN enamel-like teeth was performed for each student after assessment, and SPSS 23.0 was used to perform the least significant difference t-test and the Tambane's T2 test. Results:There was no significant difference in total assessment score between the IPN enamel-like teeth group and the natural teeth group (37.15±1.17 vs. 37.20±1.20, P>0.05), and both groups had a significantly higher total score than the resin teeth group (31.53±1.41) ( P<0.05). The IPN enamel-like teeth group and the natural teeth group had significantly higher scores than the traditional composite resin teeth group in terms of axial converging, space for repair, and shoulder quality ( P<0.05). The questionnaire survey of the students showed a relatively high score of 3.7-4.9 for each item. Conclusion:Compared with traditional composite resin teeth, IPN enamel-like teeth can more comprehensively and effectively simulate the operation and experience of natural teeth for crown preparations and thus have potential advantages in the practice teaching of crown preparations.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

This article systematically sorted out and researched the name， origin， harvesting and other aspects of Rhapontici Radix by referring to ancient materia medica， medical books and prescription books， combined with modern literature， in order to provide a reference basis for the development of the famous classical formulas containing this herb. According to the results of the herbal textual research， it can be seen that all the generations of the materia medica have taken Loulu as the proper name， and there are also aliases such as Luligen， Laowenghua and Jiahao. The mainstream base of Rhapontici Radix recorded in the past dynasties was the present Compositae plant Rhaponticum uniflorum， which is mostly used as medicine with roots. Since the Tang dynasty， the stems and leaves of Siphonostegia chinensis have been used as Rhapontici Radix in the northern region. Until modern times， Qizhou Pharmacognosy began to differentiate it into two categories， Qizhou Loulu and Yuzhou Loulu， according to the commodity circulation at that time， producing area and origin， of which Yuzhou Loulu is the roots of Echinops latifolius， a plant of Compositae family. In ancient times， the quality of Loulu was based on "the one that comes out of Shanzhou is the best". However， in modern times， the quality of Qizhou Loulu is better if the surface is black， neat， sturdy， firm， not broken， and without a withered heart， while the quality of Yuzhou Loulu is better if the branches are thick and long with an earthy-brown surface， solid texture and neat in length. In ancient times， most of the harvesting and processing of Loulu was "harvesting the roots in lunar August and drying them in the shade"， while in modern times， the roots are mostly excavated in the spring and autumn， and dried in the sun. Its ancient method of processing is to mix and steam with licorice， nowadays， it is prepared by removing impurities， washing， moistening thoroughly， cutting into thick slices and drying in the sun， and then taking the raw products as medicine. Based on the research conclusion， it is suggested that when developing and utilizing the famous classical formulas containing Loulu， the background of the formula should be verified， and if the original formula indicated the requirement of processing， it should be processed according to the requirement， but if not， it is recommended to use raw products as medicine.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objective To compare the clinical and sonographic characteristics of aggressive and nonaggressive papillary thyroid microcarcinomas(PTMC)in order to improve the preoperative predictive value of aggressive PTMC.Methods A total of 309 patients with PTMC from January 2014 to December 2016 were included in this study.Patients with lymphatic metastasis,extrathyroidal invasion,reccurence, distant metastasis and death were classified into aggressive PTMC group,and patients without above characteristics were classified into nonaggressive group.Clinical and sonographic features were reviewed and compared between the two groups.Results Among the 309 patients,76 cases(24.6%)were aggressive PTMC,and 233 cases(75.4%)were nonaggressive.Patients were younger and larger cancerous nodules, microcalcification,capsular inconnection and multifocality were seen more frequently in aggressive PTMC group compared with nonaggressive group.The best cut-off value of age and diameter were 44.5 years and 0.66 cm respectively.Advanced age was the protective factor and larger tumor size and multifocality were independent risk factors for PTMC aggressiveness.The capsular invasion was related with the lateral cervical lymph node metastasis while other features were not.Conclusions Extra attention should be paid to patients with age<44.5 years,tumor size>0.66 cm and multifocal cancerous nodules because their PTMCs are more likely to be aggressive.Thyroid capsule adjacent to the cancerous nodule should be observed carefully.If there is interruption in the capsule,lateral cervical lymph nodes should be carefully examed.

OBJECTIVETo investigate effect of Activ L total lumbar disc replacement on lumbar sagittal alignment.

METHODSThe imaging data of patients with degenerative disc disease received Activ L total lumbar disc replacement at Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University from March 2009 to March 2013 were retrospectively analyzed. The average age was 45.6 years(range, 35-60 years)and the surgery levels were as follows: L3-4 2 cases, L4-5 15 cases, L5/S1 5 cases, L3-4+ L4-5 3 cases, L4-5+ L5/S1 7 cases. All patients were followed up for 15 to 63 months(average, 32 months). Radiographic parameters such as lumbar lordosis angle(LL), segment lordosis angle(SL) and sacral slope angle(SS) were recorded. All the radiographic parameters were compared using one-way ANOVA at different stage. Lumbar lordosis angle of the two-level was compared with the one of one-level by using independent sample t-test before and after the operation. A partial correction test was carried out to determine the corrections between the parameters preoperatively, one month after the operation and at final follow-up.

RESULTSOne month after the operation, the lumbar lordosis angle decreased by an average of 1.8°, but there was no statistically significant(P>0.05). Compared with one month postoperation, the lumbar lordosis angle increased by an average of 6.8°(P<0.05), which also increased a lot compared with preoperation(P<0.05). The value of segment lordosis angle was rising up from preoperation to the final follow-up(P<0.05), so was the value of sacral slope angle, but there was no statistically significant between different stage(P>0.05). The lumbar lordosis angle showed no significant difference between double-level ones and single-level ones at different stage(P<0.05). The lumbar lordosis angle showed positive correlation with the sacral slope(P<0.001), however, the lumbar lordosis angle showed no corrected with the segment angle all the time(P>0.05).

CONCLUSIONSThe total lumbar disc replacement with Activ L prosthesis had contributed to maintain and improve the lumbar alignment in the short and medium term. Double- or single-level total lumbar disc replacement had no significant effect on the value of lumbar lordosis angle. The lumbar lordosis angle showed positive correlation with the sacral slope all the time with no correlation between lumbar lordosis angle and sacral slope.

Diagnostic Imaging ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lordosis ; diagnostic imaging ; Lumbar Vertebrae ; surgery ; Lumbosacral Region ; surgery ; Postoperative Period ; Prostheses and Implants ; Radiography ; Retrospective Studies ; Total Disc Replacement

Objective:To explore the influence of different cell culture methods in the genome-wide DNA methylation status of breast cancer MDA-MB-231 cells,and to clarify the relationship between genome-wide DNA methylation status and cell growth environment and the role of genome-wide DNA methylation status in the occurrence and development of tumor.Methods:The MDA-MB-231 cells were cultured with 2D and 3D cell culture models and mouse orthotopic transplantation model (Ti model)and collected, then DNA was extracted by DNA extraction kit and the genome-wide DNA methylation status of MDA-MB-231 cells after cultured with three different culture methods was detected by DNA methylation chip,then the value of beta,DiffScore and Delta_Beta of the CpG loci of each gene were calculated by applying Genomestudio software, and the differential methylation genes were screened by Genomestudio software and GO and Pathway analysis of these genes were performed in DAVID on-line analysis tool.Results:All 480 genes of the MDA-MB-231 cells showed significant differences in the degree of methylation in 3D and 2D models (P<0.05);86 448 genes in 3D and Ti models (P<0.05);90 005 genes in Ti and 2D models (P<0.05).The differential methylation genes in 3D and 2D,3D and Ti,and Ti and 2D models were enriched on the multicellular organismal development term and cell differentiation term (P<0.05);also on MAPK signaling pathway,cell adhesion molecules (CAMs),and regulation of actin cytoskeleton (P<0.05). Conclusion:There are differences in genome-wide DNA methylation status of MDA-MB-231 cells cultured in 2D, 3D cell culture and Ti models.