Objective:To explore the clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.

Objective The aim of this study was to investigate the prospective association between physical activity (PA),independently or in conjunction with other contributing factors,and osteoporosis (OP) outcomes. Methods The Physical Activity in Osteoporosis Outcomes (PAOPO) study was a community-based cohort investigation. A structured questionnaire was used to gather the participants' sociodemographic characteristics. Bone mineral density (BMD) measurements were performed to assess OP outcomes,and the relationship between BMD and OP was evaluated within this cohort. Results From 2013 to 2014,8,471 participants aged 18 years and older were recruited from Tangshan,China's Jidong community. Based on their PA level,participants were categorized as inactive,moderately active,or very active. Men showed higher physical exercise levels than women across the activity groups. BMD was significantly higher in the very active group than in the moderately active and inactive groups. Individuals aged>50 years are at a higher risk of developing OP and osteopenia. Conclusion The PAOPO study offers promising insights into the relationship between PA and OP outcomes,encouraging the implementation of PA in preventing and managing OP.

Diabetic peripheral neuropathy （DPN） is one of the common complications of diabetes. The disease has a long course with nerve pain and other symptoms， seriously affecting the quality of life of patients. DPN is related to high glucose in vivo， inflammation， oxidative stress， apoptosis， and autophagy， involving phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， nuclear factor-κB （NF-κB）， mitogen-activated protein kinase （MAPK）， and other signaling pathways. At present， the treatment of DPN mainly focuses on symptomatic treatments such as blood glucose control and neurotrophic therapy， but the effect is not ideal. Therefore， it is particularly important to select a reasonable and effective drug to prevent and treat DPN. In recent years， Chinese medicine has played an important role in the treatment of DPN. Many studies have explored the mechanism of Chinese medicine in the treatment of DPN， and it has been found that some Chinese medicine monomers and compounds can regulate signaling pathways to prevent and treat DPN. This paper reviewed the research results of signaling pathways involved in DPN and the regulation of related pathways by Chinese medicine， aiming to provide references for the clinical treatment of DPN.

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.

Objective:To analyze the correlation between the volume of irradiated pelvic bone marrow and acute hematologic toxicity (HT), in order to provide clinical data to reduce the risk of acute HT and optimize the radiotherapy plan.Methods:From October 2017 to May 2019, 41 LARC patients who received neoadjuvant concurrent chemoradiotherapy (CCRT) were retrospectively reviewed in our center. All patients were treated with 5-field intensity-modulated radiotherapy (IMRT), and the prescription dose delivered to PTV was 45-50.4 Gy in 25-28 fractions. Capecitabine or 5-fluorouracil (5-FU) wasadministered daily 5 days a week during radiotherapy. Different HTswere recorded according to National Cancer Institute Common Toxicity Criteria Version 5.0 (NCI-CTC.V5.0) based on laboratory tests. The volume of PBM or each site (coxal, sacrum, femoral) receiving more than x Gy refers to as TVx, CVx, SVx, and FVx, respectively. Logistic regression was performed to evaluate the association between the volume of irradiated pelvic bone marrow and different HT. Generalized additive model (GAM) and piecewise regression were used to further analyze the possible nonlinear relationship and threshold effect between them. Results:Multivariate logistic regression analysis showed that low-dose of irradiated total pelvic bone marrow volume ( TV5) and coxal bone marrow volume ( CV5, CV10) were significantly correlated with Grade ≥2 leukopenia( P<0.05). There was a significant negative correlation between the sacrum bone marrow volume ( SV5, SV10) and Grade ≥2 leukopenia ( P<0.05). A thresholdeffect has been observed between CV10 and Grade ≥2 leukopenia by Generalized additive model (GAM) and piecewise linear regression. The threshold between CV10 and Grade ≥2 leukopenia was 575 ml, OR (95% CI) was 1.85 (1.08, 3.16). Conclusions:In neoadjuvant IMRT of rectal cancer, CV is a better predictor of acute HT induced by CCRT than TV. The irradiated volume of CV associated with acute HT was mainly low-dose levels ( CV5, CV10). The thresholds of our study ( CV10= 575 ml) could be a good reference for the optimization of the radiotherapy plan.

【Objective】 To explore the feasibility and efficacy of laparoscopic bladder muscle flap ureteroplasty in the treatment of long-segment injury in the middle and lower ureter and to summarize the clinical experience. 【Methods】 The clinical data of 6 patients treated in our hospital during Oct.2018 and Aug.2021 were retrospectively analyzed. Four of them had long-segment ureteral mucosal cuff-like avulsion during ureteroscopic lithotripsy and could not undergo end-to-end ureteral anastomosis or reimplantation, and then laparoscopic bladder muscle flap ureteroplasty plus lumbaris major fixation of the bladder was performed immediately. The other 2 patients had to undergo this procedure due to stricture. 【Results】 All operations were successful. The median ureteral avulsion or ureteral stricture length was 14.5(6, 16) cm, muscle flap length 16.5(8,18) cm, operation time 190 (160, 240) min, blood loss 175 (100, 250) mL, postoperative hospital stay 8 (7, 12) days, and postoperative creatinine (89.38±21.74) μmoI/L. No major complications occurred. One patient developed urinary leakage, which returned to normal after active glycemic control and nutritional therapy; one patient developed postoperative absorption fever, which recovered after physical cooling. During the follow-up of 6 to 45 months, CT showed mild hydronephrosis in some patients, but no ureteral stenosis, impaired renal function or other complications, and patients complained no subjective discomfort. 【Conclusion】 Laparoscopic bladder muscle flap ureteroplasty is safe and effective for patients with long-segment injury in the middle and lower ureter. It has the advantages of small trauma, few long-term complications, and rapid recovery and improvement of renal function. If necessary, it can be combined with lumbaris major fixation of the bladder to shorten the distance from the muscle flap to the broken end of the ureter and to reduce the tension of the anastomosis.

【Objective】 To compare the efficacy, safety and survival of partial nephrectomy (PN) and radical nephrectomy (RN) in the treatment of clinical T1b and T2a renal cell carcinoma (RCC). 【Methods】 A total of 115 patients with stage T1b and T2a RCC treated during Apr.2014 and Jul.2017 were retrospectively analyzed. According to the different surgical methods, the patients were divided into PN group (n=55) and RN group (n=60). The clinical data and prognosis of the two groups were compared. 【Results】 There were no significant differences in the general clinical data and perioperative related factors between the two groups (P>0.05). The incidence of complications was significantly higher in PN group than in RN group (P=0.024), but there was no significant difference in serious complications (Clavien grade ≥3) (P>0.05). In terms of renal function recovery, there was no significant difference in serum creatinine between the two groups before operation (P>0.05), but the serum creatinine was significantly lower in PN group than in RN group on the 1st day, 3rd, 6th and 12th months after operation (P<0.05). After more than 5 years of follow-up, there was no significant difference in 5-year survival rate, overall survival rate, recurrence and metastasis rate, and cancer specific survival rate between the two groups (P>0.05). 【Conclusion】 Both PN and RN are safe and effective in the treatment of stage T1b and T2a RCC, and can achieve good oncological control effects. Compared with RN, PN can fully and effectively protect the postoperative renal function, but it causes more surgical complications. However, there is no significant difference in severe complications (Clavien grade ≥3).

OBJECTIVE To carry out qualitative and quantitative analysis of volatile components of Olibanum, Olibanum prepared with vinegar and Olibanum stir-fried with Rush by GC-MS, and the quantitative study of the surface color by RGB model, provide auxiliary reference for the subjective evaluation indexes of Olibanum and its products. METHODS The volatile oil of Olibanum, Olibanum prepared with vinegar and Olibanum stir-fried with Rush were extracted. Explored the difference of volatile components by GC-MS in combination with principal component analysis and orthogonal partial least-squares discriminant analysis make a comprehensive analysis. Collected the image information of Olibanum, Olibanum prepared with vinegar and Olibanum stir-fried with Rush, then measured the surface color of them by RGB color model, and counted three color differences. RESULTS The differences of odor among oils might be related to the contents and types of terpenoids and alcohols, especially linalool and 1-octanol. According to surface color determination results, Olibanum stir-fried with Rush was R*76.86%-85.49%, G*61.96%-70.59%, B*38.04%-45.88%; Olibanum prepared with vinegar was R*56.86%-61.57%, G*38.04%-41.96%, B*27.45%-30.59%; Olibanum was R*69.41%-74.51%, G*56.86%-62.35%, B*40.78%-47.06%. By t test, there were significant differences among the three color measurement results, which were consistent with the differences recorded in the corresponding standards for "yellow white" Olibanum, "yellow brown" Olibanum prepared with vinegar, and "golden yellow" Olibanum stir-fried with Rush, indicating that the model was accurate and reliable. CONCLUSION The differences of volatile components and surface color of Olibanum, Olibanum prepared with vinegar and Olibanum stir-fried with Rush are studied to provide reference for character description of Olibanum and its processed products, and to avoid errors caused by traditional subjective evaluation.

The protection of open abdomen (OA) wound is a significant subject in the field of trauma surgery. The key technical challenge in the early stage of OA wound management involves promoting granulation tissue filling between intestinal segments, reducing intestinal wall abrasion, and preventing the development of enteroatmospheric fistulas (EAF). Hydrogels, characterized by their high water content and exceptional biocompatibility, serve as extracellular matrix-mimicking materials, and are extensively employed in various medical and healthcare applications. In this review, we discuss the application of hydrogel developed by natural biomaterials in OA wounds protection, taking into consideration the unique pathophysiological characteristics of the OA wounds. This review aims to provide valuable insights for the development of hydrogel materials for early-stage OA wound protection in future research.

The protection of open abdomen (OA) wound is a significant subject in the field of trauma surgery. The key technical challenge in the early stage of OA wound management involves promoting granulation tissue filling between intestinal segments, reducing intestinal wall abrasion, and preventing the development of enteroatmospheric fistulas (EAF). Hydrogels, characterized by their high water content and exceptional biocompatibility, serve as extracellular matrix-mimicking materials, and are extensively employed in various medical and healthcare applications. In this review, we discuss the application of hydrogel developed by natural biomaterials in OA wounds protection, taking into consideration the unique pathophysiological characteristics of the OA wounds. This review aims to provide valuable insights for the development of hydrogel materials for early-stage OA wound protection in future research.