Knee osteoarthritis(KOA)and osteoporosis(OP)"co-morbidity"is a chronic progressive disease,the incidence of which is higher in recent years.Exosomes have intercellular messenger functions,which play an important role in the development of KOA and OP"co-morbidity".This article recognized the"co-morbidity"between KOA and OP from the perspective of modern medicine and the"tendon","bone","liver"and"kidney"in TCM theories,systematically reviewed the indirect regulation of KOA and OP"co-morbidity"through exosomes,and explored the possible mechanisms of exosome-based treatment of KOA and OP"co-morbidity"through Chinese materia medica in terms of inflammation,MAPK pathway,bone remodeling and cartilage metabolism,and mitochondrial autophagy,with the aim to investigate the possible mechanisms of KOA and OP"co-morbidity",and provide new ideas for the treatment of KOA and OP"co-morbidity".

Knee osteoarthritis(KOA)and osteoporosis(OP)"co-morbidity"is a chronic progressive disease,the incidence of which is higher in recent years.Exosomes have intercellular messenger functions,which play an important role in the development of KOA and OP"co-morbidity".This article recognized the"co-morbidity"between KOA and OP from the perspective of modern medicine and the"tendon","bone","liver"and"kidney"in TCM theories,systematically reviewed the indirect regulation of KOA and OP"co-morbidity"through exosomes,and explored the possible mechanisms of exosome-based treatment of KOA and OP"co-morbidity"through Chinese materia medica in terms of inflammation,MAPK pathway,bone remodeling and cartilage metabolism,and mitochondrial autophagy,with the aim to investigate the possible mechanisms of KOA and OP"co-morbidity",and provide new ideas for the treatment of KOA and OP"co-morbidity".

It is believed that the main mechanism of idiopathic membranous nephropathy is the stagnation of qi and water. The clinical practice is guided by the principle of "treating water must be preceded by treating qi"， and combined with the clinical characteristics of idiopathic membranous nephropathy， which advocated that qi regulation should be applied in the treatment of idiopathic membranous nephropathy. According to the different manifestations of disorder of qi movement in all zang-fu organs， different methods are adopted to strengthen the spleen to raise the clear， harmonise the stomach to reduce turbidity， lift the pot to uncover the lid， diffuse the lung and drain water， assist yang to transform qi， promote water retention and reduce edema， soothe the liver and resolve constraint， regulate qi movement， and promote the sanjiao to help the qi transformation， and prescribed such as Buzhong Yiqi Decoction （补中益气汤）， Shengyang Yiqi Decoction （升阳益胃汤）， Fangji Huangqi Decoction （防己黄芪汤）， Danggui Shaoyao Powder （当归芍药散）， Zhongman Fenxiao Pill （中满分消丸） are used flexibly to restore qi movement， and the edema will disappear by itself.

Objective:To explore the effect of knee arthroscopic operation training simulation system in clinical teaching of traditional Chinese medicine osteomatology resident doctor standardized training students.Methods:A total of 40 trainees were selected in Department of Orthopedics and Traumatology of the First Affiliated Hospital of Tianjin University of Chinese Medicine from January 2023 to September 2023. The trainees were divided into an experimental group and a control group according to the random number table method, with 20 in each group. Trainees in the control group was taught by presentations and video demonstrations. Trainees in the experimental group was taught by knee arthroscopic operation training simulation system. Trainees in each group were taught by a same teacher for a total of 2 weeks, with 2 class hours per week. After the teaching, the results of the assessment of theoretical knowledge, the results of the questionnaire survey on the mastery of teaching content and the results of the questionnaire survey on the evaluation of teaching methods were recorded. Then compared the results between the two groups.Results:Compared with the control group, there was no significant difference in the initial theoretical assessment scores between the two groups ( P > 0.05). The improvement rate of the test group was higher than that of the control group, with statistical significance ( P < 0.05). In terms of the mastery of teaching content, the experimental group was higher than the control group in three aspects: whether the teaching method was beneficial to the study of knee anatomy, imaging and surgical procedure, the difference was statistically significant ( P < 0.05); whether the teaching method was beneficial to the study of the selection of surgical indications, there was no statistically significant difference between the two groups ( P > 0.05). In the evaluation of teaching methods, there was no significant difference in the scores of teaching participation between the two groups ( P > 0.05), and the scores of the experimental group in six aspects of teaching interest, teaching effectiveness, teaching understanding, learning initiative, teaching course evaluation and course satisfaction were higher than those of the control group, with statistical significance ( P < 0.05). Conclusions:The application of knee arthroscopic operation training simulation operating system can significantly improve the theoretical achievements of traditional Chinese medicine bone injury training students, which is beneficial to master clinical teaching content and improve clinical teaching satisfaction.

Objective:To provide references for the application of finite element model in the study of cervical vertebra by statistically analysing the frequency, numerical value, properties, and boundary setting of the finite element model and the corresponding material features as well as boundary settings in the literature.Methods:The literature on cervical vertebra-related finite element models was collected from CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase databases from January 2013 to December 2023. The quality assessment was followed by manual screening. The data sources, application classification, material properties (Young’s modulus and Poisson’s ratio), and boundary conditions of cervical vertebra, cervical intervertebral, and cervical ligaments were statistically analyzed.Results:A total of 102 papers were included. The finite element models of the cervical vertebra were derived from medical image reconstruction modeling techniques, predominantly CT plain scan and magnetic resonance imaging. Among the 102 cervical vertebra models, the C3-C7 (lower cervical segment) model appeared with the highest frequency (19). The Young’s modulus of the cortical bone, cancellous bone, and posterior structure of cervical vertebrae were set at about 12 000 or 10 000, 440, and 3 600 MPa, respectively, and the Poisson’s ratios were mainly set at about 0.29 or 0.30, 0.29, and 0.29. The Young’s modulus of the cervical intervertebral disc endplate, nucleus pulposus, and annulus fibrosus were concentrated around 500 or 2 000, 1, and 100 MPa, respectively, and the Poisson’s ratios were set at about 0.40, 0.50, and 0.40, respectively. The Young’s modulus of the anterior longitudinal ligament, posterior longitudinal ligament, transverse ligament, ligamentum flavum, interspinous ligament, capsular ligament, and articular cartilage of the cervical spine were set around 30, 20, 20, 6-10, 4-8, 10 or 20, 10 MPa, and the Poisson’s ratios were set at aoubt 0.30, 0.30, 0.30, 0.30, 0.30, 0.40, and 0.30, respectively. The Young’s modulus of the upper cervical interdental ligament, lamina, cruciate ligament, nuchal ligament, and pterygoid ligament were set at about 10, 10, 10 or 20, 20, and 5 MPa, respectively, and the Poisson’s ratios were set at about 0.30. Head weight settings were more common at 50, 74, and 100 N.Conclusions:The finite element model of the cervical vertebra has great value in the study of cervical spondylosis, but further optimization is still needed in the assignment of material properties, mesh division, and model verification to improve the accuracy and clinical applicability of the model.

Objective:To explore the application effect of an intelligent teaching robot system of lifting manipulation in cervical spine manipulation teaching.Methods:60 doctors were randomly divided into an experimental group ( n = 30) and a control group ( n = 30). The control group was taught by a certified chief physician using a combination of "PowerPoint presentations, video demonstrations, and operation demonstrations" . Each part is 5 min. The experimental group was taught by the intelligent teaching robot system with a spinning technique. The teaching time is 15 min for both groups. At the end of the two teaching sessions, the two groups were trained five times under different BMIs and passed the system assessment. The qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude were compared between the two groups. Results:In normal, there was significant differences between the qualified rates of pre-traction force, lifting and pulling force, maximum force, pre-traction time, lifting and pulling time, rotation amplitude, and pitch amplitude in two groups (all P<0.05). For overweight people, there were significant differences in pre-traction force, pulling force, maximum force, and rotation amplitude (all P <0.05), while there were no significant differences in pre-traction time, pulling time, or pitching amplitude (all P >0.05). In obesity, there were significant differences in pre-traction force, lifting and pulling force, maximum force, and pitch amplitude (all P <0.05), but no significant differences in pre-traction time, lifting and pulling time, or rotation amplitude (all P >0.05). Conclusions:The proposed system can improve the pass rate of spinning manipulation, especially by effectively controlling the pre-traction force, pulling force, and maximum force.

Objective To analyze the changes in morphology of intervertebral foramina in patients with cervical spondylotic radiculopathy (CSR) treated with fixedpoint lateral flexion and rotation manipulation based on three-dimensional (3D) reconstruction technology, so as to provide references for the effectiveness of manipulation treatment. MethodsForty patients with CSR were treated with fixed point lateral flexion and rotation manipulation once every other day for a total of 7 times and 2 weeks as a course of treatment. CT data of the patients before and after treatment were analyzed by using multifunctional CT, Mimics 21.0, Geomagic and SolidWorks 2017. The area of the intervertebral foramen, anterior and posterior diameter of the intervertebral foramen, upper and lower diameter of the intervertebral foramen were measured before and after treatment, as well as the infrared thermal imaging temperature differences of the bilateral neck and shoulder, front and back of the upper limb, and the VAS scores of the patients were observed before treatment, 7 d after treatment, 14 d after treatment and 1 month follow-up. Results Foraminal area, anterior and posterior diameters, upper and lower diameters of 40 patients were improved after treatment, and the temperature differences of infrared thermal imaging of patients before and after treatment were statistically significant. The VAS score of the patients decreased progressively. Conclusions Fixed point lateral flexion manipulation can significantly improve the shape of the intervertebral foramen in patients with CSR, so as to achieve the treatment purpose of relieving nerve compression.

Objective:To observe the effects of "pushing patella and extending knee" manipulation on the protein and mRNA expression levels of integrin β1 (ITGβ1) and phosphorylated adhesion plaque kinase (p-FAK) in rabbit knee osteoarthritis (KOA) model, and to investigate the mechanism of manipulations in the treatment of KOA.Methods:Twenty healthy 6-month-old New Zealand rabbits were divided into the normal group, the model group, the acupuncture group, and the manipulation group according to the random number table method. Among them, the model group, the acupuncture group, and the manipulation group were modeled using the modified Hulth method for KOA. After 7 d of successful modeling, the normal group and the model group did not receive any intervention, while the acupuncture group and the manipulation group received one acupuncture intervention and one "pushing patella and extending knee" manipulation intervention daily, respectively. After 2 weeks of treatment, the rabbit KOA model was executed by air embolization, and the protein and mRNA expression levels of ITGβ1 and p-FAK in knee cartilage were measured by Western blot and real-time polymerase chain reaction (PCR), respectively.Results:Compared with the normal group, the ITGβ1 protein expression level was decreased ( P<0.05) and p-FAK protein expression level was increased ( P<0.05), and the mRNA expression levels of ITGβ1 and p-FAK did not change significantly (all P>0.05) in the model group. Compared with the model group, the ITGβ1 protein expression level was increased ( P<0.05), the p-FAK protein expression level decreased ( P<0.05), and the mRNA expression levels of both ITGβ1 and p-FAK increased (all P<0.05) in the acupuncture group. Compared with the acupuncture group, ITGβ1 protein expression level increased ( P<0.05), p-FAK protein expression level decreased ( P<0.05), and mRNA expression levels of both ITGβ1 and p-FAK increased (all P<0.01) in the manipulation group. Conclusions:The "pushing patella and extending knee" manipulation can optimize the protein and mRNA expression levels of ITGβ1 and p-FAK in the articular cartilage of the rabbit KOA model.

Objective:To systematically evaluate the medication experience and needs of patients with oral anticancer drugs at home, providing reference for the formulation and implementation of home supervision measures for these patients.Methods:PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CNKI, Wanfang database, VIP database and Chinese biomedical literature database were searched by computer to collect qualitative studies on medication experience and needs of patients with oral anticancer drugs at home. The retrieval period was from the database construction to May 1, 2021. The quality of the literature was evaluated by the Australian JBI qualitative research quality evaluation criteria for evidence-based health care centres, and the results were integrated by the pooled integration method of Meta-integration.Results:A total of 11 studies were included, 52 results were extracted, 13 categories were summarized and 4 integrated results were obtained: heavy negative psychological experience; undergo physical trials; a desire for outside support; adjust to the disease.Conclusions:According to the four aspects of experience and needs of patients with oral anticancer drugs at home, medical staff should guide them to establish health belief, improve disease perception and coping ability, and take measures to meet patients′ needs for knowledge, communication and social support through multiple channels.

The important pathogenesis of knee osteoarthritis (KOA) lies in kidney deficiency and blood stasis. Therefore, Traditional Chinese Medicine (TCM) for tonifying the kidney and activating blood circulation is widely used in clinical practise with high response. The existing literature mainly focuses on single medicine for tonifying the kidney and activating blood circulation, as well as TCM compounds, such as classic prescriptions Yougui Pill, Duhuo Jisheng Decoction, which contain TCMs for tonifying the kidney and activating blood circulation, or self-made empirical prescriptions Bushen Huoxue Recipe and Bushen Tongluo Recipe, which are based on the idea of tonifying the kidney and activating blood circulation. The above TCMs mainly regulate oxidative stress response, inflammatory cytokine level, no level, lymphatic function and microcirculation Inhibit chondrocyte apoptosis, regulate cartilage metabolism, protect and repair cartilage, and inhibit matrix degrading enzymes to play a therapeutic role.