Osteoporotic proximal humeral fracture (OPHF) is one of the common osteoporotic fractures in the aged, with an incidence only lower than vertebral compression fracture, hip fracture, and distal radius fracture. OPHF, secondary to osteoporosis and characterized by poor bone quality, comminuted fracture pattern, slow healing, and severely impaired shoulder joint function, poses a big challenge to the current clinical diagnosis and treatment. In the field of diagnosis, treatment, and rehabilitation of OPHF, traditional Chinese and Western medicine have accumulated rich experience and evidence from evidence-based medicine and achieved favorable outcomes. However, there is still a lack of guidance from a relevant consensus as to how to integrate the advantages of the two medical systems and achieve the integrated diagnosis and treatment. To promote the diagnosis and treatment of OPHF with integrated traditional Chinese and Western medicine, relevant experts from Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine have been organized to formulate Expert consensus on the diagnosis and treatment of osteoporotic proximal humeral fracture with integrated traditional Chinese and Western medicine ( version 2024) by searching related literatures and based on the evidences from evidence-based medicine. This consensus consists of 13 recommendations about the diagnosis, treatment and rehabilitation of OPHF with integrated traditional Chinese medicine and Western medicine, aimed at standardizing, systematizing, and personalizing the diagnosis and treatment of OPHF with integrated traditional Chinse and Western medicine to improve the patients ′ function.

OBJECTIVE To observe the clinical efficacy and safety of tofacitinib combined with hydroxychloroquine in the treatment of refractory rheumatoid arthritis （RA）. METHODS From January 1， 2021 to January 1， 2022， 120 patients with refractory RA were selected as the study objects. According to the principle of random allocation， the patients were divided into group A， group B and group C， with 40 patients in each group. Group A was given Tofacitinib citrate tablet + Hydroxychloroquine sulfate tablet； group B was given Tofacitinib citrate tablet + Methotrexate tablet； group C was given Tofacitinib citrate tablet + Leflunomide tablet. Three groups were given relevant medicine for 6 months. Therapeutic efficacy and disease activity score 28 （DAS 28） of 3 groups as well as Sharp score， the levels of biochemical indicators [erythrocyte sedimentation rate （ESR）， C- reactive protein （CRP）]， immune indexes [rheumatoid factor （RF）， anti-cyclic peptide containing citrulline （anti-CCP） antibody]， serum cytokine indicators [interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α）] before and after treatment were observed； the occurrence of adverse drug reactions during treatment was recorded. RESULTS After treatment， the proportions of ACR50 and ACR70 patients in group A were significantly higher than groups B and C （P＜0.05）； DAS28 score， Sharp score， biochemical indicators， immune indexes and serum cytokine indicators of 3 groups were significantly lower than before treatment （P＜0.05）， and gradually decreased with prolonged treatment time； after 6 months of treatment， DAS28 score， Sharp score， RF， anti-CCP antibody， the levels of IL-6 and TNF-α in group A were significantly lower than group B and C （P＜0.05）. There was no significant difference in the incidence of diarrhea， nausea and vomiting， leukopenia， rash， abnormal liver and kidney function， or dizziness among 3 groups （P＞0.05）. CONCLUSIONS Tofacitinib combined with hydroxychloroquine shows good efficacy and safety for refractory RA.

Bone organoids can simulate the complex structure and function of the bone tissues, which makes them a frontier technology in organoid researches. Bone organoids show a tremendous potential of applications in bone disease modeling, bone injury repair, and medicine screening. Although advancements have been made so far in constructing bone organoids with functional structures like mineralization, bone marrow, trabecular bone, callus, woven bone, etc, the researches in this field are confronted with numerous challenges such as lack of standardized construction strategies and unified evaluation criteria, which limits their further promotion and application. To standardize researches in bone organoids, the Orthopedic Expert Committee of Geriatric Branch of Chinese Association of Gerontology and Geriatrics, the Youth Osteoporosis Group of Orthopedic Branch of Chinese Medical Association, the Osteoporosis Group of Orthopedic Surgeon Branch of Chinese Medical Doctor Association, and the Osteoporosis Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine organized related experts to formulate Expert consensus on the construction, evaluation, and application of bone organoids ( version 2024) based on an evidence-based approach. A total of 17 recommendations were put forth, aiming to standardize researches and clinical applications of bone organoids and enhance their value in scientific research and clinical practice.

Objective To systematically analyze the clinical pharmaceutical rehabilitation model based on data mining,so as to explore its role in improving drug treatment efficacy,reducing drug side effects,and optimizing rehabilitation experience.Methods We retrieved published literatures related to clinical pharmaceutical rehabilitation from CNKI,Wanfang,VIP,and PubMed,with a search time from inception to June 30,2022.Results Totally 11 articles were enrolled in this study.A study involving 69 randomized controlled trials(RCTs)demonstrated that the involvement of pharmacists in medication reviews significantly improved the control of hypertension,type 2 diabetes,and high cholesterol.The odds ratio(OR)for improved control was 2.71(95%confidence interval[CI]:1.03-7.01)for hypertension,3.12(95%CI:1.12-5.84)for type 2 diabetes,and 1.90(95%CI:1.05-3.35)for high cholesterol.A study involving 6 RCTs and 2 573 patients with chronic kidney disease(CKD)showed that pharmacist-led blood pressure monitoring,lifestyle,and medication regimen assessments significantly improved blood pressure control in CKD patients,with an OR of 1.51(95%CI:1.13-2.03).A Meta-analysis,including 5 RCTs and 3 observational studies,explored the impact of medication education and behavioral interventions on the treatment outcomes of gout.The results revealed that patients receiving medication education and behavioral interventions had a significantly higher rate of uric acid control and a higher proportion of patient with uric acid less than 360 μmol/L.A Meta-analysis of 14 RCTs involving 4 509 patients showed that pharmacist interventions such as medication education and counseling significantly reduced the 30-day readmission rates for hypertension and diabetes patients,with a relative risk(RR)of 0.75(95%CI:0.53-0.96).Eighteen RCTs involving 7 244 patients investigated the impact of pharmacist-led discharge counseling on the readmission rate.The findings showed that discharge counseling significantly reduced readmission rate,with a RR of 0.864(95%CI:0.763-0.997,P=0.020).Eight studies assessed the impact of pharmacist services on readmission rate,and the result showed that patients receiving pharmacy-related services had significantly reduced readmission rates,with a 32%reduction in the risk of readmission(OR=0.74,95%CI:0.62-0.89).A Meta-analysis including 123 studies investigated the effect of pharmacist interventions in patient care on the readmission rate,and the result indicated that pharmacist interventions led to a decrease in readmission rates,with the maximum decrease of 44.5%.A Meta-analysis of 23 RCTs evaluated the impact of pharmacist interventions on medication-related adverse events in elderly residents of nursing homes.The study found that pharmacist-led medication reviews and education significantly reduced adverse events.Another Meta-analysis of 14 RCTs and intervention studies explored the effect of pharmacist involvement in multidisciplinary care on medication-related adverse events.The analysis showed that pharmacist participation in multidisciplinary care was significantly associated with a reduction in the incidence of adverse events(RR=0.47,95%CI:0.28-0.77,P<0.01).A Meta-analysis of 6 RCTs involving 29 291 pediatric inpatients revealed that pharmacist interventions effectively reduced the risk of medication errors in hospitalized children(OR=0.27,95%CI:0.15-0.49).A literature analysis on the effectiveness of clinical pharmaceutical services in patient drug treatment showed that introducing a clinical pharmaceutical service model can reduce the use of antibiotics,lower medical costs,and improve medication satisfaction among patients treated with antibiotics.Conclusion In-depth exploration of clinical pharmaceutical rehabilitation model plays an important role in clinical treatment,which can improve the effectiveness of rehabilitation and reduce the incidence of adverse reactions.

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 epidemiological characteristics of geriatric acetabular fractures in western China.Methods:A retrospective case series study was made on data of geriatric patients with acetabular fracture hospitalized in 4 grade A hospitals in western China from 2015 to 2020. The investigation content included gender, age, incidence rate, injury mechanism, combined injuries, comorbidities, fracture types and treatment plans.Results:A total of 299 geriatric patients with acetabular fractures were included, including 203 males and 96 females, aged 60-97 years [(68.6±7.6)years]. The mean age of the patients was increased from 67.5 years to 71.1 years. The incidence rate was increased from 36 cases per year to 64 cases per year. The injury mechanism was mainly traffic accidents (42.47%), followed by falls (30.44%). Thoracic injury was the most common type of combined injuries (39.81%). Hypertension was the main comorbidity (28.76%). The most common fracture type was anterior column posterior hemitransverse fracture (31.32%). Of 299 patients, 210 received surgical treatment, with the surgery rate of 70.23%.Conclusions:Geriatric acetabular fracture is characterized by gradually increased age and incidence rate, traffic accidents as the main cause of injury, thoracic injury as the main combined injury, hypertension as the main comorbidity, anterior column posterior hemitransverse fracture as the main fracture type and surgery as the main treatment option.

OBJECTIVE： To investigate the analgesic and anti-inflammatory effects of ethanol extract from Arenga pinnata in mice/rats after intragastric administration. METHODS： The mice were randomly divided into A. pinnata ethanol extract group  and solvent control group （distilled water）， with 20 mice in each group. Maximal dosage method was used to observe the acute toxicity of ethanol extract from A. pinnata with intragastric administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups [6.5， 3.25， 1.625 g/kg （by ethanol extract， similarly here in after）， i.g.]， positive control group （0.005 g/kg morphine， i.p.） and blank control group （distilled water， i.g.）. The analgesic effect was evaluated by hot plate method， and the licking latency was compared 30， 60 and 90 minutes after administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （loxoprofen sodium 0.023 g/kg， i.g.） and model control group （distilled water， i.g.）. The analgesic effect was evaluated by acetic acid writhing method. The writhing times within 20 minutes were compared and the writhing inhibition rate was calculated. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （morphine 0.005 g/kg， i.p.）， model control group （distilled water， i.g.）. The analgesic effect was evaluated by formalin-induced pain method. The total licking time was compared between 0-5 min and 10-40 min after formalin administration； the inhibition rate of licking was calculated. The mice were grouped according to acetic acid writhing test. The mice were given relevant medicine once a day for consecutive 3 days. The mice were given xylene to induce inflammation model， and the degree of ear swelling was compared. Rats were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （4.5， 2.25， 1.125 g/kg， i.g.）， positive control group （losoprofen sodium 0.016 g/kg， i.g.）， model control group （distilled water， i.g.） and blank control group （distilled water， i.g.）， once a day， for consecutive 3 days. The rats were given Freund’s complete adjuvant to induce inflammation model and then given relevant medicine for consecutive 7 d. The degree of paw swelling was compared before inflammation and within 7 days after inflammation. The number of mice/rats in each group was 8 to 14 in the analgesic and anti-inflammatory tests. RESULTS： Compared with solvent control group， the body weight of mice had no significant increase in A. pinnata ethanol extract group； no drug-induced toxicity was found. Compared with blank control group， licking latency in mice was significantly prolonged in A. pinnata ethanol extract high-dose group 30 and 60 minutes after medication （P＜0.01）. Compared with model control group， the times of writhing， total licking time and the degree of ear swelling of mice were decreased significantly in A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （P＜0.05 or P＜0.01）. Compared with model control group， the degree of paw swelling began decrease significantly in A. pinnata ethanol extract high-dose group 4 h after inducing inflammation， and the effect lacted until the 7th day （P＜0.01）. CONCLUSIONS： A. pinnata ethanol extract has no significant acute oral toxicity， and possesses significant analgesic and anti-inflammatory effects.

OBJECTIVE： To study the improvement effect and mechanism of Chuanju zhitong capsules （CZC） on migraine model rats. METHODS： SD rats were randomly divided into normal group， model group， chemical drug positive control group （Zolmitriptan tablet， 0.004 05 g/kg）， TCM positive control group （Compound yangjiao capsule， 4.32 g/kg）， CZC high-dose， medium-dose and low-dose groups （1.6， 0.8， 0.4 g/kg）， 10 rats in each group. All rats were relevant medicine intragastrically once a day， for successive 5 days. 30 min after last medication， except for normal group， rats in other groups were given glyceryl trinitrate subcutaneously （10 mg/kg） via head and neck to induce migraine model. The behavior changes of rats were evaluated using the times of scratching head as indexes within 2 h after modeling （30 min as a period of time）. 4 h after modeling， hemorheological parameters as whole blood viscosity （low-shearing， medium-shearing， high-shearing）， plasma viscosity， erythrocyte aggregation indexes and erythrocyte rigidity indexes were determined by automatic hemorheology instrument. The levels of NO， NOS， ET-1， CGRP in serum and the levels of  5-HT， 5-HIAA， DA and NE in cerebral tissue were determined by ELISA. RESULTS： Compared with normal group， the times of scratching head was increased significantly in model group at different periods （P＜0.01）. The serum levels of NO， NOS and CGRP were increased significantly （P＜0.01）， while ET-1 level was decreased significantly （P＜0.01）. The levels of 5-HT， DA and NE in cerebral tissue were decreased significantly （P＜0.01）， while 5-HIAA level was increased significantly （P＜0.01）. Whole blood viscosity （low-shearing）， plasma viscosity， erythrocyte aggregation index and erythrocyte rigidity indexes were increased significantly （P＜0.05），plasma viscosity were decreased significantly （P＜0.05） . Compared with model group， the times of scratching head were decreased significantly in TCM positive control group （0-120 min）， TCM positive control group （60-90 min）， CZC high-dose （30-120 min） and medium-dose （60-90 min） groups （P＜0.05 or P＜0.01）. The whole blood viscosity （low-shearing） and erythrocyte aggregation indexes of TCM positive control group， CZC high-dose and medium-dose groups were decreased significantly （P＜0.05 or P＜0.01）； the serum levels of NO， NOS and CGRP in chemical drug positive control group and CZC high-dose and medium-dose groups were decreased significantly （P＜0.05 or P＜0.01）， while the serum level of ET-1 was increased significantly （P＜0.01）； the levels of 5-HT， DA and NE were increased significantly in cerebral tissue （P＜0.05 or P＜0.01）， while the level of 5-HIAA was decreased significantly （P＜0.05）. CONCLUSIONS： The improvement effect of CZC on migraine model rats is associated with decreasing the serum levels of NO， NOS and CGRP and increasing the levels of 5-HT， DA and NE in cerebral tissue.

Objective To investigate the effect of calcitonin gene-related peptide ( CGRP ) in inducing os-teogenic differentiation of rat precartilaginous stem cells in vitro and the underlying mechanisms. Methods Rat pre-cartilaginous stem cells ( PSCs) were cultured in complete osteogenesis medium containing DMEM/F-12 medium and different concentrations (0, 10-8,10-9,10-10mol/L) of CGRP, the morphology changes of PSCs were observed. The proliferation of PSCs was examined at different time points by CCK-8. All the PSCs were then randomly assigned to an experimental group and a control group. The PSCs in the experimental group were cultured in complete osteogenesis medium with 10-10 mol/L CGRP , while the control group cultured merely in complete osteogenesis medium was re-ceived no special intervention. Both groups were stained by Alizarin Red and the expression of alkaline phosphatase (ALP) was detected. The osteogenic genes (RUNX2,OPN and BGP) were measured by use of RT-PCR. The activa-tion of Wnt/β-catenin signaling pathway was tested by using Western blotting to evaluate the effect of CGRP . Results Compared to the control group ( the concentration of CGRP was 0 mol/L) , the concentration of ALP was significantly higher in the experimental group, calcium deposition was significantly more obvious, and the expression of the osteogenic genes such as RUNX2,OPN and BGP as well as theβ-catenin protein expression were up-regulated significantly. However, CGRP had no effect on cell proliferation. Conclusion CGRP activated Wnt/β-catenin sig-nal pathway and induced osteogenic differentiation of precartilaginous stem cells.

Objective To investigate the expression of a dismtegnn and metalloproteinase-12 (ADAM12) and proliferating cell nuclear antigen (PCNA) in human bladder carcinoma,and to explore their correlation with different grades and stages of bladder cancer.Methods Biopsies of 12 normal bladder and 43 bladder tumors were performed.And immunohistochemistry was conducted to detect the expression of ADAM12 and PCNA in the biopsies.Results Positive expression signals of ADAM12 were detected significantly higher inthe bladder cancer biopsies than that in the normal ones (Z =4.879,P ＜ 0.05),and the expression level of ADAM-12 in lower histological grade was significantly higher than that in the moderate and higher histological grades (x2 =22.3685,P ＜ 0.01).Positive expression signals of PCNA were detected significantly higher in the bladder cancer biopsies than that in the normal ones (Z =4.879,P ＜ 0.05)).Those with lower histological grade had a higher expression level of PCNA when compared with the moderate and higher histological grades (x2 =10.665,P =0.0137).The expression of ADAM-12 was positively correlated with PCNA in bladder cancer (r =1.000,P ＜ 0.0001).Conclusion The over expression of ADAM12 and PCNA maybe play an important role in development of the bladder tumors.And ADAM12 may be a promising biomarker of bladder cancer in the clinical behavior.