BACKGROUND:Mechanical alignment is the"gold standard"alignment technique in total knee arthroplasty,but regardless of advances in prosthetic materials and robotic-assisted navigation,mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20％.OBJECTIVE:To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment.METHODS:A total of 44 consecutive cases(50 knees)that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed,including 12 males(14 knees)and 32 females(36 knees).A total of 46 consecutive cases(50 knees)that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls,including 5 males(5 knees)and 41 females(45 knees).The tibial osteotomy angle,tibial plateau osteotomy amount,femoral osteotomy angle,distal femoral,posterior and anterior osteotomy amount,and joint line movement were observed in the two groups of patients.Preoperative and postoperative flexion and extension gap internal and external laxity,hip-knee-ankle angle,mechanical lateral distal femoral angle,mechanical medial proximal tibial angle,joint line convergence angle,sagittal femoral component angle,posterior tibial slope,arithmetic hip-knee-ankle angle,joint line obliquity,coronal plane alignment of the knee classification,Western Ontario and McMaster Universities Osteoarthritis Index,and Hospital for Special Surgery score and forgotten joint score were compared between the two groups.RESULTS AND CONCLUSION:(1)The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group,and the proportion of gap imbalance(2％)was smaller than that in the mechanical axis alignment group(18％).The differences were all significant(P＜0.05).(2)The hip-knee-ankle angle,mechanical medial proximal tibial angle,arithmetic hip-knee-ankle angle,and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively,and the differences were significant(P＜0.05).(3)The most common coronal plane alignment of the knee classification before surgery was type Ⅰ(80％in the functional alignment group and 42％in the mechanical axis alignment group).(4)The proportion of joint line obliquity＜177°(44％)in the functional alignment group was greater than that in the mechanical axis alignment group(14％)postoperatively.(5)Hospital for Special Surgery score at 1 month,6 months,and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group;the differences were statistically significant(P＜0.05).The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group;the difference was statistically significant(t=-2.85,P=0.005).There was no significant difference in postoperative range of motion and forgotten joint score between the two groups(P＞0.05).(6)It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy.The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique.

[Objective]To summarize the characteristics and value of the medical records of Zhejiang physicians in order to better inherit and carry forward the traditional Chinese medicine academics in Zhejiang.[Methods]Based on the medical books of Zhejiang physicians recorded in the photocopy of Siku Quanshu Catalogue-Doctors,and referring to the classification method of the book,the catalogue of the Zhejiang physicians and their books were classified and counted by consulting the literature.[Results]A total of 38 medical books of 29 Zhejiang physicians were recorded in the Siku Quanshu Catalogue-Doctors,accounting for about 19%of the total number of books in the Siku Quanshu Catalogue-Doctors,including CHEN Yan's Sanyin Jiyi Bingzheng Fanglun,ZHU Danxi's Further Discourses on the Properties of Things and The Development of Jufang,HUA Shou's Nanjing Benyi,DAI Yuanli's Seeking Teacher's Intention,ZHANG Jiebin's The Classified Classic and Jingyue Quanshu,etc.The writings of Zhejiang physicians were based on the classics,citing various theories,creating new theories in combination with the times,focusing on the combination of theory and clinical practice,emphasizing"the past for the present"and highlighting the status of the mainstay of the Danxi school.[Conclusion]Zhejiang region was rich in cultural resources,with many practitioners,famous scholars,abundant medical works,rich content and gradually formed academic schools with regional characteristics such as the Danxi school,which provided a useful reference for the deep cultivation of Zhejiang school of Chinese medicine research,and had a positive role in promoting the inheritance and development of Chinese medicine,especially the school.

[Objective]To explore the mechanism of clear wine and analyze the theoretical and practical significance of co-decoction of wine and water recorded in Treatise on Febrile Diseases such as Zhigancao Decoction.[Methods]Grounded in the decoction methodologies documented in ancient texts such as Treatise on Febrile Diseases and the"wine-mediated drug delivery"theory,integrating modern pharmacological investigations with quantitative analysis of bioactive component dissolution,and conducting comparative clinical efficacy assessments through contemporary case studies,the synergy effect of clear wine in Zhigancao Decoction was systematically elucidated.[Results]Ancient texts emphasized the role of clear wine in Zhigancao Decoction for promoting blood circulation and drug efficacy,yet many later derivative formulas abandoned wine decoction,suggesting its synergy effects may vary with herbal compatibility and pathogenic mechanisms.Modern studies confirmed that clear wine enhances partial efficacy by increasing the dissolution of lipophilic components(such as catalpol and 5-hydroxymethylfurfural),but the regulation of herbal compatibility and decoction techniques played a more critical role in therapeutic outcomes.Clinical data demonstrated similar efficacy of water-decocted groups in relieving primary symptoms such as arrhythmia compared with clear wine-decocted groups,with no advantage observed across wine types,supporting the notion that the solvent-mediated synergy effect of clear wine in Zhigancao Decoction was non-essential.[Conclusion]Effect of promoting blood circulation and drug efficacy by clear wine exhibits pathomechanism specificity.In Zhigancao Decoction,its therapeutic action is constrained by herbal compatibility and decoction techniques,demonstrating no significant therapeutic effect on the formula's principal indications.Further multicenter randomized controlled trials can be conducted to verify the efficacy of clear wine.

BACKGROUND:Mechanical alignment is the"gold standard"alignment technique in total knee arthroplasty,but regardless of advances in prosthetic materials and robotic-assisted navigation,mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20％.OBJECTIVE:To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment.METHODS:A total of 44 consecutive cases(50 knees)that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed,including 12 males(14 knees)and 32 females(36 knees).A total of 46 consecutive cases(50 knees)that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls,including 5 males(5 knees)and 41 females(45 knees).The tibial osteotomy angle,tibial plateau osteotomy amount,femoral osteotomy angle,distal femoral,posterior and anterior osteotomy amount,and joint line movement were observed in the two groups of patients.Preoperative and postoperative flexion and extension gap internal and external laxity,hip-knee-ankle angle,mechanical lateral distal femoral angle,mechanical medial proximal tibial angle,joint line convergence angle,sagittal femoral component angle,posterior tibial slope,arithmetic hip-knee-ankle angle,joint line obliquity,coronal plane alignment of the knee classification,Western Ontario and McMaster Universities Osteoarthritis Index,and Hospital for Special Surgery score and forgotten joint score were compared between the two groups.RESULTS AND CONCLUSION:(1)The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group,and the proportion of gap imbalance(2％)was smaller than that in the mechanical axis alignment group(18％).The differences were all significant(P＜0.05).(2)The hip-knee-ankle angle,mechanical medial proximal tibial angle,arithmetic hip-knee-ankle angle,and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively,and the differences were significant(P＜0.05).(3)The most common coronal plane alignment of the knee classification before surgery was type Ⅰ(80％in the functional alignment group and 42％in the mechanical axis alignment group).(4)The proportion of joint line obliquity＜177°(44％)in the functional alignment group was greater than that in the mechanical axis alignment group(14％)postoperatively.(5)Hospital for Special Surgery score at 1 month,6 months,and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group;the differences were statistically significant(P＜0.05).The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group;the difference was statistically significant(t=-2.85,P=0.005).There was no significant difference in postoperative range of motion and forgotten joint score between the two groups(P＞0.05).(6)It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy.The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique.

[Objective]To summarize the characteristics and value of the medical records of Zhejiang physicians in order to better inherit and carry forward the traditional Chinese medicine academics in Zhejiang.[Methods]Based on the medical books of Zhejiang physicians recorded in the photocopy of Siku Quanshu Catalogue-Doctors,and referring to the classification method of the book,the catalogue of the Zhejiang physicians and their books were classified and counted by consulting the literature.[Results]A total of 38 medical books of 29 Zhejiang physicians were recorded in the Siku Quanshu Catalogue-Doctors,accounting for about 19%of the total number of books in the Siku Quanshu Catalogue-Doctors,including CHEN Yan's Sanyin Jiyi Bingzheng Fanglun,ZHU Danxi's Further Discourses on the Properties of Things and The Development of Jufang,HUA Shou's Nanjing Benyi,DAI Yuanli's Seeking Teacher's Intention,ZHANG Jiebin's The Classified Classic and Jingyue Quanshu,etc.The writings of Zhejiang physicians were based on the classics,citing various theories,creating new theories in combination with the times,focusing on the combination of theory and clinical practice,emphasizing"the past for the present"and highlighting the status of the mainstay of the Danxi school.[Conclusion]Zhejiang region was rich in cultural resources,with many practitioners,famous scholars,abundant medical works,rich content and gradually formed academic schools with regional characteristics such as the Danxi school,which provided a useful reference for the deep cultivation of Zhejiang school of Chinese medicine research,and had a positive role in promoting the inheritance and development of Chinese medicine,especially the school.

[Objective]To explore the mechanism of clear wine and analyze the theoretical and practical significance of co-decoction of wine and water recorded in Treatise on Febrile Diseases such as Zhigancao Decoction.[Methods]Grounded in the decoction methodologies documented in ancient texts such as Treatise on Febrile Diseases and the"wine-mediated drug delivery"theory,integrating modern pharmacological investigations with quantitative analysis of bioactive component dissolution,and conducting comparative clinical efficacy assessments through contemporary case studies,the synergy effect of clear wine in Zhigancao Decoction was systematically elucidated.[Results]Ancient texts emphasized the role of clear wine in Zhigancao Decoction for promoting blood circulation and drug efficacy,yet many later derivative formulas abandoned wine decoction,suggesting its synergy effects may vary with herbal compatibility and pathogenic mechanisms.Modern studies confirmed that clear wine enhances partial efficacy by increasing the dissolution of lipophilic components(such as catalpol and 5-hydroxymethylfurfural),but the regulation of herbal compatibility and decoction techniques played a more critical role in therapeutic outcomes.Clinical data demonstrated similar efficacy of water-decocted groups in relieving primary symptoms such as arrhythmia compared with clear wine-decocted groups,with no advantage observed across wine types,supporting the notion that the solvent-mediated synergy effect of clear wine in Zhigancao Decoction was non-essential.[Conclusion]Effect of promoting blood circulation and drug efficacy by clear wine exhibits pathomechanism specificity.In Zhigancao Decoction,its therapeutic action is constrained by herbal compatibility and decoction techniques,demonstrating no significant therapeutic effect on the formula's principal indications.Further multicenter randomized controlled trials can be conducted to verify the efficacy of clear wine.

[Objective]To explore the content of four Zhuyou formulas in Tianhui Medical Bamboo Slips of Han Dynasty tombs in Laoguanshan,and to identify the development process of Zhuyou and its contribution to the development of traditional Chinese medicine.[Methods]Using the literature search method and the double evidence method,the four Zhuyou formulas were connected with the works of similar times and modern literature,and the content was explained.Combined with the cultural background of the times,the treatment content was analyzed in depth.[Results]Tianhui Medical Bamboo Slips is relatively mature medical data in the Qin and Han Dynasties,including four Zhuyou formulas,involving three diseases.These prescriptions depend on the theory of gods and ghosts in content and form,but at the same time,they also show the embryonic form of the philosophy of traditional Chinese medicine and the mainstream treatment concept of later generations.There are not only the use of drugs,Zhuyou,numerology,Daoyin for treatment,but also some modern psychological and surgical treatment methods.[Conclusion]Under the background of the times,Tianhui Medical Bamboo Slips was a medical literature with relatively complete content and standardized writing at that time.The four Zhuyou formulas present the characteristics of ignorance and awakening,which is also the epitome of the evolution of traditional Chinese medicine.It is a leap from the practice of ignorance to the dawn of systematic theory.

[Objective]To explore the evolution law and treatment ideas of lily disease based on causal chain theory.[Methods]The causal chain analysis method is used to sort out the conditional and root causes of lily disease,trace the direct causes of lily disease,summarize the corresponding treatment principles and methods,and it lists a clinical case to prove it.[Results]By constructing the causal chain of lily disease,the evolution law in the development of lily disease is clarified and the causal relationship is analyzed.The cause of the condition of lily disease is the remaining evil and the failure of emotion;heart and lung Yin deficiency and internal heat are the root cause and the key factor in the occurrence of lily disease;on this basis,the further damage of the heart and lung causes the lesion of "heart loss of mind,lung losing soul" which directly leads to the abnormality of emotion,behavior and sensation,and finally develops into lily disease.Therefore,"heart loss of mind,lung losing soul" is the direct cause of lily disease.The direct cause and root cause of the disease can form a feedback chain and interact with each other.In view of the direct cause,it is proposed that the treatment of lily disease is regulating heart and lung together,and calming the spirit.The syndrome differentiation of the attached medical records belonged to the syndrome of heart and lung Yin deficiency and internal heat,and the spirit was out of control.The treatment was nourishing the heart and moistening the lung,nourishing Yin and clearing heat,calming the nerves and calming the soul,with good effect.[Conclusion]Heart and lung spirit loss is the direct cause of this disease.The analysis of lily disease by causal chain can focus on the essence,guide the clinical understanding of lily disease in a more comprehensive,intuitive and three-dimensional way,and provide new ideas and methods for clinical diagnosis and treatment,so as to improve the ability of accurate diagnosis and treatment.The application of modern thinking of the causal chain also contributes to the innovation and development of the thinking mode of traditional Chinese medicine.

[Objective]To explore the evolution law and treatment ideas of lily disease based on causal chain theory.[Methods]The causal chain analysis method is used to sort out the conditional and root causes of lily disease,trace the direct causes of lily disease,summarize the corresponding treatment principles and methods,and it lists a clinical case to prove it.[Results]By constructing the causal chain of lily disease,the evolution law in the development of lily disease is clarified and the causal relationship is analyzed.The cause of the condition of lily disease is the remaining evil and the failure of emotion;heart and lung Yin deficiency and internal heat are the root cause and the key factor in the occurrence of lily disease;on this basis,the further damage of the heart and lung causes the lesion of "heart loss of mind,lung losing soul" which directly leads to the abnormality of emotion,behavior and sensation,and finally develops into lily disease.Therefore,"heart loss of mind,lung losing soul" is the direct cause of lily disease.The direct cause and root cause of the disease can form a feedback chain and interact with each other.In view of the direct cause,it is proposed that the treatment of lily disease is regulating heart and lung together,and calming the spirit.The syndrome differentiation of the attached medical records belonged to the syndrome of heart and lung Yin deficiency and internal heat,and the spirit was out of control.The treatment was nourishing the heart and moistening the lung,nourishing Yin and clearing heat,calming the nerves and calming the soul,with good effect.[Conclusion]Heart and lung spirit loss is the direct cause of this disease.The analysis of lily disease by causal chain can focus on the essence,guide the clinical understanding of lily disease in a more comprehensive,intuitive and three-dimensional way,and provide new ideas and methods for clinical diagnosis and treatment,so as to improve the ability of accurate diagnosis and treatment.The application of modern thinking of the causal chain also contributes to the innovation and development of the thinking mode of traditional Chinese medicine.

Objective:To evaluate the feasibility and clinical outcomes of navigation-assisted total knee arthroplasty (TKA) using adjusted restricted kinematic alignment (arKA).Methods:Data of 14 consecutive cases of OrthoPilot navigation-assisted TKA using arKA from October 2019 to September 2021 were retrospectively analyzed, including 3 males and 9 females. The average age was 67.71±8.96 years with mean body mass index (BMI) 25.94±3.12 kg/m 2. 27 consecutive patients who underwent navigation-assisted TKA using aMA during the same period were assessed as the control group. There were no significant differences in gender, age or BMI between the two groups. Intraoperative parameters including operative duration, tibia resection angle, frontal femoral angle, axial femoral angle, joint line translation, medial and lateral gap in extension and flexion position were recorded. Radiographic parameters including hip-knee-ankle (HKA) angle, coronal femoral component angle (cFCA), coronal tibial component angle (cTCA), sagittal femoral component angle (sFCA) and sagittal tibial component angle (sTCA) were measured. Functional outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Hospital for Special Surgery (HSS) score. Surgery-related complications were recorded. Results:All cases were followed up. The mean follow-up of arKA group was 18.57±6.98 months and follow-up of aMA group was 22.15±4.91 months. The intraoperative tibial resection was 3.07°±1.00° in arKA group versus 0.67°±0.56° in aMA group ( P<0.05). The lateral cutting height of tibia was 9.07±1.82 mm in arKA group versus 6.89±2.94 mm in aMA group ( P<0.05). The lateral gap in flexion was 1.71±0.83 mm in arKA group versus 1.04±0.71 mm in aMA group ( P<0.05). The difference of medial-lateral flexion laxity was 1.14±0.86 mm in arKA group versus 0.41±0.75 mm in aMA group ( P<0.05). The postoperative HKA angle was 174.10°±1.63° in arKA group versus 177.12°±2.07° in aMA group ( P<0.05). The cTCA was 87.58°±0.85° in arKA group versus 89.14°±1.23° in aMA group ( P<0.05). The cFCA was 93.10°±1.75° in arKA group versus 90.41°±3.01° in aMA group ( P<0.05). There was no statistical difference between the two groups in sFCA (1.30°±0.82° vs. 1.56°±1.19°), sTCA (87.16°±0.95° vs. 87.79°±1.04°) and femoral notching (7.1% vs. 11.1%). The preoperative HSS score in arKA group was 46.07±4.68 and HSS score at 1 month postoperatively was 73.86±3.48 ( P<0.05). The preoperative HSS score in aMA group was 47.04±4.52 and HSS score at 1 month postoperatively was 74.04±3.57 ( P<0.05). There was no statistical difference between the two groups in WOMAC score (12.93±2.37 vs. 12.63±2.34) and HSS score (86.86±2.74 vs. 86.11±2.95) at 6 months postoperatively. 2 cases (14.3%) in arKA group and 5 cases (18.5%) in aMA group had deep venous thrombosis (χ 2=0.12, P=0.733). Conclusion:Navigation-assisted TKA using arKA offers the surgeons a new alignment option for severe knee deformity with satisfactory clinical outcomes, the arKA technique has advantages in soft tissue protection and gap balance regulation compared to aMA technique.