Idiopathic pulmonary fibrosis （IPF）， as a progressive lung disease， has a poor prognosis and no reliable and effective therapies. IPF is mainly treated by organ transplantation and administration of chemical drugs， which are ineffective and induce side effects， failing to meet the clinical needs. Therefore， developing safer and more effective drugs has become an urgent task， which necessitates clear understanding of the pathogenesis of IPF. The available studies about the pathogenesis of IPF mainly focus on macrophage polarization， epithelial-mesenchymal transition （EMT）， oxidative stress， and autophagy， while few studies systematically explain the principles and links of the pathogeneses. According to the traditional Chinese medicine theory， Qi deficiency and blood stasis and Qi-Yang deficiency are the key pathogeneses of IPF. Therefore， the Chinese medicines or compound prescriptions with the effects of replenishing Qi and activating blood， warming Yang and tonifying Qi， and eliminating stasis and resolving phlegm are often used to treat IPF. Modern pharmacological studies have shown that such medicines play a positive role in inhibiting macrophage polarization， restoring redox balance， inhibiting EMT， and regulating cell autophagy. However， few studies report how Chinese medicines regulate the pathways in the treatment of IPF. By reviewing the latest articles in this field， we elaborate on the pathogenesis of IPF and provide a comprehensive overview of the mechanism of the active ingredients or compound prescriptions of Chinese medicines in regulating IPF. Combining the pathogenesis of IPF with the modulating effects of Chinese medicines， we focus on exploring systemic treatment options for IPF， with a view to providing new ideas for the in-depth study of IPF and the research and development of related drugs.

【Objective】 To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique. 【Methods】 Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror; Φ1.8 mm soft grasper, tissue scissors, electric hook, and ultrasonic scalpel were used as instruments; the porcine bladder was used as a model.The PORT was placed through the urethra, and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity, the soft grasper was inserted to pull the mucosa to be removed, which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand, and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper, the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa. 【Results】 The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models. 【Conclusion】 The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors, and has the potential of clinical application after further optimization.

Artificial intelligence (AI) has a broad application prospect in the field of bone tumor. By utilizing deep learning models and AI technology, it can provide effective assistance in pathological diagnosis of bone tumors, molecular biology diagnosis, imaging diagnosis and clinical data processing, providing patients with more accurate and personalized medical services. In terms of pathological diagnosis, AI can assist doctors to accurately identify and classify tumor types by automatically analyzing and reading a large number of pathological tissue section images. In terms of molecular biology diagnosis, AI discovers key genes and signaling pathways associated with bone tumors by analyzing large-scale genomics and transcriptomics data, which provides the basis for prognostic assessment and individualized treatment development. In terms of imaging diagnosis, AI can assist doctors to quickly and accurately analyze the image characteristics of bone tumors, automatically mark the location, size and morphology of tumors, guide treatment and predict prognosis. AI can also process large-scale clinical data to identify potential clinical features and patterns to assist in risk assessment, treatment decisions, and predicting prognosis. This paper reviews recent studies on the application of AI in the field of bone tumor diagnosis and treatment, with a view to improving the accuracy of bone tumor diagnosis, improving clinical prognosis, and providing a theoretical basis for the integrated development and innovation in the cross-field of medicine and industry.

ObjectiveTo analyze the changes of volatile organic compounds （VOCs） and bacterial community characteristics in rhizosphere soil during the growth of Rehmanniae Radix， as well as the relationship between VOCs and bacterial community structure， so as to lay the foundation for the evaluation of the characteristics of continuous cropping soil and the regulation of continuous cropping soil microorganisms. MethodThe rhizosphere soil during the three main growth periods of Rehmanniae Radix in July， August and October was used as the research object. Gas chromatography-mass spectrometry （GC-MS） was used to determine the relative contents of VOCs in ethyl acetate and dichloromethane parts in rhizosphere soil. The characteristics of rhizosphere bacterial community structure was determined by high-throughput sequencing， SPSS 24， SIMCA 14.1 and other software were used to analyze the differences of VOCs and bacterial community structure in rhizosphere soil of the three periods， and the main VOCs and iconic bacteria that caused the differences were screened， and the correlation between VOCs and bacterial community structure was analyzed. ResultThere were differences in VOCs in different parts of rhizosphere soil during the three growth stages of Rehmanniae Radix. Among them， and the main VOCs that cause differences were dioctyl isophthalate， 2-octyl-1-dodecanol and 2-ethylhexyl p-toluic acid in the ethyl acetate part， and 1，3-benzenedicarboxylic acid， di （2-propylpentyl） phthalate and 2-ethylhexyl p-toluenecarboxylic acid in the dichloromethane part. From the seedling stage to the end of tuber enlargement of Rehmanniae Radix， the relative abundance of dominant bacteria such as Actinobacteria， Firmicutes and Chloroflexi in the rhizosphere soil was gradually decreased， and there were unique bacterial communities in rhizosphere soil of each growth stage. Correlation analysis showed that the VOCs in rhizosphere soil of Rehmanniae Radix had an impact on the rhizosphere bacterial community structure， especially the components of esters and alcohols. ConclusionDuring the growth of Rehmanniae Radix， the characteristics of rhizosphere soil are mainly manifested in the content changes of main VOCs such as esters and alcohols and the gradual decrease of the abundance of the main beneficial bacteria， and the VOCs in rhizosphere soil play a certain role in shaping the structure of bacterial community.

ObjectiveTo predict the potential targets and possible related signaling pathways of Salviae Miltiorrhizae Radix et Rhizoma against bladder cancer （BC） based on network pharmacology and verify the potential molecular mechanism through in vitro cell experiment. MethodActive components of Salviae Miltiorrhizae Radix et Rhizoma were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） and BC-related targets were searched from GeneCards and Online Mendelian Inheritance in Man （OMIM）. Via Venny2.1， the potential targets of Salviae Miltiorrhizae Radix et Rhizoma against BC were screened out and the Venn diagram was plotted. Protein-protein interaction （PPI） network was constructed by STRING， followed by Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Gnomes （KEGG） pathway enrichment with DAVID. Cell Counting Kit-8 （CCK-8） assay was employed to detect the inhibitory effect of tanshinone Ⅱ_A （Tan Ⅱ_A）， cryptotanshinone （CPT）， and luteolin （LUT） at different concentration （0， 1， 2， 4， 8， 16， 32 μmol·L^-1） on the proliferation of BC T24 and 5637 cells， propidium iodide （PI） staining to analyze the apoptosis of 5637 cells induced by Tan Ⅱ_A， CPT， and LUT （0， 4， 8 μmol·L^-1）， and Western blotting to detect the regulatory effect of Tan Ⅱ_A （0， 4， 8， 16 μmol·L^-1） on the expression of key target proteins. ResultA total of 65 active components and 39 anti-BC targets of Salviae Miltiorrhizae Radix et Rhizoma were screened out. The anti-BC targets were mainly involved in the KEGG pathways of neuron-ligand-receptor interaction， phosphatidylinositol 3-kinases （PI3K）/protein kinase B （Akt） signaling pathway， epidermal growth factor receptor （EGFR） tyrosine kinase inhibitor resistance， and hypoxia inducible factor （HIF）-1 signaling pathway. As for the CCK-8 assay， compared with the blank group， Tan Ⅱ_A， CPT， and LUT significantly inhibited the proliferation of T24 and 5637 cells， particularly the 5637 cells. The half maximal inhibitory concentration （IC₅₀） of Tan Ⅱ_A on 5637 cells was significantly lower than that of CPT and LUT. Moreover， compared with the blank group， Tan Ⅱ_A， CPT， and LUT all induced the apoptosis of 5637 cells， and the effect followed the order of Tan Ⅱ_A>CPT>LUT （P<0.05）. Western blot showed that Tan Ⅱ_A significantly reduced the expression of EGFR， p-PI3K， and p-Akt in 5637 cells in a concentration-dependent manner compared with the blank group （P<0.05）. ConclusionSalviae Miltiorrhizae Radix et Rhizoma exerts therapeutic effect on BC through multiple components， multiple targets， and multiple pathways. The mechanism is the likelihood that it down-regulates the expression of EGFR， p-PI3K， and p-Akt proteins， thus further inhibits cell proliferation， and induces apoptosis.

Objective To investigate the global research status and trends ofrehabilitation after arthroplasty.Methods The Wed of Science database was used to search the publications on rehabilitation after arthroplasty from 1994 to 2018.The included publish items were statistically analyzed by bibliometrics.VOSviewer software was used to analyze the visual transformation of literature coupling (including author coupling,mechanism coupling and country coupling) and co-occurrence analysis.The research status and trends of rehabilitation after arthrop]asty in recent years were analyzed and predicted.Results A total of 1 702 studies were included in the present study.The number of literatures increased year by year globally,including 612 in the United States as the top number of studies in the world.The total citation frequency (15 433 times) and H index (61) of the research publications were also the highest in the world.China (79 literatures) ranked 6th in the number of global research publications,with total citation frequency (451 times) and H index (12) ranked 14th.The number of publications published by JOURNAL OF ARTHROPLASTY and ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION on rehabilitation after arthroplasty was the highest.The University of Pittsburgh and the University of Toronto were the biggest contributors to publications on rehabilitation after arthroplasty.The theme of rehabilitation after arthroplasty can be divided into five categories:pain management,functional exercise,hospital management,complications and clinical trials.Hospital management wasthe main research field recently and the orthopedic specialty hospital would become a hot research topic in the fulure.Conclusion According to the current global trends,rehabilitation study is deepening and the number of publications will increase continuously.The United States is the largest contributor in this area.The current researches focus on the "hospital management" after arthroplasty.The new type of orthopedic specialty hospital may be the next research hotspot for arthroplasty.

Objective We aimed to explor the correlation between the serum resistin levels and the collapse process of femoral head necrosis. Methods Eighty-eight patients with osteonecrosis of the femoral head were included in this study (26, 34 and 28 cases at ARCO stage Ⅱ, Ⅲ and Ⅳ, respectively). Fifty healthy controls were enrolled. The serum resistin levels were detected with ELISA method. We compared the serum resistin levels between the patient group and control group. The differences of serum resistin levels between different ARCO stagesand various disease causes were analyzed in the patient group. Results The resistin levels were significantly higher in patients with osteonecrosis of the femoral than healthy control group (P = 0.026). Compared with control group, the resistin levels significantly increased in patients at ARCO stage Ⅲ and ARCO stage Ⅳ respectively (P = 0.001).The resistin levels of procollapse group (ARCO stage Ⅲ and Ⅳ) were significantly higher than that of precollapse group (ARCO stage Ⅱ) (P = 0.000). There was no statistic difference between ARCO stage Ⅲ andⅣ in resistin levels (P> 0.05). No statistical significance was found between different disease causes. ROC curve analysis of resisrin level indicated theertain accuracy (AUC = 0.749) , sensitivity and significant specificity (77.4％, 61.5％, respectively) in the diagnosis of femoral head necrosis. Conclusions Resistin is closely related to the collapse process of femoral head necrosis. The level of resistin was significantly increased after the collapse of femoral head, which could be useful for the clinical diagnosis of the collapse of femoral head necrosis.

Objective: To study the clinicopathologic features of dedifferentiated liposarcoma of extremities. Methods: Nine cases of dedifferentiated liposarcoma of extremities diagnosed at Beijing Jishuitan Hospital from 2009 to 2017 were selected. The histological features of cases of dedifferentiated liposarcoma of extremities were evaluated by HE and immunohistochemistry, together with the clinical and radiological features. Flourescence in situ hybridization(FISH) was used to detect MDM2 amplification. Results: They were located in the thigh (6 cases), calf (2 cases) and buttock (1 case). There were six females and three males. Patients′ age ranged from 61 to 79 years (mean 68 years). Histologically, there were two components, well-differentiated liposarcoma and dedifferentiated sarcoma with or without transitional lesions between them. The histology of dedifferentiated liposarcoma included undifferentiated sarcoma and fibrosarcoma. Heterologous elements such as bone and cartilage were present in two cases. Immunohistochemical study showed the tumor cells expressed vimentin, CDK4 and p16. MDM2 were positive in 6 cases (6/9) and p53 was positive in one case(1/9). CKpan was positive in the epithelioid differentiation area. S-100 protein was positive in the well-differentiated liposarcoma component. FISH showed the amplification of MDM2(6/9). Conclusions Dedifferentiated liposarcoma of extremities is very rare. The diagnosis should be combined with the histological characteristics and immunohistochemical results and differentiated from the other tumors and tumor-like lesions.

Objective: To study the clinicopathologic features of dedifferentiated chordoma. Methods: Four cases of dedifferentiated chordoma of sacrococcygeal region were collected at Beijing Jishuitan Hospital, from 2009 to 2014. HE and immunohistochemistry (EnVision method) were used to observe the clinical, radiological and histological features of dedifferentiated chordoma and to make the diagnosis and differential diagnosis. The literature was reviewed. Results: Four cases of dedifferentiated chordoma were all located in the sacrococcygeal region. The mean age at diagnosis was 57 years (range 49-64 years). There were 1 female and 3 males. Histologically, there were two components of conventional chordoma and dedifferentiated sarcoma with or without transitional area between them. The histology of dedifferentiated components includes undifferentiated sarcoma and fibrosarcoma. Immunohistochemical study showed that cytokeratin, epithelial membrane antigen, S-100, Brachyury were positive in the portion of chordoma while p53 were positive in the portion of undifferentiated sarcoma. INI1 and vimentin were both positive. Conclusions The dedifferentiated chordoma is very rare. The diagnosis should combine the histological characters and immunohistochemical results and should be differentiated from the sarcomatoid chordoma, poorly differentiated chordoma and other high grade sarcoma. p53 may play a role in the malignant transformation mechanism of chordoma.

Objective: To investigate the radiological and histopathological features of giant cell tumor of bone treated with RANKL inhibitor denosumab. Methods: Eleven cases were retrieved from the surgical pathology records between March 2015 and June 2017 in Beijing Jishuitan Hospital. Formalin fixed, paraffin embedded specimens were collected and the histological features were evaluated. The imaging features including X ray, magnetic resonance imaging, and computed tomography were also reviewed. Results: These 11 cases of giant cell tumor of bone were derived from five female and six male patients, with age ranged from 20 to 62 years (mean age, 35 years). The tumors were located in the sacrum (6 cases), femur (2 cases), radius (1 case), tibia (1 case) and patella (1 case), respectively. Histologically, all cases showed depletion of giant cells, proliferation of mononuclear cells and different degrees of ossification 3 to 6 months after denosumab therapy. Radiography showed marked osteosclerosis and sclerotic rim formation. Three cases of the sacrum recurred after 5, 6 and 11 months of surgery, and the remaining cases showed no recurrence within follow-up of 1 to 14 months. Conclusions Denosumab treated giant cell tumors morphologically differ from untreated tumors. Careful attention to a history of denosumab administration is crucial to avoid misdiagnosis and to allow proper differentiation from other tumors and tumor-like lesions.