[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 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.

Objective:To compare the prosthesis locations and postoperative hip functions between supercapsular percutaneously-assisted total hip (SuperPATH) approach and traditional posterolateral approach (PLA) in total hip arthroplasty.Methods:A retrospective analysis was conducted of the 107 patients who had undergone unilateral total hip arthroplasty at Department of Orthopedic Surgery, The First Affiliated Hospital to Soochow University from August 2016 to February 2019. They were divided into 2 groups according to their surgical approaches. In the SuperPATH group of 54 cases, there were 20 males and 34 females with an age of (64.3±9.1) years; in the PLA group of 53 cases, there were 20 males and 33 females with an age of (62.2±10.6) years. The 2 groups were compared in terms of abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, retroversion angle, incidence of retroversion, and differences in eccentricity and lower limb length on the first day after operation, and Harris hip scores at 1 week, 3 months and the last follow-up postoperatively. Their complications were also recorded as well.Results:There were no statistically significant differences in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The postoperative imaging data were complete for the 107 patients who had been followed up satisfactorily for 14 to 36 months (average, 25 months). The SuperPATH group had significantly larger retroversion angle (13.6°±9.6°) and incidence of retroversion (18.5%, 10/54), significantly smaller difference in eccentricity [0.26 (0.13,0.49) cm], and significantly higher Harris hip score [(74.8±7.8) points] at one week after surgery than those in the PLA group [3.0°±1.0°; 5.7%, 3/53; 0.38 (0.13,0.70) cm; (72.0±6.7) points] ( P<0.05). There were no statistically significant differences between the 2 groups in abduction angle, ratio of abduction angle to safety zone, anteversion angle, ratio of anteversion angle to safety zone, difference in lower limb length, or Harris hip scores at 3 months or the last follow-up postoperatively (all P>0.05). Follow-ups in both groups observed no more than one case of dislocation which responded to manual reduction. Conclusion:The minimally invasive SuperPATH approach may obtain better femoral eccentricity and higher early hip function scores than the traditional posterolateral approach, but may lead to a higher incidence of retroversion after prosthesis placement.

Objective:To explore the early learning curve of OrthoPilot navigation assisted total knee arthroplasty (TKA).Methods:Data of 40 consecutive cases of OrthoPilot navigation assisted TKA completed by the same surgical team in our department were retrospectively analyzed. According to the operation order, 40 cases were divided into the original phase group (the first 20 cases) and the subsequent phase group (the second 20 cases). In original phase group, the average age was 69.85±6.86 years with mean body mass index 24.10±2.88 kg/m 2, preoperative HSS score 48.80±5.33, preoperative knee ROM 87.05°±11.02° and preoperative alignment deviation of 7.40°±5.59°. In subsequent phase group, the average age was 66.65±7.92 years with mean body mass index 22.85±3.15 kg/m 2, preoperative HSS score 49.00±5.47, preoperative knee ROM 85.80°±11.65° and preoperative alignment deviation of 8.22°±5.21°. Perioperative data such as operative duration, incision length, hemoglobin drop and postoperative hospital stay, radiographic outcomes including hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), sagittal tibial component angle (sTCA), joint line convergence angle (JLCA), and functional scores were compared between the two groups. Results:All 40 cases were followed up for 24-33 months (mean, 27.38± 2.73 months). No severe postoperative complications such as infection and loosening occurred during the follow-up. The mean operative duration was 112.35±25.49 min in original phase group versus 82.10±10.96 min in subsequent phase group ( P< 0.05). The durations of tibial cutting was 11.95±3.27 min in original phase group versus 7.35±2.23 min in subsequent phase group ( P< 0.05); the femoral planning + cutting time was 20.95±6.91 min in original phase group versus 16.60±4.78 min in subsequent phase group, and trial + prosthesis implantation time was 39.65±7.72 min in original phase group versus 25.10±5.72 min in subsequent phase group,which was significantly higher in original phase group. There was no significant difference in other perioperative data such as incision length, hemoglobin drop and postoperative hospital stay between the two groups. As for radiographic outcomes, there was no statistical difference between the two groups in the postoperative angular deviation of HKAA (0.70°±0.80° vs. 0.80°±1.06°), mLDFA (0.89°±0.91° vs. 1.00°±0.86°), mMPTA (0.77°±0.53° vs. 0.76°±1.03°), sFCA (0.73°±0.48° vs. 0.87°±1.06°), sTCA (0.95°±0.58° vs. 1.16°±1.14°) and JLCA (0.27°±0.25° vs. 0.39°±0.18°). In original phase group, the HSS scores preoperative and 3 days postoperative were 48.80±5.33 and 60.05±5.10 respectively, and those in subsequent phase were 49.00±5.47 and 60.75±4.47 respectively, and both groups showed satisfactory functional recovery. There was no significant difference in HSS scores at all follow-up time points between two phases, as well as ROM (113.20°±9.82° vs. 113.50°±12.44°) and FJS-12 scores (78.00°±10.98° vs. 76.65°±10.29°) at 2 years postoperatively. Conclusion:In this study, we described a time-related early learning curve for OrthoPilot navigation-assisted TKA, in which the operative duration tended to be shorter after the first 20 cases. However, benefiting from good operative accuracy and repeatability, satisfactory radiographic and functional outcomes can be obtained in early stage of the learning curve.

Objective:To investigate the effects and mechanism of cystostomy on young rats′ bladders function.Methods:Eighty female SD rats were divided into cystostomy group, sham operation group (the two groups included day 1, 3, 5 after operation), control group(it included day 1, 3, 5 after operation) and medicine intervention group by using random number table, there were 8 rats in each group.Cystometry was conducted in cystostomy group (day 1, 3, and 5 postoperative subgroup), and voided interval (VI), voided volume (VV), postvoid residual urine (PVR), bladder capacity (BC), maximum bladder pressure (Pves.max), bladder threshold pressure (Pves.thr), and bladder compliance(△C) were recorded.The rats in sham operation and control groups voided freely in the condition of diuresis by intravenous infusion saline, and VV, PVR and BC were recorded.Bladders′ tissues were collected for HE staining and histopathological inflammation scores (HIS) after urodynamic investigations.In medicine intervention group, different doses of anisodamine were applied and the changes of VI, VV, PVR, BC, Pves.max and Pves.thr were observed.Results:The trend of VV, VI, BC and △C was upwards on days 1, 3, and 5 postcystostomy.Meanwhile, compared with control group [VV: (1.408±0.033) mL, BC: (1.411±0.032) mL], VV and BC on day 1 and 3 postcystostomy were less[VV: (0.288±0.059) mL, (0.598±0.154) mL; BC: (0.292±0.059) mL, (0.601±0.154) mL]. There were statistically significant differences ( P<0.05). However, VV, PVR and BC on day 5 postcystostomy were not different from that of control group(all P>0.05). HE staining demonstrated that the HIS of days 1 and 3 postcystostomy and day 1 post-sham operation were in severe inflammatory phase, with HIS >4 scores.Additionally, the inflammation on day 5 in cystostomy group and days 3-5 in sham operation group were mild (HIS<2 scores). The correlation test of BC and HIS was negative( r=-0.880, P<0.001). After the application of anisodamine on dose of 0.2 mg/kg, VI, VV and BC of the young rats on day 3 postcystostomy significantly increased, compared with those before intervention [(643.500±65.889) s, (1.073±0.110) mL, (1.076±0.110) mL vs.(367.938±77.697) s, (0.612±0.129) mL, (0.617±0.129) mL, all P<0.05], while PVR, Pves.max and Pves.thr did not significantly change compared with those before intervention. Conclusion:The recent abnormal changes of urodynamics postcystostomy were related to the traumatic acute bladder inflammation in the young rats.On day 5 after the surgery, the bladder function basically returned to normal with the regression of the acute bladder inflammation.Anisodamine at 0.2 mg/kg dose could effectively relieve the symptoms of overactive bladder postcystostomy.

[Objective]To research professor ZHANG's clinical experience in treatment of metrorrhagia. [Methods] By following professor ZHANG diagnosis long time, it summarizes ZHANG's experience of Chinese medicine treatment on uterine bleeding and academics from the etiology and pathogenesis.[Results] ZHANG thinks that the pathogenesis of metrorrhagia, both cold and heat, will cause Chong Ren imbalance, so the method to reconstruct the menstrual cycle as the fundamental purpose, comprehensive use of TCM and western medicine adjuvant hormonal therapy. In the acute hemorrhage, the use of clearing heat and bleeding, liver-spleen -harmonizing remission with artificial cycle therapy according to syndrome differentiation and treatment of hemorrhage, clarifying the source and rectifying the primary on the basis of syndrome making a better clinical effect during the remission. [Conclusion] Professor ZHANG's treatment of uterine bleeding experience, unique, has a strong clinical significance, with learning and promotion of application value.

[Objective] To sum up the clinical experience of famous veteran doctor LI Rongzhen in treating the fundus oculi disease. [Methods] By learning from Professor LI Rongzhen, recording the relevant cases and analyzing the typical cases, to summarize the academic idea and the clinical experience according to the viscera syndrome differentiation and treatment characteristics, as well as list two proved cases. [Results] Professor LI Rongzhen holds that this disease is closely related with the viscera, origins from heart, involving liver, lung and kidney. In the clinical treatment, Professor LI is good at using the classical prescriptions and the therapy with syndrome differentiation with the permit addition and subtraction, according to the pattern of the fundus oculi disease, which has received the remarkable effect: patients with the deficiency of both heart and spleen of sudden blind, using the principle of nourishing qi to stop bleeding with Guipi Decoction, patients with hyper-action of liver yang, using Zhengan Xifeng Decoction to nourish yin for suppressing hyperactive yang, patients with qi stagnation and blood stasis are treated by Xuefu Zhuyu Decoction to remove stasis and stopp blood;patients with deficiency of kidney-yin of vitreous opacity, using the treatment of tonifying kidney for improving eyesight, with Six Ingredient Rehmannia Pill to nourish the liver and kidney, syndrome with the disharmony of liver and spleen, using Xiaoyao Powder to replenish vital energy ,deficiency of qi and blood, applying Bazhen Decoction to invigorate qi and blood. All of the cases verify her clinical experience. [Conclusion] While treating the fundus oculi disease, Professor LI pays attention to the relation between the eyes and the viscera, using the therapy with syndrome differentiation, with the flexible application of the ancient prescriptions and the traditional Chinese medicine, her experience in treating the fundus oculi disease is well worth learning and using.

BACKGROUND:Total knee arthroplasty has matured in clinical treatment. LPS-Flex Mobile Bearing System (Zimmer, USA) artificial knee prosthesis is the high-flexion rotating platform type knee prosthesis. The time of its clinical application in China is short, so its advantages have not been reported. OBJECTIVE:To investigate the preliminary clinical outcome of the total knee arthroplasty with LPS-Flex Mobile Bearing system artificial knee prosthesis (Zimmer, USA), and to assess the biocompatibility of artificial prosthesis and host using range of motion of knee and function after replacement. METHODS:We retrospectively analyzed 37 patients (42 knees) undergoing total knee arthroplasty using Zimmer LPS-Flex Mobile Bearing prostheses (high-flexion rotating platform type knee prosthesis) in The First Hospital Affiliated to Soochow University from February 2012 to March 2014, including 9 males (10 knees) and 28 females (32 knees), aged 47-78 years, averagely 63.7 years. Bone cement fixation was used, and the patel a was not treated with replacement. Postoperative complications were observed. Ranges of motion of knee joint preoperatively and postoperatively were compared. The recovery of knee joint function was evaluated using Hospital for Special Surgery Knee Score. RESULTS AND CONCLUSION:A total of 34 cases (38 knees) were fol owed up for 6-28 months. Range of motion of knee joint improved from 88.5° before operation to 124.2° after operation on average. Hospital for Special Surgery Knee Score improved from 52.5 before replacement to 91.1 after replacement, showing significant differences (P<0.01). Therapeutic effects were assessed according to Hospital for Special Surgery Knee Score:excel ent in 20 cases, good in 16 cases, average in 2 cases, with an excel ent and good rate of 95%. The incidence of various complications was low. These data suggested that short-period clinical outcomes of high-flexion rotating platform type knee prosthesis replacement are satisfactory. This prosthesis has advantages in its design, which is more close to the physical structure of knee joint, but its long-period outcomes deserve further investigations.

Objective To investigate the preliminary results and complications of a tapered proximal femur modular stem in total hip arthroplasty (THA).Methods From October 2010 to December 2011,tapered proximal femur modular stems were used for THA in 50 patients (56 hips).There were 14males and 36 females,at a mean age of 61 years (range,25-82 years).Forty-four patients had unilateral THA and six bilateral THA.Hip osteoarthritis secondary to developmental dysplasia of the hip occurred in 15 patients,femoral neck fractures in 12,avascular necrosis of the femoral head in 10,primary hip osteoarthritis in nine,rheumatoid hip arthritis in two,malunion of femoral neck fracture in one,and femoral head fracture combined with posterior dislocation of the hip in one.The adopted femoral component was a tapered proximal femur modular stem.Femoral head-acetabulum interface composed metal-polyethylene in 34 hips,ceramics-polyethylene in 12 hips,and ceramics-ceramics in 10 hips.There were 48 hips with standard femoral head (28 mm) and eight hips with non-standard femoral head (＞28 mm).Results Mean period of follow-up was 11 months (range,6-19 months) and two patients (two hips) were lost to follow-up.Harris hip score improved from 36 points (range,4-71 points) preoperatively to 89 points (range,55-98 points) at the final follow-up.There was one patient with mild pain in the thigh,one moderate pain,but none severe or critically severe pain at the final follow-up.At the final follow-up,no migration or loosening of the implanted prostheses occurred; periprosthetic bone ingrowth fixation on the femoral side was achieved in 53 hips and fibrous stable fixation in one hip ; apart from one hip of ＜ 2 mm prosthetic subsidence,the remained revealed no subsidence of the prostheses.Intraoperative complications included acetabulum perforation in one hip and periprosthetic femoral fracture in one hip.Conclusion The short-term results are satisfactory,but the potential risk of fretting/corrosion and even breakage at the modular stem junction remains.

Postoperative X-ray films showed that the fracture healing time was averagely 5.4 months. Al of the fractures were recovered wel that subtrochanteric fractures, intertrochanteric fractures and femoral shaft fractures were al healed. There was no fracture displacement, internal fixation loosening and varus deformity. Only one case showed difficulties in nail insertion. Excellence rate of Harris hip functional scores was 88.2%postoperatively. Proximal femoral nail antirotation is a reasonable design, and the helical blade can resist the rotation and stabilize the angle. The proximal femoral nail antirotation has better effects, which is an ideal internal fixation for subtrochanteric femoral fractures.