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Due to the high mortality of lung cancer, early diagnosis followed by early effective treatment is the key to prognosis improvement, which demands to identify the biological targets. Therefore, a multistage screening analysis was used to identify biological targets of lung adenocarcinoma. Two independent datasets of DNA methylation and RNA expression microarray in lung adenocarcinoma and normal lung tissues were chosen from the Gene Expression Omnibus. The association between DNA methylation and gene expression was explored, and the prognostic value of the hub genes was also evaluated. In this study, 8533 differential methylation sites, mostly located in the CpG island region and corresponding to 2754 genes (referred as differential methylation genes), were detected from methylation microarray. Besides, we obtained 830 differential expression genes, including 570 downregulated and 260 upregulated genes, through differential expression analysis. Protein–protein interaction analysis identified CXCL12, GFR, KDR, MMP9, TEK, and TWIST as core nodes, involving in the process of tumor cell identification, cell growth, cytokine secretion, inflammatory response, and angiogenesis. Among them, MMP9 and TWIST1 were identified as more valuable biological targets for the early diagnosis and targeted therapy of lung cancer through Kaplan–Meier analysis of TCGA lung adenocarcinoma datasets. Our study should contribute to the diagnosis and treatment of lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of middle anddistal tibia fractures., Methods: The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022, were retrospectively analyzed. These patients were categorized into external fixation group ( n =30) and internal fixation group ( n =30). There were 18 males and 12 females in the external fixation group, with an average age of (49.29±2.35) years old. Among them, 14 patients presented with fractures on the left side, and 16 patients presented with fractures on the right side. Closed reduction, arched wire, and semi-circular external fixator were used for treatment. There were 20 males and 10 females in the internal fixation group, with an average age of (48.96±1.87) years old. Among them, 15 patients presented with fractures on the left side, and 15 patients presented with fractures on the right side. MIPPO technique was used for the treatment. Perioperative parameters, including time injury to surgery, surgical duration, incision length, intraoperative bleeding, time to active activity, and incision healing level, were compared between the two groups. Clinical outcomes were also assessed, including Johner-Wruhs scores, time to minimum pain-adapted full weight-bearing, visual analog scale (VAS), SF-36 scale, and complications., Results: The external fixation group exhibited a significantly shorter incision length (1.36±0.86) cm and lower intraoperative bleeding (10.83±5.73) ml compared to the internal fixation group (12.74±3.12) cm and (86.47±8.90) ml, respectively( P <0.05). The postoperative active activity time (1.50±0.54) days and minimum pain-adapted full weight-bearing activity time(108.87±3.43) days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98) days and (105.27±3.68) days, respectively( P <0.05). Over a mean postoperative follow-up duration of (6.23±1.89) months, both groups showed improved VAS and SF-36 scale scores. There were no statistically significant differences in VAS and SF-36 scale scores 1, 3, 6 months post-operatively between the two groups( P >0.05). The intraoperative surgical time in the external fixation group (35.42±9.31) minutes was shorter than that in the internal fixation group(74.22±7.81) minutes ( P <0.05). There was no intraoperative vascular or nerve injury, nor postoperative skin necrosis in the external fixation group. However, skin necrosis was observed in 6 patientsin the internal fixation group, representing a statistically significant difference ( P <0.05)., Conclusion: Both external fixation and plate internal fixation are effective methods for the treatment of middle and distal tibia fractures. External fixation exhibits the advantage of less surgical trauma and a lower incidence of complications.

Objective: To explore application value of ultrasound in treating postpartum pubis symphysis diastasis by bone setting manipulation., Methods: Retrospective analysis was performed on 30 patients (case group) with postpartum pubis symphysis diastasis diagnosed in Wangjing Hospital, China Academy of Chinese Medical Sciences from June 2017 to January 2021, aged from 21 to 43 years old, with an average of (33.0±3.5) years old. The main clinical manifestations were mobility disorders such as turning over and walking, and all patients were treated by bone setting manipulation. Before and after treatment, pain and degree of pubic symphysis separation were evaluated by visual analogue scale(VAS) and ultrasonography. In normal group, 30 menopausal women aged from 49 to 59 years old with an average of(54.0±2.9) years old who wanted to remove intra uterine device(IUD) and were underwent conventional pelvic plain radiographswere selected, and the width of pubic symphysis space was measured by ultrasound and plain radiographs., Results: In normal group, the width of pubic symphysis was about (5.2±1.7) mm by ultrasonography, X-ray measurement was (5.0±2.1) mm, and showed no difference( P >0.05).In case group, the width of pubic symphysis measured by ultrasound before manipulation was about (9.5±1.8) mm, VAS was 6.05(5.27, 6.80) scores;while the width of pubic symphysis measured by ultrasound before manipulation was about (5.8±1.3) mm, VAS was 0(0, 0) scores, and there were statistical difference before and after manipulation ( P <0.05)., Conclusion: Ultrasound is examation method with safe, non radioactive, easy to repeat for many times, could clearly show cartilage, ligament and bone structure around pubic symphysis, and is more suitable for the imaging diagnosis of postpartum pubis symphysis diastasis, which provide quantitative imaging basis for clinical evaluation of the curative effect of bone setting manipulation in treating postpartum pubis symphysis diastasis.

Objective: To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis (DS)., Methods: From June 2017 to September 2019, 120 patients with degenerative scoliosis were randomly divided into treatment group (60 cases) and control group(60 cases). The patients in treatment group were treated with chiropractic manipulation once every other day for 4 weeks. The patients in control group were treated with eperisone hydrochloride tablets combined with thoracolumbar orthopedic(TSLO)brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day. The course of treatment was 4 weeks. After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. The adverse reactions during the treatment were recorded., Results: There were significant differences in VAS and ODI between two groups at each time point after treatment ( P <0.001), VAS and ODI at 2 weeks after treatment ( P VAS =0.025, P ODI =0.032) and 3 weeks after treatment( P VAS =0.040, P ODI =0.044) in treatment group were significantly different from those in control group, but there was no significant difference in VAS and ODI at other time points between treatment group and control group ( P >0.05). There was significant difference in Cobb angle between treatment group( P =0.010) and control group( P =0.017) after treatment, but there was no significant difference in LL and SVA between treatment group and control group. There was no significant difference in Cobb angle, LL and SVA between two groups before and after treatment. During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group., Conclusion: Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

Objective: To investigate the relevance ratio of osteoporosis and bone mass of middle aged and elderly people in Beijing communities, in order to understand occurrence and development trend of abnormality of bone mass in high-risk population from community., Methods: Based on the method of cross-sectional investigation, the information data of 1 540 middle-aged and elderly people from 10 communities were collected, including 415 males and 1 125 females, aged from 45 to 80 years old with the average of (63.02±7.15) years old; the height was (161.34±7.24) cm, the weight was (65.90±10.19) kg, body mass index was (25.29±3.32) kg /m2. Bone mineral density (BMD) of lumbar vertebrae (L 1 -L 4 ) and both hips were measured by dual energy X ray absorptiometry (DEXA). The differences of bone mineral density and bone mass in different age groups were evaluated, and the relevance ratio of osteoporosis in different parts of the subjects was calculated. Elbow venous blood was collected on an empty stomach, and the gender differences of serum bone metabolic markers were detected and compared., Results: The level of β-CTX was(0.27±0.12) ng /ml, procollanen type 1 N-terminal propeptide(P1NP) was(51.03± 22.36) ng /ml, 25(OH) D3 was (16.68±6.24) ng /ml, serum calcium was(2.34±0.09) mmol / L, blood phosphorus was (1.43± 0.37) mmol / L, and blood magnesium was (0.94±0.07) mmol / L, alkaline phosphatase was (79.28±20.48) U/ L, parathyroid hormone was (3.09±1.60) pmol / L, osteocalcin was (13.29±6.65) ng /ml. Except for blood magnesium, the other indexes had significant differences between different sex groups( P <0.05). Results of T value of bone mineral density and level of bone mass showed that bone mineral density of lumbar vertebrae and both hips fluctuated and decreased with the increase of age, and there were significant differences in level of bone mass among different age groups in women( P <0.05), and except lumbar vertebrae in males, there were significant differences in other parts of bone mass among different age groups ( P <0.05). The relevance ratio of lumbar osteoporosis, left hip osteoporosis, and right hip osteoporosis was 27.89%, 14.80% and 14.47%, respectively., Conclusion: There are obvious differences in relevance ratio of osteoporosis and low bone mass among different sites. It is suggested that the clinical diagnosis of osteoporosis should be combined with bone mineral density and bone metabolic markers. With the increasing prevalence of osteoporosis among middle aged and elderly people in Beijing community, continuous follow-up research based on community primary health care units could promote early examination, early diagnosis, and early treatment of middle aged and elderly people at high risk of osteoporosis in community.

Shujin Jianyao Pills is a kind of concentrated honey pills made of 13 Chinese herbal medicines, such as Cibotii Rhizoma, Rosae Laevigatae Fructus, and Spatholobi Caulis. It has the effects in tonifying liver and kidney, strengthening muscles and bones, removing wind and dampness, activating collaterals and relieving pain. Under the leadership of the Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences and Wangjing Hospital of China Academy of Chinese Medical Sciences, the Expert consensus on clinical application of Shujin Jianyao Pills was developed by 22 universities, scientific research institutes and hospitals. This consensus formed 1 recommendation and 9 consensus suggestions, which were based on evidence and oriented to clinical practice. The expert consensus had a new understanding of the indications of Shujin Jianyao Pills, especially the applicable Western medicine diseases, the advantages and characteristics of treatment, the time of intervention, the applicable syndromes, the precautions and contraindications of medication. The indications were detailed and expressed as the combination of disease, symptom and syndrome. And it filled in the gaps of package inserts in applicable syndrome and special population medication in the process of drug use. The expert consensus showed the optimization of precautions and contraindications, and more detailed description of drug safety. Therefore, it provides guidance and reference for clinicians to use Shujin Jianyao Pills rationally.

Shujin Jianyao Pills is a Chinese patent medicine, with anti-inflammation, analgesic and anti-osteoporotic effects. Based on a questionnaire investigation of clinicians and a systematic review of study literatures on Shujin Jianyao Pills, the international clinical practice guidelines development method was adopted to analyze the optimal available evidences and expert experiences in the &quot;evidence-based, consensus-based and experience-based&quot; principles. Expert consensus on Shujin Jianyao Pills in clinical practice(GS/CACM267-2019) was developed by more than 30 multidisciplinary experts nationwide with the aim to guide and standardize the rational use of Shujin Jianyao Pills among clinicians and improve the clinical efficacy and safety. The expert consensus adopted the internationally recognized recommendation criteria for classification of evidence--GRADE. Expert consensus was formed by the nominal group method. Six main considerations were quality of evidence, curative effect, safety, economical efficiency, patient acceptability and other factors. If there were sufficient evidences, a &quot;recommendation&quot; was given, and GRADE grid voting rule was adopted. If there wasn't sufficient evidence, a &quot;consensus opinion&quot; was formed, and the majority counting rule. According to the indication, usage and do-sage, drug use for special population and safety of Shujin Jianyao Pills, one recommendation and nine consensus opinions were put forward. By means of expert meetings and correspondence, a nationwide consultations and peer reviews were conducted. This consensus is applicable to clinicians in hospitals and grass-roots health services, and provides guidance and reference for the rational use of Shujin Jianyao Pills.

Objective: To explore the influence of individual characteristics of patients on the kinematics parameters of sitting lumbar spine manipulation., Methods: From January 2016 to December 2016, 30 patients with degenerative lumbar spondylolisthesis were treatede, including 18 males and 12 females, aged from 45 to 61(52.33±2.34) years old, with a course of 2 to 72(29.13±3.23) months. Motion capture technique was used to measure the kinematics parameters of the same manipulator in sitting lumbar spine manipulation for 30 patients, including rotation time, maximum speed and maximum acceleration. The parameters of the left and right hands of the operator were different. The effects of individual characteristics on the kinematics parameters of sitting lumbar spine manipulation were analyzed., Results: The kinematic and mechanical parameters of manipulation were as follows:spin time, maximum speed, maximum acceleration, the manipulation done by right or left hand showed the similar parameters( P >0.05). According to multivariate linear regression, there was a significant correlation between the age of the patient and the rotation time of the operator( P <0.01); the height of patient had a significant correlation with the maximum speed and maximum acceleration of the operator( P <0.01)., Conclusions: There is no difference between the manipulation of left and right hand in clinical application. Age and height are important influencing factors of sitting lumbar rotation manipulation., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Due to the high mortality of lung cancer, early diagnosis followed by early effective treatment is the key to prognosis improvement, which demands to identify the biological targets. Therefore, a multistage screening analysis was used to identify biological targets of lung adenocarcinoma. Two independent datasets of DNA methylation and RNA expression microarray in lung adenocarcinoma and normal lung tissues were chosen from the Gene Expression Omnibus. The association between DNA methylation and gene expression was explored, and the prognostic value of the hub genes was also evaluated. In this study, 8533 differential methylation sites, mostly located in the CpG island region and corresponding to 2754 genes (referred as differential methylation genes), were detected from methylation microarray. Besides, we obtained 830 differential expression genes, including 570 downregulated and 260 upregulated genes, through differential expression analysis. Protein-protein interaction analysis identified CXCL12, GFR, KDR, MMP9, TEK, and TWIST as core nodes, involving in the process of tumor cell identification, cell growth, cytokine secretion, inflammatory response, and angiogenesis. Among them, MMP9 and TWIST1 were identified as more valuable biological targets for the early diagnosis and targeted therapy of lung cancer through Kaplan-Meier analysis of TCGA lung adenocarcinoma datasets. Our study should contribute to the diagnosis and treatment of lung adenocarcinoma.

Objective: To study clinical value of shear wave elastography (SWE) in the evaluation of neck-shoulder myofascial pain syndrome., Methods: From December 2013 to July 2014,30 patients diagnosed as neck-shoulder myofascial pain syndrome were in the treatment group,including 17 males and 13 females, with an average age of (44 ± 3) years old. Thirty healthy people were in the control group, including 22 males and 8 females, with a mean age of (37 ± 5) years old. The patients in the treatment group were treated with manipulation, once every other day, total 7 times. The SWE was used to detect tension part of trapezius muscle of patients in the treatment group before and after treatment, as well as to detect muscle belly at the descending part of trapezius muscle in the control group. The tissue elasticity and Yang's modulus value were recorded and compared., Results: The tissue elasticity chart of patients in the treatment group before treatment was mainly greenish blue with the score of 3.70 ± 1.53, and the Yang's modulus was (43.4 ± 15.6) kPa. The tissue elasticity figure after treatment was mainly blue with the score of 2.40 ± 0.87, and the Yang's modulus was (29.0 ± 5.9) kPa. Whereas in the control group, the tissue elasticity figure was mainly blue with the score of 1.60 ± 0.72, and the Yang's modulus was (24.0 ± 7.6) kPa. These were statistical differences between the two groups (P = 0.000)., Conclusion: SWE can be used as an evaluation method of manipulation treatment for neck-shoulder myofascial pain syndrome, which is an objective and sensitive detection method.

Objective: To improve the X-ray diagnosis of cervical spondylosis of vertebral artery type (VCS)., Methods: A blinded design research. The X-ray signs both 60 patients with VCS and 60 patients with cervical spondylotic radiculopathy were collected from January 2011 to November 2012. There were 36 males and 84 females, aged from 25 to 65 years old with an average of (48.4 ± 12.3) years old. Cervical curvature, atlanto-occipital joint angle, atlanto-axial joint angle, C2/C3 joint angle and lower cervical instability condition and segmental distribution were measured and recorded by X-rays. These data were analyzed and compared between the two groups after unblended. Combined with clinical manifestations,the X-ray imaging features of VCS were further analyzed., Results: There was significant difference in cervical curvature between two groups in anteflexion X-ray films (P < 0.05). There was significant difference in extension degree of atlanto-occipital joint angle between two groups (P < 0.01). There was significant difference in atlanto-axial joint angle between two groups in lateral X-ray films (P< 0.05). There was significant.difference in anteflexion degree of atlanto-axial joint angle between two groups (P < 0.05). There was no significant difference in C2/C3 joint angle between two groups. There was no significant difference in the lower cervical instability condition and segmental distribution between two groups. In VCS group, the mild and moderate dizziness was main symptom, flexion and extension activities of neck was most common cause in the dizziness; and always accompanied with headache; tenderness mostly concentrated in the upper cervical area., Conclusion: Both X-ray signs and clinical manifestations can prompt the abnormalities of the upper cervical structure or function in patients with VCS. Anteflexion activities of neck observed by functional position of X-ray films should be emphasized in diagnosis of VCS.

Objective: To explore the effects of removing dampness and promoting diuresis method on autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats, in order to provide the basis for the treatment of lumbar disc herniation with Chinese medical immunotherapy., Methods: Forty male Wistar rats were divided into 4 groups randomly according to body weight layer:sham operation group (group A), model contrast group (group B), colchicine tablets group (group C), modified Qingyao decoction group (group D). There were 10 rats in each group. Nucleus pulposus of coccygeal vertebra was transplanted to the gluteal muscle by operation in groups B, C, D, which can lead to autoimmune and immuno-inflammatory response of rats; the rats of group A were only treated with sham operation. At the 3rd day after operation, the rats were fed through intragastric administration, the group A and B with distilled water (10 ml/kg), the group C and D respectively with suspension of colchicine tablets (10 ml/kg, 0.01 mg/ml) and water-decocted liquid of modified Qingyao decoction (10 ml/kg,1.035 g/ml), once a day and continuous medication for 18 days. All rats were killed at the 21th day after operation. The immunoglobulin G (IgG), immunoglobulin M (IgM) and interleukin-1beta (IL-1beta), interleukin-8 (IL-8) level in serum of different groups were detected by ELISA method. At the same time, surrounding tissues of the transplanted nucleus pulposus were observed by pathological section., Results: The level of IgG, IgM, IL-1beta, IL-8 in serum of group B was significantly higher than that of group A (P < 0.01), while the level of IgG, IgM, IL-1beta, IL-8 in serum of group C, D was significantly lower than that of group B (P < 0.05 or P < 0.01). Moreover, pathological section indicated that immuno-inflammatory response was hardly found in surgical site of group A, while local immuno-inflammatory response of surrounding tissues of the transplanted nucleus pulposus of group C and D was much lighter than that of group B., Conclusion: Removing dampness and promoting diuresis method could inhibit autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats.

Objective: To observe the effects of two different therapies on patients whose cervical function were restricted due to cervical spondylotic radiculopathy., Methods: Form April 2008 to October 2009, 71 cases with cervical spondylotic radiculopathy were divided into group A (36 cases) and group B (35 cases). Among them, 22 cases were male and 49 cases were female, ranging in age form 45 to 65 years with an average of 52.27 years, course of disease was from 3 days to 5 years. The patients in group A were treated with rotation-traction manipulation, neck pain particles and cervical rehabilitation exercises; and the patients in group B were treated with cervical traction, Diclofenac sodium sustained release tablets and wearing neck collar. Theapeutic time was two weeks. The cervical anteflexion, extension, left and right lateral bending, left and right rotative activity were measured by helmet-style activities instrument before and after treatment (at the 1, 3, 5, 7, 9, 11, 13 days and 1 month after treatment respectively)., Results: There were no difference between two groups in cervical activity in all directions before treatment (P > 0.05). Compared with the beginning, cervical anteflexion and extension showed significant difference at the 5th day after treatment in group A (P < 0.01). In group B, cervical anteflexion showed significant difference at the 13th day after treatment (P < 0.05), but at the 1 month after treatment, the significant difference disappeared (P > 0.05); cervical extension showed significant difference at the 7th day after treatment compared with the beginning (P < 0.05). Compared with the beginning,left lateral bending showed significant difference at the 1st day after treatment in group A (P < 0.05) and at the 5th day after treatment in group B (P < 0.01). Both in group A or B, right lateral bending, left and right rotative activity showed significant difference at the same time after treatment, either the 3rd day (P < 0.05) or the 5th day (P < 0.05). Compared between groups, cervical anteflexion, left and right lateral bending, left and right rotative activity showed significant difference at the 1 month after treatment (P < 0.05)., Conclusion: The rotation-traction manipulation and neck pain particles and cervical rehabilitation exercises in treating cervicalspondylotic radiculopathy have quick effect to improve the activities of cervical anteflexion, extension, left lateral bending, and have durable effect to improve the activities of cervical spine in all directions.