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Idiopathic scoliosis in children and adolescents refers to the development of unexplained scoliosis during childhood and adolescence. Chinese medicine rehabilitation is one of the effective methods to prevent its occurrence and improve clinical symptoms. In order to standardize the diagnosis and treatment of scoliosis in children and adolescents in China, to raise the attention to scoliosis in children and adolescents in society, and to ensure the standardization of Chinese medicine rehabilitation diagnosis and treatment, the expert group wrote this guideline based on the concept and method of evidence-based medicine, combined with evidence from expert discussion and clinical evaluation, and in accordance with the reporting rules of clinical treatment guidelines. This guideline covered and standardized the technical scope, normative references, terms and definitions (Cobb angle, idiopathic scoliosis, functional scoliosis, forward bending test, trunk rotation angle, weak link, core muscle strengthening, and Du-moxibustion), clinical diagnosis (clinical symptoms, clinical assessment, and imaging), TCM pattern differentiation, rehabilitation treatment [TCM rehabilitation treatment (oral administration of Chinese medicine, massage therapy, moxibustion, acupuncture therapy, acupotomy therapy, sling exercise training and traditional Chinese exercrises), modern rehabilitation therapy (physical agent modalities, exercise therapy, brace therapy and psychotherapy), prevention and management], and efficacy evaluation. This guideline can provide standardized diagnosis and treatment procedures for Chinese medicine practitioners and rehabilitation therapists in implementing Chinese medicine rehabilitation treatment of idiopathic scoliosis in children and adolescents in various rehabilitation institutions at all levels in China, the departments of rehabilitation or pediatrics in other Chinese medicine hospitals or general hospitals and provide a reliable evidence reference for clinical decision-making practice, with good clinical applicability, safety and effectiveness.

Mechanical stress has been viewed as one of the key risk factors in accelerating the intervertebral disc degeneration process. The goal of the present study was to employ a repeated strike loading bovine caudal disc system to elucidate the pathophysiological impacts of cumulative mechanical stress on the disc. The discs in the model groups were subjected to two different mechanical stresses: one strike loading or repeated strike loading. The following indices were analyzed: histological morphology, glycosaminoglycan release, disc height, cell viability, apoptosis-related protein expression, and catabolism-related gene expression. Both mechanical stress modes induced degenerative changes in the discs by day 11, such as clefts and delamination of the annulus fibrosus; they increased glycosaminoglycan release. Cell viability was significantly decreased and catabolic gene expression was significantly up-regulated in the degenerative loading group and repeated strike loading group by day 9. These alterations remained evident in the annulus fibrosus tissue of the repeated strike loading group on day 11. Our data suggests that the repeated strike loading model adopted in this study could lead to degenerative changes in the disc organ model. Annulus fibrosus cells displayed a more noticeable response to mechanical stress damage and a slower recovery process, suggesting that the annulus fibrosus serves as a pivotal factor in disc degeneration due to mechanical stress injuries. The study also indicates that due to the gradual self-repair of intervertebral disc cells after injury, it is necessary to apply repeated strike loading on the disc at specific intervals when researching the repair of chronic disc injuries.

Wear debris associated periprosthetic osteolysis represents a major pathological process associated with the aseptic loosening of joint prostheses. Naringin is a major flavonoid identified in grapefruit. Studies have shown that naringin possesses many pharmacological properties including effects on bone metabolism. The current study evaluated the influence of naringin on wear debris induced osteoclastic bone resorption both in vitro and in vivo. The osteoclast precursor cell line RAW 264.7 was cultured and stimulated with polymethylmethacrylate (PMMA) particles followed by treatment with naringin at several doses. Tartrate resistant acid phosphatase (TRAP), calcium release, and gene expression profiles of TRAP, cathepsin K, and receptor activator of nuclear factor-kappa B were sequentially evaluated. PMMA challenged murine air pouch and the load bearing tibia titanium pin-implantation mouse models were used to evaluate the effects of naringin in controlling PMMA induced bone resorption. Histological analyses and biomechanical pullout tests were performed following the animal experimentation. The in vitro data clearly demonstrated the inhibitory effects of naringin in PMMA induced osteoclastogenesis. The naringin dose of 10 μg/mL exhibited the most significant influence on the suppression of TRAP activities. Naringin treatment also markedly decreased calcium release in the stimulated cell culture medium. The short-term air pouch mouse study revealed that local injection of naringin ameliorated the PMMA induced inflammatory tissue response and subsequent bone resorption. The long-term tibia pin-implantation mouse model study suggested that daily oral gavage of naringin at 300 mg/kg dosage for 30 days significantly alleviated the periprosthetic bone resorption. A significant increase of periprosthetic bone volume and regaining of the pin stability were found in naringin treated mice. Overall, this study suggests that naringin may serve as a potential therapeutic agent to treat wear debris associated osteolysis.