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Although tongue manifestation is a vital component of Traditional Chinese Medicine (TCM), relevant research on patients with osteonecrosis of the femoral head (ONFH) is still lacking. This study will explore the characteristic tongue manifestation of ONFH patients to inform future research and clinical practice.This is a cross-sectional study. All ONFH patients meeting criteria and their clinical data were collected from the online China osteonecrosis of the femoral head database (CONFHD) since it was created. Organized tongue manifestations of eligible patients through the tongue manifestation acquisition instrument, including tongue shape, tongue color, tongue coating thickness, tongue coating color and tongue coating moisture. We used descriptive analysis for the general information while systematic clustering analysis for the better summary of tongue characteristics.A total of 375 ONFH patients were included with an average age of 46.3 years. Most patients appeared with enlarged tongue body (54.4%), and the proportions of pale and red tongue (62.4%) were higher than others. Tongue coating were mainly showed as thick (64.5%), white (57.6%) and moist (79.7%). Comparison of tongue shape between different causes of ONFH had a significant statistically difference (P = 0.000). Tongue manifestations could be cluster analyzed into three categories which were matched into four TCM syndromes.The tongue manifestation of ONFH patients has a significant change both in tongue body and coating, and different features may be related to the ONFH pathology. This study provides new and valuable tongue informations for a preliminary screening of ONFH patients.

Chinese patent medicine (CPM) has been widely used in China for patients with osteoporosis (OP) but a comprehensive literature review is still important. Therefore, we performed meta-analysis using six electronic databases prior to 30 April 2021 only randomized controlled trials (RCTs) using CPM as the first-line treatment in adults with OP were included. Thirty RCTs met the inclusion criteria with a total of 2723 patients, and seven types of CPM were included. Compared with the control group, 23 studies showed significantly improved bone mineral density (BMD) (lumbar spine) (mean difference [MD] = 0.08; confidence interval [CI], 0.03 to 0.13), 15 studies showed significantly improved BMD (femoral) (MD = 0.05; 95% CI, 0.02 to 0.07), 6 studies showed significantly improved BMD (radius) (MD = 0.06; 95% CI, 0.03 to 0.09), 2 trials showed significantly improvement of BMD (ulna) (MD = 0.02; 95% CI, 0.01 to 0.03), and 4 trials showed significantly improved BMD (MD = 0.09; 95% CI, 0.09 to 0.10). The meta-analysis also showed that CPM had superior pain improvement, a higher total effectiveness rate, and a lower risk of adverse events compared with standard western treatment. The findings of this study suggest that CPM therapy may be a safe and effective alternative treatment modality for OP, it has potential benefits in relieving symptoms and improving BMD compared to western medications or placebos.

Here, a simple, economical one-step doping strategy is adopted to prepare N, S co-doped graphene hollow spheres (NSGHS). The NSGHS exhibits remarkable oxygen-reduction-reaction (ORR) activity with a high half-wave potential (E1/2) of 0.847 V vs. RHE and considerable long-term stability. When applied as anode materials for sodium-ion batteries (SIBs), it could deliver a high reversible capacity of 385 mAh g−1 at 500 mA g−1, excellent rate performance of 308 mAh g−1 at even 20 A g−1 and superior cycling performance at 10 A g−1 during 5000 cycles with negligible capacity fade. DFT calculation reveals that the doping of N and S endows the surrounding carbon with high positive charge and spin density, respectively, making them be highly active ORR catalytic sites except for S itself. Despite the possible oxidization of C–S–C active sites, the rest C atoms of NSGHS will still hold a considerably high catalytic activity superior to those of mono-doped or undoped cases. In addition, S doping will improve the binding between Na and graphene substrate to get a high capacity and N doping effectively curbs the rising of oxygen levels and oxidization of S in C–S–C active sites, thus the excellent stability for ORR and SIBs. © 2021 Elsevier Ltd

NiFe alloy NPs anchored in NGHS wrapped with self-grown NCNTs with a three-dimensional architecture was constructed successfully for ORR/OER bifunctional catalysis.

A rapid, facile, green and controllable electrodeposition method is reported for the growth of SeOx films on the surface of Ni–Fe–selenide nanosheets, which are used as highly active and stable electrocatalysts for the OER.

Background Joint-preserving treatments for osteonecrosis of the femoral head (ONFH) are an area of significant interest in orthopaedics as they may restore function and provide durable benefit to patients who would otherwise require early total hip arthroplasty. Studies reporting the outcomes for these procedures generally rely on a combination of radiographic and clinical outcomes. However, there is not currently a standardized radiographic scoring system that allows for objective reporting of radiographic outcomes following these procedures. This article introduces a novel scoring system (Beijing University of Chinese Medicine X-ray evaluation, BUCMXE) based on Anteroposterior (AP) hip radiographs to allow for objective evaluation and comparison of postoperative outcomes following joint-preserving treatments for ONFH. Methods The proposed scoring system utilizes AP radiographs of the hip and consists of a total score (0-10) derived from the sum of subscores in 3 domains: femoral head morphology, osteonecrotic lesion, and degree of osteoarthritis. Each radiographic parameter is scored from 0 (normal) to 3 or 4 (advanced disease). The scoring model was retrospectively applied to a cohort of patients who had undergone core decompression and cancellous bone grafting procedures by the principal investigator. Results The BUCMXE provided a clear and reproducible means of quantifying and communicating radiographic changes over the course of follow-up in our study cohort. Statistical analysis demonstrated that the BUCMXE was sensitive to detect the radiographic changes associated with the index procedure. The median total score was reduced from 3 preoperatively to 2 at the initial (3-month) follow-up for this cohort. This change was attributable to the obvious improvement of osteonecrotic lesion in patients who had more advanced disease at the time of their procedure. Conclusion The BUCMXE system allowed for objective quantification of radiographic changes following joint-preserving hip surgery in our cohort. Statistical analysis of BUCMXE scores demonstrated that the scoring system was sensitive to detect subtle radiographic changes associated with disease progression in the follow-up period. Level of evidence Therapeutic Level III.

Objective Physical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta‐analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis. Methods Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020. Results A total of 20 studies with 1824 participants were included. The results of the meta‐analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P, The results of this meta‐analysis show that different types of exercise therapies significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low‐quality evidence. Additional high‐quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients. Therefore, more multicenters, larger samples, long‐term, single‐blind RCTs are needed to evaluate the effects of exercise therapy on BMD, VAS and biochemical markers of bone metabolism in POP patients.

Objective The aim of the present study was to reveal the case characteristics of osteonecrosis of the femoral head (ONFH) in Mainland China. Methods This cross‐sectional epidemiological study derived data for ONFH patients from July 2016 to December 2018 from the China Osteonecrosis of the Femoral Head Database (CONFHD). The derived data included gender, age, body mass index (BMI), height, occupation, region, and etiology of femoral head necrosis. A descriptive analysis was performed to summarize the epidemiological characteristics of the case data in the CONFHD. Results A total of 1844 ONFH patients (2945 hips) were included in this study, comprising 1302 men and 542 women. The age of patients ranged from 18 to 95 years, with a median of 50 years, and the male to female ratio was 2.4. Male patients are younger than female patients (48.26 ± 12.56 years old and 55.56 ± 14.94 years old, respectively). Among the 1844 patients (2945 hips), there were 528 (17.92%) hips at ARCO stage I, 941 (31.99%) hips at ARCO stage II, 873 (29.63%) hips at ARCO stage III, and 603 (20.46%) hips at ARCO stage IV. In the subclassification of ARCO stages I and II, the majority of cases were type C; type A comprised the majority in the subclassification of ARCO stage III. According to the Kellgren–Lawrence classification system, among the 603 ARCO stage IV hips, there were 178 (29.52%) grade 1 hips, 201 (33.34%) grade 2 hips, 176 (29.18%) grade 3 hips, and 48 (7.96%) grade 4 hips. Most were from three provinces: Henan (27.3%), Shanxi (13.9%), and Shandong (11.9%). Regarding BMI, 982 patients (53.25%) were overweight or obese. Among all patients, the largest proportion of patients engaged in level IV manual work. Of all the patients, there were 495 (26.84%) with steroid‐induced ONFH, 685 (37.15%) were alcoholics, and 290 (15.73%) had traumatic ONFH. The 495 patients with steroid‐induced ONFH included 278 men (56.16%) and 217 women (43.84 %), had a complete history of hormone use. Among the primary diseases, there were 195 cases (39.39%) of immune system diseases, followed by dermatological diseases, respiratory diseases, nephropathy, and other diseases. There were a total of 685 patients with alcoholic ONFH, 589 of these patients (85.99%) were men. A total of 188 (27.45%) patients had drunk alcohol for 6–10 years (comprising the highest proportion), and 280 patients (40.88%) consumed 3001–3500 mL of alcohol each week (the highest proportion). Conclusion Osteonecrosis of the femoral head most commonly occurs after the age of 40. Male patients have an earlier onset than female patients, and the number of male patients is approximately twice that of female patients. The BMI of patients was mainly in the overweight and obese range, and half of these patients engaged in level IV manual work. From the imaging findings, the numbers of hips at ARCO stages II and III were greatest, and the number at stage I was relatively small. Among all the causes of disease, alcohol, steroid use and trauma were the three most common reasons for ONFH., This is the first Internet‐based ONFH patient case registration study for mainland China. It presents epidemiological characteristics of osteonecrosis of the femoral head in mainland China.

BackgroundCollapse risk of osteonecrosis of the femoral head (ONFH) is estimated mainly based on static indicators, including lesion size and lesion location, but bone repairing is a dynamic process that lasts for years. The present study attempted to analyze the dynamic evolution of the osseous structure and its correlation with radiographic progression.MethodsThis retrospective study included 50 hips with ONFH from 50 patients. Participants were divided into the non-collapse group (n= 25) and the collapse group (n= 25). Original files of the initial computed tomography (CT) images were imported into imaging processing software for morphology analysis. The volume of sclerotic bone, the volume of soft tissue, and bone mineral density (BMD) were calculated. The linear correlations between the aforementioned indicators and the disease duration were estimated. The logistic regression analysis was conducted to evaluate the correlation of these indicators with the radiographic progression. Receiver operating characteristic (ROC) analysis was used to evaluate these indicators’ prediction performance.ResultsThe volume of sclerotic bone and the BMD grew with disease duration, but the volume of soft tissue decrease. The logistic regression analysis found that the volume of sclerotic bone and the BMD were statistically associated with radiographic progression. The ROC analysis found that the regression model, which integrated the volume of sclerotic bone and the BMD, had satisfactory performance in predicting radiographic progression.ConclusionThe present study suggested a dynamic evolution of the osseous structure and a dynamic variation trend of the collapse risk in ONFH. The volume of sclerotic bone and the BMD might serve as further prognostic indicators when estimating the collapse risk.

Background and Purpose. Knee osteoarthritis (OA) is a major public health problem, and currently, few effective medical treatments exist. Chinese acupotomy therapy has been widely used for the treatment of knee OA in China. We conducted this systematic review and meta-analysis to evaluate the efficacy of Chinese acupotomy in treating knee OA to inform clinical practice. Methods. We performed a comprehensive search on PubMed, the Cochrane Library, EMBASE, and four Chinese databases for articles published prior to June 2020. We included only randomized controlled trials (RCTs) that used acupotomy therapy as the major intervention in adults with knee OA, were published in either Chinese and English, included more than 20 subjects in each group, and included pain and function in the outcome measures. Knee OA was defined by the American College of Rheumatology or Chinese Orthopedic Association criteria in all studies. We extracted the visual analogue scale (VAS) pain score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score, the total effectiveness rate, the modified Japanese Orthopedic Association (JOA) activities of daily living score, and Lysholm’s score. We calculated the mean difference (MD) or risk ratio (RR) for all relevant outcomes. Meta-analyses were conducted using random-effects models when appropriate. Results. We identified 1317 potentially relevant studies, thirty-two of which met the eligibility criteria and were conducted in China between 2007 and 2020. A total of 3021 knee OA patients (62.96% female, median age: 57 years, and median disease duration: 33 months) were included. The treatment duration ranged from 1 week to 5 weeks (median: 3 weeks). The typical acupotomy treatment involved releasing soft tissue adhesions and was performed once a week for 1–5 weeks until the pain was relieved. The control group treatments included acupuncture (8 studies), electroacupuncture (10 studies), sodium hyaluronate (8 studies), radiofrequency electrotherapy (1 study), and nonsteroidal anti-inflammatory drugs (NSAIDs, 5 studies). The results from the meta-analysis showed that acupotomy led to superior improvements in the VAS pain score (MD = −1.11; 95% confidence interval (CI), −1.51 to −0.71; p p p p p = 0.01) for overall pain and function. No serious adverse events were reported. Conclusion. Chinese acupotomy therapy may relieve pain and improve function in patients with knee OA. Furthermore, rigorously designed and well-controlled RCTs are warranted.

Objective The purpose of the present study was to evaluate the present situation and risk factors for the misdiagnosis of osteonecrosis of femoral head (ONFH), providing the basis for accurate diagnosis of ONFH. Methods For this retrospective study, 1471 patients with ONFH were selected from the China Osteonecrosis of Femoral Head Database (CONFHD). These patients had been recruited between July 2016 and December 2018. According to whether or not they were misdiagnosed, the patients were divided into two groups, with 1168 cases (22–84 years old) included in the diagnosis group and 303 cases (21–80 years old) in the misdiagnosis group. Misdiagnosis was measured using the following criteria: (i) the patient had the same symptoms and signs, and the second diagnosis was not consistent with the initial diagnosis within 6 months; and (ii) the patient was admitted to a hospital participating in CONFHD and the previous diagnosis was inconsistent with the diagnosis given by the expert group. Comparisons of age, visual analogue scale for pain, and body mass index between the two groups were performed using a t‐test. Gender, causes of ONFH, primary diseases requiring corticosteroids, methods of corticosteroid use, corticosteroid species, type of trauma, onset side of the disease, pain side, whether symptoms are hidden, and type of imaging examination at the initial visit were compared using the χ2‐test. Years of alcohol consumption, weekly alcohol consumption, and physician title at the initial visit were compared using a Mann–Whitney U‐test. Furthermore, the statistically significant factors were evaluated using multiple regression analysis to investigate the risk factors of misdiagnosis. Results A total of 303 patients (20.6%) were misdiagnosed: 118 cases were misdiagnosed as lumbar disc herniation, 86 cases as hip synovitis, 48 cases as hip osteoarthritis, 32 cases as rheumatoid arthritis, 11 cases as piriformis syndrome, 5 cases as sciatica, and 3 cases as soft‐tissue injury. Whether symptoms are hidden (P = 0.038, odds ratio [OR] = 1.546, 95% confidence interval [CI] = 1.025–2.332), physician title at the initial visit (P, Patient history of corticosteroid use or alcohol abuse and MRI examination at the initial diagnosis may be protective factors for misdiagnosis. Hidden symptoms, first visit physician title as attending doctor or resident doctor, and only X‐ray examination at the initial diagnosis may be the risk factors for misdiagnosis.

Objective To investigate the application of treatment modalities for patients with osteonecrosis of the femoral head (ONFH) in mainland China. Methods This cross‐sectional study was based on the online application of China Osteonecrosis of the Femoral Head Database (CONFHD). Between July 2016 to December 2018, the CONFHD program planned to recruit ONFH patients from 12 administrative areas across mainland China. Real‐world medical records of treatment regimens for these patients, including surgeries and prescriptions, were approved to upload to the CONFHD application for further analysis. The surgeries performed on these patients were classified into total hip arthroplasty and hip‐preserving procedures, and the latter was further classified into core decompression, bone grafting, and tantalum rod implantation. Prescription medications were classified into chemical medicine and Chinese herbal medicine (CHM); chemical medicine was further classified according to their chemical compounds, and CHM was classified according to therapeutic functions based on traditional Chinese medicine theory. Descriptive analysis was performed to summarize the application of different treatment regimens on the overall sample. Results A total of 1491 patients (2381 hips) who fulfilled the protocol criteria were included. There were 1039 males and 452 females with a mean age of 47.29 ± 12.69 years. The causes of ONFH were alcoholism in 642 patients (43%), corticosteroid in 439 patients (29%), trauma in 239 patients (16%), and idiopathic ONFH in 171 patients (11%). Operative treatments (including total hip arthroplasty and hip‐preserving procedures) were performed on 49% of patients (43% of hips), chemical medicine therapy (including bisphosphonate, statins, and prostacyclin) was given to 37% of patients (37% of hips), and CHM was administrated to 72% of patients (75% of hips). The aforementioned interventions were not always used alone, since 47% of patients (52% of hips) received combined regimens with multiple interventions. Among hips treated by surgery, all hips with ARCO stage IV ONFH received THA (305 hips), and THA was also performed on 63 hips with stage II ONFH. Over half of hips with stage I (81%), II (91%), and III (92%) ONFH had received pharmacological treatments. Prostacyclin and bisphosphonate were the top two most prescribed medicines used alone. CHM therapies with multiple CHM functions were more commonly prescribed. Conclusion Current treatment modalities for ONFH patients in mainland China include operative treatment, chemical medicine, and CHM. Combined regimens with different treatment modalities are common in real‐world clinical practices., A cross‐sectional study to investigate the application of treatment modalities for patients with osteonecrosis of the femoral head in mainland China based on the China Osteoncrosis of the Femoral Head Database's (CONFHD) online platform.

A novel wideband magnetoelectric (ME) dipole antenna with dual circular polarization and unidirectional radiation is proposed in this letter. The proposed antenna is based on two perpendicular sub-ME dipoles realized by four V-shaped patches and four V-section columns, and each of them is composed of an electric dipole and a magnetic dipole in parallel. Fed by two simple Γ-shaped feeds, 90° phase difference between the electric dipole and the magnetic dipole in each of the sub-ME dipoles is achieved, hence the dual-circularly polarized radiation is generated. Wide impedance bandwidth is obtained in virtue of the two kinds of dipoles being excited simultaneously. The 3 dB axial-ratio (AR) bandwidth is enlarged by optimizing the V-section columns and a circular cavity. Besides, the port isolation is apparently enhanced by adding slits on the patches and elaborating different spacings between each feed and its two-sided columns. Measured results show that the proposed antenna has many appealing properties, such as a unidirectional radiation pattern, an impedance bandwidth (reflection coefficients ≤–10 dB and port isolation ≥ 10 dB) of 51.1% and a 3 dB AR bandwidth of 41.9%.

The relationship between passive smoking and the onset of Legg-Calvè-Perthes disease is still controversial. Therefore, we conducted the study to systematically evaluate and analyze the relationship. A comprehensive search was conducted. Meta-analysis was performed with RevMan 5.3 software, with the odds ratio as the effect size. Eight English articles with a total of 1379 Legg-Calvè-Perthes disease patients were eventually included. Passive smoking type of family members smoking in indoor (odds ratio = 2.53), paternal smoking (odds ratio = 2.76), maternal smoking (odds ratio = 2.02), maternal smoking during pregnancy (odds ratio = 1.68), using stove indoor (odds ratio = 2.56) are statistically significant (P0.05). For the family members smoking indoor, region may be a confounding factor (European group I = 92%, odds ratio = 2.51; USA group I = 5%, odds ratio = 3.26; and Asian group I = 0%, odds ratio = 2.25). In addition, the type of maternal smoking (odds ratio = 0.80, for 1-10 per day; odds ratio = 2.73, for 10-20 per day; odds ratio = 2.78, for20 per day) and the type of maternal smoking during pregnancy (odds ratio = 1.36, for 1-9 per day; odds ratio = 2.02, for ≥10 per day) may show a dose-effect relationship. Passive smoking is a risk factor for the onset of Legg-Calvè-Perthes disease, but the specific types of passive smoking (haze, etc.), dose, dose-effect relationship, regional confounding, pathological mechanisms, etc. also require clinicians and researchers to continue exploring.

The porous carbon-coated LiFePO4 (LFP) nanocrystals synthesized by in situ plasma-assisted pyrolysis are reported. The particle size of LFP nanoparticles is well controlled through the coating of polyaniline (PANI) on FePO4. The effect of PANI content in FePO4/PANI on the morphology and electrochemical performance of LiFePO4 particles is extensively investigated. Results show that the optimized amount of PANI in FePO4/PANI is 10.16% and the corresponding carbon content in activated porous carbon-coated LiFePO4 (LFP/AC-P4) is 9.27%. The primary particle size of LFP/AC-P4 is 20~50 nm which are wrapped and connected homogeneously and loosely by activated porous carbon. The LFP/AC-P4 composite delivers a capacity of 166.9 mAh g−1 at 0.2 C, which is much higher than carbon-encapsulated LiFePO4 nanocomposite (LFP/C) synthesized without the assistance of plasma pyrolysis (163.5 mAh g−1). Even at high rate of 5 C, a specific capacity of 128.4 mAh g−1 is achievable with no obvious capacity fading after 250 cycles.

Large-scale production of H2 through water electrolysis is limited by the lack of efficient and crust-abundant low-cost electrocatalysts. Here, MoSe2 and N-doped carbon (NC) is successfully constructed into a double-shelled hierarchical hollow nanobox. The obtained NC@MoSe2 is demonstrated to be an active catalyst for hydrogen evolution reaction (HER). The NC@MoSe2 delicately combine the structural and functional advantages of two-dimensional layered transition metal dichalcogenides (TMDs) and NC, which yield the striking synergistic effect to endow them with extremely enhanced electrochemical activity to efficiently catalyze the evolution of H2. Remarkably, the NC@MoSe2 with the optimum thickness of MoSe2 shell can exhibit a fairly low onset potential of 61 mV, an extremely small overpotential of 164 mV vs. RHE at 10 mA cm−2, a greatly reduced Tafel slope of 55 mV dec−1, and a higher exchange current density of 0.102 mA cm−2. Specifically, this is mainly beneficial from the abundant exposed active edges from the edge-terminated ultrathin MoSe2 nanosheets with small size, the overall hierarchical hollow architecture and strong electronic coupling between MoSe2 and NC layer. Density functional theory (DFT) calculation results have well supported the experimental observations, revealing the strong synergistic effect between NC and MoSe2, thus the increased carrier density around the Fermi level and reduced hydrogen adsorption free energy (ΔGH*) for MoSe2 composited with NC.

OBJECTIVE To develop a prediction method for femoral head collapse by using patient-specific finite element analysis of osteonecrosis of the femoral head (ONFH). METHODS The retrospective study recruited 40 patients with ARCO stage-II ONFH (40 pre-collapse hips). Patients were divided into two groups according to the 1-year follow-up outcomes: patient group without femoral head collapse (noncollapse group, n = 20) and patient group with collapse (collapse group, n = 20). CT scans of the hip were performed for all patients once they joined the study. Patient-specific finite element models were generated based on these original CT images following the same procedures: segmenting the necrotic lesion and viable proximal femur, meshing the computational models, assigning different material properties according to the Hounsfield unit distribution, simulating the stress loading of the slow walking gait, and measuring the distribution of the von Mises stress. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of the maximum level of the von Mises stress. The optimal cut-off value was selected based on the Youden index and the corresponding predictive accuracy was reported as well. RESULTS The mean level of the maximum von Mises stress in the collapse group was 2.955 ± 0.539 MPa, whereas the mean stress level in the noncollapse group was 1.923 ± 0.793 MPa (P

Development of inexpensive, efficient, and stable nonprecious-metal-based bifunctional catalysts for oxygen reduction (ORR) and evolution (OER) reactions remains an enormous challenge. This work re...

Background/objective Coronavirus disease 2019 (COVID-19) is a disaster in human medical history and glucocorticoids remain the most promising therapy. Osteonecrosis is a disease caused by reduced intraosseous blood flow to bones in the joints, which will rapidly induce joint destruction. Approximately one-third patients with severe acute respiratory syndrome (SARS) who received high cumulative doses and long treatment durations of glucocorticoids occurred osteonecrosis. Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics, and therapeutic strategies, it is particularly desirable to investigate whether osteonecrosis will become a common sequela among convalescent COVID-19 patients. Methods This multi-strategy study was designed by integrating different research methods, such as meta-analysis, systematic review, and cross-sectional investigations to address above study objectives. At first, two meta-analyses were performed on the osteonecrosis incidence among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in Wuhan city of China were also conducted. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis patients with COVID-19 infection were further presented and discussed. Results Our meta-analysis showed that 32% of SARS patients had developed osteonecrosis after receiving glucocorticoid treatment with high dose, and our system review supported that low level glucocorticoid exposure might also lead to the occurrence of osteonecrosis. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in Wuhan city of China found that the average of cumulative glucocorticoid exposure level was 504 ​mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case was identified from 1406 patients with COVID-19 during our cross-sectional investigation, implying that preventive management of osteonecrosis should be better started with regular clinical follow-up observation. Conclusion Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to establish risk-classification-based early screening and to introduce early prevention protocol of its associated osteonecrosis that will be of clinical significance in favor of improved prognosis of this disease. The translational potential of this article To establish risk-classification-based early screening and to introduce early prevention protocol of glucocorticoid-induced osteonecrosis will be of clinical significance in favor of improved prognosis of COVID-19.

An amendment to this paper has been published and can be accessed via the original article.

Tripterygiumwilfordii Hook F (TwHF) is one of the most commonly used and effective traditional Chinese herbal medicines against rheumatoid arthritis (RA). Both Tripterygium Glycoside Tablets (TGT) and Tripterygium wilfordii Tablets (TWT) are the representative TwHF-based agents enrolled into the 2019 edition of Medicine Catalog for National Basic Medical Insurance, Injury Insurance, and Maternity Insurance. However, individual differences in TGT/TWT response across patients usually exist in the process of treating RA, implying that the clinical application of the two agents may not be standardized leading to the ineffective treatment and the risk of side effects. Growing evidence show that the bioactive constituents of TwHF may often have toxicity, the package insert of TGT and TWT may not be described in detail, and the therapeutic windows of the two agents are narrow. Thus, it is an urgent task to develop a standardized clinical practice guideline for TGT and TWT in the treatment of RA. In the current study, a group of clinical experts of traditional Chinese medicine and Western medicine in the research field of rheumatism diseases, pharmacists, and methodologists of evidence-based medicine were invited to select the clinical questions, to determine the levels of the evidence and the strength of the recommendations, and to develop the recommendations and good practice points. The guideline is formed based on the combination of clinical research evidence and expert experience (evidence-based, consensus, supplemented by experience). The clinical problems which are supported by clinical evidence may form recommendations, and the clinical problems without clinical evidence may form experts’ suggestions. Both recommendations and experts' suggestions in this guideline summarized the clinical indications, usage, dosage, combined medication, and safety of TGT and TWT against RA systematically and comprehensively, which may offer a professional guidance in the context of the clinical application of the two TwHF-based agents.

Background: Coronavirus disease 2019 (COVID-19) is an emerging global medical challenge and glucocorticoids remain the most promising therapy. Osteonecrosis (ON) is a disease caused by reduced blood flow to bones in the joints, which will rapidly induce joint destroy. ON had been frequently identified among convalescent patients after Severe Acute Respiratory Syndrome (SARS). Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics and therapeutic strategies, it is particularly worrying whether ON will be a common sequela among convalescent COVID-19 patient. Methods: This multi-strategy study integrating different research methods, such as meta-analysis, systematic review and cross-sectional investigation. At first, two meta-analyses were performed on the incidence of osteonecrosis among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a real-world cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in China Wuhan were also provided. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis after COVID-19 infection were further described. Findings: Our meta-analysis showed that 32% of SARS patients had developed ON after receiving glucocorticoid treatment with high dose, and our system review also supported that low level glucocorticoid exposure may lead to the occurrence of ON. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in China Wuhan found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case after COVID-19 was identified during our investigation. Preventive management of ON shall better start with regular clinical followup observation. Interpretation: Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to put forward the risk-classification-based early screening and early prevention protocol of ON, which may be of clinical significance in favorable prognosis of this disease. Registration Details: PROSPERO, registration number CRD42020203536. Funding Information: This study was supported by the Special Project For COVID-19 Prevention and Management of Ministry of Education of China (2020-JYB-YJ-023), the National Key Research and Development Program of China (2019ZX09731-002) and the State Key Program of National Natural Science Foundation of China (82030122). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol for the investigation study has been registered in the Chinese Clinical Trial Registry (ChiCTR), (URL: http://www.chictr.org.cn/showproj.aspx?proj=61769, No. ChiCTR2000038333). This study was approved by the Ethics Institutional Review Board of the Third Affiliated Hospital of Beijing University of Chinese Medicine (No. BZYSY-2020KYKTPJ-06), and informed consent was obtained from every participant patient.

The Tao-Hong-Si-Wu-Tang (THSWT) formula, a classic prescription of traditional Chinese medicine, has long been used for the treatment of osteonecrosis of femoral head (ONFH). However, its mechanisms of action and molecular targets are not comprehensively clear. In the present study, the Traditional Chinese Medicine System Pharmacology (TCMSP) database was employed to retrieve the active compounds of each herb included in the THSWT formula. After identifying the drug targets of active compounds and disease targets of ONFH, intersection analysis was conducted to screen out the shared targets. The protein-protein network of the shared targets was built for further topological analysis. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis were then carried out. A gene pathway network was constructed to screen the core target genes. We identified 61 active compounds, 155 drug targets, and 5443 disease targets. However, intersection analysis only screened out 37 shared targets. Kaempferol, luteolin, and baicalein regulated the greatest number of targets associated with ONFH. The THSWT formula may regulate osteocyte function through specific biological processes, including responses to toxic substances and oxidative stress. The regulated pathways included the relaxin, focal adhesion, nuclear factor-κB, toll-like receptor, and AGE/RAGE signaling pathways. RELA, VEGFA, and STAT1 were the important target genes in the gene network associated with the THSWT formula for the treatment of ONFH. Therefore, the present study suggested that the THSWT formula has an action mechanism involving multiple compounds and network targets for the treatment of ONFH.

Summary: Purpose: The coronavirus disease 2019 (COVID-19) reminds us of the severe acute respiratory syndrome (SARS) outbreak in 2003, and up to date, corticosteroid is commonly administrated to severe patients with COVID-19. Osteonecrosis of the femoral head (ONFH) is a common disabling complication among convalescent SARS patients who received corticosteroid therapy. In China, a considerable number of convalescent SARS patients with steroid-associated ONFH had undergone conservative treatment by traditional Chinese medicine, and this study aims to evaluate the long-term results of a spleen-invigorating Huo-Gu formula (HGF) therapy in these patients. Participants and methods: A total of 33 convalescent SARS patients (9 males and 24 females) with bilateral steroid-associated ONFH (66 hips) were enrolled in this study. All patients received oral HGF therapy for 6 months when they were confirmed the diagnosis of steroid-associated ONFH. They had been regularly followed up at an interval of 1 year. Harris hip score and medical imaging modalities, including plain radiography, computed tomography and magnetic resonance imaging, were performed to evaluate the outcomes. Results: Based on average 14 years of follow-up of HGF therapy (ranging from 6 to 16 years), 38 hips (57%) among the 66 hips developed definite osteoarthritis, and 14 hips (26%) in 53 precollapse hips (Association Research Circulation Osseous [ARCO] Stage I or II) progressed to femoral head collapse (ARCO Stage III or IV). Only five patients (also 5 hips) underwent total hip arthroplasty, and the mean hip survival time was over 15 years by the Kaplan–Meier analysis. We observed a mean Harris hip score of 63 points, which represented the reserve of 55% in pain score and 70% in physical function score. The severity of groin pain was not correlated to the severity of osteoarthritis. Conclusion: Chinese herbal HGF therapy demonstrates beneficial effects on preventing femoral head collapse, delaying total hip arthroplasty, and maintaining physical function in the treatment of steroid-associated ONFH. HGF therapy might be therefore a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infection diseases. Translational potential of the article: HGF therapy might be a good alternative for the treatment of steroid-associated ONFH secondary to rheumatologic and infectious diseases.

The hydrothermal reaction of cobalt salt in the presence of 4-pyridyl-tetrathiafulvalene-4-pyridyl (4-py-TTF-4-py) and terephthalic acid (PTA) has been employed for the preparation of a novel metal–organic framework (MOF), i.e., (4-py-TTF-4-py)2M2(PTA)4 (M = Co2+). The obtained MOF is then used as a starting material for the synthesis of Co nanoparticles embedded in N,S-codoped carbon layer and supported on multi-walled carbon nanotubes (Co@NSC/MWCNTs) through the high-temperature calcination. Specifically, the calcination leads to the formation of N,S-codoped carbon-coated Co nanoparticles with simultaneous growth on the MWCNTs due to decomposition of the MOF. When used as the electrocatalyst, the Co@NSC/MWCNTs are found to have a higher activity for the oxygen reduction reaction (ORR) and follow a four-electron pathway. The catalytic activity of the Co@NSC/MWCNTs is much higher than that of the pure MWCNTs and the MOFs/MWCNTs. Although the Co@NSC/MWCNTs still exhibit slightly higher overpotential for the ORR, it is indeed more kinetically facile than the commercial Pt/C catalyst, as demonstrated by its higher limiting current density and lower Tafel slope. Additionally, the Co@NSC/MWCNTs also show superior stability and better tolerance to methanol crossover and CO poisoning, compared with those of the commercial Pt/C catalyst. These results strongly suggest that the Co@NSC/MWCNTs could be used as one of the most promising ORR electrocatalysts for the ORR with great potential to replace the Pt/C. The work present here opens up a new route for the design of carbon-integrated ORR electrocatalysts with high performance from a great number of available and yet rapidly growing MOFs.

Background Prior studies of clinical trial planning indicate that it is crucial to search and screen recruitment sites before starting to enroll participants. However, currently there is no systematic method developed to support clinical investigators to search candidate recruitment sites according to their interested clinical trial factors. Objective In this study, we aim at developing a new approach to integrating the location data of over one million heterogeneous recruitment sites that are stored in clinical trial documents. The integrated recruitment location data can be searched and visualized using a map-based information retrieval method. The method enables systematic search and analysis of recruitment sites across a large amount of clinical trials. Methods The location data of more than 1.4 million recruitment sites of over 183,000 clinical trials was normalized and integrated using a geocoding method. The integrated data can be used to support geographic information retrieval of recruitment sites. Additionally, the information of over 6000 clinical trial target disease conditions and close to 4000 interventions was also integrated into the system and linked to the recruitment locations. Such data integration enabled the construction of a novel map-based query system. The system will allow clinical investigators to search and visualize candidate recruitment sites for clinical trials based on target conditions and interventions. Results The evaluation results showed that the coverage of the geographic location mapping for the 1.4 million recruitment sites was 99.8%. The evaluation of 200 randomly retrieved recruitment sites showed that the correctness of geographic information mapping was 96.5%. The recruitment intensities of the top 30 countries were also retrieved and analyzed. The data analysis results indicated that the recruitment intensity varied significantly across different countries and geographic areas. Conclusion This study contributed a new data processing framework to extract and integrate the location data of heterogeneous recruitment sites from clinical trial documents. The developed system can support effective retrieval and analysis of potential recruitment sites using target clinical trial factors.

Elevated adipogenesis of bone marrow stromal cells (BMSCs) is closely associated with non-traumatic osteonecrosis of femoral head (ONFH). Our previous studies have shown that Huogu (HG) formula was effective both in clinic experience and experimental ONFH. How HG impacts the differentiation of BMSCs and what is the underlying molecular mechanism remain largely unknown. Our results showed that ethyl acetate extract of HG (HGE) significantly decreased the adipocyte differentiation as determined by oil red staining, while slightly increased the ALP activity. Investigation of the molecular mechanism revealed that HGE could inhibit the mRNA and protein expression of peroxisome proliferators-activated receptor (PPAR)γ, lipoprotein lipase (LPL) and adipocyteprotein2 (AP2). Interestingly, the inhibition of adipogenic differentiation in BMSCs by HGE could be restored by DKK-1, an inhibitor of Wnts. However, Noggin (an inhibitor of BMPs) displayed an additive role with HGE in suppressing the expression of PPARγ, LPL, and AP2. Furthermore, the bone marrow fat formation, as well as the expression of Wnt3a and PPARγ, was effectively regulated by HGE in the steroid-induced ONFH rats. Our results demonstrated that HGE treatment significantly inhibited adipogenesis and slightly promoted osteogenesis of BMSCs through regulating the BMP and Wnt pathways. The findings shed lights on the molecular mechanism of HGE in the inhibition of adipogenesis and provide scientific rationale for its clinical application of HGE in the treatment of ONFH.

Substrate integrated waveguide (SIW) technology provides an attractive solution to the integration of planar and nonplanar circuits by using a planar circuit fabrication process. In this paper, a 6-order cross-coupled SIW bandpass filter is designed by coupling matrix synthesis, electromagnetic simulation, coupling matrix extraction and optimization of filter size. The relative bandwith of the filter is 10.5% and the insertion loss is less than 2.65dB in the passband of 24.75GHz-27.5GHz. The transmission zero is introduced by cross-coupling, so that the filter obtains a steep transition band and good sideband suppression characteristics, while having low insertion loss and in-band fluctuation. The filter circuit has a small area and a simple structure, and can be widely applied to the microwave millimeter wave communication system.

Elevation of brain magnesium enhances cognitive capacity. Chronic lead (Pb) exposure has been implicated in the impairment of cognition. Whether elevation of brain magnesium rescues the impairment of memory by chronic Pb exposure is still unclear. Here we investigated the effect and possible mechanisms of chronic dietary intake of magnesium-L-threonate (MgT) on impaired spatial memory by chronic developmental Pb exposure in rats. We found that MgT rescued impaired spatial memory ability in Pb-exposed rats. This positive effect is relative to increasing dendritic spine density and the expression of NR2A and GluR1.

Our recent studies have shown that Huogu (HG) formula was effective both in clinic experience and in experimental osteonecrosis of the femoral head (ONFH). Given that defective of bone marrow stromal cells (MSCs) contribute to the development of osteonecrosis and MSCs show enormous potential in the treatment of ONFH, especially to aging people. How HG impacts the differentiation of MSCs and what is the underlying cellular and molecular mechanism remains largely unknown. Here, we found that an aqueous fraction of HG (HGA) significantly increased the alkaline phosphatase (ALP) activity, mineralized nodules, and migration of MSCs in a dose-dependent manner. Meanwhile, HGA could enhance the mRNA and protein expression of Runt-related transcription factor 2 (Runx2), Alp, Bmp2, osteocalcin (Ocn), and Osterix (Osx). Further investigation of the molecular mechanisms revealed that HGA treatment obviously increased expression, secretion, and activation of bone morphogenetic protein (BMP) 2 and β-catenin, two key regulators of the BMP or Wnt signaling pathway. Furthermore, osteogenic differentiation of MSCs could be blocked by using pharmacological inhibitors for these signaling pathways such as Noggin and Dkk-1. Besides, HGA could inhibit adipogenic differentiation of MSCs. Our study reveals that HGA promotes the osteogenesis of MSCs via the BMP and Wnt signaling pathways. Our findings provide mechanistic insights into the role of HG in treating ONFH.

Rational design and preparation of waste biomass derived carbon as air electrode catalysts are pivotal for large-scale sustainable development of Zn–air battery, simultaneously promoting waste resource reuse. Herein, a three-dimensional nitrogen-doped porous graphitized carbon (MS-NPC) is designed by employing maize straw as carbon precursors. The N-doping can cause increased active sites for oxygen reduction reaction (ORR), and the FeCl3 activated porous graphitized structure provides an efficient O2 and electrolyte pathway toward easily access to active sites. The resultant N-doped porous graphitized maize straw carbon (MS-NPC) surprisingly exhibits high specific surface area (1483 m2 g−1), high nitrogen content (4.70%), a rather positive onset potential (0.985 V vs. RHE) and large limiting current density (5.8 mA cm−2), which is even better than most reported leading results based on biomass-derived carbon. Density-functional-theory computations confirm the synergetic effect between N-doping and FeCl3 activated porous graphitized structure are promising to accelerate ORR process which is the essential reason for high ORR catalytic performance of MS-NPC. Furthermore, a primary Zn–air battery (ZAB) designed with MS-NPC electrode displays a maximum power density (127.9 mW cm−2), super specific-discharge-capacity (794 mAh gZn−1 at 300 mA cm−2), longtime stability, ZnO immunity and flexible properties. Practical testing verifies that the home-made ZAB can easily power LEDs and electric fans, thereby presenting a promising strategy for the development of economical and highly active carbon as excellent ORR electrocatalyst from waste biomass.

Steroid-induced osteonecrosis of the femoral head (SONFH) is difficult to be diagnosed at the early stages when it can be administrated effectively. Yet, to date no study has been performed to identify diagnostic biomarkers and to develop diagnostic models for SONFH. In the current study, a total of 60 SONFH patients with Association Research Circulation Osseous (ARCO) stages I–IV, and 20 controls were enrolled and divided into the discovery and validation cohorts. The serum samples were collected and the gene expression profiles were detected by microarray analysis based on the discovery cohort. Then, eight genes (BIRC3, CBL, CCR5, LYN, PAK1, PTEN, RAF1 and TLR4) were identified as the candidate serum biomarkers of SONFH due to the significant differential expression patterns and the topological importance in the interaction network of SONFH-related differentially expressed genes. Functionally, these candidate serum biomarkers were significantly involved into several pathological processes during SONFH progression, such as the immune regulation and inflammation, bone metabolism and angiogenesis. After that, a prediction model for the diagnosis of SONFH was constructed using Partial least squares regression based on the serum levels of the candidate biomarkers. Notably, both the 10-fold cross-validation and the independent dataset test demonstrated the good performance of this model. In conclusion, our study discovered eight promising serum biomarkers and developed the multi-biomarker-based prediction model as a new, potential and non-invasive diagnostic tool for the detection of SONFH, as well as benefit the administration of SONFH in a daily clinical setting.

Steroid-induced osteonecrosis of the femoral head (SONFH) is difficult to be diagnosed at the early stages when it can be administrated effectively. Yet, to date no study has been performed to identify diagnostic biomarkers and to develop diagnostic models for SONFH. In the current study, a total of 60 SONFH patients with Association Research Circulation Osseous (ARCO) stages I-IV, and 20 controls were enrolled and divided into the discovery and validation cohorts. The serum samples were collected and the gene expression profiles were detected by microarray analysis based on the discovery cohort. Then, eight genes (BIRC3, CBL, CCR5, LYN, PAK1, PTEN, RAF1 and TLR4) were identified as the candidate serum biomarkers of SONFH due to the significant differential expression patterns and the topological importance in the interaction network of SONFH-related differentially expressed genes. Functionally, these candidate serum biomarkers were significantly involved into several pathological processes during SONFH progression, such as the immune regulation and inflammation, bone metabolism and angiogenesis. After that, a prediction model for the early diagnosis of SONFH was constructed using Partial least squares regression based on the serum levels of the candidate biomarkers. Notably, both the 10-fold cross-validation and the independent dataset test demonstrated the good performance of this model. In conclusion, our study identified eight promising serum biomarkers and developed the circulating gene-based prediction model as a new, efficient and non-invasive diagnostic tool for the early detection of SONFH, as well as benefit the administration of SONFH in a daily clinical setting. Funding Statement: This study is funded by National Natural Science Foundation of China (No 81373656 & 81473695). Declaration of Interests: The authors declare that there is no conflict of interests regarding the publication of this paper. Ethics Approval Statement: The study was approved by the Research Ethics Committee of Institute of Chinese Materia Medica, Wangjing Hospital, China (SFDA approval number: 81473695). The informed consent was obtained from all patients.

Objective To investigate the effects of Ermiao Fang (EM) with medical guide Xixin (Herba Asari Mandshurici) (HAM) on bone marrow stem cell migration to a focal zone in osteoarthritis (OA) rats. Methods OA rats were induced by arthrectomy and assigned to sham-operated, model, EM, or EM plus HAM groups. All rats were injected with recombinant human granulocyte colony-stimulating factor 30 μg • kg−1 • d−1 for 7 days and treated with EM or EM plus HAM at 1.6 or 1.9 g • kg−1 • d−1 for 3 or 6 weeks, respectively. Chondrocyte apoptosis and cartilage matrix components were tested by transferase-mediated deoxyuridine triphosphate-biotin nick end labeling assay and special staining. Levels of interleukin-1 beta (IL-1β) tumor necrosis factor alpha (TNF-α) nitric oxide (NO), and inducible nitric oxide synthase (iNOS) in serum were detected by enzyme-linked immunosorbent assay or radioimmunoassay. Matrix metalloproteinases (MMPs)-13, tissue inhibitors of metalloproteinases (TIMPs)-1, Bromodeoxyuridine (BrdU), cluster of differentiation 34 (CD34), and stromal cell-derived factor 1 (SDF-1) were measured by immunohistochemical assay. Results The EM and EM plus HAM groups had significantly less cartilage damage and synovium inflammation the model group. Moreover, the EM and EM plus HAM groups had less chondrocyte apoptosis and more proteoglycan and collagen content than the model group. The EM and EM plus HAM groups had obviously higher MMPs-13 and TIMPs-1 expression in the cartilage than the model group. Moreover, the two formula groups had less release of IL-1β, TNF-α, NO, and iNOS than model group. Importantly, the expressions of BrdU, CD34, and SDF-1 in cartilage were significantly higher in the EM and EM plus HAM-Medtreated rats than model group. Notably, the EM plus HAM treatment seemed to have the greatest effects. Conclusions HAM improves the therapeutic effects of EM on OA rats by enhancing BMSC directional homing to the focal zone.

Steroid-induced osteonecrosis of the femoral head (steroid-induced ONFH) is characterized by increase of intraosseous pressure because of lipid metabolism disturbance such as elevation of adipogenesis and fat cell hypertrophy in the bone marrow, subsequently leading to disturbances of coagulation-fibrinolysis system in the femoral head and finally resulting in bone ischemia. Pravastatin has been demonstrated to be useful in preventing steroid-induced ONFH in animal models. However, its exact mechanisms acting on this disease have not been fully elucidated. To address this problem, steroid-induced ONFH rat model was constructed to evaluate the effects of pravastatin treatment on the osteonecrotic changes and repair processes. Then, Micro-CT-based micro-angiography was performed to assess the effects of pravastatin treatment on vascularization. In addition, serum lipid levels were detected by haematological examination. After that, the expression of peroxisome proliferator-activated receptor gamma (PPARγ), Wnt3a, low density lipoprotein receptor-related protein 5 (LRP5), β-catenin and runt-related transcription factor 2 (RUNX2) at both mRNA and protein levels were further detected by immunohistochemistry, real-time quantitative PCR, and Western blot analyses. The results, the ratio of empty lacuna, adipose tissue area, and adipocyte perimeter in the bone marrow were dramatically lower in the pravastatin treatment groups than in the model group (all P

Steroid administration, which is commonly performed for the treatment of autoimmune inflammatory diseases, cancers or organ transplantation, has been a leading cause of nontraumatic osteonecrosis of the femoral head (ONFH). Single nucleotide polymorphisms (SNPs) of the adenosine triphosphate-binding cassette B1 (ABCB1) gene have been demonstrated to be related to steroid-induced ONFH in small sample sizes of Japanese kidney failure and Chinese systemic lupus erythematosus patients. However, there are obvious controversial results in the relationship of ABCB1 gene polymorphisms with steroid-induced ONFH. The aim of this study was to validate the genetic association of ABCB1 polymorphisms with the risk for steroid-induced ONFH in a large cohort of Chinese population. A case–control study was conducted, which included 94 and 106 unrelated patients after steroid administration recruited from 14 provinces in China, respectively. Two SNPs (rs1045642 and rs2032582) within ABCB1 were genotyped using Sequenom MassARRAY system. Multivariate analyses based on clinical information were performed to determine the associations between the SNPs and risk of steroid-induced ONFH. rs1045642 SNP was significantly associated with steroid-induced ONFH group in codominant (P = 0.02), recessive (P = 0.006) and overdominant (P = 0.03) models. However, there were no differences found in genotype frequencies of rs2032582 SNP between controls and patients with steroid-induced ONFH (all P > 0.05). These findings suggested that rs1045642 SNP of ABCB1 may be associated with the risk of steroid-induced ONFH. Thus, it is useful to analyze this polymorphism for identifying high-risk individuals before the administration of steroids.

Amine functionalized holey graphene (AFHG), synthesized by the hydrothermal reaction of GO and ammonia and the subsequent KOH etching, has been used as a metal-free catalyst for the oxygen reduction reaction (ORR). It shows that AFHG is highly active for the ORR and exhibits higher electrocatalytic activity than graphene, nitrogen-doped graphene (NG) and amine functionalized graphene (AFG), which could be demonstrated from its higher current density and more positive half-wave and onset potentials for the ORR. Although AFHG also exhibits a slightly higher overpotential towards ORR, it is indeed more kinetically facile than the commercial JM Pt/C 40 wt%. Its higher electrochemical performance could be attributed to the presence of the electron donating group (e.g. amine) and a large number of holes in its sheet plate and the porous structure in its randomly stacked solid, which provide AFHG with higher electrical conductivity, more active edge N atoms and easier accessibility to oxygen, respectively. The stability measurements show that AFHG is more stable than graphene, NG, AFG and the JM Pt/C 40 wt% and exhibits higher immunity towards methanol crossover and CO poisoning than the JM Pt/C 40 wt%. Over 10 h of the ORR, AFHG loses only

Ethnopharmacological relevance Saposhnikovia divaricata (SD), called “Fangfeng” in China, is commonly used in clinical compound prescription for treatment of rheumatoid arthritis (RA), but its actions on RA have not been clarified. The present study aims to determine the anti-inflammatory activity of SD chromone extract (SCE), the major bioactive component of SD, on collagen-induced arthritis (CIA) rats, and elucidate its underlying mechanisms with regards to its molecular basis of action on human fibroblast-like synoviocytes derived from RA patients (HFLS-RA). Materials and methods CIA model on rats was constructed by injection of bovine type II collagen. Rats were pre-treated with different dosages of SCE from 3 days before till 35 days after model building. The progression of CIA was evaluated by macroscopic scoring, X-ray observation and hematoxylin and eosin (HE) staining of paws. HFLS-RA were pre-treated with different concentrations of SCE prior to stimulation with 10 ng/ml of tumor necrosis factor (TNF) α. By radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA), levels of interleukin (IL)-1β, IL-6, TNFα and prostaglandin E2 (PGE 2 ) were quantified respectively. Nuclear factor (NF-κB) p65 expression and DNA-binding activity were tested by immunohistochemisty and electrophoretic mobility shift assay (EMSA) respectively. Phosphorylation of extracellular signal-regulated kinase (ERK), Jun N-terminal kinase (JNK) and p38 MAPKs were examined by immunohistochemisty staining and western blot analysis. Results Histological examination and radiological observation demonstrated that SCE significantly reduced the inflammatory responses in the joints of CIA rats. SCE inhibited the production of TNFα, IL-1β, and IL-6 in the joint tissues and sera. The level of PGE 2 in sera was also decreased by SCE. Moreover, SCE treatment in vivo was able to reduce protein level of NF-κB, the transcriptional factor closely related to the inflammatory process, in articular synovium and cartilage of CIA rats. In addition, SCE inhibited p-ERK, p-JNK and p-p38 expression, which were considered to be involved in the phosphorylation of transcription factor NF-κB and the transcription of pro-inflammatory factors. Further, SCE inhibited NF-κB DNA binding activity and attenuated the phosphorylation of ERK, JNK and p38 MAPKs, in a concentration-dependent manner in cultured HFLS-RA. Conclusion These results highlight the anti-arthritic potential of SCE, and provide further evidence of the involvement of the NF-κB and MARKs inhibition in the effects of SCE.

Direct-blending component oils bring great disturbance to the online gasoline blending control. A double loop optimization strategy with nested outer and inner loops is proposed, and the optimization strategy combined with a case study is illustrated in detail in this paper. The real industry application demonstrates that this new optimization strategy can not only take account of the bottom oil's properties deviation, but also timely detect the fluctuation of gasoline properties from the direct-blending oils. In this way, the final gasoline product properties can be controlled quite well at one time, and the re-blending times of final product have been much reduced compared with the conventional single loop optimization method.

Literature review shows that Chinese medicine and other related treatment are still the main stream treatment of knee osteoarthritis. Currently, there is short of handbook guiding Chinese medicine from evidence-based medical evidence, so it is a top priority to develop a clinical guideline from the expert consensus. After several rounds of discussion during the conference and examination by letter, which has collected opinions from nearly one hundred experts, consensus was reached. Nonpharmacologic interventions include health education, medical exercise, acupuncture, massage, acupotomology, and physiotherapy. Pharmacological interventions are as follows. Topical application includes fumigation, application, hot compressed, ironing and iontophoresis with Chinese herbs, etc. Chinese patent medicine for external use includes plaster, ointment, etc. Western medicine for external use mainly includes emulsion, ointment, plaster and embrocation containing nonsteroidal anti-inflammatory drugs (NSAIDs). Intraarticular injection mainly includes sodium hyaluronic acid, chitosan (for injection) with prudent use of glucocorticoid. Chinese herbal medicine and Chinese patent medicine can be taken referring to syndrome differentiation which mainly includes syndromes of qi stagnation and blood stasis, cold dampness, deficiency of Gan (Liver) and Shen (Kidney), deficiency of qi and blood. Western medicine mainly includes analgesic, NSAIDs, diseases modifying drugs. Surgery procedures mainly include joint irrigation, arthroscopic surgery, osteotomy, arthroplasty, etc.