Combating COVID-19 with integrated traditional Chinese and Western medicine in China

COVID-19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread throughout the world. China has achieved rapid containment of this highly infectious disease following the principles of early detection, early quarantine and early treatment with integrated traditional Chinese and Western medicine. The inclusion of traditional Chinese medicine (TCM) in the Chinese protocol is based on its successful historic experience in fighting against pestilence. Current findings have shown that the Chinese medicine can reduce the incidence of severe or critical events, improve clinical recovery and help alleviate symptoms such as cough or fever. To date there are over 133 ongoing registered clinical studies on TCM/integrated traditional Chinese and Western medicine. The three Chinese patent medicines (/ (Forsythiae and Honeysuckle Flower Pestilence-Clearing Granules/Capsules), (Honeysuckle Flower Cold-Relieving Granules) and (Stasis-Resolving & Toxin-Removing) were officially approved by the National Medical Products Administration to list COVID-19 as an additional indication. The pharmacological studies have suggested that Chinese medicine is effective for COVID-19 probably through its host-directed regulation and certain antiviral effects.

Four-component instructional design model and its application on clinical teaching in orthodontics / 中华医学教育探索杂志

As an important sub-discipline of dentistry,orthodontics is regarded as the post-graduate education for postgraduates and advanced doctors both at home and abroad.Orthodontics is a professional,practical and systematic discipline,therefore,the conventional education model is hard to get a good result.In this study,a new idea of four-component instructional design model(4C/ID)guided by "integration" was explored in the education of orthodontics,combined with the author's study experience in the University of Pennsylvania.The 4C/ID mainly included four elements: learning tasks,supportive information,procedural information and part-task practice,which emphasized in providing learners a set of real,specific and work-oriented complete learning tasks,so as to replace "partial task learning" to "overall task learning".This study explored the 4C/ID and its application on clinical teaching in orthodontics.

Four-component instructional design model and its application on clinical teaching in orthodontics / 中华医学教育探索杂志

As an important sub-discipline of dentistry, orthodontics is regarded as the post-graduate education for postgraduates and advanced doctors both at home and abroad. Orthodontics is a professional, practical and systematic discipline, therefore, the conventional education model is hard to get a good result. In this study, a new idea of four-component instructional design model (4C/ID) guided by "integration" was explored in the education of orthodontics, combined with the author's study experience in the University of Pennsylvania. The 4C/ID mainly included four elements: learning tasks, supportive information, procedural information and part-task practice, which emphasized in providing learners a set of real, specific and work-oriented complete learning tasks, so as to replace "partial task learning" to "overall task learning". This study explored the 4C/ID and its application on clinical teaching in orthodontics.

One stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft for type C thoracolumbar fractures / 中华创伤杂志

Objective To evaluate the therapeutic effeet of one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft versus traditional posterior and anterior approach surgery in the treatment of severe thoracolumbar fractures.Methods A retrospective case-control study was done on 40 cases of type C thoracolumbar fractures admitted from January 2012 to December 2015.There were 28 males and 12 females,with age range of 20-48 years (mean,30.6 years).The fractures were located at T11 in 4 cases,at T12 in 16,at L1 in 14,and at L2 in 6.All cases were divided into two groups (with 20 cases per group) according to treatment method difference.The cases in posterior group had one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft,and the others in posterior and anterior group were treated by traditional posterior and anterior approach surgery.The operation duration,volume of blood loss,hospital stay,kyphosis correction rate,visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups.Results All patients were followed up for 10-46 months (mean,28.6 months).In posterior group,the average operation time was 154 minutes,the average blood loss was 564 ml,the postoperative suction drainage was 180.5 ml,the time period between surgery and recovery of walking ability was 5.9 days,and the hospital stay was 10.6 days.While in posterior and anterior group,the average operation time was 248.5 minutes,with the average blood loss of 960.8 ml,the postoperative suction drainage of 359.2 ml,the time duration between surgery and recovery of walking ability of 8.4 days,and the hospital stay of 14.5 days (P ＜ 0.05).At one week and six months postoperatively,the height ratio of anterior edge,Cobb angle,VAS and ODI in both groups were improved compared to the preoperative status (P ＜ 0.05).But there was no significant difference of these indicators between two groups (P ＞ 0.05) except for lumbar back pain one week after operation (P ＞ 0.05).Conclusions Through single pathway of posterior approach,one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft can complete reduction of fractured vertebral body,spinal cord decompression,and anterior-middle column stability reconstruction.Compared with traditional combined posterior and anterior approach surgery,this technique has many advantages including simpler manipulation,less invasion,shorter rehabilitation time and equal bony fusion and hence is an ideal option for type C thoracolumbar fractures.

Unilateral atlantoaxial pedicle screw fixation plus structural iliac bone graft for treatment of unstable atlas fractures / 中华创伤杂志

Objective To evaluate the efficacy of unilateral atlanto-axial transpedicle screw fixation plus iliac bone graft for treatment of unstable atlas fractures combined with unilateral pedicle dysplasia or comminuted fractures.Methods A retrospective case control study was made on 44 patients with unstable atlas fractures surgically treated between January 2012 to June 2016.Unilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients combined with unilateral pedicle dysplasia or comminuted fractures in Group A[15 males,seven females;(37.5 ± 13.4)years],and bilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft was performed for 22 patients without unilateral pedicle dysplasia or comminuted fractures in Group B [14 males,eight females;(38.1 ± 13.3)years].Between-group differences were compared concerning operation time,intraoperative blood loss,length of hospital stay,success rate of screw placement,postoperative atlantoaxial stability,surgery-related complications,visual analog scale (VAS),Japanese orthopedic association score (JOA) and bone fusion.Results Mean duration of follow-up was 28.4 months (range,14-48 months).In Group A,operation time was (123.4 ± 18.2) min,blood loss was (218.5 ± 80.2) ml,hospital stay was (7.1 ± 1.0)d,success rate of screw placement was 100％,postoperative atlanto-axial stability of all patients was obtained,and no complications occurred.In Group B,operation time was (173.4 ± 12.4) min,blood loss was (318.2 ± 61.7) ml,hospital stay was (7.2 ± 0.8) d,success rate of screw placement was 100％,postoperative atlanto-axial stability of all patients was obtained,and no complications occurred.There were significant differences in operation time and blood loss between the two groups (P ＜0.01),while not in hospital stay,success rate,postoperative atlant-oaxial stability,complication incidence,VAS and JOA (P ＞ 0.05).Conclusion Both treatments are effective,but unilateral atlanto-axial transpedicle screw fixation combined with iliac bone graft is associated with relatively shorter operation time and less blood loss and hence is considered as a better choice for treatment of unstable atlas fractures.

High quality nursing in gastroscopy / 中国内镜杂志

Objective To analyze the effect of high quality nursing in gastroscopy examination. Method 1 300 pa﹣tients underwent gastroscopy from March 2014 to June 2014 were randomly divided to control group (n= 650) and intervention group (n= 650). Patients in control group received routine nursing, and patients in intervention group received high quality nursing intervention besides the routine nursing. Patients anxiety level, open state of esophageal meatus, one-time intubation success rate, and time-consumed in gastroscopy of the two groups were compared. Result Anxiety score between the two groups at the time of reservation was not statistically significant (P> 0.05), anxiety scores of the intervention group (31.40 ± 4.20) was lower than that of control group before gas﹣troscopy, and the difference was statistically significant (P<0.01). Open rate of esophageal meatus, one-time intuba﹣tion success rate, and time-consumed in gastroscopy of the intervention group (97.1%, 95.1%and 4.52 ± 1.23 min) were significantly better than those of the control group (79.4%, 82.3%and 5.42 ± 1.53 min). Conclusion The high quality nursing in gastroscopy can alleviate the anxiety level of patients, improve the success rate of gastroscopy, re﹣duce the pain of patients, and it is worthy of clinical promoting.

Experimental animal models of intervertebral fusion-induced adjacent segment degeneration / 中国组织工程研究

BACKGROUND:Upright rat intervertebral disc degeneration model can prove that intervertebral fusion can aggravate the adjacent-segment intervertebral disc degeneration, but cannot affirm that spinal non-fusion technology has more advantages. OBJECTIVE:Base on the affirmed intervertebral disc degeneration models of Beagle dog, we performed intervertebral fusion to affirm whether or not the intervertebral fusion can aggravate the adjacent-segment intervertebral disc degeneration. METHODS:Twelve Beagle dogs were randomly divided into two groups. The control group animals were stabbed percutaneous to injure L5/6 disc. The experimental group animals were stabbed percutaneous to injur L5/6 disc. One month later, we made L4/5 intervertebral fusion. At 3 and 6 months postoperatively, lumbar MRI was conducted. L5/6 discs were harvested and subjected to histological observation and PCR. RESULTS AND CONCLUSION:(1) MRI:in the experimental group, 3 and 6 months after fusion, different degrees of intervertebral disk herniation appeared. In the control group, no obvious intervertebral disk herniation appeared. (2) Histological observation:6 months after fusion, in the experimental group, intervertebral disc annulus and nucleus pulposus were disordered;there was a gap in the fold, and the number of nucleus pulposus cel s decreased. In the control group, nucleus pulposus and anulus fibrosus boundary was clear;col agen was loose and arranged regularly. Cel number was more. Anulus fibrosus was close to normal. Col agen fibers were regular and dense. In the experimental group, 3 and 6 months after fusion, type II col agen-positive cel s were less than the control group (P<0.05). Moreover, type II col agen-positive cel s were less at 6 months than at 3 months in the experimental group (P<0.05). (3) PCR:Bone morphogenetic protein 15 and tissue inhibitor of matrix metal oproteinase 1 gene expression was higher in the experimental group than in the control group at 3 and 6 months after fusion (P<0.05). Bone morphogenetic protein 15 and tissue inhibitor of matrix metal oproteinase 1 gene expression was higher in the experimental group at 6 months than that at 3 months (P<0.05). (4) These results suggest that intervertebral fusion can aggravate the adjacent-segment intervertebral disc degeneration.

Bone graft fusion combined with internal fixation restores vertebral height after thoracolumbar fracture and dislocation / 中国组织工程研究

BACKGROUND:Spinal canal decompression and fusion combined with pedicle screw fixation has become the main method for the treatment of thoracolumbar fracture and dislocation. OBJECTIVE:To restore the vertebral height of the patients with thoracolumbar fracture and dislocation who underwent subtotal resection and decompression through titanium cage packed with autologous cancel ous bone and pedicle screw fixation. METHODS:Thirty-one patients with thoracolumbar fracture and dislocation treated in the Shanghai 6th People’ s Hospital of Shanghai Jiao Tong University from February 2007 to September 2011 were selected. Al the patients received subtotal resection, spinal canal decompression and titanium cage packed with autologous cancel ous bone and pedicle screw fixation. Imaging examination was performed before and after treatment to observe the recovery of vertebral sequence, vertebral height and Cobb angle, as wel as the recovery of nerve function. RESUTLS AND CONCLUSION:The patients were fol owed-up for 12 months, and al the patients healed wel after treated with titanium cage packed with autologous cancel ous bone and pedicle screw fixation, and there was no loosening, shedding or breakage after pedicle screw fixation. During reexamination, the grafts fusion, good deformity correction, basic recovery of vertebral height and good recovery of Cobb angle were observed. Seven cases had neurological function recovery, and among them, six cases raised for one degree, one case raised for two degrees, and another 22 cases without recovery. Case analysis and relative researches showed that subtotal resection and decompression and titanium cage packed with autologous cancel ous bone and pedicle screw fixation can reduce the loss of correction of the patients with thoracolumbar fracture and dislocation, restore the vertebral height, and enhance the stability of the vertebral body.

Topping-off technique for the protection of degenerative intervertebral disc / 中国组织工程研究

BACKGROUND:Topping-off technique can be used for fixation treatment through the combination of fusion and interspinous dynamic device, in order to prevent or slow down the adjacent lumbar segment degeneration. OBJECTIVE:To obverse the protective effect of Topping-off technique (posterior lumbar interbody fusion procedure combined with the fixation of dynamic interspinous device Coflex) for the degenerative intervertebral disc. METHODS:A total of 32 patients with degenerative lumbar diseases who had been treated with Topping-off technique were included in this study. The Oswestry disability index, the Japanese Orthopaedic Association scores, range of motion for Coflex implanted segment and during the relative signal intensity of the Coflex implanted segment in MRI image were recorded and calculated preoperatively and the entire fol ow-up period. RESULTS AND CONCLUSION:Al patients were fol owed-up for 20.6 months averagely. Up to the last fol ow-up, the Oswestry disability index and Japanese Orthopaedic Association scores were significantly improved when compared with those before treatment (P<0.001). There was no significant difference in the range of motion for Coflex implanted segment before and after treatment (P=0.19). The relative signal intensity of the Coflex implanted segment was significantly improved when compared with that before treatment (P<0.01). The clinical application of the Topping-off technique showed a protective effect on the intervertebral disc.

Basic framework and thought of deepening reform of Shanghai healthcare system / 中华医院管理杂志

Under the general requirements of China's national health reform, the basic framework of Shanghai's health reform was constructed at five different aspects the long term vision, goal, strategies, measures, supportive reform activities. The general thought of Shanghai's health reform can be concluded into two aspects: first, establishing a basic healthcare system of covering both urban and rural residents universally; second, enhancing the foundation of enabling sustainable health development.

The overall progress and challenges of Shanghai health care for the last 30 years since reform and opening up / 中华医院管理杂志

Marked by the Third Plenary Session of the Eleventh Central Committee of the CPC, Shanghai health care started a journey of reform and opening up as with other sectors. This essay reviews various stages Shanghai health care experienced and the achievements for the last 30 years since reform and opening up, and analyzes the challenges Shanghai health care faces currently. On this basis, the essay summaries the experiences and lessons learned from Shanghai health care reform and development.

Study on the allocation of medical care resources in Shanghai / 中华医院管理杂志

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.

In vivo and in vitro animal models of intervertebral disc degeneration and repair / 中国组织工程研究

BACKGROUND:Animal models can be used to study specific scientific problems of intervertebral disc biology.Model of disc degeneration is mainly used to resolve the relevant disease mechanisms and scientific and security issues of the treatment.OBJECTIVE:To summarize currently used experimental animal models of intervertebral disc degeneration study,and to dynamically observe and confirm the pathological process of disc degeneration based on disc imaging,morphology,biomechanics and bi(o)chemicel changes.METHODS:Using "intervertebral disc degeneration,animal models,in vivo,in vitro" in English as the search words,Cochrane Library (No.1 2009),Cochrane Library Database of Controlled Clinical Trials (No.1 2009),MEDLINE from 1990 to March 2009,EMbase from 1990 to March 2009,Current Controlled Trials,and the National Research Register were retrieved.Literature was limited to English language.The disc imaging,morphology,biomechanical end biochemical composition and other indicators,as well as the pathological process of disc degeneration served as the evaluation indices.The articles related to the intervertebral disc cell culture models,the whole disc tissue culture model,mechanical model,injury model,biological model,genetically modified models,spontaneous models were included.The repetitive researches and those unrelated to animal models of intervertebral disc degeneration were excluded.RESULTS AND CONCLUSION:The establishment of a reliable animal model can provide favorable conditions for studying the pathogenesis of intervertebral disc degeneration,at the same time,provides a good experimental vehicle for various researches about the repair treatment of intervertebral disc degeneration.Animal models of intervertebral disc degeneration can be divided into two categories:in vitro models and in vivo models of disc degeneration and repair.The former can be assigned into disc cell culture models and whole disc tissue culture model;the latter is assigned into mechanical models,injury models,biological models,genetically modified models,spontaneous models and so on.The above models are commonly used in the study of the occurring mechanism of disc degeneration,as well as the feasibility and effectiveness of a variety of treatments.However,there is still no generally accepted animal models as an ideal disc degeneration model,various types of models reported have their own advantages and disadvantages.

Single anterior approach surgery for old cervical spine subluxation / 中华创伤骨科杂志

Objective To implore the feasibility of using single anterior approach surgery for old cervical spine subluxation. Methods From May 2004 to July 2006,16 cases of old cervical spine subluxation underwent cervical spine surgery through anterior approach at least 2 months after injury. During operation, we managed to reconstruct the cervical vertebral body alignment through a special anterior approach decompression, application of retractor instrument, titanium mesh and plate manipulation. Results Follow-ups averaged 8.5(6 to 11) months. The cervical vertebral body alignment Was obtained in all the 16 cases. The osseous fusion was assured in all cases with no instrument failure. The JOA neurological scores were improved from 13.4 preoperatively to 15.9 postoperatively. Conclusion If there is no posterior compression and the posterior structure has a fibrous fusion, the single anterior approach is good enough for the old cervical spine subluxation to maintain alignment and obtain stability, and posterior reduction is not necessary.

Application of total spondelyctomy in the treatment of spinal tumor / 中国组织工程研究

To date, three techniques of total spondelyctomy were used for spinal tumor, including piecemeal technique, eggshell technique and total en bloc spondelyctomy, and each has specific features and indications. Due to limitations of technique, piecemeal technique and eggshell technique are gradually replaced by total en bloc spondelyctomy in treatment of spinal tumor. Moreover, with technical development, application of total en bloc spondelyctomy in treatment of spinal tumor becomes more rigorous and standard. However, it is controversial about its indications and surgical approach. Postoperative spinal stability reconstruction is achieved through various methods according to different conditions.

Bone grafts and dynamic fixation for spine fusion / 中国组织工程研究

Concepts and techniques of spinal fusion as a therapeutic modality may date back to the origins of spinal surgery. Spinal fusion has been considered as the standard treatment of progressive deformities,including instability,scoliosis and trauma. In this study,we shall attempt to define and review the bone graft materials,progress on the operative techniques,postoperative complications and related therapy,the latest dynamic fixation,and minimally invasive technique to lumbar spine fusion.

Application of finite element analysis in the biomechanical evaluation of spine structure and lumbar fusion / 中国组织工程研究

Finite element analysis can analyze the stress and strain change of object with complex shape,structure,constitution and load condition,and is widely applied to spinal biomechanical studies due to its controllability,reproducibility and versatility in mechanics tests.The article briefly introduced several finite element analysis software,summarized the mechanical characteristics of vertebral body,intervertebral disc,accessories and the ligament and muscle around the spine,and summarized research achievements of finite element analysis in lumbar fusion,concerning the biomechanics of Cage,its influence on lumbar fusion and related surgery choice,dynamic fusion,artificial intervertebral disc and the biomechanical variation of different fusion style after spinal tumor vertebrectomy.Finite element analysis can help understand the spine biomechanics and provide biomechanical reference for lumbar fusion choice.

Surgical treatment of thoracolumbar spinal fractures in patients with multiple injuries / 中国矫形外科杂志

[Objective]To study the surgical treatment of thoracolumbar fractures in multiple injured patients.[Method]Data from 12 consecutive patients with thoracolumbar fractures and multiple trauma were reviewed retrospectively.Three patients with thoracolumber fractures were complicated by pelvic(acetabular) fracture,11 by lower extremity fracture and 6 by upper extremity fracture.All the patients were treated operatively.The spinal injury and pelvic fractures were first treated.The operation time,bleeding volume as well as Frankle score were recorded.[Result]The average operation time was(202?52)min and the blood loss was(500?325)ml per patient,and the average operation time was 59 min and blood loss was 146 ml for an injury.The average Frankle score increased from 2.8 preoperatirely to 3.5 at 3 months after operation.Bone reunion or fusion was achieved in 8 patients at a one-year follow-up.[Conclusion]Damage control orthopedics should be emphasized for severe polytrama.The operation timing and techniques depend on the characteristics of fractures and the general conditions of the patients.Minimally invasive technique is useful in reducing the operation time and injury reaction,promoting early mobilization and lessening complications.

Aleration of cystatin C in cerebrospinal fluid of patients with sciatica revealed by a proteomical approach

To better understand the pathophysiological mechanisms underlying sciatica induced by lumbar intervertebral disk herniation and to ascertain the protein that presents with the most observable changes in the cerebrospinal fluid [CSF] of patients with sciatica. We conducted the study in the Key Laboratory of Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, Peoples Republic of China, during the period June 2004 to March 2005. In 2 separate experiments, we carried out the study involving the CSF of sciatica patients [the case group] and the CSF of otherwise, healthy volunteers [the control group]. We utilized a proteomical analysis to compare the samples of 10 patients with sciatica with 10 volunteers in the control group. We individually separated each of the groups' CSF by 2-dimensional gel electrophoresis. We analyzed the harvested gel images with PD Quest 2D-gel software [Bio-Rad] to ascertain the differential proteins between the 2 groups. We based the enzyme linked immuno- absorbent assay [ELISA] experiment, which followed, on the results of the first experiment. We found 15 of the protein spots in the CSF differed appreciably in varying degrees between the 2 groups, and identification made by LC-MS/MS revealed that the most significant disparity was with cystatin C. The result of ELISA experiment confirmed a considerable decrease in the level of cystatin C [p<0.01] in the patients with sciatica. In the CSF of patients with sciatica, the volume of cystatin C increased markedly indicating that it may play an important role in the pathophysiological processes of sciatica

Long term outcome of contralateral C7 transfer: a report of 32 cases / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To observe long-term functional recovery after contralateral C7 transfer.</p><p><b>METHODS</b>From August 1986 to July 2000, 224 patients with brachial plexus avulsion injuries were treated with contralateral C7 transfer in our department. Thirty-two patients were followed up for over 2 years for evaluation of the following items: 1 influence on healthy limb function; 2 sensory and motor recovery of the recipient nerves in the affected limb; and 3 coordination between the healthy and affected limbs.</p><p><b>RESULTS</b>There was no impairment of healthy limb function. Functional recovery of the recipient area reached > or =M3 in 8 patients (8/10, 80%) after musculocutaneous nerve neurotization, > or =M3 in 4 patients (4/6, 66%) after radial nerve neurotization, > or = M3 in 7 patients (7/14, 50%) and > or = M3 in 12 patients (85.7%) after median nerve neurotization, and > or = M3 in 1 patients (1/2, 50%) after thoracodorsal nerve neurotization. Synchronic contraction of the affected limb with the healthy limb occurred within 2-3 years in 12 patients, within 5 years in 13 patients, and over 5 years in 7 patients.</p><p><b>CONCLUSION</b>Contralateral C7 transfer is an ideal procedure for the treatment of brachial plexus root avulsion injury. Selection of the whole root or the posterior division as neurotizer and a staged operation are the major factors influencing treatment outcome.</p>