Use of " short distances and multi-segment" buried guiding suture in the surgery of early descent of prosthesis after augmentation mammoplasty / 中华医学美学美容杂志

Objective:To introduce a surgical technique of " short distances and multi-segment" buried-guiding suture method and its effects in the surgery of early descent of prosthesis after augmentation mammaplasty.Methods:From August 2019 to January 2022, 15 cases of early descent of prosthesis after augmentation mammaplasty due to axillary approach breast augmentation for micromastia were admitted to the Plastic Surgery Department of Sichuan Provincial People′s Hospital, aged 23-35 years (27.3±3.6) and duration of dislocation from 16 to 35 days (23.8±5.8). There were 12 patients showed unilateral prosthesis drops and 3 patients showed bilateral prosthesis drops. " Short distances and multi-segment" buried-guiding suture method was used to solve the problem, i. e., 2-0 non-absorbable sutures were used to eliminate the lower pole of prosthetic cavity with " short distances and multi-segment" sutures. The distance from the nipple to the midline of the sternum, the distance from the sternotomy to the nipple, the distance from the nipple to the inframammary fold and the distance from the midclavicular point to the inframammary fold were measured bilaterally before and after surgery, and statistical analysis was performed to evaluate the efficacy of the " short distances and multi-segment" buried-guiding suture method for early descent of prosthesis after breast augmentation.Results:All incisions healed by first intention without complications such as hematoma, infection, or scar hyperplasia. 15 patients were followed up for 6-12 months (8.0±1.9). 14 patients were satisfied with the results after surgery, and 1 patient received satisfactory results after secondary surgery. The distance from nipple to inframammary fold was shortened by 0.8-1.4 cm after surgery (1.2±0.2), and the distance from mid-clavicle to inframammary fold was shortened by 1.0-1.6 cm (1.3±0.4), and the differences were statistically significant as compared with the values before surgery ( t=31.17, P<0.05; t=33.78, P<0.05). After surgery, the change in the distance from nipple to sternal was 0.1-0.3 cm (0.16±0.10), and the change in the distance from sternal notch to nipple was 0-0.2 cm (0.12±0.10), and the differences were not statistically significant ( P>0.05). Conclusions:With the advantages of simple operation, little trauma and no additional incision, the " short distance and multi-stage" buried-guiding suture method in the surgery of early descent of prosthesis after augmentation mammaplasty is worthy of clinical application.

Study on the accuracy of cervical pedicle screw placement assisted with improved 3D-printed drill guiding template / 中国脊柱脊髓杂志

Objectives:To explore the accuracy of pedicle screw placement assisted with improved 3D-print-ed drill guiding template in cervical spine.Methods:The clinical data of 60 patients undergone posterior cervical pedicle screw placement in our hospital between January 2016 and January 2023 were analyzed retro-spectively,including 30 males and 30 females with an average age of 17-84 years(58.7±13.8 years).The pa-tients were divided into guiding template group and free-hand group based on whether the guiding template was used to assist the placement of screws or not.The improved 3D-printed guiding template was used to assist cervical pedicle screw placement in the guiding template group(n=30),and the self-made angular-ruler was used in the free-hand group(n=30).There was no significant difference in age,gender ratio,and preoper-ative diagnosis between the two groups(P＞0.05).Cervical CT scan was performed at one week after surgery,and the accuracy of pedicle screw placement was evaluated according to the Kaneyama standard:Grade 0,the screw was completely in the pedicle;Grade 1,the size of screw penetrating the cortex＜50%of the screw diameter;Grade 2,the size of screw penetrating the cortex≥50%of the screw diameter but not com pletely out;Grade 3,the screw was completely on the outside of the pedicle.The accuracy of pedicle screw placement(ratio of grades 0 and 1)and complications such as vascular and nerve injury,incision infection,cerebrospinal fluid leakage,screw loosening and breakage caused by screw misplacement were recorded.Re-sults:A total of 152 pedicle screws were placed in the guiding template group,including 74 screws of grade 0,68 of grade 1,10 of grade 2 and 0 of grade 3,with an accuracy of screw placement of 93.4%.A total of 136 pedicle screws were placed in free-hand group,including 53 screws of grade 0,61 of grade 1,18 of grade 2 and 4 of grade 3,with an accuracy of screw placement of 83.8%.The accuracy of screw placement in the guiding template group was significantly higher than that in the free-hand group(P＜0.05).There were no related complications such as vascular and nerve injury,incision infection and cerebrospinal fluid leakage caused by misplacement of pedicle screws.The patients were followed up for 5-29 months(14.2±7.7months),and there were no complications such as screw loosening or breakage.Conclusions:Improved 3D-printed drill guiding template can improve the accuracy of pedicle screw placement in cervical spine.

Comparison of application of 3D-printed personalized guiding template and robot-assisted pedicle screw placement in adult degenerative scoliosis / 中国脊柱脊髓杂志

Objectives:To compare the effects of 3D-printed personalized guiding template and robot-assisted pedicle screw placements in orthopedic surgery for adult degenerative scoliosis(ADS).Methods:Retrospective analysis was conducted on 18 ADS patients hospitalized and treated with corrective surgery in the department between January 2020 and December 2022.There were 3 males and 15 females,aged 46-73(63.2±8.2)years old.A total of 236 pedicle screws were placed,and the patients were divided into two groups according to the auxiliary screw placement methods:the 3D-printed personalized guiding template group(3D-printed group,1 1 cases,142 pedicle screws were placed)and robot-assisted screw placement group(Robot group,7 cases,94 pedicle screws were placed).The patients were followed up for 6 months and more.The vertex rotation angle and scoliosis Cobb angle were measured and compared between groups before operation.All pedicle screws were classified by Gertzbein-Robbins classification standard at 1 week after operation,and the accuracy and satisfaction of screw placement in the two groups were compared;And the operative time and incidence of complications were also analyzed and compared between the two groups.Re-sults:The 3D-printed group was not statistically different from the robot group in terms of age(63.6±9.0 years vs.62.6±7.3 years),gender ratio(male/female:2/9 vs.1/6),number of screws placed(12.91±3.83 vs.13.43± 3.60),Cobb angle(40.36°±1 1.82° vs.38.14°±12.84°),and vertex rotation angle(30.27°±7.25° vs.29.86°±9.65°),respectively(P＞0.05).The robot group was longer in operative time than that of 3D-printed group(354.29± 53.73min vs.282.27±73.87min,P＜0.05).Of the total 142 pedicle screws placed in the 3D-printed group,128 screws were of class A,10 were of class B,and 4 were of class C;Of the total 94 pedicle screws placed in the robot group,86 screws were of class A,5 were of class B,and 3 were of class C;No class D or E screws in the two groups.The accuracy rate of screw placement(90.14％)and satisfaction rate(97.18％)of the 3D-printed group were not statistically different from the accuracy rate(91.49％)and satisfaction rate(96.81％)of the robot group,respectively(P＞0.05).The incidence of complications in the 3D-printed group(36.36％)was not significantly different from that in the robot group(57.14％,P＞0.05).Conclusions:Both auxiliary screw placement methods can assist spinal surgeons to accurately place screws in ADS patients,but 3D-printed personalized guiding template needs less time in screw placement.

Clinical application of 3D-printed drill guiding template in pedicle screw insertion in subaxial cervical spine / 中国脊柱脊髓杂志

Objectives:To explore the safety and accuracy of subaxial cervical pedicle screw(CPS)insertion assisted with optimized 3D-printed drill guiding template(DGT).Methods:A retrospective study was conducted to analyze the clinical data of 42 patients aged 32-74 years(50.1±9.8 years)who underwent posterior cervi-cal pedicle screw intemal fixation between August 2016 and October 2022.The patients were followed up for 13-25 months(19.6±3.2 months).They were divided into two groups of guiding template group(n=22)and free-hand group(n=20)according to the method of pedicle screw insertion.In the guiding template group,the sub-axial CPSs insertions were assisted with 3D-printed DGT,designed individually for each patient based on the design scheme of an optimized pedicle drill guiding template,and the patients consisted of 12 males and 10 females,among which 6 patients were with cervical spine injury or spinal cord injury,9 were with ossifica-tion of posterior longitudinal ligament(OPLL),5 were with intraspinal tumor,and 2 were with cervical spondy-lotic myelopathy.In the free-hand group,the subaxial CPSs were inserted with free hand according to the cervical parameters such as pedicle angle and diameter on the CT images measured before operation,and the patients consisted of 10 males and 10 females,among which 4 patients were with cervical spine injury or spinal cord injury,10 with OPLL,5 with intraspinal tumor,and 1 with cervical spondylotic myelopathy.There were no significant differences in sex,age,disease,and preoperative visual analogue scale(VAS)score and Japanese Orthopaedic Association(JO A)score between the two groups(P＞0.05).The operative time,intraopera-tive blood loss,and postoperative 12 months of VAS and JOA scores were recorded and compared.CT scan was performed at 1 week after operation on cervical spine,and the accuracy of pedicle screw placement was evaluated in accordance with Kaneyama's evaluation method:Grade 0,screw was contained in the pedicle;Grade 1,screw penetrated pedicle＜50％of the screw diameter;Grade 2,screw penetrated pedicle＞50％of the screw diameter;Grade 3,screw completely penetrated the pedicle.Grades 0 and 1 were considered accurate placement,and grades 2 and 3 were considered misplacement.The perioperative complications were recorded for each patient in the two groups.Results:The operative time,intra-operative blood loss in guiding template group(102.2±16.1min,89.3±17.7mL)were statistically less than those in free-hand group(142.8±20.9min,133.3±34.0mL)(P＜0.01).A total of 216 CPSs were placed:118 in the guiding template group,including 90 screws of grade 0,22 screws of grade 1,5 screws of grade 2,1 screw of grade 3,with an accuracy rate of 94.9％(112/118);And 98 in the free-hand group,including 48 screws of grade 0,36 screws of grade 1,10 screws of grade 2,and 4 screws of grade 3,with an accuracy rate of 85.7％(84/98).The accuracy rate of pedicle screw insertion was significant higher in the guiding template group than that in the free-hand group(P＜0.05).No major neurovascular complications nor internal fixation loosening or breakages were observed in two groups of patients.At 12 months after operation,the VAS score in both groups was statistically less than that before operation(P＜0.01),and the JOA score in both groups was statistically more than that before opera-tion(P＜0.01),and there were no significant differences in VAS score and JOA score between groups,respec-tively(P＞0.05).Conclusions:The optimized design scheme of 3D-printed DGT is helpful in improving the ac-curacy and safety of subaxial CPS insertion.

Application of rigid endoscope detector in testing optical performance of rigid endoscopes / 中国医学装备

Objective:To test the performances of conducting light and imaging of rigid endoscopes by applying detection method with detector and visual detection method,and to explore the application effect of rigid endoscope detector in testing the optical performance of rigid endoscope.Methods:A total of 174 rigid endoscopes that were used in surgery with bladder endoscopy at Cancer Hospital of Beijing Union Medical College from May 2022 to May 2023 were selected.The visual detection method and detection method with detector were adopted respectively to perform detection after cleaning and disinfection for 174 rigid endoscopes.According to different detection methods,the 174 rigid endoscopes were divided into visual detection group(90 pieces)and detector group(84 pieces).The performances of conducting light and imaging of the two kinds of detection methods were compared and analyzed,and the results of the two kinds of detection methods were compared.Results:In the testing of the light guiding performance of rigid endoscopes,the detection rates of unqualified items in the detector group and the visual group are 11.9%(10/84),0(0/90),respectively,the difference in luminous flux between the two groups was statistically significant(x2=9.276,P<0.05);in the imaging quality testing of rigid endoscope imaging performance,the detection rates of unqualified images in the detector group and the visual group are 9.5%(8/84),1.11%(1/90),respectively.The difference between the two groups is statistically significant(x2=6.269,P<0.05).Conclusion:The application of rigid endoscope detector can increase the accuracy of CSSD staff in detecting the optical performance of rigid endoscope,and improve the management of quality control of rigid endoscope,and reduce the loss rate of rigid endoscopes,and extend the service life of rigid endoscopes,and provide safer and more effectively medical devices for clinical work,and ensure medical safety.

Meridian Tropism and Compatibility of Chinese Medicine from Theory of Brain Sweat Pore / 中国实验方剂学杂志

Since LIU Hejian proposed the concept of sweat pore， the theory of sweat pore has experienced accelerated development. Especially with the advances in modern human anatomy and physiology， the microscopic anatomy of sweat pore begins to focus on the intercellular space， ion channels and other membranous space with channels， pores， doors， etc.， which exert the functions of exchanging fluid， information， and energy inside and outside blood vessels and discharging metabolic wastes so as to maintain the normal operation of organs. Therefore， sweat pore is the structural basis for the movement of Qi and the central link of Qi-fluid exchange in the body. The brain， as the house of original spirit， is in charge of the spirit of five Zang-organs. The brain sweat pore is pivotal for the circulation of Qi， blood， and fluid in the brain， and it is the structural basis for the normal physiological functions of the brain. The dysfunction of the brain sweat pore will cause the stagnation of Qi and the abnormal transport of blood and fluid. It will cause the abnormal exchange of Qi， liquid and other material and information， which fail to nourish the original spirt and cause the loss of vital activity， eventually leading to consciousness and emotion disorders. The treatment should focus on opening the brain sweat pore， smoothing the exchange of Qi and fluid inside and outside the pore， and restoring the Qi movement， so as to cure encephalopathy. At present， western medicine treatment of encephalopathy needs to solve the problem of drug efflux from the blood-brain barrier and improve the effective concentration of drugs into the brain. The structure and function of brain sweat pore is similar to those of the blood-brain barrier. The aromatic resuscitative medicines and wind-extinguishing medicines can open the brain sweat pore. When being combined with other medicines， they can lead the medicine to enter the brain to restore the Qi movement of the brain sweat pore and enhance the therapeutic effect. Liver-pacifying wind-extinguishing medicines， insect medicines， tonifying medicines， heat-clearing toxin-removing medicines， and damp-draining medicines can treat pathological factors such as wind， phlegm， stasis， deficiency， toxin， and dampness， respectively. These medicines， combined with the medicines with the tropism to brain meridians， can open the brain sweat pore and guide the medicine into the brain to enhance the effective concentration of the medicine， thereby enhancing the efficacy against encephalopathy.

Pharmacokinetics and tissue distribution of four alkaloids in Ermiao Pills and Sanmiao Pills in normal and arthritic model rats / 中国中药杂志

This work aimed to investigate the differences of pharmacokinetics and tissue distribution of four alkaloids in Ermiao Pills and Sanmiao Pills in normal and arthritic model rats. The rat model of arthritis was established by injecting Freund's complete adjuvant, and ultra-high performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS) in the positive ion multiple reaction monitoring(MRM) mode was used for the determination of four alkaloids in plasma and tissues of normal and arthritic rats after administration of Ermiao Pills and Sanmiao Pills, respectively. The differences in pharmacokinetics and tissue distribution of the four active components were compared, and the effect of Achyranthis Bidentatae Radix on the major components of Sanmiao Pills was explored. This study established an UPLC-MS/MS for simultaneous determination of four alkaloids, and the specificity, linearity, accuracy, precision, and stability of this method all met the requirements. Pharmacokinetics study found that as compared with normal rats, the AUC and C_(max) of phellodendrine, magnoflorine, berberine and palmatine in model rats were significantly decreased after administration of Ermiao Pills, the clearance rate CL/F was significantly increased, and the distribution and tissue/plasma concentration ratio of the four alkaloids in the liver, kidney, and joint were significantly reduced. Achyranthis Bidentatae Radix increased the AUC of phellodendrine, berberine, and palmatine, reduced the clearance rate, and significantly increased the distribution of the four alkaloids in the liver, kidney, and joints in arthritic rats. However, it had no significant effect on the pharmacokinetics and tissue distribution of the four alkaloids in normal rats. These results suggest that Achyranthis Bidentatae Radix may play a guiding role in meridian through increasing the tissue distribution of effective components in Sanmiao Pills under arthritis states.

Pig-tail catheter-assisted 6.5 F guiding catheter versus 6 F guiding catheter in transradial interventional treatment of coronary artery lesions:a comparative study / 介入放射学杂志

Objective To compare the efficacy and safety of pig-tail catheter-assisted 6.5 F guiding catheter and 6 F guiding catheter in transradial interventional treatment of coronary artery lesions.Methods A total of 390 patients with coronary artery lesions,who received percutaneous coronary intervention(PCI)at the Xijing Hospital of Air Force Medical University of China between January 2021 and June 2022,were enrolled in this study.By using the random number table method the patients were divided into pig-tail catheter-assistance group(n=130),6.5 F sheath group(n=130)and 6 F sheath group(n=130).The success rate of the guiding catheter being inserted in place,radial artery spasm,forearm pain or discomfort,forearm hematoma,radial artery wound compression time,hemostasis success rate,postoperative radial artery diameter,resolution time of distal swelling,pseudoaneurysm,and incidence of radial artery occlusion were compared between each other among the three groups.Results The differences in the time of guiding catheter being inserted in place,radial artery wound compression time,forearm hematoma,hemostasis success rate,postoperative radial artery diameter and incidence of radial artery occlusion between each other among the three groups were not statistically significant(all P＞0.05).The differences in the intraoperative radial artery spasm and forearm pain or discomfort between 6.5 F sheath group and 6 F sheath group were not statistically significant(both P＞0.05).The degrees of radial artery spasm and forearm pain or discomfort in the pig-tail catheter-assistance group were remarkably lower than those in the 6.5 F sheath group and 6 F sheath group(both P＜0.05).Conclusion In transradial PCI,the use of 6.5 F guiding catheter carries the same safety and effectiveness as the use of 6 F guiding catheter,while the use of pig-tail catheter-assisted 6.5 F guiding catheter can improve radial artery spasm and reduce forearm pain.(J Intervent Radiol,2023,32:1174-1177)

Simultaneous implantation and tooth preparation technology guided by 3D-printed guide / 华西口腔医学杂志

Using digital technologies in concurrently performing missing tooth implantation and preparation of remaining teeth is a solution to reduce the number of visits and improve efficiency. This paper proposes a digital process for simultaneously implanting and preparing teeth. It integrates implant surgical guide and 3D-printed tooth preparation guide into a single guide and completes guided implant placement and precise tooth preparation. Based on "repair-oriented" virtual implant planning, the implant surgical guide can improve the efficiency and predictability of implant placement, and its linear accuracy is about 1 mm. The tooth preparation guide precisely guides tooth preparation and restoration space visualization, ensuring the quality of the tooth preparation. The two guides have different design accuracy requirements, and thus their combination improves the overall guiding accuracy requirements. The concurrent application of the two guides minimizes the clinical operation time, number of visits, and economic burden of patients.

Effect of Pin Holes Location of Unicompartmental Knee Arthroplasty on Postoperative Tibial Plateau Mechanical Properties / 中国医疗器械杂志

OBJECTIVE@#The purpose of this study is to explore the biomechanical characteristics of the tibia after unicompartmental knee arthroplasty with different distributions of two-pin holes, and to optimize the two-pin holes scheme to reduce the risk of tibial fractures after unicompartmental knee arthroplasty.@*METHODS@#Lower limbs model is segmented and reconstructed from computed tomography images. Four combinations of two pin holes created for tibial cutting guide placement are simulated with finite element analysis.@*RESULTS@#In the third mode, the positioning hole at the proximal medial edge of the tibial plateau has the highest stress value, and the position of the positioning hole near the medial edge of the proximal tibial plateau appears stress concentration.@*CONCLUSIONS@#The present study revealed that placing tibial cutting guide holding pins centrally would lower the risks of periprosthetic fracture of the medial tibial plateau.

Clinical study on the application of guide catheter window guidance technology in intracranial artery stent angioplasty / 中国医师杂志

Objective:To explore the application value of guide tube fenestration and drainage technology in intracranial artery stenting surgery.Methods:A total of 120 patients with symptomatic intracranial atherosclerotic stenosis admitted to the Xingtai Third Hospital from January 2021 to December 2022 were selected and randomly divided into an observation group ( n=60) and a control group ( n=60). Both groups were treated with intracranial artery stenting, with the observation group receiving guidance catheterization and window opening technique during the surgery. Two groups of surgeries were observed and compared: the degree of vascular stenosis before and after surgery, the Montreal Cognitive Assessment Scale (MoCA) scores before and one month after surgery, intraoperative complications, and prognosis. Results:The surgical time and catheter placement time in the observation group were (110.20±23.32)minutes and (11.32±2.01)minutes, respectively, which were significantly shorter than those in the control group (all P<0.05). The stent placement rate and operation success rate in the observation group were 95.00% and 96.67%, respectively, significantly higher than those in the control group (all P<0.05). The degree of postoperative vascular stenosis in the observation group was (32.29±7.11)%, significantly milder than that in the control group [(44.43±8.15)%, P<0.05]. One month after surgery, the MoCA scores of both groups improved significantly compared to before surgery (all P<0.05), and there was no statistically significant difference between the groups ( P>0.05). There was no statistically significant difference in the incidence of collateral circulation occlusion and vascular rupture between the two groups (all P>0.05). During the follow-up period, there was no statistically significant difference in the incidence of restenosis, intracranial hemorrhage, and recurrent ischemic stroke between the observation group and the control group (all P>0.05); The good prognosis rate of the observation group was 73.33%, significantly higher than that of the control group (53.33%, P<0.05). Conclusions:The application of guided catheter fenestration technique in intracranial artery stenting has good value, which is beneficial for improving the stent placement rate and operation success rate, and improving the degree of vascular stenosis.

Problems and countermeasures on pharmacovigilance system of 15 marketing authorization holders in Shanghai / 中国药房

OBJECTIVE To provide policy referen ce for local marketing authorization holder （MAH）to implement their main responsibility of drug life cycle supervision and the Guiding Principles of Pharmacovigilance Inspection to be officially released. METHODS Taking 15 MAH in Shanghai who recently underwent pharmacovigilance inspection as the research objects ，the social network analysis was used to explore the logical relationship between MAHs ’enterprise attributes and inspection problems ， summarize the problems found ，analyze the causes ，and put forward corresponding countermeasures. RESULTS & CONCLUSIONS The problems found in this pharmacovigilance inspection were mainly in aspects of organization ，personnel management ，quality management system ，report quality and so on. The reasons for these problems included light punishment ，which lead to the enterprise management ’s lack of attention to the pharmacovigilance system ，unclear problem handling and risk control mechanism ， imperfect quality management system documents ，inadequate personnel training ，etc. MAH needs to pay more attention to pharmacovigilance，allocate corresponding human and resources ，constantly improve the pharmacovigilance quality management system，and improve the enforceability and effectiveness of the pharmacovigilance system. At the same time ，it is suggested that government departments should strengthen policy guidance ， publicity and implementation ， and combine with third-party institutional platforms such as industry associations to promote the smooth implementation of Good Validation Practice .

Clinical research progress of motion style acupuncture / 国际中医中药杂志

Motion style acupuncture is generally used in combination with the movement therapy of affected parts in the process of needle acupuncture. In the process of acupuncture, the "movement" of the affected part can play a targeted guiding role in "spirit" and "Qi", It can lead the mind (spirit) and Qi to the place of disease, so as to achieve the realm of "treating spirit", "guiding Qi" and "keeping Qi", and eliminate diseases by activating the self-healing force of the human body. It is not only an important operation method of this acupuncture, but also the core idea and the key to take effect. In this acupuncture method, local acupoints or acupoints on the distal unaffected side are selected for acupuncture. The exercise methods include active and passive exercise. In the treatment of depression syndrome, hiccup, angina pectoris and other medical diseases, they often cooperate with respiratory exercise, as well as massage and self feeling. This acupuncture method is mostly used in the treatment of orthopedic and traumatological diseases, and can also treat facial paralysis, depression, anxiety, stroke and stroke sequelae, hiccup, angina pectoris and other medical diseases. It is less used in gynecology, or facial features. The treatment effect is better than simple acupuncture. It can also be combined with electroacupuncture, Traditional Chinese Medicine and Western medicine to improve the curative effect. In the future, it is necessary to further explore the relevant dominant diseases and explore the exercise methods more suitable for the relevant diseases. More attention should also be paid to the thinking of exercise inducing Qi and the concept of treating God contained in this acupuncture method.

Application value of Overlap guiding tube in Overlap esophagojejunostomy of laparoscopic total gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of Overlap guiding tube (OGT) in Overlap esophagojejunostomy of laparoscopic total gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with gastric cancer who were admitted to Nanfang Hospital of Southern Medical University from June to July in 2021 were collected. There were 3 males and 2 females, aged from 48 to 61 years, with a median age of 54 years. Patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative anastomotic stenosis and esophageal reflux up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 5 patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy and D 2 lymph node dissection success-fully, achieving R 0 resection. There was no combined organ resection, intraoperative conversion to laparotomy or combined thoracotomy. There was no intraoperative conversion to other esophagoje-junostomy method either. The tumor diameter, length of surgical incision, the number of lymph nodes dissected, time of esophagojejunal anastomosis, time of digestive reconstruction, operation time, volume of intraoperative blood loss of 5 patients were 3.0(2.8)cm, 5.0(2.0)cm, 47.0(21.0), 21.0(5.0)minutes, 62.0(23.0)minutes, 295.0(75.0)minutes, and 50.0(60.0)mL, respectively. The anvil fork of linear stapler was successfully inserted into esophageal lumen by once operation in 4 cases of 5 patients and by twice operation in 1 case to complete the esophagojejunostomy. (2) Post-operative situations: the time to first out-of-bed activities, time to postoperative first anal flatus, time to postoperative initial liquid diet intake, time to postoperative initial semi-liquid diet intake, time to abdominal drainage tube removal, duration of postoperative hospital stay of 5 patients were 2.0(1.0)days, 3.0(2.0)days, 4.0(3.0)days, 6.0(3.0)days, 7.0(4.0)days, and 9.0(6.0)days, respectively. Results of postoperative pathological examination of 5 patients showed gastric adenocar-cinoma in all the 5 patients, with the TNM staging as stage pT2-4aN0M0. The esophageal surgical margin was negative in all cases, and the length of proximal margin from esophagus was 5.0(4.0)cm. None of the 5 patients developed anastomotic leakage, anastomotic bleeding or anastomotic stenosis. Two cases with mild pneumonia (Clavien-Dindo grade Ⅱ) were cured by conservative treatment such as anti-infection and expectoration promotion. There was no unplanned secondary surgery or perioperative death occurred to the 5 patients. (3) Follow-up: 5 patients were followed up for 3 months. None of the 5 patients developed anastomotic stenosis or esophageal reflux during the follow-up. Conclusion:OGT-assisted Overlap esophagojejunostomy of laparoscopic total gas-trectomy is safe and feasible, with good short-term effects.

Study on the mechanism of "guiding action" of borneol in Suxiaojiuxin pills / 药学学报

In order to research the mechanism of guiding action of borneol in Suxiaojiuxin pills, the model of in vitro intestinal absorption, in vivo drug metabolism of mice and cell in vitro absorption model of Caco-2 were established firstly. All animal experiments were in accordance with the regulations of the Animal Ethics Committee of Nankai University. The results showed that the cumulative absorption quantity and absorption permeability of ferulic acid and ligustilide in the intestinal juice of Suxiaojiuxin pills group were significantly increased comparing with fake Suxiaojiuxin pills group, which don't contain borneol. By using borneol, the content of ferulic acid and ligustilide in the blood and tissues, such as heart, were added. The transepithelial resistance value and the content of horseradish peroxidase (HRP) in Caco-2 were rapidly decreased and increased, respectively. Due to further explore mechanism of promoting intestinal absorption of borneol for drugs, in this study, photosensitive probes of borneol were synthesized to capture its targets, and dual luciferase reporter system was used to evaluate its activity of calcium. It was found that it could make calcium overload by regulating transient receptor potential cation channel, subfamily M, member 8 (TrpM8). Then, the results of mass spectrometry imaging showed that the accumulation of ferulic acid in the heart was significantly increased by borneol, and the relaxation rate of rat thoracic aorta was enhanced obviously. In summary, the borneol in Suxiaojiuxin pills can expand cell space and increase intestinal permeability by acting on TrpM8, thus promoting the intestinal absorption, tissue distribution and target organ enrichment of drugs.

Overview and changes of Guiding Principles of Clinical Application of Novel Anti -tumor Drugs over the years / 中国药房

OBJECTIVE To provide the suggestions and reference for the follow-up update of Guiding Principles of Clinical Application of Novel Anti -tumor Drugs （hereinafter referred to as “Guiding Principles ”）. METHODS The update of 2018-2021 editions of Guiding Principles were compared ；the changes of its style ，the variety and quantity of novel anti-tumor drugs ，the classification of indications ，the target ，the inclusion of medical insurance and other aspects were analyzed. Its change trend and possible problems were summarized. RESULTS There was a great change in the style of Guiding Principles in 2020 edition，i.e. deleting the item of “clinical application management ”and adding the item of “attached table ”. Totally 33 novel anti-tumor drugs were included in the 2018 edition of Guiding Principles ，and the number of novel anti-tumor varieties increased to 46，60 and 77 in 2019，2020 and 2021 editions，respectively. The time when the new varieties were included in Guiding Principles was the same year or one year after the domestic market time. Totally 26 varieties of national medical insurance negotiation were included in the 2018 edition of Guiding Principles ，and 8，10 and 12 varieties were added respectively in 2019，2020 and 2021 editions on the basis of the previous edition . Novel anti-tumor drug in the 2018 edition of Guiding Principles mainly focused on traditional targets such as EGFR，HRE2 and VEGFR. However ，since 2019，the number of new targets such as PD-1，PARP，ALK and CDK had been increasing，among which domestic original drugs accounted for a large proportion. CONCLUSIONS The revision of Guiding Principles aims to further guide the clinical application of novel anti-tumor drugs from the professional level of health technology. The new varieties and indications conform to the principles of scientificity and dynamics ；domestic original varieties have developed rapidly ，and innovative varieties to novel target have emerged. The follow-up update of Guiding Principles should refer to authoritative medical guidelines and high-quality evidence- based evidence. Attention should be paid to the types of tumors lacking therapeutic drugs and the clinical value of oushun- novel anti-tumor drugs.

Research on the features of public hospital high-quality development based on five core indicators / 中华医院管理杂志

Based on the five core indicators (the case mix index, the proportion of level-4 surgery, the proportion of technical service income in medical income, the proportion of personnel expenditure in business expenditure, and the proportion of fixed part in personnel salary), the authors discussed the guiding significance of " paying attention to the medical level, strengthening the functional orientation, reflecting the technical value, highlighting people-orientation, and ensuring sustainable development" in the high-quality development of public hospitals. In combination with the current situation of a pilot hospital of high-quality development with the corporate supports of National Health Commission and Province Government, the authors explained the common bottlenecks of public hospitals, such as inaccurate functional positioning, weak innovation ability, poor finance structure, poor salary system and insufficient attention to talents. In the last, the authors pointed out that high-quality development was the development of deepening reform, innovation driven, structural optimization, talent oriented, people-oriented and under the leadership of the Communist Party of China, and put forward targeted implementation paths to provide reference for the pilot work.

Snare Guiding Technique in Bifurcated Endovascular Repair of Abdominal Aortic Aneurysm with Severely Tortuous Iliac Artery Access: A Case Report

@#Endovascular aneurysm repair (EVAR) has gained acceptance as a viable alternative to open surgical treatment for abdominal aortic aneurysm (AAA). We report the use of snare guiding wire in bifurcated EVAR case with severely tortuous femoral access. A 63-year-old man referred to the hospital from another facility with complaints of pulsating mass in right iliac and umbilical region for the last 2 years. He was then admitted to the cardiac catheterization lab for EVAR under general anaesthetic. Endovascular aneurysm repair (EVAR), also known as an endoprosthesis, is a stent-graft device-guided therapy for a AAA. This procedure is a safer choice for individuals who are elderly or have pulmonary, cardiac, or renal problems. Tortuous iliac arteries might obstruct device delivery during EVAR. The Snare Guiding Wire approach might be an alternate method for EVAR to treat AAA if conventional cannulation is difficult or impossible in individuals with highly tortuous iliac access.

La orientación educativa del docente de ciencias médicas ante la covid-19 / The educational guiding of the medical science teacher to covid-19

RESUMEN Introducción: la orientación educativa, desde la relación profesor-alumno, es esencial para el tránsito del joven por los estudios superiores; requiere atención especial en el período de enfrentamiento a la covid-19 y es fundamental para el estudiante de ciencias médicas. Objetivo: identificar la percepción de la función orientadora del docente ante la covid-19 en estudiantes de ciencias médicas. Materiales y métodos: se realizó un estudio descriptivo, transversal en el período comprendido entre abril y octubre de 2020. El universo de trabajo estuvo representado por 18 estudiantes de primer año de la carrera de Medicina, de la Facultad de Ciencias Médicas de Mayabeque, que realizan la pesquisa en una comunidad perteneciente al Policlínico Docente Dr. Luis Li Trigent. Se analizaron datos como la existencia del profesor como orientador, áreas de la orientación educativa, problemas de los estudiantes y valoración de la comunicación empática profesor-estudiante. Resultados: los estudiantes reconocen la existencia del profesor como orientador. El área de orientación educativa de mayor incidencia en que se expresó la función orientadora del profesor fue la académica. Los problemas predominantes identificados por los estudiantes están relacionados con el proceso de enseñanza-aprendizaje. Existió una valoración positiva de la comunicación empática profesor-estudiante. Conclusiones: la relación profesor-alumno se hace más relevante durante la pandemia de covid-19. El estudiante de Medicina enfrenta nuevas condiciones en el proceso docente-educativo y demanda la orientación del docente (AU).

ABSTRACT Introduction: educational orientation, from the teacher-student relationship, is essential for the transit of the youth through higher education; it requires special attention in the period of confrontation with covid-19 and is essential for the student of medical sciences. Objective: to identify the perception of the teacher's guiding function in facing covid-19 in medical sciences students. Materials and methods: a descriptive, cross-sectional study was carried out in the period between April and October 2020. The universe of work was represented by 18 first-year students of the Medical pregraduate course, from the Faculty of Medical Sciences of Mayabeque, who carry out the research in a community belonging to the Teaching Polyclinic Dr. Luis Li Trigent. The existence of the teacher as a counselor, areas of educational orientation, student problems and assessment of empathic teacher-student communication were among the analyzed data. Results: the students recognize the teacher's existence as a counselor. The area of educational guidance with the highest incidence in which the teacher's guiding role was expressed was the academic one. The predominant problems identified by students are related to the teaching-learning process. There was a positive assessment of empathic teacher-student communication. Conclusions: the teacher-student relationship becomes more relevant during the covid-19 pandemic. The medical student faces new conditions in the teaching-educational process and demands the guidance of the teacher (AU).

Currículos prescritos em projetos sociais vinculados às atividades físicas e esportivas / Curriculums prescribed in social projects linked to physical and sports activities

Analisa os documentos institucionais de três projetos sociais e de um Serviço de Convivência e Fortalecimento de Vínculos (SCFV), a fim de compreender os modos como as atividades físicas/esportivas estão organizadas nesses contextos. Trata-se de uma pesquisa documental, na qual empregamos uma análise descritivo-interpretativa para examinar criticamente os documentos institucionais orientadores das práticas pedagógicas. Os dados apontam para o desenvolvimento de aspectos morais e éticos dos participantes, para a valorização da autonomia e do protagonismo dos sujeitos, bem como para questões sociais mais amplas, como a cidadania, o combate ao racismo, a preservação da cultura popular e a importância da educação ambiental. Uma das principais fragilidades encontradas nos documentos analisados é de natureza procedimental e está circunscrita na imprecisão de como as atividades físicas e esportivas serão trabalhadas para atingir os objetivos propostos.

The paper analyzes the institutional documents derived from three social projects and from a Living the Service and Strengthening Linkages (Serviço de Convivência e Fortalecimento de Vínculos (SCFV), in order to understand how the physical/sports activities are organized within these contexts. It is a documental research, in which a descriptive-interpretative analysis was used to critically examine the institutional policy documents of pedagogical practices. Data point to the development of moral and ethical aspects of the participants, to the appreciation of autonomy and the protagonism of the ones involved, as well as to wider social issues, such as, citizenship, the fight against racism, the preservation of popular culture and the importance of environmental education. One of the main weaknesses found in the analyzed documents has a procedural nature and is circumscribed in the inaccuracy of how physical and sports activities will be performed to achieve the proposed goals.