Application of modified mucogingival surgery in the treatment of gingival recession / 口腔疾病防治

@#With the increasing demand for beauty, the treatment of gingival recession has become a common request among patients. Clinically, gingival recession is mainly treated by surgery. The common surgical methods include free gingival grafting, pedicled flap technology and double flap technology (subepithelial connective tissue transplantation combined with coronally advanced flaps). If patients with indications are selected, satisfactory surgical results will be obtained. However, there are still some shortcomings in the above mentioned methods, such as the root coverage effect not being satisfactory. In recent years, researchers have put forward some improved schemes to minimize the shortcomings of the above methods to treat different degrees of gingival recession. A gingival unit graft containing gingival papilla and free gingiva can improve the blood supply of the recipient area and improve the effect of root coverage. It can obtain better root coverage for slight retraction, widening of the angular gingiva and deepening of the vestibular sulcus, but there may be issues with inconsistent color and shape of the gingiva after surgery, as well as poor aesthetic effects. Modified coronally advanced flaps, flaps prepared by the technique of half-thickness, full-thickness and half-thickness, and modified coronally advanced envelope flap technology are designed with the most serious retraction teeth as the center in the case of multiple gingival retractions, both of which can improve the effect of root covering. Tunnel technology and modified tunnel technology, without severing the gingival papilla and tunneling the gingival flap to accommodate the graft, can effectively reduce tissue damage and promote wound healing. This paper reviews the literature and summarizes the outcome of the modified surgery techniques in the treatment of gingival recession. These treatment options for gingival recession are proposed with the aim of improving clinical work, and some suggestions for the treatment of gingival recession to achieve a stable root coverage effect are put forward. In the future, the development direction of mucogingival surgery is to reduce trauma and have a stable curative effect.

Implementación del mini-CEX en el pregrado médico: Una experiencia con simulación / Implementation of the Mini-CEX in Medical Undergraduate Education: A Simulation-Based Experience

Resumen La evaluación es un proceso sistemático que resulta en un juicio de valor para tomar decisiones. Los instrumentos empleados para obtener datos sobre el desempeño de los estudiantes requieren de un proceso sistemático y objetivo para su implementación. El mini-CEX es un instrumento de observación directa que ha sido empleado para la evaluación de la competencia clínica en los estudiantes de pre y posgrado desde su invención en 1955. Cuenta con diferentes evidencias de validez para su uso en distintos contextos educativos y clínicos. Permite realizar evaluaciones rápidas, acompañadas de realimentación y que proporcionan información relevante del desarrollo de la competencia clínica. El objetivo de este escrito es exponer la experiencia de la implementación del mini-CEX en el pregrado médico para la evaluación formativa de los estudiantes utilizando la simulación con pacientes estandarizados. Para lograr este objetivo se empleó la siguiente secuencia: búsqueda, planeación, integración y aplicación. Posterior a estos pasos se dan una serie de recomendaciones para la implementación del mini-CEX. Se concluye que la evaluación de la competencia clínica es importante para la mejora continua y permanente de los estudiantes de pre y posgrado. Es necesario sistematizar la evaluación ajustada siempre a objetivos y necesidades específicas de la evaluación.

Abstract Evaluation is a systematic process that results in a judgment to make decisions. The instruments used to obtain data on student performance require a systematic and objective process for their implementation. The mini-CEX is a direct observation tool that has been used for the evaluation of clinical competence in undergraduate and postgraduate students since its invention in 1955. It has different validity evidence for use in different educational and clinical contexts. It allows rapid evaluations, accompanied by feedback and providing relevant information on the development of clinical competence. The objective of this paper is to expose the experience of the implementation of the mini-CEX in the medical undergraduate for the formative evaluation of students using simulation with standardized patients. To achieve this goal, the following sequence was used: search, planning, integration, and application. After these steps we make some recommendations for the implementation of the mini-CEX. Its is concluded that the evaluation of clinical competence is important for the continuous and permanent improvement of undergraduate and graduate students. It is necessary to systematize the evaluation always adjusted to objectives and specific needs of the evaluation.

Distribuição e qualidade de espaços públicos para atividade física de lazer em uma capital do Brasil / Distribution and quality of public spaces for physical leisure activity in a brazilian capital

As características físicas do ambiente podem contribuir na promoção da saúde, principalmente a disponibilidade e qualidade dos espaços públicos de lazer. O presente estudo tem como objetivo analisar a distribuição e a qualidade dos equipamentos para atividade física de lazer em uma capital brasileira. Foram avaliados 27 espaços públicos, incluindo parques, praças e canteiros habitáveis disponíveis no raio de 1.000 metros de três polos do Programa Academia da Saúde (PAS) no município de Belo Horizonte. Em 2019, os equipamentos foram auditados por meio da aplicação da versão adaptada do Physical Activity Resource Assessment (PARA), que avalia a existência, qualidade, segurança, limpeza e estética dos equipamentos. Frequências absolutas e relativas foram calculadas. Dos 27 locais avaliados, 22,2% eram parques (n = 6), 70,4% praças (n = 19) e 7,4% canteiros habitáveis (n = 2). Quadras de vôlei e campos de futebol foram os equipamentos mais identificados nos parques, presentes em todos os locais analisados, enquanto academias e estações de exercício ao ar livre foram os mais comuns nas praças (89,5%; 52,9%, respectivamente). Quanto aos canteiros habitáveis, apresentaram apenas quadras de vôlei/campos de futebol. Com relação à limpeza e estética, as maiores proporções foram pichações (74,1%), lixo espalhado/sujeira (74,1%), grama alta (44,4%) e sinais de vandalismo e sujeira de animais (37,0%). A pequena diversidade e qualidade ruim dos equipamentos, e as características inadequadas de limpeza e estética dos espaços de lazer no qual se encontram, podem impedir ou dificultar o uso dos mesmos para a prática de atividade física, demonstrando assim, a necessidade de investimentos mais expressivos nesses locais

The physical characteristics of the environment can contribute to health promotion, especially the availa-bility and quality of public leisure spaces. The present study aims to analyze the distribution and quality of equipment for leisure physical activity in a Brazilian capital. Twenty-seven public spaces, including parks, squares and boulevards available within a radius of 1,000 meters of three centers of the Health Academy Program (PAS) in the city of Belo Horizonte were evaluated. In 2019, the equipment was audited through the application of the adapted version of the Physical Activity Resource Assessment (PARA), which evaluates the existence, quality, safety, cleanliness, and aesthetics of the equipment. Absolute and relative frequencies were calculated. Of the 27 sites evaluated, 22.2% were parks (n=6), 70.4% were squares (n = 19), and 7.4% were boulevards (n = 2). Volleyball courts and soccer fields were the most identified equipment in parks, present in all analyzed places, while outdoor gyms and exercise stations were the most common in squares (89.5%; 52.9%, respectively). As for boulevards, they only had volleyball courts/soccer fields. Regarding cleanliness and aesthetics, the highest proportions were graffiti (74.1%), scattered garbage/dirt (74.1%), tall grass (44.4%), and signs of vandalism and animal dirt (37.0%). The small diversity and poor quality of equipment, and the inadequate characteristics of cleanliness and aesthetics of the leisure spaces in which they are located, can prevent or hinder their use for the practice of physical activity, thus demonstrating the need for more expressive investments in these places

Pneumatosis Cystoides Intestinalis with Non-surgical Encapsulated Pneumoperitoneum: Case Presentation and Literature Review

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare entity characterized by cysts or air bubbles in the intestinal wall, usually asymptomatic. Its uncomplicated forms are managed conservatively, and the severe ones require surgical intervention. The presence of pneumoperitoneum is a disturbing radiological finding but not an indicator of surgical intervention. Clinical case: A 23-year-old man presented with weight loss, diarrhea, and rectal bleeding; a colonoscopy showed multiple violaceous cysts in the sigmoid and descending colon that collapsed after puncture and biopsies. Computed tomography (CT) confirmed the diagnosis and the presence of an encapsulated pneumoperitoneum. The absence of signs of potential lethality allowed conservative treatment with clinical remission during the first eight months of follow-up. Discussion: The pathophysiology of PCI is not well defined. Our patient's diagnosis was incidental when performing a colonoscopy for rectal bleeding. Asymptomatic encapsulated pneumoperitoneum should be interpreted as an important but not decisive sign of surgical intervention. Its presence, along with the medical history and physical, biochemical, endoscopic, and imaging examination, can prevent unnecessary surgery.

Introducción: la neumatosis quística intestinal es una entidad infrecuente, caracterizada por la presencia de quistes o burbujas de aire en la pared intestinal, usualmente asintomática. Sus formas no complicadas son manejadas conservadoramente y las graves requieren intervención quirúrgica. La presencia de neumoperitoneo es un hallazgo radiológico inquietante, pero no es indicador de intervención quirúrgica. Caso clínico: hombre de 23 años con pérdida de peso, diarrea y rectorragia, la colonoscopia mostró múltiples quistes violáceos localizados en el sigmoide y descendente que colapsaron tras la punción y biopsias, la tomografía axial computarizada (TAC) confirmó el diagnóstico y la presencia de un neumoperitoneo encapsulado. La ausencia de signos de potencial letalidad permitió un tratamiento conservador con remisión clínica durante los primeros 8 meses de seguimiento. Discusión: la fisiopatología de la neumatosis quística intestinal no está bien definida. En el paciente presentado el diagnóstico se realizó de forma incidental al realizar una colonoscopia por una rectorragia. El neumoperitoneo asintomático encapsulado debe interpretarse como un signo importante pero no determinante de intervención quirúrgica y su presencia junto con los antecedentes médicos, examen físico, bioquímico, endoscópico e imagenológico puede evitar cirugías innecesarias.

Aproximaciones sobre el acto de mirar: la peste de Azoth

Las neurociencias contemporáneas continúan separando el acto de ver en los procesos de la visión y los procesos de la motricidad ocular, sin plantear aun una explicación unificadora de ambos en una misma realidad: como el acto de mirar. El objetivo del presente artículo es explicar este acto a través de la serie de eventos neurológicos que suceden y entender que se mira con la conciencia. Se explican los procesos visuales en base al enfoque neurocientífico contemporáneo y la Teoría Sociobiológica Informacional en "La Peste de Azoth" de Nicolas Poussin. Mientras que la explicación tradicional de la neurociencia refiere que todo estímulo activa un receptor, siguiendo una vía nerviosa hasta el cerebro, desde la Teoría Sociobiológica Informacional, el acto de mirar es una actividad epiconsciente, una construcción que resulta de la suma emergente de los cinco niveles de complejidad. Estos integran este proceso en los movimientos que describen los ojos y la acción de lo que se mira simultáneamente. "La Peste de Azoth" muestra una ciudad azotada por la peste bubónica, con dos rasgos: maldición divina y presencia de miasmas respirables. Poussin no solo pintó los motivos de una explicación mágica (tradicional) y científica, sino también de una explicación tecnológica (bacteriológica) que emergería dos siglos después de su muerte. En conclusión, el acto de mirar desde la Teoría Sociobiológica Informacional, es un proceso que principian en el neocortex y que integra la información en cinco niveles. Esta explicación permite entender La Peste de Azoth" como un enfoque tecnológico adelantado.

Contemporary neurosciences continue to separate the act of seeing in the processes of vision and the processes of ocular motor skills, without even proposing a unifying explanation of both aspects of the same reality: as the act of looking. The aim of this article is to explain the act of looking through the series of neurological events that occur and to understand that one looks with consciousness. Visual processes are explained based on the contemporary neuroscientific approach and Informational Sociobiological Theory in Nicolas Poussin's "The Plague of Azoth". While the traditional explanation traditional explanation of neuroscience refers that every stimulus activates a receptor, following a nervous path to the brain, from the Informational Sociobiological Theory, the act of looking is an epiconscious activity, a construction that results from the sum emerging from the five levels of complexity. These integrate this process in the movements that describe the eyes and the action of what is seen simultaneously. "The Plague of Azoth" shows a city plagued by the bubonic plague, with two traits: a divine curse and the presence of breathable miasmas. Poussin not only painted the grounds for a magical (traditional) and scientific explanation, but also for a technological (bacteriological) explanation that would emerge two centuries after his death. In conclusion, the act of looking from the Informational Sociobiological Theory is a process that begins in the neocortex and that integrates information at five levels. This explanation allows us to understand "The Plague of Azoth" as an advanced technological approach.

Describing physical activity in public open spaces in Brazil: Active City, Healthy City Program / Descrevendo a atividade física em espaços públicos abertos no Brasil: Programa Cidade Ativa, Cidade Saudável

This study aimed to describe the physical activity (PA) in public open spaces (POS) in a medi-um-sized city in Brazil. The System for Observing Play and Recreation in Communities (SOPARC) was applied to evaluate a representative sample of users in 10 POS which received actions from the Active City, Healthy City Program. The places were evaluated four days a week (Tuesday, Wednes-day, Saturday, and Sunday) at four times (8 am, 10 am, 2 pm, and 4 pm). The proportion of users by gender, age group, skin color, and PA level was compared between the POS using the chi-square test for heterogeneity in the STATA software (p<0.05). As main results, 32,768 scans were performed in 64 target areas and identified 8,634 individuals. The highest proportion of people were males (58%), adults (38%), with white skin color (97%), and in light or moderate PA (76%). Except for skin color, there was a significant difference in the proportion of all other variables between the POS (p < 0.05). In conclusion, the POS was more commonly used by men, adults, and people of white skin color for light and moderate PA. Based on the results, program managers could reallocate resources to increase utilization and PA at each place

O objetivo deste estudo foi descrever a atividade física (AF) em espaços públicos abertos (EPA) em uma cidade de médio porte do Brasil. O System for Observing Play and Recreation in Communities (SOPARC) foi utilizado para avaliar uma amostra representativa de frequentadores de 10 EPA que receberam ações do programa Cidade Ativa, Cidade Saudável. Os locais foram avaliados quatro dias da semana (terça-feira, quarta-feira, sábado, domingo) em quatro horários (8h, 10h, 14h, 16h). A proporção de frequentadores por sexo, faixa etária, cor de pele e nível de AF foi comparada entre os EPA pelo teste do qui-quadrado para heterogeneidade no software STATA (p < 0,05). Como resultados principais, foram realizados 32.768 scans em 64 áreas-alvo e 8.634 frequentadores foram identificados. Foi observada maior proporção de pessoas do sexo masculino (58%), adultos (38%), de cor de pele branca (97%) e em AF de intensidade leve ou moderada (76%). Com exceção da cor da pele, houve diferença significante na proporção das demais variáveis entre os EPA (p < 0,05). Em conclusão, os EPA são mais comumente utilizados por homens, pessoas adultas, de cor de pele branca e para a prática de AF de intensidade leve e moderada. Com base nos resultados, os gestores do programa poderiam realocar recursos para aumentar a utilização e a AF em cada local

Intraoperative assessment of blood supply to the femoral head after femoral neck fracture / 中华创伤骨科杂志

Objective:To explore intraoperative assessment of blood supply to the femoral head after femoral neck fracture, and the correlation between the blood supply and postoperative osteonecrosis of the femoral head.Methods:A retrospective analysis was performed of the 63 patients with femoral neck fracture who had been treated at Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University by open reduction and internal fixation with hollow compression screws from April 2016 to March 2021. They were 39 males and 24 females with an age of (44.9±13.6) years. There were 42 cases of Garden type Ⅲ and 21 cases of Garden type Ⅳ. Time from injury to operation was (4.1±2.4) days. After internal fixation, a hole was drilled using a 2.0 mm Kirschner wire at 2.0 cm above the femoral head-neck junction to observe the velocity, color, and characteristics of the blood oozing at the drill hole. The patients were divided into a good oozing group of 51 cases in whom bright red blood oozing was observed within 15 seconds after drilling and a poor oozing group of 12 cases in whom dark red blood oozing was observed beyond 15 seconds after drilling. The incidence of postoperative femoral head necrosis, Harris hip score, and visual analogue scale (VAS) for pain were compared between the 2 groups. Single factor and multi factor analyses were conducted using the Cox regression model to analyze the factors influencing postoperative femoral head necrosis in the patients.Results:The 63 patients were followed up for 24 (18, 36) months. The 2 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). Femoral head necrosis was observed in 3 cases in the good oozing group and in 5 cases in the poor oozing group, showing a significant difference between the 2 groups ( P<0.05). The Harris hip score [90.0 (86.0, 92.0)] and the VAS pain score [1.0 (1.0, 2.0)] at 1 year after surgery in the good oozing group were significantly better than those in the poor oozing group [85.5 (71.3, 88.8) and 2.5 (1.0, 3.8)] ( P<0.05). Multivariate Cox regression analysis showed that Garden type Ⅳ ( HR=6.784, 95% CI: 1.324 to 35.664, P=0.023) and intraoperative poor blood oozing ( HR=10.744, 95% CI: 2.359 to 51.774, P=0.003) were risk factors for femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck ( P<0.05). Conclusions:The blood supply to the femoral head after femoral neck fracture can be directly assessed by drilling a hole in the femoral head after open reduction and internal fixation. Intraoperative poor blood oozing is a risk factor for the femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck.

Clinical efficacy of five-element music therapy in the treatment of bipolar disorder / 中国基层医药

Objective:To investigate the clinical efficacy of five-element music therapy in the treatment of bipolar disorder.Methods:Eighty patients with bipolar disorder admitted to Shandong Mental Health Center from January 2018 to December 2019 were included in this study. They were randomly divided into a study group and a control group ( n = 40/group). The control group was treated with conventional drug treatment. The study group was treated with five-element music therapy based on conventional drug treatment. Before, during and after treatment, mania and depression were evaluated. Symptom self-evaluation scale and the Traditional Chinese Medicine Five State Emotion Questionnaire were completed to evaluate the curative effect. Patients were followed up by telephone call. Recurrence at 3, 6 and 12 months was recorded. Results:Before treatment, there were no significant differences in the scores of the Bech-Rafaelsen Mania Rating Scale (BRMs), Hamilton Depression Rating Scale (HAMD), Traditional Chinese Medicine Five State Emotion Questionnaire, Symptom Checklist-90 (SCL-90) between the two groups (all P > 0.05). During and after treatment, BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire, and SCL-90 scores were significantly decreased in each group compared with before treatment [Control group: BRMs score during and after treatment: (11.52 ± 1.57) points, (9.43 ± 1.05) points; HAMD score during and after treatment: (16.75 ± 3.05) points, (13.61 ± 2.51) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary (67.25 ± 5.7) points, (56.38 ± 4.97) points, physical symptoms (29.52 ± 3.94) points, (24.19 ± 3.05) points, SCL-90 score: (100.52 ± 10.26) points, (68.85 ± 7.33) points. Study group: BRMs score during and after treatment: (9.33 ± 1.09) points, (7.85 ± 0.82) points; HAMD score: (13.74 ± 2.54) points, (10.17 ± 1.97) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary: (58.19 ± 5.06) points, (46.85 ± 4.06) points, physical symptoms (25.14 ± 3.54) points, (20.11 ± 2.57) points; SCL-90 scores: (90.85 ± 8.97) points, (56.87 ± 5.81) points]. During and after treatment, scores of BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire and SCL-90 in the study group were significantly lower than those in the control group ( t = 3.77, 7.01, 4.48, 6.99, 8.78, 4.89, 6.05, 4.19, 7.57, all P < 0.05). Total response rate in the study group was significantly higher than that in the control group (90.0% vs. 72.5%, χ2 = 4.02, P < 0.05). At 3, 6 and 12 months after treatment, recurrence rate in the study group was 2.5%, 15.0% and 30.0%, respectively, which were significantly lower than 17.5%, 35.0%, and 52.5% in the control group ( χ2 = 5.00, 4.26, 4.17, all P < 0.05). Conclusion:Five-element music therapy for the treatment of bipolar disorder can markedly alleviate depression and mania, restore patient's emotional state, improve clinical efficacy, and decrease recurrence rate.

Application of Mini-Clinical Evaluation Exercise combined with direct observation of procedural skills in standardized training of emergency medicine guided by professional physician qualification examination / 中华医学教育探索杂志

Objective:To investigate the application effect of Mini-Clinical Evaluation Exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in standardized training of emergency medicine guided by professional physician qualification examination.Methods:Based on the time of emergency medicine teaching reform in Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, 32 standardized training residents in Emergency Department before September 2020 were included as control group and were given traditional teaching, and 32 standardized training residents after September 2020 were included as observation group and were given Mini-CEX combined with DOPS teaching under the guidance of professional physician qualification examination. The two groups were compared in terms of Mini-CEX score, DOPS score, assessment score of comprehensive emergency skills, pass rate of professional physician qualification examination, and comprehensive teaching quality. SPSS 25.00 was used to perform the t-test and the chi-square test. Results:Compared with the control group after training, the observation group had significantly higher scores of Mini-CEX, DOPS, and comprehensive emergency skill assessment ( P<0.05). There were no significant differences between the two groups in the pass rates of theoretical and practical examinations in professional physician qualification examination, and the observation group had a significantly higher total pass rate than the control group ( P<0.05). The observation group had significantly higher comprehensive teaching quality scores than the control group ( P<0.05). Conclusion:Mini-CEX combined with DOPS guided by professional physician qualification examination can help to improve the teaching effectiveness of standardized training residents in emergency, enhance their comprehensive skills and emergency professional skills, achieve a relatively high pass rate of professional physician qualification examination, and improve their post competency, and thus it holds promise for clinical application.

Application of modified DOPS as formative assessment in clinical skills training for professional graduate students / 中华医学教育探索杂志

Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.

Effect of action observation therapy on upper limb function in cerebral palsy: a systematic review / 中国康复理论与实践

ObjectiveTo systematically evaluate the effect of action observation therapy (AOT) on upper limb function in children with cerebral palsy. MethodsRelevant literatures about the effect of AOT on upper limb function in children with cerebral palsy were retrieved from the databases of PubMed, Embase, Cochrane Library, Web of Science and CNKI, from the establishment to July 9, 2022. ResultsEleven articles involving 497 patients were included, which were mainly published in the past ten years. The studies included hospital-based studies with therapist supervision and home-based studies without therapist supervision, mainly related to the improvement of upper limb function of AOT in children with cerebral palsy. Experimental group performed actions related to activities of daily living, while control group mainly watched video clips excluding actions, 15 to 120 minutes a time, three to five times a week, with most of the intervention periods of three to four weeks. AOT improved the upper limb function of children with cerebral palsy in terms of body structure and function, and activity and participation, specifically grip strength, muscle tension, and hand dexterity and function. ConclusionHospital-based AOT with therapist supervision can improve upper limb function in children with cerebral palsy, while the effect of home-based AOT without therapist supervision and the long-term effect of AOT need to be further studied.

Establishment of a mouse model of acute systemic cold injury induced by hypothermia / 中华急诊医学杂志

Objective:To establish an animal model of acute systemic cold injury in mice.Methods:There were 98 C57BL/6 mice, half male and half female, with body weight of 22-27 g and age of 10 weeks. The mice were randomly divided into 7 groups ( n=14) according to the changes of anal temperature in cold environment, namely, group A (38.5 ± 1) ℃, group B (35 ± 1) ℃, group C (30 ± 1) ℃, group D (25 ± 1) ℃, group E (20 ± 1) ℃, group F (15 ± 1) ℃, and group G (10 ± 1) ℃, among which, group A was the blank control group, and the rest groups were the experimental group. The mice in the blank control group were placed in the normal environment (20 ± 5) ℃, and the mice in the experimental group were placed in the low temperature artificial climate box at - 20℃. The anal temperature of the mice was measured intermittently (as the core temperature), and the time required for the core temperature of the mice to drop to groups B, C, D, E, F and G was recorded. The righting reflex was used to evaluate the consciousness state, the action ability and the general state of each organ of mice were observed, and the blood routine and HE staining of each organ were detected. Results:The lower the core temperature of the experimental group, the longer the time required. The consciousness state, action ability, general state of organs, blood routine, and HE staining of organs in groups B, C, and D were basically the same as those in group A, and there was no acute systemic cold injury. Therefore, the blood routine, general observation of organs, and HE staining of organs in groups B, C, and D were no longer displayed compared with those in group A. Compared with group A, mice in group E began to suffer from disturbance of consciousness and action ability. With the decrease of core body temperature, the damage was aggravated, and mice in group G died. Compared with group A, the indices of blood routine test (WBC, RBC, HGB, PLT) of mice in group E began to decrease, and the univariate variance calculation showed that only WBC changes had statistical significance ( P<0.05). Compared with groups A and E, the indices of blood routine test (WBC, RBC, HGB, PLT) of mice in group F were further reduced, and the changes of each index in univariate variance calculation were statistically significant ( P<0.05). The general observation results showed that compared with group A, the lung, liver and spleen surfaces of mice in group E began to darken, and compared with groups A and E, the lung, liver, spleen, kidney and heart of mice in group F were further deepened and darkened, with irregular edges. HE staining results of various organs showed that compared with group A, the mice in group E began to have partial alveolar structure destruction and a small amount of inflammatory cell infiltration, the central vein of the liver was slightly congested, and the red and white pulp of the spleen were indistinct. Compared with groups A and E, the pathological structure damage of the lung, liver, spleen, kidney, heart and brain tissues of the mice in group F was further aggravated. Conclusions:Detection of consciousness state, action ability, general state of organs, blood routine and HE staining indices of organs in mice under low temperature can simulate the progress of clinical acute cold injury, and the animal model of acute systemic cold injury was successfully prepared.

Clinical Efficacy of Huangqin Beimutang in Treatment of Chronic Rhinosinusitis in Children / 中国实验方剂学杂志

ObjectTo observe the clinical efficacy of Huangqin Beimutang on chronic rhinosinusitis in children. MethodA randomized controlled trial （RCT） was conducted on 70 children who met the criteria for chronic rhinosinusitis， with 35 cases in the Chinese medicine group and 35 cases in the western medicine group. In the western medicine group，children received mometasone furoate nasal spray，one spray per nostril，once a day for two weeks， and also received a small dose of azithromycin suspension at 4 mg·kg-1·d-1，once a day，3 days a week for 2 weeks. The children in the Chinese medicine group were treated with oral Huangqin Beimutang，one dose per day for 2 weeks. Before and after treatment，the scores of primary symptoms and signs of traditional Chinese medicine （TCM），visual analogue scale （VAS） symptom scores，sinus computed tomography （CT） efficacy scores，and clinical efficacy of TCM syndromes in the two groups were evaluated，and the occurrence of adverse events was recorded. ResultThe total effective rate of clinical efficacy of TCM syndrome in the Chinese medicine group was 88.57% （31/35）， which was higher than 71.43% （25/35） in the western medicine group（χ2=8.458，P<0.05）. The VAS scores， scores of TCM primary symptoms of nasal obstruction and runny nose， and physical sign scores in both groups were lower than those after treatment （P<0.01）. The above indicators in the Chinese medicine group were superior to those in the western medicine group after treatment （P<0.05， P<0.01）. Compared with the conditions before treatment， there was no significant improvement in headache in the western medicine group， while the headache score in the Chinese medicine group decreased after treatment （P<0.01）. The CT scores of the two groups showed a downward trend， but the difference was not statistically significant. There were no adverse reactions during treatment in both groups. ConclusionHuangqin Beimutang can effectively improve the clinical symptoms of patients with chronic rhinosinusitis， and it is safe and effective.

Application of Direct and Systematic Observation of Interaction with Teenage Mother-Son Dyads / Aplicação de Observação Direta e Sistemática da Interação com Díades Mãe-Filho Adolescente / Aplicación de la Observación Directa y Sistemática de la Interacción con Díadas Madre-Hijo Adolescente

Abstract The observation of parent/child interaction is an effective method for identifying, evaluating, and monitoring adolescents and families who need or are undergoing intervention. This study aims to (1) describe a method of direct and systematic observation of dyadic interaction and (2) discuss its application in research with families with adolescents in northeastern Brazil. The data collection and analysis procedures are presented, indicating their possibilities and limits based on the lessons learned from this experience. The experience of applying the method is discussed through potential advances and challenges for the field of observational research in Psychology. It is concluded that the method of direct and systematic observation of dyadic interaction is, on the one hand, expensive in terms of expertise, time, and resources, and, on the other hand, it is a rich source of data for understanding interaction patterns in multiple contexts.

Resumo A observação da interação pai/mãe e filha/o é um método efetivo para identificação, avaliação e monitoramento de adolescentes e famílias que necessitem ou estejam em intervenção. Este artigo tem como objetivos: (1) descrever um método de observação direta e sistemática da interação diádica; e (2) discutir sobre sua aplicação em uma pesquisa junto a famílias com adolescentes do nordeste brasileiro. Apresentam-se os procedimentos de coleta e análise de dados, indicando suas possibilidades e limites a partir das lições aprendidas com esta vivência. Discute-se a experiência de aplicação do método por meio dos potenciais avanços e desafios para o campo da pesquisa observacional em Psicologia. Conclui-se que o método da observação direta e sistemática da interação diádica é, por um lado, dispendioso em termos de expertise, tempo e recursos e, por outro, consiste em rica fonte de dados para a compreensão dos padrões de interação em múltiplos contextos.

Resumen La observación de la interacción padre/hijo es un método efectivo para identificar, evaluar y monitorear a los adolescentes y familias que necesitan o están siendo intervenidos. Objetivos: (1) describir un método de observación directa y sistemática de la interacción diádica y (2) discutir su aplicación en una investigación junto a familias con adolescentes en el noreste brasileño. Se presentan los procedimientos de recolección y análisis de datos, indicando sus posibilidades y límites a partir de las lecciones aprendidas de esta experiencia. Se discute la experiencia de aplicación del método a través de potenciales avances y desafíos para el campo de la investigación observacional en Psicología. Se concluye que el método de observación directa y sistemática de la interacción diádica es, por un lado, costoso en términos de experiencia, tiempo y recursos y, por otro, es una rica fuente de datos para comprender los patrones de interacción en múltiples contextos.

Os desamparos da maternidade em um contexto de vulnerabilidade social / The helplessness of motherhood in a context of social vulnerability / El desamparo de la maternidade en un contexto de vulnerabilidad social

Algumas mães, mesmo acompanhadas de um parceiro, desempenham solitariamente múltiplos papéis, cuidando da rotina de casa, do trabalho e, precariamente, de si mesmas. Com o objetivo de discutir a maternidade em um contexto de vulnerabilidade e suas implicações no estabelecimento da relação mãe e filhos, a partir de um caso, utilizou-se um método observacional psicanalítico inspirado no Método Bick de Observação, sendo uma pesquisa qualitativa. As observações foram realizadas considerando os três tempos: observação semanal, no mesmo dia e hora; relato da observação, de forma descritiva e implicada; e, seminário de supervisão, para discussão das observações. Evidenciou-se o desamparo sentido por essa mulher-mãe que, apesar da presença da família e do esposo, não recebia o apoio necessário. Sua exaustão, oriunda do desamparo, resultava em perda de controle emocional em relação aos filhos. Ressalta-se o valor do Método Bick de Observação ao possibilitar um olhar sensível à maternidade

Some mothers, even when joined by a partner, end up playing multiple roles alone, taking care of the household chores, their work lives and, precariously, of themselves. In order to discuss motherhood in a context of vulnerability and its implications in the establishing of the relationship between a mother and her children, based on a specific case, an psychoanalytic observational method inspired by the Bick Method of Observation was employed, being a qualitative research. The observations were carried out considering three tempos: weekly observation, on the same day and time; observation report, in an involved and descriptive way; and supervision seminar, to discuss the observations. It was made evident the helplessness experienced by this woman-mother, who, despite the presence of her husband and family, did not receive the necessary support. Her exhaustion, stemming from this helplessness, resulted in a loss of emotional control over her children. The value of the Bick Observation Method is highlighted, as it enables a sensitive outlook towards motherhood

Algunas madres, incluso las acompañadas de pareja, desempeñan múltiples papeles solas, cuidando la rutina de la casa, el trabajo y, precariamente, ellas mismas. Para discutir la maternidad en un contexto de vulnerabilidad y sus implicaciones para el establecimiento de la relación entre las madres y sus hijos, a partir de un caso, se utilizó un método observacional psicoanalítico inspirado en el Método de Observación Bick, haciendo de esta una investigación cualitativa. Las observaciones se realizaron considerando los tres tiempos: observación semanal, en el mismo día y hora; informe de la observación, de forma descriptiva y implícita; y, seminario de supervisión, para discutir las observaciones. Se hizo evidente el desamparo que siente esta mujer-madre, quien, a pesar de la presencia de su familia y esposo, no recibe el apoyo necesario. Su agotamiento, derivado del desamparo, resultó en una pérdida del control emocional sobre sus hijos. Se destaca el valor del método de observación de Bick, que permite una mirada sensible a la maternidad

Clinical Efficacy of Qiangxin Decoction Combined with Baduanjin in Treatment of Elderly Patients with Chronic Heart Failure and Weakness / 中国实验方剂学杂志

ObjectiveChronic heart failure （CHF） is the terminal stage of cardiovascular disease. The adverse cardiovascular events of CHF patients with weakness have increased significantly. Traditional Chinese medicine （TCM） has a good effect on CHF. However，there are few reports on the clinical observation of the treatment of CHF with weakness in elderly patients by TCM combined with conventional health-preserving exercises. This study aimed to explore the clinical efficacy of Qiangxin decoction combined with Baduanjin in the treatment of elderly patients with CHF and weakness. MethodSixty CHF patients with Qi deficiency，blood stasis，and water retention syndrome admitted to the Cardiovascular Department of the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2020 to December 2021 were enrolled. The patients in the control group were treated with conventional western medicine according to the guidelines，while those in the treatment group received additional Qiangxin decoction and Baduanjin exercise based on the therapeutic protocol of the control group. The levels of serum N-terminal B-type brain natriuretic peptide precursor （NT-proBNP），creatine kinase （CK），lactate dehydrogenase （LDH），free fatty acid （FFA），left ventricular ejection fraction （LVEF），left ventricular end-diastolic dimension （LEVDD），6-minute walk distance （6MWD），Minnesota Living with Heart Failure Questionnaire （MLHFQ）， and Tilburg Frailty Indicator （TFI） scores of the two groups were observed before and one month after treatment. At the same time，the re-admission within three months was compared between the two groups. ResultThere was no significant difference between the two groups in terms of the general data and the therapeutic indexes before treatment. After treatment，the NT-proBNP，CK，LDH，FFA，LVEDD，MLHFQ， and TFI scores of the two groups were lower than those before treatment（P<0.05，P<0.01）， and the LVEF and 6MWD were higher（P<0.05，P<0.01）. The efficacy of the treatment group was superior to that of the control group after treatment （P<0.05，P<0.01）. The re-admission rate within three months in the treatment group was 7.1% （2/28）， lower than 30.8% （8/26） in the control group （χ2=4.897，P<0.05）. ConclusionQiangxin decoction combined with Baduanjin is helpful to improve the body energy metabolism，heart function，quality of life，and weakness level of elderly CHF patients with weakness， and reduce the rate of re-admission.

Governance in primary care systems: Experiences and lessons from urban, rural, and remote settings in the Philippines

Methods@#Data on governance issues were obtained from participant observation and regular meetings facilitated over one year. Conducted across urban, rural, and remote settings, the present study outlines experience-near insights throughout a hierarchy of system implementers—from those in positions of authority to frontline workers. These insights were thematically analyzed and organized following the Health System Dynamics Framework.@*Results@#This study identified six governance challenges: 1) establishing a health information system; 2) engaging leaders, healthcare staff, and communities; 3) assuring efficient financing; 4) assuring health workforce sufficiency; 5) addressing legal challenges; and 6) planning evaluation and monitoring. To address these challenges, this study forwards systemic solutions to advance effective governance and improve healthcare performance.@*Conclusion@#A renewed approach to strengthening primary care systems is fundamental to achieving universal healthcare. This entails good governance that develops strategies, equips people with tools for proper implementation, and provides data for evidence-based policies. The experiences outlined in the present study envisions guiding policymakers toward improving health outcomes in a devolved setting.

Effect of mirror therapy with augmented reality on attention of stroke patients / 中国康复理论与实践

ObjectiveTo investigate the effect of mirror therapy with augmented reality on attention of stroke patients. MethodsFrom January, 2020 to December, 2022, 60 stroke patients in the First People's Hospital of Changzhou were randomly divided into control group (n = 30) and observation group (n = 30). Both groups received routine occupational therapy, and the observation group received mirror therapy with augmented reality additionally, for four weeks. They were assessed with Digit Span Test (DST), Digit Cancellation Test (D-CAT3 and D-CAT3P), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) before and after treatment. ResultsBefore treatment, there was no significant difference in the scores of the DST, D-CAT3, D-CAT3P, SDMT and PASAT between two groups (P > 0.05). After treatment, all the indexes improved in the observation group (|t| > 3.663, P < 0.01), and improved more in the observation group than in the control group (|t| > 2.037, P < 0.05). ConclusionThe mirror therapy with augmented reality could effectively improve attention of stroke patients in the short term.

Clinical Study of Osteoking Combined with Non-Steroidal Anti-inflammatory Drugs in Treatment of Knee Osteoarthritis / 中国实验方剂学杂志

ObjectiveTo explore the clinical efficacy of Osteoking combined with non-steroidal anti-inflammatory drugs in the treatment of knee osteoarthritis based on real-world data and provide a basis for clinical medication. MethodFrom May 2020 to December 2021， the data of a total of 1 002 patients with knee osteoarthritis who did not undergo knee joint replacement surgery was collected through the registration method. 952 patients were ultimately included， including 133 cases orally taking Osteoking combined with non-steroidal anti-inflammatory drugs as the observation group and 73 cases orally taking non-steroidal anti-inflammatory drugs alone as the control group. Statistical analysis was conducted on the baseline data， VAS scores， WOMAC scores， and other items. The visit point is the 4th and 8th weeks after registration. In order to further elucidate the clinical efficacy of Osteoking combined with non-steroidal anti-inflammatory drugs in the treatment of knee osteoarthritis， the effective components of Osteoking and the relevant gene sets of non-steroidal anti-inflammatory drugs and knee osteoarthritis were obtained through network pharmacology methods and retrieval in bone injury cross database， TCMSP， and other databases. Venn analysis was performed on the relevant gene sets， and a PPI network diagram was constructed. Then key core targets were screened out， and enrichment GO and KEGG enrichment analyses were conducted. ResultThe VAS score of the observation group decreases by an average of （-2.79±1.206） scores in the 4th week， which is better than the control group ［（-2.73±1.575） scores， P<0.05］. The VAS score of the observation group decreases by an average of （-3.97±1.308） scores in the 8th week， which is better than the control group ［（-3.89±1.822） scores， P<0.05］. The total WOMAC score of the observation group decreases by an average of （-52.07±21.677） scores points in the 8th week， which is significantly better than the control group ［（-46.75±25.368） scores， P<0.05］. The observation group has an average decrease of （-10.99±4.229） scores in WOMAC （pain） score in the 8th week， which is better than the control group ［（-10.03±5.535） scores， P<0.05］. The observation group has an average decrease of （-1.49±2.901） in WOMAC （stiffness） score in the 4th week， which is better than the control group ［（-0.92±1.998） scores， P<0.05］， and the observation group has an average decrease of （-1.90±3.200） scores in WOMAC （stiffness） score in the 8th week， which is better than the control group ［（-1.26±2.230） scores， P<0.05］. The observation group shows an average decrease of （-39.17±16.562） scores in WOMAC （joint function） score in the 8th week， which is significantly better than the control group ［（-35.47±20.098） scores， P<0.05］. According to network pharmacology analysis， the core network target of Osteoking in treating knee osteoarthritis is manifested as regulating signal pathways such as signal transduction transcription activator 3（STAT3）， vascular endothelial growth factor A（VEGFA）， tumor necrosis factor （TNF） to regulate cell signaling， angiogenesis， chondrocyte proliferation and migration， and inflammatory cells， thereby inhibiting inflammatory reactions， reducing damage， and delaying the development of the disease. ConclusionAfter a 4-week and 8-week course of treatment for knee osteoarthritis with Osteoking combined with non-steroidal anti-inflammatory drugs， there is a significant therapeutic effect on relieving pain and joint stiffness and improving joint function. In network pharmacology， Osteoking is involved in regulating inflammatory factors， metabolic response-related biological processes， the proliferation and apoptosis of chondrocytes， etc. in the treatment of knee osteoarthritis， resulting in anti-inflammatory and analgesic effects and improving joint mobility and joint stiffness. Therefore， it is worthy of clinical promotion and application.

A Real-World Clinical Study of Osteoking Combined with Intra-Articular Injection of Sodium Hyaluronate in Treatment of Knee Osteoarthritis / 中国实验方剂学杂志

ObjectiveTo investigate the improvement of the efficacy of Osteoking in patients with knee osteoarthritis in the onset and remission stage and to systematically explore its potential intervention mechanism， so as to provide a certain reference for improving the clinical application value of Osteoking and guiding its clinical rational drug use. MethodThrough the real-world study of the treatment of knee osteoarthritis with Osteoking， the data was obtained and entered into the "Osteoking for the treatment of knee osteoarthritis case registration system"， and 105 patients with episodic and remission knee osteoarthritis from the outpatient or inpatient orthopedic department of 20 medical institutions， including the Third Affiliated Hospital of Beijing University of Chinese Medicine， Peking Union Medical College Hospital， Wangjing Hospital of the Chinese Academy of Chinese Medical Sciences and Hunan Aerospace Hospital， from May 1， 2020 to December 31， 2021， were selected in the system. It included 60 patients treated with Osteoking and joint injection， and 45 patients treated with joint injection alone. The WOMAC osteoarthritis index score， visual analogue （VAS） pain score， individual types of pain symptoms （cold pain， hot pain， tingling， dull pain， soreness） and other TCM symptoms were observed and compared between the two groups， and statistically analyzed. In order to further elucidate the potential molecular mechanism of Osteoking combined with joint injection in the treatment of knee osteoarthritis in the treatment of onset and remission， this study used the "Bone Injury Cross Database （http：//bone-xtrans.com/database，BX-Data）" to collect the gene set of knee osteoarthritis disease， the traditional Chinese medicinal materials， chemical composition， material base， candidate target， candidate target， sodium hyaluronate candidate target data for screening， and constructed an interaction network of "disease target". ResultsAmong the 105 patients with knee osteoarthritis enrolled， 15.24% （16/105） were in the episodic period， 84.76% （89/105） were in remission， and there were no convalescent patients. There were 72 cases （68.57%） in women， 33 cases （31.43%） more than men， 60 cases in the observation group and 45 cases in the control group in 105 patients. There were 20 patients with a VAS score of 5 and 19 patients with a score of 6 in the observation group， accounting for 65.00% of the observation group. The comparative results of VAS scores between groups before and after treatment showed that the scores of the two groups were （4.42±1.01） scores， （5.00±1.02） scores.4 weeks after treatment， and （3.12±1.04） scores and （3.56±1.08） scores，8 weeks after treatment， respectively， which were lower than those before treatment （6.23±1.28） scores，（ 6.02±1.22） scores （P<0.05）， and the comparative results of the pain properties of the two groups showed that the improvement rates before and after thermal pain and tingling in the observation group were 3.3%（2/60） and 16.7%（10/60）， respectively. The control group was 2.2% （1/45）and 15.6%（7/45）［（χ2=4.034、13.583，P<0.05）］， respectively， and the improvement rate of cold pain and soreness in the observation group was 5.0%（3/60） and 3.3%（2/60）， which was higher than that of the control group . The results of comparing the WOMAC scores before and after treatment of the two groups showed that the difference between the stiffness score before and after treatment in the observation group was （1.68±1.42） scores， the difference between the score before and after treatment in the control group was （1.20±1.60） scores （P<0.05）， and the pain score before and after treatment was （3.43±2.88） scores， the difference before and after daily activity score was （12.37±10.21） scores， and the total score before and after treatment was （17.48±12.76） scores， which were also higher than those in the control group （2.82±3.29）， （10.80±9.63），（14.82±12.62） scores. The results of comparing the improvement of other symptoms before and after treatment showed that the improvement rate of less sleep and more dreams in the observation group was 28.3%（17/60）， which was significantly higher than that of the control group of 2.2%（1/45）（χ2=5.914，P<0.05）， and the improvement rates of the five symptoms of thirst and drinking， irritability， dry mouth and pharynx， dull complexion and hand， foot and mouth fever in the observation group were 3.3%（2/60）， 10.0%（6/60）， 8.3%（5/60）， 10.0%（6/60） and 5.0%（3/60）， respectively， which were higher than those in the control group -2.2%（1/45）， 2.2%（1/45）， 2.2%（1/45）， 4.5%（2/45）， -6.7%（3/45）. Through network analysis， it was found that the enrichment pathway of Henggu bone wound healing agent mainly acted on the three mechanisms of bone improvement， energy metabolism and anti-inflammatory and analgesic， and the sodium hyaluronate enrichment pathway mainly acted on the anti-inflammatory and analgesic mechanism. ConclusionThe efficacy of Osteoking combined with intra-articular injection of sodium hyaluronate in the treatment of patients with knee osteoarthritis in attack and remission is better than that of sodium hyaluronate alone， especially in anti-inflammatory and analgesic， and the two drugs have synergistic effect. Osteoking may play its role in relieving the symptoms of joint stiffness， tingling， heat pain， and less sleep and more dreams by improving bone quality and regulating the body's energy metabolism pathways， which is worthy of clinical promotion.