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The clinical value of Chinese patent medicine is the core direction of the development of the traditional Chinese medicine industry. The precise clinical positioning determines the way to prove the value of the drug， and is a key link to highlight the clinical value. This paper presented a case study of clinical positioning for Chinese patent medicine， namely Qizhi Tongluo capsules， and the key technical framework of precise clinical positioning of Chinese patent medicine， which was manifested as a comparison of prescription target spectral effect， discovery of core value of prescription， and confirmation of clinical positioning trial. The technical framework was designed to address a range of issues in the realm of precise clinical positioning. Before the clinical positioning trial， based on the multi-component， multi-target， and multi-phenotype data of prescription and clinical indication， the multi-omics network analysis technology was used to identify the core value of the traditional Chinese medicine varieties and predict the potential clinical advantages. Then， based on the predicted clinical advantages， reasonable efficacy indicators were selected， and the clinical efficacy was judged and verified by dynamic and flexible innovative clinical trials to improve the success rate of clinical positioning. This research paradigm integrates "omics technology" with "evidence-based" principles and follows the "precise evidence-based" concept. This research aims to provide a new strategy and method for the precise medication and positioning of Chinese patent medicine with traditional Chinese medicine characteristics after being put into the market and provide more technical thinking for traditional Chinese medicine to move towards precise medicine.
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Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.
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To solve the problems of insufficient airway opening, insufficient or excessive ventilation, ventilation interruption, and the rescuer's physical strength during the process of cardiopulmonary resuscitation (CPR) outside the hospital and in the hospital, and to ensure the accuracy of ventilation frequency rate and tidal volume. Zhongnan Hospital and School of Nursing, Wuhan University, jointly designed and developed a smart emergency respirator with open airway function, that has been granted National Utility Model Patent of China (ZL 2021 2 1557989.8). The device is structured of pillow, pneumatic booster pump and mask. It can be used simply by plugging the pillow under the patient's head and shoulder, turning on the power supply and wearing the mask. The smart emergency respirator can quickly and effectively open the patient's airway and give accurate ventilation with adjustable ventilation parameters. The default settings are 10 times/min in respiratory rate and 500 mL in tidal volume. The whole operation does not require the operator have professional operation ability, which can be independently applied used in any cases without oxygen source or power supply, therefore, the application scenario has no limit. The device has the advantages of small size, simple operation and low production cost, which can reduce human source, save physical strength and significantly improve the quality of CPR. The device is suitable for respiratory support in multiple scenes outside and inside the hospital, and can significantly improve the success rate of treatment.
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Objective @#To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). @*Methods @# This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P<0.05 indicating a statistically significant difference. @*Results @#The experimental group was significantly better than the control group in terms of the success rate of the first puncture (χ2 = 21.51, P<0.001), puncture time (Z = -5.51, P<0.001), operative time (t = 9.37, P<0.001), and the number of C-arm scans (Z = -4.59, P<0.001). Postoperative BNI scores of the experimental group included 21 cases of grade Ⅰ (91.5%) and 1 case of grade Ⅱ, while the control group included 17 cases of grade Ⅰ (85.0%), 2 cases of grade Ⅱ (10.0%) and 1 case of grade Ⅲ (5.0%), with no statistical significance (P>0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. @* Conclusions @#3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.
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Cell membrane camouflaged nanoparticles have been widely used in the field of drug leads discovery attribute to their unique biointerface targeting function. However, random orientation of cell membrane coating does not guarantee effective and appropriate binding of drugs to specific sites, especially when applied to intracellular regions of transmembrane proteins. Bioorthogonal reactions have been rapidly developed as a specific and reliable method for cell membrane functionalization without disturbing living biosystem. Herein, inside-out cell membrane camouflaged magnetic nanoparticles (IOCMMNPs) were accurately constructed via bioorthogonal reactions to screen small molecule inhibitors targeting intracellular tyrosine kinase domain of vascular endothelial growth factor recptor-2. Azide functionalized cell membrane acted as a platform for specific covalently coupling with alkynyl functionalized magnetic Fe3O4 nanoparticles to prepare IOCMMNPs. The inside-out orientation of cell membrane was successfully verified by immunogold staining and sialic acid quantification assay. Ultimately, two compounds, senkyunolide A and ligustilidel, were successfully captured, and their potential antiproliferative activities were further testified by pharmacological experiments. It is anticipated that the proposed inside-out cell membrane coating strategy endows tremendous versatility for engineering cell membrane camouflaged nanoparticles and promotes the development of drug leads discovery platforms.
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In atherosclerosis, chronic inflammatory processes in local diseased areas may lead to the accumulation of reactive oxygen species (ROS). In this study, we devised a highly sensitive H2O2-scavenging nano-bionic system loaded with probucol (RPP-PU), to treat atherosclerosis more effectively. The RPP material had high sensitivity to H2O2, and the response sensitivity could be reduced from 40 to 10 μmol/L which was close to the lowest concentration of H2O2 levels of the pathological environment. RPP-PU delayed the release and prolonged the duration of PU in vivo. In Apolipoprotein E deficient (ApoE‒/‒) mice, RPP-PU effectively eliminated pathological ROS, reduced the level of lipids and related metabolic enzymes, and significantly decreased the area of vascular plaques and fibers. Our study demonstrated that the H2O2-scavenging nano-bionic system could scavenge the abundant ROS in the atherosclerosis lesion, thereby reducing the oxidative stress for treating atherosclerosis and thus achieve the therapeutic goals with atherosclerosis more desirably.
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Due to the inherent disease characteristics and surgical difficulties, the develop-ment of minimally invasive surgery in biliary tract cancer has encountered more difficulties and controversies. As one of the representative fields of modern precise surgery and an important part of multidisciplinary therapy, the value and application of minimally invasive surgery in the treatment of biliary tract cancer need to be further elaborated and standardized. Minimally invasive surgical techniques should be explored and studied under reasonable norms and supervision. More higher level evidence-based evidences should be obtained under the premise of ensuring the ethical prin-ciple of maximum benefit to patients, and ultimately promote the overall progress in the field.
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As precision and intelligent medicine takeing hold, the concept of minimally invasive surgery for gastric cancer has evolved from simply pursuing the effect of surgical results to being more patient-centered, safer, less trauma, more efficient, and more in line with the spirit of the evidence-based decision-making comprehensive treatment model. The authors review the develop-ment and technical innovation of precise and intelligent surgery in recent years, and proposes the expanding direction of new paradigm of precise and intelligent minimally invasive surgery for gastric cancer based on the work and achievements of team work. It is believed that in the future, advances in artificial intelligence, fluorescence imaging, surgical navigation, optical biopsy and other technolo-gies will bring new vitality to minimally invasive surgery for gastric cancer.
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In China, gastric cancer is the top three malignant tumors with high incidence and mortality, which seriously endangers the lives and health of people. The comprehensive treat-ment based on surgery is still the main treatment for gastric cancer. Through the unremitting efforts and hard works of gastric cancer experts, the treatment effect of gastric cancer in China has made great progress. However, gastric cancer surgery still faces some outstanding problems. How to further improve preoperative accurate diagnosis? How to further rationalize the treatment of early gastric cancer? Where is the future development of minimally invasive techniques for gastric cancer surgery? How to break through the bottleneck of conversion therapy? These are the challenges for gastric cancer surgery. Based on relevant literature and combined with own clinical practice, the author explores the hot issues of gastric cancer surgery.
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Objective:Severe trauma events are emergent, with low incidence and unpredictable. Current guideline does not provide precise recommendations on how the trauma centers should arrange the number of beds in trauma intensive care units while making rational use of medical resources. We analyzed the trauma intensive care unit bed requirement in the branch campus of our hospital to propose a reasonable assessment.Methods:Patients with severe trauma sent to the Intensive Care Unit of Peking University People's Hospital from January 2022 to June 2022 were collected. The daily number of patients received intensive care was counted. The bed requirement of the intensive care unit covering 99% of clinical needs was calculated based on the probability distribution function.Results:From January 2022 to June 2022, 103 patients with severe trauma [74 males and 29 females, aged (51.47±16.06) years, ranging 16 to 87 years] were included in the study. Among the 103 patients, 57 were injured in traffic accidents, 26 fell from a high altitude, 12 fell, 4 were hit by heavy objects, and 4 were stabbed. TISS ranged from 16 to 50. The range of the daily bed requirement in the intensive care unit was 0–10, which was consistent with the Poisson distribution. According to the probability distribution function, nine trauma intensive care beds could meet 99.19% of clinical needs.Conclusions:In severe traumatic events, patients need to be transferred to intensive care unit as soon as possible. For our branch campus, nine trauma intensive care beds can cover more than 99% of clinical needs. It follows that, in accordance with the basic requirements of trauma center construction, hospitals with trauma centers need at least 9 beds in intensive care units. However, traumatic events cannot be predicted; thus, the bed requirement needs to be regularly evaluated.
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Epilepsy is a chronic nervous system disease, which affects more than 70 million people all over the world. Although more than 30 kinds of antiepileptic drugs (AEDs) have been on the market, about one third of the patients with epilepsy fail to respond to medical treatment, who become drug-resistant epilepsy patients. Identifying the mechanism and developing effective treatment methods for drug-resistant epilepsy have become a hot area in the field of epilepsy research. This review discussed resent advance on the pathogenesis of drug-resistant epilepsy from the transporter hypothesis, neural network hypothesis and target hypothesis, and we also summarized the existing potential treatment methods and research progress of drug-resistant epilepsy, such as surgical resection, deep brain stimulation, ketogenic diet, precise treatment, and traditional Chinese medicine treatment. Our review may provide useful clues for the mechanisms research and clinical treatments of drug-resistant epilepsy.
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@#Three-dimensional (3D) visualization technology can well characterize lung nodules, accurately locate lung nodules, accurately identify lung anatomical structures, shorten operation time, reduce intraoperative and postoperative complications, and make thoracoscopic precise lung resection safer and more efficient. However, the mastery of 3D reconstruction technology in some hospitals still needs to be improved. Due to the time and economic cost of 3D printing, the development of this technology is restricted. With the application and improvement of 3D visualization technology in more centers in the future, the development of precise lung resection will be more extensive. This article reviewed the progress on 3D visualization technology in thoracoscopic precise lung resection.
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Lumbar surgical operation is the crucial treatment against lumbar degenerative diseases (LDDs), whose development depends on persistent comprehension and innovation of vertebral biomechanics. The thorough understanding of biomechanical changes during lumbar senescence and degeneration is the important bedrock to grasp LDDs pathogenesis, renovate LDDs surgical strategy, and embrace more precise and minimally invasive treatment against LDDs. Herein, in this review, the intimate crosstalk between LDDs with degenerative biomechanics of vertebrae, intervertebral disc and paravertebral muscles was elucidated, followed by the classification of lumbar surgery history into non-vertebral implant era (before the year 1980), vertebral implant era (during the year 1980-1990), vertebral fusion era (during the year 1990-2010), precise and minimally invasive decompression era (after the year 2010) based on lumbar surgical characteristics in each era. The significance of representative biomechanical studies in each era for lumbar surgery was also concluded. From biomechanical perspectives, the history of spinal surgery is the development history of surgical strategies that has progressed as the continuously in-depth understanding of spinal biomechanics. With the deepening of spinal biomechanical researches, spinal surgeons are expected to develop treatment strategies that are more adapted to physiological and biomechanical characteristics of the spine, thereby guiding the future direction of spinal surgery advancement.
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Objective To analyze the epidemiological investigation results and emergency response to a coronavirus disease 2019 （COVID-19） epidemic in Shanghai. Methods Descriptive epidemiological method was used to describe the epidemiological characteristics， such as population， time and spatial distribution of a COVID-19 epidemic on January 20， 2021 in Huangpu District of Shanghai. The advantages and disadvantages of the emergency response to this epidemic were analyzed. Results All of the 22 cases were found by active screening， which included high-risk population screening （18.2%， 4/22）， medium-risk area screening （9.1%， 2/22）， and close contact population screening （72.7%，16/22）. The first 2 cases were detected by routine nucleic acid screening for staff in two hospitals. The confirmed cases appeared mostly during the first 3 days of the epidemic （45.5%，10/22）， and mainly distributed in the neighborhood C of Huangpu district. There were 6 key locations or regions of Huangpu District involved in this epidemic， and different control measures were adopted in these different regions according to the risk assessments. After precise epidemic prevention and control， it took only 14 days from the first to the last confirmed case of this epidemic （from January 21， 2021 to February 4， 2021）， and no new related cases appeared afterwards. Conclusion Active screening and early finding of COVID-19 cases play a key role in timely control of the epidemic， with the smallest cost， the highest efficiency and the most limited urban impact.
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With the increase of aging population, the rising demand for cataract surgery, along with the growing demand for post-operative visual quality, the concept of refractive cataract surgery has been put forward, which places more emphasis on the cataract surgical precision.In order to improve the spectacle independence rate, optimize the surgical experience, and obtain the best visual quality, new technologies involving all aspects of cataract surgery are emerging.Ophthalmologists should pay close attention to the updates of biometry measurement, types and design principles of intraocular lens, application of femtosecond technology, surgical assistant system and perioperative management concept, so as to improve the precision and accuracy of cataract surgery.
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This study introduces a non-invasive gastrointestinal early cancer magnetic anchor ablation electrode endoscopy system, including a magnetic anchor module and ablation electrode module. The magnetic anchoring module is composed of an external guide magnet and an internal magnet, made of permanent magnet material NdFeB; the ablation electrode module is based on the modification of the front end lens hood of the existing endoscope (CMD-90D LED electronic upper gastrointestinal endoscope). The new endoscope system not only includes all the functions of the original endoscope, but also introduces magnetic anchoring to enable the ablation electrode to be accurately positioned and controllable in the process of treating tumors, avoiding the phenomenon of gastric perforation; the introduction of steep pulse electric field ablation electrodes realizes the purpose of non-invasive treatment. Its clinical application will become a new method to treat early cancer of the digestive tract.
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Humans , Electrodes , Endoscopes , Gastrointestinal Tract , Magnetic Phenomena , NeoplasmsABSTRACT
The current prevention and control strategy of iodine deficiency disorders in China is "adjust measures to local conditions, guide by classification and supplement iodine scientifically". The ultimate goal of the implementation of this prevention and control strategy is to carry out "precise iodine supplementation". However, at present, the implementation of "precise iodine supplementation" faces some difficulties, mainly how to accurately measure individual iodine nutrition. This paper discusses the current framework of iodine nutrition indicators, the advantages and disadvantages of various indicators, the gold standard for measuring the indicators, and the application scope and joint application of each indicator from three aspects: the intake of iodine, the level of iodine and the excretion of iodine.
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Objective:To compare the effects of modified incision drainage combined with thread-drawing and precise minimally invasive surgery in the treatment of anal fistula on anal defecation function and complications.Methods:A total of 105 patients with anal fistula who were diagnosed and treated in Xin′an International Hospital from December 2018 to December 2020 were collected. The patients were divided into the observation group (58 cases) and the control group (47 cases) according to surgical methods. The observation group received modified incision drainage combined with thread-drawing surgery. The control group received precise minimally invasive anal fistula surgery. The treatment outcome, anal defecation function and complications were compared between the two groups.Results:The operation time, intraoperative blood loss, first defecation time after operation, normal eating time after operation in the two groups had no significant differences ( P>0.05). The hospital stay in the observation group was significantly longer than that in the control group: (5.29 ± 1.53) d vs. (4.02 ± 1.16) d, there was statistical differences ( P<0.05). After operation, the resting pressure of the anal canal, resting rectal pressure, length of the tube high pressure belt, the maximum systolic pressure of the anal canal between the two groups had no significant differences ( P>0.05). The excellent and good rate of anal defecation function and complication rate between the two groups had no significant differences ( P>0.05). Conclusions:Modified incision drainage combined with thread-hanging surgery in the treatment of anal fistula is equivalent with precision minimally invasive surgery. Both can effectively improve the anal defecation function. The postoperative safety is good and there is no recurrence. However, the hospital stay of patients with precision minimally invasive surgery for anal fistula is relatively shorter.
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Helicobacter pylori (HP) infection is one of the most prevalent chronic bacterial infections in the world, which is closely related to the development of gastrointestinal diseases, such as chronic gastritis, gastroduodenal ulcer and gastric cancer. Empirical treatment of HP infection may lead to antibiotic resistance, adverse reactions and poor compliance. The decreased HP eradication rate is related to antibiotic resistance, HP converting to coccoid form and admission of proton pump inhibitors (PPI). The implementation of precise therapy can effectively enhance the HP eradication rate, through antibiotics selecting based on detection of drug sensitivity phenotype and drug resistance genes, reducing adverse drug reactions, increasing patient compliance, and rationally administrating PPI, etc. This article reviews the research progress of precision therapy for HP infection to provide reference for clinicians.
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A total of three early gastric cancers (EGC)patients with submucosal severe fibrosis were successfully treated by endoscopic precise muscular dissection (EPMD) from May 2018 to August 2020.All the three lesions were en bloc resection and specimens were not damaged. The maximum diameter of specimens and fibrosis areas were 2.0-5.7 cm and 0.5-0.8 cm, respectively. The operation time was from 30 to 70 mins. Intraoperative perforation occurred in one case, post-operation fever cccured in one case, and no delayed perforation or bleeding occured. Two cases were cured resection and one case was non-cured resection without additional treatment. No recurrence or metastasis was observed during follow-up period.According to primary results, EPMD can be used for EGC with submucosal severe fibrosis, but the safety and effectiveness need clinical validation with more samples.