“支医”行动干预方案对基层护士护理质量的效果评价

目的探讨＂支医＂干预方案对基层护士护理质量的影响。方法对2009年6月~2010年6月对口支医的11名基层护士实施干预,比较＂支医＂干预前后的考核评分。结果干预后的护士,在基础护理质量、急救物品管理检查、护理文书书写、病区质量检查、消毒隔离评分等方面与干预前比较,差异均有统计学意义（均P〈0.05）。干预后患者健康知识宣教率和满意度与干预前比较,差异有统计学意义（P〈0.05）。结论 ＂支医＂干预方案能提高基层护士护理质量和综合素质,值得进一步研究推广。

Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

Gastrectomy is commonly performed for both benign and malignant lesions.Although the incidence of post-gastrectomy acute pancreatitis(PGAP)is low compared to other well-recognized post-operative complications,it has been reported to be associated with a high mortality rate.In this article,we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis.His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis.The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage,together with aggressive antibiotic therapy and nutritional support.For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy,clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.

Effects of a symptom management intervention based on group sessions combined with a mobile health application for persons living with HIV in China:A randomized controlled trial

Objective:This study aims to evaluate the effects of a symptom management intervention(SMI)based on symptom management group sessions combined with a mobile health(mHealth)application(app)on the knowledge of symptom management,the certainty of symptom self-management,symptom severity,symptom distress,medication adherence,social support,and quality of life among persons living with HIV(PLWH)in China.Methods:A parallel randomized controlled trial with 61 PLWH was conducted in Shanghai,China.The participants in the control group(n¼30)downloaded the Symptom Management(SM)app according to their needs and preferences,and received routine follow-ups.The participants in the intervention group(n¼31)were guided to download and use the SM app,and received four tailored weekly group sessions at routine follow-ups.Each group session lasted for approximately 2 h and targeted one of the major modules of the SM app.All the outcomes were assessed at baseline and post-intervention.The study was registered with the Chinese Clinical Trial Registry(ChiCTR1900024821).Results:The symptom management knowledge and certainty of symptom self-management were significantly improved after the intervention(all P<0.01).Compared with the control group,the scores of symptoms reasons knowledge score improved 11.47 points(95%CI:3.41,19.53)and scores of symptoms self-management knowledge score improved 12.80 points(95%CI:4.55,21.05)in the intervention group after controlling for covariates.However,other outcomes did not show statistically significant differences between the intervention group and the control group(P>0.05).Conclusion:The SMI could improve PLWH’s symptom management knowledge and certainty of symptom self-management.Multi-center studies with larger sample sizes and longer follow-ups are needed to further understand the effects of SM app on ameliorating symptom severity and symptom distress.More innovative strategies are also needed to promote and maintain the sustainability of the SM app.

Research for the Relationships between Body Acceleration and Energy Expenditure

During our research,It has been found that body acceleration has strong relationships with the human energy expenditure.This paper discusses the methods to assess physical activity and concludes that for accurate assessment of physical activity under free living conditions the recently introduced accelerometer looks most promising.We developed a new computerized machine to assess the body activity and energy expenditure.Test datas of the treadmill experiment,respiration experiment and 5-kilometer-running experiment have been archieved,we found that body acceration integrals with time has linear relations with body energy expenture.

Economic impact of traditional medicine practice worldwide

The aim of this literature review was to summarize available findings from publications that reported expenditure on traditional/complementary and alternative medicine(TM/CAM)within a representative general population sample of a nation or a defined geographical area.A total of 24 publications met the inclusion criteria and were included in the review.The expenditure on TM/CAM varies worldwide,but direct comparison of the findings of publications included in this review is limited due to the differences in the definitions of TM/CAM,inclusion of various forms of TM/CAM,use of different names and categorization,as well as differences in reported currencies and time periods in which data were collected.Data about the expenditure on TM/CAM in most countries throughout the world are scarce.Further national studies should be conducted in order to provide up-to-date assessment of the TM/CAM related expenditure patterns and use.Uniform nomenclature,definition of TM/CAM and standardized instruments would provide basis for comparability of data of studies conducted in various regions and time periods.

Esophageal tissue engineering:A new approach for esophageal replacement

A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and ClinicalTrials.gov databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement.Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus.Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease,important barriers remain that need to be addressed.

Government Provides Vigorous Supports to the Improvement of Health Care in Qinghai Province,China

Qinghai province is located in the northeastern part of the Tibetan Plateau,and is an underdeveloped province of inland China.Chinese government gives high priority to the improvement of the wellbeing of Qinghai people,and have provided great supports in aspects of policy,funding,and professional resource to the development of health care and medical system in Qinghai.Great progress has been made,and wellness of residents in Qinghai has been significantly improved.This article reviews the strategies and measures from central and provincial government in improving health care of Qinghai province under the leadership of the Communist Party of China.

Clinical Observation in 31 Cases of Chronic Bronchitis at Remission Stage Treated with Bufei Keli

To observe the therapeutic effects of a Chinese drug Bufei Keli (补肺颗粒 granules for invigorating the lung) in the treatment of chronic bronchitis at remission stage, 62 cases were randomly divided into a treatment group (treated with Bufei Keli) and a control group (treated with Yupingfeng Keli 玉屏风颗粒). The results turned out to be that the short-term clinically controlled and markedly effective rate was 77.42% and the long-term relapse-resisting markedly effective rate was 74.2% in the treatment group, which were obviously higher than 45.16% and 38.71% respectively in the control group (P<0.05). And the increase in contents of SOD and CD_3 and the decrease in LPO content in the treatment group were also bigger than that in the control group (P<0.01). It is therefore concluded that Bufei Keli can improve qi deficiency syndrome and raise the immunity of patients with chronic bronchitis, hence its effect of resisting relapse of chronic bronchitis.

CLINICAL OBSERVATION ON TREATMENT OF ACUTE BRONCHITIS PRIMARILY WITH PRICKING-CUPPING ON BACK-SHU POINTS

To observe the clinical effect of treatment of acute bronchitis primarily with prickingcupping method on Back-shu points. Methods. The patients of acute bronchitis were randomly divided into 2 groups. In the observation group, there were 36 cases, who were treated with the integrated traditional Chinese and western medicine, primarily the pricking-cupping method on Back-shu points; while in the control group, there were 29 cases who were given the conventinal treatment of western medicine. All the 2 groups were treated for 7 days as one treating course. Results： The total effective rate of the observation group was 97.2% while that of the control group was 82,8%, so there is a significant difference between them. On the first and third days the clinical manifestations were more satisfactorily improved in the treatment group than in the control group （P 〈 0.01） and on the fifth and seventh days, the comparison showed no significant difference （P〉0.05）. Conclusion： The treatment of acute bronchitis by means of the integrated traditional Chinese and western medicine primarily with pricking-cupping method on Back-shu points is of marked therapeutic effect, simple manipulation, and little untoward effects, thus claiming the unique advantage.

MEDICINAL VESICULATION THERAPY AND ITS CLINICAL APPLICATION

In this paper, the authors introduce medicinal vesiculation therapy from its origin, points for attention in clinical application, and their individual experiences. In clinical application, the authors advocate: ① avoid using drugs that are over-irritating in the property, and strictly controlling the dose of drugs and the duration of application, ② in selection of drugs, some factors as patients’ conditions, the season, the geographic location, etc. should be taken into account. In the present paper, 3 typical cases of bronchial asthma, tonsil swelling and facial paralysis treated with medicinal vesiculation therapy are introduced. Clinical practice demonstrates that this therapy is economical, simple and convenient and fairly effective in treatment of some chronic diseases.

SHALLOW NEEDLING USED FOR THE TREATMENT OF 35 CASES OF FACIAL SPASM

In the present paper, the authors sum up results of acupuncture treatment of 35 cases of facial spasm. Of the 35 cases, 14 were male and 21 female, ranging in age from 19 to 62 years and in the disease duration from 1 week to 21 years. Shallow needling was applied to the surrounding region of Ahshi points (the twitching locus), Hegu (LI 4), Taichong (LR 3), etc., once daily, 4 weeks altogether. In addition, according to syndrome differentiation, other acupoints as Fengchi (GB 20), Waiguan (TE 5), Zusanli (ST 36), Sanyinjiao (SP 6), etc. were supplemented. After treatment, out of the 35 cases, 26 (74.3%) were cured, 5 (14.3%) experienced markedly improvement, and the rest 4 (11.4%) cases had a certain degree of amelioration. The key point for treating facial spasm is applying shallow needling around the twitching muscles.

Computational Fluid Dynamics Simulation on Biomedical Stent Design

The stent was a major breakthrough in the treatment of atherosclerotic vascular disease. The permanent vascular implant of a stent, however, changes the intra-stent blood flow hemodynamics. There is a growing consensus that the stent implant may change the artery wall shear stress distribution and hence lead to the restenosis process. Computational fluid dynamics （CFD） has been widely used to analyze hemodynamics in stented arteries. In this paper, two CFD models （the axisymmetric model and the 3-D stent model） were developed to investigate the effects of strut geometry and blood rheology on the intra-stent hemodynamics. The velocity profile, flow recirculation, and wall shear stress distribution of various stent strut geometries were studied. Results show strong correlations between the intra-stent hemodynamics and strut geometry. The intra-stent blood flow is very sensitive to the strut height and fillet size. A round strut with a large fillet size shows 36% and 34% reductions in key parameters evaluating the restenosis risk for the axisymmetric model and the 3-D stent model, respectively. This suggests that electrochemical polishing, a surface-improving process during stent manufacturing, strongly influences the hemodynamic behavior in stented arteries and should be controlled precisely in order to achieve the best clinical outcome. Rheological effects on the wall shear stress are minor in both axisymmetric and 3-D stent models for the vessel diameter of 4 mm, with Newtonian flow simulation tending to give more conservative estimates ofrestenosis risk. Therefore, it is reasonable to simulate the blood flow as a Newtonian flow in stented arteries using the simpler axisymmetric model. These findings will provide great insights for stent design optimization for potential restenosis improvement.

Framework and local experience of pharmaceutical reimbursement criteria policy (PRCP) in China

In the present study, we compared local policies in Chongqing, Zhejiang, Anhui, Fujian and Sanming and summarized connotation and framework of PRCP. Moreover, we proposed that China should make PRCP at the provincial level, strengthen connection with other health care reform policies under tripartite system reform, such as equivalence evaluation of quality and efficacy of generics, and evaluate policy effects timely to improve the policy.

Mycoplasma lipoproteins and Toll-like receptors

Mycoplasmas, the smallest free-living, self-replicating bacteria with diameters of 200 to 800 nm, have been reported to be associated with human diseases. It is well known that the mycoplasma lipoprotein/peptide is able to modulate the host immune system, whose N-terminal structure is an important factor in inducing immunity and distinguishing Toll-like receptors (TLRs). However, there is still no clear elucidation about the pathogenic mechanism of mycoplasma lipoprotein/peptide and the signaling pathway. Some researchers have focused on understanding the structures of these proteins and the relationships between their structure and biological function. This review provides an update on the research in this field.

General Situation on Clinical Application of Dragon-Tiger Fighting Needling Technique in the Recent Years

Depending upon the descriptions of the ancient literature, such as Jin Zhen Fu （Odes to Golden Needles, 《金针赋》）, the dragon-tiger fighting needling technique has the effects to dredge the meridians, circulate qi, activate blood, stop and remove pain. ＂Dragon＂ implies to twist the needle leftward for reinforcing, and ＂tiger＂ means to twist the needle rightward for reducing. To twist the needle leftward and rightward alternately is termed ＂fighting＂ After the arrival of the needling sensation by inserting the needle to the proper depth, the needle is first twisted leftward with the thumb forward in a method of nine yang numbers, and then twisted backward and rightward with the thumb backward in a method of six yin numbers, in alternation of reinforcing and reducing repeatedly. Therefore, the general information on clinical application of dragon-tiger fighting needling technique in the recent sixteen years is given in the following.

Advancements in three-dimensional titanium alloy mesh scaffolds fabricated by electron beam melting for biomedical devices: mechanical and biological aspects

We elucidate here the process-structure-property relationships in three-dimensional（3 D） implantable titanium alloy biomaterials processed by electron beam melting（EBM） that is based on the principle of additive manufacturing. The conventional methods for processing of biomedical devices including freeze casting and sintering are limited because of the difficulties in adaptation at the host site and difference in the micro/macrostructure, mechanical, and physical properties with the host tissue. In this regard, EBM has a unique advantage of processing patient-specific complex designs, which can be either obtained from the computed tomography（CT） scan of the defect site or through a computeraided design（CAD） program. This review introduces and summarizes the evolution and underlying reasons that have motivated 3 D printing of scaffolds for tissue regeneration.The overview comprises of two parts for obtaining ultimate functionalities. The first part focuses on obtaining the ultimate functionalities in terms of mechanical properties of 3 D titanium alloy scaffolds fabricated by EBM with different characteristics based on design, unit cell, processing parameters, scan speed, porosity, and heat treatment. The second part focuses on the advancement of enhancing biological responses of these 3 D scaffolds and the influence of surface modification on cell-material interactions. The overview concludes with a discussion on the clinical trials of these 3 D porous scaffolds illustrating their potential in meeting the current needs of the biomedical industry.

4-Axis printing microfibrous tubular scaffold and tracheal cartilage application

Long-segment defects remain a major problem in clinical treatment of tubular tissue reconstruction.The design of tubular scaffold with desired structure and functional properties suitable for tubular tissue regeneration remains a great challenge in regenerative medicine.Here,we present a reliable method to rapidly fabricate tissueengineered tubular scaffold with hierarchical structure via 4-axis printing system.The fabrication process can be adapted to various biomaterials including hydrogels,thermoplastic materials and thermosetting materials.Using polycaprolactone(PCL)as an example,we successfully fabricated the scaffolds with tunable tubular architecture,controllable mesh structure,radial elasticity,good flexibility,and luminal patency.As a preliminary demonstration of the applications of this technology,we prepared a hybrid tubular scaffold via the combination of the 4-axis printed elastic poly(glycerol sebacate)(PGS)bio-spring and electrospun gelatin nanofibers.The scaffolds seeded with chondrocytes formed tubular mature cartilage-like tissue both via in vitro culture and subcutaneous implantation in the nude mouse,which showed great potential for tracheal cartilage reconstruction.

Large-scale functionalization of biomedical porous titanium scaffolds surface with TiO_2 nanostructures

Construction of functional porous titanium scaffold is drawing ever growing attention, due to its effectiveness in solving the mechanical mismatch between titanium implant and bone tissue. However, the poor water permeability as well as the problem in achieving uniform surface modification inside scaffold hinders the further biomedical application of porous titanium scaffold. In this study, largescale functional Ti O2 nanostructures（nanonetwork, nanoplate and nanowire） were constructed on three-dimensional porous titanium scaffolds surface via an effective hydrothermal treatment method. These nanostructures increase the hydrophilicity of the titanium scaffold surface, facilitating the cell culture medium to penetrate into the inner pore of the scaffold. Zeta potential analyses indicate that the surface electrical properties depend on the nanostructure, with nanowire exhibiting the lowest potential at p H 7.4. The influence of the nano-functionalized scaffold on protein adsorption and cell adhesion was examined. The results indicate that the nano-functionalized surface could modulate protein adsorption and bone marrow derived mesenchymal stem cells（BMSCs） adhesion, with the nanowire functionalized porous scaffold homogeneously promoting protein adsorption and BMSCs adhesion. Our research will facilitate future research on the development of novel functional porous scaffold.

Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux

OBJECTIVE:To assess the effectiveness and safety of Traditional Chinese Medicine(TCM) treatment of non-acute bronchial asthma complicated by gastroesophageal reflux.METHODS:We searched databases from MEDLINE,Cochrane Library,CNKI,VIP,CBM,Wanfang Data,and TCM Database Systems.All randomized,controlled trials(RTCs) of TCM treatment of non-acute asthma complicated by gastroesophageal reflux were included.Data were independently collected by two reviewers.The standards for assessing quality described in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate articles.Meta-analyses were conducted using RevMan 5.0.17 software.Heterogeneity was assessed,and a corresponding effects model was used to merge and analyze results.Indexes used to evalu-ate curative effects were:clinical efficacy,symptom scores,pulmonary function values,and adverse incidents.Effectiveness was indicated using risk ratio(RR) or mean difference(MD),and 95% confidence intervals(CIs) were calculated.RESULTS:Six RCTs were included,involving 304 patients with non-acute asthma complicated by gastroesophageal reflux.The treatment groups received Chinese drugs alone or TCM combined with standard Western medical treatment,and the control groups received standard Western medical treatment alone.Standard Western medical treatment included anti-inflammatory drugs and bronchodilators for asthma,and drugs to promote gastric peristalsis and inhibit gastric acid production for gastroesophageal reflux.Methodological quality was low in all six RCTs.Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group(RR:1.43,95%CI:1.10 to 1.87 vs RR:1.51,95% CI:1.09 to 2.08).One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group(MD:-1.10,95% CI:-2.04 to-0.16).Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group(RR:-3.70,95% CI:-4.30 to 3.10 vs RR:-5.30,95% CI:-6.32 to-4.28).One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group(P< 0.05).No differences were seen in the various indexes between groups in the other RCTs.No adverse reactions,dropout rates,or follow-up rates were reported in any of the RCTs.CONCLUSIONS:The clinical symptoms ofnon-acute asthma complicated by gastroesophageal reflux can be improved by some Chinese drugs.Curative effects can be increased by combining the use of TCM with Western medicine.Because of the small quantity and low quality of research reported to date,it is necessary to conduct further RCTs to confirm these results.The results of this systematic review indicate that the quality of future clinical trials should be improved by including larger patient numbers,correctly randomizing patients into study groups,using blinding methods to measure and assess outcomes,and using accepted indexes to evaluate curative effects.