Objective To find a method to inherit the experiences of famous senior TCM physicians,through verification and inheritance research of Professor Tian Cong-huo's clinical experience on degenerative gonarthrosis treatment.Methods By means of database of famous senior TCM physicians and various data explore methods,we performed multi-group controlled verification on Professor Tian Cong-huo's acupuncture prescription on degenerative gonarthrosis,in order to investigate the experience thoroughly.Results The three groups treated by Professor Tian Cong-huo's acupuncture prescription got similar therapeutic effects,and patients' symptoms have been relieved remarkably.Compared with the baseline,the scores of the knee joint ache in the group of Professor Tian,Successor,Senior and Control were decreased 1.20 (t=9.00,P＜0.05),1.13 (t=15.76,P＜0.01),1.1 (t=15.99,P＜0.05) and 1 (t=10.42,P＜0.05),respectively.Significant improvements of pain relieves had been achieved in all groups.No significant difference was observed among the previous three groups(F=2.64,P＞0.05),which had obvious improvement effect in comparing with the control group(t=3.81,P＜0.01).Conclusion demonstrated that the group of Professor Tian,the successor,and the senior each did better in knee pain-relief than the control group.Conclusion Confirmed by our research,this acupuncture prescription proves to be repeatable,safe,reliable and stable.Perfoming inheritance and verification research of famous and senior TCM physicians could help juniors learn and investigate their predecessors academic thoughts and connotation,proceed to the next step,inherit the precious experience through verification and combination of theory and practice.

BACKGROUND: A new type of materials, Collamer, is polymerized with type V collagen and HEMA by Staar company, which is a good material for the establishment of intraocular contact lens(ICL). There is no similar material in our country.OBJECTIVE: To evaluate the biocompatibility of ICL made mainly by collagen-polymer in animals.DESIGN: A randomized controlled trial.SETTING: Testing Center of Shanghai Institute of Biomaterial.MATERIALS: Our study was conducted in the Testing Center of Shanghai Institute of Biomaterial from January 2000 to April 2000. Cell strain: hearty L-929 cells(fibroblast of mouse) after 48-72 hours of passage; Twenty white guinea pig of either gender aged between 1 month and 3 months with a body mass between 300 g and 500 g; Seven healthy adult New Zealand rabbit of either gender(female rabbits were not required pregnant for pyrogenic reaction test) with a body mass between 1.7 kg and 3.0 kg or between 2.5 kg and 3.5 kg(experimental animals were obtained from Shanghai experimental animal center, ordinary grade).INTERVENTIONS: Collagen was used to perform the following biological tests: ① cytotoxicity test (cell growth rate); ② anaphylaxis test; ③ pyrogenic reactions test; ④ subcutaneous implant test. The data were analyzed and evaluated according to criteria.MAIN OUTCOME MEASURES: ① Growth and proliferation of fibroblast in mice; ② Reactions of erythema and edema of every provocation site and every observatory time after the induction of intradermal injection and local patch test; ③ Increase of body temperature of the rabbit after the injection of the extraction of the material into auricle marginal vein; ④ Reactions around the materials after 4 weeks of collagen implantation in rabbits subcutaneously.RESULTS: ① Cytotoxicity test: relative growth rate of collagen group was 99％ to 106%, and the toxicity grade was level 0 - 1. ② Anaphylaxis test:there was no erythema or edema reaction at every provocation site at each time point of collagen group. The skin reaction to collagen-polymer was level 0. ③ Pyrogenic reactions test: the temperature increased in rabbit was below 0.6 ℃ and the total increase of the temperature was below 1.4 ℃ in rabbits. ④ Subcutaneous implant test: there was very little lymphocyte infiltration around the sample in both collagen group and control group with Level I inflammatory reaction. And the evaluation of the formation of fiber cyst was level I.CONCLUSION: Results of material biological evaluation tests demonstrate that this collagen-polymer has high biocompatibility, and can become an ideal material for ICL.

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

A comprehensive literature on the utility of ultrasound guidance for artery catheterization were searched. The research of the literature was divided to three parts:evaluation of radial artery, the process of puncture and the application progress. Ultrasound is a useful adjunct to arterial catheter insertion and increase the rate of success. During the process of ultrasound guidance, evaluation of radial artery, preparation, the way of poke and the direction of the needle were recommended.

BACKGROUND:Abdominal incision healing is not only related with the patient’s own situation, but also closely related with the surgeon's suture technique, suture method, choice of stitches. ＜br> OBJECTIVE:To compare the absorbable sutures and silk sutures for abdominal incision. ＜br> METHODS:Total y 153 colorectal cancer patients, including 91 males and 62 females, aged 30-82 years, were randomly divided into observation group (n=78) and control group (n=75). An abdominal midline incision was made in al patients receiving radical surgery of colorectal cancer. The Vicryl suture and silk suture were respectively used in the observation and control groups for abdominal incision closure. Suturing time, length of hospital stay, incision infection, disruption of wound, fat liquefaction of wound and rejection were compared between two groups. ＜br> RESULTS AND CONCLUSION:The suturing time and length of hospital stay were less in the observation group than the control group (P＜0.05). In the observation group, there were three cases of incision infection, but no incision dehiscence and rejection occurred;in the control group, there were 10 cases of incision infection, 4 cases of incision dehiscence, and 5 cases of rejection. A significant difference was found in the incision infection, dehiscence and rejection between the two groups (P＜0.05). Hospitalization expenses and fat liquefaction of incision had no difference between the two groups. these findings indicate that the Vicryl plus as an absorbable suture is simple, effective and safe that can promote wound healing and reduce complications.

Objective: To evaluate the feasibility of ICU nurse-performed lung ultrasound in screening the reason of dyspnea in ICU patients, and to explore the effect on nursing decisions. Methods: ICU nurses trained on lung ultrasound with 16 hours performed point-of-care lung ultrasound in patient with acute respiratory failure to assess the condition of the patient′s lungs and screen for pleural effusion, atelectasis/lung consolidation. Etc; Repeated examinations by ICU physicians accredited by the International Critical Ultrasound Alliance to evaluate the accuracy of ICU nurse interpretation. Results: A total of 510 lung ultrasonographic examinations were performed in 51 patients. Compared with physicians, ICU nurses correctly interpreted 472 ultrasound signs, accounting for 92.53%. ICU nurses found that the sensitivity of the pleural effusion was 86.7%, the specificity was 95.2%, and the diagnostic accuracy rate was 90.2%, and Youden index was 81.9%. The ultrasonography revealed a sensitivity of 92.1% for atelectic/pulmonary consolidation and a specificity of 92.3.%, the diagnostic accuracy rate was 92.2% and Youden index was 84.4%. Conclusion ICU nurses who have undergone standardized training can correctly interpret lung ultrasound signs and have good diagnostic value for screening of pleural effusions and atelectasis/lung consolidation; they provide the basis for optimization of chest physiotherapy programs.

Objective:To explore the diagnosis, staging, and treatment of fibro-adipose vascular anomaly(FAVA).Methods:The data of the patients with FAVA admitted to Xi’an International Medical Center Hospital between October 2019 and February 2023 were retrospectively reviewed. Ultrasound and magnetic resonance imaging (MRI) were routinely performed. X-ray and CT were performed for patients with unequal length of lower limbs, lesions involving joints, and obvious joint deformities. The treatment plan was made according to the stage: stage Ⅰ (pain stage), open or laparoscopi radical resection of the lesion was performed; stage Ⅱ (contracture stage), radical surgery was performed to remove the lesion, sometimes combined with Achilles tendon lengthening or tenolysis, and rehabilitation training was performed 2 weeks after surgery; stage Ⅲ(deformity stage), comprehensive treatment based on surgical resection was adopted, combined with joint capsule release, Achilles tendon lengthening or dissection, tendon transfer and oral sirolimus (each time 0.08 mg/m 2, twice daily ) before and after the operation. For patients with lesions involving multiple anatomical regions, staged surgery was performed, and in principle, only one anatomical region was operated per time. Patients were followed up for pain, joint activity and recurrence. Results:A total of 42 patients were admitted, including 18 males and 24 females. The onset age was (7.3±5.0) years, but the average age of diagnosis was (12.5±6.0) years. The lower limbs were involved in 38 cases, the upper limbs in 4 cases. There were 17 cases of stage Ⅰ, 17 cases of stage Ⅱ and 8 cases of stage Ⅲ. Only 4 cases had no misdiagnosis experience, and the misdiagnosis rate was 90.5%(38/42). Persistent pain, muscle contractures and joint deformities were the main clinical symptoms of the disease. MRI showed heterogeneous high and low signal intensity on T1-weighted images, and the high signal intensity was the same as that of subcutaneous adipose tissue. T2 fat-suppressed sequences showed stronger heterogeneous hyperintensity. The follow-up time was (14.6±10.8) months. Patients who took sirolimus orally before or after surgery experienced significant relief of pain symptoms. Of the 42 patients, the symptoms of 31 patients were completely relieved after the operation, and 11 patients still had residual pain or joint movement disorder or even deformity after the operation. Sixteen of 17 stage Ⅰ patients were cured, the lesion was further expanded and the pain recurred in 1 case after the operation. Of the 17 stage Ⅱ patients, 15 were cured, and 2 had mild limitation of ankle movement after the operation. Eight stage Ⅲ patients had varying degrees of pain or joint movement disorder after surgery, postoperative oral sirolimus significantly relieved symptoms. All 10 patients with stage Ⅰ and Ⅱ who underwent endoscopic resection were cured.Conclusion:FAVA usually occurred in school-age and adolescent children. Pain, muscle contracture and joint deformity were the characteristic clinical features. Combined with MRI features, the diagnosis can be confirmed. FAVA staging system could guide treatment and predict prognosis. For stage Ⅰ and Ⅱ patients, surgery should be performed as soon as possible and the prognosis was good. For stage Ⅲ patients, surgery-based comprehensive treatment could improve symptoms, but it was difficult to cure them radically. Oral sirolimus was also required after surgery.

Objective To describe the current accuracy of ICU nurses in evaluating Glasgow Coma Scale (GCS) and to analyze its influencing factors, so as to provide a basis for observing patients' consciousness level dynamically. Methods Totally 206 patients hospitalized at the Intensive Care Unit of a ClassⅢ Grade A hospital in Beijing from November 2016 to January 2017 were selected by convenience sampling. Then both researchers and clinical nurses measured the GCS of these patients respectively, and analyzed the differences in their GCS as well as its influencing factors by using SPSS 17.0 software. Results In the GCS evaluation, the members of the study group composed of primary nurses were completely consistent with 129 evaluations, with 62.6% accurate, but the congruence of evaluation on motor reaction was poor, accounting for 68.0%. According to Logistic regression analysis, the consistency of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, delirium and Richmond Agtation-sedation Scale(RASS) score assessment are the influencing factors of the accuracy of GCS assessment (OR=0.904, 0.389,4.980; P<0.05). Conclusions The accuracy of GCS score evaluation is low, and the accuracy of motor reaction assessment is lower than that of eye opening response and verbal response assessment. The consistency of APACHE Ⅱ score, delirium and RASS score evaluation are the main influencing factors for the accuracy of GCS assessment.

Objective:To explore the diagnosis, staging, and treatment of fibro-adipose vascular anomaly(FAVA).Methods:The data of the patients with FAVA admitted to Xi’an International Medical Center Hospital between October 2019 and February 2023 were retrospectively reviewed. Ultrasound and magnetic resonance imaging (MRI) were routinely performed. X-ray and CT were performed for patients with unequal length of lower limbs, lesions involving joints, and obvious joint deformities. The treatment plan was made according to the stage: stage Ⅰ (pain stage), open or laparoscopi radical resection of the lesion was performed; stage Ⅱ (contracture stage), radical surgery was performed to remove the lesion, sometimes combined with Achilles tendon lengthening or tenolysis, and rehabilitation training was performed 2 weeks after surgery; stage Ⅲ(deformity stage), comprehensive treatment based on surgical resection was adopted, combined with joint capsule release, Achilles tendon lengthening or dissection, tendon transfer and oral sirolimus (each time 0.08 mg/m 2, twice daily ) before and after the operation. For patients with lesions involving multiple anatomical regions, staged surgery was performed, and in principle, only one anatomical region was operated per time. Patients were followed up for pain, joint activity and recurrence. Results:A total of 42 patients were admitted, including 18 males and 24 females. The onset age was (7.3±5.0) years, but the average age of diagnosis was (12.5±6.0) years. The lower limbs were involved in 38 cases, the upper limbs in 4 cases. There were 17 cases of stage Ⅰ, 17 cases of stage Ⅱ and 8 cases of stage Ⅲ. Only 4 cases had no misdiagnosis experience, and the misdiagnosis rate was 90.5%(38/42). Persistent pain, muscle contractures and joint deformities were the main clinical symptoms of the disease. MRI showed heterogeneous high and low signal intensity on T1-weighted images, and the high signal intensity was the same as that of subcutaneous adipose tissue. T2 fat-suppressed sequences showed stronger heterogeneous hyperintensity. The follow-up time was (14.6±10.8) months. Patients who took sirolimus orally before or after surgery experienced significant relief of pain symptoms. Of the 42 patients, the symptoms of 31 patients were completely relieved after the operation, and 11 patients still had residual pain or joint movement disorder or even deformity after the operation. Sixteen of 17 stage Ⅰ patients were cured, the lesion was further expanded and the pain recurred in 1 case after the operation. Of the 17 stage Ⅱ patients, 15 were cured, and 2 had mild limitation of ankle movement after the operation. Eight stage Ⅲ patients had varying degrees of pain or joint movement disorder after surgery, postoperative oral sirolimus significantly relieved symptoms. All 10 patients with stage Ⅰ and Ⅱ who underwent endoscopic resection were cured.Conclusion:FAVA usually occurred in school-age and adolescent children. Pain, muscle contracture and joint deformity were the characteristic clinical features. Combined with MRI features, the diagnosis can be confirmed. FAVA staging system could guide treatment and predict prognosis. For stage Ⅰ and Ⅱ patients, surgery should be performed as soon as possible and the prognosis was good. For stage Ⅲ patients, surgery-based comprehensive treatment could improve symptoms, but it was difficult to cure them radically. Oral sirolimus was also required after surgery.

Objective To study the mechanism of Yangjing Zhongyu Decoction in regulating the initiation of primordial follicles in model rats with diminished ovarian reserve(DOR)based on lncRNA.Methods Three-day-old female rats were selected and their ovaries were cultured in vitro.The blank group,model group,DHEA group and Yangjing Zhongyu Decoction high-,medium-and low-dosage groups were set.The DOR model was induced by triptolide,corresponding drug containing serum was given to culture respectively.HE staining was used to observe germ cells and follicles,Western blot was used for determining the expressions of AMH,BMP15,PTEN,MST,TGF-β1,p-Smad1 protein,RT-PCR was used to detected AMH,BMP15,PTEN,MST,LTCONS-00011173,TGF-β1,Smad1 mRNA expression.Results Compared with the blank group,the number of primordial and growing follicles in the model group rats decreased(P<0.05),the expression of AMH,BMP15,TGF-β1,p-Smad1 protein in ovarian tissue decreased(P<0.05),expressions of PTEN and MST proteins increased(P<0.05),AMH,BMP15,TGF-β1,Smad1 mRNA expression decreased(P<0.05),while the expressions of PTEN,MST,and LTCONS-00011173 mRNA increased(P<0.05).Compared with the model group,the DHEA group and Yangjing Zhongyu Decoction high-and medium-dosage groups showed an increase in the number of primordial and growing follicles(P<0.05),the expressions of AMH,BMP15,TGF-β1 and p-Smad1 protein in ovarian tissue increased(P<0.05),PTEN and MST protein expressions decreased(P<0.05),AMH,BMP15,TGF-β1,Smad1 mRNA expressions increased(P<0.05),while PTEN,MST,and LTCONS-00011173 mRNA expressions decreased(P<0.05).Conclusion Yangjing Zhongyu Decoction may mediate TGF-β1/Smad1 signaling pathway through LTCONS-00011173,regulating primordial follicle initiation in DOR model rats.