Based on the theory of "one qi circulation" founded by HUANG Yuanyu， the core disease mechanism of colorectal cancer is the innate spleen deficiency and stomach qi failing to bear downward， which leads to the turbidity assemble in large intestine， forming the carcinoma toxin， and ultimately transforms into colorectal cancer. The treatment should base on recovering the circulation of qi， Huangya Decoction （黄芽汤） as the basic formula， the circulation of qi ascending and descending as the base， adjusting ascending and descending together with Xiaqi Decoction （下气汤）， and differentiating the syndrome on yin-yang excess-deficiency； for spleen-kidney yang deficiency syndrome， treated with Tianhun Decoction （天魂汤） to supplement liver， kidney and assist yang； for liver-kidney yin deficiency syndrome， treated wtih Dipo Decoction （地魄汤） to supplement lung， kidney， and assist yang. They jointly prompt one qi circulation to provide the thoughts for the treatment of colorectal cancer by traditional Chinese medicine.

Objective:To explore the research hotspots and development trends of the transformation of virtual skill training to practical clinical ability in current medical simulation education, and to conduct visual bibliometric analysis.Methods:Taking 783 pieces of literature related to the transformation of simulation skill training to clinical competence collected from the Web of Science core collection database from 2006 to 2020 as data sources, CiteSpace V was used for visualization processing and analysis, so as to reveal the transformation effect and future research direction.Results:The number of published papers and citations increased exponentially with each year. The United States and Canada were the main research forces, the University of Toronto Medical Center contributed the largest number of research, and Professor McGaghie of Northwestern University was the author with the most published articles. According to the literature co-citation cluster analysis, it is found that the transformation of simulation skill training includes both operation and non-operation skills. High-frequency cited references reflect the knowledge base of this field and research to a certain extent. Research frontiers include the improvement of virtual reality simulators, clinical outcomes of simulated training in pediatrics, nursing, and emergency disciplines, and the design of randomized controlled clinical trials.Conclusion:The research on the clinical effect verification of simulation skill training is developing rapidly in the world. The research on medical skills' transformation represented by minimal invasive surgery such as endoscopy is a hot topic. Non-operational skills including communication skills, teamwork, pediatric emergency skills, and virtual reality technology simulation effects are the research frontiers. The number of researches on the effect of simulation training is small and the effect is unclear. In the future, more randomized controlled studies are still needed to determine the effectiveness of the transformation of simulation training to clinical competence.

A 6-year-old girl presented with recurrent skin rash at the initial stage, recent joint pain, and neutrophilia was found during a routine blood test. After a multidisciplinary case discussion, she was diagnosed with chronic neutrophil leukemia, and the symptoms were relieved after hydroxyurea and luxolitinib treatment. She received the allogeneic hematopoietic stem cell transplantation subsequently. At present, she is in stable condition and under follow-up. Chronic neutrophil leukemia is a rare disease, which rarely occurs in children. It is more difficult to diagnose in patients with skin rash as the first manifestation. The diagnosis and treatment of this case reflects the important role of multidisciplinary cooperation in the diagnosis and treatment of difficult and rare diseases.

BACKGROUND:Polyvinyl alcohol (PVA) hydrogel with similar porous structure and mechanical properties to the natural cartilage is very suitable for the repair of articular cartilage. However, the pure PVA hydrogel after lyophilization wil be accompanied by the shrinkage of the polymer network and the col apse of the pores, leading to the inhomogeneous performance of the material even in the state of re-swel ing. Addition of the active polymer wil increase the cel adhesion ability of PVA hydrogel. OBJECTIVE:To construct PVA/lota-carrageenan (l-CA) composite materials with different mass fractions of l-CA and evaluate the biocompatibility with vascular endothelial cel s. METHODS:PVA/l-CA composite films with different contents of l-CA were fabricated and then co-cultured with vascular endothelial cel s. Attachment, proliferation and morphological changes of vascular endothelial cel s on the composite were observed by scanning electron microscope and MTT assay to evaluate its biocompatibility. PVA/l-CA three-dimensional scaffold with different contents of l-CA were constructed, and hemolysis experiment was conducted according to the biological evaluation standards of medical devices, and the porosity and pore size were observed using scanning electron microscope. RESULTS AND CONCLUSION:In vitro experimental results showed that the addition of l-CA could significantly increase the biological activity of PVA hydrogel, and promote the cel attachment and proliferation on the scaffold. The hemolysis rate of each experimental group was less than 5%(the accepted safety standard), suggesting that the composite materials were in accordance with the standard of medical devices for hemolysis experiment. These findings indicate that the composite scaffolds with 20%-30%l-CA possess the pore size suitable for cel growth and proliferation and the porosity beneficial for transportation of nutrients and metabolites, which can serve as an excel ent scaffold for tissue engineering.

Objective: To investigate the effect of cartilage tissue engineering scaffold PVA/ι-CA on the biological behavior of the ATDC-5 cells,and to evaluate its feasibility on constructing tissue engineering cartilage. Methods:The polyvinyl alcohol (PVA)and carrageenan were used to make the composite scaffold material PVA/ι-CA according to a certain proportion by physical blending technology and repeated freezing thawing method,and the porosity and pore size of PVA/ι-CA were detected.The ATDC-5 cells were seeded into the composite scaffold and its growth was observed; the expressions of collagen type Ⅱ in the ATDC-5 cells were tested by immunohistochemical staining and immunofluorescence staining; the morphology of the ATDC-5 cells was confirmed by Toluidine blue staining.The growth and secretion of extracellular matrix of the ATDC-5 cells were observed under scanning electron microscope (SEM);the proliferative rates of ATDC-5 cells in composite scaffold materials in negative control group (added with DMEM culture media)and experimental group (added with DMEM contain scaffold)were determined by MTT assay.The composite scaffolds were implanted subcutaneously in the SD rats.The histocompatibility and vascularization in vivo of the composite scaffolds were evaluated.Results:The average porosity of cartilage tissue engineering scaffold PVA/ι-CA was (86.88±3.88)%,and the average pore size was 20-40 μm.The HE staining results showed that the ATDC-5 cells grew well with the polygon and plumpness morphology. All the samples were stained positive for collagen type Ⅱ by immunohistochemistry and immunofluorescence staining,which verified the normal phenotype of chondrocytes on the scaffolds. All the sample were stained positive for toluidine blue staining,which verified ECM deposition of the ATDC-5 cells on the scaffolds.The number of the positive cells was significantly increased with the prolongation of time.After cultured for 7 d,few of the ATDC-5 cells presented polygonal;after cultured for 14 d,the ATDC-5 cells distributed more densely,and contacted with each other on the scaffold;after cultured for 21 - 28 d,the ATDC-5 cells filled the interconnected pores of the scaffolds,synthesizing a significant amount of neo-formed ECM.The proliferation of ATDC-5 cells in PVA/ι-CA grew fast during 7-14 d,and it became slow during 21-28 d;the difference was not statistically significant compared with control group (P >0.05).The subcutaneous implantation results showed the inflammatory reactions were slight at the early stage and eviated gradually,there was an increasing angiogenesis at the late stage,and the degradation and absorption of the meterial were slight.Conclusion:PVA/ι-CA composite material will be an ideal material for the cartilage tissue engineering.

Objective: To explore auxiliary diagnostic value of fragmented QRS complex on ECG for acute myocardial infarction (AMI).Methods: Clinical data of 102 AMI patients (AMI group) and 132 CHD patients (CHD) group, who were treated in our hospital from Apr 2013 to Apr 2014, were retrospectively studied, another 120 healthy subjects undergoing physical examination in our hospital during the same period were regarded as normal control group.AMI was diagnosed by myocardial perfusion tomography, all subjects received ECG examination, and incidence rates of fragmented QRS complex and pathological Q wave at different sites were recorded.Sensitivity, specificity and accuracy of fragmented QRS complex and pathological Q wave diagnosing AMI were compared.Results: Incidence rate of fragmented QRS complex was highest on inferior wall in AMI group, and that of pathological Q wave was highest on anterior wall in AMI group.Except fragmented QRS complex in sidewall, compared with normal control group, there were significant rise in incidence rates of fragmented QRS complex on anterior wall (0.8% vs.22.5%, 13.6%) and inferior wall (6.7% vs.26.5%, 17.4%);pathological Q wave on anterior wall (0 vs.41.2%, 29.5%), inferior wall (0.8% vs.40.2%, 35.6%) and side wall (0 vs.2%, 2.3%) in AMI group and CHD group, P<0.01 all.Compared with pathological Q wave, there was significant rise in diagnosing sensitivity for AMI (40.00% vs.89.47%), for CHD (41.94% vs.91.50%) of fragmented QRS complex (P<0.01 both), but there were no significant difference in specificity and accuracy between them (P>0.05 all).Conclusion: Fragmented QRS complex can be used as an important auxiliary index diagnosing acute myocardial infarction.When combined with pathological Q wave, it can further improve diagnostic value of ECG for acute myocardial infarction.

Objective To introduce a new method of trans-superior limb of cerebellopontine fissure approach for exploring and managing superomedial responsible vessels of facial nerve of patients with hemifacial spasm.Methods Clinical data of 21 patients with hemifacial spasm among 183 consecutive patients were analyzed retrospectively in our hospital from February 2009 to December 2013.Dissection of the superior limb of the cerebellopontine fissure was performed to explore the distribution and the severity of compression of the superomedial responsible vessels of the facial nerve,and microvascular decompression was performed.Results Neurovascular compression was found in all of the patients,primary responsible vessels were found in 13 patients,and secondary responsible vessels were found in 8 patients.Complete spasm alleviation was achieved immediately after operation in 18 patients,and complete spasm alleviation was achieved in all of the patients 3 months after operation.No severn complications occurred and no patient died.No recurrence was noted after an average 56 months of follow-up.Conclusion The trants-superior limb of cerebellopontine fissure approach could avoid the defects of standard suboccipital retrosigrnoidal approach,which allows easy identification and management of the superomedial responsible vessels of the facial nerve of patients with hemifacial spasm;thus,high consistent successful rate and low complication rate could be found.

Because TCM transdermal medicine delivery preparations are hot spots in domestic researches, the rational application of penetration enhancers in prescriptions and the evaluation methods become increasingly important. This article reviewed the recent application of natural penetration enhancers and synthetic penetration enhancers in the prescription design of TCM transdermal medicine delivery preparations, and analyzed the existing problems and development prospects.

BACKGROUND:Some studies have showed that the accuracy and surgery outcome of the percutaneous pedicle screw implantation was superior to open surgery, but the relationship between the angle of pedicle screws and screw stability is stil unclear in previous studies. OBJECTIVE:To investigate the effect of different angles of implanted screws on the stability of pedicle screw. METHODS:A total of 30 vertebral specimens of adult pigs were selected and screws were implanted respectively according to different coronal and sagittal angles. The maximum pul-out strength of screws from each specimen was tested by machine. Load-displacement curves were drew and statistical y analyzed. RESULTS AND CONCLUSION:The maximum pul-out strength and maximum energy of screw with 10° and 15° coronal and sagittal angles implantation were significantly better than those of 0° angle group (P<0.05). When the stress exceeded the maximum pul-out strength, the pul-out strength of screw decreased gradual y. The curves in coronal and sagittal 10° and 15° angle groups was similar, and the slope was better than 0° angle group (P<0.05). These results confirm that the angle of the implanted screw provides effective assistance to the stability of percutaneous pedicle screw. After the looseness of the screws, the pul out strength shows a steady downward trend.

Objective To investigate the knowledge about risk factors for stroke in stroke patients. Methods 1043 stroke patients in 10 hospitals were investigated with self-designed questionnaire. Results The rate of awareness of risk factors for stroke was: hypertension 61.55%, hyperlipidemia 40.27%, drinking 32.21%, smoking 30.11%, diabetes mellitus 28.67%, heart disease 23.11%. 6.42% knew all the 6 risk factors, and 20.13% did not know any risk factor. The rate of awareness of diabetes mellitus was different among various aged groups (P<0.01), and the rate of awareness of hypertension, hyperlipidemia, and diabetes mellitus increased with the years of education. Conclusion The stroke patients know less about the common risk factors for stroke, who need more health education.