Promoting the construction of a “Healthy China” is essential to building a great modern socialist country. Health workers in every era have their historical missions and they are the “benevolent doctors” of their own era. Therefore， clarifying the basic connotation and times requirements of “benevolent doctors” has become the first question to be answered in cultivating “benevolent doctors”. The basic connotation of “benevolent doctor” should reflect not only the comprehensive development of moral， intellectual， physical， aesthetic， and labor education in fostering virtue and nurturing talents， but also embody the people-centered development philosophy， promote social equity and justice， and reflect the strategic needs of building a “Healthy China.” Specifically in the practice of medical education， emphasizing both medical science spirit and medical humanities spirit has become an important path to cultivate “benevolent doctors” in the new era.

Bortezomib exerts its anti-myeloma effect by reversibly inhibiting the proteasome through various mechanisms, and it is currently the first-line drug for the treatment of multiple myeloma in China. Bortezomib-induced peripheral neuropathy is one of the most common dose-limiting adverse reactions in the treatment process, which seriously affects the quality of life of patients, leading to dose reduction or even drug withdrawal. How to reduce or prevent Bortezomib-induced peripheral neuropathy remains a challenging problem in the treatment of multiple myeloma. Based on this, this article reviews the pathogenesis of Bortezomib-induced peripheral neuropathy from the perspectives of Schwann cells, neurons, astrocytes, macrophages, and other aspects.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Nanomedicine is charactered with a high specific surface area, diversified structure and function, and charged surface. It can realize the targeted therap by functional modification of surface or introducing the stimuli-responsive unit. Therefore, nanomedicine is increasingly being concerned. Because nanomedicine can accumulate efficiently in the lungs, drug delivery systems based on nanotechnology have broad prospects in the field of the diagnosis, prevention, and treatment in pediatric lung diseases. Herein, we reviewed the research progress of nanomedicine in pediatric lung diseases, especially in respiratory syncytial virus infection and cystic fibrosis.

To unravel the genetic mechanisms of disease and physiological traits, it requires comprehensive sequencing analysis of large sample size in Chinese populations. Here, we report the primary results of the Chinese Academy of Sciences Precision Medicine Initiative (CASPMI) project launched by the Chinese Academy of Sciences, including the de novo assembly of a northern Han reference genome (NH1.0) and whole genome analyses of 597 healthy people coming from most areas in China. Given the two existing reference genomes for Han Chinese (YH and HX1) were both from the south, we constructed NH1.0, a new reference genome from a northern individual, by combining the sequencing strategies of PacBio, 10× Genomics, and Bionano mapping. Using this integrated approach, we obtained an N50 scaffold size of 46.63 Mb for the NH1.0 genome and performed a comparative genome analysis of NH1.0 with YH and HX1. In order to generate a genomic variation map of Chinese populations, we performed the whole-genome sequencing of 597 participants and identified 24.85 million (M) single nucleotide variants (SNVs), 3.85 M small indels, and 106,382 structural variations. In the association analysis with collected phenotypes, we found that the T allele of rs1549293 in KAT8 significantly correlated with the waist circumference in northern Han males. Moreover, significant genetic diversity in MTHFR, TCN2, FADS1, and FADS2, which associate with circulating folate, vitamin B12, or lipid metabolism, was observed between northerners and southerners. Especially, for the homocysteine-increasing allele of rs1801133 (MTHFR 677T), we hypothesize that there exists a "comfort" zone for a high frequency of 677T between latitudes of 35-45 degree North. Taken together, our results provide a high-quality northern Han reference genome and novel population-specific data sets of genetic variants for use in the personalized and precision medicine.

Objective To study the effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment. Methods A total of 60 adult healthy male Wistar rats were randomly divided into normal (N) group, hypoxia model (M) group, rhodiola crenulata (RC) group, low dose of gastrodin (GAS-L) group, medium dose of gastrodin (GAS-M) group and high dose of gastrodin (GAS-H) group (10 for each group). The intragastric administration on rats was continued for 7 days timely in each day. Under simulated 8000m altitude using low pressure oxygen cabin, the arterial blood gas of each group were tested, pathological changes of brain tissues were observed and related indexes of brain were detected after 12h hypoxia. Results Comparing with group N, the blood oxygen partial pressure (PO2), value of blood oxygen saturation (SO2), oxygenation index (PO2/FIO2), Na+ concentration (Na+), actual bicarbonate radical (HCO3–) significantly decreased (P<0.01), lactic acid (Lac), hemoglobin concentration (Hb) significantly increased (P<0.01) and pathological damage was inflicted in group M; and contents of malondialdehyde (MDA), hydrogen peroxide (H2O2) in brain tissue significantly increased (P<0.01), content of glutathione(GSH) and activity of glutathione peroxidase (GSH-Px) in brain tissue significantly decreased (P<0.01) in group M. Compared with group M, PO2, SO2 and PO2/FIO2 significantly increased (P<0.01, P<0.05) in group GAS-L; Na+ and HCO3– significantly increased (P<0.01, P<0.05) in three dose groups of GAS; Lac significantly decreased (P<0.01, P<0.05) in group GAS-L and GAS-H. Hb significantly increased (P<0.01) in group GAS-H, a rising trend appeared in group GAS-L but with no statistical significance. Damages of brain tissue were alleviated in group RC and three dose groups of GAS comparing with group M. Compared with group M, MDA significantly decreased (P<0.01) in three dose groups of GAS; there was a decreasing trend of H2O2 but with no statistical significance in three dose groups of GAS; GSH and GSH-Px significantly increased (P<0.01, P<0.05) in three dose groups of GAS. However, three groups of GAS has no dose dependent. Conclusion There was an protective effect of gastrodin on arterial blood gas and brain injury of rats under simulated high altitude hypoxia environment.

ObjectiveTo analyze complications following the treatment of peri-knee fracture or nonunion by locking plates.Methods From January 2005 to May 2009, we used internal fixation with a locking plate to treat 106 closed peri-knee fractures in 97 patients (46 distal femoral fractures and 60 proximal tibia fractures). There were 85 cases of fresh fracture and 21 cases of nonunion. They were 62 males and 35 females, with an average of 34.8 years (from 18 to 54 years). The patients were followed up monthly for The Hospital for Special Surgery (HSS) scores and complications. Analyses were done to find associations between complications and gender,injury cause,injury type,facture type and operation time. ResultsThe follow-ups averaged 23.8 months (from 10 to 32 months ). The 46 distal femoral fractures obtained an average HSS score of 83.4 points one year after operation and had a complication rate of 32.6 ％ ( 15 cases); the 60 proximal tibia fractures obtained an average HSS score of 86. 4 points one year after operation and had a complication rate of 16.7 ％ (10 cases). There were no significant associations between complication rate and gender, injury cause, injury type and fracture type ( P ＞ 0. 05). There was a significant association between complication rate and operation time(x2 = 5.440, P = 0. 015).Conclusions Although locking plates are a new and effective treatment for peri-knee fracture or nonunion, they still have drawbacks. Indications should be strictly followed and care should be taken to avoid postoperative complications as much as possible.

Objective To summarize the clinical outcomes of reconstruction of malunited ankle fractures.Methods From January 2006 to October 2009,23 malunited ankle fractures were treated in our department.All deformities were evaluated individually based on pre-operatively X-ray and CT scan.Varying degrees of fibular shortening or rotational deformity were found in all patients,with 4 cases of varus or valgus deformity,and 5 of a widen syndesmosis.Then different reconstructive techniques were chosen according to the type of malunion:a lengthening fibular osteotomy was performed in patients with fibular shortening or rotational deformity;an opening or closing wedge osteotomy was chosen correspondingly in patients with varus or valgus deformity;functional fusion of syndesmosis was performed in cases of widen syndesmosis.The postoperative follow-up included standard radiography to evaluate bone union;relative complications were also recorded and functional outcome were assessed with American Orthopedic Foot Ankle Society (AOFAS)ankle-hindfoot scores.Results Twenty-one patients were followed up with an average period of 36 months (12-58 months).There were no complications of infection,implant failure,nonunion or malunion.Solid union with a favorable alignment was obtained at an average of 12 weeks (10-14 weeks).The mean pre-operative AOFAS ankle-hindfoot score was 28 (15-39).While the score increased to 82 (70-94) one year after operations.But 2 patients underwent ankle arthrodesis correspondingly 18 months and 24 months post-operatively due to severely post-traumatic arthritis.Conclusion An early realignment reconstruction of the length and rotation of fibula and the congruity of ankle mortise may improve the ankle function and slow down the development of post-traumatic arthritis for patients who suffered from malunited ankle fractures.

Objective To compare the clinical results of minimally invasive percutancous plate os-teosynthesis (MIPPO) and open reduction with internal fixation (ORIF) for treatment of distal tibial fractures. Methods From October 2006 to June 2007, 94 cases of closed distal tibial fracture with intact articular surface were treated by internal fixation with plates. Of them, 42 were treated with ORIF and 52 with MIPPO. We retrospectively analyzed their union time, malunion and complications. Results The average follow-up was 14.5 (8 to 24) months. In the ORIF group, 35 cases got union, 3 cases delayed union and 4 cases nonunion. The average time for union was 3.83 (3 to 8) months. There were no cases of malunion and 2 cases of superficial infection in this group. In the MIPPO group, 47 cases obtained union, 5 cases delayed union and none nonunion. The average time for union was 3.66(2 to 8) months. No significant differences were found between the 2 groups in total union time or in the union time for Type AI, Type A2 and Type B fractures respectively. The union time for Type A3 fracture was longer in the MIPPO group than in the ORIF group, but the union time for Type C fracture in the MIPPO group was shorter than in the ORIF group. In the MIPPO group, external rotation occurred in 2 cases and posterior angnlation displacement in 3, and 8 cases com-plained of discomfort around the ankle which was relieved after removal of the plate. Conclusions Gen-erally speaking, there is no significant difference between ORIF and MIPPO in union time for distal tibial fractures. ORIF may be superior to MIPPO in treatment of Type A3 fracture, but inferior to MIPPO in treatment of Type C fracture. A high rate of delayed union may be expected in patients who have been treated with MIPPO and have had anteroposterior angnlation.

BACKGROUND: Re-injury of organism and sufficient of materials exist in the autologous transplantation of tendon to treat defected tendon following trauma. Carbon fiber artifical tendon, human hair tendon and other artifical tendons are also proved to be transplantable. But immunological rejection and biomechanical inadaptability exist following artifical tendons are transplanted. Therefore, the development of new human tendon substitute is the major problem to be solved at present.OBJECTIVE: To observe the porcine small intestinal submucosa as artificial tendon to repair 2 cm tendon defect of the 3rd toe of the left and right feet of chicken, and the immunological rejection and biomechanical adaptability following repair.DESIGN: A randomized and controlled animal experiment.SETTING: Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University.MATERIALS: Totally 45 Leghorn chickens, aged 12 weeks, of either gender, with body mass of 4.0 to 4.4 kg, were chosen.METHODS: This experiment was conducted at the Department of Orthopaedics, Sixth Hospital Affiliated to Shanghai Jiaotong University from September 2002 to June 2003. ① Totally 45 Leghorn chicken, aged 12 weeks, were randomly divided into 3 groups. The third toe of the left and right feet was chosen from 20 chicken respectively of autologous transplantation group and porcine small intestinal submucosa group, flexor digitorum profundus muscle tendon was cut off at middle phalanx, and 2 cm tendon defect model was created. The defected tendon in the autologous transplantation group was performed in situ suture; the defected tendon in the porcine small intestinal submucosa transplantation group was repaired with porcine small intestinal submucosa; There was not any treatment on the 5 Leghorn chicken in the blank control group. ② Histomorphologyl, transplantation immunology, biomechanics and functional recovery were measured at 3,6 and 9 weeks following tendon transplantation.MAIN OUTCOME MEASURES: ① Gross observation of operated toes of chicken and optical observation of grafts in each group. ② White blood cell (WBC) differential count at 3 days preoperation,3 days postoperation,and 1 week and 2 weeks postoperation. ③ Biomechanical test and functional recovery test of chicken in each group.RESULTS: Totally 45 chicken entered the stage of result analysis. ① At 9 weeks after operation, morphology of porcine small intestinal submucosa was basically the same as that of normal tendon by naked eyes; Under optical microscope, fibroblasts on the porcine small intestinal submucosa arranged in order along long-axis and collagen extracellular matrix appeared.② Within 2 weeks after operation, there was no significant difference of WBC measurement between porcine small intestinal submucosa transplantation group and autogolous transplantation group (P ＞ 0.05), suggesting that porcine small intestinal submucosa, as xenogenic material, has no obvious immunological rejection. ③ In the biomechanical test, biomechanical adaptability at postoperative 12 weeks was superior in the porcine small intestinal submucosa group to in the autologous transplantation group [(22.22±0.90),(20.78±0.94) ,P ＜ 0.05]. ④ In the test of functional recovery, there was no obvious difference of activity of metecarpophalangeal joint (P ＞ 0.05), the activity of proximal interphalangeal joint was superior in the blank control group to in the porcine small intestinal submucosa group and autologous transplantation group [(21.0±1.6)°, (15.1±1.7)° , (16.0±2.1)° ,P ＜ 0.05].CONCLUSION: There is no evidence of immunological rejection after porcine small intestinal submucosa is transplanted into the body of chicken. Therefore, porcine small intestinal submucosa can be used as the xenogenic material to repair tendon defect.