Objective To observe the effect of extracorporeal shock waves (ESW) therapy on avascular necrosis of femoral head (ANFH) of stage IV. Methods 72 hips of 44 patients with ANFH of stage IV, according to Association Research Circulation Osseous, were randomly divided into treatment group (n=37) and control group (n=35). The control group received routine therapy, while the treatment group received ESW in addition, 2.0-4.0 bar, 10 Hz, 6000 times. They were evaluated with Harris Hip Score, Manual Muscle Test (MMT) and Short Form of health survey (SF-36) before and 1 month after treatment. Results The scores of Harris Hip Score and MMT improved more in the treatment group than in the control group (P<0.05) after treatment, as well as the scores of SF-36 except physical health and vitality (P<0.05). Conclusion The ESW can obviously improve the motor function and quality of life of patients with ANFH of stage IV.

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

Objective Study the diagnostic value of CT to assess the transfer of right recurrent nerve nodes(RRNN) on the thoracic esophageal squamous carcinoma,so as to provide reference for thoracic segment esophageal surgery way.Methods A retrospective analysis from January 2011 to February 2014 in the first affiliated hospital of zhengzhou university at the records of 132 cases of thoracic segment esophageal thoracic surgery with preoperative CT image data,recorded each patient's right recurrent nerve nodes in the largest length to diameter and the average CT number,and compared with postoperative pathologic results.Results With the ROC curve analysis,considering transfer when the length of RRNN' s diameter 8.5 mm or more in CT,the area under the curve is 0.911,the sensitivity is 85.7％,specificity is 78.8％.Considering transfer when the RRNN average CT number acuity 32.50 HU,the area under the curve is 0.815,the sensitivity is 85.7％,specificity is 76.9％.Whether RRNN transfer has significant correlation(P ＜ 0.05) with the length of tumor,tumor location and whether lymph node of other station transfer,doesn' t have significant correlation (P ＞ 0.05)with patients'age,sex,tumor differentiation degree and the T stage.Conclusion When the RRNN length to diameter 8.5 mm or RRNN average CT numberr acuity 32.50 HU,right recurrent nerve nodes should be considered lymph node metastasis,and choose chest conclusion laparoscopic radical prostatectomy.The upper thoracic portion esophageal tumor's length is 5 cm or more,or clinical suspected lymph node metastasis of other station is the risk factor for metastasis of RRNN.

Objective To evaluate the efficacy and safety of double guidewire technique in perforation of duodenal papilla caused by guide wire during endoscopic retrograde cholangiopancreatography ( ERCP ) intubation. Methods A retrospective analysis was performed on data of 57 patients whose duodenal papilla were perforated by guidewire in ERCP from January 2008 to September 2016. Among the 57 patients, 30 patients were cannulated with double guidewire technique ( double guidewire group ) and 27 patients were performed with traditional technique ( standard group ) for continue. The biliary intubation success rate, intubation time, and post-ERCP complication rate were compared between the two groups. Results The rate of successful intubation of the double guidewire group was significantly higher than that of the standard group[96. 7％ (29/30) VS 74. 1％ (20/27),χ2=5. 545, P=0. 019]. The intubation time of the double guidewire group was significantly shorter than that of the standard group (21. 8±7. 8 min VS 40. 7 ±8. 4 min, t=8. 076, P=0. 000). The double guidewire group had a similar incidence of post-ERCP complication compared to the standard group[ 13. 3％ ( 4/30) VS 11. 1％ ( 3/27) ,χ2=0. 292, P=0. 596] , and the complication in two groups was hyperamylasemia. Conclusion Double guidewire technique is safe and effective for difficult biliary cannulation because of perforation of duodenal papilla with a higher success rate and less time compared to classic technique.

Objective To compare the safety and effectiveness of endoscopic retrograde biliary drainage ( ERBD ) and endoscopic nasobiliary drainage ( ENBD ) in treatment of acute cholangitis. Methods A retrospective analysis was performed on data of 272 patients with acute cholangitis who underwent emergent endoscopic retrograde cholangiopancreatography ( ERCP ) in Beijing Chaoyang Hospital from January 2009 to June 2017. Patients were divided into ERBD group ( n=143) and ENBD group ( n=129) according to the drainage measures. In the ERBD group, there were 63 cases of gradeⅠ(mild) acute cholangitis, 51 of grade Ⅱ ( moderate) , and 29 of grade Ⅲ ( severe) , and the corresponding cases in the ENBD group were 54, 37 and 38, respectively. The rate of improvement of inflammation, ERCP-related complications and interventions to drainage were compared between the two groups in all patients and each grade. Results The rates of improvement of inflammation in the ERBD group and the ENBD group were 89. 5％ (128/143) and 94. 6％ (122/129), respectively, in overall patients (χ2=2. 399, P=0. 126), 93. 7％ (59/63) and 98. 1％ (53/54), respectively, in grade Ⅰ patients (χ2 =0. 548, P=0. 459), 90. 2％ (46/51) and 94. 6％ (35/37), respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 79. 3％ (23/29) and 89. 5％ (34/38), respectively, in grade Ⅲ patients (χ2=0. 657, P=0. 418). The incidence of ERCP-related complications in the ERBD group and the ENBD group were 11. 9％ ( 17/143) and 7. 8％ ( 10/129) , respectively, in overall patients (χ2=1. 298, P=0. 225) , 9. 5％ ( 6/63) and 7. 4％( 4/54) , respectively, in grade Ⅰ patients (χ2=0. 006, P=0. 939) , 13. 7％ ( 7/51) and 8. 1％ ( 3/37) , respectively, in grade Ⅱ patients (χ2=0. 230, P=0. 632), and 13. 8％ (4/29) and 7. 9％ (3/38), respectively, in grade Ⅲ patients (χ2=0. 144, P=0. 705) . There were no significant differences in the rate of improvement of inflammation and ERCP-related complications between the two groups. The incidences of interventions to drainage in the ERBD group and the ENBD group were 10. 5％ ( 15/143 ) and 3. 1％(4/129), respectively, in overall patients (χ2=5. 699, P=0. 017), 6. 3％ (4/63) and 1. 9％ (1/54), respectively, in grade Ⅰ patients (χ2 = 0. 548, P = 0. 495 ) , 9. 8％ ( 5/51 ) and 5. 4％ ( 2/37 ) , respectively, in grade Ⅱ patients (χ2=0. 125, P=0. 724), and 20. 7％ (6/29) and 2. 6％ (1/38), respectively, in grade Ⅲ patients (χ2 = 3. 965, P= 0. 046 ) . There were significant differences in the incidence of interventions to drainage between the two groups in overall and gradeⅢpatents. Conclusion ERBD and ENBD are equally safe and effective in treatment of different grades of acute cholangitis, but ENBD can reduce the incidence of interventions to drainage.

OBJECTIVE To optimize the management of the China Listed Drug Patent Information Registration Platform as well as to provide guidelines and references for generic drug enterprises to carry out generic research， production and launch in order to further improve the drug patent linkage system. METHODS The used method is to log in and search the National Medical Products Administration （NMPA）， China Listed Drug Patent Information Registration Platform， China National Intellectual Property Administration （CNIPA） and other websites. The search content included the Chinese drug patent declaration system and other legal or policy information， as well as registration data for class 1 drug patent declarations in China. The above data were mined as a whole together with analysis of the varieties with a high composite ranking in the quantity with class 1 declaration； the improvement measures for China’s class 1 declaration system for generic drugs were put forward based on the practice of Chinese pharmaceutical market. RESULTS & CONCLUSIONS Class 1 drug patent declarations of chemical generic drugs accounted for over 99% of the total， and there were 5 varieties among the top 5 in the number of class 1 patent declarations （e.g. Tadalafil tablets， Sodium hyaluronate eye drops）. Based on the analysis of the overall situation and individual cases， it is suggested that China should improve its drug patent linkage system； improve functions of China Listed Drug Patent Information Registration Platform by establishing relief mechanism of right-to-know and ex officio examination； help companies select generic drug varieties timely by strengthening data tracking of generic drug companies during the pending approval period and adding a generic drug variety screening function.

BACKGROUND:Sarcopenia refers to age-related progressive,systemic muscle mass reduction and/or muscle strength decline or muscle physiological function decline,which is related to the occurrence of a variety of adverse outcomes in older adults.Exercise is considered to be one of the main strategies for combating sarcopenia in older adults,but there is a lack of specific intervention methods of different exercise patterns to intervene in sarcopenia. OBJECTIVE:To elaborate the main influencing factors of sarcopenia and the research progress of different exercise methods to improve sarcopenia in older adults,providing reference and basis for combating sarcopenia in older adults. METHODS:Web of Science,PubMed,CNKI,VIP,WanFang databases were retrieved for relevant literature published from January 2000 to October 2023 using the keywords of"sarcopenia,sport,exercise intervention,resistant training,aerobic exercise,whole body vibration training,mixed training,physical performance,muscle strength,muscle mass"in Chinese and English,respectively.A total of 126 articles were included for review. RESULTS AND CONCLUSION:Resistance exercise is still the most effective way to prevent and treat senile sarcopenia,and the effect of high-intensity resistance exercise is more significant.However,in practical application,we should pay attention to the gradual increase of training load intensity.Aerobic exercise combined with resistance exercise is more effective to improve muscle mass and function in the elderly than a single exercise mode.It is suggested that older adults can carry out the transition of low-intensity aerobic exercise in the early stage and increase resistance exercise individually in the late stage.Whole body vibration training is a new treatment method for the prevention and treatment of senile sarcopenia,but particular attention should be paid to the effects of frequency,amplitude,and duration on patients during practical application.Multicomponent exercise combines different exercise modes,which can give full play to their respective advantages,so as to personalize exercise interventions.

In 2020, two formulations of botulinum toxin type A (BoNT-A)named AbobotulinumtoxinA(Dysport ?) and LetibotulinumtoxinA(Letybo ?) have been officially approved by National Medical Products Administration to come on the market. To compare BoNT-As with different formulations, three BoNT-As[AbobotulinumtoxinA, OnabotulinumtoxinA(Botox ?), IncobotulinumtoxinA(Xeomin ?)] with relatively more clinical evidences internationally and two domestic BoNT-As[LanbotulinumtoxinA(Prosigne ?), LetibotulinumtoxinA] were included. Diffusion scale, conversion ratio, onset, duration and immunogenicity of different BoNT-As were reviewed in detail to provide reference for clinical practice.

In 2020, two formulations of botulinum toxin type A (BoNT-A)named AbobotulinumtoxinA(Dysport ?) and LetibotulinumtoxinA(Letybo ?) have been officially approved by National Medical Products Administration to come on the market. To compare BoNT-As with different formulations, three BoNT-As[AbobotulinumtoxinA, OnabotulinumtoxinA(Botox ?), IncobotulinumtoxinA(Xeomin ?)] with relatively more clinical evidences internationally and two domestic BoNT-As[LanbotulinumtoxinA(Prosigne ?), LetibotulinumtoxinA] were included. Diffusion scale, conversion ratio, onset, duration and immunogenicity of different BoNT-As were reviewed in detail to provide reference for clinical practice.

Objective To explore whether oxygen saturation-related dispersion index can be used as a non-invasive index for nurses to monitor ARDS patients' oxygenation and conditions.Methods Totally 23 patients with mechanical ventilation-associated complication and ARDS admitted in Peking Union Medical College Hospital between April 2015 and April 2016 were reviewed. Their PaO2, SpO2, PEEP and FiO2 values were recorded, and oxygenation index (OI) and oxygen saturation-related dispersion index were calculated for 132 case-times, respectively.Results The patients in the death group showed lower OI and oxygen saturation-related dispersion index than the patients in the survival group (P<0.05). The difference in oxygen saturation-related dispersion index between the light, middle and heavy groups were statistically significant (P<0.05).Conclusions Oxygen saturation-related dispersion index can be used to determine the prognosis of ARDS patients and the severity of the disease, especially the conditions of severe ARDS patients. As a non-invasive and continuous indicator, it provides a new measure for the nursing assessment of patients with mechanical ventilation-associated complication and ARDS.