Objective To explore the indications,feasibility and clinical outcome of minimally invasive laminoplasty for cervical spondylotic myelopathy (CSM) using microendoscopic technique.Methods From January 2011 to December 2013,51 patients with CSM treated by this technique in our hospital were reviewed in this study.All these patients were followed up at least 9 months.There were 28 males and 23 females with a mean age of 58 years (range 41-76 years).All patients were found to have cervical disc herniation with spinal cord compression.Among these patients,2 segments (C5-6),3 segments (C3-5/C4-6),4 segments (C3 -6) and 5 segments (C3-7) laminoplasty performed in 5,7,22 and 17 cases respectively.Therapy effect and axial symptom were evaluated according to Japanese Orthopedic Association (JOA) scores and visual analogue scales (VAS) respectively.Cervical curvature index (CCI) and range of motion (ROM) were judged by X-ray.The sagittal diameter of cervical spine,canal enlargement and bony healing were judged by CT scans.Spinal cord signal intensity changes and spinal cord decompression status judged by MRI.Statistical analysis of JOA score,VAS score,CCI and ROM were performed by paired design t test.Results The mean operative time was (1 15±21.9) min,ranging 58-139 min.The mean blood loss was (227.8±73.2) ml,ranging 110-380 ml.The followe-up time ranged 9-36 months with an average of (20±5.9) months..The mean JOA scores had improved from 8.02± 1.69 pre-operatively to 13.02± 1.48 post-operatively.The results were excellent in 17 cases,good in 28 and fair in 4.The VAS scores of axial pain significantly improved to 2.22±0.90 at the final follow-up compared with 4.96± 1.39 preoperatively.Axial symptom were excellent in 18 cases,good in 21 and fair in 12.Pre-operative was 15.40％±4.50％ and postoperative was 15.09％±4.87％,there was no significant difference.ROM of pre-operative was 40.98°±8.27° and postoperative was 38.88°±9.53°,and there was no significant difference.The sagittal diameter of the spinal canal increased 1.3-3.2 mm postoperatively with an average of (2.32±0.42) mm.A total of 204 vertebral lamina were bilaterally slotted and fixed.146 lamina were observed bone healing at the last follow-up.The bone healing rate was 71.6％.Complications such as upper limb motion dysfunction occurred in 1 case muscle strength restored after treatment of methylprednisolone sodium succinate,and little screw looseness in occurred 1 case,and non special treatment was given..Conclusion CMEL is a newsurgical approache which causes less damage to the spinous process-ligament complex and the deep extensor muscles,and the procedure can be used for CSM effectively and safely.

Objective:To improve the centralized bidding procurement practice of essential medicine in China. Methods:By using literature review, comparative analysis and field investigation, implementation plans and regula-tions of the centralized bidding procurement of essential medicines in 30 provinces were collected and analyzed. Re-sults:There are differences in the operating organization, scope of implementation, purchasing cycle, bidding pro-curement mode, judgment criteria and other aspects among provinces. Conclusion: The progress of the implementa-tion of the centralized bidding procurement practice of essential medicine under the request of Document No. 56 of the State Council differed greatly among the provinces. The government should adhere to the centralized bidding procure-ment practice of essential medicine, give full play to the advantages of group purchasing, explore approaches of medi-cal insurance institutions participating in the centralized bidding procurement practice, and perfect the assessment of drug quality to assure the quality of essential medicine.

Objective:The paper aims to provide recommendations for improving the essential medicines’ cen-tralized bidding procurement and quantity-based pricing policy. Methods: Based on the documents and literature on essential medicines’ centralized bidding procurement, we analyzed the factors which have a great impact on implemen-tation of the quantity-based pricing in essential medicines’ centralized procurement using the text research, semi-structured interview questionnaire and on-phone interviews. Results:The quantity-based pricing needs to define a ge-neric name and specific dosage form of drugs in the essential medicines’ centralized procurement. Its implementation was mainly influenced by the following factors:the procurement area accessibility, the pharmaceuticals category, dis-ease and drug alternative procurement methods and cycle, the payment and settlement time, and irregularities in the procurement process. Suggestions:During this implementation, we also need to clearly predict the quantity and pro-curement method, set up a proper policy environment for a quantity-based pricing, cancel the price linkage mecha-nism, strictly put into practice the payment deadline, employ a unique billing method and strengthen the information construction for the provincial centralized procurement platform. Some medicines’ quantity-based pricing should be carried out in the chosen pilots for laying a good foundation for its promotion.

Objective: To screen dynamic cardiorespiratory fitness indices for effective assessment of aerobic endurance using incremental load exercise tests. Methods: From March to November 2019, 266 volunteers who were able to understand the trial and voluntarily cooperated with the entire testing process were randomly recruited from 5 universities in Beijing. Gas metabolism and cardiac function were monitored in real time using the German Cortex Metalyzer 3B system and the US Cheetah NICOM system, and maximum oxygen uptake was measured by a linear incremental loading scheme. Aerobic endurance and dynamic cardiopulmonary function indices were selected according to the study design, and the relationship between the two indicators was analyzed using correlation and typicality correlation. Results: The absolute maximum oxygen uptake (VO 2max ), relative maximum oxygen uptake, maximum stroke volume (SV max ), and maximum stroke volume index (SVI max ) were significantly higher in males than in females, and the dynamic cardiopulmonary function index K was significantly lower than in females ( t =17.8, 10.1, 8.5, 4.3 , -6.3, P < 0.05 ). Simple correlation revealed that absolute VO 2max and relative VO 2max were negatively correlated with K and b, and absolute VO 2max and relative VO 2max were positively correlated with SV max and SVI max ( P <0.01); Both dynamic cardiopulmonary function indices were significantly correlated with aerobic endurance. Aerobic endurance indexes closely related to dynamic cardiopulmonary function were absolute VO 2max , relative VO 2max ; dynamic cardiopulmonary function indexes closely related to aerobic endurance were K, b, SV max , SVI max . Conclusion Improvement of dynamic cardiorespiratory fitness contributes to the improvement of aerobic endurance, the dynamic cardiorespiratory fitness indices K, b, SV max , and SVI max can be used as important candidates to predict the assessment of aerobic exercise capacity.

OBJECTIVETo establish a new optimized extraction process based on dynamic changes in extract concentration during the extraction process.

METHODSanqi was taken as an example to compare the concentration of marker components, total solids yield and similarity evaluation of the fingerprint images of extracts by orthogonal design optimization process and dynamic optimization process to assess the feasibility of dynamic process optimization method.

RESULTThe concentration of marker components and total solids yield vary less than 5%, with a 100% of similarity in fingerprints, indicating basic coincidence between extracts by the two optimized processes. The dynamic process optimization process could save 79% of the extraction time.

CONCLUSIONIn the extraction time, the dynamic optimization process is superior to the orthogonal design optimization process in that it can significantly reduce the extraction time and lower production costs.

BACKGROUND:Heart rate variability biofeedback is a respiratory training method that uses slow and deep breathing at the resonant frequency to induce rhythmic,high-amplitude oscillations in the cardiovascular system,thereby stimulating and exercising the autonomic and baroreflex.However,current studies have not systematically reviewed how heart rate variability biofeedback modulates the autonomic function and produces effects.There is a lack of public understanding of the mechanism of heart rate variability biofeedback,and its application progress and scheme are not fully understood. OBJECTIVE:To review the existing experimental studies on the effects of heart rate variability biofeedback on symptoms in different populations at home and abroad and to introduce the mechanisms and advances in the application of heart rate variability biofeedback to modulate the autonomic nervous system. METHODS:"Heart rate variability biofeedback,resonance breathing,heart rate variability,autonomic nerve,breathing training,chronic diseases,mental illness,biofeedback"were used as Chinese or English keywords to search in CNKI,WanFang Database,PubMed,and Web of Science.A total of 72 core related papers were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:The body's oscillation system and resonance system are essential for the effectiveness of heart rate variability biofeedback.Oscillations reflect the response to external stimuli and self-regulating reflex systems,while resonances involve synchronous oscillations that result in higher amplitude operations.The balance between sympathetic and parasympathetic nerves is crucial for maintaining a stable internal environment.Autonomic nervous system disorders are associated with reduced heart rate variability and are closely linked to the progression of related diseases.Heart rate variability biofeedback utilizes the resonance characteristics of the cardiovascular system,inducing rhythmic high-amplitude oscillations by employing deep slow breathing at the resonance frequency.This method improves the regulatory function of the sympathetic and parasympathetic system reflexes and enhances the balance regulation between the two systems.Two major mechanisms of cardiovascular system resonance are the baroreflex closed-loop pathway and respiratory sinus arrhythmia.These mechanisms,along with the unique delay of baroreflex,result in a 0° phase angle oscillation between heart rate and respiration and a 180° phase angle oscillation between blood pressure and respiration during breathing at the resonant frequency rhythm.Periodically stimulating the human cardiovascular oscillation system through this method is an easy-to-operate and effective training approach.Currently,heart rate variability biofeedback is mainly applied in the fields of mental illness,chronic disease,and sports.However,the intervention mechanism and efficacy are unclear,the intervention content,frequency and duration are varied,and there are limited review studies on the intervention methods tailored to different types of individuals.As a non-drug and non-invasive intervention,heart rate variability biofeedback can significantly increase heart rate variability,regulate the balance between sympathetic and parasympathetic nerves,and improve the stability and adaptability of the autonomic nervous system.In the future,it is suggested to investigate the mechanisms and potential applications of the pathways of the heart rate variability biofeedback that induce cardiovascular resonance.It is also recommended to incorporate long-term follow-ups to assess the sustained value of heart rate variability biofeedback in various fields.This would provide new directions and strategies for the comprehensive treatment of complex diseases.

Objective:To analyze the clinical efficacy and safety of endoluminal treatment of complex renal artery aneurysm (RAA).Methods:The clinical data and follow-up results of 19 patients with complex RAA admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from November 2014 to September 2021 were retrospectively analyzed. Two patients were treated with simple spring coil embolization into the aneurysmal artery, 14 patients were treated with simple spring coil embolization of the aneurysmal cavity, and 3 patients were treated with stent-assisted + spring coil embolization technique. Based on the location of the aneurysm, RAA were classified into type Ⅰ, Ⅱ, and Ⅲ. 7 patients with type Ⅰ, 10 patients with type Ⅱ, and 2 patients with type Ⅲ were studied. Variance analysis was used to compare the differences in glomerular filtration rate(GFR) of the affected side when the tumor was located at different locations, and Pearson was used to analyze the correlation between the number of coils implanted and the size of the tumor and GFR.Results:Ten of the 19 patients who were underwent successful endoluminal intervention. The average size of the patients′ aneurysms was (20.89±6.65) mm, and the average number of spring coils implanted was 8.22±3.08. The preoperative and postoperative serum creatinine were in the normal range, and no RAA tumor enlargement or recurrence was found during the follow-up period. The postoperative GFR was abnormal in patients with type Ⅰ, type Ⅱ, and type Ⅲ renal aneurysms, and the mean GFR value differed among the three types of patients( P=0.003). There was a negative correlation between the postoperative GFR values of the affected kidney and the number of spring coils implanted ( P=0.047), and no significant relationship between GFR and aneurysm size. Conclusion:The endovascular technique is an effective and safe means of treating complex RAA.

BACKGROUND:Mechanical stimulation has been confirmed to promote osteogenic differentiation of bone marrow stromal stem cells,but the mechanism is unknown.Primary cilia are important mechanoreceptors and regulate various signaling pathways such as TGF-β1/BMP-2/SMAD.They are likely to be important targets for mechanical regulation of bone marrow stromal stem cells. OBJECTIVE:To investigate the effect and mechanism of fluid shear stress on osteogenic differentiation of bone marrow stromal stem cells. METHODS:Rat bone marrow stromal stem cells were divided into control group,mechanical stimulation group(fluid shear mechanics intervention by shaking table),mechanical stimulation + IFT88 silencing group(mechanical stimulation + silencing IFT88 expression with siRNA).After 24 hours of intervention,qRT-PCR was utilized to determine the expression of transforming growth factor β1 and bone morphogenetic protein 2.Western blot assay was used to detect the expression of phosphorylated SMAD2/3 protein.Immunofluorescent staining of primary cilia was conducted and morphology was analyzed. RESULTS AND CONCLUSION:Shear stress stimulation could promote the transcriptional activity of transforming growth factor β1 and bone morphogenetic protein 2 genes,and increase the expression of phosphorylated SMAD2/3 protein.After siRNA interfered with primary cilia,this mechanical response effect was significantly reduced.There was a Spearman correlation between the change ratio of the primary cilium area of bone marrow stromal stem cells and the increased ratio of transforming growth factor β1 and bone morphogenetic protein 2 gene transcription.These findings indicate that primary cilia/intraflagellar transport mediates the activation of fluid shear stress-responsive transforming growth factor β1/bone morphogenetic protein 2/SMAD signaling pathway and promotes osteogenic differentiation of bone marrow stromal stem cells.

Objective To study the safety and effectiveness of arc edge needle therapy for moderate to severe tenosynovitis of the flexor digitorum tendon in the thumb.Methods A total of 62 patients with moderate to severe stenosing tenosynovitis of the flexor digitorum thumb who met the inclusion criteria were collected.The patients were randomly assigned 1:1 to the arc edge needle group and the needle knife group using a random number table method.Among them,31 patients in the arc edge needle group were treated with arc edge needles,while 31 patients in the needle knife group were treated with traditional needle knife release surgery.Both groups were treated once.Record the number rating scale(NRS),range of motion(ROM),Quinell grade,and disease efficacy score(WDES)of patients before and after treatment at various stages(1 week,2 weeks,4 weeks),and at follow-up after 24 weeks to evaluate the treatment effect.Results During the 24 weeks follow-up of 62 patients after treatment,the Quinell grading comparison between the two groups showed that the arc edge needle group was better than the needle knife group(P<0.05);The total effective rate of disease efficacy score(WDES)was 96.77%in the arc edge needle group and 83.87%in the needle knife group.The clinical total effective rate of the arc edge needle group was better than that of the needle knife group(P<0.05);After treatment,both groups showed significant improvement in pain numerical score(NRS)and joint range of motion(ROM),and the degree of improvement increased over time(P<0.05);And the inter group comparison at 1 week,2 weeks,4 weeks and 24 weeks time points after treatment showed that the curved blade needle was superior to the needle knife group in improving pain and joint mobility(P<0.05).Conclusion Both the 45° tenosynovitis incision and release surgery with arc edge needle and traditional needle knife release surgery are effective in treating moderate to severe tenosynovitis of the thumb flexor digitorum tendon.However,the 45° tenosynovitis incision and release surgery with arc edge needle has significant advantages in improving pain,interphalangeal joint mobility,and safety.

ObjectiveTo analyze the effectiveness and safety of clinical use of different types of stem cells to provide evidence for governmental supervision of key issues in clinical utilization of stem cells. MethodsSix literature databases in China and abroad were searched for relevant literature published from January 2010 to July 2020， and a systematic review was conducted. ResultsThe study showed 72 studies concerning the effectiveness and safety of different types of stem cells in clinical utilization. Although clinical utilization of stem cells had some therapeutic effects for certain diseases， their long-term effect and safety need to be further evaluated， especially their potential risk of tumorigenicity. ConclusionTo protect the patients’ interest， physicians should fully weigh the benefits against the risks of clinical utilization of stem cells， and relevant governmental departments should strengthen supervision of ethics of clinical research and therapies involving stem cells as well as supervision of stem cell products.