BACKGROUND:Myocardial patches are used as an effective way to repair damaged myocardium,and there is controversy over which cells to use to make myocardial patches and how to maximize the therapeutic effect of myocardial patches in vivo. OBJECTIVE:To find out the best way to make myocardial patches by overviewing the cellular sources of myocardial patches and strategies for perfecting them. METHODS:The first author searched PubMed and Web of Science databases by using"cell sheet,cell patch,cardiomyocytes,cardiac progenitor cells,fibroblasts,embryonic stem cell,mesenchymal stem cells"as English search terms,and searched CNKI and Wanfang databases by using"myocardial patch,biological 3D printing,myocardial"as Chinese search terms.After enrollment screening,94 articles were ultimately included in the result analysis. RESULTS AND CONCLUSION:(1)The cellular sources of myocardial patches are mainly divided into three categories:somatic cells,monoenergetic stem cells,and pluripotent stem cells,respectively.There are rich sources of cells for myocardial patches,but not all of them are suitable for making myocardial patches,e.g.,myocardial patches made from fibroblasts and skeletal myoblasts carry a risk of arrhythmogenicity,and mesenchymal stem cells have a short in vivo duration of action and ethical concerns.With the discovery of induced multifunctional stem cells,a reliable source of cells for making myocardial patches is available.(2)There are two methods of making myocardial patches.One is using cell sheet technology.The other is using biological 3D printing technology.Cell sheet technology can preserve the extracellular matrix components intact and can maximally mimic the cell growth ring in vivo.However,it is still difficult to obtain myocardial patches with three-dimensional structure by cell sheet technology.Biologicasl 3D printing technology,however,can be used to obtain myocardial patches with three-dimensional structures through computerized personalized design.(3)The strategies for perfecting myocardial patches mainly include:making myocardial patches after co-cultivation of multiple cells,improving the ink formulation and scaffold composition in biological 3D printing technology,improving the therapeutic effect of myocardial patches,suppressing immune rejection after transplantation,and perfecting the differentiation and cultivation protocols of stem cells.(4)There is no optimal cell source or method for making myocardial patches,and myocardial patches obtained from a particular cell or technique alone often do not achieve the desired therapeutic effect.Therefore,researchers need to choose the appropriate strategy for making myocardial patches based on the desired therapeutic effect before making them.

This article introduced the background,drafting process,and main content of the Interim Measures for the Management of Surplus Drugs in Medical Institutions of Hubei Province(referred as the Measures).It focused on explaining the definition of surplus drugs and analyzing the requirements for drug dismantling,surplus drug billing,recovery and use procedures,special fund management,and duties and responsibilities of management departments.This paper aimed to guide readers to learn the Measures,understand the Measures and implement the Measures.It would help to improve the efficiency of medical resources,ensure medication safety,reduce patients'medication burden,and promote the rational use of medical insurance funds.

Objective     To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods     The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results     A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P>0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P>0.05). Conclusion    Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.

Objective:To analyze the surveillance data of Kashin-Beck disease (KBD) in Shandong Province, master the changes of KBD, and provide scientific basis for formulating prevention and control strategies of KBD and adjustment of the prevention and control focus of KBD.Methods:According to the requirements of the "National KBD Monitoring Plan" and the "Shandong KBD Monitoring Plan", from 2016 to 2020, the disease monitoring was carried out in the villages of KBD areas in Shandong Province, including the number of clinical positive cases, the number of X-ray positive cases, and the number of metaphyseal positive cases. The detection rate was calculated, and the dynamic changes of the disease was analyzed macroscopically.Results:From 2016 to 2020, a total of 1 816 children aged 7 - 12 years were clinically examined in Shandong Province, and no child with KBD was found. A total of 1 224 children were examined by X-ray, among which 1 positive patient was found in 2016 and 2017, respectively, both of whom were metaphyseal changes, with a total detection rate of 0.16%. There were 367 adult patients with KBD in Shandong Province, including 304 patients with grade Ⅰ, 47 patients with grade Ⅱ and 16 patients with grade Ⅲ. All villages in the KBD areas in Shandong Province had reached the elimination standard, with the elimination rate of 100%.Conclusion:No clinical case of KBD is detected in children aged 7 - 12 years in Shandong Province from 2016 to 2020, which has reached the elimination standard and is in a continuous elimination state.

Objective     To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods     This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. Results    The average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). Conclusion    Compared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.

Objective:To dynamically monitor the prevalence and trend of dental fluorosis in children in Shandong Province, and to evaluate the prevention and control measures for drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis), and to provide scientific basis for the next step.Methods:Totally 40 counties (cities, districts) were selected as project counties (cities, districts) from drinking water-borne fluorosis areas in Shandong Province in 2018, and all counties (cities, districts) were selected in 2019 and 2020, to investigate the situation of water improvement, detect water fluoride content, and investigate the prevalence of dental fluorosis in children aged 8 - 12 years.Results:From 2018 to 2020, the detection rates of dental fluorosis in children aged 8 - 12 years were 10.30% (503/4 884), 8.94% (25 895/289 539) and 8.66% (24 061/277 689), respectively, with statistically significant differences (χ 2 = 27.10, P < 0.001), and the dental fluorosis indexes were 0.21, 0.18 and 0.17, respectively. The total detection rates of dental fluorosis in children of different age groups in the 3 years were 7.26% (6 590/90 775), 7.97% (9 303/116 680), 9.29% (12 167/130 915), 9.29% (12 238/131 670) and 9.95% (10 161/102 072), the differences were statistically significant (χ 2 = 615.71, P < 0.001). In the 3 years, the total detection rate of dental fluorosis was 8.93% (28 101/314 737) in boys and 8.69% (22 358/257 375) in girls, the difference was statistically significant (χ 2 = 10.27, P = 0.001). In 2018 and 2019, the detection rates of dental fluorosis of children aged 8 - 12 years in water fluoride qualified villages [5.74% (235/4 095) and 7.98% (20 200/253 082)] were significantly lower than those in villages with excessive water fluoride [33.97% (268/789) and 15.62% (5 695/36 457), χ 2 = 570.61, 2 283.76, P < 0.001]. Conclusions:The prevalence of dental fluorosis among children aged 8 - 12 years has been effectively controlled, and remarkable results have been achieved in prevention and treatment of drinking water-borne fluorosis in Shandong Province. However, the detection rate of dental fluorosis among children in a few endemic villages is high, so it is necessary to continue to strengthen the monitoring of fluoride content in drinking water and the condition of dental fluorosis among children.

Objective:To evaluate the effect of health education of a three-year special action for prevention and control of drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis) in Shandong Province, and to provide basis for formulating health education measures in the next step.Methods:Nineteen of the disease affected counties (cities and districts) were selected as project counties (cities and districts) in key areas for prevention and control of drinking water-borne fluorosis in Shandong Province in 2018, and 50 disease affected counties (cities and districts) were selected in 2019, and the project counties (cities and districts) were expanded to all of the 105 disease affected counties (cities and districts) in Shandong Province in 2020. Three disease affected townships (towns) were selected in each county (city and district), and health education activities on drinking water-borne fluorosis were carried out in Grade 4 to Grade 6 of the central primary schools and the three villages under its jurisdiction. Students and housewives were selected to conduct questionnaire surveys on prevention and control knowledge of drinking water-borne fluorosis before and after health education. The incidence of dental fluorosis among children aged 8 - 12 years was investigated annually in 6 villages (with children aged 8 - 12 years > 50) , where health education activity was implemented and the incidence of dental fluorosis among children was > 30%, water fluoride content was > 1.5 mg/L and water improvement time was < 5 years.Results:After health education, the awareness rates of drinking water-borne fluorosis in fifth grade pupils [92.46% (4 571/4 944) vs 65.80% (3 334/5 067) in 2018; 94.84% (12 897/13 599) vs 73.55% (9 993/13 587) in 2019; 95.59% (30 407/ 31 809) vs 77.52% (24 463/31 557) in 2020] and housewives [94.12% (2 400/2 550) vs 76.04% (1 939/2 550) in 2018; 94.99% (6 412/6 750) vs 72.00% (4 860/6 750) in 2019; 95.53% (16 183/16 941) vs 78.43% (12 971/16 539) in 2020] were significantly improved (χ 2 = 1 070.47, 2 315.27, 4 456.40, 328.25, 1 294.80, 2 174.63, P < 0.05). After health education in 2020, there were significant differences in the correct answer rates of epidemic causes, hazards and preventive measures of drinking water-borne fluorosis in the questionnaire of fifth grade pupils and housewives (χ 2 = 390.78, 164.94, P < 0.05). The awareness rates of drinking water-borne fluorosis in fifth grade pupils and housewives in the eastern region (Qingdao City, Yantai City and Weifang City) were significantly higher than those in the western region (Dezhou City, Liaocheng City and Heze City) before health education (χ 2 = 547.43, 210.12, P < 0.05), and after health education, the awareness rates increased to more than 90%. The detection rate of dental fluorosis in children decreased year by year (χ 2trend = 27.95, P < 0.05). Conclusions:Through implementation of a three-year special action for prevention and control of drinking water-borne fluorosis in Shandong Province, the awareness rate of fluorosis among target populations has been significantly improved. However, it is still necessary for government departments to further increase investment in health education and carry out health education activities in a deep-going way.

Objective:To analyze the iodine content distribution of drinking water in Jingdezhen City, and master the status of prevention and control of iodine deficiency disorders (IDD), so as to provide a basis for adopting targeted control measures and scientific adjustment of control and prevention strategies.Methods:According to the "National Iodine Deficiency Disorders Surveillance Program" and the "National Water Iodine Content Survey Program for Drinking Water", the surveillance of IDD in Jingdezhen City was carried out from 2017 to 2020. Household edible salt samples from pregnant women and students aged 8 to 10 were collected to detect salt iodine content, and urine samples were collected to detect urinary iodine. Thyroid volume of students was measured by B-ultrasonography, and the rate of goiter was calculated. In 2017, the iodine content of drinking water in Jingdezhen City was investigated, and the results were analyzed.Results:From 2017 to 2020, a total of 1 800 students were examined for thyroid gland, and 11 students were found to have goiter, with an goiter rate of 0.61%. A total of 3 201 edible salt samples and 3 201 urine samples were collected from students, the median of salt iodine was 24.96-26.40 mg/kg, the consumption rate of qualified iodized salt was 98.50%-99.50%, and the median of urinary iodine was 172.56-218.35 μg/L. A total of 1 600 edible salt samples and 1 600 urine samples were collected from pregnant women, the median of salt iodine was 24.40-25.38 mg/kg, the consumption rate of qualified iodized salt was 97.25%-98.00%, and the median of urinary iodine was 161.55-205.60 μg/L. In 2017, a total of 667 water samples were collected from 52 villages and towns in 4 counties and districts. The median of water iodine of the 4 counties and districts was 0.6-3.2 μg/L, and that of the 52 villages and towns was 0.3-12.3 μg/L.Conclusions:The iodine nutrition level of students and pregnant women in Jingdezhen City is generally at an appropriate level, but the iodine content of drinking water is low. It is suggested to strengthen the health education and health promotion of IDD among key population, guide the residents to supplement iodine scientifically, and continuously eliminate the harm of IDD.

Objective To understand the defluoridation effect in the historical severe endemic fluorosis areas of Shandong Province,and to analyze characteristics of children's dental fluorosis and related factors.Methods In 2015,using cross-sectional survey,11 villages in historical severe endemic fluorosis counties were selected for water fluoride test according to previous investigation of endemic diseases in Shandong Province.In which,4 normal water fluoride villages,4 excessive water fluoride villages and 3 villages without water improvement were included.Dental fluorosis in children aged 7 to 12 was examined and urine fluoride was measured.Logistic regression was used to analyze the related factors affecting the detection rate of dental fluorosis.Results A total of 732 children aged 7 to 12 were examined,with total detection rate of dental fluorosis 73.2％ (536/732).The detection rate of dental fluorosis was 31.0％ (65/210),86.7％ (176/203) and 92.5％ (295/319) in the villages with normal,excessive and without water improvement villages,respectively.And the differences were statistically significant (x2 =270.498,P ＜ 0.01).The prevalence of dental fluorosis in girls (77.4％,264/341) was significantly higher than that in boys (69.6％,272/391,x2 =5.337,P ＜ 0.05),and the dental fluorosis prevalence in elderly group (10-12 years old,76.9％,382/497) was higher than that of younger group (7-9 years old,65.5％,154/235),the difference was statistically significant (x2 =10.445,P ＜ 0.05).In water fluoride normal villages,the detection rate of dental fluorosis in girls (40.0％,36/90) was higher than that in boys (24.2％,29/120,x2 =6.033,P ＜ 0.05).In water fluoride unqualified villages,the dental fluorosis prevalence rates in boys and girls were 89.7％ (243/271) and 90.8％ (228/251),and the difference was not statistically significant (x2 =0.202,P ＞ 0.05).The urinary fluoride content of children with dental fluorosis was higher than that of non-fluorosis children [(4.5 ± 2.7) vs (1.9 ± 1.5) mg/L,t =-8.125,P ＜ 0.01].Logistic analysis showed that the risk of children's dental fluorosis in unqualified water fluoride village was 14.362 times high than that of normal water fluoride villages.The risk of dental fluorosis in children with high urinary fluoride was 2.497 times higher than that in normal urinary fluoride group.The risk of detecting moderate and severe fluorosis in children in the elderly group was 2.270 times higher than that in the younger group.The risk of detecting moderate and severe dental fluorosis in girls was 1.988 times higher than that in boys.The risk of detecting moderate and severe dental fluorosis in children in unqualified water fluoride villages was 49.190 times higher than that in normal water fluoride villages.Conclusions Water-quality-improvement project is an effective means to control the epidemic of dental fluorosis in children in severe fluorosis areas.Age,gender and water fluoride are influencing factors associated with dental fluorosis.

Objective To explore the influence of 8-week aerobic exercise in heart rate variability (HRV)in obese adolescents and to provide the evidence for formulating special exercise prescription.Methods Forty male obese adolescents (BMI≥25 kg·m-2 )were randomly divided into exercise group (n=20)and control group (n=20). The subjects in exercise group conducted a 8-week (five times/week,50-60 min)aerobic exercise while those in control group maintained their routine lifestyle. The body composition, hemodynamic parameters including heart rate(HR)and blood pressure and HRV parameters including total power (TP),normalized low frequency (LFn), normalized high frequency (HFn)and LFn/HFn ratio were measured before and after experiment.Results There were no significant differences of the indicators of the subjects between two groups before experiment (P>0.05). At the end of experiment,compared before experiment,the fat mass(FM),the percentage of body fat(BF%), the rest HR,SBP and DBP were decreased (P<0.05 or P<0.01);the TP and HFn were increased(P<0.01);the LFn and LFn/HFn ratio were reduced (P<0.01)in exercise group after experiment;but the indexes of the subjects in control group showed no significant changes (P>0.05).Compared control group,the FM,the BF%, the rest HR,SBP,DBP,LFn and LFn/HFn ratio were decreased while the TP and HFn were increased (P<0.01)in exercise group after experiment.Conclusion Aerobic exercise may effectively reduce the sympathetic activity and increase the vagal tone in the obese adolescents.