Objective To study the pathogenesis and the effect of early drugs therapy of symptoms after concussion.Methods One-hundred and thirteen patients with symptoms after suffered concussion enrolled in the study and divided randomly into three groups.The patients of different groups were treated respectively with drugs,i.e.erigeron breviscapus,nimodipine,energy mixture.Symptom Check-List 90 ( SCL-90 ) and electroencephalogram(EEG) and cerebral blood flow of trancranial Doppler(TCD) were examined in the early and late stage of post-concussion.Normal population were recruited as control.All examination results and the effect of treatment were compared between treatment group and control group.Results In the scores of SCL-90,the factor scores of somatization symptom,compulsion,depressive disorder,anxiety disorders,and hostile symptom in 113 post-concussion patients in early stage were all higher than those in the normal( t =10.78,2.08,9.53,11.09 and 2.52,P ＜0.01or P ＜0.05),and as well as that of somatization symptom,depressive disorder,anxiety disorders,terror and mental disorder symptom in 12 post-concussion patients in late stage compared to normal( t =3.21,6.85,3.07,3.14 and 4.73,Ps ＜ 0.01 ).The test of EEG was abnormal in 57.4 ％ of patients in early stage and in 33.3％ in the late stage.Of all TCD results,67.0 ％ was abnormal in the early stage and 25.0％ in the late stage,The disappearance rate of post-concussion symptoms in the 14th day was significantly higher in the erigeron breviscapus group ( 45.0％ ) than in the nimodipine group ( 23.7％ ) ( x2 =3.91,P ＜0.05 ) and in the energy mixture group ( 20.0％ ) ( x2 =5.25,P ＜ 0.05 ).The disappearance rate of postconcussion symptoms in the 30th day in the energy mixture group(40.0％ ) was significantly lower than those in nimodipine group( 68.4％ )( x2 =5.94,P ＜ 0.05 ) and in erigeron breviscapus group( 75.0％ )( x2 =9.43,P ＜ 0.01 ).The occurrence rate of post-concussion sequelae was higher in the energy mixture group ( 22.9％ )than in the nimodipine group ( 5.2％ ) ( x2 =4.77,P ＜ 0.05 ) and in the erigeron breviscapus group (5.0％ )( x2 =5.15,P ＜ 0.05 ) three month after injuries.Conclusion The occurrence of symptoms originated from the organic damage of brain tissue.However,its changes were influenced by psychologic factors after concussion.Early vasodilative drugs therapy could improve the recovery of patients with post-concussion symptoms in time and decrease the occurrence of post-concussion sequelae.

Objective To establish the proposals of clinic and rehabilitation pathway for spine and spinal cord injury. Methods The experiences in clinic and rehabilitation treatment fields, the flow path of admission and the costs of hospitalization for spine and spinal cord injury patients in Chinese Rehabilitation Research Center were retrospectively summarized and analyzed. Related data in International Classification of Functioning, Disability and Health (ICF) core sets were also referred. Results The present proposals were applied to patients suffered from thoracic, lumbar or sacral spine injury with spinal cord injury. The proposals consisted of two parts: the surgical interventions in acute stage (within 2 weeks after injury) and clinic and rehabilitation treatments of spinal cord injury in sub acute and later stages (2 weeks to 6 months after injury). The criteria of surgical interventions in acute stage materialized the core therapies such as reconstruction of spine stability and neural decompression, etc. The criteria of treating spinal cord injury in subacute and later stages demonstrated the characteristic of combined therapy in which rehabilitation was the central element. Conclusion The establishment and implement of the present pathways were based on the time course of disease development and the staging feature of neural recovery and treatment after spinal cord injury. The purpose of this work is to improve the quality of medical service and reduce medical consumption.

Nowadays, PDCA circle is a widely used theory of quality management system. Through the PDCA approach, the management reform was conducted in 17 anesthesia teachers of the Anesthesiology department. After 18 months of training and promotion, the problems such as lack of enthusiasm for teaching, uneven level of teachers, and boring single teaching method were basically solved, which improved their teaching skills. Certain effectiveness has been achieved in teacher training management including continuity of quality management, timely feedback and emphatically improvement, student-center teaching philosophy, and mutual promotion of teaching and learning.

Objective:To compare the difference between breast bracket combined with polyurethane foam and single polyurethane foam in the accuracy of immobilization, providing a better immobilization for breast cancer radiotherapy.Methods:Fifty breast cancer patients who received radiotherapy in Sun Yat-sen University Cancer Center from March 2021 to July 2021 were selected. Among them, 25 patients were immobilized with polyurethane foam (foam group), and the other 25 patients were immobilized with polyurethane foam combined with breast bracket (combination group). All patients were scanned by CBCT once a week to obtain setup errors in the SI, LR and AP directions for t-test. The formula M PTV=2.5 Σ+0.7 σ was used to calculate the margin of the planning target volume(M PTV). Results:The setup errors in the foam group were SI (2.0±3.26) mm, LR (0.88±2.76) mm, AP (1.22±3.55) mm, Rtn -0.24°±0.85°, Pitch 0.16°±1.11°, Roll -0.32°±1.05°, and the M PTV were 6.75 mm, 8.46 mm and 8.73 mm, respectively. The setup errors in the combination group were SI (1.0±3.01) mm, LR (0.62±2.74) mm, AP (1.82±3.21) mm, Rtn 0.64°±0.59°, Pitch 0.71°±1.22°, Roll 0.29°±0.73°, and the M PTV were 6.35 mm, 7.47 mm, and 7.61 mm, respectively. After comparing the setup errors in the three-dimensional directions between two groups, the t value of LR, SI, AP and Rtn, Pitch, Roll was -4.304, -2.681, 1.384, and -9.457, -3.683, -5.323, respectively. And the differences in the LR, SI, Rtn, Pitch and Roll directions were statistically significant (all P<0.05). Conclusions:The immobilization effect of polyurethane foam combined with breast bracket is better and the M PTV is also smaller than those of polyurethane foam alone. Therefore, it is recommended to use polyurethane foam combined with breast bracket for immobilization in breast cancer radiotherapy.

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Objective:To explore the clinical significance of multi-sample next-generation sequencing (NGS) in detecting gene mutations in non-small cell lung cancer (NSCLC), so as to provide a basis for individualized targeted treatment.Methods:The data of 51 patients with NSCLC in the First Affiliated Hospital of Zhejiang University Medical College from June 2016 to February 2019 was retrospectively analyzed. The patients' age, gender, smoking status, pathological type, tumor staging, pleural invasion status and meningeal invasion status were collected, and the tissues, cerebrospinal fluid, pleural effusion and plasma samples were detected by NGS. The correlations between the driver gene mutations [epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and ROS proto-oncogene 1, receptor tyrosine kinase (ROS1)] and the clinicopathological features of patients were analyzed by χ 2 test or Fisher exact probability method. Cohen Kappa coefficient analysis was used to compare the consistency of NGS detection results in different samples. Results:Among the 51 patients, 3 different types of specimens were examined in 7 patients. Of which, the driver gene mutations were all positive in 3 cerebrospinal fluid samples and double gene mutations were found in 2 hydrothorax samples. Driver gene mutations were more common in female [90.48% (19/21) vs. 50.00% (15/30), χ 2 = 9.107, P = 0.003], non-smokers [80.00% (24/30) vs. 47.62 (10/21), χ 2 = 5.829, P = 0.016], adenocarcinoma patients [72.34% (34/47) vs. 0, P = 0.017] and patients with malignant pleural effusion [92.86% (13/14) vs. 56.76% (21/37), χ 2 = 4.443, P = 0.035], and the differences were statistically significant. However, there was no statistically significant difference in mutations of driver gene among patients with different age or tumor stages (both P > 0.05). The consistency rate of genetic test results of the driver gene mutations in 37 plasma samples and matched tissue samples was 70.27% (26/37), κ value was 0.430, which suggested a good consistency between them. Conclusions:In patients with advanced NSCLC, gene detection of cerebrospinal fluid is of high application value for patients with meningeal metastasis; for patients with pleural invasion, gene detection of pleural effusion is an effective means to screen targeted therapy drugs. NGS detection of multiple specimens can better reflect the status of gene mutations and guide the individualized targeted therapy of lung cancer patients.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

MicroRNAs are short non-coding RNAs that regulate and control the translation of target genes, and play an important role in gene expression involved in the development of spinal cord and spinal cord injury, which constitute novel targets for therapeutic intervention to promote repair and regeneration of the spinal cord, also they are the potential biomarkers of spinal cord injury. This article reviewed the mechanism of microRNAs and listed several microRNAs in spinal cord injury area.