Most of the medical colleges and universities in China follow the traditional three-stage teaching mode centering on subjects, and a number of colleges and universities have implemented the teaching mode of organ-system-based curriculum (OSBC). With the OSBC course for the nervous system in our university as an example, this article analyzes the advantages and challenges of OSBC course of the nervous system in the context of integrative medicine.
Neurology

Objective To understand the equity and influencing factors of maternal health service utilization in Changning District, Shanghai. Methods A convenience sampling method was used to conduct a questionnaire survey among mothers of children aged 1 to 1.5 years old who received health services from the child health care clinics and EPI clinics of 10 community health service centers in Changning District, Shanghai from March to April 2022. Count data was expressed by frequency and percentage. Chi-square analysis, binomial logistic regression analysis, and multivariate logistic regression analysis were used to analyze fairness-related factors. Rate difference, rate ratio and concentration index were used to represent fairness. Results A total of 696 subjects were investigated, with an average age of (33.35±4.76) years. There were statistically significant differences in service utilization among women with different household registrations only in early pregnancy registration (χ²=11.026, P=0.001) and postpartum visits (χ²=4.989, P=0.026). Women with a career showed differently in folic acid supplement (χ²=6.247, P=0.012), early pregnancy registration (χ²=12.989, P=0.002), physical examination in 42 days postpartum (χ²=4.446, P=0.035) and postpartum contraception (χ²=4.061, P=0.044), and the differences were statistically significant. Women with different monthly family income had a statistically significant difference in pre-pregnancy examination (χ²=8.977, P=0.030) and postpartum visit (χ²=16.114, P=0.001). There was a statistically significant difference between women with maternity insurance or not in the early pregnancy registration (χ²=10.576, P=0.001) and physical examination in 42 days postpartum (χ²=8.166, P=0.004). The results of the multivariate analysis showed that occupation (OR=2.616, 95% CI: 1.142-5.990) and maternity insurance (OR=4.490, 95% CI: 1.992~10.120) affected the utilization of service in early pregnancy registration. The monthly household income (OR=0.278, 95% CI: 0.124-0.625) affected the utilization of services in postpartum visit. At the same time, the monthly household income (10,000-19,999: OR=0.286, 95% CI: 0.090-0.907; ≥30,000: OR=0.180, 95% CI: 0.041-0.801) also affected the utilization of service in physical examination in 42 days postpartum. Conclusion The equity of maternal health care service utilization overall is good in central area in Shanghai, but there is still room for improvement. It is necessary to strengthen community mobilization, propagandize maternal health services, and expand the coverage of maternity insurance to improve the equity of maternal health service utilization and provide equal access to maternity health services.

Enhanced recovery after surgery (ERAS) is a series of perioperative optimization measures based on evidence-based medicine aimed at achieving rapid recovery. Existing studies have shown that ERAS can effectively reduce surgical stress, decrease the incidence of complications, shorten hospital stays, save medical costs, and improve patient satisfaction. Although lung transplantation techniques have become increasingly mature, lung transplant recipients still have a high incidence of complications during perioperative period. To further improve the perioperative survival rate of lung transplant recipients, introducing ERAS concept into the perioperative management strategy of lung transplantation is of great significance for reducing incidence of perioperative complications, promoting rapid recovery and long-term survival of lung transplant recipients. This article discusses the advances in application of ERAS concept in the perioperative management of lung transplantation, aiming to provide references for optimizing the perioperative management of lung transplant recipients and reducing perioperative complications.

AIM To explore the clinical effects of oral administration and enema of Tongfu Paiqi Mixture on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction.METHODS One hundred and eight patients were randomly assigned into control group(54 cases)for 5-day intervention of both oral administration and enema of Tongfu Paiqi Mixture simulant and conventional treatment,and observation group(54 cases)for 5-day intervention of both oral administration and enema of Tongfu Paiqi Mixture and conventional treatment.The changes in clinical effects,GIDS score,Phlegm and Blood Stasis Obstructing Lung Syndrome score,gastrointestinal mucosal barrier serum markers(DAO,D-LA,IFABP),intra-abdominal pressure,gastrointestinal hormones(MTL,GAS,VIP),inflammatory factors(IL-1β,IL-6,TNF-α,PCT),pulmonary function indices(FEV1、FEV1％)and PaO2/FiO2 were detected.RESULTS The observation group demonstrated higher total effective rate than the control group(P＜0.05).After the treatment,the two groups displayed decreased GIDS score,Phlegm and Blood Stasis Obstructing Lung Syndrome score,intra-abdominal pressure,VIP,gastrointestinal mucosal barrier serum markers,inflammatory factors(P＜0.05),and increased MTL,GAS,pulmonary function indices,PaO2/FiO2(P＜0.05),especially for the observation group(P＜0.05).CONCLUSION For the patients with acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction,the oral administration and enema of Tongfu Paiqi Mixture can regulate gastrointestinal hormones,reduce inflammatory degree,protect intestinal barrier functions,alleviate clinical symptoms,and improve pulmonary functions.

Objective To explore the distribution characteristics and development trend of TCM prevention and treatment for irritable bowel syndrome(IBS)by analyzing the clinical trials of TCM prevention and treatment for IBS registered in China Clinical Trial Registry(ChiCTR).Methods The ChiCTR database was retrieved to collect and organize clinical trials related to the TCM prevention and treatment of IBS from the establishment of the database to May 1,2024.Characteristics of the included trials were analyzed and summarized using SPSS 25.0 and Excel 2021.Results A total of 73 clinical trials were included,of which 65 were pre-registered.The registered research projects involved 14 provincial-level administrative regions,including Beijing,Jiangsu,Guangdong,Shanghai,and Sichuan,and 46 clinical trial institutions,among which Beijing University of Chinese Medicine(6 items,7.89%)registered a higher number.The top three sources of research funding were,in order,local finance(26 items,35.62%),state finance(20 items,27.40%),and hospital funding(10 items,13.70%).The types of studies were predominantly interventional(68 items,93.15%),and the study designs were predominantly randomized parallel controlled studies(64 items,87.67%),but only 27 studies(36.99%)used a blinded approach.The main interventions included acupuncture and moxibustion,Chinese patent medicines,classic prescriptions/hospital-prepared remedies,etc.Conclusion The number of clinical research registrations in this field has been gradually increasing in recent years,but there are problems such as uneven regional distribution,low use of blinding,and lack of standardization of registration information.

Objective To analyze the clinical trial projects of TCM treatment for psoriasis registered at the China Clinical Trial Registry(ChiCTR);To provide references for clinical research in this field.Methods Clinical trial studies on the TCM treatment for psoriasis were retrieved from the ChiCTR database from the establishment of the database to June 17,2024.Excel 2019 and GraphPad Prism 9.0 were used to organize and analyze the general characteristics included in registered clinical trials.Results Totally 65 TCM-related trials were included,of which 58(89.23%)were prospectively registered,and 55(84.62%)had undergone ethical review.The majority of trials were registered in Guangdong,Beijing and Shanghai,collectively accounting for 78.46%(n=51)of the total.The leading institution,Guangdong Provincial Hospital of Chinese Medicine,contributed 19 trials.Funding was predominantly sourced from governmental bodies,with 72.31%(n=47)supported by national or regional grants.Among the registered studies,interventional trials predominated(n=56),including 46 randomised parallel-controlled designs.Blinding was implemented in 23 trials,and biospecimen collection was reported in 48 studies.40 trials were single-centre studies,and a cumulative sample size was 17 695 participants.Common interventions included oral administration of classical TCM formulations or hospital-prepared remedies,alongside topical applications such as medicated baths and ointments.The primary outcome measure in most trials was the Psoriasis Area and Severity Index.Conclusion While the number of registered clinical trials on TCM for psoriasis in China demonstrates a fluctuating yet upward trend,the overall volume remains modest.Disparities in regional distribution,methodological variability,and incomplete trial registration details highlight areas for improvement.

Family with sequence similarity 3 member A(FAM3A),a novel mitochondrial protein,plays a pivotal role in hepatic glucose and lipid metabolism by enhancing ATP synthesis and secretion and mod-ulating the ATP-P2 receptor-Akt signaling pathway.Dysregulation of FAM3A is closely associated with the pathogenesis of non-alcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).In this study,targeting FAM3A as a therapeutic candidate,we conducted virtual screening to identify 47 small-molecule compounds with potential binding activity.Surface plasmon resonance(SPR)analysis re-vealed three compounds exhibiting high binding affinity to FAM3 A.Further structural characterization of the FAM3A-compound complexes,combined with intermolecular interaction analysis,elucidated the binding mode of the lead compound Index 2(taxifolin)to FAM3A at atomic resolution.These findings provide critical insights into the molecular mechanisms underlying ligand-FAM3A interactions and deliver valuable chemical scaffolds for the development of therapeutics targeting NAFLD and T2DM.This work establishes a foundation for advancing drug discovery efforts focused on FAM3A-mediated metabolic disor-ders.

BACKGROUND:There are few studies on the effect of different patellar morphologies on the outcome after unicompartmental knee arthroplasty.OBJECTIVE:To investigate the effect of different patellar morphologies on functional recovery and patellofemoral joint alignment after unicompartmental knee arthroplasty based on patellar Wiberg classification.METHODS:A retrospective study was conducted in 186 patients with medial knee osteoarthritis who underwent unicompartmental knee arthroplasty at Affiliated Hospital of Xuzhou Medical University between January 2022 and March 2023.Patients were categorized into group A(type Ⅰ,n=43),group B(typeⅡ,n=104),and group C(type Ⅲ,n=39)according to the Wiberg classification.The Hospital for Specia Surgery knee score,Feller score,and incidence of anterior knee pain,as well as radiologic data(patellar index,patellar tilt angle,and lateral patellofemoral angle)were compared among the three groups.RESULTS AND CONCLUSION:(1)There was no significant difference in the Feller patellar score and Hospital for Specia Surgery score at the final postoperative follow-up in patients with Wiberg type Ⅰ,type Ⅱ,and type Ⅲ patellae(P＞0.05).(2)Although there was no significant difference in the incidence of anterior knee pain among the three groups at the final follow-up,patients with type Ⅲ patellae were significantly more likely to have experienced anterior knee pain early in the postoperative period.(3)Different patellar morphologies can improve patellar position to some extent after unicompartmental knee arthroplasty,but type Ⅲ had greater patellar tilt than types Ⅰ and Ⅱ,both preoperatively and postoperatively.(4)This finding highlights the need for tailored morphological adjustments to the Wiberg Ⅲ patella during unicompartmental knee arthroplasty to improve surgical outcomes.

BACKGROUND:Unicompartmental knee arthroplasty effectively addresses medial knee osteoarthritis.The accurate tibial component rotational alignment is crucial to ensure the best surgical outcome.OBJECTIVE:To assess the impact of tibial component rotational alignment on short-term outcomes after unicompartmental knee arthroplasty in medial knee osteoarthritis patients.METHODS:From February 2021 to February 2023,91 patients who underwent mobile-bearing unicompartmental knee arthroplasty in Affiliated Hospital of Xuzhou Medical University were selected.According to the rotational alignment of tibial prosthesis relative to Akagi's line measured by postoperative CT,the patients were divided into three groups.Group A had internal rotation greater than 0°,group B had external rotation from 0° to 5°,and group C had external rotation greater than 5°.The knee range of motion,Oxford knee score,and forgotten joint score were recorded and compared among three groups preoperatively,at the last follow-up after surgery.RESULTS AND CONCLUSION:(1)At the last follow-up after surgery,the Oxford knee score of group B was significantly lower than that of group A(P=0.003)and group C(P=0.025).The knee range of motion of group B was higher than that of group A(P=0.011)and group C(P=0.024),and the forgotten joint score of group B was higher than that of group A(P=0.001)and group C(P=0.049).(2)The forgotten joint score in group C was significantly higher than that in group A at the last follow-up(P=0.044).(3)Patients were followed up for 12-36 months after arthroplasty.There were 2 and 7 cases of postoperative knee pain in groups B and C,and the difference was statistically significant(P=0.033).(4)It is indicated that external rotation of the tibial prosthesis by 0°-5° is ideal for achieving satisfactory short-term clinical outcomes,so we should avoid intraoperative tibial prosthesis malrotation.

Objective To explore the correlation between the systemic immune-inflammation index(SII)and the clinical and pathological characteristics of patients with IgA nephropathy(IgAN).Methods A total of 350 patients who underwent renal biopsy and were initially diagnosed with primary IgAN were selected.The clinical and pathological data of the patients were collected,and SII was calculated.According to the median SII level of 554.78 in peripheral blood,the IgAN patients were divided into the low SII group(SII≤554.78,175 cases)and the high SII group(SII>554.78,175 cases).Based on the presence or absence of endocapillary hyperplastic(E)lesion,350 patients were also divided into the E0 group(279 cases,79.7%)and the E1 group(71 cases,20.3%).Multivariate Logistic regression analysis was conducted to determine the influencing factors of E1 in IgAN patients.A predictive model was established,and the predictive value of the model was evaluated using the receiver operating characteristic(ROC)curve.Results There were higher systolic blood pressure(SBP),platelet count(PLT),neutrophil count(NEU),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),total cholesterol(TC),serum creatinine(Scr),serum C3 and 24-hour urine protein levels in the high SII group than those of the low SII group,while the lymphocyte count(LYM)was lower(P＜0.05).In terms of pathological manifestations,the proportion of E1 was higher in the high SII group than that of the low SII group(P＜0.05).There were lower PLT,NEU,NLR,PLR,Scr and 24-hour urine protein in patients of the E0 group than those of the E1 group,while higher Hb,LYM and ALB levels in the E0 group than those of the E1 group(P＜0.05).Multivariate Logistic regression analysis showed that elevated SII,Scr and 24-hour urine protein levels were independent risk factors for E1 lesion in IgAN patients(P＜0.05).The area under the curve(AUC)of the predictive model for E1 lesion in IgAN patients was 0.781(95%CI:0.722-0.840).Conclusion SII can reflect the clinical and pathological severity in IgAN patients,providing new insights for clinical evaluation of the disease progression in IgAN patients.