Osteosarcoma(OS)is a common primary malignant bone tumor with high mortality,disability,metastasis,and recurrence rates and a complex pathogenesis,Resulting in serious effects on patient quality of life and huge economic burdens on families and society.Traditional Chinese medicine(TCM)has"multi-target,multi-component and multi-pathway"characteristics.Recent studies using animal and cell models demonstrated that the mechanism of OS progression was related to Notch,mitogen-activated protein kinase,Wnt/β-catenin,phosphatidylinositol 3-kinase/AKT,Hedgehog and nuclear factor-κB,transforming growth factor-β/Smad and signal transducer and activator of transcription pathways.TCM can exert anti-tumor effects by influencing biological processes such as cell proliferation,migration,invasion,apoptosis,and autophagy via interfering with the above signaling pathways.This review considers the roles of these signaling pathways in OS and summarizes the current research status of TCM interventions in the prevention and treatment of OS,with the aim of providing a reference for future studies of TCM treatments of OS and to provide new ideas for its clinical treatment.

Osteosarcoma(OS)is a common primary malignant bone tumor with high mortality,disability,metastasis,and recurrence rates and a complex pathogenesis,Resulting in serious effects on patient quality of life and huge economic burdens on families and society.Traditional Chinese medicine(TCM)has"multi-target,multi-component and multi-pathway"characteristics.Recent studies using animal and cell models demonstrated that the mechanism of OS progression was related to Notch,mitogen-activated protein kinase,Wnt/β-catenin,phosphatidylinositol 3-kinase/AKT,Hedgehog and nuclear factor-κB,transforming growth factor-β/Smad and signal transducer and activator of transcription pathways.TCM can exert anti-tumor effects by influencing biological processes such as cell proliferation,migration,invasion,apoptosis,and autophagy via interfering with the above signaling pathways.This review considers the roles of these signaling pathways in OS and summarizes the current research status of TCM interventions in the prevention and treatment of OS,with the aim of providing a reference for future studies of TCM treatments of OS and to provide new ideas for its clinical treatment.

Ankylosing spondylitis is a chronic immunoinflammatory disease that mainly affects the spine and the sacroiliac joint,the mechanism of which is closely related to signaling pathways,such as osteoprotegerin(OPG)/receptor activator of nuclear factor-κB(RANK)/RANK ligand,mitogen-activated protein kinase(MAPK),Wnt/β-catenin(β-catenin),phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(PI3K/Akt/mTOR).Traditional Chinese medicine has the characteristics of multiple components and targets,and is widely used for the treatment of autoimmune diseases due to its low toxicity,strong specificity,and high efficacy.This review found that monomers and compounds of traditional Chinese medicine can exert anti ankylosing spondylitis effects by intervening in the aforementioned signaling pathways,regulating immune inflammatory responses,and inhibiting biological processes such as bone destruction,ectopic osteogenic differentiation,cell apoptosis,and autophagy.

While the development of multi-campus hospitals is conducive to promoting the expansion and equal distribution of high-quality medical resources and improving the overall medical quality of municipalities, the model puts forward high requirements for the capabilities of integrated operation and management of public hospitals. As key part of health services and the higher medical education system, facing the multi-campus hospital reform, hospital affiliated to colleges and universities should carry out rearrangements in both medical and educational aspects at the same time. Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine has made substantial progress in integrated and homogenized management since the integration of the Lingang campus as a whole into the parent hospital in 2021. The department of undergraduate clinical medical education has analyzed the difficulties in teaching management and talent cultivation in the multi-campus system during the rearrangement process, forming a coordinated management mechanism for undergraduate clinical medical education within campuses under the concept of "homogeneity-difference-collaboration". This article may provide a reference for enriching multi-campus hospital management practice and improving the quality of undergraduate clinical medical education in hospitals affiliated to colleges and universities.

Objective:To explore the teaching effect of virtual patient combined with case-based learning (CBL) and investigate its impact on improving students' clinical thinking ability.Methods:From July 2021 to December 2022, 71 students practicing in the Department of Internal Medicine at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were randomly divided into three groups: virtual patient teaching group (24 students), CBL teaching group (23 students), and mixed teaching group (24 students, virtual patient + CBL). After the teaching, a skill test and a teaching satisfaction survey were conducted. The data analysis was conducted using SPSS 24.0 software. The comparison of means among multiple groups was performed using analysis of variance. The pairwise comparisons between the three groups were performed using the least significant difference method.Results:In comparison of the scores of the three groups of students in skill test, there was a statistically significant difference in "consultation ideas" among the three groups of students [(82.04±3.76) vs. (79.00±4.93) vs. (78.61±4.56), P=0.018)], and the mixed teaching group performed better than the virtual patient teaching group and CBL teaching group. There was a significant difference in "total score" among the three groups of students [(81.33±5.02) vs. (80.65±5.67) vs. (79.76±5.15), P=0.046]. Pairwise comparisons showed that the mixed teaching group was significantly better than the CBL teaching group in "total score" ( P=0.013). The survey on teaching satisfaction showed that the scores of "improving learning motivation and initiative" were higher in the mixed teaching group and the virtual patient teaching group than in the CBL teaching group. The scores of "enhancing the ability to analyze problems" were higher in the mixed teaching group and CBL teaching group than in the virtual patient teaching group. The score of "deepening understanding of knowledge" was higher in the mixed teaching group than in the virtual patient teaching group. The score of "improving innovation ability" was higher in the mixed teaching group than in the CBL teaching group. Overall, students in the mixed teaching group showed the highest satisfaction. Conclusions:The teaching method combining virtual patient and CBL can more effectively enhance students' clinical thinking ability, promote self-learning, and improve teaching satisfaction, providing a new mode for teaching clinical thinking.

Objective:To explore the teaching effect of virtual patient combined with case-based learning (CBL) and investigate its impact on improving students' clinical thinking ability.Methods:From July 2021 to December 2022, 71 students practicing in the Department of Internal Medicine at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were randomly divided into three groups: virtual patient teaching group (24 students), CBL teaching group (23 students), and mixed teaching group (24 students, virtual patient + CBL). After the teaching, a skill test and a teaching satisfaction survey were conducted. The data analysis was conducted using SPSS 24.0 software. The comparison of means among multiple groups was performed using analysis of variance. The pairwise comparisons between the three groups were performed using the least significant difference method.Results:In comparison of the scores of the three groups of students in skill test, there was a statistically significant difference in "consultation ideas" among the three groups of students [(82.04±3.76) vs. (79.00±4.93) vs. (78.61±4.56), P=0.018)], and the mixed teaching group performed better than the virtual patient teaching group and CBL teaching group. There was a significant difference in "total score" among the three groups of students [(81.33±5.02) vs. (80.65±5.67) vs. (79.76±5.15), P=0.046]. Pairwise comparisons showed that the mixed teaching group was significantly better than the CBL teaching group in "total score" ( P=0.013). The survey on teaching satisfaction showed that the scores of "improving learning motivation and initiative" were higher in the mixed teaching group and the virtual patient teaching group than in the CBL teaching group. The scores of "enhancing the ability to analyze problems" were higher in the mixed teaching group and CBL teaching group than in the virtual patient teaching group. The score of "deepening understanding of knowledge" was higher in the mixed teaching group than in the virtual patient teaching group. The score of "improving innovation ability" was higher in the mixed teaching group than in the CBL teaching group. Overall, students in the mixed teaching group showed the highest satisfaction. Conclusions:The teaching method combining virtual patient and CBL can more effectively enhance students' clinical thinking ability, promote self-learning, and improve teaching satisfaction, providing a new mode for teaching clinical thinking.

As an important complementary form of decoction pieces of traditional Chinese medicine（TCM）， TCM dispensing granules has the advantages of being free of decoction， easy to take， easy to carry and easy to be dispensed， which greatly improves the capacity of emergency services of TCM and is more in line with the needs of modern society. With the end of the pilot project of TCM dispensing granules， the market has been fully liberalized， the competition has been intensified， and it is in the transition period of switching between the new standard and the old one， and there are some problems such as the shortage of varieties， the change of specifications and the difference of quality， and the production enterprises are facing new opportunities and challenges. Based on this， the authors intend to systematically sort out the policies and regulations， enterprise layout and standard formulation since the pilot of TCM dispensing granules. In view of the problems in the post-pilot stage and from the perspective of survival and development of enterprises， it is suggested that enterprises should establish a quality control system for the whole industry chain of TCM dispensing granules to reduce process costs and increase enterprise competitiveness， further increase the investment in scientific research， overcome the key technical problems of difficult varieties， actively and orderly promote the research of national standards， in order to ensure the integrity of clinical formula varieties， and establish and improve the efficacy evaluation mechanism of TCM dispensing granules， build a consistency evaluation system between TCM dispensing granules and decoction pieces. Government departments should strengthen the guidance， fully mobilize the enthusiasm of scientific research institutions， enterprises and hospitals， and explore the establishment of "government-industry-study-research-application" mode to promote the development of TCM dispensing granule industry.

Background Neck-shoulder pain is one of the most common discomfort symptoms among nursing staff, mostly caused by a heavy workload, restricted workstation, and prolonged poor posture. Objective To investigate the prevalence of neck-shoulder pain among nursing staff in tertiary general hospitals in Hunan Province, and to analyze workload-related risk factors. Methods From October to December 2018, a multi-stage stratified randomized cluster sampling method was adopted to select a total of 1 200 nursing staff who met the inclusion andexclusion criteria in six tertiary general hospitals from five geographic subdivisions of Hunan Province were selected. A self-designed questionnaire was used to collect demographic characteristics, and past 1-month prevalence of neck-shoulder pain, a neck disability index (NDI) was used to assess the impact of neck pain on daily life, and functional disability was graded by the index of impaired neck function; a self-designed questionnaire was adopted to evaluate potential workload-related risk factors (working time, postural load, and force load) of neck-shoulder pain after a Delphi expert consultation. A total of 1 161 valid questionnaires were returned, and χ^２test and logistic regression model were used to screen the potential risk factors for neck-shoulder pain. Results The prevalence rate of neck-shoulder pain in the past 1 month was 87.5% (1 016/1 161) and varied by different characteristics of the nursing staff, ranging from 76.9% to 91.2%. The scores of the 10 items of the NDI ranged from 0 to 5, but most of them were 0, 1, and 2; of the 10 items, neck pain had the greatest impact on sleep (1.30±1.21) and the least impact on self-care behaviors (0.35±0.65). The index of impaired neck function showed that the majority (65.4%) of nurses had mild cervical spine dysfunction and 30.1% had moderate cervical spine dysfunction. The univariate analysis results revealed that 24 out of the 31 workload-related risk factors had significant differences, and further multiple analysis results showed that three variables entered the logistic regression model. Under the same conditions, nurses with ≥5 h of cumulative head-down tasks per shift had 3.03 times higher neck-shoulder pain risks compared with those with ＜1 h. Compared with “occasionally or never”, nurses who “sometimes” and “often” tilted their necks back and maintained this posture for a long time showed 2.36 and 2.94 times higher risks for neck-shoulder pain respectively. The nurses who reported “sometimes” and “often” having difficulty using their force at work due to unnatural posture had 2.78 times and 7.08 times higher neck-shoulder pain risks than those who “occasionally or never” respectively. Conclusion The reported rate of neck-shoulder pain among nurses in tertiary general hospitals in Hunan Province is high, but most of them are mild dysfunction. Working hours and posture load may affect the risk of neck-shoulder pain.

Objective:To study the patterns of tocilizumab (TCZ) use, its efficacy and safety in patients with rheumatoid arthritis (RA) in routine clinical practice.Methods:A total of 407 patients with RA were enrolled from 23 centers and treated with TCZ within 8 weeks prior to the enrollment visit, and were followed for 6-month. The patterns of TCZ treatment at 6 months, the effectiveness and safety outcomes were recorded. Statistical analysis was performed using SAS version 9.4.Results:A total of 396 patients were included for analysis, in which 330 (83.3%) patients received TCZ combined with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 16.7%(66/396) received TCZ monotherapy. At baseline, TCZ was initiated in 56.6%(224/396) and 9.6%(38/396) of patients after failure of DMARDs and other biological agents (bDMARDs) respectively. During the 6-month follow-up period, the mean frequency of TCZ administration was (3.7±1.6), the mean TCZ dosage was (7.4±1.2) mg/kg, and the mean interval between doses was (40±13) days. 120(25.8%) patients were on TCZ treatment at the end of the study. Improvements in disease activity, systemic symptoms and patient report outcomes were observed at the end of the study. 22.7%(90/396) patients experienced at least one treatment related adverse event, and 8 patients experienced at least one serious adverse event.Conclusion:This study demonstrates that TCZ treatment is effective in patients with RA when being treated for 6 months with an acceptable safety profile. The duration of TCZ treatment needs to be extended.

OBJECTIVE: We propose a sparse-view helical CT iterative reconstruction algorithm based on projection of convex set tensor total generalized variation minimization (TTGV-POCS) to reduce the X-ray dose of helical CT scanning. METHODS: The three-dimensional volume data of helical CT reconstruction was viewed as the third-order tensor. The tensor generalized total variation (TTGV) was used to describe the structural sparsity of the three-dimensional image. The POCS iterative reconstruction framework was adopted to achieve a robust result of sparse-view helical CT reconstruction. The TTGV-POCS algorithm fully used the structural sparsity of first-order and second-order derivation and the correlation between the slices of helical CT image data to effectively suppress artifacts and noise in the image of sparse-view reconstruction and better preserve image edge information. RESULTS: The experimental results of XCAT phantom and patient scan data showed that the TTGVPOCS algorithm had better performance in reducing noise, removing artifacts and maintaining edges than the existing reconstruction algorithms. Comparison of the sparse-view reconstruction results of XCAT phantom data with 144 exposure views showed that the TTGV-POCS algorithm proposed herein increased the PSNR quantitative index by 9.17%-15.24% compared with the experimental comparison algorithm; the FSIM quantitative index was increased by 1.27%-9.30%. CONCLUSIONS The TTGV-POCS algorithm can effectively improve the image quality of helical CT sparse-view reconstruction and reduce the radiation dose of helical CT examination to improve the clinical imaging diagnosis.