[Objective] : To systematically evaluate the overall efficacy of external application of traditional Chinese medicine (EA-TCM) in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain (CIBP). [Methods] : We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems. It included four Chinese databases [Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP) ], six English databases (Scopus, Embase, Web of Science, PubMed, Cochrane Library, and OpenGrey), and two registration systems (Chinese Clinical Trial Registry and ClinicalTrials.gov). The timeframe for the literature search extended from the inception of each database to December 31, 2023. Meta-analysis was performed using RevMan (v5.4.1), and the outcome indicators (pain relief rate, analgesic duration, quality of life, pain intensity, breakthrough pain frequency, and adverse reactions) were graded using GRADE profiler (v3.6). [Results] : According to the established inclusion and exclusion criteria, a total of 43 studies was deemed eligible, involving 3 142 participants with CIBP. The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone, the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate [risk ratio (RR) = 1.32, 95% confidence interval (CI): 1.24 to 1.41, P < 0.000 01], analgesic duration [mean difference (MD) = 1.33, 95% CI: 0.97 to 1.69, P < 0.000 01], and quality of life (MD = 5.66, 95% CI: 4.88 to 6.44, P < 0.000 01). Furthermore, the combined therapy significantly reduced pain intensity (MD = – 1.00, 95% CI: – 1.19 to – 0.80, P < 0.000 01), breakthrough pain frequency (MD = – 0.43, 95% CI: – 0.51 to – 0.36, P < 0.000 01), and adverse reactions (RR = 0.60, 95% CI: 0.53 to 0.68, P < 0.000 01) in CIBP patients. Based on the GRADE assessment, the level of evidence varied from low to moderate. [Conclusion] EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life. Additionally, the EA-TCM can effectively reduce the incidence of adverse reactions associated with three-step analgesic therapy.

Background Injury poses a serious threat to human health. As global warming continues to intensify, there is an urgent need to explore the impact of temperature changes on injury deaths. However limited research has focused on this issue. Objective To investigate the relationship between daily mean temperature change (Tm) and injury death, as well as to estimate the associated future death burden in Hunan Province. Methods We employed an individual-level, time-stratified case-crossing design to establish a conditional logistic regression model to analyze the exposure-response relationship between daily mean temperature change and injury death in Hunan Province from 2013 to 2018. Consequently, we conducted subgroup analysis of gender, age group, and injury type. Finally, we estimated the excess burden of injury death attributable to temperature changes under a sustainable development path [low emission scenario (SSP1-2.6)], regional competition path [high emission scenario (SSP3-7.0)], or fossil fuel development path [very high emission scenario (SSP5-8.5)]. Results The study collected 155577 injury deaths in Hunan Province. The results indicated that for each 1 ℃ increment in daily mean temperature, the cumulative excess risk (CER) of injury mortality among Hunan residents increased by 0.71% (95%CI: 0.53%, 0.90%). Notably, the CER for intentional injuries (1.06%, 95%CI: 0.51%, 1.61%) was higher than that for unintentional injuries (0.66%, 95%CI: 0.46%, 0.87%). Warmer temperatures were positively associated with CER of mortality due to drowning, falls, transport injuries, assaults, and suicides, while they were negatively associated with mortality due to poisoning. Compared with 2010–2019, for 2090–2099, the excess mortality rate (EMR) due to ambient temperature increase in Hunan Province under the SSP5-8.5 scenario (14.62/100000, 95%CI: 10.81/100000, 18.40/100000) would be higher than that of the SSP3-7.0 scenario (10.28/100000, 95%CI: 7.58/100000, 12.97/100000) and the SSP1-2.6 scenario (3.35/100000, 95%CI: 2.46/100000, 4.23/100000); the EMR would be around 2.5 times among men (20.64/100000, 95%CI: 14.44/100000, 26.8/100000) than that among women (8.33/100000, 95%CI: 3.98/100000, 12.6/100000). Among unintentional injuries, the leading contributors to EMR would be drowning (4.46/100000), falls (3.96/100000), and transport injuries (2.96/100000). And among intentional injuries, the EMR for suicide (2.08/100000) would be higher than that for assault (0.47/100000). Conclusion Climate warming will increase the total burden of injury-related deaths among residents in Hunan Province, especially in the absence of effective mitigation strategies and measures. It is necessary to strengthen the prevention and control of severe injuries closely related to temperature changes, such as drowning, falls, traffic, and suicides injuries, in order to reduce injury deaths associated with climate change.

Objective To systematic evaluate the effectiveness and safety of driving pressure-guided fixed positive end-expiratory pressure(PEEP)titration in intraoperative mechanical ventilation.Methods PubMed,Web of Science,the Cochrane Library,Embase,CNKI,Wanfang and VIP databases were searched for collect randomized controlled trials(RCTs)of PEEP titration guided by driving pressure in intraoperative mechanical ventilation from inception to November 8,2023.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias of the included studies,the meta-analysis was conducted by Rev-Man 5.4 software.Results Nineteen studies with a total of 2 906 patients were included.There were 1 440 patients in the study group with the lung protective ventilation strategy guided by PEEP titration,and 1 466 patients in the control group with the traditional lung protective ventilation strategy.Compared with the con-trol group,the incidence of postoperative pulmonary complications(PPCs)in the study group was lower in the non-thoracic surgery(RR=0.53,95%CI:0.43-0.65,P<0.001),but there was no statistical difference in the incidence of PPCS in the thoracic surgery(RR=0.89,95%CI:0.78-1.02,P=0.09).Compared with the control group,the intraoperative lung compliance was increased(MD= 6.90 L/cmH2O,95%CI:5.80-7.99,P<0.001),and the length of hospital stay was shortened in the study group(MD=-0.27 d,95%CI:-0.43 to-0.12,P<0.001),while there was no significant difference in intraoperative mean arterial pres-sure(MAP)between the two groups(MD=0.36 mmHg,95%CI:-1.30 to 2.01,P=0.67).Conclusion Com-pared with the traditional lung protective ventilation,driving pressure-guided PEEP titration ventilation can im-prove intraoperative lung compliance,reduce the incidence of PPCs in non-thoracic surgery,shorten the length of hospital stay,and does not increase the risk of hemodynamic disturbances in patients undergoing surgery.

Osteoporosis is an emerging threat characterized by systemic damage to bone mass and microarchitecture leading to fragility fractures.Exosomes are nanosized vesicular particles secreted by cells into the extracellular compartment with biological activities similar to those of their cell of origin and play an important role in intercellular communication processes.Exosomes from multiple cell sources are involved in the regulation of bone-related cell proliferation and differentiation during bone metabolism,and have the advantages of high stability,non-immunogenicity and strong targeting ability,which make up for the shortcomings of traditional drug and stem cell therapies.Exosomes secreted from bone marrow mesenchymal stem cells(MSCs)can promote bone regeneration and improve morphology,biomechanics and histological damage,and exosomes derived from bone marrow mesenchymal stem cells(BMSCs)in the mechanical microenvironment are more effective in inducing osteogenesis,significantly enhancing the osteogenic effect of BMSCs and promoting bone regeneration.Therefore,this article provides a review on the mechano-sensitivity of MSCs,mechanical responsive functionalized exosomes of MSCs,and explores their potential role in the treatment of osteoporosis.

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Femoral fracture is a common type of fracture in clinical practice, and poor fracture reduction may lead to malunion and dysfunction. At present, traditional reduction with manipulation and intramedullary nailing are the mainstream treatments, but there exist problems such as X-ray exposure or poor reduction. Fracture reduction robots are of positive significance in improving the safety of surgical treatment of femur fracture, avoiding repetitive operations and poor alignment, and shortening the patients′ postoperative recovery time. Navigation algorithm is the key to achieve the function of femoral repositioning. Understanding the advantages and disadvantages that various types of navigation algorithms demonstrated in femoral reduction applications is important for giving full play to the value of fracture reduction robots in femoral reduction. Therefore, the authors reviewed the research progress in existing robot navigation algorithms applied in femoral fracture repositioning from the following four aspects, including image alignment algorithm, algorithm for establishing the target pose of femoral repositioning, algorithm for compensating the mechanical error, and algorithm for path planning, hoping to provide a reference for the application and research of navigation algorithms of fracture reduction robots.

Bone defects, often accompanied by osteomyelitis, soft tissue contusions, etc, are facing lengthy treatment process and slow healing, seriously jeopardizing the structural integrity of the human bone tissue. Currently, the main treatment for bone defects involves autologous or allogeneic bone transplant. However, autologous bone transplant poses problems, including long surgical duration, increased pain and complications such as infections. Additionally, immune rejection reactions also limit the effectiveness of allogeneic bone transplant of the same species. Bone scaffolds have become a potential alternative for bone transplant, but problems such as sharp edges of the scaffolds and poor compatibility with human tissues exist. Triply periodic minimal surface (TPMS), with an average curvature of zero has lower levels of stress concentration and the ability to be precisely expressed with mathematical formulas, compared with other structures. Its application in bone scaffolds attracts much attention, but there is currently a lack of comprehensive understanding of the impacts of different types of TPMS on the performance of bone scaffolds. With this purpose, the authors reviewed the research progress in the impacts of different types of TPMS on the performance of bone scaffolds, providing a reference for the construction of bone scaffolds.

Objective:Focusing on the medical protection of marine sports events at the 19th Asian Games in Hangzhou. This paper analyzes the effect of the development and implementation of the medical protection program to provide a referable summary of experience for the medical protection of future large-scale international maritime events.Method:This paper retrospectively analyzed the medical protection of Ningbo Xiangshan Yafan Center during the preparation stage of the Asian Games Sailing Competition, and during the period from September 21 to September 27, 2023 when the Asian Games Sailing Competition is held. Analyze the organizational structure and scheme of medical support.Results:During this Asian Games sailing competition, there were a total of 14 paramedics, 4 rescue helicopter crews, 2 ambulances and 1 rescue helicopter in and around the competition venues. In the city, the designated hospital has set up a total of 12 working groups, 15 protection outpatient clinics and a number of various types of clinic areas. There are 129 medical and nursing staff directly participating in the medical protection work of the Asian Games. A total of 44 specialized beds were reserved in the designated hospitals. There were also a number of volunteers and logistic staff who relied on the support work. The top three major disease types were trauma with 66 cases (29.2%), upper respiratory tract infection with 34 cases (15.04%) and skin allergy with 19 cases (8.51%). The top two population groups consulted were staff with 95 visits (44.19%) and technical officers with 89 visits (41.40%).Conclusions:During the sailing competitions of the Asian Games, the medical care was smooth and orderly. Trauma, upper respiratory tract infections and skin allergies are the most prominent diseases. The number of medical consultations for staff and technical officials of the Asian Games Sailing Competition accounted for more than 80% of the total number of consultations for all personnel. They should be given priority care.

Radiopharmaceutical dynamic imaging typically necessitates intravenous injection via the bolus method. However, manual bolus injection carries the risk of handling errors as well as radiological injuries. Hence, there is potential for automated injection devices to replace manual injection methods. In this study, the effect of micro-bolus pulse injection technology was compared and verified by radioactive experiments using a programmable injection pump, and the overall bubble recognition experiment and rat tail vein simulation injection verification were performed using the piezoelectric sensor preloading method. The results showed that at the same injection peak speed, the effective flushing volume of micro-bolus pulse flushing (about 83 μL/pulse) was 49.65% lower than that of uniform injection and 25.77% lower than that of manual flushing. In order to avoid the dilution effect of long pipe on the volume of liquid, the use of piezoelectric sensor for sealing preloading detection could accurately predict the bubbles of more than 100 μL in the syringe. In the simulated injection experiment of rat tail vein, when the needle was placed in different tissues by preloading 100 μL normal saline, the piezoelectric sensor fed back a large difference in pressure attenuation rate within one second, which was 2.78% in muscle, 17.28% in subcutaneous and 54.71% in vein. Micro-bolus pulse injection method and piezoelectric sensor sealing preloading method have application potential in improving the safety of radiopharmaceutical automatic bolus injection.
Animals ; Rats ; Radiopharmaceuticals/administration & dosage*

OBJECTIVE: To review the research progress of design of bone scaffolds with different single cell structures. METHODS: The related literature on the study of bone scaffolds with different single cell structures at home and abroad in recent years was extensively reviewed, and the research progress was summarized. RESULTS: The single cell structure of bone scaffold can be divided into regular cell structure, irregular cell structure, cell structure designed based on topology optimization theory, and cell structure designed based on triply periodic minimal surface. Different single cell structures have different structural morphology and geometric characteristics, and the selection of single cell structure directly determines the mechanical properties and biological properties of bone scaffold. It is very important to choose a reasonable cell structure for bone scaffold to replace the original bone tissue. CONCLUSION Bone scaffolds have been widely studied, but there are many kinds of bone scaffolds at present, and the optimization of single cell structure should be considered comprehensively, which is helpful to develop bone scaffolds with excellent performance and provide effective support for bone tissue.
Bone and Bones ; Tissue Scaffolds