Shared decision-making is a medical model developed in the 1970s where physicians and patients jointly participate in making healthcare decisions. It has been widely adopted in developed countries in Europe and the United States. In recent years, more and more studies have explored the localization of shared decision-making in China, but the clinical application model in Chinese context has not yet been established. This article reviews the basic concept, clinical application, advantages and disadvantages, and future development of the shared decision-making between doctor and patient, in hope of providing ideas for the construction of a shared decision-making model in China.

Objective:This study aims to summarize the theoretical basis and practical effect of interdisciplinary team building in the National Clinical Medical Research Center for Aging and Medicine, Huashan Hospital.Methods:Interactive memory was employed as the theoretical basis for building cross-disciplinary teams, and the work was carried out in three dimensions of specialization, credibility, and coordination.Results:The center had shaped a coordinative team atmosphere and strengthened its integrity in five dimensions, including discipline construction, open platform, innovation curation, science popularization, and technology transfer. The center also promoted the implementation of research tasks in the three core areas.Conclusions:As the aging healthcare issues are highly diversified, complex, and systematic, the center needs to continuously improve its ability to build interdisciplinary teams and provide a platform for integrating various types of resources into the solution of healthcare problems of the elderly.

Objective:To analyze clinical and imaging features of Sturge-Weber syndrome in children.Methods:Clinical data were collected from 27 children with Sturge-Weber syndrome in Xuzhou Children′s Hospital, Xuzhou Medical University from July 2013 to December 2019, and analyzed retrospectively.Results:Among the 27 children, 17 were males and 10 were females. Their age at the clinic visit ranged from 2 days to 10 years and 7 months, and averaged 2.54 years. All the 27 patients presented with facial port-wine stains of varied color from light red to purple red, which were all distributed across the facial midline, including 21 with predominantly unilateral port-wine stains and 6 with bilateral symmetrical port-wine stains. There were 17 patients with ocular choroidal vascular malformations, including 14 with congenital glaucoma, 5 with high intraocular pressure, and 1 with optic nerve atrophy accompanied by transient blindness. Neurological impairment occurred in 12 patients, and all manifested as epilepsy. All the 27 children underwent imaging examination, and abnormalities were found in 20. Among the 10 patients with abnormal computed tomography images, local calcification was observed in 8, and local thickening of the skull on the side affected by skin lesions in 8; 13 of 14 patients with abnormal magnetic resonance imaging scan results had signs of brain atrophy, 9 showed enhanced gyrus-like blood vessel formation by enhanced magnetic resonance imaging, and 5 showed decreased branches of the anterior and middle cerebral artery on the affected facial side by magnetic resonance angiography.Conclusions:Children with Sturge-Weber syndrome are clinically characterized by predominantly unilateral port wine stains on the face, some of whom are accompanied by epilepsy, glaucoma or mental retardation, and imaging examinations mainly show local calcification, brain atrophy, local thickening of the skull plate, enhanced gyrus-like blood vessel formation, etc. Early definite diagnosis and comprehensive systemic treatment are needed to reduce disability and mortality rates in patients with Sturge-Weber syndrome, and long-term follow-up should be considered.

Objective To determine the effect of trunk motion control on knee biomechanics during single-leg landing. Methods Twenty male healthy basketball players were recruited. The kinematics, kinetics parameters and surface electromyogram (EMG) of knee joints under trunk motion control during single-leg landing were studied by using Vicon motion Analysis system, Kistler force platform and Noraxon surface EMG system. Results Compared with natural landing, there were significant differences in flexion angle at initial contact moment, peak flexion angle and peak flexion moment during deeply inspiratory landing and landing with a stick, and a significantly larger flexion angle at initial contact moment, a larger peak flexion angle and smaller peak flexion moment were also found. Compared with natural landing, there was no statistical difference in peak valgus angle and peak valgus moment, as well as EMG activity of hamstrings, quadriceps muscles of the knee during deeply inspiratory landing and landing with a stick. Conclusions Deeply inspiratory landing or landing with a stick reduce the risk of anterior cruciate ligament (ACL) injury, and the results provide the theoretical basis for prevention of ACL injuries in basketball players during landing.

Objective To study the effect of ankle taping (restriction of ankle varus and plantar flexion) on biomechanical characteristics of the knee during drop landing on the dominant leg. Methods Eighteen amateur athletes performed the dominant-legged drop landing under two different ankle conditions (with or without taping). Vicon three-dimensional (3D) motion capture system, Kistler force plate and Noraxon surface electromyography (sEMG) system were used to collect kinetic, kinematic and sEMG data for statistical analysis. Results Compared with control group, ankle taping significantly increased flexion angle at initial contact and maximum flexion angle, while significantly decreased the maximum valgus angle. Conclusions The restriction of varus and plantar flexion might reduce the risk of anterior cruciate ligament (ACL) injury. The intervention with ankle taping could modify biomechanical parameters of the knee during drop landing. The ankle taping by restriction of ankle varus and plantar flexion may be an effective measure to prevent ACL injury for collegiate athletes.

Objective:To explore multidisciplinary team (MDT) for the treatment of hip fracture in the elderly.Methods:A retrospective analysis was done of the 196 elderly patients who had been admitted to Department of Joint Surgery, Beijing Shijitan Hospital from September 2017 to December 2018 for hip fractures. They were divided into 2 groups depending on whether MDT had been applied or not. In the MDT group of 102 patients, there were 43 males and 59 females with an age of 81.9±8.4 years, and 63 femoral neck fractures and 39 intertrochanteric fractures. In the traditional treatment group of 94 patients, there were 37 males and 57 females with an age of 81.3±8.6 years, and 55 femoral neck fractures and 39 intertrochanteric fractures. The 2 groups were compared in terms of complications and mortality during hospitalization, interval from admission to surgery, total hospital stay, and Harris hip scores at 6 months after surgery.Results:There were no statistically significant differences in general data before surgery between the 2 groups, indicating comparability ( P>0.05). Eighty-four patients (89.4%) in the traditional treatment group and 98 patients (96.1%) in the MDT group underwent surgery, showing no significant difference between the groups ( χ2=3.327, P=0.068). In the patients undergoing surgery in the MDT group, the incidences of postoperative delirium [12.2% (12/98)], pulmonary infection [11.2% (11/98)], cardiogenic disease [13.3%(13/98)], electrolyte disturbance[12.2%(12/98)] and deep venous thrombosis of lower extremity [6.1% (6/98)] were significantly lower, the interval from admission to surgery (1.9 d±0.9 d) and total hospital stay (10.2 d±0.9 d) significantly shorter, and Harris hip scores (81.3±6.2) at 6 months after surgery significantly higher than those in the patients undergoing surgery in the traditional treatment group [31.0%(26/84), 22.6% (19/84), 25.0% (21/84), 28.6% (24/84), 16.7%(14/84); 3.1 d±1.6 d and 14.1 d±6.2 d; 75.4±7.8; respectively] (all P<0.05). Conclusion:In the treatment of hip fracture in the elderly, multidisciplinary team is effective in reducing complications during hospitalization, shortening the interval from admission to surgery and total hospital stay, and promoting functional recovery of the hip.

In this paper, a novel and simple RP-HPLC method for the determination of related substances of tiopronin for injection was described. The RP-HPLC analysis was performed on a C18 column, with acetonitrile-0. 1% phosphoric acid(8 ∶92), mobile phase in isocratic mode at a rate of 1. 0 mL/min. The photodiode array detector was set at 210 nm. Seven related substances were detected and the structures were characterized by mass spectrometry. The method showed great suitability, specificity and excellent linearity over the concentration range of 0. 3 to 50 μg/mL(r≥0. 999), and the limits of detection and quantitation were found to be 0. 10 and 0. 31 μg/mL, respectively. The accuracy of the method determined by the entire mean recovery ranged from 98. 7% to 103. 7%. The intra-and inter-day precision was satisfactory(RSD≤4. 4%)and robust(RSD≤6. 4%). And this method was successfully applied for the determination of related substances of tiopronin for injection, which revealed the retention of sulfhydryl compounds and glycine analogues on the RP-HPLC and the effect of the pH value of the mobile phase on the chromatographic behavior of the analytes.

Objective To evaluate clinical effect of volume modulated arc therapy ( VMAT) for spinal metastases .Methods Twenty patients with spinal metastases who had been treated with VMAT were chosen to participate in the study .The prescribed dose varied from 45 to 60 Gy within 15 -20 fractions, 3 Gy per fraction, and one fraction per day of VMAT .Pain and quality of life were measured before VMAT and at several time points up to 6 months after treatment , by the numerical rating scale (NRS) and verbal rating scale (VRS) and the quality of life scale for bone metastases (EORTC QLQ-BM22) questionnaire.In addition, Frankel grading was used to evaluate the neurological function of spinal cord.The primary endpoint was frequency and duration of complete pain relief , and the secondary endpoint was death.Results At the end of the follow-up, the number of patients reporting no pain from spinal metastases, as measured by the NRS, increased from 0 of 20 before VMAT to 10 of 14 ( t =20.24, P<0.05) .NRS-reported pain reduction from baseline to 1 weeks and 4 weeks after VMAT were clinically meaningful with NRS score (6.50 ±0.51) at baseline,(4.30 ±0.47)at 1 week and(2.50 ±0.50)at 4 weeks (t=15.98, 27.57, P<0.05).The pain reduction maintained until the end of the follow-up.These improvements were accompanied by significant reduction in opioid use during the first 6 months after VMAT (16 of 20 patients with strong opioid use at baseline vs.6 of 18 at 6 months; t =8.46, P <0.05). According to EORTC QLQ-BM22 questionnaire , patients obtained significant improvement in pain location , severity, and function with the score (46.50 ±1.50)at baseline, (38.35 ±0.98) at 4 weeks(t=21.51, P<0.05).However,no significant alleviation in social psychology was reported (P>0.05).After VMAT, the patients who suffered from nerve function impairment recovered to different extent . No one had radiation-induced injury , such as radiation myelitis , radiation pneumonitis , etc.Median survival time was 10 month.Conclusions VMAT is a safe and effective treatment method for spinal metastases .Significant reductions in patient-reported pain were observed , along with nerve dysfunction improved .The patients′quality of life was significantly improved .VMAT has no late spinal cord toxicities .

OBJECTIVE: To study the distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps. METHOD: The purulent discharges were collected from sinus of 175 patients with chronic rhinosinusitis with or without nasal polyps during endoscopic sinus surgery. The results of germiculture and drug sensitivity test were analyzed. RESULT: From 175 specimens, 118 (67%) showed positive results in germiculture. Among them, 79 strains of gram positive bacteria and 39 strains of gram negative bacteria were detected. Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus were the most common pathogens in gram positive bacteria. The most common pathogens of gram negative bacteria were P. Aeruginosa, Enterobacter aerogenes, Enterobacter cloacae. The sensitive antibiotic on gram positive bacteria were amikacin, Daptomycin, Linezolid, vancomycin, teicoplanin, amoxicillin and clavulanate potassium, cefuroxime, respectively. The sensitive antibiotics on Gram negative bacteria were amikacin, Cefoperazone/sulbactam and imipenem, ceftazidime ceftazidime, aztreonam, levofloxacin, respectively. CONCLUSION Bacterial infection was common happened in the sinus cavity of patients with chronic rhinosinusitis with or without nasal polyps. Gram positive bacteria were the main pathogenic bacteria and gram positive bacteria and gram negative bacteria have great differences in the sensitivity of antibiotics. For patients with chronic rhinosinusitis, the using of antibiotics should depend on the drug sensitivity test.
Bacterial Infections ; complications ; drug therapy ; Gram-Negative Bacteria ; drug effects ; Gram-Positive Bacteria ; drug effects ; Humans ; Microbial Sensitivity Tests ; Nasal Polyps ; microbiology ; Rhinitis ; microbiology ; Sinusitis ; microbiology