New drug discovery is under growing pressure to satisfy the demand from a wide range of domains, especially from the pharmaceutical industry and healthcare services. Assessment of drug efficacy and safety prior to human clinical trials is a crucial part of drug development, which deserves greater emphasis to reduce the cost and time in drug discovery. Recent advances in microfabrication and tissue engineering have given rise to organ-on-a-chip, an in vitro model capable of recapitulating human organ functions in vivo and providing insight into disease pathophysiology, which offers a potential alternative to animal models for more efficient pre-clinical screening of drug candidates. In this review, we first give a snapshot of general considerations for organ-on-a-chip device design. Then, we comprehensively review the recent advances in organ-on-a-chip for drug screening. Finally, we summarize some key challenges of the progress in this field and discuss future prospects of organ-on-a-chip development. Overall, this review highlights the new avenue that organ-on-a-chip opens for drug development, therapeutic innovation, and precision medicine.

Objective? To define the difficulty coefficient of Operating Room nursing items which is suitable for difficulty evaluation and can represent the workload of Operating Room nursing. Methods? From January 2017 to March 2018, through literature review, questionnaire survey and expert demonstration meeting, the nursing work items and operational difficulty indicators suitable for difficulty evaluation in Operating Room were determined. The weight of difficulty indicators was determined by analytic hierarchy process. Fifteen experts were selected for three rounds of Delphi inquiry. The coefficients of difficulty were determined by weighted linear method. Results? Finally, the difficulty coefficients of 68 operating room nursing items were obtained. The top three difficulty coefficients were "position placement and observation of lateral traction bed (7.268 7)", "position placement and observation of fixed skull (7.254 0)" and "position and observation of skull-brain frame lateral decubitus position (7.243 3)"; the last three difficulty coefficients were "horizontal supine position placement and observation (2.178 2)" and "sterile sheet laying (2.046 0)" , "no-contact wearing of sterile gloves (1.000 0)". Conclusions? This study defines 68 difficulty coefficients of operating room nursing work items which are suitable for difficulty evaluation and can represent the workload of Operating Room nursing. It can quantify the difficulty of Operating Room nursing work items and enhance the rationality of Operating Room nursing workload counting.

OBJECTIVETo observe the clinical efficacy of acupuncture combined with western medicine in the treatment of rheumatoid arthritis (RA) and its effect on blood stasis, and to explore ways to improve the clinical curative effect.

METHODSA total of 56 patients of RA were randomly divided into an observation group and a control group, 28 cases in each one. ① ibuprofen sustained-release tablets, 2 times a day, each time 0.3 g; ② methotrexate tablets (MTX), once a week, each time 10 mg ③ folic acid tablets, once a week, each time 5 mg were given in the control group, 30 days as one course, a total of 3 courses were required. In the observation group, acupuncture was adopted on the basis of the treatment as the control group. The main acupoints were Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) combined with local points. The treatment was given once every day for continuous 6 days a week, the treatment for 30 days as one course, a total of 3 courses were required. The serological indexs were evaluated before and after treatment, including the rheumatoid factor (RF), hypersensitive C-reactive protein (hs-CRP), erythrocyte sedirnentation rate (ESR), platelet (PLT), fibrinogen (FBG) and D-dimer (D-D), the changes of disease activity score (DAS-28), symptom grade quantitative score, blood stasis syndrome symptom (the joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin) score were observed.

RESULTS① The scores of RF, hs-CRP, ESR, PLT, D-D, FBG, DAS-28 and symptom grade quantitative were significantly improved in the two groups compared with those before treatment (all <0.05), and the scores of hs-CRP, ESR, DAS-28 and symptom grading in the observation group were more better than those in the control group (all <0.05). ② The total score of joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin and blood stasis syndrome in both groups were decreased after treatment (all <0.05), the joint tingling, tongue, lip color and subcutaneous ecchymosis were improved obviously in the observation group than those in the control group (all <0.05). ③ The total effective rate in the observation group was 85.7% (24/28), which was better than 75.0% (21/28) in the control group (<0.05).

CONCLUSIONAcupuncture combined with western medicine can not only improve the clinical efficacy of RA patients but also improve the blood stasis.

Acupuncture Points ; Acupuncture Therapy ; Arthritis, Rheumatoid ; therapy ; Combined Modality Therapy ; Folic Acid ; therapeutic use ; Humans ; Ibuprofen ; therapeutic use ; Methotrexate ; therapeutic use ; Treatment Outcome

Objective: To understand the molecular evolution characteristics of the nucleoprotein (N) genes and epidemiological feature of 118 rabies virus (RABV) strains isolated in Yunnan province, China from 2006 to 2015. Methods: The brain tissue samples from mad dogs, suspicious sick dogs, sick cow, and human brain tissue, saliva and CSF samples from rabies patients were collected in Yunnan province to detect the viral antigen by direct immunofluorescence assay (DFA). The viral RNA from positive samples was extracted. Coding region of N gene was amplified by RT-PCR and sequenced. The phylogenetic tree was constructed by Neighbor-Joining method of MEGA5.0 software. Results: The sequences of N genes of 91 RABV strains in Yunnan from 2012 to 2015 were obtained. With the sequences of N genes of 27 RABV strains in Yunnan from 2006 to 2011 and 29 RABV strains from Southeast Asian Countries, the phylogenetic analysis was performed. RABV strains in Yunnan were divided into clades YN-A (105 strains), YN-B (6 strains), YN-C (7 strains), which belonged to clades China-I, China-VI, China-II respectively. Clade YN-A was epidemic every year from 2006 to 2015, of them, 14 strains from 2006 to 2011 and 91 strains from 2012 to 2015 were distributed in 13 prefectures (cities) of Yunnan. Clades YN-B and YN-C were epidemic only from 2006 to 2010 and from 2008 to 2011 respectively. The regional distribution of clades YN-B and YN-C was limited. The strains of YN-A and YN-C were closely related to the strains of clades China-I and China-II from neighboring Sichuan, Guizhou, Guangxi and Hunan provinces. The strains of YN-B were closely related to the strains from Myanmar, Laos, Vietnam and Cambodia. Conclusions Three RABV clades with multiple transmission sources were identified in Yunnan. Clade YN-A was widely distributed in rabies endemic area in Yunnan from 2006 to 2015, and it has strong ability to spread as principal clade in Yunnan. Since 2012, clades YN-B and YN-C were not found again in Yunnan.

Objective To evaluate the effect of health education on the compliance and health status of epileptic patients after discharge. Methods A total of 88 patients with epilepsy were selected and divided into control group (January to June in 2014) and experimental group (July to December in 2014)with 44 patients each.During hospitalization,the patients in control group were given routine health education,discharge guidance,on the basis of the control group,the patients in experimental group were added health education after discharge. The health status were evaluated at the time of admission and discharge(1 days before discharge)and 1,3,6 and 12 months after discharge.The medication compliance and clinical efficacy of the two groups were evaluated at 12 months after discharge. Results The medication compliance at 12 months after discharge was 97.73%(43/44)in experimental group and 63.64% (28/44)in control group,and there was significant difference(x2=15.92,P<0.01).The total effective rate was 84.09%(37/44)in experimental group and 40.91%(18/44)in control group,and there was significant difference (x2=12.31, P<0.01). Repeated measurement of variance analysis showed that there was no significant difference between two groups of self testing health score during hospitalization (P>0.05), there were significant differences in the health status at 1, 3, 6, 12 months after discharge between two groups, treatment effect, time effect, interaction effect (F =57.50, 5.69, 8.35, P<0.01). Conclusions Health education after discharge can improve the medication compliance, health status and clinical efficacy of patients with epilepsy and promote their rehabilitation.

OBJECTIVETo explore the clinical efficacy of moxibustion on rheumatoid arthritis (RA) in the patients and the impacts on the inflammatory indices.

METHODSForty RA patients were randomized into an observation group and a control group, 20 cases in each one. In the control group, diclofenac sodium sustained release tablets were used, 0.3 g each time, twice a day; methotrexate tablets were used, 10 mg each time, once a week; folic acid was used, 5 mg each time, once a week. In the observation group, on the basis of the treatment as the control group, moxibustion was added specially on the swelling and painful joints, once a day, 15-20 min each time till: the local skin turned slightly red. The treatment was given once a day, at the interval of 1 day after every 6 treatments. In the two groups, the efficacy was observed after 30-day treatment. Before and after treatment, the rheumatoid factor (RF), high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), disease activity score-28 (DAS-28) and the score of joint symptom and physical signs were observed.

RESULTSCompared with those before treatment, the levels of RF, hs-CRP, ESR, DAS-28 and the symptom scale score were all reduced in the RA patients of the two groups after treatment (all P < 0.05). Compared with the control group, the levels of RF, hs-CRP, ESR, DAS-28 and the symptom scale score in the observation group were improved much apparently (all P < 0.05). The total effective rate was 85.0% (17/20) in the observation group and was 80.0% (16/20) in the control group. The total effective rate in the observation group was apparently better than that in the control group (P < 0.05).

CONCLUSIONMoxibustion as supplement relieves the joint symptoms, reduces the inflammatory reactive indices and improves the clinical efficacy in the RA patients.

Adult ; Aged ; Arthritis, Rheumatoid ; blood ; therapy ; C-Reactive Protein ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Rheumatoid Factor ; blood ; Treatment Outcome ; Young Adult

Background Juvenile Graves ophthalmopathy has a low prevalence and few relevant studies.Analyzing and reviewing the clinical features and therapeutic effectiveness of juvenile Graves ophthalmopathy is helpful to its diagnosis and management.Objective This study was to evaluate the clinical characteristics of Graves ophthalmopathy and its management in children and adolescents.Methods The clinical data of 54 eyes from 29 patients with Graves ophthalmopathy who were diagnosed in Shanghai Changzheng Hospital from January 2007 to December 2012 were retrospectively analyzed.The ocular manifestations,thyroid function,CT or MRI testing results were collected,and the activity of Graves ophthalmopathy was scored based on the criteria of CAS.Artificial tears was topically administered in 44 eyes with CAS ≤ 2.In the eyes with CAS ≥ 3,corticosteroids drug was systemically used in 3 patients,and orbital decompression surgery and excision of Müller muscle were performed in 3 eyes of 2 patients respectively.The follow-up was carried out for 1.5-6 years.The treatment outcomes were evaluated according to the reduction of exophthalnos and the improvement of upper eyelid retraction.Results The patients were 5-18 years old with an average age of 12.9 years old.Out of 29 Graves ophthalmopathy patients,5 males and 24 females were included.The initial clinical manifestations were proptosis,eyelid retraction and swelling,and accompanied by conjunctival congestion and hypophasis.The best corrected visual acuity (BCVA) was ≥ 0.8 in all the eyes.CAS scores wcre 0-2 in 48 eyes of 26 patients and ≥ 3 (active Graves ophthalmopathy) in 6 eyes of 3 patients.The increase of orbital adipose volume was exhibited in all the eyes and the enlargement of extraocular muscle was revealed in parts of eyes by CT/MRI.Laboratory examination showed normal thyroid function in 12 patients (41.4％),hyperthyreosis in 15 patients (51.7％) and hypothyroidism in 2 patients (6.9％).The ocular symptom was improved in 20 eyes of 11 patients (37.9％),stabilized in 29 eyes of 16 patients (55.2％) and worsen in4 eyes of 2 patients (6.9％) in following-up duration.Conclusions Graves ophthalmopathy occurs much more in female than in male.The clinical manifestations are mild,with low activity and good prognosis in children and adolescents Graves ophthalmopathy.

OBJECTIVETo compare the clinical effective differences between pricking blood combined with moxibustion and west medication for acute gouty arthritis.

METHODSForty patients with acute gouty arthritis were randomly divided into a pricking blood combined with moxibustion group (a combination group) and a western medication group, 20 cases in each one. In the combination group, pricking blood was used at the most painful points of the red turgid and painful joint once three days, total 3 times; moxibustion was applied at the same joint for 15-20 min, once a day. The moxibustion was adopted for 10 days. In the western medication group, 0. 3 g ibuprofen was prescribed orally twice a day for 10 days. The changes of uric acid (UA), high sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR) and the joint syndrome and symptom score before and after: treatment were observed. Results In the two groups, the UA, the hs-CRP, the ESR and the joint syndrome and symptom scores were lower than those before treatment (all P<0. 05). After treatment, the UA, the ESR and the joint syndrome and symptom scores in the combination group were declined more apparently than those in the western medication group (all P<0. 05). The total effective rate in the combination group was 85. 0% (17/20) which was better than 75. 0% (15/20) in the western medication group (P<0. 05).

CONCLUSIONPricking blood combined with moxibustion could improve the joint symptoms more effectively and the effect is better than ibuprofen orally.

Adolescent ; Adult ; Aged ; Arthritis, Gouty ; therapy ; Bloodletting ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Treatment Outcome ; Young Adult

Objective We conducted a survey on the awareness rate of stroke in Yangquan residents and analyzed factors affecting awareness to provide basic information for Yangquan residents to prevent and treat stroke in Shanxi.MethodsA questionnaire regarding awareness and basic knowledge of stroke was used in this study and applied to Yangquan residents.A cluster stratified sample of 7983 residents were questionnaired by cross-sectional method.Results7921 returned copies were valid.The awareness rate of stroke in 7921 selected Yangquan residents was 30.14％ (2387/7921). Upon the occurrence of stroke,the awareness rates of the way to see a doctor,the right department to look for medical care and test manners to diagnose the illness as stroke were relatively high in these investigated people,which were 74.03％ (5864/7921),78.17％ (6192/7921) and 84.04％ (6657/7921),respectively.However,the number of people who knew characteristic symptoms and complications of stoke,risk factors that cause stroke and how to treat stroke was 2021 (25.51％),841 ( 10.62％ ),and 902 ( 11.39％ ),respectively,which was relatively low. After multivariate analysis,the awareness rate of stroke in Yangquan residents was positively correlated with an education degree.ConclusionsYangquan residents know little about stroke.Therefore,it is necessary to increase the level of their knowledge regarding stroke by extended propaganda and encourage them to live a healthy life to be able to treat stoke in time and to reduce the possibility of stroke occurring.

A total of 192 patients with sepsis were tested by Montreal Cognitive Assessment (MoCA) for a preliminary diagnosis of whether or not there was sepsis associated encephalopathy (SAE) according to their test results.SAE was diagnosed or excluded after consultations and comprehensive analysis on the basis of clinical manifestations and auxiliary examination results.The scores of the patients in this group were (25.7 ± 3.3) points.The sensitivity of MoCA for screening SAE was 0.776 and its specificity 0.963.The rate of diagnostic coincidence between MoCA and comprehensive analysis for SAE was 0.880.The diagnostic concordance between two diagnostic methods of SAE was excellent (kappa value =0.753 ± 0.048,P =0.000).The area under the receiver operating characteristic (ROC) curve of MoCA for screening SAE was 0.929 ± 0.019 (P =0.000) ; the optimal cutoff value was 25.5 points; and its sensitivity was 0.779 and specificity 0.962.And negative correlations existed between score of MoCA and age,disease course and co-existing shock or multiple organ dysfunction syndrome (P ＜ 0.05).