The "pre-disease" theory of traditional Chinese medicine focuses on the dynamic and continuous evolution from health to disease, and emphasizes early identification and intervention in the complex and gradual process of evolution from health to disease. The "pre-disease" theory and complexity science share the same perspective on health and disease from the standpoint of features of the dynamic evolution and holism, i. e., life is considered as a complex system with ongoing dynamic changes, which exhibit the nonlinear features of " homeostasis-destabilization-phase transition-another homeostasis". In this paper, from the perspective of nonlinear dynamics in complexity science, we explain the scientific connotation of the evolution law of "pre-disease"-disease based on the theory of critical slowing down in traditional Chinese medicine. Based on the theory of critical slowing down and the dynamic network biomarker method generated by its development, combined with the macro signs of comprehensive analysis of data gained by four diagnostic method and the micro features including transcriptomics and the microbiomics, this paper proposes to integrate macro and micro multi-hierarchy information to construct a "pre-disease" critical slowing down identification model with the characteristics of traditional Chinese medicine diagnosis and treatment, which provides a new perspective and method for the early warning of complex diseases.

Case-based reasoning is a method of reasoning from experience to solve current problems in the field of cognitive science， which has the advantages of easy acquisition of knowledge， simple operation steps， and the ability to improve the efficiency of reasoning with the growth of experience. Formula-syndrome differentiation is a method of differentiation and treatment based on the scope of the adapted disease， disease mechanism， therapeutic methods， and contraindications of the formula. Analysed from the perspectives of concept， applicable field， and implementation steps， it is believed that the concept of formula-syndrome differentiation belongs to the scope of case-based reasoning， the clinical diagnosis and treatment of traditional Chinese medicine belongs to the applicable field of case-based reasoning， and the steps of formula-syndrome differentiation are consistent with the process of case-based reasoning. Based on the characteristics of case-based reasoning， we analyse the advantages， limitations and problems to be noted in the process of formula-syndrome differentiation， and put forward four strategies to improve the ability of formula-syndrome differentiation， including accumulating experience on formulas and syndromes， cultivating the ability to grasp the main symptoms， accumulating a rule base to improve the ability to modify formulas according to the symptoms， and improving the ability to assess the effect of treatment plans and obtain corresponding feedback， with a view to promoting the clinical application of formula-syndrome differentiation.

Objective:To compare the clinical effects of platelet-rich plasma (PRP) and sodium hyaluronate on rotator cuff injury.Methods:From February 2022 to December 2022, 226 patients with rotator cuff injury caused by military training were treated at Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University. They were all male, aged (24.5±3.7) years, and their time from injury to treatment was (4.6±2.2) months. They were divided into 2 even groups according to different treatments: an observation group of 113 cases into whose subacromial space PRP was injected, and a control group of 113 cases into whose subacromial space sodium hyaluronate was injected. In both groups, the injection was performed once a week for consecutive 3 weeks. The 2 groups were compared in terms of visual analogue scale (VAS) and Constant-Murley shoulder function scale (CMS) before treatment and 4 and 8 weeks after treatment, and the levels of TNF- α and IL-6 in the shoulder synovial fluid before treatment and 8 weeks after treatment. Results:There was no statistical difference between the 2 groups in general clinical data before treatment, indicating comparability ( P>0.05). At 4 and 8 weeks after treatment, compared with the pre-treatment values, the VAS scores were significantly decreased and the Constant-Murley scores significantly increased in both groups ( P<0.001). At 4 and 8 weeks after treatment, the VAS scores in the observation group (3.1±0.9 and 1.5±0.5) were significantly lower than those in the control group (3.7±0.8 and 2.3±0.6) while the Constant-Murley scores in the observation group (58.6±4.5 and 72.2±4.1) significantly higher than those in the control group (55.2±5.3 and 67.8±5.0) ( P<0.001). At 8 weeks after treatment, the levels of TNF- α and IL-6 in the 2 groups were significantly lower than the levels before treatment ( P<0.001). At 8 weeks after treatment, the levels of TNF- α and IL-6 in the observation group [(2.9±0.9) μg/L and (0.8±0.2) μg/L] were significantly lower than those in the control group [(4.0±0.4) μg/L and (1.1±0.4) μg/L] ( P<0.001). Conclusion:Injection of PRP or sodium hyaluronate can relieve pain and improve shoulder function obviously in patients with rotator cuff injury, but PRP is superior to sodium hyaluronate in the treatment of rotator cuff injury.

Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.

We strive to explore a student-centered evaluation system focused on improving students' learning efficiency and learning effect. Through classroom questioning, discussion of difficult cases, new progress report, question bank test, writing of clerkship notes, simulated inquiry between students with bedside inquiry, physical examination between students with bedside physical examination, operation training of basic clinical skills, direct observation and evaluation of clinical skills, mini-clinical exercise evaluation, graduation examination and other measures, an evaluation system for promoting learning by class evaluation, clerkship evaluation and practice evaluation has been established to cultivate the connotation construction of medical moral quality and clinical practice ability of medical students, and further promote the mastery of basic theoretical knowledge and clinical operation skills. By comparing the results of the phased examination for medical practitioners, the passing rate of 2018 is significantly higher than that of 2017, with 23.31% increased passing rate of theoretical results, and 0.79% increased passing rate of skills operation results. It can be seen that the evaluation system for promoting learning has played a guiding role in the teaching practice of clinical courses in our hospital.

Objective To observe the effect of a pulsed electromagnetic field (PEMF) on the bone structure and metabolism of rats with disuse osteoporosis (DOP).Methods One hundred 4-month-old female Sprague-Dawley rats were randomly divided into a control group (INT group),an osteoporosis model group (DOP group),a sodium alendronate group (ALN group) and a pulsed electromagnetic field group (PEMF group),each of 25.The right hind-limbs of the rats in the DOP,ALN and PEMF groups were immobilized by tibia-tail fixation for two weeks to establish a DOP model.The rats in the ALN group were given 1 mg/kg of sodium alendronate once a day,while those in the PEMF group received PEMF at 3.82 mT and 10 Hz with a pulse time of 8 ms for 40 min/d.Five rats in each group were sacrificed at the 2nd,4th,8th and 12th week and their right hind-limbs were separated to measure the bone mineral density (BMD),structural mechanics indexes (the maximum load,maximum displacement and rupture energy) and material mechanics indexes (maximum stress,maximum strain and modulus).Moreover,the expression of tumor necrosis factor alpha (TNF-α) and bone morphogenetic protein 2 (BMP-2) were detected using immunohistochemical methods.Results The average BMD of the model group was significantly lower than that of the ALN group after 2 weeks,and lower than that of the PEMF group after 4 and 8 weeks.After 12 weeks the average BMD of the PEMF group was significantly higher than that of the ALN and model groups.After two and four weeks,all the structural and material mechanics measurements had decreased significantly compared with those of the control group.The average maximum displacement and load of the ALN group had increased significantly compared with the model group after 4 weeks of treatment.After 8 weeks the average maximum load,maximum displacement,rupture energy and maximum stress of the ALN and PEMF groups had increased significantly compared with the model group.Compared with the model group,the average level of TNF-α decreased gradually in both the ALN and PEMF groups from the 2nd week on,while that of BMP-2 increased from the same time point.However,at the 8th week the expression of BMP-2 protein in the PEMF group was on average significantly higher than in the ALN group.Conclusion Both PEMF and sodium alendronate can increase bone density,but PEMF has more persistent effects.

ObjectiveTo assess China’s newly evolved hot spots and novelty of structural electronic medical record in TCM field.Methods Articles about electronic medical record in TCM field were retrieved from CNKI from January 2000 to December 2015, focusing on researchers, research institutes, and key words for bibliometric analysis. Then visualization software CiteSpace was used to establish co-occurrence network.ResultsThe top 3 productive authors were LIU Bao-yan (13 articles), ZHANG Run-shun (8 articles), XIE Qi (7 articles), and ZHOU Xue-zhong (7 articles). Institutes highly cooperated with others included China Academy of Chinese Medical Sciences, Information Engineering College of Hubei University of Chinese Medicine and The First Affiliated Hospital of Henan University of Chinese Medicine. The major clusters were TCM diagnosis (#0), China’s TCM information (#1), artificial intelligence (#2), medical record management (#3), and medical laboratory department (#4). The representative keywords involved electronic medical record, TCM hospital, data mining, telemedicine, and artificial intelligence. ConclusionIn the field of TCM electronic medical record, cooperation is not sufficiently facilitated among researchers and institutes. Research hot spots are not formed and novelty is not obvious, which is probably because of the overall status quo for China’s TCM information construction.

In recent years, TCM integrative data analysis has become an important issue requiring urgent solution because of the trend of exponential growth of clinical and scientific TCM research data. This article analyzed the necessity and problems of TCM integrative data analysis from the aspects of background and significance of TCM integrative data, status analysis, data visualization, and application prospect, and put forward the idea of applying data visualization method to data integrative analysis, with a purpose to provide new angles for the reasonable application of TCM data resources.

Objective To observe the clinical efficacy of HMME-SDT therapy for the treatment of hypertrophic scar (HS) of rabbit ear.Methods 60 white rabbits were randomly divided into five groups.The model group and HMME-SDT treatment group were used to establish the models of hypertrophic scar in ears.Results The effect of HMME-SDT on the fibroblastic density in the hypertrophic scarring models was observed in rabbit ears.The HMME-SDT could lower the fibroblastic density,compared with the model group,with significant difference (P＜ 0.05).The effect of HMME-SDT on the collagen area density was noted in the hypertrophic scarring models in rabbit ears.The HMME-SDT could lower the collagen area density,compared with the model group,with significant difference from the fourth week of the epithelialization (P＜0.01).Conclusions HMME is an effective sonosensitizer.HMME-SDT can significantly inhibit hypertrophic scar of rabbit ear.

Objective To observe the effectiveness of treating essential thrombocytosis(ET) with Buyang Huanwu Decoction plus hydroxyurea. Methods 120 patients with ET were randomly divided into observation group(OG) and control group(CG). Patients from OG were treated with Buyang huanwu decoction plus hydroxyurea, while those from CG were given hydroxyurea. After 6 months, the treatment effectiveness indexes including symptoms in a sense of chinese medicine, cell counts and saffy were observed. Results Total effective rate of OG was higher than that of CG(P<0.05). TCM symptoms remission in OG group was better than that of CG(P<0.05). After treatment, blood platelet count and megakaryocyte count were decreased in two groups(P<0.05), and the difference between two groups was signiifcan(P<0.05). Conclusion The therapy combined Chinese and western medicine deals with ET is better than simple western medicine treatment.