By applying "homeostasis" to the study of the meridian and collateral system， the concept of meridian and collateral homeostasis has been proposed which refers to a balanced and stable state of meridian and collateral system， and plays an important role in maintaining body health and can provide a reference for the diagnosis and treatment of diseases. Phenomics realizes the cross-scale correlation from micro-phenotypic data， such as genome， proteome， and metabolome， to macro-phenotypic data， such as physiological state， behavioral activities， and external manifestations. From the perspective of phenomics， this paper proposes a meridian and collateral homeostasis dynamic mapping model of "macroscopic signs and microscopic expression". This model combines macro signs such as the four examinations of traditional Chinese medicine （TCM）， biophysical indicators of acupoints， and micro expression information such as genes， proteins， and metabolism， and systematically investigates the relationship between meridian and collateral homeostasis and health and disease， thereby providing ideas and references for the identification of pre-disease states as well as precise diagnosis and treatment in TCM.

In the face of the current professional ethical crisis among medical staff caused by the contradiction between doctors and patients,sorting out and exploring the professional ethical values contained in red doctor's spirit and its ethical foundation is an important direction for thinking and solving this problem.The professional ethics of red doctor's reflects the ethical standards of this group in the career of medical and health,and has important value presentation.To fully understand the functional value of the professional ethics of red doctor's,it is necessary to grasp its ethical foundation:linking the heart to the country and being loyal to the Party are the souls of the spirit,pursuing the highest good and achieving oneself are the driving forces for practice,having both virtue and action,as well as combining knowledge and action are inherent characteristics,putting the people in the first place and rooting in the people are the values orientation.In the context of the construction of a healthy China,deeply exploring the professional ethics resources of red doctor's is of great realistic significance for promoting the transformation of professional emotions,the formation of professional values,and the sublimation of professional spirit among medical staff,as well as achieving people's health and well-being.

Soft tissue defects resulting from head and neck tumor resection seriously impact the physical appearance and psychological well-being of patients. The complex curvature of the human head and neck poses a formidable challenge for maxillofacial surgeons to achieve precise aesthetic and functional restoration after surgery. To this end, a normal head and neck volunteer was selected as the subject of investigation. Employing Gaussian curvature analysis, combined with mechanical constraints and principal curvature analysis methods of soft tissue clinical treatment, a precise developable/non-developable area partition map of the head and neck surface was obtained, and a non-developable surface was constructed. Subsequently, a digital design method was proposed for the repair of head and neck soft tissue defects, and an in vitro simulated surgery experiment was conducted. Clinical verification was performed on a patient with tonsil tumor, and the results demonstrated that digital technology-designed flaps improved the accuracy and aesthetic outcome of head and neck soft tissue defect repair surgery. This study validates the feasibility of digital precision repair technology for soft tissue defects after head and neck tumor resection, which effectively assists surgeons in achieving precise flap transplantation reconstruction and improves patients' postoperative satisfaction.
Humans ; Plastic Surgery Procedures ; Surgical Flaps/surgery* ; Head and Neck Neoplasms/surgery* ; Head/surgery* ; Neck/surgery*

Objective:To analyze the application effect of health failure mode and effect analysis (HFMEA) model in patients with artificial airways in the cardiovascular surgery intensive care unit (CSICU) by establishing a HFMEA project team, and to develop targeted improvement measures and processes.Methods:The patients undergoing cardiovascular surgeries and with established artificial airways in the Shandong Provincial Hospital Affiliated to Shandong First Medical University were recruited from October 2021 to March 2022. The enrolled patients were divided into the conventional management group and the HFMEA model management group according to random number table method. The conventional management group applied the conventional procedures for monitoring the air bag pressure. The HFMEA model management group used the HFMEA model to implement and improve the airbag pressure monitoring process. The efficacy of HFMEA was assessed by comparing the incidence of ventilator-associated pneumonia (VAP), the pass rate of airbag pressure monitoring, the duration of endotracheal intubation and the length of CSICU stay between two groups. The practicability of HFMEA model was evaluated by analyzing the theoretical assessment scores and practical skill scores of nurses and their satisfaction scores with HFMEA.Results:Compared with the conventional management group, the patients in the HFMEA mode management group had a significantly higher rate of passing airbag pressure monitoring [94.99% (2 994/3 152) vs. 69.97% (1 626/2 324), P < 0.01], shorter duration of endotracheal intubation and length of CSICU stay [duration of endotracheal intubation (hours): 6 (7, 12) vs. 6 (8, 13), length of CSICU stay (hours): 40 (45, 65) vs. 41 (46, 85), both P < 0.05], but the incidences of VAP between the two groups were similar. The theoretical assessment scores and practical skill scores of nurses were significantly higher (theoretical assessment score: 44.47±2.72 vs. 37.59±6.56, practical skill score: 44.56±2.66 vs. 40.03±4.32, total score: 89.03±3.07 vs. 77.63±9.56, all P < 0.05) in the HFMEA mode management group. And the satisfaction scores with airbag pressure management were also significantly higher in the HFMEA mode management group (7.72±1.11 vs. 6.44±1.32, P < 0.05). Conclusions:The application of the HFMEA can improve the airbag pressure measures and standardize the monitoring procedures in patients with artificial airways, and reduce the risk of clinical nursing. It is safe and effective for patients with invasive mechanical ventilation in the CSICU.

Objective:To understand the incidence and risk factors of high-risk drowning behaviors among primary and middle school students in Shufu county, Kashgar area, Xinjiang Uygur Autonomous Region, and provide a theoretical basis for the development of drowning prevention policies and intervention measures.Methods:Cluster random sampling method was adopted in Bulakesu and Uppal of Shufu county. A total of 28 primaries and 2 middle schools were selected, and questionnaires surveyed all the students in grades 1-8.Results:A total of 14 543 questionnaires were sent out. 23.9% of primary and secondary school students had experienced high-risk drowning behavior in the past 12 months. Higher swimming level, introversion, intense curiosity, poor relationship with classmates, poor relationship with family, and open water near the school and open water near home were the risk factors of high-risk drowning behaviors.Conclusions:More attention should be paid to the psychology and high-risk behaviors of primary and middle school students, and the education of drowning knowledge and skills should be strengthened. Meanwhile, schools and communities should pay attention to the management and intervention of open water.

Objective:To investigate the protein expression changes of human umbilical cord mesenchymal stem cells (hUCMSCs) modified with pigment epithelium-derived factor ( PEDF) gene mediated by lentivirus. Methods:The hUCMSCs were divided into the control group and experimental group.Cells in the control group were normal hUCMSCs and the cells in experimental group were hUCMSCs with PEDF modification.The proteins from the two groups were collected and processed by FASP method.Samples were fractionated by liquid chromatography and analyzed by tandem mass spectrometry, and SWATH mode was applied.Differential protein analysis, Gene Ontology (GO) analysis and Reactome pathway enrichment analysis were performed. Results:A total of 5 361 quantified proteins were detected in this experiment, of which 432 proteins were differentially expressed (fold change>1.5, P<0.05). There were 219 of the 432 proteins up-regulated, including serpin family F member 1 (SERPINF1) (PEDF), DEAD-box helicase 59 (DDX59) and thrombospondin 1 (THBS1), etc., whereas 213 proteins were down-regulated, including collagen type Ⅰ alpha 1 (COL1A1), COL18A1, etc.GO analysis indicated that the differential proteins were mainly involved in fibrinolysis, extracellular structure organization, regulation of transporter activity, biosynthetic process of secondary alcohol and cholesterol, coenzyme metabolic process and regulation of peptidase activity, etc.Reactome pathway analysis showed that the differential proteins were mostly involved in regulation of insulin like growth factor (IGF) transport and uptake by IGF binding protein, post-translational protein phosphorylation, extracellular matrix organization, metabolism of steroids. Conclusions:After gene modification with PEDF mediated by lentivirus, the expression of many proteins in hUCMSCs were changed. PEDF gene modification can alter the structure of extracellular matrix and regulate the expression of proteins associated with cell proliferation, self-renewal and multipotency.

Objective:To evaluate the efficacy of roxatidine and omeprazolein on preventing gastrointestinal bleeding in critically ill patients.Methods:A prospective cohort study was conducted in adult patients admitted to an intensive care unit (ICU), who had risk factors for stress related mucosal disease (SRMD), and had an estimated stay of no less than 5 days and mechanical ventilation for more than 48 h. Patients were randomized into the experiment group (Roxatidine 75 mg IV Q12 h) and control group (Omeprazole 40 mg IV Q12 h). Demographic data, acute physiology and chronic health score (APACHEⅡ) and SOFA score on day 1 were collected, intragastric pH values were tested every 2 hours for the first 5 days, the daily average of pH and proportion of patients with average pH≥4 were calculated. Stool occult blood were detected at day 1 and bacterial culture of gastric juice were performed before medication administration and on day 5 after medication administration. The implementation of enteral nutrition support, situation of gastrointestinal hemorrhage and adverse effects were analyzed. Furthermore, length of hospital stay and mortality in ICU and on the 28th day were acquired. SPSS 22.0 software was used for data analysis. Consecutive data were expressed as mean and standard deviation, categorical data were expressed as frequencies (percentage). Comparison of measurement data between groups was performed by analysis of variance or rank sum test. Comparison of count data between groups was performed by the Chi-square test. P<0.05 was regarded as statistically significant. Results:A total of 91 patients were recruited and randomly separated into experimental group ( n=46) and control group ( n=45) from October 2017 to March 2018. There were no statistical differences in gender, age, body mass index (BMI), enteral nutrition status, APACHEⅡ and SOFA score on day 1 between the two groups (all P>0.05). Roxatidine in the experiment group rapidly increased the intragastric pH to ≥4.0 and continued to stabilize at pH ≥4.0 during the monitoring period. Omeprazole increased and maintained intragastric pH≥5.0. The proportion of patients with average pH≥4.0 was 82.5% in the second 24 hours in the experiment group, and stably increased to 90% on day 5. There were no significant differences between groups in gastrointestinal bleeding, length of hospital stay, and mortality in ICU and on 28th day(all P> 0.05). No drug related adverse effects occurred during the study period. Logistic-regression analysis did not screen for risk factors of SRMD. Conclusions:Roxatidine acetate hydrochloride can rapidly elevate and maintain the gastric pH above 4.0, and has similar efficacy and safety as omeprazole in inhibiting gastric acid secretion and preventing SRMD with gastrointestinal bleeding.

Objective To explore the feasibility and repeatability of deltoid muscle volume measurement using MR volume of interest method, and discuss the clinical significance. Methods Seventy-eight subjects'' MR images were retrospectively reviewed including 33 normal shoulders, 22 rotator cuff tear (7 male, 15 female), 12 cases with labrum lesions (11 male, 1 female), and 2 long head of biceps tendon lesions. Routine axial 2D MR images of deltoid muscle were transported into post-processing work station, the matrix of all images were higher than 275 × 336, and the imaging field included the upper and lower margin of the deltoid muscle, and the three dimension shape of muscle was reconstructed by software based on MR volume of interest, then the muscle volume was calculated automatically. This process was independently performed by 2 operators, and operator 1 repeated this process 1 week later. Intra-class correlation coefficient and 95％confidence interval were used to analyze the reliability and repeatability of the measurement. Deltoid muscle volumes of different ages and different pathological processes were compared using stratified sampling method, one-way analysis of variance (ANOVA), least significant difference (LSD) multiple comparison method, and independent-samples t test. Results Three-dimensional shape of deltoid muscle were well demonstrated and corresponded well to the known anatomy. The measurement showed very good inter-and intra-observer consistency (ICC: 0.983 and 0.995, respectively). There were statistical differences in deltoid muscle volume between group A and C [volume:(382.39 ± 38.87) cm3 and (279.15 ± 63.65) cm3;P=0.000], group B and C [volume:(358.49 ± 44.50) cm3 and (279.15 ± 63.65) cm3; P=0.000]. The normal participants were divided by gender into normal group 1 (9 males and 15 females) and normal group 2 (13 males and 1 female) using stratified random sampling method. The deltoid muscle volume of patients with rotator cuff tear was lower than the normal group 1 [volume:(313.21±63.48) cm3 versus (359.08±57.98) cm3;t=-2.562, P<0.05], and there was no statistical difference in deltoid muscle volume between labrum-ligament complex lesions patients and the normal group 2 [volume: (394.28 ± 33.67) cm3 versus (389.30 ± 22.14) cm3; t=0.385, P=0.704]. Conclusions Volume of interest measurement based on routine MR images could evaluate the deltoid muscle volume conveniently and directly, and which could be used as a preferred choice for muscle volume evaluation.

Objective To evaluate the feasibility of anticoagulant therapy for acute proximal deep vein thrombosis without inferior vena cava filter placement for femoral neck patients before hip arthroplasty.Methods From January 2013 to August 2017,9 femoral neck fractures patients with acute proximal deep vein thrombosis before hip arthroplasty were enrolled into this study.There were 3 men and 6 women.The average age was 76.44±5.39 years old (range,69 to 83 years old).The average injured time before admission was 4.00±4.06 days.All patients received anticoagulant therapy without placement of inferior vena cava filter before hip arthroplasty.Four patients received Rivaroxaban 10mg,two times per day,while two patients received Enoxaparin 0.4 ml,two times per day;3 cases received Batroxobin 0.5 ml,every other day combined with Rivaroxaban 10 mg one time per day or Enoxaparin 0.4 ml,one time per day.The size of thrombus before and after treatment,changes of coagulation markers,the outcome of thrombosis before surgery,during surgery,postoperatively and during follow-up,the related complications were recorded.Results The diagnosis time for proximal DVT was 3.89±3.01 days after admission.8 patients showed proximal DVT combined with distal thrombus and 1 patient showed isolated proximal DVT.The average length of proximal thrombus was 10.78±6.10 cm (range,4.0-20.0 cm).The mean duration of treatment was 14.22±7.03 days.The results showed 5 proximal DVTs have complete disappeared,3 cases significantly improved,and 1 case had no change but showed stable.After treatment,the length of the proximal thrombus was significantly decreased (10.77±6.10 cm vs.4.39±6.50 cm),there were statistically significant between two groups (t=3.429,P=0.009);D-dimer was significantly lower after treatment (10.47±4.87 μg/ml vs.2.59± 1.60 μg/ml) with statistical difference (t=4.970,P=O.O01).However,no statistical significance was found in other coagulation parameters such as plasma prothrombin time,the international normalized ratio,activated partial thromboplastin time,thrombin time,fibrinogen.Incision exudate occurred in one patient and anticoagulant therapy was paused,however,two days later,DVT recurred and then the patient received continuous therapy with drug anticoagulation.The average time for postoperative follow-up was 8.3±7.6 months.At the latest follow-up,4 cases had thoroughly recovered with the thrombi fully resolved;4 cases had significantly improved including three thrombi partly locating in the muscular veins and one partly locating in the infra-popliteal vein.One case became more severe after discharge and received continuous anticoagulant therapy.No death,symptomatic pulmonary embolism,bleeding and other adverse events occurred.Conclusion Inferior vena cava filter placement for femoral neck fracture patients with acute proximal venous thrombosis before hip arthroplasty may not be potent.Anticoagulant therapy which make the proximal thrombus completely dissolved or stabilized before surgery may be effective.

Objective: To investigate the diagnostic value and influential factors of washout fluid thyroglobulin collected during fine-needle aspiration (FNA-Tg) in detecting lymph node metastases of papillary thyroid carcinoma (PTC) before thyroidectomy. Methods:We retrospectively analyzed 131 patients diagnosed with PTC based on histopathology. They presented with suspicious enlarged cervi-cal lymph nodes and underwent high-frequency ultrasound-guided FNA before the surgery. FNA and FNA-Tg were performed simulta-neously. All the related data were collected. In order to obtain the best cut-off value, the FNA-Tg receiver-operating characteristic curve was generated. The cytopathology and postoperative pathologic results, as well as the ultrasound images during the follow-up, were considered the gold standard. The diagnostic performance of each method (FNA, FNA-Tg, and FNA+FNA-Tg) were compared. Ad-ditionally, some suspicious influential factors such as the anatomical location of lymph nodes and associated laboratory indexes were also analyzed for the diagnostic accuracy of FNA-Tg. Results: The best cut-off value of FNA-Tg in our study was 1.295 ng/mL. The diag-nostic performance of the combined method was the best when compared with other methods, with a sensitivity of 96.4% and speci-ficity of 99.2%. Additionally, FNA-Tg was much more accurate when used in diagnosis of lateral cervical lymph nodes. Among all the as-sociated laboratory indexes, the level of serum Tg (sTg) was an independent predictive factor for an FNA-Tg level above 1.295 ng/mL (odds ratio=1.018). Conclusions: FNA-Tg is a useful tool in the identification of metastatic cervical lymph nodes preoperatively, espe-cially for lateral cervical lymph nodes. In addition, 1.295 ng/mL could be one of the reference standards of the FNA-Tg cut-off value. When the sTg level is high, we should interpret the FNA-Tg results cautiously.