Supervision Strategy and Implementation Key Points of Scientific and Technological Ethical Governance in Health and Medical Field / 中国医学伦理学

The ethical governance of science and technology is a kind of practical ethics, which develops in the process of continuously solving the ethical problems and ethical conflicts arising from scientific and technological activities. Ethical governance has common requirements and professional standards. Health-related science and technology activities, including the application of life science and artificial intelligence in health and medical field, make the medical ethical governance face common and unique challenges. The supervision and ethical review should consider the speciality of life science and medical research, and bring the existing ethical review system into full play. However, the focus, emphasis and standards of ethical governance have changed with the application of some technologies (ex. the next-generation sequencing, gene editing, and artificial intelligence). Actions should be taken to strengthen the ethical governance and promote ethics in advance with science and technological implementation in health and medical field. Here in this article, the classified, hierarchical supervision and ethical review strategies are discussed; then some potential effective organization and mechanisms for regional ethics committees are introduced. Promoting the medical education and continuing education of ethical governance of science and technology is also recommended.

Ethical Issues in the Development of Smart Healthcare / 中国医学伦理学

Smart healthcare is the outcome of integration and application of the internet, Internet of things (IOT), big data analysis and artificial intelligence (AI) in the medical field. Smart healthcare has been developed rapidly in China. However, smart healthcare has both advantages and risks, thus, it faces challenges and ethical issues in practice. Technological restrictions of smart healthcare increase the risk of privacy disclosure and delayed treatment. Besides, it also induce some ethical issues.Smart healthcare turns the "justice" issue of regional equity into the population equity of medical benefits. In addition, balancing between humanities and science technology should be considered. Smart healthcare should follow the basic ethical principles and the experience of clinical medical ethics. To give full play to the advantages of smart healthcare, the ethical challenges during its development must be regulated at the legal level, and simultaneously governed through ethical norms and guidance.

Suggestions on the evaluation system of science and technology in the field of health policy and management research / 中华医学科研管理杂志

Objective:Health policy and management, and its development as a discipline, play an important role in promoting the development of medicine; however, where is no scientific and reasonable evaluation system of science and technology in practice.Here we will explore and establish a special evaluation system to this research feild.Methods:To analyze the problems, tasks and unique research methods specially solved and used in the field of health management and policy; to discuss the existing problems with theory combined with practice.Results:According to the guidance of national policy, put forward principles and some assessment indicators with their weight grading, index, and examples in detail for the academic evaluation system in the field of this field.Conclusions:Health policy and management is a kind of discipline of the category of social science that possesed the particularity of practice management. Thus, it is important that the academic evaluation should reflect the responsibilities, contributions and characteristics of this subject and the researchers.

Prognostic accuracy of five common scoring systems for mortality in elderly patients with sepsis / 中国医师杂志

Objective:To assess the prognostic accuracy of five scoring systems for mortality in elderly patients (≥80 years old) with sepsis.Methods:A retrospective study was conducted on elderly patients with sepsis (≥80 years old, meeting Sepsis 3.0 diagnostic criteria) in Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ). The participants were divided into survival and death group according to the 28-day mortality. The baseline data of patients was collected based on the peak of vital signs and laboratory test results within 24 hours after admission to intensive care unit (ICU). Systemic Inflammatory Response Syndrome (SIRS) score, quick Sequential Organ Failure Assessment (qSOFA), Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS) and Oxford Acute Severity of Illness Score (OASIS) were calculated and prognosis was recorded. The accuracy of the above scoring systems in predicting 28-day mortality was calculated, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated and compared.Results:A total of 42 037 hospital records were screened, and 956 sepsis patients (456 males, 47.70%) who were aged ≥80 years and met the Sepsis 3.0 diagnostic criteria within 24 hours of admission to ICU were included. There were 696 patients (72.8%) in the survival group and 260 patients (27.2%) in the death group. There were no significant difference in age, gender, Charlson Comorbidity Index, length of stay before admission to ICU and length of stay in ICU between 2 groups (all P>0.05). The proportion of patients receiving mechanical ventilation and septic shock in the death group were higher comparing with those in the survival group (both P<0.001), and the total length of hospital stay in the survival group was longer than that in the death group ( P<0.001). The proportion of SOFA score≥7, qSOFA score≥2, SIRS score≥2, NEWS score≥8, OASIS score≥42 in the death group was higher than that in the survival group (all P<0.05). The AUC of qSOFA, SOFA, SIRS, NEWS and OASIS in predicting the mortality of elderly sepsis patients were 0.587 (95% CI: 0.556-0.617), 0.694 (95% CI: 0.655-0.732), 0.591 (95% CI: 0.555-0.627), 0.684 (95% CI: 0.646-0.721) and 0.718 (95% CI: 0.681-0.755), respectively. Conclusions:OASIS was superior than qSOFA, SOFA, SIRS and NEWS scores in predicting the mortality of elderly patients with sepsis, but the prognostic accuracy of all above scoring systems for elderly patients with sepsis was insufficient.

Expression and Clinical Significance of ATP Citrate Lyase in Hepatocellular Carcinoma / 中国医学科学院学报

Objective To investigate the role of ATP citrate lyase(ACLY)in the development of hepatocellular carcinoma(HCC)and the impact of this enzyme on the immune microenvironment of HCC.Methods We utilized the University of Alabama at Birmingham Cancer Data Analysis Portal and the Gene Expression Profiling Interactive Analysis to identify the changes in ACLY expression and prognosis across different tumor types from The Cancer Genome Atlas.With HCC as the disease model,we analyzed the ACLY expression in HCC samples from the gene expression database.Furthermore,we collected the clinical specimens from HCC patients to verify the mRNA and protein levels of ACLY.In addition,we conducted transcriptome sequencing after knocking down the expression of ACLY to analyze the differentially expressed genes and investigated the impact of ACLY expression interference on cell proliferation and other functions.Finally,we explored the correlations of ACLY with immune cells and immune infiltration in the tumor microenvironment,new antigens,and immune checkpoint genes.Results ACLY expression was significantly up-regulated in solid tumors including HCC(all P<0.05),and high ACLY expression was associated with overall survival rate in HCC(P=0.005).Furthermore,high ACLY expression affected the presence of immune cells(e.g.,tumor-associated fibroblasts)and the expression of genes involved in lipid metabolism(all P<0.05).Conclusions ACLY is closely related to the occurrence and development of HCC and lipid metabolism abnormalities.Moreover,it has a specific impact on the immune microenvironment of HCC.

Role and clinical significance of MLLT1 super elongation complex subunit in the occurrence and development of hepatocellular carcinoma / 解剖学报

Objective To investigate the role of MLLT1 in hepatocellular carcinoma (HCC)and its impact on the tumor immune microenvironment. Methods Multivariate Cox regression analysis and tumor gene analysis tools such as GEPIA and UALCAN were used to explore the expression of the MLLT1 gene and its prognostic significance in different tumors. Real-time PCR, Western blotting, and immunohistochemistry were used to investigate the differential expression of MLLT1 between HCC tumor tissue and normal tissue. MTT assay and cell cycle analysis were performed to assess the effect of MLLT1 knockdown on cell proliferation and cell cycle. The correlation between MLLT1 and immune cells, as well as immune infiltrates in the tumor microenvironment, and their correlation with immune neoantigens, immune checkpoints, tumor mutation burden, and microsatellite instability were also explored. Results The MLLT1 gene was found to be aberrantly expressed in various solid tumors including HCC, and its high expression was associated with poor prognosis in HCC. Knockdown of MLLT1 inhibited HCC cell proliferation and blocked the cell cycle. High expression of MLLT1 was found to affect the content of multiple immune cells, including CD4

Value of MRI Ovarian-Adnexal Reporting and Data System in Differentiating Benign and Malignant Ovarian-Adnexal Lesions / 中山大学学报(医学科学版)

ObjectiveTo explore the value of MRI ovarian-adnexal reporting and data system （O-RADS MRI） in differentiating benign and malignant ovarian-adnexal masses.MethodsTotally 146 patients （202 masses） with ovarian-adnexal lesions who underwent pelvic examination at 3.0 T MRI according to standardized scan protocol of O-RADS MRI and were pathologically confirmed in The First Affiliated Hospital of Sun Yat-sen University between January 2020 and February 2022 were retrospectively analyzed. Two radiologists classified the ovarian-adnexal masses as risk levels 1~5 according to O-RADS MRI and evaluated their consistency by Cohen’s kappa. Using pathological findings as the gold standard， the detection yield of malignant lesions with O-RADS MRI classification was analyzed. Sensitivity， specificity， accuracy， and the area under the receiver operating characteristic curve were calculated （cutoff for malignancy， score ≥ 4）.ResultsOf 202 masses， 62 （30.7%） were malignant， 140 （69.3%） were benign. The two radiologists presented good agreement in O-RADS MRI classification of ovarian adnexal masses （Kappa=0.932）. The malignancy rates of masses with scores of 1， 2， 3， 4 and 5 were 0%， 0%， 7.7%， 95%， 97.6%， respectively. Sensitivity， specificity， accuracy， and the area under the receiver operating characteristic curve were 96.8% （60/62）， 98.6% （138/140）， 98.0% （198/202）， 0.977.ConclusionsO-RADS MRI yields high diagnostic efficiency for benign and malignant ovarian adnexal masses and its widespread implementation will improve communication between radiologists and clinicians， and facilitate optimal patient management. Therefore， O-RADS MRI warrants widespread use in clinical setting.

Therapeutic Efficacy of Shexiang Baoxin Pill Combined with Exercise in Patients with Heart Failure with Preserved Ejection Fraction: A Single-Center, Double-Blind, Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the therapeutic efficacy of Shexiang Baoxin Pill combined with exercise in heart failure patients with preserved ejection fraction (HFpEF).@*METHODS@#Sixty patients with HFpEF were randomly divided into group A (n=20), receiving Shexiang Baoxin Pill combined with home-based exercise training based on conventional drugs for 12 weeks; group B (n=20), receiving conventional drugs combined with home-based exercise training for 12 weeks; and group C (n=20), receiving conventional drug treatment only. Peak oxygen uptake (peakVO2), anaerobic threshold (AT), 6-min walking test (6MWT), Pittsburgh Sleep Quality Index (PSQI), and SF-36 questionnaire (SF-36) results before and after treatment were compared among groups.@*RESULTS@#After the 12-week intervention, patients in group C showed significant declines in peakVO2, AT, 6MWT, PSQI, and SF-36 compared with pre-treatment (P<0.01), while groups A and B both showed significant improvements in peakVO2, AT, 6MWT, PSQI, and SF-36 results compared with pre-treatment (P<0.01). Compared with group C, patients in groups A and B showed significant improvements in peakVO2, AT, 6MWT, PSQI, and SF-36 (P<0.01). In addition, patients in group A showed more significant improvements in physical function, role-physical, vitality, and mental health scores on the SF-36 questionnaire, and PSQI scores than those in group B (P<0.01).@*CONCLUSIONS@#Exercise training improved exercise tolerance, sleep quality and quality of life (QoL) in patients with HFpEF. Notably, Shexiang Baoxin Pill played an active role in sleep quality and QoL of patients with HFpEF. (The trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2100054322)).

A new cinnamic acid ester derivative from Liquidambaris Resina / 中国中药杂志

Twelve compounds were isolated from Liquidambaris Resina by silica gel column chromatography and thin layer chromatography. Their structures were identified on the basis of spectral data, electron capture detector data, and physicochemical properties as(2'R, 3'R)-2',3'-dihydroxy-hydrocinnamyl-(E)-cinnamate(1),(E)-cinnamyl-(E)-cinnamate(2), cinnamic acid(3), 28-norlup-20(29)-en-3-one-17β-hydroperoxide(4), erythrodiol(5), 13β,28-epoxy-30-hydroxyolean-1-en-3-one(6),(3β)-olean-12-ene-3,23-diol(7), 2α,3α-dihydroxy-olean-12-en-28-oic acid(8), 28-hydroxyolean-12-en-3-one(9), 3-epi-oleanolic acid(10), 3-oxo-oleanolic acid(11), and hederagenin(12). Compound 1 was a new cinnamic acid ester derivative and compounds 2-4,6-8, and 12 were isolated from Liquidambaris Resina for the first time. Compounds 4, 5, 10, and 12 exerted inhibitory effects on the proliferation of human umbilical vein endothelial cells(HUVEC) with the IC_(50) values of(17.43±2.17),(35.32±0.61),(27.50±0.80), and(46.30±0.30) μmol·L~(-1), respectively.

Expression and clinical significance of phosphoglycerate kinase 1 in hepatocellular carcinoma based on bioinformatics methods / 解剖学报

Objective To investigate the role of phosphoglycerate kinase 1 (PGK1) in tumorigenesis and its potential post-translational modification sites were investigated by bioinformatics method and molecular biology experimental techniques, in order to provide evidence for PGK1 as a hepatocellular carcinoma ( HCC) diagnostic biomarker and therapeutic target. Methods From pan-cancer's point of view, 10 967 samples were obtained from the cancer genome database TCGAs, and the expression of PGK1 in different tumors was explored by using cBioPortal and UALCAN analysis tools; Focusing on HCC, the expression differences of PGK1 in hepatocellular carcinoma tumor tissues and normal tissues were further analyzed by using GEO database analysis, Real-time PCR, Western blotting and cell invasion assay;The String database was used to analyze the protein-protein interaction network and gene set enrichment analysis; The CSS-Palm database and bioinformatics method were used to predict protein post-translational modification sites on PGK1. Results The PGK1 gene was abnormally amplified and overexpressed in various solid tumors, including hepatocellular carcinoma, and overexpression of PGK1 was correlated with a poor prognosis in hepatocellular carcinoma. Multiple novel posttranslational modifications were existed on PGK1. Conclusion PGK1 is closely related to the occurrence and development of various cancers including HCC and glycolytic metabolism abnormalities. Epigenetic modifications can regulate PGK1 and affect its cellular function in HCC.

Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study / 中华耳鼻咽喉头颈外科杂志

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.

Correlation between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and diabetic nephropathy / 中国基层医药

Objective:To correlate neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with diabetic nephropathy (DN).Methods:A total of 160 patients with type 2 diabetes mellitus (T2DM) who received treatment between January 2017 and October 2020 in People's Hospital of Suzhou National New & Hi-Tech Industrial Development Zone were included in this study. These patients were randomly divided into DN [urinary albumin-to-creatinine ratio (UACR) ≥ 30 μg/mg, n = 85) and non-DN (UACR < 30 μg/mg, n = 75)] groups according to UACR values. A total of 150 healthy controls who concurrently received health examination were included in the control group. The clinical data and biochemical indicators were collected in each group and their clinical characteristics were compared. The factors that affect DN were analyzed using a logistic regression model. Results:Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with T2DM were (2.14 ± 1.12) and (175.00 ± 56.21), respectively, which were significantly higher than those in the healthy controls [(1.53 ± 0.29), (142.70 ± 37.25), t = 3.584, 5.642, both P < 0.05). NLR and PLR in the DN group were (2.64 ± 1.22) and (278.00 ± 72.23), respectively, which were significantly higher than those in the non-DN group [(1.80 ± 0.90), (193.00 ± 62.40), t = 2.738, 3.166, both P < 0.05)]. Logistic regression analysis showed that NLR and PLR are the risk factors of DN ( OR = 5.981, 1.807; 95% CI = 2.104-15.563, 1.327-2.795). Conclusion:Combined detection of NLR and PLR in the clinic may help early prediction of DN.

Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Objective@#: To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making. @*Methods@#: Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded. @*Results@#: Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up. @*Conclusion@#: SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.

Effect of electroacupuncture on rehabilitation of knee joint movement after anterior cruciate ligament reconstruction / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction.@*METHODS@#A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation.@*RESULTS@#One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (<0.05), the IKDC score and Lysholm score were higher than those in the control group (<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative.@*CONCLUSION@#EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.

MRI diagnosis and clinical analysis for autosomal dominant polycystic kidney disease related male infertility / 中华放射学杂志

Objective To improve the recognition and knowledge of autosomal dominant polycystic kidney disease (ADPKD) related male infertility through investigation for MRI characteristics of this disease. Methods Fourteen patients confirmed with ADPKD related obstructive azoospermia were retrospectively analyzed. All patients referred to clinic with male infertility, and obstructive azoospermia were additionally confirmed by laboratory tests and clinical examination. Subsequent abdominopelvic MR examinations were performed to comfirm obstructive factors and obstructive location. All patients were performed an abdominopelvic MR examination including non-enhanced and enhanced MR. MR imaging characteristics were analyzed and summarized by two experienced radiologists. Results MRI results for all cases were classified into 4 groups:10 cases with bilateral polycystic kidneys and bilateral seminal vesicle cysts, 2 cases with bilateral polycystic kidneys, polycystic liver and bilateral seminal vesicle cysts, 1 case with bilateral polycystic kidneys, polycystic liver and absence of bilateral seminal vesicles, 1 case with bilateral cystic kidneys, bilateral seminal vesicle cysts as well as Müllerian duct cyst. A wide range of coronal T2WI scan was necessary to observe cystic lesions in both liver and bilateral kidneys as well as abnormal changes in pelvis. The obstructive sites in all cases were located in level from ejaculatory duct to seminal vesicle. Bilateral seminal vesicle cysts presented as significantly dilated glandular ducts of seminal vesicles, in which flocculence or nodular sediment can be found. Conclusion Male infertility caused by ADPKD-related deferential duct obstrution is characterized by bilateral polycystic kidney disease and Seminal vesicle ejaculatory duct obstruction in MRI, which can be combined with other abnormalities.

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite / 中华外科杂志

Objective@#To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.@*Methods@#Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.@*Results@#The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.@*Conclusions@#The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

Design of genital organ traction bag and its application in radiotherapy / 中国实用护理杂志

Objective@#To investigate clinical application of self-designed organ traction bag in male genital immobilization during radiotherapy.@*Methods@#The male patients in the Department of Radiation Oncology, Suzhou Municipal Hospital from August 2018 to June 2019 were immobilized by using organ traction bag. Clinical effect was evaluated by subjective and objective ways which were the location relationship between contents and reference field under visual observation and fluoroscopy, and setup errors by CBCT images.@*Results@#A total of 11 patients were selected, including 3 seminoma, 2 low rectal carcinoma, 2 prostatic carcinoma, 4 pelvic lymph nodes and bone metastases, with mean age 57.18 years old. Patients received 273 times of treatment and 55 times of CBCT verifications in all. Analysis results that the setup errors of the whole group in upper and lower (Vrt), head and foot (Lng), left and right (Lat) directions are less than 0.5 cm, within acceptable clinical threshold. The contents under visual observation and fluoroscopy were not in reference field and were fixed well.@*Conclusions@#Organ traction bag provides stable effect on male genital immobilization while taking patients’ privacy and clinical operability into account. It has high clinical application value in radiotherapy involving male genital protection.

Ethical challenges and responses of big data in healthcare / 中华医学科研管理杂志

Objective To analyze ethical challenges raised from big data in healthcare,provide suggestions for improving its application and development.Methods The ethical challenges were discussed according to the study of important literatures,typical case analysis,analyzing the current situation and its development trend of big data in healthcare.Results The advancement of technology and policies favorable have provided new opportunities for development of big data in healthcare.However,there are still some ethical challenges for its application.For instance,the difficulty of perform traditional informed consent process,the high risk of EHR information release during data storage and transmission,and inadequate privacy protection.To solve these problems,the corresponding regulation and some guidelines should be refined and/or updated;the management system that include informed consent should be adjusted;the corresponding technical supporting platform and specialized interdisciplinary team are also needed.Conclusions The establishment and application is a systematic project.The solution of the ethical challenges is also based on a comprehensive safeguard system of laws,regulations,management and technology.