Ethical Controversy and Reflection on Gene Enhancement / 中国医学伦理学

Gene enhancement is one of the research hotspots at home and abroad in recent years. Gene enhancement is expected to treat human genetic diseases and improve human abilities and traits, but it also raises a series of ethical problems. From the perspective of ethics, those who support gene enhancement, starting from the open and unfinished state of human nature, advocate that gene enhancement is an effective alternative to promote human nature for kindness and social equity, and believe that gene enhancement does not necessarily lead to inequality, on the contrary, it contributes to moral improvement. Opponents, starting from the integrity of human nature, hold that gene enhancement challenges human dignity, causes a crisis of human identity, has a serious impact on social fairness and justice, and is also a violation of the natural order. By sorting out and analyzing the ethical viewpoints that support and oppose gene enhancement, this paper found that the social fairness and justice issues caused by gene enhancement can be reasonably solved through exercising the roles of the government and the market, while the human nature problems caused by gene enhancement are more complex, and the setting of natural standards lacks a basis. At the same time, gene enhancement also makes people further reflect on the relationship between human and technology.

Efficacy and Safety of Shenfu Qiangxin Pills Combined with Chemical Medicine Conventional Therapy in the Treatment of Chronic Heart Failure ：A Meta-analysis / 中国药房

OBJECTIVE：To systematically evaluate the effectiveness and safety of Shenfu qiangxin pills combined with chemical medicine conventional therapy in the treatment of chronic heart failure ，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，Google Scholar ，PubMed，the Cochrane Library and Embase database ，RCTs about Shengfu qiangxin pills combined with chemical medicine conventional therapy （trial group ） versus chemical medicine conventional treatment （control group ）were collected during the inception to May 12th，2020. After literature screening and data extraction ，the quality of the literatures was evaluated with risk bias assessment tool recommended by Cochrane 5.1.0 system evaluator manual. Meta-analysis and sensitivity analysis were performed by using Stata 14.0 software. RESULTS：A total of 7 RCTs were included ，involving 596 patients. Meta-analysis results showed that the total response rate of trial group was significantly higher than that of control group [OR ＝4.14，95％CI（2.15，7.97），P＜0.000 01]；the results of sub-group analysis according to the different criteria for determining the efficacy showed that the total response rates of trial group determined by Lee integral method and cardiac function grading method were sig nificantly higher than that of the control group （P＜0.05）. After treatment ，N-terminal pro-B-type natriuretic peptide （NT-proBNP） level of trial group was significantly lower than that of control group [OR ＝－1.33，95％CI（－1.55， qq.com －1.11），P＜0.000 01]. Results of sub-group analysis accor- ding to cardiac failure type showed that NT-proBNP level of patients with chronic heart failure in trial group was lower than control group （P＜0.001）. The level of left ventricular ejection fraction （LVEF）in trial group after treatment [WMD ＝5.76，95％CI （5.05，6.47），P＜0.000 01] was significantly higher than control group ；after treatment ，the level of B-type natriuretic peptide [SMD＝－1.61，95％CI（－2.58，－0.54），P＜0.000 01]，left ventricular end-diastolic diameter （LVEDD）level [WMD ＝ －6.06，95％CI（－6.84，－5.27），P＜0.000 01]，left ventricular end-systolic diameter level [WMD ＝－0.52，95％CI（－5.70，－4.33）， P＜0.000 01] were significantly lower than control group. There was no statistically significant difference in the incidence of ADR between 2 groups（P＞0.05）. Results of sensitivity analysis showed that when NT-proBNP ，LVEF level ，LVEDD level after treatment were used as indicators ，there was no significant difference in the analysis results after eliminating heterogeneity source ， compared with before elimination. CONCLUSIONS ：Shenfu qiangxin pills combined with chemical medicine conventional treatment has good efficacy and safety.

Study on the Mechanism of “Astragalus membranaceus -Draba nemorosa ”Couplet Medicine for Heart Failure Based on Network Pharmacology / 中国药房

OBJECTIVE： To explore potential mechanism of “Astragalus membranaceus-Draba nemorosa” couplet medicine for heart failure. METHODS： By network pharmacology， based on drug-like and oral bioavailability， the active components of “A. membranaceus-D. nemorosa” for chronic heart failure were screened and the targets of treating chronic heart failure were predicted by using TCMSP，GeneCards database， OMIM database and DRAR-CPI. The active component-chronic heart failure target network was established by Cytoscape 3.6.0 software. The protein-protein interaction network was constructed by utilizing STRING database. Then top 5 targets in the list of connectivity were screened and performed a molecular docking in molecular docking server. Finally， GO bioprocess analysis and KEGG pathway enrichment analysis were performed in DAVID database. RESULTS： The study predicted 28 active components in total， including 20 A. membranaceus and 12 D. nemorosa， such as kaempferol and quercetin， there were four components in common. Totally 92 target gene of active components were obtained， including heat shock protein 90α （HSP90AA1）， tyrosine protein kinase SRC gene， etc. Results of GO bioprocess analysis showed an association with mitochondrial electron transport， mitochondrial intima， cytoplasmic sol， extracellular body， mitochondrial matrix and drug response. KEGG pathway enrichment analysis showed a link with MAPK signal pathway， TGF signal pathway， PI3K signal pathway， cAMP signal pathway， protein kinase B signal pathway， EPK1 signal pathway and NF-κB signal pathway. CONCLUSIONS： “A. membranaceus-D. nemorosa” couplet medicine exerts therapeutic effects on heart failure from multiple targets as HSP90AA1， SRC and mitochondrial electron transport and MAPK signaling pathway. The study can provide reference for further researches on its material basis and mechanism.

Effects of precautionary nursing intervention on nursing quality score and rescue efficacy for neonates with hypoxic ischemic encephalopathy / 中国中西医结合急救杂志

Objective To investigate the effects of precautionary rescue nursing intervention on the nursing quality score and efficacy of rescue for neonates with hypoxic ischemic encephalopathy. Methods One hundred children with neonatal hypoxic ischemic encephalopathy admitted to the First Hospital of Hebei Medical University from January 2017 to December 2018 were enrolled. Fifty children from January to December 2017 were assigned in the routine rescue nursing group; and 50 children from January to December 2018 were in the precautionary rescue nursing group. The routine rescue nursing group received routine rescue nursing; and the precautionary rescue nursing group was given pre-planned rescue nursing intervention. The rescue success rate, rescue time, Apgar score within rescue for 5 minutes, poor prognosis, etc. were recorded in both groups; the infant intelligence development scale was used to evaluate the situation of children's development of IQ in 6 months; a self-made questionnaire was used to investigate the rate of satisfaction in 100 children family guardians; the hospital's self-made Nursing Quality Assessment Form was applied to assess the quality of care of nursing staff. Results The rescue successful rate and the 5-minute Apgar score of the precautionary rescue nursing group were significantly higher than those of the routine rescue nursing group [rescue success rate: 98.0% (49/50) vs. 72.0% (36/50), Apgar score: 8.43±1.28 vs. 5.74±1.39], and the rescue time and poor prognosis rate were significantly lower than those in the routine rescue nursing group [rescue time (minutes):3.18±1.20 vs. 6.78±2.23, poor prognosis rate: 2.0% (1/50) vs. 14.0% (7/50), both P < 0.05]. The 6-month intelligence index and psychomotor index in the precautionary rescue nursing group were significantly higher than those in the routine rescue nursing group (intelligence index scores: 96.43±5.85 vs. 85.40±8.90, psychomotor index scores:97.38±4.03 vs. 78.43±10.22, both P < 0.05). The satisfaction rate in precautionary rescue nursing group was obviously higher than that in the routine rescue nursing group [92.0% (46/50) vs. 76.0% (38/50), P < 0.05]; the rescue technology, rescue efficiency, rescue effect, humanistic care score in precautionary rescue nursing group were significantly higher than those in the routine rescue nursing group (8.12±0.89 vs. 2.74±1.02, 8.23±1.24 vs. 3.01±0.83, 7.80±1.33 vs. 3.44±1.25, 8.03±1.32 vs. 3.29±1.38, respectively all P < 0.05). Conclusion The precautionary rescue nursing intervention used for neonates with hypoxic ischemic encephalopathy can significantly improve the rescue effect, degree of satisfaction to nursing and the quality of nursing care, so that it is worthy to be applied clinically.

Application of FMEA regulated drug supply chain collaborative service platform for drug-receiving in outpatient pharmacy / 药学实践杂志

Objective To strengthen the system of drug supply chain collaborative service platform in drug supply, decrease drug inventory backlog, and improve the outpatient pharmacy management capacity in outpatient pharmacy.Methods Failure mode and effects analysis (FMEA) method was used to discover the potential risks in the drug supply chain collaborative service platform and formulate the corresponding improvement measures.Results The number of drug-receiving errors dropped from 137times to 32times and the risk reduction rate was 76.64％after improving the procurement process of the supply chain service platform, which significantly reduced the risk of contracting errors.Conclusion FMEA method could help to figure out the loopholes and hidden dangers of the pharmacy system, which made the outpatient pharmacy more reasonable and accurate by constantly improving the measures of the drug supply chain collaborative service platform.

Continuous Improvement Practice and Effectiveness of Electronic Pharmaceutical System on Tollying in Outpatient Pharmacy of Our Hospital / 中国药房

OBJECTIVE:To optimize the workflow of electronic pharmaceutical system(ePS),and improve the work efficiency of outpatient pharmacy. METHODS:The problems about the application of ePS on tollying in outpatient pharmacy of our hospital were analyzed. The improvement measures were put forward and implemented. The effectiveness was summarized by evaluating relevant work indicators 6 months before and after optimization. RESULTS:Referring to main problems during the application of ePS on tollying as repetition of tallying drugs,complexity of stocking checking,low efficiency in the management of drug expiry date,deviation in the tracking of"batch/expiry",a series of measures were carried out in outpatient pharmacy of our hospital,including optimizing tallying process,updating tracking process,adding the function of alerting the near-expiry drug, etc.The system optimization shortened the time of replenishment(26.32 s vs. 7.78 s,improving by 3.38 times)and stock checking [(165.50±5.75)s vs.(146.70±4.54)s,shortening by 11.36%],realized accurate tracing of drug information"batch/expiry"and improved drug management [(58.00±1.88)s vs.(18.00±1.23)s,shortening by 68.97%]. CONCLUSIONS:The optimization of ePS on tallying in our hospital improves work efficiency of pharmacists and guarantees the accuracy of tracing drug"batch/expiry".

Control Study of Cervical Spondylotic Radiculopathy Treated by Loosening Posterior Tubercle of Cervical Transverse Process with CT-guided Insertion of Small Needle Knife and Blind Insertion of Small Needle Knife / 广州中医药大学学报

Objective To investigate the successful rate and the therapeutic effect of loosening posterior tubercle of cervical transverse process with CT-guided insertion or blind insertion of small needle knife for cervical spondylotic radiculopathy. Methods Ninety patients with cervical spondylotic radiculopathy were divided into CT-guided insertion group and blind insertion group in the admission order using the random number table method, 45 cases in each group. CT-guided insertion group adopted the insertion of small needle knife following by the guide of CT, and the blind insertion group adopted the insertion of small needle knife following by cervical bony landmarks and muscles. After insertion, the position of the small needle knife in patients of the two groups was located by CT scan. If the needle knife did not arrive to the foci, it will be inserted again following by the guide of CT till successful insertion and location. The successful rate for the two times of insertion was calculated, and the pain scores were evaluated by visual analogue scale(VAS). Results(1) The successful rate for the first insertion of CT-guided insertion group was 73.3％, and that of the blind insertion group was 47.8％, the difference being significant(P < 0.01). The successful rate for the second insertion of CT-guided insertion group was 92.2％, and that of the blind insertion group was 80.0％, the difference being significant (P<0.01). (2) After treatment for one week, pain VAS scores of the two group were decreased (P < 0.01 compared with those before treatment) , and the decrease in the CT-guided insertion group was more obvious than the blind insertion group (P < 0.05). Conclusion CT-guided insertion makes the small needle knife therapy be more accurate and safer, ensures much better therapeutic effect, and brings less pain in the patients.

Relationship among pyroptosis,inflammasome and tumor / 国际肿瘤学杂志

Pyroptosis is a new way of programmed cell death,a number of researches have found that it is associated with a variety of diseases.Inflammasome and caspase protein family play key roles in regulating pyroptosis.Intracellular pattern recognition receptor oligomers under external stimulus,then assemble with apop-totic speck-like protein containing a caspase recruitment domain and caspase precursor into inflammatory com-plex body,thus activation of caspase can induce pyroptosis.While as the upstream regulation mechanism of pyroptosis,inflammasome might be double edged swordfor tumor growth.On the one hand,inflammasome can inhibit the proliferation of tumor cells by inducing pyroptosis;on the other hand,the cumulative effect of the inflammsome can also form a suitable microenvironment for tumor cells and promote tumor growth.

Clinical analysis of the microangiopathic hemolytic anemia and renal impairment secondary to methylmalonic ;academia in children / 临床儿科杂志

Objectives To review the clinical features in children with methylmalonic academia (MMA) having the primary clinical manifestations of microangiopathic hemolytic anemia and renal impairment. Methods The clinical data of 4 children diagnosed of MMA with the primary clinical manifestations of microangiopathic hemolytic anemia and renal impairment were retrospectively analyzed from August 2013 to present. Results In the four children (two boys and two girls) with the age from nine months to three years seven mouths, two children were diagnosed with MMA combined with homocysteine, and 2 children were diagnosed with MMA, but there was no homocysteine testing. All four children showed moderate to severe anemia, proteinuria, hematuria, and hypertension. One child had abnormal renal function and thrombocytopenia, and manifested as hemolytic uremic syndrome. Renal biopsy was performed in 2 children and they had glomerular sclerosis lesions with renal tubular necrosis and mesangial proliferative glomerulonephritis respectively. All children were treated with vitamin B12, and the indexes of microangiopathic hemolytic anemia and renal impairment were improved signiifcantly. Conclusions MMA may be combined with microangiopathic hemolytic anemia, renal impairment and even hemolytic uremic syndrome, and the early diagnosis and treatment is required.

Prospective multicentre study of chemotherapeutic regimen containing pirarubicin on the treatment of relapsed or refractory acute myeloid leukemia in adults / 中华血液学杂志

<p><b>OBJECTIVE</b>To compare the efficacy and toxicity of the chemotherapeutic regimen containing pirarubicin and mitoxantrone on the treatment of relapsed or refractory acute myeloid leukemia (AML) in adults.</p><p><b>METHODS</b>In this open prospective multicentre study, we randomly assigned patients with relapsed or refractory AML to receive TAE regimen (pirarubicin+cytarabine+etoposide) versus MAE regimen (mitoxantrone + cytarabine + etoposide). The efficacy and toxicity were compared between the two groups.</p><p><b>RESULTS</b>56 patients entered this clinical trial. The complete remission (CR) rate on TAE arm was 79.0% versus 55.6% on MAE arm with the overall response (OR) rates of 86.8% versus 88.9%, respectively. The CR was higher on TAE arm (P=0.035) but with no significant difference between the two groups regarding the overall response (OR) rate. The regimens were well tolerated in both groups. Hematologic and non-hematologic toxicity were similar except relatively lower the mean dosage of G-CSF, red blood cells and platelets transfusion on TAE arm. No significant differences were seen between the two groups regarding the overall survival and relapse free survival rates.</p><p><b>CONCLUSION</b>TAE regimen might be an effective salvage therapy in patients with relapsed or refractory AML.</p>

Effects of arsenic trioxide plus thalidomide on immune function in patients with myelodysplastic syndrome / 中国综合临床

Objective To investigate the effects of arsenic trioxide plus thalidomide on immune function of patients with myelodysplastic syndrome (MDS).Methods Fifty-seven MDS patients (Low risk,medium risk and high risk) and 30 healthy volunteers were selected as our subjects.Thirty-four cases with medium risk Ⅱ and high risk MDS patients were randomly divided into A and B groups.Seventeen MDS patients in A group were treated with arsenic trioxide plus thalidomide,and 17 MDS patients in B group were treated with low-dose cytarabine.Lymphocyte subsets in peripheral blood were examined by flow cytometry (FCM).The adverse effect of arsenic trioxide and thalidomide were recorded.Results Compared with control group,the number of T lymphocytes(CD3 +),B lymphocytes (CD3-CD19 +) and NK cell (CD3-(CD16 CD56) +) of patients with MDS were significantly lower,and the differences were statistically significant (t =2.157,2.349,2.958 ; P ＜ 0.05 or P ＜ 0.01).The helper CD3 + CD4 + T cell (Th) ratio decreased in MDS patients than that of control group (t =2.412,P ＜ 0.05).The inhibition CD3 + CD8 + T cells (Ts) ratio increased (t =2.749,P ＜ 0.01).Th/Ts ratio inversion was seen in MDS patients.As the progression of MDS increase,Ts cell expression gradually increased and NK cells ratio gradually decreased.However,there was no significant difference among three groups.Th cells and B lymphocytes in the risk group were lower than that in the low risk group,and the difference was statistically significant (F =4.896 and 4.516,P ＜0.05),but there was no significant difference in the terms of the number of T lymphocytes,Th cell,ratio of Th/Ts and B lymphocytes among MDS groups.Number of T lymphocytes,B lymphocytes and NK cell count in group A after treatment were increased than that before treatment (t =2.435,2.468,2.653,P ＜ 0.05).In group A,2 cases were complete remission,4 cases with partial remission,and 5 cases with hematologic improvement.The total effective rate was 64.71％ (11/17),and curative effect is obviously better than that of B group (x2 =4.253,P ＜ 0.05).Meanwhile adverse effect was mild.Conclusion The cellular and humoral immune function decreased in MDS patients.The treatment of arsenic trioxide plus thalidomide on MDS is proved safety and efficacy,which might work by improving immune function of MDS patients.

Effect of livin gene suppression by genistein on apoptosis, cell cycle and proliferation of malignant melanoma LiBr cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of livin gene suppression by genistein on apoptosis, cell cycle and proliferation of malignant melanoma LiBr cells.</p><p><b>METHODS</b>RT-PCR was used to detect the expression of livin mRNA in LiBr cells 48 h after treatment with 40 µmol/L genistein. Flow cytometry with annexin V-FITC/PI double staining was employed to detect cell apoptosis, and the caspase-3 protein expression in the cells following genistein treatment was assayed using Western blotting. The changes in the cell cycle and proliferation of the cells after genistein treatment were examined with flow cytometry with PI staining and MTT colorimetric assay, respectively.</p><p><b>RESULTS</b>Genistein can suppress the expression of Livin Gene (87.94% with 40 µmol/L genistein) and induce the apoptosis of LiBr effectively, both in the early and late phases (27.87∓5.38% and 11.87∓3.86% respectively). LiBr cells in phase G(0)/G(1) increases notably(G(0)/G(1)=72.11∓5.89%,S=14.53∓3.47%,G(2)/M=12.36∓2.64%). Genistein significantly reduced caspase-3 protein expression and inhibit cell proliferation.</p><p><b>CONCLUSION</b>Genistein can suppress Livin Gene expression, induce LiBr cell apoptosis, hinder cell generation cycle, restrain cell proliferation.</p>

Bloom's syndrome in two brothers / 中华皮肤科杂志

The patient 1 was a 9-year-old boy of Hui nationality who presented with recurrent erythema over the face and auricles for 8 years.Telangiectasis and erythema developed on both cheeks 7 months after birth,which gradually spread to the auricles,forearms and both legs with a mild ichthyosiform appearance.At 5 years of age blisters and erosions appeared on the lips,which occurred and were aggravated after exposure to strong sunlight during summer and spontaneously subsided or disappeared in winter.The patient 2,a 3-year-old boy who was the younger brother of the patient 1,presented with recurrent erythema for 2 years.At 1 year of age,erythema began to appear on both cheeks and gradually spread to the buccal region,with mild pruritus and scaling.Meanwhile,the skin of both legs was dry and scaling and gave an ichthyosifonn appearance.The lesions usually appeared in early summer and gradually subsided in winter.No abnormality was found by systemic,laboratory,pathological or other auxiliary examination.Chromosomal abnormality was undetected.Body height was normal.The parents of the two siblings were first cousins.Both children were diagnosed with Bloom's syndrome.

Expression of extracellular signal-regulated kinase in lesions of psoriasis vulgaris / 中华皮肤科杂志

Objective To investigate the expression and activation of extracellular signal-regulated kinase 1/2 (ERK 1/2), its upstream molecule, epidermal growth factor receptor (EGFR), and downstream transcription factor, Ets-like protein 1 (ELK-1), in lesions of psoriasis vulgaris, and to evaluate the relationship between ERK pathway and psoriasis vulgaris. Methods Tissue samples were obtained from the lesions of 40 patients with psoriasis vulgaris and normal skin of 20 normal human controls. Immunohistochemistry and Western blot were performed to detect the expressions of phosphorylated ERK1/2, EGFR and ELK-1 in the tissue samples.Results As immunohistochemistry showed, the integrated optical density (IOD) of p-ERK1/2, p-EGFR and p-ELK-1 was 269.85 ± 57.96, 136.88 ± 30.33 and 237.61 ± 56.29 respectively in the psoriatic lesions, significantly higher than that in the normal controls ( 140.24 ± 24.42, 110.66 ± 28.99 and 119.04 ± 21.99, respectively, all P ＜ 0.05). A positive correlation was observed between the expression of p-EGFR and p-ERK1/2(r = 0.57, P ＜ 0.05) and between that of p-ERK1/2 and p-ELK-1 (r=0.72,P＜0.05) in psoriatic lesions.Conclusion The enhanced signal transduction through phosphorylated EGFR→ERK1/2→ELK-1 pathway may play a certain role in the pathophysiological process of psoriasis vulgaris.

Survey of critical thinking disposition and related factors in master degree medical students / 中国实用护理杂志

ucting the students to correct their attitudes to-ward learning, consolidate the professional thinking, intensify their critical thinking awareness, then further improve the masters' ability of critical thinking.

Determination of Ginsenoside Rb_1 in AITONG Capsules / 浙江中医药大学学报

[Objective] To establish n HPLC method for analysis of ginsenoside Rb1 in AITONG capsules. [Method]The HPLC system consists of G1314A variable wavelength un-visible detector,Hypersil ODS(4.6mm?250mm,5?m),HP chemstation, Hp1100 Series Quaternary Pump and Vacuum degasser (G1322A). The mobile phase was: Acetonitrile:Water (30∶70,v/v). The flowrate was 1.0ml?min-1,the injection volume was 20?l,and the detector wavelength was 203nm. [Results] The method was linear at the ginsenoside Rb1 ranging from 0.04?g to 2?g. The recovery of method was 98.26%(n=5),the average RSD was 1.41% .

Discussion on advantages and law location of health food in China / 中华中医药杂志

Health food has been used for a long history in our country,and it has unique advantages and is an important part of national medical care delivery in China. Up to now,its use is not under administration of food safety law. This article analyzes the differences among health food,drug and common food,the advantages in theory,resource,safety and compatibility of health food,the laws and regulations of health food published by government,and the status of health food industry,in order to demonstrate the importance and urgency of health food being administrated under food safety law,for the purpose of obtaining the academic and legal consensus.