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Objective To investigate the clinical efficacy and safety of Danshu Capsule in the treatment of chronic cholecystitis and gallstones through a large-sample, multicenter, open-label real-world research. Methods A total of 9579 patients with chronic cholecystitis and/or gallstones who were treated in 329 hospitals of China from January 2017 to December 2019 were enrolled and divided into gallstones group with 1148 patients, chronic cholecystitis group with 5360 patients, and chronic cholecystitis+gallstones group with 3071 patients.All patients were treated with oral administration of Danshu Capsule at a frequency of 1-2 capsules/time, three times a day after meals, for 4 consecutive weeks.Abdominal pain, biliary dyspepsia, traditional Chinese medicine (TCM) syndromes, and imaging findings of the biliary system were recorded before and after treatment to evaluate the efficacy of medication, and adverse drug reactions were monitored to evaluate the safety of Danshu Capsule.The Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment, and the Wilcoxon rank-sum test was used for comparison between any two groups.The paired chi-square test was used for comparison of categorical data before and after treatment; the Kruskal-Wallis H method was used for comparison between multiple groups, and the Logistic regression analysis and the Nemenyi test was used for further comparison between two groups. Results After treatment with Danshu Capsule, all patients had significant reductions in the overall incidence rate of pain induced by lipid meal ( χ 2 =32.422, P < 0.001), the frequency, duration, and degree of pain ( Z =-1.985, -2.887, and-3.178, all P < 0.05), the symptom scores of abdominal distension, abdominal fullness, belching, and nausea (all P < 0.001), and the total symptom score of biliary dyspepsia ( Z =-4.128, P < 0.001);there were also significant reductions in the TCM syndrome scores of right upper quadrant pain, bitter taste, acid regurgitation, chest distress, abdominal distension, poor appetite, and heaviness of limbs (all P < 0.05) and a significant reduction in total TCM syndrome score ( Z =3.860, P < 0.001).Subgroup analysis showed that after treatment, the gallstones group, the chronic cholecystitis group, and the chronic cholecystitis+gallstones group had significant reductions in the degree, frequency, and duration of pain, the symptom score of biliary dyspepsia, and TCM syndrome score (all P < 0.05), as well as a significant reduction in the number of patients with pain induced by lipid meal ( P < 0.001).The chronic cholecystitis group had significantly greater reductions in the score of pain frequency, the score of pain duration, the score of pain degree compared with the other two groups (all P < 0.05).Ultrasound examination showed that after treatment, all patients had significant reductions in poor sound transmission of gallbladder, gallbladder wall thickness, incidence rate of gallbladder wall thickening or roughness, and the number and size of gallstones (all P < 0.05).Danshu Capsule showed an overall response rate of 74.75% in the treatment of gallbladder wall lesion and an overall response rate of 67.40% in the treatment of gallstones.A total of 84 patients reported adverse events, mainly gastrointestinal symptoms, and the overall incidence rate of adverse reactions was 0.87%. Conclusion Danshu Capsule can significantly alleviate the symptom of pain and improve the symptoms of biliary dyspepsia, TCM syndrome, and gallbladder imaging findings in patients with chronic cholecystitis and/or gallstones, with a low incidence rate of adverse reactions, and therefore, it is a safe and effective drug for the treatment of chronic cholecystitis and gallstones.
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Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.
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Parkinson's disease combined with thyroid dysfunction is not uncommon in clinical practice.Due to similarities and overlaps between their symptoms and an unclear cause-and-effect relationship, the diagnosis and treatment may be missed and delayed.Here we summarize the clinical manifestations of the two diseases and analyze the potential pathogenic mechanisms shared between them, in order to provide a reference for the understanding of their pathogenesis and for the treatment of Parkinson's disease.
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Treatment of H.pylor(Hp)-relatedgastropathy with traditional Chinese medicine(TCM) therapy has prominent advantages. Integration of traditional and western medicine can remarkably increase negative conversion ratio, reduce drug resistance rate and effectively decrease adverse reactions and recurrence rate. This paper summarized the research progress of the treatment for Hp-related gastropathy and related mechanism with TCM recently. The content included the aspects of theory, treatment and anti-Hp mechanism of Hp-related gastropathy in TCM, in order to provide relevant reference for clinical medication and scientific research direction in future .
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Objective Non-muscle myosin heavy chain ⅡA (NMHC ⅡA ) plays a significant role in tumor progression and metastasis .Our prior study showed that the expression of NMHC ⅡA was much higher in human bladder cancer sample than that in adjacent tissue .The increased level of NM HC ⅡA expression was correlated with worse prognosis .However ,the role of NMHC ⅡA is unknown in the invasion and metastasis of bladder cancer .Methods RT-PCR and western blotting were used to examine NMHC ⅡA expression lev-els in normal bladder epithelial cells and bladder cancer cell lines .T he migration and invasion ability of cells was tested by wound healing assay and Transwell invasion assay ,respectively .Results Our study showed that knockdown of NMHC ⅡA inhibited migration and invasion in bladder cancer cell line .Conclusion The study indicated that NM HC ⅡA expression increased the invasion and metastasis ability of bladder cancer cell line in vitro .
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Objective@#To investigate the CRISPR genotypes (clusters) and regional distribution of Yersinia pestis in Qinghai-plateau.@*Methods@#One hundred and two isolates of Y. pestis isolated from human plague patients, host animal and insect vectors from Qinghai-plateau were selected. The DNAs were extracted using the traditional sodium dodecyl sulfate decomposition and phenol-chloroform method. Three CRISPR loci YPa, YPb and YPc of 102 isolates of Y. pesits were amplified and sequenced, and then the CRISPR sequence analysis was carried out by comparing the latest published CRISPR spacer dictionary and the NCBI database to identify the spacer and spacer array. CRISPR genotyping of isolates of Y. pesits were finally conducted according to the polymorphism of the spacer arrays and the regional distribution pattern of isolates of Y. pesits in Qinghai-plateau was described.@*Results@#Forty spacers including 22 of YPa, 13 of YPb and 5 of YPc were observed among 102 isolates of Y. pestis in Qinghai-plateau, of which 5 spacers (a1', a103, a104, b4'' and b4''') were firstly identified. Meanwhile, 16, 10, and 5 different spacer arrays were obtained in YPa, YPb and YPc respectively, including 11 new spacer arrays detected in this study. One hundred and two isolates were divided into 24 CRISPR genotypes and classified into 9 CRISPR clusters (Cb4, Cb4', Cb2, Ca37, Ca7, Ca7', CaΔ5', Ca35' and Cc3'). Each dominant cluster presented significant aggregation geographically: Ca7 were found in Yushu, Nangqian, Chenduo, Zaduo, Zhiduo and Qumalai countries. Ca7' were found in Xunhua, Tongren, Zeku, Tongde, Maqin and Guinan countries. CaΔ5' were restricted to Qilian, Gangcha, Menyuan and Datong countries. CaΔ35' were found in Huangyuan, Haiyan, Gangcha, Tianjun, Delingha, Wulan, Doulan, Gonghe, Xinghai, Guide and Tongde countries.@*Conclusion@#CRISPR-based genotyping analyses showed complicated population of Y. pestis in Qinghai-plateau. Four clusters, Ca7, Ca7', CaΔ5' and Ca35' were the most epidemic dominant four clusters and presented obvious regional distribution patterns, which instructed us to strengthen the surveillance and prevention and control by CRISPR-genotyping technique.
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Objective To analyze the radiographic characteristics of right hand X-ray film of adult patients with Kaschin-Beck disease (KBD) in Qinghai Province, to understand the most affected locations in adult KBD. Methods According to the criteria of KBD diagnose (WS/T 207-2010), 111 cases of patients were taken X-ray films of right hands. Joint space narrow, joint deformity, subchondral sclerosis, osteophyte, coarse and irregularity of joint, marginal retraction sign and capsule changes were chosen as the descriptive indexes, and these indexes were analyzed with SPSS 17.0. Results A total of 111 cases adult patients with KBD were examined right hand by X-ray, abnormality on X-ray film were 103 cases, the abnormal rate was 92.79%. The most affected fingers were Ⅱ- Ⅳphalanx bones, Ⅱphalanx bones accounted for about 92.23% (95/103), Ⅲ phalanx bones accounted for about 99.03% (102/103), and Ⅳ phalanx bones accounted for about 99.03% (102/103). There was significant difference of the abnormality between th e proximal phalanx and the middle phalanx among the Ⅱ - Ⅳ phalanx bones(χ2=79.33, P<0.05). Abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the proximal phalanx were 212, 7, 134, 47, 15 and 115 in Ⅱ - Ⅳ proximal phalanx, respectively; while the abnormal numbers of joint deformity, marginal retraction sign, coarse and irregularity of joint, osteophyte, capsule changes and joint space narrow in the middle phalanx were 77, 37, 137, 26, 19 and 126 in Ⅱ - Ⅳmiddle phalanx, respectively. Conclusion The Ⅱ - Ⅳ phalanx bones of right hand are the most affected locations in adult KBD.
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In the perspective of medical ethics,doctor-patient relationship is a particular kind of social relations that contains a combination of factors such as biological,psychological and social basis,including certain moral standards and ethical norms formed.Ethical property is a fundamental property of the doctor-patient relationship.In current medical practice,doctor-patient relationship unprecedented tensions,conflicts between doctors and patients,the frequent occurrence of medical trouble,has become the social factors of disharmony and highly attention.In order to make the medical humanity regression and construct a new doctor-patient relationship reflecting equality and cooperation,with medical ethics as the angle of view,the author the author has discussed and demonstrated how to improve doctor-patient ethics accomplishment,rebuild the doctor-patient relationship of trust,reshape the respect for life and personality of medical humanism spirit,safeguard the equality of the subject position of both doctors and patients,and how to provide humane medical services etc.in order to indicate the direction for the deepening of China's reform of the medical system and provides theoretical support.
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Objective To determine the prognostic value of standardized uptake value(SUV)of fluorodeoxyglucose(FDG)by positron emission tomography and computed tomography(PET-CT)in nonsmall cell lung cancer(NSCLC).Methods Forty-eight patients(39 male,9 female)with stage ⅢNSCLC were reviewed.All patients had at least two repeated FDG PET-CT scans either before and after therapy and the maximum standardized uptake value(SUVmax)of the primary lung lesion was calculated. Resuits Of the 45 eligible patients,after a median follow-up of 22.5 months(rang,13 to 35 months),24 patients had local and regional recurrenee or metastasis and 21 remain disease-free.The mean SUVmax of patients who had local recurrence or metastasis before and after treatment was 12.30±3.17 and 5.35±2.29,respectively.The mean SUVmax of patients who had no loeal recurrence or metastasis before and after treatment was 8.46±3.00 and 2.82±0.63,respectively.Significant differences(tbefore=4.15,Pbefore＜0.01;Pafter=4.88,Pafter＜0.01)in SUVmax were observed either before and after treatment.However,the percent change of SUVmax between pretreatment and post-treatment were not significiantly different(t=1.99,P＞0.05).Using the SUVbefore of 9.0 yielded 92% sensitivity,62% specificity,73% positive predictive value and 87%negaffve Dredictive value in predicting regional recurrence or metastasis. While using the SUVafter of 4.3 yielded 71% sensitivity,100% specificity,100% positive predictive valne and 72% negative Dredictive value. Conclusions PET-CT may have the potientials to predict response to therapy and the SUVmax is a significant predictor for recurrent or metastasis in patients of NSCLC.
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Objective To discuss the value of dual-time-point 18FDG PET-CT imaging on involved field radiotherapy for hilar and mediastinal metastatic lymph nodes in patients with non-small cell lung cancer (NSCLC).Methods Fifty-four patients with NSCLC were included in this analysis,including 34 men and 20 women with mean age of 59(34-76)years.Two sequential PET-CT scans given 3-5 days before surgery were standard single-time-point imaging for the whole body and delayed imaging for the thorax.The pathologic data were used as golden standard to determine the difference between the standard single-time-point and dual-time-point FET-CT imaging in the definition of gross target volume(GTV)of involved-field radiotherapy for metastatic lymph nodes. Results For hilar metastatic lymph nodes,the GTV defined by single-time-point imaging was consistent with pathologic GTV in 21 patients(39%),comparing with 31 patients(57%) by dual-time-point imaging.Using pathologic data as golden standard,GTV alteration defined by single-time-point imaging had statisticaly significant difference comparing with that defined by dual-time-point imaging(u=519.00,P=0.023).For mediastinal metastatic lymph nodes,the GTV defined by single-time-point imaging was consistent with pathologic GTV in 30 patients(56%),comparing with 36 patients(67%)by dual-time-point imaging.Using pathologic data as golden standard.GTV alteration defined by single-time-point imaging had no statisticaly significant difference comparing with that defined by dual-time-point imaging(u=397.50,P=0.616).Conclusions For patients with NSCLC receiving involved-field radiotherapy,GTV definition for hilar and mediastinal metastatic lymph nodes by dual-time-point imaging is more consistent with that by pathologic data.Dual-time-point imaging has a larger value in terms of target delineation for hilar and mediastinal metastatic lymph nodes.
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There are many problems existing in humanities and social science courses in education and teaching of medical colleges and universities.Changing concepts of education,adjusting the curriculum,improving teaching methods and improving the quality of teachers are effective measures in medical colleges to strengthen the humanities and social science courses.We have made a preliminary exploration on teaching practice for humanistic education and professional education.
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BACKGROUND: At present, researches have been proved that nerve growth factor (NGF) plays an important role in repairing neural regeneration after spinal cord injuries. Poor ability of neural regeneration is related to lack of microenvironment for neuronal growth at local injured site. Whether electro-acupuncture can protect nerve after spinal cord injuries through increasing NGF level in injured spinal cord or not is lack of experimental data on the view of molecule.OBJECTIVE: To observe the effect of electro-acupuncture on motor function, morphology of spinal cord and mRNA expression of NGF in rats with experimental spinal cord injuries through morphology and hybridization in situ.DESIGN: Randomized controlled animal study.SETTING: Department of Acupuncture and Moxibustion, the Tenth People's Hospital Affiliated to Tongji University; Shanghai Institute of Acupuncture and Meridian.MATERIALS: The experiment was completed in the Shanghai Institute of Acupuncture and Meridian from January 1999 to February 2002. A total of 15 male SD rats weighing (260±9.52) g were randomly divided into sham operation group, injured control group and acupuncture group with 5 in each group.METHODS: Models of spinal cord injuries were established in injured control group and electro-acupuncture group, and rats in sham operation group were just treated with resection of lamina of vertebra. Two hours after operation, rats in electro-acupuncture group were treated with electroacupuncture at Daczhui (GV14) and Mingmen (GV4), L2 Jiaji (Ex-B2-L2)and Huantiao (GB30), alternatively. Then, G6805 electro-acupuncture apparatus was used with distant wave, 0.8 Hz, 0.3-0.6 mA, and slight shake on muscle was regarded as proper response. The electro-acupuncture was performed every 30 minutes a day for 30 days. Rats in injured control group and sham operation group were not treated with any way, and motor functions 2 hours and 30 days after operation were observed with modified Tarlov scale and Rivlin method. ① Modified Tarlov scale: Pamplegia and irresponsivity of lower limbs during electro-acupuncture were scored from 0 to 6 points. ② Modified Rivlin method: Tiltboard was consisted of two rectangular alloy boards which was connected to one end through hinge.Board turned around axis at the beginning of horizontal position (0°) and the angle of ram could be measured. Rats faced towards front were put vertically as longitudinal axis of body to longitudinal axis of tiltboard.Angle was increased gradually when rats were not able to keep the primary position for 5 seconds, and the critical angle was recorded. Hybridization in situ assay: Amount of positive NGF cells was recorded under light microscope and photographs were completed at the same time.MAIN OUTCOME MEASURES: Scale of motor function (modified Tarlov score), critical angle of ram test (modified Rivlin method) and changes of amount of positive NGF mRNA cells in rats with spinal cord injuries.RESULTS: A total of 15 experimental rats were involved in the final analysis. ① Two hours after spinal cord injuries of rats in injured control group and electro-acupuncture group, score of motor function and critical angle of ram which was measured with modified Rivlin method were decreased remarkably; 30 days later, score of motor function measured with modified Tarlov scale and critical angle of ram were increased at various degrees, especially those in electro-acupuncture group were increased remarkably, and there was significant difference from those in injured control group [35.40±6.62, 27.80±1.10; (35.40±6.62)°, (27.80±1.10)°, P ＜ 0.05]. ② Thirty days after injury, pathological lesion of rats in electroacupuncture group was milder than that in injured control group, and morphological injury of spinal cord and amount of positive NGF mRNA cells were obvious as compared with those in injured control group (28.13±1.64,12.63±1.41, P ＜ 0.01).CONCLUSION: Electro-acupuncture can improve mRNA expression of NGF in spinal cord, relieve morphological injury of spinal cord, accelerate recovery of motor function of rats with spinal cord injuries, and protect nerve through mRNA expression of NGF.
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This paper presents a method for trace level analysis of microcystins in water using solid-phase extraction and high performance liquid chromatography.The optimized condition enabled the determination of common microcystins at levels as low as 0.02～0.05μg/L,and the liner range is from 0.1μg/L to 50 μg/L. The method has been applied to the analysis of field sample from Dianchi lake.