Perioperative management and operative treatment of malignant tumor of anal canal merging severe abdominal protuberance / 中华胃肠外科杂志

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.

CiteSpace knowledge map of research hotspots and frontiers of traditional Chinese medicine intervention in psoriasis in recent ten years / 中国中药杂志

This study aimed to investigate the development status of traditional Chinese medicine(TCM) intervention in psoriasis in recent ten years, analyze the research hotspots, and summarize the development trends to provide reference materials for scholars in this field. Taking the available literature related to the field of TCM intervention in psoriasis as the research object, the trends, contents, and source publications were statistically analyzed based on bibliometrics. The research cooperation and co-occurrence of keywords in this field were studied by the knowledge map analysis method based on CiteSpace. The total number of Chinese papers was 2 993 and English papers 285. In terms of publication trend, the annual publication of English papers was low but showed an obvious upward trend, while the increase in Chinese papers fluctuated and tended to be flat. In terms of the content of Chinese papers published, TCM ranked first according to the discipline(2 415). In English papers, the number of publications in pharmacology and pharmaceutical science was the highest(87). Literature source analysis showed that the Chinese and English journals with the most publications were China Journal of Traditional Chinese Medicine and Pharmacy and Evidence Based Complementary and Alternative Medicine, respectively. Beijing University of Chinese Medicine published the most dissertations in China(99). The authors with the most publications in Chinese and English were LI Bin(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine) and LU Chuan-jian(Guangdong Hospital of Traditional Chinese Medicine). As revealed by the CiteSpace analysis of the research cooperation network, there were four mature and stable core teams in this field, but the cooperation intensity between different teams was weak. According to the keywords co-occurrence knowledge graph constructed by CiteSpace, the current hot keywords in this field are as follows: psoriasis, blood-heat syndrome, blood-stasis syndrome, fire needle, blood-dryness type, imiquimod, TCM bath, etiology and pathogenesis, cytokines, cupping therapy, etc. In summary, Chinese scholars have conducted active exploration and research in the field of TCM intervention in psoriasis in recent ten years. The overall development trend is good, and the breadth and depth of the research are constantly extending. It is suggested that relevant research should be free from discipline restrictions and strive for interdisciplinary integration.

Research progress in targeting autophagy of traditional Chinese medicine and natural compounds to regulate atherosclerosis / 中国中药杂志

Atherosclerosis(AS) is the common pathological basis of many ischemic cardiovascular diseases, and its formation process involves various aspects such as vascular endothelial injury and platelet activation. Vascular endothelial injury is the initiating factor of AS plaque. Monocytes are recruited to differentiate into macrophages at the damaged endothelial cells, which absorb oxidized low-density lipoprotein(ox-LDL) and slowly transform into foam cells. Smooth muscle cells(SMCs) proliferate and migrate continuously. As the only cell producing interstitial collagen fibers in the fibrous cap, SMCs largely determine whether the plaque ruptured or not. The amplifying inflammatory response during the formation of AS recruits platelets to adhere to the damaged area of vascular endothelium and stimulates excessive platelet aggregation. Autophagy activity is associated with vascular lesions and abnormal platelet activation, and excessive autophagy is considered to be a negative factor for plaque stability. Therefore, precise regulation of different types of vascular autophagy and platelet autophagy to treat AS may provide a new therapeutic perspective for the prevention and treatment of atherosclerotic ischemic cardiovascular disease. Currently, treatment strategies for AS still focus on lowering lipid levels with high-intensity statins, which often cause significant side effects. Therefore, the development of safer and more effective drugs and treatment modes is the focus of current research. Traditional Chinese medicine and natural compounds have the potential to treat AS by targeted autophagy, and have been playing an increasingly important role in the prevention and treatment of cardiovascular diseases in China. This paper summarizes the experimental studies on different vascular cell types and platelet autophagy in AS, and sums up the published research results on targeted autophagy of traditional Chinese medicine and natural plant compounds to regulate AS, providing new ideas for further research.

Effects of Zhongfeng capsule on autophagy related proteins expressions of brain tissue in rats with cerebral ischemia/reperfusion injury / 中国应用生理学杂志

Objective: To investigate the effects of Zhongfeng capsule on the autophagy-related proteins expression in rats with cerebral ischemia/reperfusion injury (CI/ RI), and to explore its neural protection mechanisms of the decoction. Methods: Rat middle cerebral artery ischemia/reperfusion injury model (ischemia for 2 h, reperfusion for 24 h) was prepared by the improved line plug method. Sixty male SD rats were randomly divided into sham operation group, model group, butylphthalide group(0.054 g/kg), Zhongfeng capsule high-dose groups (1.08 g/kg), Zhongfeng capsule middle-dose groups (0.54 g/kg), Zhongfeng capsule low-dose groups (0.27 g/kg), with 10 rats in each group. Rats were treated with Zhongfeng capsule by gavage once a day for 10 days. The rats were sacrificed and the brain tissue was obtained after the experiment in each group. Score neurological deficit was evaluated after 24 h of the last intervention in rat of each group. The pathological changes of brain tissue were observed by HE staining. The serum levels of estradiol (E2) and follicle stimulating hormone (FSH) were determined by ELISA. The expressions of key genes and proteins of PI3K/Akt/Beclin1 signaling pathway in brain tissue were detected by qRT-PCR and Western blot respectively. Results: Compared with the sham operation group, the body weight and protein expressions of p-PI3k and p-Akt in brain tissue of rats were decreased significantly in the model group, while the brain index, neurological deficit score, gene and protein expressions of Beclin1 and LC3 were increased markedly in the model group(P＜0.05 or P＜0.01). In the model group, nerve cells of brain tissue were loosely packed, interstitial edema, triangular in shape, nuclear pyknosis and dark-blue staining were observed. Compared with the model group, the body weight of rats was increased obviously, the neurological deficit score was decreased significantly and the pathological injury of brain tissue was alleviated evidently in high-dose of Zhongfeng capsule group (P＜0.05). The brain index, the gene and protein expressions of Beclin1 and LC3 were decreased apparently in Zhongfeng capsule treatment groups(P＜0.05 or P＜0.01), while the expressions of p-PI3k and p-Akt in brain tissue were increased evidently in Zhongfeng capsule treatment groups(P＜0.05 or P＜0.01). Conclusion: Zhongfeng capsule can inhibit autophagy and improve brain neurons lesion of CIRI rats, the mechanism may be related to regulate the expression of Beclin1 and LC3 in PI3K/Akt/Beclin1 signaling pathway.

TRPV4 channel mediates the increase of pulmonary microvascular endothelial permeability in rats with chronic hypoxic pulmonary hypertension / 生理学报

The purpose of the present study was to investigate the effect of transient receptor potential vanilloid 4 (TRPV4) channel on the permeability of pulmonary microvascular endothelial cells (PMVECs) in rats with chronic hypoxia-induced pulmonary hypertension (CHPH), so as to clarify the mechanism of vascular endothelial dysfunction during the occurrence of pulmonary hypertension (PH). CHPH rat model was established by exposure to chronic hypoxia (CH) for 21 days. Primary PMVECs were cultured by adherent tissue blocks at the edge of the lung. The permeability coefficient of primary cultured PMVECs was detected by fluorescein isothiocyanate (FITC)-dextran. The structure of tight junction (TJ) was observed by transmission electron microscope. The expression of TRPV4 and TJ-related proteins, such as, Occludin, Claudin-5, ZO-1 were examined by real-time fluorescence quantitative PCR and Western blotting. The intracellular calcium concentration ([Ca

LC-MS-Based Metabonomics Study of Yangxin Tongmaifang Against Coronary Heart Disease Differentiated into Blood Stasis Syndrome / 中国实验方剂学杂志

Objective:To observe the effect of Yangxin Tongmaifang （YXTM） on endogenous metabolites in the myocardial tissue of rats with coronary heart disease due to blood stasis based on the metabolomics approach， and to explore its mechanism in the treatment of heart blood stasis syndrome. Method:A rat model of chronic myocardial ischemia due to heart blood stasis was established via the high-fat diet combined with intragastric administration of vitamin D₃ and subcutaneous injection of isoproterenol （ISO）， followed by the intervention with YXTM. The metabolites in the myocardial tissues of rats in the normal group （<italic>n</italic>=8）， model group （<italic>n</italic>=8）， and YXTM group （<italic>n</italic>=8） were detected by ultra-high performance liquid chromatography coupled to high resolution mass spectrometry. The high-throughput metabolomics data were then subjected to multivariate statistical analysis using SIMCA 14.1， and the related metabolic pathways were analyzed with MetaboAnalyst. Result:The myocardial sample points of rats in the three groups were located in different areas of the elliptical confidence interval. The normal group and the model group were completely separated. There existed some crossovers and overlaps between the YXTM group and the normal group. The heart blood stasis syndrome model was proved successfully replicated from the perspective of metabolic profiling， and YXTM had the potential to promote the body to return to a normal state. After the intervention with YXTM， six differential metabolites changed significantly. Such metabolic pathways as valine， leucine， and isoleucine biosynthesis， pantothenate and coenzyme A （CoA） biosynthesis， valine， leucine， and isoleucine degradation， biosynthesis of aminoacyl-transfer RNA synthetases， and purine metabolism were involved. Conclusion:The therapeutic effect of YXTM on heart blood stasis syndrome in rats is related to the improved levels of myocardial endogenous metabolites， and its mechanism involves phospholipid metabolism， amino acid metabolism， energy metabolism， inflammatory response， and platelet activation and aggregation.

Air conditioning condition of observation hotels for COVID-19 prevention and control / 上海预防医学

Objective:To investigate the hygienic condition and maintenance management of air conditioners in observation hotels， and give suggestions on reducing the risk of COVID-19 transmission from the daily use. Methods:This study selected 11 observation hotels chosen by government and 3 observation hotels chosen by large companies in Minhang District. The types and sanitary conditions of the air conditioning system were revealed through the daily supervision. Hotel staffs’ knowledge of air conditioning system and their mastery of how to use and maintain air conditioning system were surveyed through questionnaire. Results:Survey of air conditioning types showed that in 14 hotels， 12 were distributed air conditioning systems and 2 were semi-centralized air conditioning systems （including fresh air systems）. The investigation found that there was dust accumulation in the fresh air ducts in one hotel guest room， dust accumulation in the filter screen of fresh air intake in one hotel， and the sanitary problem of condensate water （without centralized discharge） in two hotels. All of 14 hotels had daily cleaning and disinfection records， but they were not perfect. The hotel health management personnel’ awareness rate of air conditioning was low， although they had a positive attitude towards the cleaning and disinfection of the air conditioning system. They could do the active entrusted testing， cleaning and disinfection of the air conditioning systems. Conclusion:The air conditioning systems of some hotels have hygiene problems， and hotel health management personnel are lack of knowledge of standard operation and maintenance of air conditioning systems. The air conditioning systems of observation hotel should be cleaned and disinfected before use. At the same time， it is necessary to strengthen the training of hotel health management personnel on the use and maintenance of air conditioning systems. So the transmission of the COVID-19 through air conditioning systems can be effectively prevented.

Inhibitory Effect and Mechanism of Yiqi Jianpi Huayu Recipe Combined with 5-FU on Gastric Cancer / 中国实验方剂学杂志

Objective::To observe the synergistic effect and mechanism of Yiqi Jianpi Huayu (YQJPHY) recipe combined with 5-fluorouracil (5-FU) on inhibiting gastric cancer growth, and investigate its possible mechanism through polarization direction of tumor-associated macrophages (TAMs) in tumor micro-environment. Method::A total of forty 615 mice were randomly divided into four groups including control group, YQJPHY(25 g·kg-1) group, 5-FU (25 mg·kg-1) group and combined group (YQJPHY plus 5-FU), with 10 mice in each group. The gastric cancer transplantation model was induced by axillary inoculation of MFC gastric cancer cells. Changes in tumor pathology were observed with hematoxylin-eosin staining (HE) method. The contents of M1 and M2 TAMs in tumor tissues were determined with flow cytometry, while the expression of CD206 in tumor was observed with immunohistochemistry. The mRNA expressions of TAM-related genes including interleukin-1β(IL-1β), interleukin-12(IL-12), tumor necrosis factor-α(TNF-α), arginase-1(Arg1), and chitinase 3-like 3(Ym1) were detected by using quantitative real-time polymerase chain reaction (Real-time PCR). Furthermore, the mRNA and protein expressions of epithelial-mesenchymal transition (EMT) related epithelial calcium adhesion protein(E-cadherin), nervous calcium adhesion protein(N-cadherin), Zinc finger transcription factor Slug, Snail and Waveform protein (Vimentin) were detected with Real-time PCR and Western blot, respectively. Result::The gastric cancer cells in tumors were distributed in nest and/or flaky shape, with fibroblastic connective tissue reaction and inflammatory cells infiltrated in interstitium. Coagulative necrosis of tumor was observed in various treatment groups. The amount of residual cancer cells in mouse was as follows from largest to smallest: control group>YQJPHY group>5-FU group>combined group. Immunohistochemical studies showed that all treatment groups can reduce the expression of CD206 in the tumor, and the effect was most obvious in the combined group. The contents of M2-TAM in all treatment groups were lower than those in control group(P<0.05, P<0.01), and the most significant difference in the content of M2-TAMs was shown between the control group and the combined group. The contents of M1 TAMs were increased in YQJPHY and combined groups(P<0.05, P<0.01), with the largest incremental range in YQJPHY group. The expressions of Arg1 and Ym1 in YQJPHY and combined groups were lower, while IL-1β, TNF-α and IL-12 levels were higher than those in control group(P<0.05). The mRNA expressions of IL-1β, IL-12 and TNF-α in the combined group were significantly higher, while Arg1 and Ym1 mRNA expression levels were lower than those in the 5-FU group(P<0.05). As compared with the control group, the mRNA and protein expression levels of E-cadherin were up-regulated(P<0.05), while the mRNA expression levels of N-cadherin and Vimentin were down-regulation in the YQJPHY group (P<0.05), E-cadherin mRNA and protein expression levels were up-regulated, while N-cadherin, Slug, Snail, Vimentin mRNA expression as well as N-cadherin and Slug protein expression levels were down-regulated in the combined group(P<0.05). As compared with the 5-FU group, the mRNA and protein expression levels of E-cadherin were up-regulated(P<0.05), while the mRNA and protein expression levels of N-cadherin, Slug and Vimentin were down-regulated in the combined group(P<0.05). Conclusion::YQJPHY has an inhibitory effect on the growth of gastric cancer, and after being combined with 5-FU, it has a good synergistic effect on inhibiting the growth of gastric cancer and decreasing EMT. The mechanism may be related to promoting the conversion from M2-TAMs to M1-TAMs in gastric tumor micro-environment.

Textual research on traditional application of Moringa / 中国中药杂志

Moringa has a long history of edible and medicinal use in foreign countries, this paper collected and sorted out the traditional application of Moringa recorded in the ancient medical books and historical materials of countries and regions along the ancient Silk Road. According to preliminary research, the earliest record of Moringa in China can be traced back to The Bower Manuscript(volume Ⅱ)(about the 4 th-6 th century A.D.) unearthed in Kuqa, Xinjiang. Around the 8 th century, with the communication between countries along the ancient Silk Road becoming prosperous, more and more medical books containing Moringa and its prescriptions were introduced to Tibet, Xinjiang and other places in today's China. The leaves, root bark, seeds and stem bark of Moringa all can be used for medicinal purposes and are recorded in The Ayurvedic Pharmacopoeia of India(API). Among them, Moringa leaves have been approved as a new resource food in China. According to the API, it is of cold property and sweet taste, its post-digestive effect is sweet and has the functions of removing wind, bile and fat, relieving pain, killing abdominal worms, moistening skin, brightening eyes and clearing brain. It can be used to treat edema, parasitic diseases, spleen diseases, abscess, tumor, pharyngeal swelling and other diseases. This study explored and organized the historical evidence of communication through the Silk Road and traditional application records of Moringa, in order to provide the evidence of traditional medicine basis, medicine property and efficacy application reference for the realization of the introduction of Moringa as a new resource of traditional Chinese medicine.

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19 / 中华创伤杂志(英文版)

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.

Possible aerosol transmission of COVID-19 and special precautions in dentistry / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Since its emergence in December 2019, corona virus disease 2019 (COVID-19) has impacted several countries, affecting more than 90 thousand patients and making it a global public threat. The routes of transmission are direct contact, and droplet and possible aerosol transmissions. Due to the unique nature of dentistry, most dental procedures generate significant amounts of droplets and aerosols, posing potential risks of infection transmission. Understanding the significance of aerosol transmission and its implications in dentistry can facilitate the identification and correction of negligence in daily dental practice. In addition to the standard precautions, some special precautions that should be implemented during an outbreak have been raised in this review.

Addition and Subtraction Therapy of Buyang Huanwutang Combined with Si Junzitang to Poststroke Fatigue and Antioxidant and Anti-inflammatory with Syndrome of Qi Deficiency and Blood Stasis / 中国实验方剂学杂志

Objective:To evaluate effect of addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang and acupuncture to poststroke fatigue （PSF） and syndrome of Qi deficiency and blood stasis， at the same time we studied the antioxidant and anti-inflammatory effects. Method:One hundred and forty-four patients were randomly divided into control group and observation group （1∶1） by random number table. 66 patients in control group completed the therapy （4 patients were falling off or missing visit， 2 patients were eliminate）， 67 patients in observation group completed the therapy （2 patients were falling off or missing visit， 3 patients were eliminate）. In control group， patinets got acupuncture， 1 time/day， 6 times/week， they also got Geqi Tongmai grain， 10 g/time， 3 times/day. Patients in observation group got acupuncture （the same as which in control group）， and addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang， 1 dose/day， and courses of treatment in two groups were 4 weeks. Before and after treatment， fatigue severity scale （FSS）， NIH stroke scale （NIHSS）， syndrome of Qi deficiency and blood stasis， stroke specific quality of life scale （SS-QOL）， and scores of ability of daily life （ADL） were recorded. And levels of superoxide dismutase （SOD）， malondialdehyde （MDA）， glutathione peroxidase （GSH-Px）， homocysteine （Hcy）， interleukin-1β （IL-1β）， IL-6， tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP） were detected. And the safety evaluated. Result:Disease effect in observation group was better than which in control group （Z=2.118， P<0.05）. And effect after using traditional Chinese medicine （TCM） was also better than that in control group （Z=2.046， P<0.05）. Scores of FSS， syndrome of Qi deficiency and blood stasis， NIHSS， and levels of IL-1β， IL-6， Hcy， CRP， TNF-α and MDA in observation group were all lower than those in control group （P<0.01）， and scores of SS-QOL， ADL， and levels of GSH-Px and SOD were all higher than those in control group （P<0.01）. Then there was no related safety issues caused by drug. Conclusion:Addition and subtraction therapy of Buyang Huanwutang combined with Si Junzitang and acupuncture had effect of anti-oxidation and anti-inflammatory， and can significantly reduce fatigue and degree of neurological impairment and can improve patients' quality of life and daily life ability. The clinical effect is significant and safe， which is worthy of further research and application.

Recent trends in waist circumference and central obesity in Chinese children and adolescence during 1993-2015 / 中国学校卫生

Objective@#To analyze recent trends in waist circumference(WC) and central obesity rate of Chinses children and adolescence aged 7-18 from 1993 to 2015, and to provid the theoretical basis for further prevention and control of children obesity.@*Methods@#The samples were derived from the China Health and Nutrition Survey from 1993 to 2015 (both boys and girls aged 7-18). The criteria of WS/T 586—2017 were adopted as classification standard for central obesity and the coefficient of skewness-median-coefficient of variation method was used to reveal the trends of waist circumference distribution.@*Results@#From 1993 to 2015,waist circumference curves flattened and expanded at higher levels in boys and girls. The P50 and P85th percentile WC curves showed an increasing trend with high percentile increasing more obviously. WC increased 3.84 and 1.55 cm for boys and girls. The prevalence rate of central obesity increased in both genders, which increased from 4.08% to 20.64% in boys and from 6.29% to 20.98% in girls. Besides, higher increasing rate was observed among boy, and urban.@*Conclusion@#A rapid increase in waist circumference was present among Chinese children and adolescence. A gradient of increasing prevalence of central obesity was also observed in boys and girls, as well as in different BMI levels. Appropriate measures should be taken to control the increase in the course of the central obesity epidemic.

Pancreatic fistula after pancreaticoduodenectomy: Risk factors and preventive strategies

Purpose: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. This study aimed to investigate the risk factors and preventive strategies for POPF after PD. Materials and Methods: We retrospectively reviewed 301 consecutive patients who underwent PD at our hospitals between January 2011 and December 2017. We analyzed the pancreatic fistula rate according to the clinical characteristics, pathologic and laboratory findings, and the anastomotic methods and summarized the prevention measures. Results: Postoperative morbidities included pancreatic leakage in 10.30% (31/301), delayed gastric emptying in 22.92% (69/301), abdominal infection in 6.98% (21/301), post-PD hemorrhage in 4.65% (14/301), and bile leakage in 4.98% (15/301), and the mortality rate was 2.33% (7/301). POPF was the most prominent factor for preoperative morbidity. Significant risk factors for pancreatic fistula were a soft pancreas, small pancreatic duct, tumor location, and interrupted anastomosis. Of these, soft texture, pancreatic duct <4 mm, and end-to-end anastomosis through hand suture closure were independent risk factors on multivariate analysis, while interrupted anastomosis, internal stent, and somatostatin use were risk factors in the high-risk pancreas subgroup. Conclusions: Our study demonstrated that pancreatic fistula is related to a soft texture and small pancreatic duct. The surgeon must consider these risk factors when performing PD. Thus, we propose a risk- and indication-adapted choice of anastomosis or an individualized approach for the pancreatic remnant to reduce the pancreatic fistula rate

Plasma Macrophage Migration Inhibitory Factor and CCL3 as Potential Biomarkers for Distinguishing Patients with Nasopharyngeal Carcinoma from High-Risk Individuals Who Have Positive Epstein-Barr Virus Capsid Antigen-Specific IgA / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to identify novel plasma biomarkers for distinguishing nasopharyngeal carcinoma (NPC) patients from healthy individuals who have positive Epstein-Barr virus (EBV) viral capsid antigen (VCA-IgA). MATERIALS AND METHODS: One hundred seventy-four plasma cytokines were analyzed by a Cytokine Array in eight healthy individuals with positive EBV VCA-IgA and eight patients with NPC. Real-time polymerase chain reaction, Western blotting, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry were employed to detect the expression levels of macrophage migration inhibitory factor (MIF) and CC chemokine ligand 3 (CCL3) in NPC cell lines and tumor tissues. Plasma MIF and CCL3 were measured by ELISA in 138 NPC patients, 127 EBV VCA-IgA negative (VN) and 100 EBV VCA-IgA positive healthy donors (VP). Plasma EBV VCA-IgA was determined by immunoenzymatic techniques. RESULTS: Thirty-four of the 174 cytokines varied significantly between the VP and NPC group. Plasma MIF and CCL3 were significantly elevated in NPC patients compared with VN and VP. Combination of MIF and CCL3 could be used for the differential diagnosis of NPC from VN cohort (area under the curve [AUC], 0.913; sensitivity, 90.00%; specificity, 80.30%), and combination of MIF, CCL3, and VCA-IgA could be used for the differential diagnosis of NPC from VP cohort (AUC, 0.920; sensitivity, 90.00%; specificity, 84.00%), from (VN+VP) cohort (AUC, 0.961; sensitivity, 90.00%; specificity, 92.00%). Overexpressions of MIF and CCL3 were observed in NPC plasma, NPC cell lines and NPC tissues. CONCLUSION: Plasma MIF, CCL3, and VCA-IgA combination significantly improves the diagnostic specificity of NPC in high-risk individuals.

Comparative Studies of Two Major Sets of Tibetan Medical Paintings: A Historical Perspective / 中国结合医学杂志

Tibetan medicine, one of the time-honored medical systems in the world, has increasingly been receiving attention the world over. Tibetan medical paintings (TMP, tib. Sman thang) has become one of the focal points in the studies of this medical system. To date, there are many atlases and publications on TMP, which are principally based on the two major sets of TMP series existing today in the world, the Lhasa set and the Buryat set. It has been found that the Buryat set is based on the Lhasa set, which was brought in late 19th to the first half of the 20th century from Tibet to Buryatia, Russia. A careful investigation on the basic structure of the two sets reveals that there are many differences between the two sets of paintings, including the total number of the paintings involved, of which some are missing in one set, the details of the captions of some of the paintings, the existence of the 80th painting and its supervisor, and the overall order of the entire set, etc. The details of the differences are elaborated and discussed, and the prospective of developing the research to arrive at a standard and perfect TMP set in the future is also analyzed and anticipated.

Pregnancy outcomes among women with high and low risk in first and second trimester prenatal screening analysis / 预防医学

Objective To analyze adverse pregnancy outcomes among women with high risk and low risk during prenatal screening. Methods Clinical data of 180006 pregnancies in 5 prenatal screening center in Hangzhou were collected. We compared the adverse pregnancy outcomes of high and low risk pregnancies. Results Among 180006 pregnancies (age<35 years old), there were 10296 high-risk cases and 169710 low-risk cases, with 168654 cases followed. There were 9406 high-risk cases of Down's syndrome (DS) (5.23％), 273 high-risk cases of Edwards' syndrome (ES) (0.15％) and 617 high-risk cases of open neural tube defect (ONTD) (0.34％) . The detection rate of pregnancy outcome of premature birth, spontaneous abortion, termination of pregnancy, stillbirth in the high risk was 5.46％, 0.80％, 1.80％, 0.37％, respectively, and that rate in low risk results was 3.50％, 0.21％, 0.38％, 0.18％, respectively. Adverse pregnancy outcomes in high-risk group were significantly higher than that in low-risk group (all P<0.001) . The actual incidence rate of DS, ES or ONTD in high-risk group (4.56‰, 1.65‰, 0.97‰, respectively) were significantly higher than that in low-risk group (0.12‰, 0.04‰, 0.09‰, respectively, all P<0.001) . The detection rates of prenatal screening were 70.15％, 68.00％ and 38.46％, and false positive rates were 5.23％ , 0.14％ and 0.34％ . Conclusion High risk of serum prenatal screening analysis is associated with adverse pregnancy outcomes. The number of pregnancies experienced invasive prenatal diagnosis can be reduced by routine serum prenatal screening. That is an Effective method to reduce the birth defects.

New Thoughts for Development of Tibetan Medicine of Ganzi Tibetan Autonomous Prefecture / 中国中医药信息杂志

Ganzi Tibetan Autonomous Prefecture is the birthplace of Tibetan medicine of southern school, also rich in natural resources of Chinese and Tibetan medicine (CTM). As the pillar industry of Ganzi prefecture, CTM shows a trend of improvement of overall services, growing of the number of companies and increasing scale of industries. However, the CTM industry in Ganzi prefecture still has some shortcomings. This article reviewed the development and existential problems of CTM industry of Ganzi prefecture. In addition, the article carries on relevant thinking through literature review and discussion and analysis. It is believed that CTM industry of Ganzi prefecture faced with the conflict between environmental protection and the development of CTM industry, small scale of CTM industry, inadequate expertise and insufficient product innovation. This article gave some feasible suggestions, such as coordinated development of cultural tourism and medical industry, establishment of high efficient mode to promote producing-learning-research development, enhancement of quality standardization of CTM industry, with a purpose to guarantee the quality transmission of each step.

External therapies of traditional Chinese medicine combined with sodium hyaluronate injected in articular cavity therapy on knee osteoarthritis: Meta-analysis / 中国中药杂志

To systematically evaluate the efficacy and safety of external therapies of traditional Chinese medicine(TCM) combined with sodium hyaluronate(SH) injected in articular cavity therapy on knee osteoarthritis(KOA). The following databases such as CNKI, WanFang, VIP, CBM, PubMed and Medline were researched to collect the randomized controlled trails on external therapies of TCM combined with sodium hyaluronate injected in articular cavity therapy on KOA. The selection of studies, assessment of methodological quality and data extraction were performed independently by two researchers. The methodological quality was assessed by using the Cochrane system evaluation methodology and Meta-analysis were performed by using Cochrane Collaboration's the RevMan 5.3 software. Forteen studies involving 1 449 patients were included. All of the trails were not adequate enough in methodological quality. Meta-analysis indicated that compared with control group, external therapies of TCM combined with sodium hyaluronate injected in articular cavity could raise effectiv rate(<0.000 01) and cure-rate(<0.000 01), improve Lysholm score(=0.003) and reduce VAS score(<0.000 1). But two groups have no difference in Womac score (=0.13).Compared with the treatment with sodium hyaluronate injected in articular cavity, external therapies of TCM combined with sodium hyaluronate injected in articular cavity, a promising treatment options, can be complementary advantages, improve the clinical curativ effect. But it still needs low risk and high quality clinical trials to verify.

Factors influencing the decision to pursue emergency medicine as a career among medical students in Singapore

<p><b>INTRODUCTION</b>The introduction of the residency programme in Singapore allows medical students to apply for residency in their graduating year. Our study aimed to determine the interest levels and motivating factors for pursuing emergency medicine (EM) as a career among medical students in Singapore.</p><p><b>METHODS</b>A self-administered questionnaire was distributed to Year 1-5 medical students in 2012. Participants indicated their interest in pursuing EM as a career and the degree to which a series of variables influenced their choices. Influencing factors were analysed using multinomial logistic regression.</p><p><b>RESULTS</b>A total of 800 completed questionnaires were collected. 21.0% of the participants expressed interest in pursuing EM. Perceived personality fit and having done an elective in EM were strongly positive influencing factors. Junior medical students were more likely to cite the wide diversity of medical conditions and the lack of a long-term doctor-patient relationship to be negative factors, while senior medical students were more likely to cite personality fit and perceived prestige of EM as negative factors.</p><p><b>CONCLUSION</b>Careful selection of EM applicants is important to the future development of EM in Singapore. Our study showed that personality fit might be the most important influencing factor in choosing EM as a career. Therefore, greater effort should be made to help medical students explore their interest in and suitability for a particular specialty. These include giving medical students earlier exposure to EM, encouraging participation in student interest groups and using appropriate personality tests for career guidance.</p>