Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019 / 中国当代儿科杂志

OBJECTIVE@#To systematically summarize the clinical features of coronavirus disease 2019 (COVID-19) in children.@*METHODS@#PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Weipu Database, and Wanfang Database were searched for clinical studies on COVID-19 in children published up to May 21, 2020. Two reviewers independently screened the articles, extracted data, and assessed the risk of bias of the studies included. A descriptive analysis was then performed for the studies. Related indices between children with COVID-19 and severe acute respiratory syndromes (SARS) or Middle East respiratory syndrome (MERS) were compared.@*RESULTS@#A total of 75 studies were included, with a total of 806 children with COVID-19. The research results showed that the age of the children ranged from 36 hours after birth to 18 years, with a male-female ratio of 1.21 : 1. Similar to SARS and MERS, COVID-19 often occurred with familial aggregation, and such cases accounted for 74.6% (601/806). The children with COVID-19, SARS, and MERS had similar clinical symptoms, mainly fever and cough. Some children had gastrointestinal symptoms. The children with asymptomatic infection accounted for 17.9% (144/806) of COVID-19 cases, 2.5% (2/81) of SARS cases, and 57.1% (12/21) of MERS cases. The children with COVID-19 and MERS mainly had bilateral lesions on chest imaging examination, with a positive rate of lesions of 63.4% (421/664) and 26.3% (5/19) respectively, which were lower than the corresponding positive rates of viral nucleic acid detection, which were 99.8% and 100% respectively. The chest radiological examination of the children with SARS mainly showed unilateral lesion, with a positive rate of imaging of 88.9% (72/81), which was higher than the corresponding positive rate of viral nucleic acid detection (29.2%). Viral nucleic acid was detected in the feces of children with COVID-19 or SARS, with positive rates of 60.2% (56/93) and 71.4% (5/7) respectively. The children with COVID-19 had a rate of severe disease of 4.6% (31/686) and a mortality rate of 0.1% (1/806), the children with SARS had a rate of severe disease of 1.5% (1/68) and a mortality rate of 0%, and those with MERS had a rate of severe disease of 14.3% (3/21) and a mortality rate of 9.5% (2/21).@*CONCLUSIONS@#Children with COVID-19 have similar symptoms to those with SARS or MERS, mainly fever and cough. Asymptomatic infection is observed in all three diseases. Children with COVID-19 or SARS have milder disease conditions than those with MERS. COVID-19 in children often occurs with familial aggregation. Epidemiological contact history, imaging examination findings, and viral nucleic acid testing results are important bases for the diagnosis of COVID-19.

Involvement of intrathecal activation of MrgC receptor in pathological pain and morphine tolerance / 生理学报

Rodent MrgC receptor (Mas-related G-protein-coupled receptor subtype C) shares 65% sequence homology and similarities in terms of expression pattern and binding profile with human Mas-related gene X receptor 1 (hMrgX1). Therefore, researchers generally explore the role of hMrgX1 by studying the function of MrgC receptor. Murine MrgC receptor is uniquely expressed in small-diameter neurons of dorsal root ganglia (DRG) and trigeminal ganglia (TG), which is closely related to the transmission process of pain. This review summarizes the analgesic effects of intrathecal activation of MrgC receptors in pathological pain and morphine tolerance.

Standard Protocol Items for Clinical Trials with Traditional Chinese Medicine 2018: Recommendations, Explanation and Elaboration (SPIRIT-TCM Extension 2018) / 中国结合医学杂志

Traditional Chinese Medicine (TCM) is one of the oldest systems of medicine. More and more attention has been paid to TCM application, but the variable quality of clinical trials with TCM impedes its widespread acceptance. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement has established guidelines for designing clinical trials to ensure that the trial results are accurate and reliable. However, there are difficulties when applying SPIRIT 2013 Statement to trials with TCM, due to the unique theory and the characteristic of TCM intervention. An Extension to the original SPIRIT was developed to ensure the quality of trial design with TCM. As Chinese herbal formulae, acupuncture and moxibustion are common and representative interventions in TCM practice, the executive working group determined that the SPIRIT-TCM Extension focus on these three interventions. Extension was developed through initiation, 3 rounds of Delphi consensus survey, and finalizing expert meeting. Seven items from the SPIRIT 2013 Statement were modified, namely, "title", "background and rationale", "objectives", "eligibility criteria", "interventions", "outcomes", and "data collection methods". The Extension includes the introduction of the concept of TCM pattern and 3 major TCM interventions, with examples and explanations. The SPIRIT-TCM Extension 2018 provides suggestion for investigators in designing high quality TCM clinical trials. It is expected that wide dissemination and application of this extension ensure continuous improvement of TCM trial quality throughout the world.

Effect of Regulatory Network of Exosomes and microRNAs on Neurodegenerative Diseases / 中华医学杂志(英文版)

<p><b>Objective</b>A comprehensive review of the network regulation of exosomes and microRNAs (miRNAs) in neurodegenerative diseases was done, centering on the mechanism of the formation of exosomes and miRNAs and the sorting mechanism of exosomal miRNAs, with the aim to provide a theoretical basis in the search of biomarkers and the treatment of neurodegenerative diseases.</p><p><b>Data Sources</b>The comprehensive search used online literature databases including NCBI PubMed, Web of Science, Google Scholar, and Baidu Scholar.</p><p><b>Study Selection</b>The study selection was based on the following keywords: exosomes, miRNAs, central nervous system (CNS), and neurodegenerative diseases. The time limit for literature retrieval was from the year 2000 to 2018, with language restriction in English. Relevant articles were carefully reviewed, with no exclusions applied to study design and publication type.</p><p><b>Results</b>Exosomes are the smallest nanoscale membranous microvesicles secreted by cells and contain important miRNAs, among other rich contents. In the CNS, exosomes can transport amyloid β-protein, α-synuclein, Huntington-associated protein 1, and superoxide dismutase I to other cells. These events relieve the abnormal accumulation of proteins and aggravating neurological diseases. In some neurodegenerative diseases including Alzheimer's disease, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis, miRNAs are pathologically altered as an inexorable course, suggesting that miRNAs may contribute neurodegeneration. Exosomes and miRNAs form a network to regulate the homeostasis of the CNS, both synergistically and individually.</p><p><b>Conclusion</b>The network of exosomes and miRNAs that regulates CNS homeostasis is a promising biomarker for the diagnosis and treatment of neurodegenerative diseases.</p>

Toward Evidence-Based Chinese Medicine: Status Quo, Opportunities and Challenges / 中国结合医学杂志

How to test the treatments of Chinese medicine (CM) and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM. For centuries, various approaches have been used to identify and measure the efficacy and safety of CM. However, the high-quality evidence related to CM that produced in China is still rare. Over the recent years, evidence-based medicine (EBM) has been increasingly applied to CM, strengthening its theoretical basis. This paper reviews the past and present state of CM, analyzes the status quo, challenges and opportunities of basic research, clinical trials, systematic reviews, clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China, pointing out how EBM can help to make CM more widely used and recognized worldwide.

Evidence-based Chinese medicine：theory and practice / 中国中药杂志

The introduction and popularization of evidence-based medicine has opened up a new research field of clinical efficacy evaluation of traditional Chinese medicine(TCM), produced new research ideas and methods, and promoted the progress of clinical research of TCM. After about 20 years assiduous study and earnest practice, the evidence based evaluation method and technique, which conforms to the characteristics of TCM theory and practice, has been developing continuously. Evidence-based Chinese medicine (EBCM) has gradually formed and become an important branch of evidence-based medicine. The basic concept of evidence-based Chinese medicine: EBCM is an applied discipline, following the theory and methodology of evidence-based medicine, to collect, evaluate, produce, transform the evidence of effectiveness, safety and economy of TCM, to reveal the feature and regular pattern of TCM taking effect, and to guide the development of clinical guidelines, clinical pathways and health decisions. The effects and achievements of EBCM development: secondary studies mainly based on systematic review/Meta-analysis were extensively carried out; clinical efficacy studies mainly relying on randomized controlled trials grew rapidly; clinical safety evaluations based on real world study have been conducted; methodological researches mainly focused on study quality control deepened gradually; internationalization researches mainly on report specifications have got some breakthroughs; standardization researches based on treatment specification were strengthened gradually; the research team and talents with the characteristics of inter-disciplinary have been steadily increased. A number of high-quality research findings have been published at international well-known journals; the clinical efficacy and safety evidence of TCM has been increased; the level of clinical rational use of TCM has been improved; a large number of Chinese patent medicines with big market have been cultured. The future missions of EBCM mainly consist of four categories (scientific research, methodology and standard, platform construction and personnel training) with nine tasks. ①Carry out systematic reviews to systematically collect clinical trial reports of TCM and establish database of clinical evidence of TCM; ②Carry out evidence transformation research to lay the foundation for the development of clinical diagnosis and treatment guidelines, clinical pathways of TCM, and for the screening of basic drug list and medical insurance list, and for the policy-making relevant to TCM; ③Conduct researches to evaluate the advantages and effective regular patterns of TCM and form the evidence chain of TCM efficacy; ④Carry out researches for the safety evaluation of TCM, and provide evidence supporting the rational and safe use of TCM in clinical practice; ⑤Conduct researches on methodology of EBCM and provide method for developing high quality evidence; ⑥Carry out researches to develop standards and norms of TCM, and to form methods, standards, specifications and technical systems; ⑦Establish data management platform for evidence-based evaluation of TCM, and promote data sharing; ⑧Build international academic exchange platform to promote international cooperation and mutual recognition of EBCM research; ⑨Carry out education and popularization activities of evidence-based evaluation methods, and train undergraduate students, graduate students, clinical healthcare providers and practitioners of TCM. The development of EBCM, as it was, not only promoted the transformation of clinical research and decision-making mode of TCM, contributed to the modernization and internationalization of TCM, but also enriched the connotation of Evidence-based Medicine.

Systematic Reviews/Meta-Analyses of Integrative Medicine in Chinese Need Regulation and Monitoring Urgently and Some Suggestions for Its Solutions / 中国结合医学杂志

With the introduction and development of evidence-based medicine in China, it has been spread rapidly in the area of integrative medicine (IM) and has become a new unique discipline. During almost 20 years, as one of the most important parts of evidence-based IM, systematic review (SR)/meta-analysis (MA) of IM have shown a good development momentum in the aspects of quantity, depth, breadth and influence, but also face the harsh situation of the uncontrolled quantity and quality, especially for SRs in Chinese. Therefore, how to supervise and standardize this area effectively becomes a problem to be solved. Based on the experience both at home and abroad, the authors put forward several kinds of solutions for laying the foundation for further development such as promoting the registration system of SR/MA of IM, effectively setting up the regulatory platform of quality and quantity, launching professional training for SR/MA reviewers, forming qualification registration, developing the data transfer and sharing platform to realize the transparency of evidence process.

Effectiveness of moxibustion for exercise-induced fatigue--a systematic review for randomized controlled trials / 中国结合医学杂志

<p><b>OBJECTIVE</b>To review and assess the effect of single moxibustion for exercise-induced fatigue: (EIF).</p><p><b>METHODS</b>Computer-search for 8 medical databases and 5 clinical trail registries were conducted for: randomized controlled trials (RCTs), added with hand-search for 10 Chinese acupuncture-moxibustion journals and additional references. Data from included RCTs were pooled by RevMan5.1. Methodology quality of RCTs was judged by Cochrane Collaboration assessment tool while quality of primary outcomes was evaluated by GRADE3.2.</p><p><b>RESULTS</b>Five RCTs were finally included, all reported in small sample size with high risk of: bias. Comparisons on single moxibustion and rest relief (without treatment) were studied. Six outcomes were reported, all favored moxibustion to rest relief for EIF. Primary outcomes showed as rating of perceived exertion (RPE) with mean difference (MD)=-0.49, 95% confidence interval (CI) [-0.80, -0.19], 800-m race performance with MD=-2.21, 95% CI [-3.57, -0.85], and Harvard Step Index (HSI) with MD=14.75, 95% CI [8.35, 21.15]. Moreover, all primary outcomes as RPE, 800-m race performance and HSI were rated low quality.</p><p><b>CONCLUSIONS</b>Single moxibustion might be considered effective for EIF. However, due to small samples of included RCTs, high risk of bias among studies and poor quality of primary outcomes and subjects restricted to Chinese athletes only, these results present limitation, and should be taken with caution for practice. More large-size studies with rigorous design are warranted to further test effectiveness of moxibustion for EIF.</p>

Interventions to improve chronic cyclosporine A nephrotoxicity through inhibiting renal cell apoptosis: a systematic review / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To reveal interventions for chronic cyclosporine A nephrotoxicity (CCN) and provide new targets for further studies, we analyzed all relevant studies about interventions in renal cell apoptosis.</p><p><b>DATA SOURCES</b>We collected all relevant studies about interventions for cyclosporine A (CsA)-induced renal cell apoptosis in Medline (1966 to July 2010), Embase (1980 to July 2010) and ISI (1986 to July 2010), evaluated their quality, extracted data following PICOS principles and synthesized the data.</p><p><b>STUDY SELECTION</b>We included all relevant studies about interventions in CsA-induced renal cell apoptosis no limitation of research design and language) and excluded the duplicated articles, meeting abstracts and reviews without specific data.</p><p><b>RESULTS</b>There were three kinds of intervention, include anti-oxidant (sulfated polysaccharides, tea polyphenols, apigenin, curcumin, spirulina, etc), biologics (recombinant human erythropoietin (rhEPO), a murine pan-specific transforming growth factor (TGF)-beta-neutralizing monoclonal antibody1D11, cartilage oligomeric matrix protein (COMP)-angiopoietin-1 and hepatocyte growth factor (HGF) gene), and other drugs (spironolactone, rosiglitazone, pirfenidone and colchicine). These interventions significantly improved the CCN, renal cell apoptosis and renal dysfunction through intervening in four apoptotic pathways in animals or protected renal cells from apoptosis induced by CsA and increased cell survival through respectively four pathways in vitro.</p><p><b>CONCLUSIONS</b>There are three group interventions for CCN. Especially anti-oxidant drugs can significantly improve CCN, renal cell apoptosis and renal dysfunction. Many drugs can improve CCN through intervening in Fas/Fas ligand or mitochondrial pathway with sufficient evidences. Angiotensin II, nitric oxide (NO) and endoplasmic reticulum (ER) pathways will be new targets for CCN.</p>

Prevention of platelet transfusion refractoriness and HLA alloimmunization by leukocyte filtered platelet transfusion: a meta analysis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To compare and assess the effectiveness of leukocyte-filtered platelet and standard platelet concentrates transfusion in preventing platelet transfusion refractoriness (PTR) and human leukocyte antigen (HLA)-alloimmunization.</p><p><b>METHODS</b>Randomized controlled trials (RCTs) or quasi-RCTs comparing leukocyte-filtered platelet with standard platelet concentrates transfusion (up to December 31, 2009) were searched and identified from Medline, EMBASE, The Cochrane Library, and CBM. A meta-analysis was conducted with Cochrane Collaboration's RevMan 5. 0.</p><p><b>RESULTS</b>The search identified 558 citations in total, in which 7 articles in English were finally included in the meta-analysis. The analysis showed that compared with standard platelet concentrates transfusion, leukocyte-filtered platelet transfusion significantly decreased PTR [ RR = 0. 59, 95% CI (0. 42, 0. 82) , P = 0. 002 ] and HLA-alloimmunization [ RR = 0. 49,95% CI (0. 33, 0. 74) , P =0. 0006]. Subgroup analysis showed that HLA-alloimmunization was significantly reduced by leukocyte-filtered platelet transfusion among the patients with acute myelocytic leukemia [ RR =0.42, 95% CI (0.32, 0.56), P <0. 00001], while no significant difference was detected in patients with acute lymphoblastic leukemia because of the limited sample size [ RR = 0. 50, 95% CI (0. 10, 2.41) , P =0. 39].</p><p><b>CONCLUSIONS</b>The current evidence shows that leukocyte-filtered platelet transfusion can prevent PTR and HLA-alloimmunization more effectively than standard platelet transfusion. Well-designed large-scale RCTs are still needed to further confirm this finding.</p>

Efficacy and safety of natalizumab for multiple sclerosis and Crohn's disease: a meta analysis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To systematically evaluate the safety and efficacy of natalizumab in treating multiple sclerosis (MS) and Crohn's disease(CD).</p><p><b>METHODS</b>Literatures from 1998 to 2009 were searched in databases including MEDLINE,EMBASE,The Cochrane Library, and CBM for randomized controlled trials (RCTs) and quasi-randomization controlled trials. Quality assessment and data extraction were conducted using the Cochrane Collaboration's RevMan 5.0 software and then a Meta analysis was performed. The main indicators included the rate of adverse reactions, the rate of serious adverse reactions,response rate,and remission rate.</p><p><b>RESULTS</b>Thirteen trials entered the final analysis. The main findings in the MS trials included: the rate of serious and general adverse effects were no significantly different among different groups (P>0.05). The new lesions rate was not significantly different within 3 months after treatment [RR=0.99, 95%CI (0.82, 1.18), P=0.87], but was significantly lower in 6 months in the treatment group [RR=0.45, 95%CI (0.33, 0.60), P<0.00001], and such advantage was maintained till 2 years later [RR=0.49, 95%CI (0.45, 0.53), P<0.00001]. The 2-year relapse rate was also significantly lower in the treatment group [RR=0.51, 95%CI (0.38, 0.69), P<0.0001]. The main findings in CD trials were as follows: The incidences between serious reactions and general adverse reactions were not significantly different (P>0.05). The remission rate was not significantly different between treatment group and control group in the 2nd week [RR=4.67, 95%CI (0.65, 33.26), P=0.12], but became significantly higher in the treatment group after 12 weeks [RR=1.46, 95%CI (1.26, 1.70), P<0.00001]. The response rate was significantly higher in the treatment group [RR=1.53, 95%CI (1.15, 2.03), P=0.004].</p><p><b>CONCLUSIONS</b>The rates of serious and general adverse reactions are not remarkably increased after natalizumab treatment for both MS and CD. The new lesions rate and 2-year relapse rate of MS as well as the response rate and remission rate of CD are all improved after natalizumab treatment,especially after long-term administration. Although severe adverse effect such as progressive multifocal leukoencephalopathy may occur,its clinical application can be further promoted after cautiously balancing the benefits and risks.</p>

How to connect the gap between clinical trials and clinical practice / 中国结合医学杂志

Clinical research methods have been rapidly developing, and the design of clinical trials including traditional Chinese medicine is advancing. To a certain extent, all of these ensure that the results of clinical research are objective and scientific, but whether these results and the resulting guidelines or consensus have much practical significance on clinical practice is still controversial. The authors engage in both clinical practice and clinical research; they strongly feel that it is necessary to discuss the relationship between clinical trials and clinical practice. This essay discusses this relationship in four parts.

Thinking and methods in practical assessment of TCM clinical therapeutic effect / 中国中西医结合杂志

Although traditional Chinese medicine (TCM) shows its effectiveness undoubtedly in clinical practice, the deficiency in objective assessment methods is yet a bottleneck which has restricted its development of modernization and internationalization. On the basis of clinical experiences, the authors discussed the title cutting from current situation and tendency, and expanded gradually. It is concluded that by aiming directly at problems and referring to the principle and methods of evidence-based medicine (EBM), using rationally the design in clinical practice and combined with individualization and standardization should be a feasible way for TCM clinical therapeutic effect assessment.

Enhancing active immunity against hepatitis B virus by HBV vaccine immunization in patients with HBV-related end-stage liver diseases treated with liver transplantation / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To study the active immunity response of liver transplant patients for HBV-related diseases after hepatitis B virus (HBV) vaccine immunization and to investigate the factors that influence the effectiveness of the vaccination in order to find measures to increase its success.</p><p><b>METHODS</b>Thirteen patients who had liver transplants because of HBV-related end-stage liver diseases received hepatitis B virus immunoglobulin and lamivudine for an average of 38 months (range 27-77 months). They received double intramuscular doses (40 microg) of a recombinant vaccine at months 0, 1, 2 and 6. The anti-HBs titers were tested regularly at months 1, 2, 3, 6 and 7.</p><p><b>RESULTS</b>Seven of the 13 patients (53.8%) developed higher serum titers of anti-HBs compared with their titers prior to the vaccinations, 2 patients of the 13 (15.4%) developed an increase by 100 U/L and in 4 patients (30.8%) their base levels were doubled. Those responding patients were followed-up for another 8 months after the fourth vaccination, and only 1 patient among them had a decrease of the anti-HBs titers below the level prior to the vaccination.</p><p><b>CONCLUSION</b>Hepatitis B vaccine immunization can be used to enhance the active immunity against HBV in patients who had liver transplants for HBV-related diseases.</p>

Expressed sequence tags analysis of a liver tissue cDNA library from a highly inbred minipig line / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Porcine liver performing efficient physiological functions in the human body is prerequisite for successful liver xenotransplantation. However, the protein differences between pig and human remain largely unexplored. Therefore, we investigated the liver expression profile of a highly inbred minipig line.</p><p><b>METHODS</b>A cDNA library was constructed from liver tissue of an inbred Banna minipig. Two hundred randomly selected clones were sequenced then analysed by BLAST programme.</p><p><b>RESULTS</b>Alignments of the sequences showed 44% encoded previously known porcine genes. Among the 56% unknown genes, sequences of 72 clones had high similarities with known genes of other species and the similarities to human were mostly above 0.80. The other 40 clones showing no similarity to genes in National Centre for Biotechnology Information are newly discovered, expressed sequence tags specific to liver of inbred Banna minipig. Twenty-two of the 200 clones had full length encoding regions, 38 complete 5' terminal sequences and 140 complete 3' terminal sequences.</p><p><b>CONCLUSION</b>These newly discovered expression sequences may be an important resource for research involving physiological characteristics and medical usage of inbred pigs and contribute to matching studies in xenotransplantation.</p>

Study on the results of treating tuberculosis inpatient in the general hospitals: a correspondence analysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the current status of treatment among inpatients of tuberculosis (TB) in general hospitals, and to related to different attrributes.</p><p><b>METHODS</b>A retrospective study was designed for inpatients with TB who were discharged from general hospitals in Nachong region, 2003. Factors associated with the results of treatment were selected, using Chi-square test. Further correspondence analysis (CA) was used to visualize the relationship between attributes of inpatients and results of treatment in general hospitals.</p><p><b>RESULTS</b>Statistically significant factors associated with treatment results would include gender, age, state of illness at access to hospital, comorbidity and length of stay, while ways of payment, occupation and marital status were not statistically significant. The joint plot of CA showed results as follows: (1) Attributes of inpatients died in general hospitals were clearly different from that of cured or improved inpatients. (2) Result of hospitalization on treatment was more likely to be 'improved' for TB inpatients who were male, aged > or = 15 yrs, and with urgent condition when administered into the hospitals. (3) Result of cure was likely to be seen among inpatients who were female, length of stay >8 days, with no comorbidity, and with average illness state when accessing to hospitals. (4) Bad treatment results were appeared for inpatients younger than 15 yrs, with critical state when administered to hospitals.</p><p><b>CONCLUSION</b>(1)CA provided us with a new way on how to extract useful information from miscellaneous data of the patients. (2) The relationships between the results of treatment from the general hospitals and TB inpatients' attributes might provide tips to develop a series of corresponding strategies for treating TB inpatients with special attributes in order to obtain higher cure rate.</p>

Study on Meta analysis regarding the acceptability of medical abortion compared with surgical abortion / 中华流行病学杂志

<p><b>OBJECTIVE</b>To analyze and evaluate the acceptability of mifepristone compatible with misoprostone versus conventional surgical abortion among women under unwanted early pregnancy, so as to help the unexpected pregnant women to choose the satisfactory abortion, and to provide the evidence for clinicians to make a proper clinical decision.</p><p><b>METHODS</b>Six medical databases were searched, including MEDLINE, EMBASE, Cochrane library, CBMdisc, CNKI and VIP, together with twelve journals hand-searched, and references of included studies additionally searched. Two qualified reviewers reviewed the original articles, evaluating qualities of articles, and extracting data independently. After heterogeneity test, the data was pooled using Revman software if capable, or descriptive analysis was applied.</p><p><b>RESULTS</b>In total, nine original clinical controlled trials were included, containing 3565 cases. Before abortion, more unwanted pregnant women chose the medical abortion because they believed medical abortion was less painful than surgical abortion (OR = 466.51, 95% CI: 91.37 - 2381.88), but medical abortion was less time-consuming than surgical abortion (OR = 0.02, 95% CI: 0.01 - 0.06). After abortion, satisfaction with medical abortion was similar to that with surgical abortion, with insignificant difference (P = 0.89). However, second choice and recommendation rates of medical abortion were much higher than those of surgical abortion with OR and 95% CI as 2.72, 2.13 - 3.47 and 4.19, 2.16 - 11.16, respectively.</p><p><b>CONCLUSIONS</b>Medical abortion was less painful than surgical abortion and the rate of second choice and recommendation to others were all also higher than those of surgical abortion. However, the process of medical abortion was not as quick as surgical abortion but the satifacation of both methods seemed similar. Therefore, the two artificial abortion methods were not recommended to replace each other at the present time.</p>

Preliminary study on human embryonic kidney cell line HEK-293 after porcine endogenous retrovirus infection / 中华病理学杂志

<p><b>OBJECTIVE</b>To assess the infectivity of porcine endogenous retrovirus (PERV) via in vitro infection of human embryonic kidney cell line HEK-293.</p><p><b>METHODS</b>PERV particles were detected by immunoelectron microscopy. PERV DNA and mRNA were studied in HEK-293 24 hours after the infection using polymerase chain reaction and reverse transcriptase-PCR respectively. The PERV types were also analyzed. PERV-gag protein was observed by confocal microscopy.</p><p><b>RESULTS</b>Retroviral particles were round under electron microscope. PERV-gag pol gene and gag protein were detected and expressed in the infected HEK-293 cells. The types of PERV were PERV-A and PERV-B. PERV-gag protein was also identified in the cytoplasm of infected cells by confocal microscopy.</p><p><b>CONCLUSIONS</b>PERV is able to infect HEK-293 cell line in vitro; types of PERV-gag protein is also expressed as a result. Further studies are thus necessary in order to evaluate the possibility of xenozoonoses in pig-to-human xenotransplantation.</p>

Influence of anoxia/reoxygenation on immunofunction of endothelial cells and effect of intervention with yisheng injection on it / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the influence of ischemia/reperfusion (anoxia/reoxygenation) on immunofunction of endothelial cells (ECs) and effect of intervention with Yisheng injection (YSI, a pure natural medicine) on it.</p><p><b>METHODS</b>Model of ECs induced by anoxia/reoxygenation was established to mimic ECs ischemia/reperfusion injury in vivo with human umbilical vein endothelial cell line ECV304. Then YSI was used to intervene the anoxia/reoxygenation process. Nuclear transcriptional factor-kappa B (NF-kappa B) was exhibited by fluorescent staining, HLA-ABC, HLA-DR, CD86 and CD54 were detected by flow cytometry. Mixed endothelial cell-lymphocyte reaction (MELR) was conducted to examine the proliferation of lymphocyte, production of IL-2 and percentage of apoptotic lymphocyte.</p><p><b>RESULTS</b>Anoxia/reoxygenation made the ECV304 cell became round, shrunk and abscised, with increased plasma NF-kappa B, and changed from positive cytoplasm to positive nucleus. HLA-ABC, HLA-DR and CD86 on surface of cells increased but CD54 showed unchanged. MELR showed the incorporation of 3H-TdR and production of IL-2 increased significantly and the percentage of apoptotic lymphocyte decreased. After YSI intervention, the ECV304 cell shaped recovered, NF-kappa B expression didn't down-regulated, but the percentage of positive cells decreased, changed to positive dominant. Besides, reversal changes were shown in other parameters.</p><p><b>CONCLUSION</b>Anoxia/reoxygenation influences some important immune related molecules in ECV304 cells, YSI could antagonizing these influences to maintain the immune function of endothelial cells in a relative normal manner.</p>

Evidence-based medical approach to clinical medicine and health policy-making in the 21st century / 中国医学科学院学报

In the late part of the 20th century, due to the change of disease spectra, rapid increase of health expenditure and imbalanced distribution of health resources, the health management sectors and doctors increasingly demand the scientific decision-making. With the development of clinical evidences and research, evidence-based medicine (EBM) became emerged in the early 1990's. EBM, the medical science in compliance with the best available clinical evidence, integrates clinical epidemiology (CE), systematic reviews (SRs) and health technology assessment (HTA) as the major technology, to emphasize that the clinical practice should be based on the combination of the best available clinical evidence, medical experiences and patient desire to cope with the demand of medical decision-making. Some governments and international organizations like WHO, and Australia have now adopted the high-quality evidence of EBM for decision-making. As the largest developing country, China is challenged by variety of health problems. The introduction, adaptation and implementation of EBM will improve the decision-making and health care services, which should enhance the competitive capacity of medical and pharmaceutical manufactures, as well as promote the popularization of EBM, and protect the doctors and patients rights.