Spinopelvic Alignment and Lumbar Diseases(review) / 中国康复理论与实践

The spinopelvic alignment(SPA)closely relates to lumbar disease.This paper summarized various kinds of SPA parameters, introduced a new measure of computer motion analysis system.Most of patients with lumbar disc degeneration are found the lumbar lordo-sis decreasing,which indicates pelvic tilt and trunk anteversion.However,no obviously SPA varieties are found in patients with lumbar spi-nal stenosis and nonspecific low back pain.The SPA parameters can also be used as indices for evaluation of treatment for lumbar disease. Future researches may focus on selection of SPA parameters,noninvasive measurements,relationship to lumbar disease and application of SPA for evaluation of interventions.

Study on Lung Injury of Rats Caused by PM2.5 and Intervention Effect of Platycodonis Radix Total Saponins / 中国中医药信息杂志

Objective To observe the lung injury of rats caused by PM2.5 and the intervention effect of Platycodonis Radix total saponins (PGS); To discuss the repair mechanism of PGS for lung injury caused by PM2.5. Methods The model of lung injury caused by PM2.5 was induced by tracheal instillation. The rats were randomly divided into blank group, model group and PGS high-, medium- and low-dose groups, with 10 rats in each group. After medication for 14 d, BALF and left lung and right lung tissue of rats were collected. HE staining was used to observe the pathological changes of lung tissue. The contents of TNF-α, IL-6, IL-10 and IL-13 in BALF were detected by ELISA. RT-PCR was used to detect the expression of TGF-β mRNA in lung tissues. The expression of TGF-β protein in lung tissue was detected by Western blot. Results Compared with model group, TNF-α and IL-6 decreased significantly while IL-10 and IL-13 increased significantly in BALF in high- and medium-dose group of PGS. Degree of pulmonary interstitial edema and fibroplasia alleviated in PGS groups. Expressions of TGF-βmRNA and protein in lung tissue was reduced in PGS groups. Conclusion PGS can alleviate inflammatory injury caused by PM2.5 via regulating the balance of cytokine and down-regulating the expression of TGF-β and inhibiting the development of fibrosis, which results in the protection and repair on the lung injury of rats caused by PM2.5.

Effect of Protective Analgesia on Incidence of Phantom Limb Pain after Amputation:A Meta-analysis / 中国康复理论与实践

Objective To systemically evaluate the effect of protective analgesia on preventing phantom limb pain(PLP)after amputa-tion.Methods Published articles from the earliest date available to June,2017 were recalled from Cochrane Library,PubMed,Embase,Web of Science,OVID,and Science Direct to collect prospective studies using protective analgesia in perioperative period to prevent PLP after amputation.Two reviewers screened literatures referring to studies according to the inclusion and exclusion criteria,and assessed the quality of them.Data of general information and incidence of PLP in the follow-up period were extracted and analyzed with RevMan 5.3 software. Results Six studies were included with a total of 256 patients in the one-month follow-up period including 127 cases in the protective anal-gesia group(group P)and 129 cases in the control group(group C),a total of 232 patients in the six-month follow-up period including 114 cases in group P and 118 cases in group C,and a total of 118 patients in the twelve-month follow-up period including 58 cases in group P and 60 cases in group C.The incidence of PLP were lower in group P than those in group C in the one-month follow-up period(RD=-0.21, 95%CI[-0.38,-0.04],Z=2.47,P=0.01)and in the six-month follow-up period(RD=-0.28,95%CI[-0.52,-0.05],Z=2.37,P=0.02),and it was not significant in the twelve-month follow-up period(RD=-0.20,95%CI[-0.48,0.09],Z=1.35,P=0.18).Conclusion Protective analge-sia in perioperative period can prevent against PLP after amputation in the recent time,however,it needs further observation in long-term.

Percutaneous Sacroiliac Screw Placement: A Prospective Randomized Comparison of Robot-assisted Navigation Procedures with a Conventional Technique / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sacroiliac (SI) screw fixation is a demanding technique, with a high rate of screw malposition due to the complex pelvic anatomy. TiRobot™ is an orthopedic surgery robot which can be used for SI screw fixation. This study aimed to evaluate the accuracy of robot-assisted placement of SI screws compared with a freehand technique.</p><p><b>METHODS</b>Thirty patients requiring posterior pelvic ring stabilization were randomized to receive freehand or robot-assisted SI screw fixation, between January 2016 and June 2016 at Beijing Jishuitan Hospital. Forty-five screws were placed at levels S1 and S2. In both methods, the primary end point screw position was assessed and classified using postoperative computed tomography. Fisher's exact probability test was used to analyze the screws' positions. Secondary end points, such as duration of trajectory planning, surgical time after reduction of the pelvis, insertion time for guide wire, number of guide wire attempts, and radiation exposure without pelvic reduction, were also assessed.</p><p><b>RESULTS</b>Twenty-three screws were placed in the robot-assisted group and 22 screws in the freehand group; no postoperative complications or revisions were reported. The excellent and good rate of screw placement was 100% in the robot-assisted group and 95% in the freehand group. The P value (0.009) showed the same superiority in screw distribution. The fluoroscopy time after pelvic reduction in the robot-assisted group was significantly shorter than that in the freehand group (median [Q1, Q3]: 6.0 [6.0, 9.0] s vs. median [Q1, Q3]: 36.0 [21.5, 48.0] s; χ2 = 13.590, respectively, P < 0.001); no difference in operation time after reduction of the pelvis was noted (χ2 = 1.990, P = 0.158). Time for guide wire insertion was significantly shorter for the robot-assisted group than that for the freehand group (median [Q1, Q3]: 2.0 [2.0, 2.7] min vs. median [Q1, Q3]: 19.0 [15.5, 45.0] min; χ2 = 20.952, respectively, P < 0.001). The number of guide wire attempts in the robot-assisted group was significantly less than that in the freehand group (median [Q1, Q3]: 1.0 [1.0,1.0] time vs. median [Q1, Q3]: 7.0 [1.0, 9.0] times; χ2 = 15.771, respectively, P < 0.001). The instrumented SI levels did not differ between both groups (from S1 to S2, χ2 = 4.760, P = 0.093).</p><p><b>CONCLUSIONS</b>Accuracy of the robot-assisted technique was superior to that of the freehand technique. Robot-assisted navigation is safe for unstable posterior pelvic ring stabilization, especially in S1, but also in S2. SI screw insertion with robot-assisted navigation is clinically feasible.</p>

Clinical practice of integrative medicine in the United States and its development in primary care / 中国中西医结合杂志

The field of integrative medicine (IM) has grown tremendously in the United States over last two decades, in terms of clinical practice, research, and education. Its growing popularity among patients has led to increased need for physicians with appropriate counseling skills and a knowledge base of the efficacy and safety of complementary and alternative medicine (CAM) therapies. Family medicine is the first specialty as a whole to embrace IM, which encounters similar ailing conditions and emphasizes similar core values-person centered, evidence based, proactive, and continuous in nature. As integrative family medicine emerges, family medicine educators have developed suggested curriculum guidelines and approved measurable competencies to implement the best of evidence-based CAM and principles of IM. There are currently over 40 family medicine residencies that officially advertise CAM/IM in their programs. Meanwhile, IM centers have also been developing their own primary care programs based on their unique characteristics. This physician-led IM workforce is similar to that of China's IM in the early 1960s. As the Chinese government embarks on repeating its efforts to educate more Western medicine trained physicians in Chinese medicine in primary care training programs, the process and insights related to implementation of their practice in the United States would provide useful food for thought.

Effects of trimetazidine therapy on left ventricular function after percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the effects of trimetazidine therapy on left ventricular (LV) function after percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>A total of 106 patients with unstable angina pectoris underwent successful elective PCI were randomly assigned to standard therapy group (control, n = 55) or trimetazidine group (n = 51, 60 mg trimetazidine loading dose prior to PCI followed by 20 mg Tid after PCI on top of standard therapy). cTnI level was measured before and at 16-18 hours after PCI. LV function was evaluated by echocardiography and major adverse cardiac events (MACE, including death, re-infarction and target vessel revascularization) at 12 months after PCI was compared between the two groups.</p><p><b>RESULTS</b>Post procedural cTnI level increased from [0.02 (0.01, 0.03)] µg/L at baseline to [0.11 (0.07, 0.13)] µg/L (P < 0.05) at 16-18 hours in the trimetazidine group, while [0.02(0.01, 0.03)] µg/L to [1.31(0.44, 2.31)] µg/L in the control group (P < 0.05). Post procedural cTnI level was significantly reduced in the trimetazidine group compared to the control group (P < 0.05). At 12 months follow-up, left ventricular ejection fraction in the trimetazidine group was significantly higher than in control group [(65.65 ± 3.94)% vs. (62.29 ± 3.06)%, P < 0.01] while incidence of MACE was similar between the two groups.</p><p><b>CONCLUSION</b>Trimetazidine can reduce the post-PCI cTnI release and improve left ventricular function after PCI in patients with unstable angina pectoris.</p>

Comparision of high sensitivity C-reactive protein and matrix metalloproteinase 9 in patients with unstable angina between with and without significant coronary artery plaques / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inflammation within vulnerable coronary plaques may cause unstable angina by promoting rupture and erosion. C-reactive protein (CRP) is the most reliable and accessible test method for clinical use for identifying coronary artery disease event. Matrix metalloproteinase 9 (MMP-9) is highly over-expressed in the vulnerable regions of a plaque. Our aim was to evaluate the plasma levels of MMP-9 and hsCRP in subjects with both unstable angina and coronary plaques, as well as in those with unstable angina without coronary plaques.</p><p><b>METHODS</b>Patients with newly diagnosed unstable angina pectoris from clinical presentation and ECG, who were undergoing coronary angiography from April 2007 to April 2009, were included in this study. A total of 170 subjects were enrolled in the study. Before angiography, the baseline clinical data (mainly including conventional risk factors) was collected. These patients were divided into two groups, a non-plaque group (G1) which included 55 patients with no significant stenosis or less than 20% stenosis in at least one of the major coronary artery branches, and a plaque group (G2) which included 115 patients with at least one of the major coronary artery branches unstable angina pectoris with at least 50% stenosis of one major coronary artery. The patients presenting with calcified nodules of a major coronary artery were excluded from this study. We examined the serum levels of MMP-9 for all cases by multi-effect enzyme-linked immunosorbent assay.</p><p><b>RESULTS</b>There was a significant difference in the serum levels of MMP-9 between the two groups (P < 0.001). The percentage of patients with hypertension, diabetes and current smokers were significantly different between the two groups (P = 0.034, P = 0.031, and P = 0.044 respectively). The univariate Logistic regression analyses of risk factors showed that smoking was the main risk factor for angina in the non-plaque group with the OR being 1.95 (95%CI 1.02 - 3.75). Hypertension, diabetes mellitus were negatively related with the occurrence of angina in the non-plaque group with the ORs being 0.50, and 0.36, respectively (95%CI 0.26 - 0.96 and 0.14 - 0.94). The MMP-9 level was negatively related to the occurrence of angina in the non-plaque group with an OR of 0.59 (95%CI 0.47 - 0.81).</p><p><b>CONCLUSIONS</b>There is a significantly difference in MMP-9 levels between the plaque and non-plaque groups. Current smoking has a significant influence on unstable angina patients without documented plaques. The serum MMP-9 level may be a significant biomarker which can help differentiate patients with unstable angina with plaques from those with unstable angina but without plaques.</p>

Coronary spasm, a pathogenic trigger of vulnerable plaque rupture / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>This coronary artery spasm review aimed to explore the most possible pathogenic trigger mechanism of vulnerable plaque rupture.</p><p><b>DATA SOURCES</b>Data used in this coronary artery spasm review were mainly from Medline and Pubmed in English.</p><p><b>STUDY SELECTION</b>These reports from major review on coronary artery spasm. and these research included coronary artery conception, pathogenesis of spasm, mechanisms of plaque rupture, epidemiological evidence, clinical manifestation and the relationship between coronary artery spasm and vulnerable plaque rupture.</p><p><b>RESULTS</b>Coronary artery spasm is somehow related to the presence of atherosclerotic intima disease in the coronary artery. However, chronic low-grade inflammation causes coronary vessel smooth muscle cell hypersensitivity, which can directely cause coronary artery spasm. Myocardial infarction and sudden cardiac death may be initiated by a sudden intense localized contraction of coronary artery smooth muscle.</p><p><b>CONCLUSION</b>Coronary artery spasm may be one trigger that can initiate and exacerbate vulnerable plaque rupture.</p>

China is poised to build a better healthcare delivery system using the integrative health paradigm / 中国中西医结合杂志

China and the United States share similar goals regarding their health care reform: expanding coverage, bending the curve of healthcare expenditure, and ensuring quality improvement and effectiveness of healthcare. Though many differences in the two health care systems exist, there are still many innovative strategies both countries can learn from each other. This paper first discusses two major problems in the America's health care system: an increasing aging population coupled with ineffective chronic disease management; and a failing primary care system. Next it discusses the role of integrative medicine in the United States health care reform. We also review some key strategies in China's health care reform, which we believe if these policies are implemented fully and effectively, China is poised to build a better healthcare delivery system using the integrative health paradigm.

Intensity-modulated or 3-D conformal radiotherapy combined with chemotherapy with docetaxel and cisplatin for locally advanced esophageal carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect and toxicity of intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy combined with chemotherapy (3-DCRT) with docetaxel and cisplatin in the treatment of locally advanced esophageal carcinoma.</p><p><b>METHODS</b>Sixty patients with locally advanced esophageal carcinoma were randomly assigned in two equal groups to receive IMRT or 3-DCRT, both combined with the chemotherapy with docetaxel and cisplatin. The total dose of radiotherapy was 64 Gy, administered in 30 fractions in 6 weeks.</p><p><b>RESULTS</b>The complete response rate (complete and partial remissions) of IMRT group was 90.0%, significantly higher than the rate of 80.0% in 3-DCRT group (P>0.05). The 1-, 2-, and 3-year survival rates of IMRT group were 86.7%, 70.0%, and 66.7%, as compared to 70.0%, 63.3%, and 63.3% in 3-DCRT group, respectively, showing no significant differences between the two groups (P>0.05). IMRT showed advantages over 3-DCRT in terms of the V20 and V30 parameters of the lung (P<0.05), and the incidences of radiation-induced esophagitis were comparable between the two groups (P>0.05).</p><p><b>CONCLUSION</b>When combined with the chemotherapy with docetaxel and cisplatin, IMRT appears to be a more effective treatment than 3-DCRT for locally advanced esophageal cancer.</p>

Pericardial endothelin secretion in patients underwent open heart surgery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate pericardial endothelin (ET) secretion by the human pericardial mesothelial cells.</p><p><b>METHODS</b>Plasma, pericardial fluid and pericardial tissue were obtained in 51 patients receiving open heart surgery (coronary artery bypass grafting, elective heart valvuloplasty or valve replacement). ET concentrations in the plasma, pericardial fluid and pericardial tissues were measured by radioimmunoassay (RIA). ET mRNA expression in the human pericardium was detected by in situ hybridization.</p><p><b>RESULTS</b>(1) The levels of ET in human pericardial fluid was significantly higher than that in the plasma [(128.8 +/- 44.0) ng/L vs. (93.7 +/- 28.6) ng/L, P < 0.001]; (2) ET concentration in the pericardial tissue was (510.3 +/- 156.7) ng/kg; (3) In situ hybridization technique evidenced the abundant ET mRNA expression in human pericardial mesothelial cells.</p><p><b>CONCLUSION</b>The study indicated that pericardium secreted ET into the pericardial space.</p>

Purification and functional analysis of Helicobacter pylori UreB protein fragment / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an effective method for purification of Helicobacter pylori UreB fragment and conduct functional analysis of the purified protein.</p><p><b>METHODS</b>The protein fragment expression was induced by IPTG and the expressed protein was purified through affinity chromatography and ion-exchange chromatography. The purity of the fragment was determined by high-performance liquid chromatography (HPLC), and the specific biological activity of the purified fragment was assayed by urease activity inhibition test.</p><p><b>RESULTS</b>The protein fragment was highly expressed in E. coli with a purity over 91%. The protein fragment showed highly specific biological activity and the specific antibody induced by this fragment in rabbits could inhibit the activity of urease in a dose-dependent manner.</p><p><b>CONCLUSION</b>The UreB fragment with high purity and biological activity can be applied for further studies.</p>

Study of the relationship between cardiovascular risk factors and severity of coronary artery disease in patients underwent coronary angiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between multiple cardiovascular risk factors and the extent and severity of angiographic coronary artery disease (CAD) in patients underwent coronary angiography.</p><p><b>METHODS</b>Nine hundred and twenty consecutive patients underwent coronary angiography were selected according to inclusion criteria. The extent and severity of angiographic CAD was diagnosed by: (1) whether or not CAD was diagnosed by angiography; (2) the number of diseased vessels; (3) The CAD Gensini cumulative index. Cardiovascular risk factors included were age, gender, hypertension, smoking status, type 2 diabetes mellitus, dyslipidemia, and high uric acid level. Analyses were achieved by univariate and multivariate analysis.</p><p><b>RESULTS</b>(1) Logistic regression analysis showed that high low-density lipoprotein was a prominent predictor of the extent and severity of angiographic CAD (OR = 2.816, 95% CI 1.903 - 4.167, P = 0.001). (2) High low-density lipoprotein was the most important risk factor in men, whereas smoking and high uric acid were the most important risk factors in women.</p><p><b>CONCLUSION</b>(1) It is very important to control risk factors in the intervention and prevention of CAD. (2) Distribution of risk factors and their severities vary in different genders, therefore the treatment of risk factors should be done differently.</p>

Expression of heat-labile enterotoxin and the strategy of purification and storage / 生物工程学报

Heat-labile enterotoxin (LT) from Escherichia coli is a bacterial protein toxin with an AB5 hexamer structure. LT is a powerful mucosal adjuvant when co-administered with soluble antigens. However, its use in mucosal immunity is inconvenient because of its low yield and depolymerization during long-term storage under normal condition. In this study, we report an efficient expression system and optimized purification and storage strategy of LT. A gene encoding LT was cloned into the vector pET11c and transformed in E. coli BL21(DE3). By growing this strain on modified M9-CAA medium, LT was expressed efficiently. About 46mg/L LT could be purified from the supernatant of bacteria lysate. Using D(+)-Immobilized galactose column, LT could be purified at a wide pH range with various elution buffers. The optimized elution buffers are TEAN (pH 7.3) containing 0.3mol/L galactose and carbonate buffer (pH 10.4) containing 0.3mol/L galactose. After dried by freeze and placed in 4 degrees C, LT dissolved in TEAN (pH 7.3) and carbonate buffer (pH 10.4) were assayed by HPLC. The results indicated that the integrity of AB5 hexamer was kept well. LT could undergo long-term storage under this condition. This was proved to be an optimized strategy of LT storage. The results of GM1 binding assay and toxicity assay showed that the purified recombinant LT has normal biological character.