Traditional Chinese medicine treatment for COVID-19: An overview of systematic reviews and meta-analyses / 中西医结合学报

BACKGROUND@#Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused an extensive burden to the world. Consequently, a large number of clinical trials have examined the efficacy of traditional Chinese medicine (TCM) for treating and preventing COVID-19, with coinciding proliferation of reviews summarizing these studies.@*OBJECTIVE@#This study aimed to evaluate the methodological quality and evidence quality of systematic reviews and meta-analyses on the efficacy of TCM.@*SEARCH STRATEGY@#Seven electronic databases, including PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chongqing VIP, Wanfang Data and SinoMed, were searched for systematic reviews and meta-analyses in October 2021. Search terms such as "Chinese medicine," "Lianhua Qingwen" and "COVID-19" were used.@*INCLUSION CRITERIA@#Systematic reviews and meta-analyses of randomized controlled trials that evaluated the efficacy of TCM treatment of COVID-19 were included.@*DATA EXTRACTION AND ANALYSIS@#A Measurement Tool to Assess Systematic Reviews Version 2.0 (AMSTAR 2) was used to evaluate the methodological quality. The quality of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Data extraction and analysis were performed by two reviewers independently.@*RESULTS@#There were 17 meta-analyses included in our overview. The intervention group was defined as TCM combined with Western medicine, while the control group was Western medicine alone. The methodological quality of all the included studies was moderate to poor. A total of 89 outcome indicators were evaluated, of which, 8 were rated as moderate quality, 39 as low quality, and 41 as very low quality. Only one outcome measure was graded as being of high quality. The moderate quality of evidence indicated that, for the treatment of COVID-19, the clinical efficacy of TCM in combination with Western medicine was better, in terms of lung recovery, rate of conversion to severe/critical cases, symptom scores, duration of symptoms, mortality, and length of hospital stay.@*CONCLUSION@#Evidence from the included studies shows that, compared with conventional Western medical therapy alone, the addition of TCM to COVID-19 treatment may improve clinical outcomes. Overall, the quality of evidence of TCM for COVID-19 was moderate to poor. Meta-analyses of the use of TCM in the treatment of COVID-19 can be used for clinical decision making by accounting for the experiences of clinical experts, medical policies, and other factors.

Efficacy of colonoscopy combined with X-ray stent implantation in the treatment of colorectal cancer intestinal obstruction and risk factors of postoperative delayed bleeding / 中国医师进修杂志

Objective:To explore the effect of colonoscopy combined with X-ray stent implantation in the treatment of colorectal cancer intestinal obstruction, and analyze the risk factors of postoperative delayed bleeding.Methods:From November 2016 to December 2020, 382 patients with colorectal cancer intestinal obstruction in Hainan Provincial People′s Hospital were selected. Among them, 254 patients were treated by colonoscopy combined with X-ray stent implantation (stent implantation group), and 128 patients were treated by emergency radical resection (control group). The operation time, intraoperative bleeding, number of lymph node dissections, tumor diameter, incision length, exhaust time, hospital stay, fluid feeding time, fistulation, perioperative death and delayed bleeding were compared between 2 groups. Based on the random number generated by the computer, 254 patients who underwent colonoscopy combined with X-ray stent implantation were divided into training set (190 cases) and test set (64 cases) according to the ratio of 3∶1. In the training set, the patients were divided into postoperative delayed bleeding and non postoperative delayed bleeding, and the clinical indicators were compared; the multivariate Logistic regression model was performed to analyze the independent risk factors of postoperative delayed bleeding, and the prediction model of postoperative delayed bleeding was established and verified according to the independent risk factors.Results:All patients in the stent implantation group were successfully implanted with stents, and the obstructive symptoms were relieved 24 to 48 h after operation. The operation time, intraoperative bleeding, incision length, fistulation rate, exhaust time, hospital stay and fluid feeding time in stent implantation group were significantly lower than those in control group: (88.89 ± 5.97) min vs. (116.58 ± 20.17) min, (33.18 ± 16.52) ml vs. (92.35 ± 25.64) ml, (4.50 ± 0.96) cm vs. (14.26 ± 2.88) cm, 10.24% (26/254) vs. 98.44% (126/128), (1.18 ± 0.58) d vs. (1.53 ± 0.77) d, (7.69 ± 5.12) d vs. (12.88 ± 6.54) d and (1.46 ± 0.68) d vs. (2.12 ± 1.18) d, the number of lymph node dissections was significantly higher than that in control group: (19.88 ± 4.47) lymph nodes vs. (17.47 ± 3.11) lymph nodes, and there were statistical differences ( P<0.01); there were no statistical differences in tumor diameter and perioperative fatality rate between 2 groups ( P>0.05). Among 190 patients in the training set, 18 patients had postoperative delayed bleeding, with an incidence of 9.47%; 172 cases did not have postoperative delayed bleeding. The age, course of obstruction, complete obstruction rate, intestinal almost occlusion rate under enteroscopy, intraoperative bleeding rate and preoperative intestinal surgery history rate in patients with postoperative delayed bleeding were significantly higher than patients without postoperative delayed bleeding: (69.52 ± 10.54) years old vs. (58.65 ± 15.87) years old, (14.56 ± 10.12) d vs. (8.13 ± 7.68) d, 11/18 vs. 20.35% (35/172), 11/18 vs. 16.28% (28/172), 7/18 vs. 11.63% (20/172) and 12/18 vs. 37.79% (65/172), and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistics regression analysis result showed that old age, long duration of obstruction, complete obstruction, almost intestinal obstruction under enteroscopy and intraoperative bleeding were independent risk factors for postoperative delayed bleeding in patients with colorectal cancer intestinal obstruction undergoing colonoscopy combined with X-ray stent implantation ( OR = 3.925, 4.802, 1.727, 2.710 and 2.581; 95% CI 1.352 to 8.330, 1.064 to 8.869, 1.063 to 2.804, 1.118 to 4.400 and 1.689 to 3.479; P<0.05 or<0.01), while the history of preoperative intestinal surgery was not related to postoperative delayed bleeding ( P>0.05). The consistency indexes of nomogram training set and test set were 0.742 and 0.726 (95% CI 0.684 to 0.845 and 0.640 to 0.812). The receiver operating characteristic (ROC) curve analysis results of 2 models showed that the area under the curve (AUC) of the training set nomogram model and Tree Augmented Na?ve Bayes (TAN) model was 0.758 and 0.752 respectively, and the AUC of the test set nomogram model and TAN model was 0.702 and 0.706 respectively. The prediction accuracy of training set nomogram model and TAN model was 84.74%(161/190) and 85.26%(162/190) respectively, the prediction accuracy of test set nomogram model and TAN model was 82.81%(53/64) and 84.38%(54/64) respectively. Conclusions:Colonoscopy combined with X-ray stent implantation is safe and feasible in patients with colorectal cancer intestinal obstruction. But for the old age, long duration of obstruction, complete obstruction, almost intestinal obstruction under colonoscopy and intraoperative bleeding, careful operation should be carried out to reduce the occurrence of postoperative delayed bleeding.

Bayesian network Meta-analysis of Chinese medicine injections in treatment of chronic renal insufficiency / 中国中药杂志

In this study, Honghua Injection, Danshen Injection, Shenkang Injection, Shuxuetong Injection, Lulutong Injection, Shenxiong Glucose Injection and Chuanxiong Injection were compared for their clinical efficacy on chronic renal insufficiency by using the method of network Meta-analysis, with Western medicine as the common reference. The randomized controlled trial(RCT) of Hong-hua Injection, Danshen Injection, Shenkang Injection, Shuxuetong Injection, Lulutong Injection, Shenxiong Glucose Injection and Chuanxiong Injection for the treatment of chronic renal insufficiency were obtained by computer-based retrieval. The literature quality was evaluated by using the method in Cochrane Reviewer's Handbook 5.1 after independent screening of the included literature by two reviewers. The RJAGS package and GEMTC package of RevMan 5.3, GEMTC software, R software were used for statistical analysis to compare and sort the different injections in terms of efficacy. A total of 6 197 patients with chronic renal failure were included in 79 RCTs, involving 8 treatment measures. The effective rates of conventional treatment combined with Shenxiong Injection(OR=3.55, 95%CI[1.98, 6.37], P<0.000 1), Honghua Injection(OR=3.77, 95%CI[2.45, 5.81], P<0.000 01), Shuxuetong Injection(OR=6.71, 95%CI[3.30, 13.65], P<0.000 01) and Shenkang Injection(OR=4.14, 95%CI[3.42, 5.03], P<0.000 01) were all better than that in control group, and the effective rate of Honghua Injection combined with conventional treatment(OR=3.89, 95%CI[1.73, 8.74], P=0.001) was better than that in Danshen Injection combined with conventional treatment, all with statistically significant differences. By comprehensive comparison, Shuxuetong Injection, Honghua Injection and Shenkang Injection combined with Western medicine had good clinical effect on the effective rate, serum creatinine reduction and urea nitrogen reduction in patients with chronic renal insufficiency. However, due to the relatively low quality of the included literature, the conclusion has yet to be verified clinically.

Taurochenodeoxycholic acid mediates cAMP-PKA-CREB signaling pathway / 中国天然药物

Taurochenodeoxycholic acid (TCDCA) is one of the main effective components of bile acid, playing critical roles in apoptosis and immune responses through the TGR5 receptor. In this study, we reveal the interaction between TCDCA and TGR5 receptor in TGR5-knockdown H1299 cells and the regulation of inflammation via the cyclic adenosine monophosphate (cAMP)-protein kinase A (PKA)-cAMP response element binding (CREB) signal pathway in NR8383 macrophages. In TGR5-knockdown H1299 cells, TCDCA significantly activated cAMP level via TGR5 receptor, indicating TCDCA can bind to TGR5; in NR8383 macrophages TCDCA increased cAMP content compared to treatment with the adenylate cyclase (AC) inhibitor SQ22536. Moreover, activated cAMP can significantly enhance gene expression and protein levels of its downstream proteins PKA and CREB compared with groups of inhibitors. Additionally, TCDCA decreased tumour necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-8 and IL-12 through nuclear factor kappa light chain enhancer of activated B cells (NF-κB) activity. PKA and CREB are primary regulators of anti-inflammatory and immune response. Our results thus demonstrate TCDCA plays an essential anti-inflammatory role via the signaling pathway of cAMP-PKA-CREB induced by TGR5 receptor.

Endemic situation of schistosomiasis in national surveillance sites of Hunan Province from 2015 to 2019 / 中国血吸虫病防治杂志

Objective To analyze the changes in the endemic situation of schistosomiasis in national surveillance sites of Hunan Province, so as to provide scientific basis for the development of the schistosomiasis elimination programme in the province. Methods According to the requirements of the National Guidelines for Schistosomiasis Surveillance in China (2014 version), a total of 41 national schistosomiasis surveillance sites were assigned in all disease-endemic counties (districts) across Hunan Province. During the period between 2015 and 2019, Schistosoma japonicum infections were monitored in local residents, mobile populations and livestock, and snail status was monitored. The morbidity due to schistosomiasis and snail status was compared between years. Results The sero-prevalence of S. japonicum infections was 2.57% and 1.56% in local residents and mobile populations in national surveillance sites of Hunan Province from 2015 to 2019, respectively, and the sero-prevalence appeared a tendency towards a decline over years. A higher sero-prevalence rate of S. japonicum infections was seen in men than in women (P < 0.01). During the 5-year study period, the sero-prevalence rate of human S. japonicum infections appeared a tendency towards a decline in the marshland, embankment, inner embankment and hilly types of endemic areas over years. There were 44 and 19 egg -positives detected in local residents and 5 and 1 egg-positives in mobile populations in 2015 and 2016 respectively. A total of 9 346 domestic animals were monitored from 2015 to 2019, and 6 egg-positives were detected in 2015 and 2016 (all were bovine). A total of 0.155 billion m2 settings were surveyed from 2015 to 2019, and the mean density of living snails appeared a tendency towards a decline over years, with a 45.79% reduction in 2019 as compared to 2015. However, no S. japonicum infections were identified in snails during the 5-year period. A total of 1 469 mixed snail samples were detected using loop-mediated isothermal amplification (LAMP), and 6 positive snail samples were identified in 2015 (one sample) and 2017 (5 samples). Conclusions The overall endemic situation of schistosomiasis appears a tendency towards a decline in Hunan Province, and the prevalence of S. japonicum infections is at a low level in humans and livestock; however, there is still a risk of schistosomiasis transmission. Improvements of health education, intensification of schistosomiasis examinations in mobile populations and reinforcement of the surveillance-response system is required to consolidate the achievements of schistosomiasis control in Hunan Province.

Analysis on status and disease burden of injury deaths in Guangxi from 2014 to 2015 / 中华疾病控制杂志

Objective To analyze the death and disease burden of injury in Guangxi from 2014 to 2016, so as to provide scientific basis for making policy strategies on injury prevention. Methods Datas from the Death Monitoring Network in Guangxi from 2014 to 2016 were analyzed. Descriptive statistics and Chi square were used to describe the mortalities. The potential years of life lost (YPLL) and average years of potential life lost(AYPLL) were assessed. Results A total of 29 288 deaths were reported in Guangxi. The mortality rate was 42.77/100 000. The overall mortality rate decreased over the past three years. Traffic accident, accidental fall, drowning, suicide and sequela, accidental poisoning were the top five causes of injury deaths. The leading cause of injury death in the 0 to 14 age group was drowning, traffic accident in the 15 to 64 age group and accidental fall in the 65 years old and above group. The AYPLL was 29.11 years and, which was higher in male than in female and there was no significant difference between urban and rural. Suicide and sequela had become the biggest average disease burden. Conclusions The average mortality rate decreased in Guangxi from 2014 to 2016. It is necessary to take effective measures to prevent and control injury.

Correlation between blood-brain barrier permeability and cognitive impairment of neurosyphilis patients / 第二军医大学学报

Objective: To determine the cerebrospinal fluid/serum albumin ratio (QALB) in patients with neurosyphilis, and to explore the correlation between the blood-brain barrier permeability and the cognitive impairment. Methods: A retrospective study was conducted on the clinical data from 93 patients with anti-human immunodeficiency virus (HIV)-negative neurosyphilis diagnosed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2018. According to the mini-mental state examination (MMSE) score, the patients were divided into cognitive dysfunction group (n = 38) and non-cognitive dysfunction group (n = 55), and the demographic data, clinical data and cerebrospinal fluid biochemical data were compared between the two groups. Pearson bivariate correlation analysis was used to analyze the relationship between blood-brain barrier permeability and cognitive dysfunction in neurosyphilis patients. Results: There were no significant differences in gender, age, education level, marital status, cerebrospinal fluid leukocyte count, cerebrospinal fluid protein, immunoglobulin G (IgG), IgG index, 24-h intrathecal IgG synthesis, or oligoclonal band between the cognitive dysfunction group and non-cognitive dysfunction group (all P 7× 10-3) patients versus the normal QALB (≤7 ×10-3) patients (92.11% [35/38] vs 67.27% [37/55], χ2 7.927, P = 0.002). Pearson bivariate correlation analysis showed that QALB was negatively correlated with MMSE score (r 0.410, P = 0.024). Conclusion: The neurosyphilis patients with blood-brain barrier damage are prone to cognitive dysfunction, and the higher the blood-brain barrier permeability, the more serious the cognitive dysfunction. Monitoring the permeability of blood-brain barrier can contribute to the assessment of intelligent damage in patients with neurosyphilis.

Efficacy of double fltration plasmapheresis on nine patients with severe anti-N-methyl-D-aspartate receptor encephalitis / 第二军医大学学报

Objective: To investigate the therapeutic effect of double filtration plasmapheresis (DFPP) on severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and its clinical significance. Methods: We retrospectively analyzed the clinical data from 9 patients with severe anti-NMDAR encephalitis confrmed by Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Mar. 2018. The 9 patients did not respond to methylprednisolone shock therapy. We collected the clinical manifestations, and examination results of laboratory, electroencephalogram and imaging, and analyzed the therapeutic effect of DFPP. Results: Nine anti-NMDAR encephalitis patients, including 5 females and 4 males, were admitted to neurology intensive care unit. Their ages were ranged from 15 to 69 years old, median age of onset was 37 years old, and average hospital stay was (33.2 ± 7.6) d. The main clinical symptoms were mental behavioral abnormalities (9 cases), autonomic dysfunction (9 cases), seizures (7 cases), central hypopnea (5 cases), and consciousness disorders (5 cases). One patient was complicated with ovarian teratoma. Nine patients were positive for anti-NMDAR antibodies in cerebrospinal fluid, and 7 patients were positive for anti-NMDAR antibodies in serum. All the 9 patients were examined by electroencephalogram, and 7 of them had abnormal findings, mainly with diffuse changes and abnormal slow waves. Brain magnetic resonance imaging showed that abnormal signals could be seen in the frontal lobe, parietal lobe, temporal lobe, hippocampus and other brain regions of 4 patients, and no abnormal signals were found in the other 5 patients. Nine patients were treated with DFPP after ineffective treatment with methylprednisolone, 5 of them recovered completely, and the other 4 cases had significantly improved residual symptoms. Conclusion: DFPP can be used as an alternative for patients with severe anti-NMDAR encephalitis who are not sensitive to glucocorticoid therapy. It has better clinical efficacy and it is not restricted by allogeneic plasma resources.

Primary study of chronic kidney disease with intravoxel incoherent motion diffusion-weighted imaging / 中华放射学杂志

Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the staging of chronic kidney disease(CKD).Methods From May 2016 to April 2017,seventy-two patients diagnosed as CKD according to the criteria of clinical diagnostic and 20 healthy volunteers (control group) underwent routine MRI and IVIM-DWI ( 8 b values, 0 to 800 s/mm2).CKD patients were divided into two groups based on their estimated glomerular filtration rate (eGFR): mild CKD group(45 cases,eGFR≥60 ml·min-1·1.73m-2)and moderate to severe CKD group(27 cases,eGFR<60 ml·min-1·1.73 m-2).The ADC,true diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction (f) were measured on both cortex and medulla. The paired-samples t test was used to compare the cortico-medullary difference of the ADC,D,D*and f values in three groups.Differences of the ADC,D, D*and f values among three groups were compared using the one-way analysis of variance (ANOVA). Correlations between eGFR and the IVIM-DWI parameters in CKD were evaluated by using Pearson correlation analysis. ROC was performed to evaluate the diagnostic efficiency of using IVIM-DWI parameters to distinguish CKD with moderate to severe renal impairment from mild renal impairment, as well as distinguish CKD with mild renal impairment from healthy volunteers.Results The cortical ADC,D, D*and f values were significantly higher than that in the medulla in healthy volunteers(all P<0.05). The cortical ADC,D*and f values were significantly higher than that in the medulla in mild CKD group(all P<0.05). The cortical ADC,D and f values were significantly higher than that in the medulla in moderate to severe CKD group (all P<0.05). The ADC,D,D*and f values of cortex and medulla showed significantly differences among three groups(all P<0.05).In CKD patients,no significant correlation was found between medullary D*,f values and eGFR, there was a significant positive correlation between eGFR and cortical ADC,D,D*and f values(r=0.475,0.362,0.625,0.276;all P<0.05),as well as between eGFR and medullary ADC,D values(r=0.427,0.615;P<0.05). The results of the ROC analysis for distinguishing the mild CKD group from the moderate to severe CKD group revealed that the cortical D*value had the highest area under the ROC curve (AUC=0.965), cortical f value showed high sensitivity(92.6%) to distinguish CKD with different degree of renal impairment, with the threshold of 32.99%, and cortical D*value showed high specificity(97.8%)with the threshold of 17.07×10-3mm2/s;the results of the ROC analysis for distinguishing the mild CKD group from healthy volunteers revealed that the cortical D*value had the highest AUC(0.885), medullary ADC value showed high sensitivity (82.2%) to distinguish mild CKD group from healthy volunteers,with the threshold of 1.83×10-3mm2/s,and medullary f value showed high specificity(100.0%)with the threshold of 21.70%,as well as medullary D value showed high specificity(100.0%)with the threshold of 1.75× 10-3mm2/s.Conclusion IVIM-DWI may be useful for CKD early diagnosis and assessing renal function.

Roles of CX3CR1 in mediation of post-incision induced mechanical pain hypersensitivity: Effects of acupuncture-combined anesthesia / 生理学报

Post-incision pain often occurs after surgery and is emergent to be treated in clinic. It hinders the rehabilitation of patients and easily leads to various types of postoperative complications. Acupuncture-combined anesthesia (ACA) is the combination of traditional acupuncture and modern anesthesia, which means acupuncture is applied at acupoints with general anesthesia. It was testified that ACA strengthened the analgesic effect and reduced the occurrence of postoperative pain, but its mechanism was not clear. Numerous reports have shown that chemokine receptor CX3CR1 is involved in the development and progression of many pathological pains. The present study was aimed to reveal whether ACA played the analgesic roles in the post-incision pain by affecting CX3CR1. A model of toe incision pain was established in C57BL/6J mice. The pain threshold was detected by behavioral test, and the expression of CX3CR1 protein was detected by immunohistochemical method and Western blot. The results showed that the significant mechanical allodynia and thermal hyperalgesia were induced by paw incision in the mice. Mechanical allodynia was significantly suppressed by ACA, but thermal hyperalgesia was not changed. CX3CR1 was mainly expressed in microglia in the spinal cord dorsal horn, and its protein level was significantly increased at 3 d after incision compared with that of naïve C57BL/6J mice. ACA did not affect CX3CR1 protein expression at 3 d after incision in the toe incision model mice. Paw withdrawal threshold was significantly increased at 3 d after incision in CX3CR1 knockout (KO) mice compared with that in the C57BL/6J mice. But the analgesic effect of ACA was disappeared in CX3CR1 KO mice. Accordingly, it was also blocked when neutralizing antibody of CX3CR1 was intrathecally injected (i.t.) 1 h before ACA in the C57BL/6J mice. These results suggest that CX3CR1 in microglia is involved in post-incision pain and analgesia of ACA.

Research Progress of Angiogenesis in Atherosclerotic Plaque in Chinese Medicine and Western Medicine / 中国结合医学杂志

Angiogenesis in atherosclerotic plaque plays a critical role in the mechanism of atherosclerotic physiopathology. Present consensus shows that angiogenesis in atherosclerotic plaque is mainly resulted in hypoxia, inflammation and some pro-angiogenic factors. The homeostasis in plaque, which is hypoxic and infiltrated by inflammatory cells, may lead to angiogenesis, increase the plaque instability and the incidence rate of vascular events. This article reviews the progression of pathogenetic mechanism, physiopathological significance, relevant detecting technique and corresponding therapeutic methods of Chinese and Western medicine of angiogenesis in atherosclerotic plaque, so as to provide more theoretical basis for atherosclerotic clinical treatment.

Design of wearable multi-parameter monitor / 医疗卫生装备

Object To develop a wearable multi-parameter monitor to facilitate cardiac monitoring of the aged.Methods The monitor had MSP430F5529 micro controller as the core unit, which realized physiological signals acquisition, transmission and storage with ADS1292R chip 2-channel analog front-end to acquire ECG and respiratory signals, ADXL345 sensor to collect postural information, and Bluetooth 4.0 module to send the acquired data to the intelligent mobile terminal and store them in TF card.Results The developed monitor had the continuous working time being 24 hrs, and provided auxiliary diagnosis by monitoring ECG, respiration and posture parameters.Conclusion The monitor behaves well in small size and high wearability, and gains prospects in ECG monitoring in the field of mobile medicine.

Geometric features of proximal cllosing wedge osteotomy in the treatment of hallux valgus / 中国组织工程研究

BACKGROUND: With the wide application of the proximal closing wedge osteotomy in treatment of hallux valgus deformity, the metatarsal shortening and metatarsal elevation are constantly being mentioned. Scholars even think that the operation is complicated, the technical requirements are high, and the incidence of complications is high, and other osteotomy should be used instead. However, through literature research and clinical experience, it is found that the facts are not completely the case. OBJECTIVE: To perform geometric study of the plane and the physical model of the proximal closing wedge osteotomy so as to reasonably evaluate the effect of this technique on metatarsal shortening and metatarsal elevation. METHODS: The research was divided into four stages, in which the first three stages were plane geometric researches, with weight-bearing frontal image of the patient with hallux valgus as the research materials; the fourth one was solid geometric research, with plaster model of the first metatarsal bone as the research material. In research I (Stage I), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial border of the first tarsometatarsal joint was different (B, A, C, D respectively from the near to the distant, with a distance of 10 mm). In research II (Stage II), the changes in 1/2 inter-metatarsal angle, length of the first metatarsal and distal metatarsal articular angle were learnt through angle adjustment after clipping when the distance from the wedge osteotomy vertex to medial and lateral connection of the first tarsometatarsal joint was same, and the distance from the wedge osteotomy vertex to axis of the first metatarsal bone was different. In research III (Stage III), the changes in the above-mentioned research indexes were studied through angle adjustment after clipping when the wedge osteotomy vertex and wedge angle were fixed, but the proximal osteotomy line slope was different. Research IV (Stage IV) was the simulated osteotomy comparison, osteotomy perpendicular to metatarsal backbone or perpendicular to the horizontal plane was conducted on the model through plaster casting, and then osteotomy section was closed; the changes in elevation of the metatarsal head, 1/2 inter-metatarsal angle and length of the first metatarsal bone were measured. RESULTS AND CONCLUSION: (1) Results of plane geometry: The closer the wedge osteotomy vertex was to the proximal end, the larger the correction gained was and the smaller the changes in the distal metatarsal articular angle were, but the shortening was more obvious. Moreover, the closer the wedge osteotomy vertex was to the axis of the metatarsal bone, the smaller the shortening was; if only the proximal osteotomy line was different, the indices were the same. (2) Results of stereoscopic geometry: In the case of the same osteotomy angle, the cuneiform bone of the same angle was intercepted, and the degree of correction was obviously greater than that of the plane geometry. This should be related to the thickness of the osteotomy saw and the loss of bone mass caused by the osteotomy. The metatarsal bone was significantly higher after correction when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. In 1/2 inter-metatarsal angle, the difference between the two was only 1°. In metatarsal shortening, it was smaller when perpendicular to the metatarsal stem compared with that perpendicular to the horizontal surface. (3) In conclusion, a. the optimal wedge osteotomy vertex is not at the medial border of the joint but is 1 cm from the medial border of the joint; then, it will approach the axis of the metatarsal. In this way, good correction, steady fixation and further reduction of metatarsal shortening can be achieved. b. The optimal direction of the oscillating saw blade is perpendicular to horizontal plane; however, an approximately perpendicular position to the horizontal plane is acceptable. It does not affect the effect of orthopedics, and further reduces the metatarsal shortening. When the bony closure is closed, the distal end of the metatarsal bone is taken to avoid the elevation of the metatarsal bone with a 2 mm step with the proximal end. c. The angle selection of proximal osteotomy surface can be placed on the metatarsal stem according to the internal fixation condition, and it can also form an acute angle with the metatarsal stem, so that the effect of osteotomy will not be changed.

Distribution of psychiatric disturbances and relevant factors in patients with multiple system atrophy / 中华神经科杂志

Objective To study the clinical distribution characteristics of psychiatric symptoms in patients with multiple system atrophy ( MSA ) and analyze the influence factors of neuropsychiatric symptoms.Methods Twelve psychiatric symptoms were evaluated in 47 patients with MSA by the Neuropsychiatric Inventory of the Chinese version ( CNPI ) .The occurrence rate and distribution were evaluated.The correlation between the neuropsychiatric symptoms and the clinical features including gender , age, education duration, disease course, cognitive level, Unified Multiple System Atrophy Rating Scale part 3 ( UMSARS-Ⅲ) score, Unified Parkinson's Disease Rating Scale part 3 ( UPDRS-Ⅲ) score, Hamilton Depression Rating Scale ( HAMD) score, Hamilton Anxiety Scale ( HAMA) score, MSA subtype and levodopa and benserazide usage dose was also analyzed .Results A total of 74.5%( 35/47 ) of the MSA patients presented at least one kind of psychiatric symptoms .The most common neuropsychiatric symptoms were depression (66.0%, 31/47) and sleep disorder (63.8%, 30/47), while the symptom of euphoria was not found.The highest mean score was found for depression ( mean score:5.23 ±1.67 ) .The CNPI scores of MSA patients were negatively correlated to the education duration and Simple Mental State Examination (MMSE) score (r=-0.238, -0.334 respectively, both P<0.01).The CNPI scores of MSA patients were positively correlated to the disease course and HAMD score ( r=0.308, 0.307 respectively, both P<0.01) .The CNPI scores of MSA patients had no relevance to the gender , age, UMSARS-Ⅲscore, UPDRS-Ⅲscore, MSA subtype and levodopa and benserazide dosage ( all P>0.05). Multiple liner regression analysis showed that HAMA and MMSE scores had the greatest impact on CNPI (r2 =0.196, 0.270, respectively, both P=0.000) .Conclusions The incidence of neuropsychiatric symptoms is high and varied in patients with MSA .The neuropsychiatric symptoms were more severe in MSA patients with lower cognitive levels and longer disease courses .

Pathway research on medical equipment personnel training from viewpoint of supply side / 医疗卫生装备

Objective To explore the present situation and measures of medical equipment personnel training with considerations on idea of precision interaction and precision service as well as the viewpoint of supply side.Methods The present situation and requirements of medical equipment personnel training were analyzed with the methods of literature query,field survey,questionnaire survey,panel discussion,expert consultation and etc.Results Medical equipment personnel shortages occurred in management,research,development and other fields,and efforts had to be executed from the aspects of policy,industrial idea and etc.Conclusion A multi-dimension medical equipment personnel training system has to be established involving in personnel training,development and utilization.

Literature Study on Acupuncture-moxibustion for Bi-impediment Syndrome in Ming and Qing Dynasties / 上海针灸杂志

Objective To summarize the treatment principle of acupuncture-moxibustion in treating Bi-impediment syndrome from the application rules of meridians and acupoints in Ming-Qing Dynasties by sorting out and analyzing the Chinese medicine literatures about acupuncture-moxibustion for Bi-impediment syndrome in Ming-Qing Dynasties, for providing literature evidence for basic and clinical research of Bi-impediment syndrome.Method Via electronic retrieval ofZhong Hua Yi Dian (Zhen Jiu Tui Na Lei) (Chinese Medical Encyclopedia,Chapter of Acupuncture-Moxibustion and Tuina), the data related to Bi-impediment syndrome in Ming-Qing Dynasties were extracted to establish a database categorized by meridians and acupoint features in Excel for analysis.Result There were 267 items of records about acupuncture-moxibustion in treating Bi-impediment syndrome in Ming-Qing Dynasties, involving the fourteen ordinary meridians, and 131 acupoints including 5 extra points; the frequency of using the Gallbladder Meridian ranked the top, followed by the Large Intestine Meridian; points from the Bladder Meridian were predominant, followed by the Gallbladder Meridian; there were 28 commonly-used acupoints (frequency>5), which were Quchi (LI 11, 26 times), Huantiao (GB 30, 23 times), Hegu (LI 4, 22 times), Chize (LU 5, 16 times),Yanglingquan (GB 34, 15 times), and Weizhong (BL 40, 14 times). Of the specific acupoint, the five Shu points were most frequently used, with a frequency of 217.Conclusion In the treatment of Bi-impediment syndrome with acupuncture-moxibustion, doctors in Ming and Qing Dynasties selected yang meridians more often than yin meridians, and Gallbladder, Large Intestine and Bladder Meridians had comparatively higher frequencies; regarding the application of acupoints, the specific acupoints were often used, especially the five Shu acupoints. The study results provide reference for acupoint selection in the treatment of Bi-impediment syndrome with acupuncture-moxibustion.

Pathway research on medical equipment personnel training from viewpoint of supply side / 医疗卫生装备

Objective To explore the present situation and measures of medical equipment personnel training with considerations on idea of precision interaction and precision service as well as the viewpoint of supply side.Methods The present situation and requirements of medical equipment personnel training were analyzed with the methods of literature query,field survey,questionnaire survey,panel discussion,expert consultation and etc.Results Medical equipment personnel shortages occurred in management,research,development and other fields,and efforts had to be executed from the aspects of policy,industrial idea and etc.Conclusion A multi-dimension medical equipment personnel training system has to be established involving in personnel training,development and utilization.

Literature Study on Acupuncture-moxibustion for Bi-impediment Syndrome in Ming and Qing Dynasties / 上海针灸杂志

Objective To summarize the treatment principle of acupuncture-moxibustion in treating Bi-impediment syndrome from the application rules of meridians and acupoints in Ming-Qing Dynasties by sorting out and analyzing the Chinese medicine literatures about acupuncture-moxibustion for Bi-impediment syndrome in Ming-Qing Dynasties, for providing literature evidence for basic and clinical research of Bi-impediment syndrome.Method Via electronic retrieval ofZhong Hua Yi Dian (Zhen Jiu Tui Na Lei) (Chinese Medical Encyclopedia,Chapter of Acupuncture-Moxibustion and Tuina), the data related to Bi-impediment syndrome in Ming-Qing Dynasties were extracted to establish a database categorized by meridians and acupoint features in Excel for analysis.Result There were 267 items of records about acupuncture-moxibustion in treating Bi-impediment syndrome in Ming-Qing Dynasties, involving the fourteen ordinary meridians, and 131 acupoints including 5 extra points; the frequency of using the Gallbladder Meridian ranked the top, followed by the Large Intestine Meridian; points from the Bladder Meridian were predominant, followed by the Gallbladder Meridian; there were 28 commonly-used acupoints (frequency>5), which were Quchi (LI 11, 26 times), Huantiao (GB 30, 23 times), Hegu (LI 4, 22 times), Chize (LU 5, 16 times),Yanglingquan (GB 34, 15 times), and Weizhong (BL 40, 14 times). Of the specific acupoint, the five Shu points were most frequently used, with a frequency of 217.Conclusion In the treatment of Bi-impediment syndrome with acupuncture-moxibustion, doctors in Ming and Qing Dynasties selected yang meridians more often than yin meridians, and Gallbladder, Large Intestine and Bladder Meridians had comparatively higher frequencies; regarding the application of acupoints, the specific acupoints were often used, especially the five Shu acupoints. The study results provide reference for acupoint selection in the treatment of Bi-impediment syndrome with acupuncture-moxibustion.

Effects of hydrosoluble active constituent ofSalvia miltiorrhiza Bge on endothelial progenitor cell functions / 中国药理学通报

The hydrosoluble active constituent of Salvia miltiorrhiza Bge has a wide range of physiological activities and pharmacological effects.Endothelial progenitor cells(EPCs) comprise a cell population that has the capacity to circulate, proliferate and differentiate into mature endothelial cells but that has not yet acquired characteristic mature endothelial markers nor formed precursor cells of blood vessels.It was found that the hydrosoluble active constituent of Salvia miltiorrhiza Bge could protect endothelial functions through modulation of EPCs functions, thus exerting therapeutic effects in endothelium injured related diseases.This paper reviewed the effects of the hydrosoluble active constituent of Salvia miltiorrhiza Bge on EPCs functions.We hope that the paper could provide a reference for further utilization of hydrosoluble active constituent of Salvia miltiorrhiza Bge.

Alpha-fetoprotein-high-producing hepatoid adenocarcinoma of the stomach:A case report and litera-ture review / 实用肿瘤学杂志

Hepatoid adenocarcinoma of the stomach ( HAS) belongs to one of the rare cases in gastric cancer types ,which has extremely high malignant degree and poor prognosis .Lymph node metastasis and liver me-tastasis are common in HAS.In this article,we reported alpha-fetoprotein-high-producing hepatoid adenocar-cinoma of the stomach(HAS),and reviewed the related literature at home and abroad in order to improve clinical physicians understanding of these diseases and treatment experience .