Mechanism of heat-clearing prescriptions in alleviating type 2 diabetes mellitus:a review / 中国中药杂志

Type 2 diabetes mellitus(T2DM), a common chronic metabolic disease, is often accompanied by internal heat syndrome. Heat-clearing prescriptions are widely used to treat different heat syndromes of T2DM from the aspects of clearing stagnant heat, excess heat, damp heat, phlegm heat, and heat toxin, demonstrating remarkable effects. The mechanism of blood sugar-lowering agents has always been a hotspot of research. Recently, the basic studies of heat-clearing prescriptions from different perspectives have been increasing year by year. To clarify the mechanisms of heat-clearing prescriptions and find specific mechanisms, we systematically reviewed the basic studies of heat-clearing prescriptions commonly used for the treatment of T2DM in the past decade, intending to provide a reference for related research.

Clinical outcomes of minimally invasive coronary artery bypass grafting in 239 patients: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective     To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods     The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results     A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P>0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P>0.05). Conclusion    Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.

Study on the construction of self-examination index system for hospital legal practice / 中华医院管理杂志

Objective:To construct a self-examination index system for hospital legal practice, and provide effective reference for the self-examination work of hospital practice in accordance with the law.Methods:From May 2021 to September 2022, a multi-dimensional and multi-level indicator system was initially constructed through literature review and expert interviews; Delphi expert consultation method was used to carry out a three-round questionnaire survey, experts were invited to assess the importance of indicators, and the weight values of indicators were processed by using analytic hierarchy process-fuzzy comprehensive evaluation method.Results:The Cs value of consulting experts′ familiarity with the survey content was 0.84, Ca value of judgment basis was 0.78, Cr value of authoritative evaluation was 0.81, and Kendall W value was 0.630. The index system of hospital self-examination included 5 first-level indexes, 19 second-level indexes, and 30 third-level indicators. The 5 first-level indicators included institutional practice, personnel practice, disinfection and prevention of infectious disease, online diagnosis and treatment, and anti-fraud insurance, with weights of 0.235, 0.186, 0.188, 0.185, and 0.206 respectively. Among the second-level indicators, the weights of rational use of medical insurance fund, internet hospital and internet diagnosis and treatment, organization qualification and practice behavior were the highest, with values of 0.206, 0.185, 0.122 and 0.113 respectively. Among the third-level indicators, the internet hospital physician qualification, whether the hospital had obtained the license to practice, cracking down on fraudulent insurance practices, real-name medical treatment, and reasonable and standardized use of health insurance costs had the highest weight, which were 0.185, 0.122, 0.076, 0.065, and 0.065, respectively. Conclusions:The self-examination index system of medical institutions is scientific, which could help the medical institutions to practice self-examination and ensure medical quality and safety.

Clinicopathological and genetic characteristics of bronchial sialadenoma papilliferum: report of four cases / 中华病理学杂志

Objective: To investigate the clinicopathological, immunophenotypic, and molecular genetic features of bronchial sialadenoma papilliferum (BSP). Methods: Four cases of BSP collected at the Shanghai Pulmonary Hospital from May 2018 to June 2021 were retrieved and analyzed. These cases were evaluated for their clinical, histological, immunohistochemical (IHC) and genomic features. The patients were followed up and relevant literature was reviewed. Results: All four patients were male, aged from 55 to 75 years (mean 62 years), with tumor diameter of 6 to 21 mm (mean 13.5 mm), and lesions were located in the left lower lobe (n=2), right lower lobe (n=1), and trachea (n=1). They were characterized by a combination of surface exophytic endobronchial papillary proliferation and an endophytic two-cell layered ductal structure. IHC staining showed that CK7 and EMA were strongly positive in ductal epithelium; p63, p40, CK5/6 were positive in ductal and papillary basal cells; SOX10 was positive in ductal epithelium and basal cells; S-100 was positive in basal cells and ductal epithelium in two cases. Next generation sequencing showed that two cases harbored BRAF V600E mutation. Conclusions: BSP is an extremely rare primary lung tumor arising from the salivary gland under bronchial mucosa. The primary treatment choice of this tumor is complete surgical resection. The diagnosis and differential diagnosis of this tumor depend on classic histomorphologic and IHC features, and BRAF V600E gene mutation can be detected.

Complexity of coronary artery lesions on the effect of minimally invasive or conventional bypass surgery based on SYNTAX score / 中华胸心血管外科杂志

Objective:To investigate the influence of the complexity of coronary artery disease based on SYNTAX score(SS) on the effect of minimally invasive or conventional bypass surgery.Methods:From January 2017 to January 2020, the medical group of the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital received a total of 760 patients undergoing off-pump coronary artery bypass grafting(OPCABG) surgery, including 596 males and 164 females. 28-85 years old, with an average of(60.88±9.36) years old. 379 cases underwent minimally invasive coronary artery bypass grafting(MICS CABG)(minimally invasive group) and 381 cases underwent median thoracotomy CABG(conventional group). In this study, according to the SS, patients of both groups were divided into 3 levels, and then the perioperative data of the two sets of high, medium, and low score intervals were compared respectively, and a preliminary analysis of the perioperative data for patients in each SS score section was performed.Results:There was no significant difference in the SS value between the minimally invasive group and the conventional group in the three intervals. There was no statistical difference in preoperative data including age, sex ratio, body mass index, hypertension, diabetes, abnormal head CT history, lung disease, history of tobacco and alcohol. The number of minimally invasive bypasses in the three groups was significantly less than that of the conventional group. The duration of minimally invasive surgery in the SS low score group was similar to that of conventional surgery, and the duration of minimally invasive surgery in the SS medium and high score group was longer than that in the conventional group. The hospital stay in the SS low and middle score group was less than that of the conventional group. There was no statistical difference in the proportion of MACCE and auxiliary equipment implantation in the 30-day perioperative period.Conclusion:In the same grade of SS group, there is no significant difference on the perioperative clinical effect between conventional CABG or MICS CABG group. The complexity of coronary artery disease is not the decisive basis for choosing minimally invasive or conventional bypass.

Minimally invasive coronary artery bypass grafting versus off-pump: a propensity-matched study for patients with multi-vessel lesion / 中华胸心血管外科杂志

Objective:To compare the perioperative outcomes and short-term graft patency between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via left intercoastal space or sternotomy.Methods:Between January 2017 and August 2019, 100 patients who underwent minimal invasive coronary artery bypass graft(MICS CABG) were compared with 235 patients who underwent OPCABG by single surgeon at our institute. Among them, 257 cases were male and 78 were female, aged 34 to 84 years, with mean age(61.35±8.79)years old. Due to important differences in patients’ characteristics, a propensity score-matched analysis based on 12 covariates was performed to match in a 1∶2 fashion. 82 patients(MICS group) were matched with 127 patients(OPCABG group). Surgical and postoperative outcomes were evaluated.Results:There was no statistical difference of perioperative mortality, myocardial infarction, and stroke rate( P>0.05). In MICS group, use of internal thoracic artery was higher and conversion to cardiopulmonary bypass was lower( P<0.05), but reoperation, new onset atrial fibrillation , and the use of mechanical device were similar( P>0.05). In addition, operation duration was longer but transfusion rate, postoperative chest tube drainage within 24 hours and postoperative hospital stays were less in the MICS group( P<0.05). LIMA, vein and overall graft patency were similar in the two groups shown by postoperative one-year CTA( P>0.05). Conclusion:MICS CABG is safe and feasible for patients with multiple coronary lesions. It has similar in-hospital outcomes and short-term graft patency but less transfusion and faster recovery compared to conventional OPCABG via sternotomy.

Assessment of postoperative outcomes of radial artery as a sequential graft in coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To explore the perioperative effect of radial artery as a sequential graft in coronary artery bypass grafting(CABG).Methods:The clinical data and perioperative complications of 109 patients, who underwent radial artery(RA) or great saphenous vein(SVG) as a sequential graft during CABG from April 2020 to December 2020 in Beijing Anzhen Hospital, were analyzed, there were 86 males and 23 females, aged from 39 to 79 years, with an average of(61.1±8.0)years old. According to the graft materials, they were divided into the RA group(n=47) and SVG group(n=62).Results:There were no significant differences between the two groups in age, gender, comorbidities, echocardiographic results, transplant vascular indexes, coronary angiography results, and operation methods(on-pump or off-pump, use of left internal mammary artery, number and distribution of distal anastomoses)( P>0.05). There were also no significant difference between the two groups in ICU stay, postoperative hospital stay and drainage with 24 hours after CABG( P>0.05). The incidence of postoperative cerebrovascular events, postoperative infection and secondary thoracotomy in the RA group were higher than that in the SVG group. The incidence of myocardial infarction, postoperative ventricular arrhythmia and postoperative IABP assistance in the SVG were higher than that in the RA group, but the difference was not statistically significant( P>0.05). Conclusion:The application of radial artery as a sequential graft during CABG does not increase the risk of perioperative complications, and the patients recover smoothly.

Early effects of simultaneous carotid artery stenting combined with off-pump coronary artery bypass grafting in the treatment of severe coronary heart disease complicated with carotid artery stenosis / 中华胸心血管外科杂志

Objective:The perioperative and early follow-up data of the simultaneous hybrid CAS+ OPCABG and sequential CAS+ OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+ OPCABG.Methods:A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021, among which 12 patients received simultaneous CAS+ OPCABG and 14 patients received staged sequential CAS+ OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results:There were no significant differences in the operation time, drainage on the first day after surgery, ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group, but no secondary thoracotomy occurred in both groups. The number of days in hospital after operation was significantly less in the simultaneous group. There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group, but there was no statistical difference between the two groups. There was no new cerebral infarction in the two groups, carotid artery ultrasound stent was unobstructed, and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion:Simultaneous CAS+ OPCABG surgery is safe and feasible, it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.

The clinical effects of minimally invasive versus conventional coronary artery bypass grafting for coronary heart disease: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods     This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. Results    The average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). Conclusion    Compared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.

Regulatory Effect of Modified Liu Junzitang on Immune Function, Nutritional Status and Intestinal Microecology in Advanced Gastric Cancer Patients with Syndrome of Deficiency of Qi and Blood / 中国实验方剂学杂志

Objective:To explore the regulatory effect of modified Liu Junzitang on the immune function， nutritional status and intestinal microecology in advanced gastric cancer patients with syndrome of deficiency of Qi and blood. Method:The 86 advanced gastric cancer patients with syndrome of deficiency of Qi and blood were randomly divided into control group and observation group according to their admission numbers， with 43 cases in each group. The control group was given Yiqi Yangxue oral liquid on the basis of basic treatment while the observation group was given modified Liu Junzitang. After 4 weeks， compare the clinical efficacy of two groups of patients， traditional Chinese medicine （TCM） syndrome score， gastrointestinal function recovery， adverse reaction and quality of life， immune function， T cell subsets CD3⁺， CD4⁺， CD8⁺， C₃ and C₄ levels， immunoglobulin A （IgA）， immunoglobulin G （IgG）， immunoglobulin M （IgM）， nutritional status： albumin （propagated）， prealbumin （PA）， serum total protein （TP） and hemoglobin （Hb） content changes， the intestinal micro ecology： <italic>Bifidobacterium</italic>， <italic>Lactobacillus</italic>， <italic>Enterococcus aureus</italic>， <italic>Escherichia coli</italic> content changes. Result:The total effective rate of the observation group was 95.35% （41/43）， which was significantly higher than 79.07% （34/43） of the control group （<italic>χ²</italic>=5.108，<italic>P</italic><0.05）， after treatment， the TCM syndromes such as dizziness， pale complexion， palpitation， shortness of breath and fatigue in the observation group were significantly lower than those in the control group （<italic>P</italic><0.05）， the bowel sound recovery， exhaust and defecation time of the observation group were significantly lower than those of the control group （<italic>P</italic><0.05）， the quality of life scores in the observation group， such as the nature-to-human correspondence， form and spirit integration， specific modules， functional areas， and overall health score， were significantly higher than those in control group （<italic>P</italic><0.05）， the CD3⁺， CD4⁺， CD4⁺/CD8⁺， C₃， C₄， IgA， immune function indexes such as IgG and IgM were significantly higher than those of the control group， and the CD8⁺ level was lower than which of control group （<italic>P</italic><0.05）， the nutritional status levels such as Alb， PA， TP and Hb in the observation group were significantly higher than those of the control group （<italic>P</italic><0.05）， <italic>Bifidobacterium</italic>， <italic>Lactobacillus</italic>， and <italic>E. faecalis </italic>in the observation group were higher than those in the control group， and <italic>E. coli</italic> was lower than the control group （<italic>P</italic><0.05）， the adverse reaction rate of the observation group was 11.63% （5/43） and the control group was 16.28% （7/43） ， and there was no statistical difference between two groups. Conclusion:Modified Liu Junzitang has a good clinical effect on advanced gastric cancer patients with syndrome of deficiency of Qi and blood. It can improve TCM syndromes and gastrointestinal function， improve quality of life， and its mechanism is related to improving immune function， enhancing nutritional status， and improving intestinal microecology， and it has good safety.

Safety and effectiveness of minimally invasive coronary artery bypass grafting in 143 patients: A propensity-score matching study / 中国胸心血管外科临床杂志

@#Objective    To investigate the safety and effectiveness of minimally invasive coronary artery bypass grafting (MICABG) through comparing the perioperative clinical effects of conventional surgery and MICABG. Methods    A total of 543 patients in the single medical group of Beijing Anzhen Hospital who underwent beating coronary artery bypass grafting from January 2017 to September 2020 were collected, including 161 patients receiving MICABG (a minimally invasive group, 143 males and 18 females, aged 60.08±9.21 years), 382 patients receiving median thoracotomy (a conventional group, 284 males and 98 females, aged 61.68±8.81 years). The propensity score was used to match 143 patients in each of the two groups, and the perioperative data of the two groups were summarized and analyzed. Results    There was no death, perioperative myocardial infarction or stroke in the minimally invasive group. Compared with the conventional group, the minimally invasive group had longer operation time (296.36±89.4 min vs. 217.80±50.63 min, P=0.000), less number of bypass grafts (2.86±1.03 vs. 3.17±0.78, P=0.005), shorter postoperative hospital stay (6.29±1.46 d vs. 6.78±2.61 d, P=0.031), less drainage on postoperative day 1 (339.57±180.63 mL vs. 441.92±262.63 mL, P=0.001) and lower usage rate of inotropic drugs (9.09% vs. 26.57%, P=0.001). There was no statistical difference between the two groups in postoperative ICU stay ventilator assistance time, blood transfusion rate, secondary thoracotomy rate, or use of mechanical equipment. Conclusion    Reasonable clinical strategies can ensure the satisfactory overall safety of MICABG. In addition, it has the advantages of shorter postoperative hospital stay, less bleeding and smaller dosage of inotropic drugs.

Analysis of learning curve of minimally invasive coronary artery bypass grafting surgery / 中国胸心血管外科临床杂志

@#Objective    To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods    From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results    There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion    The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.

The relationship between brain networks and symptoms of schizophrenia / 生理学报

The pathogenesis of schizophrenia (SCZ) is not yet clear, and the pathological changes of the brain activity remains debatable. There are still numerous unresolved issues and debates regarding the relationship between functional connection of the brain network and the symptoms of SCZ. In this paper, we provide a comprehensive review of recent research progresses on resting-state and task-based brain networks, which covers the symptoms of SCZ. Furthermore, we discuss the relationship between large-scale brain networks and SCZ symptoms, and propose possible future research directions in the field of SCZ diagnosis and treatment.

Minimally invasive coronary artery bypass grafting single-center experience in 50 patients with multi-vessel lesion / 中华胸心血管外科杂志

Objective To compare the perioperative outcomes between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via single left intercoastal space and sternotomy,and to explore the perioperative outcomes and technigues about minimally coronary artery bypass grafting with multi-vessel lesion.Methods From January 2017 to July 2018,100 patients were recruited using both left internal mammary artery and vein graft.They were divided into minimal invasive coronary artery bypass grafting(MICS) group and control group.Perioperative outcomes were analyzed and surgical techniques were summarized.Results There was no statistical difference in preoperative profiles,mean grafts and postoperative complications(P ＞0.05).Compared with control group,MICS group had statistical benefits in length of operation incision [(8.2 ± 1.2) cm vs.(25.3 ± 3.5) cm,P =0.000],i ntraoperative washed blood loss [(301 ± 188) ml vs.(444 ± 331) ml,P =0.01],postoperative ventilation duration [(16.18 ± 5.90) h vs.(19.60 ± 3.92) h,P =0.001] and length of ICU stay [(19.19±6.85)hvs.(23.44±4.64)h,P=0.001].Conclusion There is a learning process for surgeons to perform minimal invasive OPCABG via single left intercoastal space.Surgery is feasible for patients with multiple coronary lesions.Mid and long term following up need to be studied.

Relationship of Platelet Activation Markers and Vitamin D to Clopidogrel Resistance / 中国康复理论与实践

Objective:To explore the relationship of platelet activation markers and vitamin D to antiplatelet drug resistance in ischemic stroke patients. Methods:From June, 2017 to June, 2018, 190 patients with ischemic stroke were tested their maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA), activation of platelet CD62P and P-selectin vitamin D seven to ten days after dual antiplatelet treatment (aspirin 100 mg/d + clopidogrel 75 mg/d). According to the MPAR induced by ADP and AA, the patients were divided into resistance group and sensitive group. Results:The prevalence of aspirin resistance was 1.2%, while the prevalence of clopidogrel resistance was 24.7% (47 in the resistance group and 143 in the sensitive group). The activation of platelet CD62P (t = -5.232, P < 0.001) and the prevalence of hypertension (χ2 = 4.878, P < 0.05) were more in the resistance group than in the sensitive group, while the vitamin D concentration was less (t = 3.052, P < 0.01). There was no significant difference in P-selectin between the resistance and sensitive groups (t = -0.684, P = 0.253). Logistic regression analyses showed that hypertension (OR = 5.538, 95% CI: 1.204-25.470, P < 0.05), activation of platelet CD62P (OR = 1.082, 95% CI: 1.041-1.092, P < 0.05) and vitamin D (OR = 0.848, 95% CI: 0.755-0.953, P < 0.01) were the independent related factors for clopidogrel resistance. Conclusion:Inhibition of platelet activation and supplementation of vitamin D may help to overcome the resistance of clopidogrel.

Relationship of Platelet Activation Markers and Vitamin D to Clopidogrel Resistance / 中国康复理论与实践

Objective:To explore the relationship of platelet activation markers and vitamin D to antiplatelet drug resistance in ischemic stroke patients. Methods:From June, 2017 to June, 2018, 190 patients with ischemic stroke were tested their maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA), activation of platelet CD62P and P-selectin vitamin D seven to ten days after dual antiplatelet treatment (aspirin 100 mg/d + clopidogrel 75 mg/d). According to the MPAR induced by ADP and AA, the patients were divided into resistance group and sensitive group. Results:The prevalence of aspirin resistance was 1.2%, while the prevalence of clopidogrel resistance was 24.7% (47 in the resistance group and 143 in the sensitive group). The activation of platelet CD62P (t = -5.232, P < 0.001) and the prevalence of hypertension (χ2 = 4.878, P < 0.05) were more in the resistance group than in the sensitive group, while the vitamin D concentration was less (t = 3.052, P < 0.01). There was no significant difference in P-selectin between the resistance and sensitive groups (t = -0.684, P = 0.253). Logistic regression analyses showed that hypertension (OR = 5.538, 95% CI: 1.204-25.470, P < 0.05), activation of platelet CD62P (OR = 1.082, 95% CI: 1.041-1.092, P < 0.05) and vitamin D (OR = 0.848, 95% CI: 0.755-0.953, P < 0.01) were the independent related factors for clopidogrel resistance. Conclusion:Inhibition of platelet activation and supplementation of vitamin D may help to overcome the resistance of clopidogrel.

Study on Stability of Volatile Oil in Foeniculi Fructus and Screening Its Antioxidants in Accelerated Oxidation Environment / 中国实验方剂学杂志

Objective: To screen the accelerated oxidation environment with the most drastic changes in the volatile oil composition of Foeniculi Fructus, and to optimize the type and concentration of antioxidants. Method: The volatile oil of Foeniculi Fructus was extracted by steam distillation. Taking thiobarbituric acid reactive substances (TBARS) value and peroxide value (POV) as evaluation indexes, response surface method was used to investigate the effects of temperature, concentrations of ferrous ion (Fe2+) and azoamidine initiator V50 (AAPH) on volatile oil components of Foeniculi Fructus and its oxidation products. TBARS and POV were detected by ultraviolet chromatography. The oxidative environment with the most drastic changes of volatile oil composition of Foeniculi Fructus was screened. The type and concentration of antioxidants were selected by single factor experiments. The change discipline of volatile oil in Foeniculi Fructus after added different concentrations of antioxidants were analyzed by GC-MS. Result: The worst oxidizing environment for volatile oil of Foeniculi Fructus was as follows:temperature at 42.5℃,AAPH concentration of 1 g·L-1,Fe2+ concentration of 20.85 mg·L-1. Ascorbyl palmitate with concentrations of 0.2 mol·L-1 and 0.8 mol·L-1 could effectively improve the stability of volatile oil from Foeniculi Fructus. Conclusion: Under the accelerated oxidation environment, the terpenes in volatile oil from Foeniculi Fructus are significantly changed, but its stability can be improved by ascorbyl palmitate.

Further Discussion on the Problems and Countermeasures of Single Disease Payment Reform / 中国卫生经济

Through the investigation of the single disease policy and the local actual situation in many regions of the country, it analyzed the practical problems faced by Chinese medical institutions in the implementation of single disease payment policy. The necessity and urgency of the national unified single disease payment policy were put forward, and the system of standard quota payment for single disease standard was preferred, supporting patients to pay extra fees for differential medical services, standardize the accounting policy of single disease payment.

Graft heaIing and functionaI recovery after anterior cruciate Iigament reconstruction:a case study of rehabiIitation training / 中国组织工程研究

BACKGROUND: Anterior cruciate ligament (ACL) injury directly impacts the individual's lower limb function. It is very important for althelets whether rehabilitation training after ACL reconstruction is reasonable, effective and can restore the normal function of the knee joint.OBJECTIVE: To explore the effect of rehabilitation training on graft healing and knee joint function recovery after ACL reconstruction. METHODS: An elite rugby player was enrolled and subjected to phased rehabilitation training after ACL reconstruction. MRI examination was done before and after rehabilitation training. Then, the following indicators were tested, including joint flexion of knee, leg circumference degrees, isokinetic muscle strength of the lower limb, feedback test, the test of YBT, the Balance Error Scoring System, feedforward test, static balance test on one foot, dynamic balance test on the feet, Lysholm knee score, anaerobic work of the upper extremity, torso strength, to analyze the graft healing, body shape, the knee joint function and physical quality improvement after ACL reconstruction. RESULTS AND CONCLUSION: After 10 months of phased rehabilitation training, the graft healed well; the knee flexion degree was back to normal; knee joint swelling basically eliminated; the muscle strength of the extensor flexor of the knee joint was back to over 95% of the normal level; the function of the injured knee joint was good and returned to a higher level; the Lysholm knee score was 85 points; the anaerobic work of the upper limbs and trunk strength reached to 120% of the normal level; and the quality of the body was greatly improved. To conclude, a great improvement in graft healing, knee joint function, recovery of muscle strength and physical qualities has been achieved in athletes who receive rehabilitation training after ACL reconstruction.

Correlation analysis of reject reaction and corneal endothelial cells after penetrating keratoplasty from donation after cardiac death / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To study the relativity between reject reaction from donation after cardiac death (DCD) and corneal endothelial cell source of corneal graft after penetrating keratoplasty.METHODS:Totally 28 cases of corneal graft rejection after penetrating keratoplasty with cardiac death donor cornea were analyzed using corneal endothelial microscope at less than 1mo,2-3mo,4-6mo,7-12mo after operation.RESULTS:Coefficient variation of corneal endothelial cell of the 28 cases at less than 1 mo,2-3mo,4-6mo and 7-12mo were 38.23％,49.56％,57.18％,65.04％.Corneal endothelial cell density were 2071.15 ± 311.47,1771.33 ± 348.18,1626.59±353.92,1553.14±307.31.The coefficient variation of corneal endothelial cells was positively correlated with rejection (r =0.95,P ＜ 0.05).The postoperative corneal endothelial cell density was negatively correlated with rejection (r=-0.93,P＜0.05).CONCLUSION:The corneal endothelial cell coefficient variation increased gradually and the corneal endothelial cell density decreased gradually after DCD corneal allograft rejection.Corneal endothelial cell coefficient variation and corneal endothelial cell density can be used as indicators of early detection of postoperative rejection.