Theory and application of pulse diagnosis at Renying and Cunkou regions / 中国针灸

Renying and Cunkou pulse diagnostic method is one of the important parts of the pulse diagnosis in Huangdi Neijing (Inner Canon of Yellow Emperor) and has been controversial since its proposal. This article takes WANG Shu-he's diagnostic operation as the evidence, and is in reference of the statement, "Cun region (the region ahead of Guan region of Cunkou) determines the human life, that on the left hand refers to Renying, while on the right hand is Qikou". The pulse conditions on the left and right hands represent yin and yang. If Renying pulse on the left is greater, the diseases are in yang meridians, while if Cunkou pulse on the right is bustling, the diseases are in yin meridians. By comparing the pulse condition and strength, as well as the pulse beating (rapid and urgent) between Guan region and region ahead of Guan on the same side, the conditions of three yang and three yin meridians are detected. In treatment, based on the records of Renying and Cunkou pulse diagnosis in Huangdi Neijing, the principles are proposed for reinforcing and reducing methods on hand and foot meridians of yin and yang. Five-shu points and yuan-source points are taken as the main acupoints in acupuncture treatment. During treatment, the changes in pulse conditions should be emphasized specifically and those at Renying and Cunkou regions are the criteria for judging qi arrival and qi regulation.

Influencing factors for occupational stress among frontline employees in a chemical fiber manufacturing enterprise / 预防医学

Objective @#To investigate the status of occupational stress and analyze its influencing factors among frontline employees working in a chemical fiber manufacturing enterprise, so as to provide insights into the development of occupational stress interventions. @*Methods @#The frontline employees working in a chemical fiber manufacturing enterprise were selected as the study subjects using a cluster sampling method in October 2018. The status of occupational stress was investigated using the Chinese version of the effort-reward imbalance ( ERI ) questionnaire. The influencing factors for occupational stress were identified using a multivariable logistic regression model. @*Results @#A total of 1 780 questionnaires were sent out, and 1 115 valid ones ( 62.64% ) were recovered. Among the 1 115 respondents, there were 427 men ( 38.30% ) and 688 women ( 61.70% ), and 71.22% were at ages of 21 to 39 years. There were 561 respondents with < 1 year of service ( 50.31% ), and the longest length of service was 11 years. In addition, there were 1 069 respondents ( 95.87% ) exposed to high noise, and 346 respondents ( 31.03% ) were diagnosed at a high occupational-stress state and 769 ( 68.97% ) at a low state. Multivariable logistic regression analysis identified 5 years or longer of service ( OR=1.540, 95%CI: 1.057-2.245 ) and exposure to high noise ( OR=1.917, 95%CI: 1.004-3.659 ) as risk factors for occupational stress among frontline employees in the chemical fiber manufacturing enterprise. @*Conclusions @#There are 31.03% of frontline employees at a high occupational-stress state in the chemical fiber manufacturing enterprise, and a high occupational-stress state is associated with exposure to high noise and 5 years or longer of service.

Epidemiological and etiological analysis of two infantile cases of serogroup B epidemic cerebrospinal meningitis epidemics in Shandong Province, 2021 / 中华预防医学杂志

Two cases of epidemic situation of serogroup B meningitis in infants in Shandong Province in 2021 were investigated. Samples of cases and their close contacts were collected for isolation, culture and identification of Neisseria meningitides (Nm). The isolates were subjected to multi-locus sequence typing, outer membrane protein porA and fetA genotyping and drug sensitivity test. Two laboratory-confirmed outbreaks of serogroup B meningitis were reported from Yantai city and Linyi city. The indicated cases were infants aged 5 months and 2 months old respectively. They were not vaccinated with meningitis vaccine. Their epidemiological characteristics and clinical manifestations were similar and the prognosis was good. The same sequence type (ST) of serogroup B Nm strains as the indicated cases was detected in the samples of close family contacts, but without subsequent cases. Among them, Yantai strain was were identified as the type ST-8920, belonging to CC4821 clonal complex, and the genotypes of porA and fetA were p1.21-2, 23 and F3-1. Linyi strain was a new type, belonging to CC4821 clonal complex and the genotypes of porA and fetA were p1.20, 23 and F1-91. The above strains were resistant to penicillin, ciprofloxacin, levofloxacin and Chemitrim, and their sensitivity to cephalosporin decreased. Two cases of infant serogroup B epidemic were relatively rare in China, which were different from the epidemiological and pathogenic characteristics of other Nm serogroups in the past.

Dynamic assessment of the dose perturbation by sliding rails in intensity-modulated radiotherapy for spinal metastases / 中华放射医学与防护杂志

Objective:To investigate the impact of carbon based non-conductive sliding rails on intensity-modulated radiation therapy (IMRT) planning for vertebral tumors.Methods:A reconstruction imaging of the couch plate and its rails removed from the EDGE linear accelerator was acquired by helical computed tomography (CT), and pushed into the treatment planning system (TPS). Based on CT images of homogeneous phantom and patients in our database, 6 and 10 MV photon IMRT plans were designed with five fields (180°, 200°, 220°, 160°, 140°), setting a prescribed dose of 3 Gy/F ×10 F to the planning target volume (PTV), and the dose was calculated by AcruosXB. In addition, optimization plans (OP) without rails and with rails symmetrically moving (4-19 cm, step size 1 cm) were created and verification plans(VP) were created by inserting and removing slide rail′s structure from the corresponding OP in VP. The differences in mean dose ( Dmean), homogeneity index (HI), and conformability index (CI) of the PTV, and maximum dose ( Dmax) of the spinal cord were compared and analyzed between the VP and OP. Results:HI of PTV with and without the rails were worse in the 6/10 MV verification plans, with a maximum difference of 2%. In 6 MV plans, with rails Dmean of PTV decreased by (2.07±0.99)%, CI increased by (4.91±3.12)%, and Dmax of spinal cord decreased by (1.83±1.37)%. Without rails, the Dmean of PTV increased by (2.02±0.96)%, but CI decreased by (3.07±1.31)% and Dmax of the spinal cord increased by (2.03±1.44)% in the patient respectively. There were significant statistical differences between groupswith and without rails( F=27.55, 361.32, 13.05, P<0.05). The target volume Dmean and spinal cord Dmax decreased with a sloping " W" with the change of the rail position. The difference appeared to be noticeable in the range of less than 10 cm, but it gradually decreased as the rails slid to the outside until it reached zero, and the Dmean of PTV and Dmax of the spinal cordchanges were less in 10 MV plans, comparing to 6 MV plans. Conclusions:The dose attenuation by the sliding rails of the Qfix kVue should not ignored in the IMRT of spinal metastases and the slide position should be consistent with the planned position.

Qualitative and quantitative analysis of aristolochic acid components in nine Chinese medicinal materials containing toxic aristolochic substances / 药学学报

The objective of this work was to explore the content and composition of aristolochic acid compounds in Chinese medicinal materials containing toxic aristolochic chemicals, so as to ensure the safety of these medicinal materials and their related products. Nine Chinese medicinal materials were selected for study, including the tuber of Aristolochia cinnabarina, the herbs of Asarum forbesii, the stems of Aristolochia manshuriensis., the fruits of Aristolochia debilis, the roots of Aristolochia debilis, the stems and leaf of Aristolochia debilis, the herbs of Aristolochia mollissima, the roots of Aristolochia fangchi, and the roots of Asarum heterotropoides var. mandshuricum. The aristolochic acid components in the nine Chinese medicinal materials were analyzed by high performance liquid chromatography-quadrupole time of flight mass spectrometry (HPLC-Q-TOF-MS) combined with high performance liquid chromatography diode-array detection. The separation was performed on an Agilent ZORBAX SB-Aq column (250 mm×4.6 mm, 5 μm) with gradient elution using a mobile phase consisting of acetonitrile and 0.2% acetic acid. ESI positive ion mode MS was used to investigate the ionization pathways of aristolochic acid Ⅰ, Ⅱ, Ⅲa, Ⅳa, Ⅶa, and aristololactam Ⅰ, Ⅱ using seven reference standards, and the structures of the components with UV spectrasimilar to those of the seven reference standards in the selected medicinal materials were qualitatively analyzed by following the investigated ionization pathways. The identified aristolochic acid components were quantified using an external standard method by HPLC-UV with detection at 254 nm. Twenty-two aristolochic acid components including 11 aristolochic acids and 11 aristololactams were identified from the nine selected medicinal materials; 15 aristolochic acids were found in the tuber of Aristolochia cinnabarina and the roots of Aristolochia debilis, followed by 14 aristolochic acids in the fruits of Aristolochia debilis and the stems of Aristolochia manshuriensis. The greatest content of aristolochia components was found in the tuber of Aristolochia cinnabarina and the stems of Aristolochia manshuriensis, ranging from 8.91 mg·g-1 to 13.40 mg·g-1, and the least amount was in the herbs of Asarum forbesii, at less than 0.10 mg·g-1 and containing only two aristolochia components. This study systematically explored the quantity and composition of aristolochic acid components in selected Chinese medicinal materials believed to contain toxic aristolochic compounds, providing a basis for follow-up studies on the toxicity of these substances that can lead to safety standards for their use.

25G PPV combined with IOL ciliary sulcus suture, fixation and replacement in the treatment of IOL capsule bag complex dislocation in the vitreous cavity / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with intraocular lens(IOL)ciliary sulcus suture fixation and replacement of IOL capsular bag complex.<p>METHODS: A retrospective analysis of 21 patients(21 eyes)in our hospital who applied 25G PPV combined with IOL ciliary sulcus suture and fixation replacement in our hospital from January 2015 to January 2020 to treat the IOL capsular complex completely detached from the clinical data.<p>RESULTS: All the cases were successfully removed the dislocated IOL complex during the operation. There was no iatrogenic retinal damage. During the operation, 4 cases(4 eyes)were found to have the retina hole, 2 cases(2 eyes)were found to be retinal lattice degeneration area, which were treated with laser photocoagulation of the retina. Follow-up for 6-18mo, best corrected visual acuity(BCVA)(LogMAR)increased from 0.40±0.30 before operation to 0.33±0.25 after operation(<i>P</i>=0.040). The BCVA at the last follow-up of all cases reached the BCVA before surgery. The absolute value of the difference between the postoperative spherical equivalent power and the preoperative IOL refractive power prediction value is less than or equal to 0.75D. At the last follow-up, the position of the intraocular lenses in all cases was good, and there were no complications such as retinal detachment. <p>CONCLUSION: The technique of 25G PPV and the exchange of IOL ciliary sulcus fixation with intraocular IOL capsule complex is a safe and effective procedure for dislocation of IOL-capsular bag complex entirely into the vitreous cavity.

Effect and safety of PPV assisted by intravitreal injection of Conbercept in the treatment of PDR combined with vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect and safety of pars plana vitrectomy(PPV)assisted by intravitreal injection of conbercept in the treatment of proliferative diabetic retinopathy(PDR)combined with vitreous hemorrhage(VH).<p>METHODS: In the prospective randomized controlled study, patients with PDR and VH who were admitted to ophthalmology department of the hospital from February 2017 to September 2019 were enrolled as the research objects. They were randomly divided into observation group(39 cases, 39 eyes)and control group(38 cases, 38 eyes). Both groups underwent standard 27G PPV. The observation group underwent intravitreal injection of conbercept within 6-7d before surgery. The perioperative indexes were collected. The best corrected visual acuity(BCVA), intraocular pressure and central macular thickness(CMT)were followed up. The occurrence of surgical related complications was statistically analyzed.<p>RESULTS: Operation time(74.18±15.26 <i>vs </i>96.17±14.27min), number of bleeding eyes(8% <i>vs </i>37%), ratio of silicone oil filling(18% <i>vs </i>53%)and incidence of iatrogenic retinal breaks(15% <i>vs </i>47%)were lower in observation than control group(<i>P</i><0.05). BCVA at 1mo after surgery(0.33±0.10 <i>vs </i>0.60±0.21), 3mo after surgery(0.29±0.08 <i>vs </i>0.59±0.30)and 6mo after surgery(0.28±0.10 <i>vs </i>0.66±0.25)were significantly better in observation than control group(<i>P</i><0.05). CMT at 3mo after surgery(252.15±56.96 <i>vs </i>278.41±57.48μm)and 6mo after surgery(239.65±41.52 <i>vs </i>268.59±33.71μm)were significantly better in observation than control group(<i>P</i><0.05). During follow up, the incidence rates of VH in observation group and control group were 5% and 21%, respectively(<i>P</i><0.05). In control group, there were 3 eyes(8%)with tractional retinal detachment after surgery, while there was no tractional retinal detachment in observation group(<i>P</i>>0.05).<p>CONCLUSION: For patients with PDR and VH, intravitreal injection of conbercept before PPV can shorten operation time, reduce intraoperative blood loss and alleviate macular edema to obtain better visual acuity, with better curative effect and safety.

Comparison of corneal biomechanics among primary open-angle glaucoma with normal tension or hypertension and controls / 中华医学杂志(英文版)

BACKGROUND@#Normal tension glaucoma (NTG) is a less pressure-dependent type of glaucoma with characteristic optic neuropathy. Recently, the biomechanical mechanism has been thought to account for glaucomatous optic neuropathy to some degree. We intended to compare dynamic corneal response parameters (DCRs) among patients with primary open-angle glaucoma with normal tension or hypertension and controls. The correlations between DCRs and known risk factors for glaucoma were also analyzed.@*METHODS@#In this cross-sectional study, 49 NTG subjects, 45 hypertension glaucoma (HTG) subjects, and 50 control subjects were enrolled. We compared the differences in DCRs using corneal visualization Scheimpflug technology among the NTG, HTG, and control groups. We also analyzed the correlations between DCRs and known risk factors for glaucoma (eg, central corneal thickness [CCT], intraocular pressure [IOP], etc).@*RESULTS@#The maximum inverse concave radius (NTG: 0.18 [0.17, 0.20] mm-1; control: 0.17 [0.16, 0.18] mm-1; P = 0.033), deformation amplitude ratio of 2 mm (DAR 2 mm, NTG: 4.87 [4.33, 5.39]; control: 4.37 [4.07, 4.88]; P  0.05). In the univariate and multivariate analyses, some of the DCRs, such as IR, were negatively correlated with CCT and IOP, whereas SP-A1 was positively correlated with CCT and IOP.@*CONCLUSIONS@#The cornea was more deformable in NTG than in HTG or controls. There were no significant differences in corneal deformability between HTG and controls. The cornea was more deformable with the thinner cornea and lower IOP.

Promotion of Analgecine on Polarization of M1 Microglia to M2 and Inhibition on Secretion of Inflammatory Factors in Vitro / 中国康复理论与实践

Objective:To investigate the effect of analgecine (AGC) on inflammatory response in the cell model of ischemic stroke and its mechanism. Methods:Sodium hydrosulfite (Na2S2O2) combined with sugar-free culture-medium was used to stimulate the model of ischemic stroke in vitro. BV2 cells were divided into six groups: control group, control with 0.5 U/ml AGC group, oxygen deprivation and recovery (OGD/R) group, OGD/R with AGC (0.25 U/ml, 0.5 U/ml, 1 U/ml) groups. After oxygen and glucose deprivation for 1.5 hours, they were changed to normal medium and given different concentrations of AGC in OGD/R with AGC groups. After co-incubation for three hours, the cells were treated. The content of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the supernatant was detected. The expression of M1-type microglia marker CD16+CD32 and M2-type microglia marker CD206 were detected with immunofluorescent staining. BV2 cells were divided into seven groups: control group, control with 0.5 U/ml AGC group, IL-4 group, IL-4 + lipopolysaccharide (LPS) + interferon (IFN)-γ group, IL-4 + LPS + IFN-γ with AGC (0.25 U/ml, 0.5 U/ml, 1 U/ml) groups. After 24 hours of IL-4 treatment, LPS + IFN-γ were added for 18 hours, they were changed to normal medium and given different concentrations of AGC for 24 hours, the expression of CD16+CD32 and CD206 were observed by flow cytometry. Results:Compared with the control group, the IL-6 and TNF-α level increased (P < 0.01), the number of CD16++CD32+ increased and the number of CD206+ decreased in OGD/R group. Compared with the OGD/R group, the IL-6 and TNF-α level decreased (P < 0.01), the number of CD16++CD32+ decreased and the number of CD206+ increased in AGC groups. Compared with the control group, the number of CD206 tended to increase, and the number of CD16+CD32 tended to decrease in IL-4 group; compared with IL-4 group, the number of CD16+CD32 tended to increase, and the number of CD206 tended to decrease in IL-4 + LPS + IFN-γ group; compared with IL-4 + LPS + IFN-γ group, the number of CD16+CD32 tended to decrease, and the number of CD206 tended to increase in IL-4 + LPS + IFN-γ + 0.25 U/ml AGC group and IL-4 + LPS + IFN-γ + 0.5 U/ml AGC group, while the number of CD206 increased in IL-4 + LPS + IFN-γ + 1.0 U/ml AGC group (P < 0.05). Conclusion:AGC could inhibit the secretion of inflammation factors by promoting the polarization of microglia from M1 phenotype to M2 phenotype.

Effect of Individualized Moderate-intensity Exercise Prescription on Cardiopulmonary Function for Patients with Pulmonary Arterial Hypertension / 中国康复理论与实践

Objective:To analyze the cardiopulmonary function of stable patients with pulmonary arterial hypertension (PAH), and to explore effects of the cardiopulmonary exercise testing (CPET)-based individualized moderate-intensity exercise prescription on cardiopulmonary functional reserve and exercise capacity in patients with PAH. Methods:From April, 2018 to July, 2019, 31 stable patients with PAH (PAH group) and 32 healthy counterparts (normal group) were enrolled. All subjects underwent CPET. PAH group was assessed with 6-Minute Walking Test (6MWT), and then was divided into exercise group (n = 16) and control group (n = 15). Both groups were treated with ordinary targeted drugs, while the exercise group was additionally provided with an individualized moderate-intensity exercise prescription of △50% power treadmill training, five days a week for eight weeks. CPET and 6MWT were conducted again after intervention. Results:Before intervention, body mass, body mass index (BMI), force vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum voluntary ventilation (MVV), anaerobic threshold (AT), peak heart rate (HRpeak), peak systolic blood pressure (SBPpeak), peak load power (WRpeak), peak oxygen uptake (VO2peak), peak oxygen pulse (VO2/HRpeak), peak cardiac output (COpeak), peak minute ventilation (VEpeak), peak end-tidal carbon dioxide (PETCO2peak), peak pulse oxygen saturation (SpO2peak) and oxygen uptake efficiency plateau (OUEP) were significantly lower (t > 2.419, P < 0.05), and the rest heart rate (HRrest), peak dead space to tidal volume ratio (VD/VTpeak), minimum ventilatory equivalent for carbon dioxide (Lowest VE/VCO2) and slope of ventilatory equivalent for carbon dioxide (VE/VCO2 slope) were higher (|t| > 2.615, P < 0.05) in PAH group than in the normal group. After intervention, FEV1, MVV, VO2peak (ml/min/kg) and VO2/HRpeak decreased in the control group (t > 2.272, P < 0.05); FVC, FEV1, MVV, AT, SBPpeak, WRpeak, VO2peak, VO2/HRpeak, COpeak, VEpeak, PETCO2peak, SpO2peak and 6-Minute Walking Distance (6MWD) increased (|t| > 2.167, P < 0.05), while the average Lowest VE/VCO2 and VE/VCO2 slope decreased (t > 2.264, P < 0.05) in the exercise group. Compared with the control group, the FEV1/FVC, AT, WRpeak, VO2peak, VO2/HRpeak, COpeak and 6MWD increased in the exercise group (|t| > 2.168, P < 0.05). Conclusion:The holistic cardiopulmonary function of stable patients with PAH decreases. CPET-based individualized moderate-intensity exercise could enhance the cardiopulmonary functional reserve and exercise capacity of patients with PAH.

Effects of Analgecine on Apoptosis and Neuroinflammation in Cerebral Ischemia-reperfusion Injury Rats / 中国康复理论与实践

Objective:To observe the effects of Analgecine (AGC) on middle cerebral artery ischemia-reperfusion injury in rats and its mechanism. Methods:A total of 61 Sprague-Dawley rats were divided into sham group (n = 11), sham-AGC group (n = 11), model group (n = 20) and model-AGC group (n = 19). The model group and the model-AGC group were occluded the middle cerebral arteries for 1.5 hours and reperfused (2 rats in each group unsuccessful). The sham-AGC group and the model-AGC group were injected AGC 20 U/kg through tail-vein, while the sham group and the model group were injected saline of same volume. Four rats in each group were tested heat shock proteins 70 (HSP70), Bcl-2 and Bax in brain with Western blotting 48 hours after injection. The other rats were assessed with Prehensile Traction Test seven days after injection, and then, four of each group were detected ionized calcium binding adapter molecule 1 (Iba1) and glial fibrillary acidic protein (GFAP) expression with immunohistochemistry. Results:The prehensile time increased in the model-AGC group compared with that of the model group (P < 0.01), with the increase of HSP70 and Bcl-2 (P < 0.01) and decrease of Iba1 and GFAP expression (P < 0.05). Conclusion:AGC may promote the recovery of motor function in rats with cerebral ischemia-reperfusion injury, which may associate with inhibiting cell apoptosis and neruoinflammatory response.

Effect of decompression range on decompression limit of cervical laminoplasty / 中华医学杂志(英文版)

BACKGROUNDS@#Cervical posterior decompression surgery is used to relieve ventral compression indirectly by incorporating a backward shift of the spinal cord, and this indirect decompression is bound to be limited. This study aimed to determine the decompression limit of posterior surgery and the effect of the decompression range.@*METHODS@#We retrospectively reviewed the data of 129 patients who underwent cervical open-door laminoplasty through 2008 to 2012 and were grouped as follows: C4-C7 (n = 11), C3-C6 (n = 61), C3-C7 (n = 32), and C2-C7 (n = 25). According to the relative location of spinal levels within a decompression range, the type of decompression at a given level was categorized as external decompression (ED; achieved at the levels located immediately external to the decompression range margin), internal decompression (ID; achieved at the levels located immediately internal to the decompression range margin), and central decompression (CD; achieved at the levels located in the center, far from the decompression range margin). The vertebral-cord distance (VCD) was used to evaluate the decompression limit. The C2-C7 angle and VCD on post-operative magnetic resonance images were analyzed and compared between groups. The relationship between VCD and decompression type was analyzed. Moreover, the relationship between the magnitude of the ventral compressive factor and the probability of post-operative residual compression at each level for different decompression ranges was studied.@*RESULTS@#There was no significant kyphosis in cervical curvature (> -5°), and there was no significant difference among the groups (F = 2.091, P = 0.105). The VCD of a specific level depended on the decompression type of the level and followed this pattern: ED < ID < CD (P < 0.05). The decompression type of a level was sometimes affected by the decompression range. For a given magnitude of the ventral compressive factor, the probability of residual compression was lower for the group with the larger VCD at this level.@*CONCLUSIONS@#Our study suggests that the decompression range affected the decompression limit by changing the decompression type of a particular level. For a given cervical spinal level, the decompression limit significantly varied with decompression type as follows: ED < ID < CD. CD provided maximal decompression limit for a given level. A reasonable range of decompression could be determined based on the relationship between the magnitude of the ventral compressive factor and the decompression limits achieved by different decompression ranges.

Influencing factors for hospitalization of pneumoconiosis patients / 预防医学

Objective@#To analyze the influencing factors for hospitalization of pneumoconiosis patients, so as to provide reference for improving the timeliness of treatment and quality of life in these patients. @*Methods@#The pneumoconiosis patients in Changshan, Wenling and Changxing ( having mining industry ) of Zhejiang Province were selected by stratified and typical sampling methods. Their demographic features, prevalence of pneumoconiosis and hospitalization status were collected by a questionnaire survey. Logistic regression analysis was conducted to analyze the influencing factors for hospitalization. @*Results@#Among 166 pneumoconiosis patients, 122 ( 73.49% ) chose to be hospitalized. The multivariate logistic regression analysis revealed that the patients who scored higher in ED-5Q ( OR=65.821, 95%CI: 3.831-1130.781 )and who would communicate with other pneumoconiosis patients ( OR=3.744, 95%CI: 1.261-11.115 ) were more likely to be hospitalized; the patients who were under the medical insurance for urban employees were more likely to be hospitalized than those who were under the new rural cooperative medical care system ( OR=0.033, 95%CI: 0.007-0.154 ) and others ( OR=0.038, 95%CI: 0.002-0.960 ) . @*Conclusion@#The quality of life, communication with other pneumoconiosis patients and type of medical insurance were the influencing factors for hospitalization of pneumoconiosis patients.

Spectrum-effect Relationship of Anti-hepatoma Activity from 3 Kinds of Genus Paris Based on Cluster Analysis and Grey Relational Analysis / 中国实验方剂学杂志

Objective::To study the spectrum-effect relationship between HPLC fingerprints and anti-hepatoma activity of Paris polyphylla var. yunnanensis, P. forrestii and P. vietnamensis, and to elucidate its effective substance. Method::HPLC was used to establish the fingerprint of three extracts from the plant. The mobile phase was consisted of acetonitrile (A)-water (B) for gradient elution (0-10 min, 20%A; 10-20 min, 20%-25%A; 20-30 min, 25%-30%A; 30-40 min, 30%-35%A; 40-50 min, 35%-40%A; 50-60 min, 40%A; 60-75 min, 40%-45%A; 75-80 min, 45%-60%A), and the flow rate was 0.9 mL·min-1. The UV detection wavelength was 203 nm. Thiazolyl blue tetrazolium bromide (MTT) array was used to detect the inhibitory effects of three extracts on the proliferation of HepG2 cells, and the half inhibitory concentration (IC50) was calculated. Cluster analysis and grey relational analysis were used to analyze the data of spectrum and efficacy, and to find out the components that contributed a lot to the anti-liver cancer effect. Result::A total of 11 common peaks were identified as common peaks among HPLC fingerprints of three kinds of Paris. After treated 72 h, P. forrestii has the highest inhibitory effect on the HepG2 cells, the IC50 of P. forrestii, P. polyphylla var. yunnanensis and P. vietnamensis were 148.33, 178.87, 208.09 mg·L-1, respectively. According to the grey relational analysis, the common peaks 1-10 from P. polyphylla var. yunnanensis had great correlation to anti-tumor effect, and the common peaks 1-7 for P. forrestii, the common peaks 1-4, 6-10, N1 for P. vietnamensis, all the correlation degrees with IC50 were >0.7.Cluster analysis of variables in each Paris showed that peaks with correlation degree >0.7 could cluster with IC50. Conclusion::The established HPLC fingerprint method is reliable with good reproducibility. The peaks 1-4, 6 and 7 from three kinds of Paris have the greatest contribution to the anti-hepatoma effect.

Terpenoids from Stems and Leaves of Aphanamixis grandifolia / 中国实验方剂学杂志

Objective:Aphanamixis grandifolia，a perennial herb of genus Aphanamixis （Meliaceae），has effects in soothing activating collaterals，dredging paisy，expelling wind-evil and removing wetness. This paper aimed to investigate terpenoids from the stems and leaves of A. grandifolia and reveal the effective substances. Method:Totally 22 kg leaves and twigs of A. grandifolia were extracted with 90% EtOH for three times by heating reflux. These extracts were decompressed and concentrated，and then dissolved in water. The solvent was successively extracted with petroleum ether and ethyl acetate. The chemical constituents from petroleum ether and ethyl acetate fractions were isolated by macroporous，silica gel，Sephadex LH-20 and ODS columns，and their chemical structures were determined through MS，NMR analysis（1H and 13C-NMR）and spectroscopic data from literatures，respectively. Result:Twelve compounds were obtained and identified as 16α-hydroxy-3-oxo-24-methyllanosta-7，9（11），24（31）-triene-21-oic acid （1），23（E）-cycloart-en-25-ethoxy-3-ol（2），23（Z）-9，19-cycloart-ene-3β，25-diol（3），23（E）-cycloart-en-3β，25-diol（4），labda-8，13-（E）-dien-15-ol（5），labda-7，13-（E）-dien-15-ol（6），vulgarol（7），（S，E）-6-[6-（5，5-dimethyl-4-oxo-4，5-dihydrofuran-3-yl]-2-methylhepta-1，6-dien-1-yl]-4-methyl-5，6-dihydro-2H-pyran-one（8），nemoralisin（9），nemoralisin C（10），1S，4R，5S，6R，7S，10S-1（5），6（7）-diepoxy-4-guaiol（11） and 1S，4S，5S，10R-4，10-guaianediol（12），respectively. Conclusion:The structures involves triterpenoids，diterpenoids and sesquiterpennoids，and eight of them （1-3，5-8 and 12） are obtained from A. grandifolia for the first time. Those compounds are also isolated from the geneus Aphanamixis for the first time.

Preliminary study of in vivo dose measurement of intensity-modulated radiotherapy for cervical cancer / 中华放射肿瘤学杂志

Objective:To monitor and evaluate in vivo dose changes of intensity-modulated radiotherapy (IMRT) in patients with cervical cancer in a real-time manner. Methods:Twelve patients with cervical cancer admitted to our hospital were enrolled in this study. The in vivo doses were monitored by PerFRACTION?. Electronic portal imaging device (EPID) were collected in each treatment fraction for two-dimensional in vivo dose verification[γ index and dose difference (DD) index]. Log files were recorded for three-dimensional in vivo dose verification (γ index). The correlation between in vivo dose and treatment duration was analyzed by Pearson correlation analysis. Results:A total of 206 sets of EPID images and corresponding Log files were collected. The three-dimensional in vivo dose verification γ 1%/1mm of all patients was not correlated with treatment fraction ( P>0.05). Among them, the absolute difference of γ 1%/1mm of 94.66% fractions was< 1%. The mean DD 3% of two-dimensional in vivo dose verification of all patients was negatively correlated with treatment fraction ( P<0.05). Among which, the average γ 3%/3mm of 9 patients was>89% in the treatment fractions, and the average γ 3%/3mm of 98.57% fractions of these 9 patients was>93%. The other 3 patients had an average γ 3%/3mm ranged from 38% to 100%. CBCT images showed that the bladder volume of these 3 patients was significantly decreased with the relative changes by 82.08%, 84.41% and 73.59%, respectively, and the target area was retracted significantly with the relative changes by 38.12%, 59.79% and 24.46%, respectively. Conclusion:Combined with γ index and DD index, PerFRACTION? can monitor the mechanical stability of accelerator and MU delivery accuracy during treatment fractions, and monitor the changes of in vivo dose in patients with cervical cancer, which can improve the safety and quality assurance of IMRT for cervical cancer patients and provide guidance for patients with adaptive radiotherapy.

Risk factors for multiple debridements of the patients with deep incisional surgical site infection after spinal surgery / 北京大学学报(医学版)

OBJECTIVE@#To investigate the risk factors that contribute to multiple debridements in patients suffering from deep incisional surgical site infection after spinal surgery and advise medical personnel to pay special attention to these risk factors.@*METHODS@#We retrospectively enrolled 84 patients who got deep incisional surgical site infection after spinal surgery from Jan. 2012 to Dec. 2017. The infections occurred within 30 days after the surgery, and the identification met the criteria of deep incisional surgical site infection of Centers of Disease Control (CDC). Early debridement with first stage closure of the wound and a continuous inflow-outflow irrigation system was used, and reasonable antibiotics were chosen according to the bacterial culture results. During the treatment, the vital signs, clinical manifestations, blood test results, drainage fluid colour and bacterial culture results were acquired. If the infection failed to be controlled or relapsed, a second debridement was performed. Of the 84 cases, 60 undergwent single debridement which included 36 male cases and 24 female cases, and the age ranged from 36 to 77 years, with a mean of 57.2 years. Twenty four had multiple debridements (twice in 14 cases, three times in 6 cases, four times in 1 case, five times in 2 cases, six times in 1 cases) which included 17 male cases and 7 female cases, and the age ranged from 21 to 70 years, with a mean of 49.5 years. Risk factors that predispose patients to multiple debridements were identified using univariate analysis. Risk factors with P values less than 0.05 in univariate analysis were included together in a multivariate Logistic regression model using back-forward method.@*RESULTS@#Multiple debridements were performed in 28.6% of all cases. The hospital stay of multiple debridements group was (82.4±46.3) days compared with (40.4±31.5) days in single debridement group (P=0.018). Instrumentation was removed in 6 cases in multiple debridements group and 4 cases in single debridement group (P=0.049). Flap transplantation was performed in 7 cased in multiple debridements group while none in single debridement group (P < 0.001). Diabetes, primary operation duration longer than 3 hours, primary operation blood loss more than 400 mL, bacteriology examination results, distant site infection were significantly different between the two groups in univariate analysis. In multivariate analysis, primary operation duration longer than 3 hours (OR=3.60, 95%CI: 1.12-11.62), diabetes (OR=3.74, 95%CI: 1.06-13.22), methicillin-resistant Staphylococcus aureus (MRSA) infected (OR=16.87, 95%CI: 2.59-109.73) were the most important risk factors related to multiple debridements in the patients with deep incisional surgical site infection after spinal surgery.@*CONCLUSION@#Diabetes, primary operation duration more than 3 hours, MRSA infected are independent risk factors for multiple debridements in patients suffering from deep incisional surgical site infection after spinal surgery. Special caution and prophylaxis interventions are suggested for these factors.

An anterior neurovascular interval approach to coronal shear fractures of the distal humerus: a prospective clinical study with short- to mid-term follow-up

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.

A new Cannabis germplasm classification system and research strategies of non-psychoactive medicinal cannabis / 中国中药杂志

At present,China manages cannabis into industrial and medical types. Industrial cannabis( THC<0. 3%) is grown for fiber and seed,while medical cannabis( THC>0. 3%) is prohibited from being planted and used. In recent years,breakthroughs have been made in the applications for a variety of fields of CBD,a non-psychoactive cannabinoid of Cannabis. However,China made a minimal contribution to this international research hotspot,mainly due to the outdated way of classification on cannabis. Here we reviewed the medicinal use history of cannabis,achievements in the study of Cannabis germplasm,and first proposed the three-level classification of management: psychoactive medicinal cannabis( THC>0. 3%),non-psychoactive medicinal cannabis( THC<0. 3%,high CBD)and industrial cannabis( THC<0. 3%,for fiber and seed,low CBD). Based on summarizing the research progress of the non-psychoactive medicinal cannabis,four key research strategies of breeding,sex control,plant factory,and synthetic biology are proposed.

Determination and Analysis of Heavy Metals of Paridis Rhizoma from Different Localities and Pieces / 中国实验方剂学杂志

Objective:To analyze and determine heavy metal content in Paridis Rhizoma from different genus and localities,in order to provide a reference for selecting cultivation areas and establishing the quality standard of Paridis Rhizoma of heavy metals content. Method:Microwave digestion method combined with inductively coupled plasma atomic emission spectrometry method (ICP-AES) method were applied to determine the contents of 6 heavy metals,i.e. As,Cu,Hg,Cd,Pb and Cr in 39 samples of Paridis Rhizoma of different genus and localities in Yunnan Province. Cluster analysis,statistical analysis and principal component analysis (PCA) were used to compare the differences of heavy metals contents in different localities and species. Result:The contents of six heavy metals in Paridis Rhizoma met the ISO international standard of Heavy Metal Limit of Traditional Chinese Medicine-traditional Chinese Medicinal Materials. Under the limited value standard of Green Trade Standards of Importing Medicinal Plants and Preparations,the over-standard rate of heavy metal As was 15.4%,the excess rate of Cd was 5.1%,and the excess rate of Pb was 2.6%. The contents of Cu and Hg conformed to relevant requirements. Cluster analysis,statistical analysis and principal component analysis showed that for the same variety,differences in producing places had significant effects on heavy metal content,while differences in species had little effects. Conclusion:The results of this study indicated that the heavy metal content of Paris planted in and around Dali basically conformed to relevant standards. The differences of heavy metal content in Paris were mainly regional differences,which provided a theoretical basis for standardizing the cultivation of medicinal materials and formulating the limit standards of heavy metals for Paridis Rhizoma.