This article reviews the regulation and management of Traditional Chinese Medicine by the government and associations in the United States of America,and lists the detailed licensure requirements of acupunctadst by every state's laws and regulations,and it will facilitate the information exchange and cooperation in the field of Traditional Chinese Medicine.

The paper is to report the preparation of realgar bioleaching solution (RBS) by bacteria and the comparison of pharmacokinetics of RBS and H3AsO3 (ATO), and the study of its possible change of absorption and distribution of soluble arsenic in rat. The experiment was carried out on Wistar rats given peritoneal injection of RBS at a dose of 0.3 mg x kg(-1) (soluble arsenic content, 0.3 mg x kg(-1)), and rats given ATO at the dose of 0.3 mg x kg(-1) (soluble arsenic content, 0.3 mg x kg(-1)). The arsenic concentrations in many tissues including heart, liver, spleen, lung, renal and brain were determined. The changes of pharmacokinetic parameters and arsenic distribution in different tissues were detected and compared in these two groups of rats. The pharmacokinetic parameters of RBS and ATO are very similar. There is very few distribution of arsenic in the tissues in RBS group, compared with the ATO group. There is significant difference in the content of arsenic between two groups statistically (P < 0.01). It is feasible that we select the bacteria bioleaching solution as a candidate drug, which may be employed for primary change of arsenic compounds including dissolved inorganic arsenic and organic arsenic, in order to improve bioavailability and decrease the amount of arsenic accumulation in animal tissues. In addition, there is significant difference in the change of arsenic compounds between two groups. It can be concluded that, the investigation on application of microbial technology may provide a basis for exploratory research of realgar.

Objective To explore the effective procedures and practices to solve the ethical dilemma of nursing, and to building nursing ethics decision path. Methods Using inductive-deductive method, summarize predecessors′ research on nursing ethics mode and decision-making process, and establish nursing ethical decisions paths, then display the application based on clinical case. Results Six-steps-Nursing ethics decision path was established, and tested. Conclusions Pay attention to strengthen the cultivation of nurses nursing ethics accomplishment and ability of the decision.

Objective To explore the effect of motor imagery on motor recovery in hemiplegic patients after stroke. Methods From May, 2015 to October, 2016, 40 hemiplegic patients after stroke were randomly divided into control group (accepted routine rehabilitation, n=20) and motor imagery group (accepted motor imagery and routine rehabilitation, n=20). They were assessed with Fugl-Meyer Assess-ment (FMA), modified Barthel Index (MBI) before and six weeks after treatment. Fractional anisotropy (FA) of the focus was measured with diffusion tensor imaging (DTI). Results The scores of FMA and MBI improved in both groups after treatment (t>5.088, P<0.001), and improved more in the motor imagery group than in the control group (t>2.124, P<0.05). The FA reduced in the focus compared with the same site of unaffected side in both groups before treatment (t>3.892, P<0.01), and there was no significant difference between two groups (t<1.144, P>0.05). FA increased in more patients of the motor imagery group (5/5) than in the control group (2/4). Conclusion Motor imag-ery can promote the recovery of motor function and activities of daily living in stroke patients, and may help the recovery of fibers in white matter.

Objective To explore the application range and preponderance of different therapeutic methods of traditional medicines in overseas countries with retrospective studies on bibliographies of overseas traditional medicines. Methods All bibliographies were articles written in August 1964 to September 2009 and came from MEDLINE data base through searching 17 inferior words of"replacement therapy" in MeSH subject headings. Results We got altogether 10103 articles in 1633 kinds of periodicals concerned with replacement therapy, and summed up to 9841 effective articles in the end. Conclusion More and more attentions have been paid to traditional medicine in overseas countries; Such kinds of articles were mostly published in American and British medical periodicals; articles with advanced technologies and high reliability have more chances to be adopted by medical periodicals; traditional Chinese medicine plays a leading role in the fields of traditional medicines in the whole world; replacement therapy were increasingly adopted to deal with disease protection and health care.

Objective To investigate the characteristic sonographic and pathological features of breast ductal carcinoma in situ (DCIS) without microcalcifications on mammography (MG).Methods Forty cases of DCIS without microcalcifications on MG were retrospectively reviewed.The 40 lesions were classified into mass and non-mass groups according to their sonographic findings.The pathological subtypes and nuclear grades of these cases were also analyzed.Fisher exact test was used to compare the differences of the sonographic accuracy rate,sonographic microcalcification rate,pathological nuclear grade and subtype rate between mass and non-mass groups.Results No abnormal finding was found in sixteen cases (40.0％)on MG and only one case (2.5％) on ultrasonography (US),respectively.The most common sonographic feature of DCIS without microcalcifications on MG were masses (75.0％,30/40),and other sonographic findings were round/oval and irregular shape,microlobulated margin,heterogeneous hypoechogenicity and isoechogenicity,and posterior acoustic feature.Ductal dilatations and heterogeneous isoechogenicity were present in most non-mass lesions of DCIS without microcalcifications on MG (22.5％,9/40).The ultrasonographic microcalcifications were found in 5 cases of DCIS without microcalcifications on MG.The common pathological features of DCIS without microcalcifications on MG were medium-low nuclear grade (85.0％,34/40) and noncomedo (87.5％,35/40).The difference of US accuracy rate in mass and non-mass groups was statistically significant [73.3％ (22/30) vs 33.3％ (3/9),P=0.047].The differences of US microcalcification rate,pathological subtype and nuclear grade were not significant (P=1.000,0.070).Conclusions The mass appearance and medium-low nuclear grade were most common sonographic findings and pathological features of DCIS without microcalcifications on MG.Ultrasonography should be an helpful tool for improving the diagnostic sensitivity ofmammography in breast DCIS.

Objective:To explore the intervention effect of cognitive-walking dual-task training on executive and walking function in patients with cerebral apoplexy.Methods:A total of 70 stroke patients who were hospitalized in the Department of Rehabilitation Medicine of Baoding Taihe Rehabilitation Hospital from June 2020 to October 2020 were selected as the study subjects.All 70 hemiplegic patients with stroke were randomly divided into control group ( n=35) and test group ( n=35) by random number table method, and a prospective study was conducted.The control group was given routine walking training, and the test group was given cognitive-walking dual-task training at the same time and frequency as the control group.E-Prime software was used to evaluate the executive function of patients before and 4 weeks after intervention, including three sub-tests of Flanker, 1-back and More-odd shifting, and the reaction time of each test was recorded.The score changes of Mini-Mental Status Examination (MMSE) and Modified Rankin Scale (MRS) were recorded.The single-task walking time, dual-task walking time and dual-task walking time cost during 10 m Walk Test were calculated.Finally, 33 cases in the experimental group and 31 cases in the control group completed the study.Finally, 33 cases in the experimental group and 31 cases in the control group completed the study. Results:After 4 weeks of intervention, the MMSE scores of the experimental group and the control group were improved compared with those before intervention (the experimental group (26.39±1.90) and (24.42±2.69), t=10.824, P<0.001; the control group (25.45±1.77) and (24.61±2.16), t=7.325, P<0.001), and the experimental group was significantly better than the control group ( t=2.049, P=0.045)). The duration of three tests of executive function in the experimental group and the control group was significantly shorter than that before the intervention (Flanker task: the experimental group (752.38±178.28) ms and (939.42±260.11) ms, t=10.467, P<0.001; the control group (863.40±227.86) ms and (951.67±265.93) ms, t=8.140, P<0.001.1-back task: the experimental group (983.31±314.16) ms and (1 242.10±444.77) ms, t=10.386, P<0.001; the control group (1 186.89±293.80) ms and (1 238.27±305.95) ms, t=9.569, P<0.001.More odd shifting task: the experimental group (1 121.29±260.17) ms and (1 362.32±352.80) ms, t=13.084, P<0.001; the control group (1 255.81±269.41) ms and (1 351.37±287.46) ms, t=8.550, P<0.001), and the experimental group was significantly better than the control group (Flanker task: t=2.198, P=0.032; 1-back task: t=2.691, P=0.009; more odd shifting task: t=2.044, P=0.045). The results of 10 m walking test in the experimental group and the control group were improved compared with those before the intervention (single task walking time: the experimental group (20.71±9.61) s and (26.10±13.88) s, t=6.312, P<0.001; the control group (22.42±9.60) s and (25.62±10.97) s, t=13.009, P<0.001). The duration of dual task walking: the experimental group (22.73±10.28) s and (31.64±16.07) s, t=7.931, P<0.001; the control group (28.30±11.72) s and (31.89±13.65) s, t=9.348, P<0.001.The cost of dual task walking: the experimental group (10.32±6.87)% and (23.26±11.40)%, t=10.602, P<0.001; the control group (27.39±7.38)% and (24.94±7.48)%, t=2.719, P=0.011). The 10 m walking test time of the experimental group was shorter than that of the control group ( t=2.027, P=0.047), and the walking time cost of the experimental group was lower than that of the control group ( t=9.583, P<0.001). Conclusion:Cognitive walking dual task training can improve the walking function of patients, which is more conducive to the recovery of executive function than conventional walking training.

OBJECTIVETo seek a new method for reconstructing bilateral intemrnal jugular vein invaded by metastasis lymph node in advanced oral cancer patients.

METHODSA combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions.

RESULTSPostopera-tive follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60% (3/5).

CONCLUSIONMicrovascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.

Carcinoma, Squamous Cell ; Constriction ; Humans ; Jugular Veins ; Lymphatic Metastasis ; Mouth Neoplasms ; Neck Dissection ; Postoperative Period ; Reconstructive Surgical Procedures ; Sutures

Objective To compare the effect of levosimendan and milrinone on treatment of severe heart valve disease patients with postoperative low cardiac output syndrome. Methods Fifty-six severe heart valve disease patients with postoperative low cardiac output syndrome were selected, and the patients were divided into levosimendan group and milrinone group according to treatment method with 28 cases each. Both groups received symptom-relieved therapy, including cardiotonic, diuresis and other drugs. The patients in levosimendan group were combined with 24 h of continuous intravenous injection of levosimendan 0.05-0.20 μg/(kg·min) for 1 week, and the patients in milrinone group were combined with 24 h of continuous intravenous injection of milrinone 0.25-1.00 μg/(kg·min) for 1 week, in order to maintain mean arterial pressure ≥ 65 mmHg (1 mmHg=0.133 kPa). The cardiac output, cardiac index, left ventricular ejection fraction (LVEF), and the serum levels of lactic acid, creatinine, N-terminal pro brain natriuretic peptide (NT-proBNP) were compared between 2 groups. Results There were no statistical differences in cardiac output, cardiac index, LVEF, and the serum levels of creatinine, lactic acid, NT-proBNP before treatment between 2 groups (P>0.05). The cardiac output, cardiac index, LVEF, and the serum levels of creatinine, lactic acid and NT-proBNP after treatment in 2 groups were significantly better than those before treatment, and there were statistical differences ( P<0.05). There were no statistical differences in cardiac output, cardiac index and LVEF after treatment between 2 groups (P>0.05). The serum levels of creatinine, lactic acid and NT-proBNP after treatment in levosimendan group were significantly lower than those in milrinone group: (102.82 ± 21.31) μmol/L vs. (115.64 ± 58.73) μmol/L, (1.7 ± 1.4) mmol/L vs. (2.2 ± 1.0) mmol/L and (1 149 ± 515) ng/L vs. (1 321 ± 472) ng/L, and there were statistical differences (P<0.05). Conclusions Both the two drugs can significantly improve cardiac function in severe heart valve diseases patients with postoperative low cardiac output syndrome, while the levosimendan has more advantages in lowering serum creatinine, lactic acid value and NT-proBNP.

Objective:Previous studies suggested that the-308G/A allele in the tumor necrosis factor-α(TNF-α) gene promoter (-308G/A) may be a potential risk factor for inflammatory diseases and tumor progression. However, only a few studies have focused on the-308 polymorphism of TNF-αgene with primary lung cancer in Chinese population. This study aims to evaluate the role of TNF-α-308G/A single nucleotide polymorphism (SNP) and the risk of primary lung cancer in Chinese population. Methods:A total of 250 patients and 447 healthy individuals (control group) were involved in this study. Genotyping was performed using TaqMan technology. Results:The frequencies of (GG), (A/G), and (A/G+AA) genotypes of-308G/A SNP in TNF-αgene were 183 (73.2%), 67 (26.8%), and 67 (26.8%) in the patients, and 406 (90.8%), 39 (8.7%), and 41 (9.2%) in the control group, respectively. The distribution of poly-morphism frequencies in the case group and the control group showed a statistically significant difference for the Chinese population (P<0.05). Conclusion:Results indicated that TNF-αgene polymorphism at position-308G/A is associated with susceptibility to lung cancer in Chinese Han population.