With the high incidence of diabetic nephropathy, the clinical trials of traditional Chinese medicine (TCM) in diabetic nephropathy area play an important role in the development of this subject. Therefore, follow-ing the principles of medical ethics, issues of fully understanding professional requirements of ethics review for clinical research of diabetic nephropathy and the protection of patients' rights are questions which should be solved. This article was based on the investigations on ethical needs of experts and patients in diabetic nephropathy area of TCM clinical trials . Discussions and considerations were made on results . A the more per-fect and regulated medical informed consent formwork for diabetic nephropathy of TCM clinical trials was made based on these consultations .

Since the launch of the comprehensive public hospital reform in Zhejiang Province, the price of medical services has been adjusted, and the charging structure of medical services has been improved. Likewise, medical insurance policies have been optimized. Through several price adjustment strategies, such as the“loosen-re-strain” policy, the labor of medical personnel has been better valued, the operation of public medical institutions has been stabilized, and the allocation of medical resources has been optimized. Hence, this paper aims to measure the achievements and drawbacks of the medical service price adjustments by analyzing the various strategy. It is suggested that the comprehensive public hospital reform should be further intensified via the advancement of coordination of healthcare, medical insurance and medicine, the exploration of new procurement mechanisms for drugs and medical equipment, the establishment of dynamic adjustment mechanisms for medical service pricing, the exploration of new management mechanisms for medical services, and the strengthening of medical service supervision.

OBJECTIVE To review and analyze the distribution and antimicrobial resistance of nosocomial Escherichia coli and Klebsiella pneumoniae.METHODS Disk diffusion test(Kirby-Bauer)was used for anti-microbial susceptibility.Extended spectrum ?-lactamases(ESBLs)were detected by double disk synergy test and disk diffusion confirmatory test.AmpC enzyme was detected by the three dimensional assay.RESULTS The positive rate of the production of ESBLs and AmpC enzyme was 34.6% and 5.0%,respectively.The production rate of both ESBLs and AmpC enzyme positive was 2.4%.Isolated rate of ESBLs-producing strains in sputum and urine of the inpatients in respiratory ward and urinary ward was higher than others.All strains were 100% susceptible to meropenem and imipenem but resistant to 15 other antimicrobials in different degrees.CONCLUSIONS The isolated rate of ?-lactamases-producing strains is increasing year by year.These strains are multi-drug resistant.Attention must be paid to their detection and surveillance.

Objective To investigate the chromosome damage in peripheral lymphocytes of underground gold miners.Methods Conventional method and cytokinesis-block micronuclens assay were used to analyze frequency of chromosome aberrations and micronucleus in peripheral lymphocytes in 58 gold miners,respectively.Results Frequencies of chromosome-type aberrations,ehromatid-type aberrations and total aberrations were higher in the miners than those in the control group(0.72%,0.41%,1.16% vs 0.14%,0.18%,0.33,X2=44.322,9.501,50.476,P＜0.01).Both micronucleated cell rate and micronucleus rate were higher in the miners group than those in the control group(10.8‰ and 11.6‰ vs 8.7‰ and 9.0‰,X2=8.672,12.546,P＜0.01).Frequencies of chromosomal aberrations and micronucleus proportionally increased with underground working years.Compared with those miners who had worked underground 6 years or shorter,both frequencies were statistically higher among the miners who had worked underground for more than 21 years(P＜0.05).No difference was found among other groups of working years(P＞0.05).Compared with the control group,both frequencies increased in the miner group,and the differences were statistically significant(X2=2.395,P＜0.05 for chromosomal aberrations and X2=2.319,P＜0.05,respecfvely).The common types of chromosome aberrations were acentrie fragments,while chromatid break and dicenrics were subordinate.Conclusions Chromosomal damages were observed in the gold workers who exposed high radon in the underground mining.

Objective To optimize the volatile oil extraction and inclusion process of Wenweiyang capsules. Methods An orthogonal test was adopted in this study. The extraction technology was optimized for the yield of volatile oil regarding the amount of water loaded, grain size of medicinal material, and decoction time as factors. The inclusion technology was optimized for the inclusion yield and volatile oil inclusion rate using the ratio ofβ-CD:oil, amount of water and grinding time as factors. Results The optimized extraction parameters were as follows:breaking medicinal material through 10 mesh screen, adding 6 fold volume of water and extracting for 5 h. The optimized inclusion progress was grinding at theβ-CD:oil ratio of 81, loading equivalent amount of water and grinding for 30 minutes. The average yield of volatile oil is 1. 72%, the average inclusion rate is 93. 01% and the average volatile oil inclusion rate is 74. 82%. Conclusion The extraction and inclusion technology is simple, reliable, which can effectively retain the volatile oil and provide evidence for the preparation of Wenweiyang capsules.

Objective To evaluate the efficacy of interventional MRI in radiofrequency ablation (RFA)of breast cancer.Methods 12 patients with breast carcinoma proven by core-needle biopsy-were enrolled in this study.Among them, 7 patients were in phase Ⅳ(6 with lung metastasis, 1 with bone metastasis),and 5 patients were in phase Ⅲ(all of them rejected the surgical operation because of various contraindications,including severe hypertension,diabetes mellitus,liver or kidney dysfunction,and advanced age).Moreover, all of the tumor size could not be further shrunk after medical treatment (such as 4-6 cycles chemotherapy, endocrine therapy or targeted therapy).Additionally,breast lesions were still remained to be confirmed by imaging examination and biopsy pathology.Then the tumor and surrounding breast tissue were ablated with radiofrequency,followed by clinical follow-up and imaging examination after 1, 3, 6 and 12 months.Results All the patients completed 18 times RFA treatment.MRI showed that all the tumor lesions were necrotic, blood supply was disappeared and therewas no enhancement.Radiographic examination showed the original breast lesions were fuzzy or disappeared.All the tumors were achieved complete remission (CR) examined by imaging,and the effective rate was 100%.All the postoperative patients survived 1 year according to the follow-up data.Conclusion Interventional MRI is safe and effective method in the radiofrequency ablation of breast cancer.

Objective To investigate the selective killing effect of MDA/IL-24 on human hepatocellular carcinoma line HepG2 in vitro and provide a theoretical basis for gene therapy of hepatocellular carcinoma.Methods The MDA-7/IL-24 gene was transfected into human hepatocullular carcinoma cell line HepG2 and normal liver cell line L02 with a replication-incompetent adenovirus vector.The mRNA and protein expression of MDA7/IL-24 in HepG2 and L02 cells was examined by RT-PCR and ELISA assay respectively.MTT assay and flow cytometry were used to study tumor cell proliferation and cell cycle in vitro.Hoechst and Annexin-V and PI staining were studied to indicate the apoptosis.Results RT-PCR confirmed that the exogenous MDA-7/IL-24 gene was expressed in HepG2 and L02 cells.The protein product was confirmed by assay of the supernatant with ELISA.MTT and apoptosis test indicated MDA-7/IL-24 induced growth suppression and cell apoptosis of the HepG2 cell in vitro but not in cell line L02,and cell cycle test revealed MDA-7/IL-24 could block HepG2 cell in G2/M but not in L02.Conclusions MDA-7/IL-24 selectively induces growth suppression and apoptosis in lines HepG2 in vitro but not in L02 cell,which indicates that adenovirus mediated MDA-7/IL-24 can be an excellent tool for gene therapy in hepatocellular carcinoma.

Objective: To explore the improvement influence of three combined exercise programs on sleep quality among college students with sleep disorders, so as to provide reference for the construction of exercise intervention programs for sleep disorder. Methods: A total of 35 college students with sleep disorders were randomly divided into AR group ( n =10), AM group ( n =8), RM group ( n =9) and CG group ( n =8). The three exercise groups were provided with exercise intervention for 8 weeks, 3 times/week , 60 min/time, and the CG group maintained previous lifestyle.Before and after the intervention,evaluation of subjective sleep quality and reduction rate of sleep disorder by PSQI, and Actigraph GT3X+ was used to monitor the changes in the objective sleep quality. Results: After the intervention,the total score of PSQI ( t =3.49, 2.31, 2.73), sleep quality score ( t =2.71, 3.00 , 5.29),sleep duration of AR group ( t =2.74), daytime dysfunction of AM group ( t =2.64) and sleep duration of RM group ( t = 2.29) significantly decreased ( P ＜0.05); The scores of sleep duration in AM group were significantly lower than those in AR group, and the scores of PSQI,sleep quality and daytime dysfunction in AM group were significantly lower than those in CG group (P<0.05). After intervention,TST ( t =-4.41, -8.37, -6.79) and SE ( t =-4.40, -5.86, -4.91) of AR group, AM group and RM group significantly increased( P <0.05), SOL ( t =4.18, 9.93), WASO ( t =2.91, 3.46) and NA ( t =4.80, 3.37) of AM group and RM group significantly decreased ( P <0.05). The changes of TST,SE and WASO in RM group were significantly higher than those in CG group, and SOL was significantly lower than those in CG group ( P <0.05). Conclusion The three kinds of combined exercise programs can improve the subjective and objective sleep quality of college students with sleep disorders, and reduce the incidence of sleep disorders; different combined exercise programs have different influence on the improvement of sleep quality of college students with sleep disorders, aerobic combined meditative movement exercise program has a prominent influence on the improvement of subjective sleep quality, and resistance combined meditative movement exercise program has a prominent influence on the improvement of objective sleep quality.

China still has more than 30,000 patients of advanced schistosomiasis while new cases being reported consistently. D-dimer is a fibrin degradation product. As ascites being the dominating symptom in advanced schistosomiasis, the present study aimed to explore a prediction model of ascites with D-dimer and other clinical easy-achievable indicators. A case-control study nested in a prospective cohort was conducted in schistosomiasis-endemic area of southern China. A total of 291 patients of advanced schistosomiasis were first investigated in 2013 and further followed in 2014. Information on clinical history, physical examination, and abdominal ultrasonography, including the symptom of ascites was repeatedly collected. Result showed 44 patients having ascites. Most of the patients' ascites were confined in the kidney area with median area of 20 mm². The level of plasma D-dimer and pertinent liver function indicators were measured at the initial investigation in 2013. Compared with those without ascites, cases with ascites had significantly higher levels of D-dimer (0.71±2.44 μg/L vs 0.48±2.12 μg/L, P=0.005), as well ALB (44.5 vs 46.2, g/L) and Type IV collagen (50.04 vs 44.50 μg/L). Receiver operating characteristic curve analyses indicated a moderate predictive value of D-dimer by its own area under curve (AUC) of 0.64 (95% CI: 0.54–0.73) and the cutoff value as 0.81 μg/L. Dichotomized by the cutoff level, D-dimer along with other categorical variables generated a prediction model with AUC of 0.76 (95% CI: 0.68–0.89). Risks of patients with specific characteristics in the prediction model were summarized. Our study suggests that the plasma D-dimer level is a reliable predictor for incident ascites in advanced schistosomiasis japonica patients.
Area Under Curve ; Ascites* ; Case-Control Studies ; China ; Cohort Studies ; Collagen Type IV ; Fibrin ; Humans ; Kidney ; Liver ; Physical Examination ; Plasma* ; Prospective Studies* ; ROC Curve ; Schistosoma japonicum ; Schistosomiasis japonica* ; Schistosomiasis* ; Ultrasonography

To evaluate the efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for patients with metastases to the pancreas.Data on patients with pancreatic lesions who underwent EUS-FNA and confirmed as having metastases to the pancreas at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2015 to November 2020 were retrospectively analyzed.Characteristics of patients, EUS performance, pathological results, and follow-up were reviewed and analyzed. A total of 11 patients were diagnosed of metastasis to pancreas by EUS-FNA.The primary tumor mainly came from kidney (4/11) and lung (4/11), and the rest from colon (1/11), breast (1/11) and bladder (1/11), respectively. EUS performance of metastases to the pancreas mostly presented homogeneous hypoecho (10/11)with unclear margin (6/11). Enlarged lymphnodes were noticed in nearly half of the patients (5/11). The time span from detection of primary tumor to metastases ranged from 6 days to 27 years. EUS-FNA is effective in the diagnosis of metastases to the pancreas.