Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which is the core technology that can embody the characteristics and advantages of TCM diagnosis and treatment. This is based on holistic view to illustrate individual diagnosis and treatment and dynamic treatment. However, RCT, which is frequently used in TCM clinical studies, can not reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies in clinical researches can adjust therapy in patients according to the changes of diseases, so it can reflect individual diagnosis and treatment and dynamic treatment. From this perspective, the process of treatment based on syndrome differentiation is a process of decision-making of adaptive treatment. So the method for developing adaptive treatment strategies can effectively evaluate the efficacy of different treatment strategies in TCM clinical studies. Adaptive treatment strategies have been used in some clinical studies from some published foreign literatures. However, the use of adaptive treatment strategies in domestic clinical researches is seldom reported. This article discussed the concept of adaptive treatment strategies and their important components in detail. In addition, it presented three methods which can take the delayed effects of the current treatment action into consideration and can compare the overall effect of different adaptive treatment strategies, with a purpose to lay some foundation for future TCM researches in the development of optimal clinical pathway and provide new ideas and methods for researches.

[Objective]To observe the relationship between blood uric acid(UA)level and carotid atherosclerosis(CAS)in perimenopausal women.[Methods] Two hundred and thirty-three perimenopausal women were selected.Intima media thickness(IMT)of bilateral carotid arteries were measured by colour Doppler ultrasound.They were divided into normal group(162 cases)and CAS group(71 cases)according to the results of colour Doppler ultrasound.The level of blood UA between two groups was compared and the influence factors of CAS we re analyzed.[Results] The level of blood UA in CAS group was significantly higher than that in normal group[(341 ± 86)μ mol/L vs.(293±78)μ mol/L](P ＜ 0.05).The detection rate of hyperuricemia in normal group was 10.49％(17/162),while the detection rate in CAS group was 40.85％(29/71),which had statistical significance between two groupe(P＜0.01).Pearson correlation analysis showed that CAS had positive correlation with age(r=0.233,P=0.028),body mass index(BMI)(r=0.215,P=0.044),bloodUA(r=0.249,P=0.019)and fasting plasma ghcose(r=0.214,P=0.046).AndCASwas negatively correlated with high density lipoprotein cholesterol(r=-0.224,P=0.036).Logistic regression analysis showed that after the factors of age and BMI were corrected,CAS still had significantly positive correlation with the level of blood UA(OR＝4.805,95％ CI 1.700-11.673,P ＜ 0.05).[Conclusion]Hyperuricemia is a related risk factor of the incidence of carotid atherosclerosis in perimenopausal women.

Traditional Chinese medicine (TCM) emphasizes treatment based on syndrome differentiation, which em-bodies the concept of individualized diagnosis and dynamic treatment on a holistic view. RCT was frequently used in TCM clinical study. However, it cannot reflect the concept of treatment based on syndrome differentiation. The use of adaptive treatment strategies (ATS) in clinical research can adjust therapy in patients according to the change of disease, so it can reflect personalized medicine and dynamic treatment. From this perspective, the process of treat-ment based on syndrome differentiation was a process of adaptive treatment decision. So the method for developing ATS can effectively evaluate the efficacy of different treatment strategies in TCM clinical study. ATS had been used in some clinical studies from published literatures abroad. However, the use of ATS in domestic clinical research was seldom been reported. This paper gave an outline of the concept of ATS. In addition, this paper focused on three methods which can take the delayed effects of current treatment action into consideration and can compare the over-all effect of different ATS. It was hoped to lay foundation for future scientific research of TCM in the implementation of SMART and provide a new idea.

DICOM is a standard for data format and transmission of digital medical image. DICOM Data Set is a binary data stream using DICOM encoding rule. DICOM Nesting Data Set is a kind of complex Data Set with a tree structure, and is widely used in DICOM services and encoding of DICOM files for its special structure. In this article, the functions and encoding rule of Data Set and Nesting Data Set in DICOM format are presented, and the way of parsing and organizing of them is put forward. The realization method and practical application are also discussed.

Aim To investigate the effects of co-administration of L-Arginine (L-Arg) and aspirin (ASA) on platelet aggregation in vitro and gastric damage in vivo. Methods Citrate anti-coagulation venous blood was obtained from rabbits. The blood was centrifuged at 1 100 r?min-1 for 10 min to obtain platelet-rich plasma (PRP). 500 ?l of PRP was poured into a cuvette, and then incubated with various concentrations of L-Arg and a small dose of ASA for 5 min. Platelet aggregation was assayed with Chrono-Log platelet aggregometer by changes in light transmission of platelet suspensions. After co-administration of L-Arg and ASA for 7days to rats, gastric damages were induced by water immersion restraint stress or reserpine. Results Co-administrateion of L-Arg and a small dose of ASA strengthened the inhibitory effects on platelet aggregation. Platelet aggregation rate was 6.6% using 3 mmol?L-1 of L-Arg and small dose of ASA. Platelet aggregation rate was 93.9% using the same concentration of L-Arg alone. 1 g?kg-1 of L-Arg and 0.1 g?kg-1ofASA co-administration for 7 days,significantly reduced gastric damage induced by water immersion restraint stress on Wistar rat. Similar results were observed on other animal experiments with gastric lesions induced by reserpine. The effects of L-Arg on prevention of gastric lesion were almost same as that of famotidine. Conclusion Co-administration of L-Arg and ASA can enhance the inhibitory effects on platelet aggregation and prevent gastric damage.

BACKGROUND:The enamel matrix derivative has been used in the clinical treatment of severe periodontitis; however, the mechanism(s) by which enamel matrix derivative promotes periodontal regeneration is stil obscure. OBJECTIVE:To explore the effects of enamel matrix derivatives on the differentiation and proliferation of periodontal ligament stem cels. METHODS:Periodontal ligament stem cels were isolated and identified from human teeth. Cloning forming efficiency, surface antigen expression and pluripotency were detected and identified. Enamel matrix derivatives with different concentrations (20, 50, 100 mg/L) were used to culture periodontal ligament stem cels for 2 and 4 weeks. Colagen synthesis and mineralized nodule formation were detected using Trichrom staining and Von Kosa’s staining, respectively; real-time RT-PCR was employed to detect expressions of colagen type I, osteocalcin, and RUX2; MTT and cel growth rate assay were used to detect the proliferation of periodontal ligament stem cels. RESULTS AND CONCLUSION:Periodontal ligament stem cels were spindle-shaped and showed a higher colony forming efficiency than periodontal ligament cels. The expressions of surface antigens of periodontal ligament stem cels-CD105, CD29, CD45, CD44 were respectively 99.8%, 99.7%, 1.26%, 98.8%, indicating periodontal ligament stem cels have the multilineage differentiation potential. Enamel matrix derivatives improve the colagen synthesis and mineralization nodule formation of periodontal ligament stem cels in a time-dose dependent manner. They also can improve the expression of osteogensis-related genes colagen type I, osteocalcin, RUX2 and proliferation of periodontal ligament stem cels.

BACKGROUND:Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy.
OBJECTIVE:To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation.
METHODS:A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final fol ow-up.
RESULTS AND CONCLUSION:Post-treatment, 29 patients were fol owed-up for an average period of 12 months. (1) Al the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. (2) Spinal compression was obviously lessened after treatment in al patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final fol ow-up and pre-treatment (P<0.05). (3) There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. (4) Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.

ObjectiveTo explore the relationship between the negative co-inhibitor programmed death-1 ( PD-1 ) and the pathogenesis of myasthenia gravis ( MG), by detecting the expression of PD-1 and programmed death ligand-1 ( PD-L1 ) on peripheral blood mononuclear cells (PBMCs) and soluble PD-1 (sPD-1) in plasma from myasthenia gravis patients. MethodsPeripheral blood samples were collected from 45 MG patients and 33 healthy persons without prednisone or other immunodepressant treatment during the half year ahead of withdrawal.The expression of PD-1 and PD-L1 on PBMCs were detected using immuno-fluorescence labeling and flow cytometry, and the concentrations of sPD-1 in plasma were measured using an ELISA kit. Results(1) The proportion of CD4+ PD-1 + T cells, as well as CD14+ PD-L1 +monocytes of the MG group was higher than that of the control group. There were no significant differences in the proportion of CD4+ PD-1 + T cells or CD14+ PD-L1 + monocytes in the MG sub-groups between different genders or MG types. While the proportion of CD4+ PD-1 + T cells of the late-onset MG (age ≥40) group was higher than that of the early-onset MG group (age ＜40). And it was higher in the MG patients with thymoma or thymus hyperplasia than that from the MG patients with normal thymus. The proportion of CD14+ PD-L1 +monocytes from the MG patients with thymoma or thymus hyperplasia group decreased obviously compared with that of the patients with normal thymus group; but no difference could be found between the late-onset group and early-onset group. (2)The concentration of sPD-1 in the plasma from the group of MG patients was(6. 92 ±0. 72) ng/ml,which was higher than that of the healthy control group ( (3.28 ±0. 42) ng/ml),even more, it was significantly higher in the early-onset MG group than that of the late-onset MG group,there was a negative correlation( r =-0. 526, P =0. 000) between the age of onset and the concentration of sPD-1. ConclusionsThe increased expressions of PD-1 on CD4+ T cells and PD-L1 on CD14+ monocytes in MG patients suggested the involvement of the couple of molecules in the pathogenesis of MG.Higher concentration of soluble PD-1 in the plasma of patients with MG suggested that it might disturb the ligation of PD-1 and PD-L1 on T cells and antigen presenting cells, which might result in the abnormal transportation of the negative modulating signal, and accelerate the pathological progress of MG.

Objective:To investigate the effects of Dickkopf-1(DKK1) on the proliferation of human lens epithelial cells (LECs) and its possible mechanism in order to search a new target for the treatment of posterior capsular opacification (PCO).Methods:Human LECs line (SRA 01/04 cells )were divided into Wnt3a overexpression group, DKK1 group and control group.Wnt3a gene expression vector was transfected into SRA 01/04 cells by liposome mediated transfection to establish a PCO model in the Wnt3a overexpression group, DKK1 of 100 μg/ml was added into the medium 48 hours after transfection of Wnt3a gene vector in the DKK1 group, and only pcDNA3-HA vector was transfected in the control group.The survival rate of SRA 01/04 cells was detected with a cell counting kit-8 (CCK-8) assay.The expression rate of proliferating cell nuclear antigen (PCNA) in the cells was detecteds by immunocytochemistry.The expression of β-catenin in the cells was detected and located by immunofluorescence.The expression of Wnt3a CyclinD1 and C-Myc were detected by Western blot assay.Results:The relative expression of Wnt3a protein in the control group was 0.49±0.07, which was significantly lower than that in the Wnt3a overexpression group (0.84±0.06) ( t=3.704, P=0.02). The survival rate in the Wnt3a overexpression group, DKK1 group and control group showed significant difference over time ( Fgroup=10.910, P<0.05; Ftime=6.041, P<0.05). The survival rate in the Wnt3a overexpression group was significantly increased in comparison with the control group and that in the DKK1 group was significantly reduced in comparison with the Wnt3a overexpression group(all at P<0.05). β-Catenin was expressed mainly in cytoplasm and cell nucleus in the Wnt3a overexpression group and only in cytoplasm in the DKK1 group. in the control group, β-catenin showed a weaked expression in the cytoplasm and nucleus in comparison with the Wnt3a overexpression group.The expression rates of PCNA protein were (9.4±1.4)%, (43.4±5.4)%, and (14.2±2.3)% in the control group, Wnt3a overexpression group and DKK1 group, respectively, with a significant difference among the groups ( F=28.250, P<0.05), and the expression rates of PCNA protein were significantly reduced in the control group and DKK1 group compared with the Wnt3a overexpression group (both at P<0.05). β-Catenin protein were expressed mainly in the cytoplasm and nucleus in the Wnt3a overexpression group and only in the cytoplasm in the control group.In the DKK1 group, the expression of β-catenin protein was weakened in the cytoplasm and nucleus in comparison with the Wnt3a overexpression group.The relative expressions of CyclinD1 were 0.64±0.07、0.84±0.03 and 0.55±0.10, C-Myc were 0.59±0.05、0.93±0.02 and 0.47±0.08 in the control group, Wnt3a overexpression group and the DKK1 group, respectively with significant differences among the groups ( F=20.580, 5.040, both at P<0.05). The relative expressions of CyclinD1 and C-Myc in the Wnt3a overexpression group were significantly higher than those in the DKK1 group and the control group (all at P<0.05). Conclusions:DKK1 inhibits activation of Wnt/β-catenin signaling pathway induced by Wnt3a overexpression in SRA01/04 cells, and down-regulation of downstream target proteins cyclin D1 and C-Mgc may be the biological mechanism of Dkk1 inhibiting human LECs proliferation.

Objective To explore the influence of emotional care based on the intrinsic motivation theory in the treatment of patients with ovarian cyst.Methods From September 2014 to October 2016,106 patients with ovarian cysts admitted to our hospital were selected and randomly divided into control group and study group with 53 in each group.The control group and the study group received routine nursing and emotional care based on intrinsic motivation theory,respectively.The two groups were evaluated before and after the intervention using the stages of change readiness and treatment eagerness scale (SOCRATES).Result After intervention,the scores of cognitive sub-scale,hesitation sub-scale and act sub-scales of the study group were higher than those of the control group, with significant difference (P＜0.05).Conclusion Emotional nursing based on intrinsic motivation theory is effective for the improved treatment of patients with ovarian cyst surgery,worth further promotion in clinic.