Chinese materia medica (CMM) as well as its interrelated industries has huge exploitable potential and developing prospect At present, it has become one of the directions with the worldwide exploitation of new medicine and development in medicinal industry The establishment of quality standard system of CMM in China is one of the key problems that the modernization of them should be first of all resolved In order to ensure the accuracy, credibility, comparability and mutual recognition of data examined by each laboratory, our research should be based on the international theory and method of the traceability Our government and CMM administration department should strengthen the esablishment and promulgation of criteria, laws, regulations of CMM and its interrelated industries, so as to make the quality assurance system approach to the international standard, and to protect our economic benefits, people's health and most consumers' interests from being affected

Objective To investigated the correlation between the focus-to-flat panel detector distance and entrance surface dosed in digital radiography of lumbar spine.Methods The spine phantom used for bone mineral density(BMD) calibration was radiographed at different value of FFD (100 ～ 240 cm with the interval 10 cm,totally 15 times) using 70 kV and 90 kV with the automatic exposure control (AEC) mode without anti-scatter grid.The parameters measured by QUART dido 2100K type X-ray dose meter.So record the value parameters of the tube current (mAs) and entrance surface dose (ESD).The relation curve were counted between FFD,ESD,mAs and Exposure index (EI) use excle.Pearson correlation analysis and related coefficient difference analysis were performed using the SPSS 19.0 software (P ＜0.05 for the statistically significant level).The FFD and ESD values of regression equation were obtained with regression analysis.Results (1) When the tube voltage was 70 kV:FFD and ESD were negative correlation (r =-0.922,P ＜ 0.001),FFD and mAs were positive correlation (r =0.991,P ＜0.001),FFD and EI negative correlation (r =-0.938,P ＜ 0.001).(2) When the tube voltage was 90 kV:FFD and ESDwere negative correlation (r=-0.955,P ＜0.001),FFD and mAs were positive correlation (r=0.994,P ＜0.001),FFD and EI showed no significant correlation (r=-0.523,P＞0.05).(3) Different position correlation coefficient analysis of the difference was not statistically significant difference.(4) The regression analysis results:The regression equation of the lumbar anteriorposterior position FFD and the ESD at 70 kV:y=0.805 x + 319.731 (F=74.175,P ＜0.001).The regression equation of the lumbar lateral position FFD and the ESD at 90 kV:y =3.152 x + 457.613 (F =133.524,P ＜ 0.001).Conclusions The FFD and ESD in the lumbar spine X-ray radiography were relevant and highly negative correlation.It can effectively reduce the radiographic ESD of lumbar spine with the increasing of the FFD.

AIM: To evaluate the safety and efficacy of oral oxycodone /acetaminophen or tramadol in early postoperative patients undergoing laparoscopic gynecological operations. METHODS: 120 gynecologic patients receiving laparoscopy operation were enrolled in a randomized,double blind, placebo controlled, multi center clinical trial with early oral analgesics if the vasual analgesia scores (VAS) was scored higher than 3.0. All patients were randomly received a single dose of oral analgesic: oxycodone/acetaminophen, tramadol or placebo, respectively. For rescue medication, PCA pump was provided in all three groups with a dose of 1 mg morphine and lockout of 5 minutes. The VAS scores, pain relief, PCA morphine consumption and side effects were evaluated at the following occasions of 0.25 , 0.5 , 0.75 , 1, 2, 4, 6, 8, 12 and 24 h throughout the study. RESULTS: The VAS scores and pain relief were significantly different in three groups at 0.75 , 1, 2, 4, 6, 8 and 12 h. The VAS scores and PCA morphine consumption was significantly lower in oxycodone/acetaminophen and tramadol groups than those in placebo group. Pain relief in oxycodone/acetaminophen and tramadol groups was better than those in placebo group. The incidence of side effects such as nausea and vomiting significantly increased in tramadol group at 24 h compared with those in the other two groups. CONCLUSION: Early oral administration of oxycodone /acetaminophen or tramadol can provide surgical patients with good and safe postoperative analgesia after laparoscopy gynecologic operation. The incidence of side effects in oxycodone /acetaminophen group is lower than that in tramadol group in this clinical trial.

The emergence of immune checkpoint inhibitors (ICIs) have changed the pattern of anti-tumor therapy and brought new hope to the treatment of small cell lung cancer (SCLC). Currently, ICIs are most widely studied mainly include programmed death-1/ligand-1 and cytotoxic T-lymphocyte antigen-4. Altezumab is recommended for the first-line treatment of extensive SCLC, while pebrizizumab is recommended for the third-line treatment of extensive SCLC. There has been no breakthrough in the second-line and maintenance treatment of SCLC with ICIs.

Objective To investigate the associations between expression of Tensin1 protein and clinicpathological characteristics and prognoses of gastric cancer (GC) patients.Methods The retrospective casecontrol study was conducted.The clinicopathological data of 163 GC patients who were admitted to the Affiliated Hospital of Jiangsu University between July 31,2011 and December 31,2013 were collected.The GC tissues and adjacent normal tissues were taken to paraffin imbedding,and then were detected by immunohistochemistry.Observation indicator:(1) expressions of Tensinl protein in GC tissues and adjacent normal tissues;(2) association between expression of Tensinl protein in GC tissues and clinicopathological characteristics;(3) followup and survival situations;(4) prognostic factors analysis.Follow-up using telephone interview was performed to detect survival up to January 1,2017.Measurement data with skewed distribution were described as M (range).Count data were analyzed using the chi-square test or pairing chi-square test.The survival curve and rate were respectively drawn and calculated using the Kaplan-Meier method,and Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were done using the COX roportional hazard model.Results (1) Expressions of Tensinl protein in GC tissues and adjacent normal tissues:immunohistochemistry showed that Tensinl protein in GC tissues and adjacent normal tissues mainly expressed in cytoplasm.Of 163 patients,154 (66 with high expression and 88 with low expression) and 9 had respectively positive and negative expressions of Tensinl protein in GC tissues;79 (37 with high expression and 42 with low expression) and 84 had respectively positive and negative expressions of Tensinl protein in adjacent normal tissues,with statistically significant differences in positive expression ratio and expression levels (x2=64.65,12.93,P＜0.05).(2) Association between expression of Tensinl protein in GC tissues and clinicopathological characteristics:high expression rate of Tensinl protein in GC tissues were respectively 31.34％ (21/67) in GC patients with tumor metastases and 46.88％ (45/96) in GC patients without tumor metastasis,with a statistically significant difference (x2 =3.95,P＜0.05).(3) Follow-up and survival situations:all the 163 patients were followed up for 3.3-64.7 months,with a median time of 28.7 months.The 3-year cumulative disease-free survival rate and cumulative overall survival rate in GC tissues were 63.12％,74.22％ in 66 patients with high expression of Tensinl protein and 47.30％,55.74％ in 97 patients with low and negative expressions of Tensin1 protein,showing statistically significant differences in above indicators (x2 =4.58,4.11,P＜0.05).Survival analysis of subgroups showed that 3-year cumulative disease-free survival rate in GC tissues of patients with maximum tumor dimension ≥ 5 cm,nerve and / or vascular invasions and stage Ⅲ of TNM staging were 45.98％,62.79％,52.75％ in patients with high expression of Tensin1 protein and 18.11％,31.10％,32.80％ in patients with low and negative expressions of Tensin1 protein,with a statistically significant difference (x2 =5.85,7.89,4.96,P＜0.05).The 3-year cumulative overall survival rate was respectively 66.00％,75.75％,67.93％ in patients with high expression of Tensin1 protein and 30.74％,40.15％,44.67％ in patients with low and negative expressions of Tensinl protein,with statistically significant differences (x2 =7.59,9.62,4.32,P ＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that maximum tumor dimension,histological grade,nerve and / or vascular invasions,postoperative TNM staging,postoperative adjuvant chemotherapy and expression of Tensin1 protein were related factors affecting prognoses of GC patients [hazard ratio (HR) =3.66,2.45,2.17,3.36,0.41,0.54,95％ confidence interval (CI):2.09-6.41,1.43-4.19,1.17-4.04,1.52-7.41,0.23-0.72,0.31-0.96,P＜0.05].Results of multivariate analysis showed that maximum tumor dimension ≥ 5 cm and grade Ⅲ of histological grade were independent risk factors affecting prognoses of GC patients (HR=3.21,2.17,95％CI:1.63-6.32,1.18-3.99,P＜0.05),and postoperative adjuvant chemotherapy and high expression of Tensin1 protein were independent protective factors affecting prognoses of GC patients (HR=0.50,0.44,95％CI:0.28-0.90,0.24-0.82,P＜0.05).Conclusion High expression of Tensin1 protein may inhibit GC metastasis,and it is also an independent protective factor affecting prognoses of GC patients.

OBJECTIVETo describe a new noncontact balloon catheter mapping system and to assess the clinical utility of this system for guiding endocardial mapping and ablation of tachycardia.

METHODSFive patients with tachycardia underwent endocardial mapping and radiofrequency ablation using the noncontact balloon catheter mapping system. A 9 French, 64-electrode balloon catheter and a conventional 7 French electrode catheter for mapping and ablation were positioned in the same ventricular chamber. Ventricular three-dimensional geometry was established by the computerized mapping system. Using a boundary element inverse solution, 3360 virtual endocardial electrograms were computerized and used to derive isopotential maps. The earliest endocardial activation site, the exit site and the activation sequence of tachycardia or the critical isthmus of the reentry circuit were identified. Radiofrequency ablation with circular or linear lesion was performed at the target sites guided by the locator system.

RESULTSSix clinical types of tachycardia, 5 of which were ventricular tachycardia and one was concealed fasciculoventricular fiber mediated tachycardia, were induced by programmed stimulation. The mean cycle length of these tachycardias was 336.6 +/- 42.69 msec. The earliest activation site and the exit site of 5 mapped tachycardias were all identified using the system. One type of ventricular tachycardia was hemodynamically unstable and difficult to terminate, and could not be mapped. Among the 6 types of tachycardias, radiofrequency ablation was successful in 4. There was no complication during and after the procedure. During the mean follow-up of 6 months, no tachycardia recurred in the patients with a successful ablation.

CONCLUSIONSThe noncontact mapping system described in this study has advantage over conventional mapping techniques for refractory tachycardia. It is not only helpful for understanding the electrophysiologic mechanism of a complex case, but also suitable for mapping hemodynamically intolerated and nonsustained ventricular tachycardia.

Adult ; Body Surface Potential Mapping ; methods ; Cardiac Catheterization ; Catheter Ablation ; methods ; Catheterization ; methods ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular ; physiopathology ; surgery

Objective To evaluate the effect of intelligentized patient-controlled analgesia ( PCA) management on the quality of postoperative analgesia in the patients. Methods A total of 6601 patients who underwent postoperative PCA from January 1, 2015 to December 31, 2017 searched from the intelli-gentized PCA system database were selected as intelligentized PCA management group ( I group) , and then were divided into 3 subgroups according to the year: 2015 subgroup ( n=2221 ) , 2016 subgroup ( n=2152) and 2017 subgroup (n=2228). A total of 1235 patients who underwent PCA which was mainly performed by a department of anesthesiology in the postoperative analgesia-related multi-center questionnaire from April 11, 2016 to April 22, 2016 in 12 grade A tertiary hospitals in Guangdong Province were select-ed as the traditional PCA management group (C group). The development of moderate and severe pain, nausea and vomiting, over-sedation at rest and during activity and patient′s satisfaction were recorded on 1st and 2nd days after operation. Results Compared with C group, the incidence of moderate and severe pain, nausea and vomiting and over-sedation at rest and during activity was significantly decreased, and the rate of patient′s satisfaction was increased at each time point after operation in I group ( P<0. 05 or 0. 01) . Com-pared with 2015 subgroup, the incidence of moderate and severe pain at rest and severe pain during activity was significantly decreased in 2016 and 2017 subgroups ( P<0. 05 or 0. 01) , and the incidence of nausea and vomiting was significantly increased in 2017 subgroup ( P<0. 05) . Compared with 2016 subgroup, the incidence of nausea and vomiting was significantly increased in 2017 subgroup (P<0. 05). Conclusion Intelligentized PCA management can improve the efficacy of PCA, mitigates the occurrence of adverse reac-tions and raise the quality of postoperative analgesia in the patients.

Objective To investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) and understand the relationship between NAFLD and metabolic risk factors in middle-aged and elderly adults.Methods This cross-sectional study recruited 2 935 subjects in Guangzhou,Guangdong province.Face-to-face interviews and laboratory analyses were conducted to collect general information and other covariates.Analysis of covariance and logistic regression analysis were performed to investigate the relationship between metabolic factors and the prevalence of NAFLD.NAFLD was diagnosed based on standard criteria recommend by the Fatty Liver Disease and Alcoholic Liver Disease Branch of Chinese Hepatology Society,and the degree of steatosis was assessed (mild,moderate or severe).Results Compared with normal subjects,those with NAFLD had higher levels of WC,BMI,FPG,TG,SBP,DBP and greater prevalence of metabolic syndrome,but lower levels of physical activity and HDL-C.After adjusted for covariates,the OR for each standard deviation change was 2.70(95％CI:2.45-2.98) for WC,1.47(95％ CI:1.35-1.59) for SBP,1.48 (95％CI:1.37-1.60) for DBP,1.88 (95％CI:1.66-2.12) for TG,1.25 (95％ CI:1.15-1.36) for FPG and 0.51 (95％CI:0.47-0.56) for HDL-C (all P＜0.001).Higher levels of WC,BMI,TG,SBP,DBP and FPG were significantly related with the increase in degree of NAFLD (P-trend＜0.001).Conclusion There is a relatively high prevalence of NAFLD in middle-aged and elderly adults in China.NAFLD is closely related with the different forms of metabolic syndrome,and WC is the leading risk factor for NAFLD.

Objective    To investigate the feature of the angulation between left pulmonary artery (LPA) and main pulmonary artery (MPA) and its relationship to pulmonary artery development in patients with tetralogy of Fallot (TOF). Methods    A total of 101 TOF patients in West China Hospital from 2014 to 2018 were enrolled in a TOF group, including 62 males and 39 females, aged 6.8 (0.3-45.8) years, and another 20 patients without basic cardiac diseases at the same stage were enrolled in a control group, including 10 males and 10 females, aged 6.9 (0.3-54.0) years. Diameters of LPA, right pulmonary artery (RPA) and MPA, the angulation between LPA and MPA (MPA-LPA), McGoon ratio, and Nakata index were measured and compared between the two groups. The relationship between the above data and MPA-LPA angulation was also analyzed. Results    The average MPA-LPA angulation was smaller in the TOF group than that in the control group (113.63° vs. 128.45°, P=0.001 8). The MPA Z score was also smaller in the TOF group than that in the control group (0.46 vs. 2.75, P=0.000 4). No relationship was found by correlation analysis between the MPA-LPA angulation and MPA Z score or LPA Z score in the control group (P=0.239 6, 0.114 7) and the TOF group (P=0.759 3, 0.242 7). The McGoon ratios (2.22±0.72, 2.43±0.94, P=0.340 0) and Nakata index (359.3±294.24, 395.52±329.31, P=0.650 0) were not significantly different between the two groups. Conclusion    The angulation of LPA-MPA and MPA Z score are smaller in the TOF group than those in the control group. There is no relationship between MPA-LPA angulation and pulmonary artery diameters. The LPA-MPA angulation should not be considered as an influence factor for LPA development and trans-annular patch surgery.

ObjectiveTo investigate and analyze case reporting ethical review and patient informed consent reports published in the comprehensive journals of clinical medicine in China in 2022. MethodsAccording to the data from the 2022 Edition of the Chinese Science and Technology Journal of the Citation Reports （Extended Version），the case reports published in comprehensive journals of clinical medicine in 2022 were selected as the research objects.The information on ethics and patient informed consent was extracted from the case reports that met the selection criteria，and Microsoft Excel 2021 and SPSS 21.0 were used to sort out and analyze the data. ResultsA total of 587 case reporting articles were published in the 42 included journals in 2022，of which 36 （6.13%） reported on science and technology ethics and/or informed consent.Case reports reporting on science and technology ethics and/or informed consent mostly came from the key magazine of China technology （88.89% Vs.65.88%），and the proportion of manuscripts involving science and technology ethics on the official website of the journal was relatively high （86.11% Vs.63.88%），and the difference was statistically significant （P<0.01）. ConclusionThe proportion of case reports of science and technology ethics and/or informed consent in journals of comprehensive discipline classification of clinical medicine was relatively low.Currently，most international journals are required to obtain the informed consent of patients or legal guardians before publishing case reports.Compared with this，there are still certain gaps in China，which need to be paid great attention to.