E-health is a new kind of health care model, which raises medical efficiency, brings happiness and hope to the therapy of severe disease, and stands for the future of health care. However, it is faced with many issues and challenges, such as the safety of information storing, privacy protection and the distribution of health resources.Therefore, research & development in e-health should observe some criterion. The author holds that the development of e-health should observe ethical principles such as inform-concent, safety, justice, risk-benefit and developing step by step, and puts forward regulating recommendations in many aspects.

A total of 192 poststroke patients with depression and anxiety were assigned randomly into study group (n =96) and control group (n =96).The study group received both capsules Shugan-jieyu and paroxetine while the control group paroxetine alone.Compared with the control group,scores of both Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were significantly different at the end of week 2 and 6 in the study group (P ＜ 0.05).The HAMD and HAMA deduction rate and the scores of mangled extremity severity,mini-mental state examination and modified Barthel index at the end of week 6 of the study group were better than those of the control group (all P ＜ 0.05).The combined use of capsules Shugan-jieyu and paroxetine could improve symptoms of depression and anxiety,offer a higher safety and accelerate the rehabilitation of extremity function.

Objective To investigate the effects of gabapentin(GBP) on plasma β-endorphin(β-EP) level in the patients with painful diabetic neuropathy(PDN). Methods We detected the plasma β-EP level in 24 PDN patients in the treatment with GBP, 18 PDN patients without GBP treatment, 20 diabetic mellitus patients without PDN and 24 healthy control subjects. Results (1)The level of β-EP in diabetic mellitus patients was lower than in the healthy control(P<0.01). (2)The patients who received GBP had a significant change of β-EP level after treatment(P<0. 01).. Conclusions Gabapentin is effective for the treatment of PDN and its adverse effects are mild. It can lower the plasma β-EP level in the patients with PDN.

Objective To observe the effects of nourishing lung and kidney formulas on inflammatory response of alveolar epithelial cells stimulated by monocytes conditioned medium and study the anti-inflammatory mechanism of the formulas for the treatment of chronic obstructive pulmonary diseases (COPD).Methods The reproduction of inflammation models of A549 cells were stimulated by monocyte THP-1 cell strain conditioned medium.A549 cells were randomly divided into blank control group (20％ blank rabbits serum),model group (20％ blank rabbits serum+25.0％ THP-1 cell conditioned medium),nuclear transcription factor activator protein-1 (AP-1) pathway inhibitor T-5224group (20％ blank rabbits serum+25.0％ THP-1 cells conditioned medium+100 μmol/L T-5224),nourishing lung and kidney group (20％ rabbits serum with nourishing lung and kidney formulas+25.0％ THP-1 cells conditioned medium).The contents of interleukins (IL-6,IL-8),tumor necrosis factor-α (TNF-αα),matrix metalloprotein-9 (MMP-9) in cell culture supernatant were detected with enzyme linked immunosorbent assay (ELISA),the supernatant content of malondialdehyde (MDA) was detected with thibabituric acid (TBA) method,the total activity of superoxide dismutase (T-SOD) was detected with hydroxylamine method,and the activity of AP-1 pathway was detected with electrophoretic mobility shift assay (EMSA) method.Results Compared with the blank control group,the A549 cell proliferation were significantly increased at 24 hours,48 hours stimulation by 25.0％ cell conditioned medium (A value:24 hours was 0.41 ± 0.02 vs.0.37 ± 0.04,48 hours was 1.30 ± 0.09 vs.1.15 ± 0.19).Compared with the blank control group,the contents of IL-6,IL-8,TNF-αα,MMP-9,MDA,AP-1 expression were significantly increased in model group [IL-6 (ng/L):35.00±3.63 vs.23.15±1.72,IL-8 (ng/L):273.09± 164.36 vs.231.45±33.90,TNF-α(ng/L):51.61 ± 9.51 vs.28.87 ± 3.34,MMP-9 (ng/L):442.85 ± 78.86 vs.235.60 ± 14.62,MDA (μmol/L):6.90 ± 0.11 vs.6.01 ± 0.12,AP-1 expression (A value):2.260 ± 0.062 vs.1.000 ± 0.000],MDA/T-SOD ratio was increased (4.43 ± 0.05vs.3.96 ± 0.06).Compared with model group,the levels of IL-8 (ng/L:100.29 ± 17.03),TNF-α (ng/L:25.13 ± 0.46),AP-1 expression (A value:1.38 ± 0.02),and the MDA/T-SOD ratio (4.23 ± 0.23) in T-5224 group,and MMP-9 (ng/L:195.44±9.80),MDA (μmol/L:5.86±0.30),MDA/T-SOD ratio (3.56±0.41),AP-1 expression (A value:0.76 ± 0.01) in nourishing lung and kidney group were all reduced significantly (all P ＜ 0.05).Conclusion Nourishing lung and kidney formulas can suppress the inflammatory response through regulating the alveolar epithelial cells AP-1 signaling pathways.

Objective To explore the influence of the combination therapy of probucol with atorvastatin on levels of serum high sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoproteins (ox-LDL), and marix metallopro? teinase-9 (MMP-9) and resolution of carotid plaque in patients with acute cerebral infarction (ACI). Methods One hun? dred-six patients with acute cerebral infarction who had carotid artery color Doppler ultrasound-confirmed atherosclerot? ic plaques , were included in the present study. The patients were randomly divided into two groups: conventional treat? ment group ( 40 cases) which received atorvastatin (20mg/d) and co-treatment group (40 cases) which received Atorvas? tatin (20mg/d) and Probucol (500mg/d). Levels of hs-CRP, ox-LDL and MMP-9 were detected in all patients before treat? ment and 1, 6 and 12 months after drug therapy. The Intima-media thickness, area and numbers of carotid plaques were evaluated by using Doppler ultrasonography during a 12 months follow-up period. Results ① Serum hs-CRP and MMP-9 levels were significantly decreased at 1, 6 and 12 months after treatment, (conventional treatment group:t =14.662, 23.586, 28.179 and co-treatment group:t =47.023, 50.239, 50.774,P <0.01). The ox-LDL levels was obviously de? creased in the combined treatment group (t =4.592, 5.011, 5.892,P <0.01) but not in conventional treatment group (P > 0.05) at 1, 6 and 12 months after treatment. Serum hs-CRP, ox-LDL and MMP-9 levels were significantly lower in com? bined treatment group than in the conventional treatment group at all time points after treatment (t =7.655, 5.271, 2.492, t =4.927, 3.772, 4.673 andt =16.862, 4.251, 2.045.P <0.01 orP <0.05). ②There were not statistically differences in the IMT, plaque area and plaque numbers between these two groups before treatment (P >0.05). The IMT, plaque area and plaque numbers were significantly smaller in combined treatment group than in conventional treatment group (t =6.117, 3.290, 2.158,P <0.05). Conclusions The combination therapy of probucol with atorvastatin can greatly reduce levels of serunl hs-CRP,ox-LDL and MMP-9, indicating that the combination therapy has a strong anti-oxidant function, thereby reversing and stabilizing the atherosclerosis plaque.

Objective:To identify gene variants and investigate clinical features of nonmuscle myosin heavy chain 9-related disease (MYH9-RD).Methods:In this retrospective study, the data of patients with MYH9-RD admitted to Shenzhen Children′s Hospital from July 2017 to September 2020 were extracted. The gene variants, clinical features and laboratory tests results were summarized.Results:Among the 6 children, 4 were males and 2 were females, aged 4.0 (0.5-7.6) years. Main clinical manifestations included thrombocytopenia (6 cases), epistaxis (3 cases), petechias (2 cases), traumatic hematoma (1 case), and abnormal liver enzymes (1 case). One patient had no family history, and the other 5 cases were pedigrees. Two pedigrees (2 cases) had long-term microscopic hematuria, one pedigree (2 cases) had history of early cataract, and three pedigrees (5 cases) had chronic mild elevation of liver enzymes. Four MYH9 gene variants were found in 12 patients, including c.2104C>T(p.R702C) in exon 17, c.4270G>A(p.D1424N) in exon 31, c.5521G>A (p.E1841K) in exon 39, and c.5797C>T (p.R1933X) in exon 41. According to the family pedigrees analysis, except for the case of variant in exon 17 which was spontaneous mutation with no family history, the other variants were from their father or mother. The complete blood count results showed a decreased platelet number in these patients, and the counting results of the automated hematology analyzer were significantly lower than that of manual counting method ((33.4±17.2) × 10? vs. (60.4±21.0) × 10 9/L, t=-5.83, P<0.05). The examination of the peripheral blood smear revealed the presence of thrombocytopenia with giant platelets and granulocyte inclusion bodies. The MYH9 gene variant (R702C) located at the N-terminus head domain of non-muscle myosin heavy chain ⅡA (NMMHC-ⅡA), which has ATPase activity, led to severe reduction of platelet number (<20×10 9/L) and obscure granulocyte inclusion bodies. However, higher platelet numbers (40×10 9-80×10 9/L) and obvious granulocyte inclusion bodies were observed in patients with tail-position mutations at C-terminus. Conclusions:The clinical phenotypes of MYH9-RD were variable. The mutations in certain regions of MYH9 gene were related to platelet count and granulocyte inclusion bodies. MYH9-RD should be considered in individuals with unknown etiology and persistent thrombocytopenia which is non-responsive to conventional treatment, regardless of family history. Complete blood count and blood smear morphology examinations are the first steps to screen and diagnose the disease. The laboratory should pay attention to the morphological review rules and standardized reports.

OBJECTIVE： To investigate how pharmacists provide through individualized pharmaceutical care for patients medication therapy management（MTM） combined with medicine gene detection， and to promote rational drug use in clinic.METHODS： A case of elderly comorbidity with acute upper gastrointestinal hemorrhage caused by Warfarin sodium tablets was taken as an example. The patient had a history of type 2 diabetes mellitus and hypertension. Coronary artery bypass grafting was performed two months before admission， and urinary tract infection occurred half a month ago. Medication therapy course was analyzed retrospectively before and after hospitalization； based on gene typing detection of CYP2C9*3 and VKORC1-1639， the individualized dose of Warfarin sodium tablets was evaluated. MTM was perfomed for acute upper gastrointestinal hemorrhage and all medication of patient to formulate individualized medication scheme. RESULTS： The genotyping of warfarin CYP2C9*3 and VKORC1-1639 indicated that the patients were of super slow metabolic type. The recommended dosage of warfarin should be 0.86-1.86 mg/d. Based on MTM analysis of acute upper gastrointestinal hemorrhage， the main causes of acute upper gastrointestinal hemorrhage were Warfarin sodium tablets 3.0 mg/d， poor drug compliance， disease status and co-morbidity and multi-drug combination. Clinical gastrointestinal hemorrhage of the patients were improved after drug withdrawal， anticoagulant drugs was changed into Rivaroxaban tablet，10 mg/d. Through MTM for all drug use in the patient， results of medication reorganization showed that Diltiazem hydrochloride tablet， Amoxicillin/clavulanate potassium dispersible tablet， Compound vitamin tablet were stopped； hypoglycemic drug Glimepiride tablet was changed into Gliquidone tablet； Metoprolol tartrate tablet was changed into Bisoprolol tablet after coronary artery bypass graft； proton pump inhibitor Esomeprazole enteric-coated tablet was changed into Pantoprazole sodium enteric-coated capsule. CONCLUSIONS： The pharmaceutical care mode of MTM combined with medicine gene detection can guide rational drug use in clinic， realize individualized pharmaceutical care， improve patient compliance and prevent problems related to adverse drug reactions.

ObjectiveTo investigate the changes of surface electromyography (sEMG) of the flexors and extensors of the affected fingers after manual digitorum sensory stimulation (MDSS) in the hemiplegic patients after stroke. MethodsFrom April to August, 2020, 50 stroke patients in Department of Rehabilitation Medicine, the Second Hospital of Anhui Medical University accepted MDSS on the nail beds and the third knuckles of affected fingers, until the fingers extended actively. The tension of affected flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were assessed with modified Ashworth Scale (MAS) before and immediately after stimulation; while the root mean square (RMS) of sEMG of bilateral flexor pollicis brevis, flexor digitorum superficialis and extensor digitorum were recorded. ResultsThe MAS score of all the muscles decreased after stimulation (|Z| > 2.699, P < 0.01), while the RMS of affected extensor digitorum increased (t = -2.069, P < 0.05). Compared with the unaffected ones, RMS of affected flexor pollicis brevis and extensor digitorum decreased before and after stimulation (t > 2.450, P < 0.05). ConclusionMDSS may immediately relieve the spasm of flexors of hemiplegic fingers after stroke, which associates with the promoting muscle strength of the extensors.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.