Traditional Chinese Medicine (TCM), as a treasure of the Chinese nation, plays a significant role in maintaining public health. In 2019, the Central Committee of the Communist Party of China and the State Council proposed for the first time the establishment of a TCM registration and evaluation evidence system that integrates TCM theory, "personal experience" and clinical trials (referred to as the "Three-in-One" System) to promote the inheritance and innovation of TCM. Subsequently, the National Medical Products Administration issued several guiding principles to advance the improvement and implementation of this system. Owing to the complexity of its implementation, there are still differing understandings within the TCM industry regarding the positioning of the "Three-in-One" Registration and Evaluation Evidence System, as well as the connotation and value orientation of the "personal experience." To address this, Academician WANG Qi, President of the TCM Association, China International Exchange and Promotion Association for Medical and Healthcare and TCM master, led a group of academicians, TCM masters, TCM pharmacology experts and clinical TCM experts to convene a "Seminar on Promoting the Implementation of the ′Three-in-One′ Registration and Evaluation Evidence System for Chinese Medicinals." Through extensive discussions, an expert consensus was formed, clarifying the different roles of the TCM theory, "personal experience" and clinical trials within the system. It was further emphasized that the "personal experience" is the core of this system, and its data should be derived from clinical practice scenarios. In the future, the improvement of this system will require collaborative efforts across multiple fields to promote the high-quality development of the Chinese medicinal industry.

Objective:To investigate the expressions of glutathione S-transferases M1 (GSTM1) and glutathione S-transferases M2 (GSTM2) in follicular thyroid carcinoma (FTC) and their clinical significances.Methods:Gene expression profile of GSE82208 generated from 52 human thyroid samples, including 27 cases of FTC and 25 cases of follicular adenoma (FA) were collected from Gene Expression Omnibus (GEO) database. The gene matrix data were extracted and analyzed, and then differentially expressed genes (DEG) between FTC and FA were identified by using Limma package. Immunohistochemical SABC method was used to detect the expression levels of GSTM1 and GSTM2 proteins in FTC tissues and FA tissues collected from 56 FTC samples and 56 FA samples in Dandong First Hospital of Liaoning Province from January 2000 to December 2020. The relationship between GSTM1 and GSTM2 was analyzed; the association of expression levels of GSTM1 and GSTM2 with the clinicopathological factors of FTC patients was also analyzed.Results:Based on the GEO database, a total of 40 DEG were identified, including 9 up-regulated DEG (GSTM1, GSTM2, COL6A2, CUX2, CLUH, TSC2, OGDHL, ACADVL, SDHA) and 31 down-regulated DEG in FTC. The immunohistochemistry results of samples resected showed that the positive rates of GSTM1 and GSTM2 proteins in FTC tissues were higher than those in FA tissues [71.4% (40/56) vs. 23.2% (13/56), 80.4% (45/56) vs. 14.3% (8/56)], and differences were statistically significant ( χ2 values were 26.11 and 49.03, both P < 0.01). The expressions of GSTM1 and GSTM2 in FTC tissues were correlated with clinical staging, invasion degree and distant metastasis (all P < 0.05), but not with gender, age and tumor diameter (all P>0.05). There was a positive correlation between GSTM1 and GSTM2 proteins expressions in FTC ( r = 0.384, P = 0.004). Conclusions:The expression levels of GSTM1 and GSTM2 in FTC are increased. The interaction between GSTM1 and GSTM2 proteins can be involved in the development and progression of FTC.

Objective:To explore the operative effect and treatment strategies for the low distal humerus fracture.Methods:A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results:The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion:Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

Objective:To explore the operative effect and treatment strategies for the low distal humerus fracture.Methods:A retrospective analysis was conducted on the clinical data of 16 patients with the low distal humerus fracture between January 2016 and January 2018 at Department of Orthopaedics, Shanghai Tongji Hospital Affiliated to Tongji University.All fractures were coronal fractures of humeral head, partly combined fractures of humeral trochlea or posterior part. Fractures were classified according to Dubberley classification as 9 cases in type Ⅰ, 3 cases in typeⅡ and 4 cases in type Ⅲ.Selection of the kind of operative approach and internal fixation was made according to the fracture type and shape. For simple coronal fractures of humeral head or combining humeral trochlea fractures, which were relatively stable, single or multiple countersunk screws fixation by the lateral approach were chosen.For humeral head coronal fractures, which combining obviously displaced comminuted humeral trochlea factures, posterolateral locking plates and countersunk screws internal fixation by the olecranon osteotomy approach were chosen. The incision and elbow soft tissues were observed within 2 weeks after operation.The radiographic evaluation of fracture reduction, bone healing, internal fixation, arthritis and elbow range of motion were made at 3, 6, 12 months after operation. The Mayo elbow functional scores were documented for analysis of elbow joint function, and compared between different surgery groups by Kruskal-Wallis H test. Results:The follow-up time was (22.1±9.2)months(range: 15 to 39 months). The incisions healed well in 2 weeks after operation without soft tissue infection, necrosis or vascular complications. There was no fracture reduction loss or internal fixation loosening according to radiographic evaluation 3 months after operation. One case of ectopic ossification was observed 6 months after operation and inhibited by the treatment of non steroidal anti-inflammatory drugs.One case of ulnar neuritis occurred after operation and released after removing the long screw and loosing the ulnar.Osteoarthritis images were observed at the end of follow-up.Arc of motion was (120.4±11.2) ° in flexion and (5.5±1.9) ° in extension. The Mayo score was 88.7±9.1, including 11 excellent, 4 good, and 1 fair.The Mayo score was 90.1±3.7 in Dubberley classification type Ⅰcases, 89.7±4.6 in type Ⅱ cases and 84.5±5.8 in type Ⅲ cases. There were no significant differences in Mayo scores between 3 types cases according to Kruskal-Wallis H test. Conclusion:Choosing the appropriate surgical approach and composite internal fixation according to the fracture types and shapes of low distal humerus fracture, anatomic reduction of the articular surface and early functional exercise are the keys to obtain ideal curative effect.

Objective To observe the effects of endoscopic drug therap on hemostasis, re-bleeding and the risk of occurrence of complication in patients with acute esophageal and gastric variceal bleeding (EGVB). Methods A retrospective method was conducted, and 100 patients with EGVB who were admitted to the Affiliated Hospital of Yan'an University from June 2015 to June 2017 were enrolled. According to the difference in treatment methods, they were divided into an endoscopy Sclerotherapy and Ligation group and transjugular intrahepatic portosystemic shunt (TIPS) group, 50 cases in each group. The TIPS group was treated with TIPS; the endoscopy Sclerotherapy and Ligation group underwent endoscopic variceal sclerotherapy, endoscopic esophageal variceal ligation and postoperative non-selective β blockers oral administration. After 2 years of follow-up, the patients' hemostasis, re-bleeding at acute stage, survival situation and the incidences of complications were recorded. Before treatment and 2 weeks after treatment, the levels of serum albumin (Alb), total bilirubin (TBil) and platelet count (PLT) were measured by Hitachi automatic biochemical analyzer in the two groups. Results The success rate of hemostasis in the endoscopy Sclerotherapy and Ligation group was significantly higher than that in the TIPS group [98.0% (49/50) vs. 82.0% (41/50) ], and the recurrence rate of varices, during 1- and 2-year follow-up, the recurrence rate of bleeding and the incidences of complications were significantly lower than those in TIPS group [the recurrence rate of varicose veins: 6.0% (3/50) vs. 24.0 (12/50), 1-year re-bleeding rate: 12.0% (6/50) vs. 30.0% (15/50), 2-year re-bleeding rate: 42.0% (21/50) vs. 66.0% (33/50), esophageal ulcer: 2.0% (1/50) vs. 14.0% (7/50), upper abdominal discomfort: 2.0% (1/50) vs. 14.0% (7/50), hepatic encephalopathy:4.0% (2/50) vs. 16.0% (8/50), chest pain: 6.0% (3/50) vs. 20.0% (10/50), all P < 0.05]. After treatment, the levels of Alb and PLT in the endoscopy Sclerotherapy and Ligation group were higher than those in the TIPS group [Alb (g/L):43.84±4.34 vs. 40.83±3.21, PLT (×109/L): 26.33±3.37 vs. 21.12±3.89, both P < 0.05], and the TBil was lower than that in the TIPS group (μmol/L: 13.82±4.32 vs. 19.33±4.59). Conclusion Endoscopic Sclerotherapy and Ligation can significantly improve the effect of hemostasis of patients with acute EGVB, the rate of re-bleeding does not increase compared with that of western medicine group using TIPS, and the incidences of complications are significantly lower than those of applying TIPS.

Objective To explore the diagnostic value of helical CT,fluid attenuated inversion recovery(FLAIR),magnetic resonance angiography (MRA)and susceptibility weighted imaging (SWI)at 3.0T MR for acute ischemic stroke (AIS).Methods 48 cases of AIS(<72 h)underwent conventional CT,MRI,MRA and SWI.The correlations between hyperdense middle cerebral artery sign (HMCAS),proximal hyperintense vessel sign(HVS),magnetic sensitive spatially-integrated susceptibility vessel sign(SVS),vascular dot middle cerebral artery sign(DMCAS),distal HVS and collateral circulation of the blood vessels surrounding leptomeninges expansion degree were analyzed.Results In 48 AIS cases,HMCAS were showed in 18(37.5%),DMCAS 12(25.0%),proximal HVS 33(68.7%), distal HVS 40(83.3%),SVS 43(89.6%)and surrounding soft meningeal vascular 39(81.2%).The difference between spatially-integrated SVS and HVS was statistically significant (P<0.05);For HVS and HMCAS responsibility blood vessels at the bottom,the difference was statistically significant(P<0.01).For pia mater lesions around the blood vessel and distal HVS display degree,the responsibility of the blood vessels was high consistency(P=0.789).The difference between MCA distal HVS and DMCAS was statistically significant (P<0.01).Conclusion It has obvious consistency for SVS,proximal HVS and HMCAS of MCA on the responsibility of AIS.SWI is better than FLAIR and CT.It has obvious statistical sighificance between DMCAS,HVS and surrounding leptomenings vasodilatiov.

Objective To examine characteristics of patients with blood urea nitrogen (BUN) levels higher and lower than the normal limit.Methods During January 2012 to January 2015,116 patients with upper gastrointestinal diseases were selected to study,according to the patient's blood urea nitrogen level,all the patients were divided into high BUN group and low BUN group,and there were 76 patients in the high BUN group,and 40 patients in low BUN group,compared the biochemical indices,gastrointestinal bleeding forrest grading and disease severity of the two groups,and univariate logistic regression analysis.Results The serum white blood cell count,blood urea nitrogen,creatinine and glycated hemoglobin levels in patients of high BUN group [(9 593±5 012)× 102/μl,368.1±162.3 mg/L,11.2±3.7 mg/L and 6.38±1.08％] were significantly higher than that of low BUN patients [(6 804 ± 2 087) × 102/μl,121.0 ± 39.3 mg/L,8.1 ± 3.2 mg/L and 5.51 ± 0.42 ％] (t =3.645～12.659,all P＜0.05),and the hemoglobin levels (87.3±35.1 g/L) of the patients in high BUN group was significantly lower than that of the low BUN patients (108.0 ± 31.2 g/L) (t=3.252,P=0.032).Logistic regression analysis showed the presence of hemoglobin and glycosylated hemoglobin levelst of wo groups of patients was significantly different (P＜0.05),and showed that showed the highest correlation with BUN.Gastrointestinal bleeding forrest hierarchical data of the two groups of patients showed no significant difference (P＞0.05).The proportion of patients with gastric ulcers of high BUN patients was significantly higher than that of the low BUN patients (x2 =39.655,P=0.000).Conclusion Patients with high expression of serum urea nitrogen had more severe upper gastrointestinal bleeding,and it is worthy of attention in the process of clinical diagnostic.

Objective To investigate the feasibility and clinical effect of cannulated screws plus separate vertical wirings technique for acute fracture of the inferior pole of the patella.Methods From May 2012 to September 2013,14 patients with fresh closed unilateral fracture of the inferior pole of the patella were treated with the cannulated screws plus separate vertical wirings.Eight patients were injured in traffic collisions and 6 in fall accidents.Fracture AO classification was type 34A1 in 8 patients and type 34A2 in 6 patients.Time from injury to operation was 1-7 days (mean,2.5 days).Number of tie wires was determined according to the degree of fracture comminution.Fracture healing,fixed position and patellar length were evaluated by radiographic examination postoperatively.Knee mobility and Bostman evaluation system were investigated to analyze the clinical effect.Results All the patients obtained average 15-month follow-up (range,12 to 29 months).At postoperative 2 months,the fracture healed with good alignment of the broken bone and proper place of the internal fixation device noted on the X-ray films.At postoperative 6 and 12 months,X-ray films revealed fracture bony healing,good location of the wire internal fixation,and no apparent shortening of the patella.At the 12 months,range of knee motion was (126.0 ± 4.5) ° for flexion and (2.0 ± 1.7) ° for extension.Bostman functional score for patella fracture was (28.1 ± 1.9) points.And 12 patients were rated as excellent and 2 good,with excellence rate of 100％.Conclusion Cannulated screw fixation plus separate vertical wiring is effective to stabilize patella inferior pole fracture and has good results,indicating a recommended surgical method.

OBJECTIVETo explore the clinical value of multi-slice spiral computed tomography portography (MSCTP) in assessing severity of liver cirrhosis and predicting episode risks of hepatic encephalopathy (HE).

METHODSEighty-six patients with liver cirrhosis who were hospitalized in the Department of Gastroenterology at the Affiliated Hospital of Yan'an University were included in the study.All patients underwent 64-slice MSCTP to grade the portal vein anatomy.The West Haven criteria were used for semi-quantitative assessment of each patient's mental state.The Child-Pugh grading system was used to assess the extent of cirrhosis.Comparison of measurement data between multiple groups was made by one-way ANOVA analysis, and comparison of such between two groups was made by the Mann-Whitney U test, Ranked data were compared with the rank-sum test, and count data were compared by the Chi-Square test.Correlation analysis was performed with Spearman's correlation test.

RESULTSComparison of the HE grade III group and the HE grade I group showed significant differences between the two in the diameters of left gastric vein, the splenic vein, the intrahepatic left portal vein and the intrahepatic right portal vein (P less than 0.05).Comparison of the Child-Pugh grade C group and the Child-Pugh grade A group showed significant differences between the two in diameters of the left gastric vein, the splenic vein, the intrahepatic left portal vein and the intrahepatic right portal vein (P less than 0.05).The diameters of the main portal vein were not significantly different between the ChildPugh grades and HE classifications (P more than 0.05).The results of MSCTP did show significant differences between different HE classifications in patients with liver cirrhosis and the rate of formation of portal vein thrombosis and fistulas of the hepatic artery-portal vein (P less than 0.05), .but no significant differences with the esophageal and gastric varices, varicose veins around the esophagus, and periumbilical varicose veins (P more than 0.05).HE classification was significantly correlated with formation of portal vein thrombosis and fistula of the hepatic artery-portal vein (r=0.687, P less than 0.05 and r=0.565, P less than 0.05, respectively).MSCTP grading (grade 1:n=35, grade 2:n=36, grade 3:n=15) was not correlated with the Child-Pugh grade (grade A:n=36, grade B:n=32, grade C:n=18) (Z=-0.135, P more than 0.05).Incidence of HE was significantly different among the different MSCTP grades (grade 1:0%(0), grade 2:33.3% (12/36), grade 3:66.7% (10/15); x2=26.468, P less than 0.05).The MSCTP grade was significantly correlated with the episode risks of HE (r=0.552, P less than 0.05).

CONCLUSIONMSCTP may be valuable for assessing severity of liver cirrhosis and for predicting episode risks of HE; however, future studies with larger sample numbers is required for validation of our findings.

Esophageal and Gastric Varices ; Hepatic Encephalopathy ; etiology ; Hepatic Veins ; Humans ; Liver Cirrhosis ; diagnostic imaging ; pathology ; Portal Vein ; Portography ; Risk Factors ; Tomography, Spiral Computed

BACKGROUNDL-shaped incision of pronator quadratus (PQ) muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation. Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons. But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ. Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through mini-incisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus. The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.

METHODSBetween September 2010 and April 2012, 65 patients (42 males and 23 females; aged 20-68 years and a mean age of 42.5 years) with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates (Depuy or Smith companies). The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association (OTA) classifications. All surgeries were completed by the same trained team. The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females. We compared the two groups for wrist pain, forearm range of motion, grip strength, perioperative complications and wrist functional recovery score.

RESULTSThe minimum follow-up for the whole cohort was one year. The differences between the two groups were significant with regard to wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, and 6 weeks postoperatively, but insignificant at 6 and 12 months postoperatively. No significant differences were found in the perioperative complications and radiographs postoperatively.

CONCLUSIONSPreservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates, as this technique can yield better early wrist function and shorten the rehabilitation.

Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Palmar Plate ; surgery ; Radius Fractures ; surgery