In order to better construct important diseases of traditional Chinese medicine ( TCM ) clinical re-search base , and strengthen the construction of medical and clinical research of TCM information sharing sys-tem, Hubei Provincial Hospital of Traditional Chinese Medicine has constructed research type clinic. The con-struction idea of research type clinic is the mode of real world TCM clinical research . The construction of research type clinic mode was from three aspects, which were the clinical research, health management and distinctive diagnosis and treatment .

Objective To observe the effects of comprehensive measures of changing grain,selenium supplementation,off-site education and resettlement on prevention of children's Kashin-Beck disease in Aba state.Methods Fifty eight villages in Aba Kashin-Beck disease areas were chosen as intervention points in Aba state Sichuan province from 2007 to 2011.Based on the implementation of prevention and control measures,the villages were divided into off-site education + changing grain + selenium supplementation group and resettlement + off-site education + changing grain + selenium supplementation group,Geletuo town of Seda county,Ganzi state was selected as a control point,and right-hand anteroposterior X-ray examination(including the wrist) was carried out on children aged 6-13 from 2007 to 2011 annually.Clinical and X-ray diagnosis of Kashin-Beck disease was made in accordance with the Diagnostic Criteria of Kaschin-Beck Disease(GB 16003-1995).The effects of prevention and control measures were evaluated by comparing the child X-ray detection rate before and after the implementation of the measures.Results The average X-ray positive detectable rate of children in the intervention points was 2.07％(66/3181),2.72％ (69/2540),1.16％ (35/3017),0.56％ (19/3397) and 0.56％ (24/4273),respectively from 2007 to 2011,with a downward trend (x2trend =66.74,P ＜ 0.01).There was a downward trend in the average X-ray positive detectable rate of children in off-site education + changing grain + selenium supplementation group [1.60％(29/1809),2.63％ (39/1484),1.29％ (25/1941),0.64％ (15/2332),0.42％ (10/2379)] and resettlement + off-site education + changing grain + selenium supplementation group [2.70％ (37/1372),2.84％ (30/1056),0.93％(10/1076),0.38％ (4/1065),0.74％(14/1894)] (x2trend=30.97,35.19,all P ＜ 0.01).The average X-ray positive detectable rate of children in the intervention group was 0 from 2007 to 2010,and was 1.61％ (1/62) in 2011.The difference of X-ray positive detectable rate was not statistically significant in the control group in the 5 years from 2007 to 2011.The difference of children's X-ray positive detectable rate was not statistically significant between control group and intervention group.Conclusions The effect of taking changing grain,selenium supplementation,off-site education and resettlement comprehensive measures to prevent children's Kashin-Beck disease is not significant in those places where the state of Kaschin-Beck disease is not active.

Objective: To observe the effects of acupuncture plus spinal manipulations on the physical functioning and levels of alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and osteoprotegerin (OPG) in patients with ankylosing spondylitis (AS). Methods: A total of 128 AS cases were allocated into a control group and an observation group using random number table method, with 64 cases in each group. Patients in both groups took sulfasalazine and meloxicam. Patients in the observation group received additional acupuncture plus spinal manipulations. The efficacy, Bath AS functional index (BASFI), Bath AS disease activity index (BASDAI), and the levels of ALP, ESR, CRP and OPG were compared between the two groups after eight weeks of treatment. Results: After treatment, the symptom scores of traditional Chinese medicine in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); the VAS, BASFI and BASDAI scores in both groups were decreased (all P<0.05), and these scores in the observation group were significantly lower than in the control group (all P<0.05); and the ALP, ESR, CRP and OPG levels in both groups were decreased (all P<0.05), and these levels in the observation group were significantly lower than in the control group (all P<0.05). The total efficacy rate was 92.2％ in the observation group, versus 78.1％ in the control group, presenting a statistical significance (P<0.05). Conclusion: Conventional medication combined with acupuncture and spinal manipulations can improve clinical symptoms, accelerate the recovery of physical functioning, and reduce the ALP, ESR, CRP and OPG levels.

OBJECTIVETo observe the expression of Runx2 in osteoblasts in response to centrifugation in vitro and discuss the function of bone morphogenetic protein (BMP) signal transduction pathway in this course.

METHODSCells were divided into four groups, group A, B, C and D, pretreated with DMEM containing 10% fetal bovine serum, 10% fetal bovine serum, 100 ng x mL(-1) Noggin and 100 ng x mL(-1) Noggin for 24 hours separately. 271 x g centrifugation was loaded for 5 min to these groups except group A and C, other conditions were the same. The total RNA of each group were extracted, and reversed transcription to cDNA after 30 min. The expression of Runx2 in response to centrifugation in vitro was analyzed by quantitative real time PCR.

RESULTSThe expression of Runx2 mRNA in group B was significantly higher than that in group A (P < 0.05). The expression of Runx2 mRNA in group D was significantly lower than that in group B (P < 0.05). There was no statistically significant difference among group A, C, D (P = 0.692).

CONCLUSIONBMP signal transduction pathway plays an important role in the response of osteoblasts to mechanical stimulations. It may also play a central role in the cascade information dissemination of osteoblasts.

Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Cell Differentiation ; Centrifugation ; Core Binding Factor Alpha 1 Subunit ; Gene Expression Regulation ; Humans ; In Vitro Techniques ; Osteoblasts ; RNA, Messenger ; Signal Transduction

OBJECTIVEto explore the value of in vivo dynamic monitoring of abdominal aortic atherosclerosis (AS) by high field magnetic resonance (MR) imaging (MRI) in apoE-/- mice fed a high fat diet or infused with angiotensin.

METHODShigh fat diet or angiotensin II infusion was applied to apoE-/- mice for establishment of abdominal aortic atherosclerosis model. Abdominal aorta MRI was performed at 3 time points (baseline, 3 and 6 months) in 13 high fat diet fed apoE-/- mice aged 10-12 months and 3 wild-type control mice; 10 apoE-/- mice aged 6 months were infused with angiotensin II (1000 or 500 ng × kg(-1)× min(-1), n = 5 each) or saline for 14 d through Osmotic minipump. The abdominal aortic artery MRI was performed at baseline and 14 d after infusion. Black blood sequences of FLASH T1 weighted images and Proton density weighted-T2 weighted dual echo images were obtained. At each observation time post MRI, mice (n = 3, 5 and 5 for high fat diet group and n = 5 and 5 for angiotensin II infusion group) were sacrificed for pathological examination of the abdominal artery.

RESULTS(1) the abdominal aorta atherosclerosis was identified in both high fat diet and angiotensin II treated apoE-/- mice but in WT controls. Lesion progression was documented in high fat diet fed apoE-/- mice characterized by significantly increased vessel wall (a marker of atherosclerotic burden, F = 29.94, P < 0.05) and gradually increased plaque signal in PDW and T2W images. Results derived from MRI corresponded histopathology findings in high fat diet fed apoE-/- mice (correlative coefficient = 0.84, 0.95, 0.90, P < 0.05, respectively). Both MRI and histology showed increased lipid composition and decreased fibrotic composition in these mice. (2) The vessel wall area increased significantly [(1.21 ± 0.21) mm(2) vs. (2.65 ± 0.48) mm(2), P < 0.05] and the abdominal aortic dissection aneurysms was identified in apoE-/- mice infused with high angiotensin II. The vessel wall area also increased [(0.85 ± 0.11) mm(2) vs. (1.01 ± 0.17) mm(2), P < 0.05] in low angiotensin II infused apoE-/- mice and the coefficient between MR and histopathology is 0.934.

CONCLUSIONabdominal aortic unstable plaque model could be established by both high fat diet and angiotensin II infusion in apoE mice, angiotensin II infusion can transiently accelerate the progression of AS and can induce abdominal aortic dissection. Serial MR black blood sequences could demonstrate the development and progression of atherosclerosis in mouse abdominal aorta with excellent agreement to histopathology finding in terms of atherosclerotic burden and plaque composition. Thus, MRI appears to be a useful tool for in vivo AS plaque dynamic monitoring in mice.

Angiotensin II ; administration & dosage ; Animals ; Aorta, Abdominal ; Apolipoproteins E ; Arteriosclerosis ; Diet ; Dietary Fats ; administration & dosage ; Disease Models, Animal ; Magnetic Resonance Imaging ; methods ; Male ; Mice ; Mice, Knockout

Objective To evaluate the clinical efficacy of percutaneous ultra-fine needle CO_2 splenoportography (CO_2-SP).Methods CO_2-SP and 3D-CE-MRA were performed in 36 patients.The imaging quality of the methods was compared by a scoring criterion setup based on the visualization of the trunk,intrahepatic branches of the portal vein and collateral vessels.Results Transient mild abdominal discomfort was presented in 19 patients(52.8% )receiving CO_2-SP.One patient developed snbcapsular splenic hematoma and was discharged with clinical stability several days later after conservative treatment. The imaging quality of the intrahepatic branches of the portal vein with CO_2-SP was much more superior to 3D-CE-MRA (the score was 232 and 198 respectively,t=4.52,P0.05 ).Conclusion Ultrafine needle CO_2-SP is a minimally invasive and safe procedure,able to provide dynamic and clearer imaging of the intrahepatic branches of the portal vein.

Objective To investigate the changes in function of liver and kidney of the rabbits bearing VX2 liver tumor after transarterial embolization and hyperthermia with magnetic nanoparticles suspended in lipiodol(MN-L) and its therapeutic effect Methods Thirty-two rabbits bearing VX2 liver tumor were randomly divided into four groups and each group contained 8 rabbits The four groups were MN-L embolization hyperthermia group (Group A), MN-L embolization group(Group B),Lipiodol embolization group(Group C), and Control group (Group D), Each rabbit in Group A and B was embolized with 0.5-0.8 ml MN-L through hepatic artery, while each rabbit in Group C was embolized with 0.5-0.8 ml lipiodol.Hyperthermia in alternating magnetic field was performed in Group A after embolization.The remaining groups did not undergo hyperthermia.The rabbits in control group were not treated.The function of liver and kidney of all the animals was measured 1d before embolization,and 1,7,and 14 d after embolization/hyperthermia respectively.Alanine aminotransferase (ALT) and aspartate aminotransaminase (AST) were used to reflect the function of liver,and blood urea nitrogen(BUN) and creatinine (Cr) were used to reflect the function of kidney.CT was performed on all of subjects before and after embolization to determine the embolization effect and the tumor size, and follow-up CT was performed weekly.All of subjects were sacrificed 14 days after embolization/hyperthermia, and their livers, spleens, kidneys and lungs were removed for histopathology examination.The data from every group were analyzed using analysis of variance of repeated measure data.Results On 1 day before embolization and 1,7, and 14 d after embolization/hyperthermia, the function of liver of the rabbits was as follows:Group A:ALT was (43.9±19.0),(795.1±327.1),(67.0±9.3), and(41.9±10.8) U/L respectively,and AST was (50.2±13.6),(1011.2±655.9),(62.4±24.1),and(51.6±7.9) U/L respectively; Group B: ALT was(45.0±19.1),(580.8±160.4),(67.2±31.0),and(47.6±7.8) U/L respectively, and AST was (52.9±20.3),(735.2±186.1),(57.9±24.8),and (50.9±9.8) U/L respectively; Group C: ALT was (47.4±14.6),(558.5±167.8),(63.5±21.9),and (48.0±9.3) U/L respectively, and AST was (51.8±9.5),(752.5±112.0),(56.5±20.6),and(51.4±8.6) U/L respectively.Both ALT and AST mean values of the rabbits were significantly elevated 1 d after embolization/hyperthermia in Group A, B and C, and the data showed statistically significant difference comparing with that before therapy and that of Group D 1 d after therapy (P<0.01).The function of liver showed no statistically significant difference between 7 or 14 days after embolization and 1 day before embolization in Group A,B and C. BUN and Cr mean values in pre-embolization and post-embolization rabbits revealed no statistically significant difference in group A, B, C and D.The MN-L /lipiodol were deposited in the tumor when it was injected, which was validated by CT.To compare with immediate CT after embolization, the MN-L deposited in tumors was not significantly different on CT 7 d after embolization .On the 14 th day after treatment,the MN-L deposited in tumors became concentrative and compact in Group A, while the MN-L/lipiodol deposited at the rim of tumors disappeared on CT in five rabbits of Group B and C.And the tumor size decreased by 21.7% compared to that before treatment in Group A [from (7.8±1.4)cm~3 to(6.1±0.6) cm~3,F=17.56, P<0.01], but tumor size increased by 16.2% and 18.9% in Group B and C respectively [from (7.9±1.1)and (7.8±0.9)cm~3 to (9.1±0.8) and (9.3±1.0)cm~3, F =25.23,55.50, P<0.01].Histopathologically, the tumor of Group A was necrotic for at least 80% 14 day after embolization, while the tumor of Group B and C was necrotic for 30% to 50% .Conclusion Transarterial embolization and hyperthermia with MN-L is safe, effective and feasible on the rabbits bearing VX2 liver tumor.

OBJECTIVETo investigate the anatomical study and clinical applications of sural neuron-myocutaneous flap transposition for repairing the special patients with soft tissue defect in foot and ankle.

METHODSThe branches, distributions and anastomoses of the vessels and nerves lie in superficial layer of the posterior crural region were observed on 30 sides of adult cadaver lower limb specimens perfused with red latex. Since February 2004, distally based sural neuron-myocutaneous flap was applied for repairing 7 cases of soft tissue defect in foot and ankle.

RESULTSThe nutrient vessels of sural nerve, small saphenous vein and posterior femoral cutaneous nerve anastomosed permanently with the musculocutaneous perforators of medial and lateral head of gastrocnemius. There were 2 - 3 anastomoses found respectively. The musculocutaneous perforators pierced the two heads of gastrocnemius muscle (1.8 +/- 0.5) cm medially and (3.7 +/- 0.9) cm laterally away from the groove of the muscle. The medial anastomoses more closed to the middle groove and their diameters were found larger than the lateral ones. In operation, we routinely observed the compound flap for 15 to 20 minutes and found actively errhysis on the muscle, so the fine blood circulation in the flap was demonstrated. All flap survived after operation and the cases were followed up 2 to 6 months with cured osteomyelitis and satisfied flap outline.

CONCLUSIONSDistally based sural neuro-myocutaneous flap can live. The operative method is simple. The flap offers an excellent donor site for repairing the soft tissue defect in foot and ankle in special cases.

Adult ; Female ; Humans ; Male ; Middle Aged ; Popliteal Artery ; anatomy & histology ; Soft Tissue Injuries ; surgery ; Sural Nerve ; anatomy & histology ; surgery ; Surgical Flaps ; blood supply ; innervation

Objective To determine the changes of cerebrospinal fluid(CSF) ?-endorphin(?-EP) and C-reactive protein(CRP) in children with central nervous system(CNS) infection.Methods Sixty-five children suffered from CNS infection were determined the plasma and CSF ?-EP and CRP concentration during the acute and recovering stage with radioimmunoassay, which included 48 viral encephalitis, 12 purulent meningitis and 5 tuberculou meningitis,and 24 non-CNS disease children were as control group.Results The concentrations of plasma and CSF ?-EP of every experimental group were obviously higher than those of control group during the early stage of CNS infection and these were obviously lower during the recovering stage. The serum concentration of CRP during acute stage was significantly higher than that during recovering stage. No change of serum and CSF CRP concentration was determined during either the acute or recovering stage in the other two experimental groups.Conclusions Determining the plasma and CSF ?-EP is mea-(ningful) in early diagnosis of CNS infection,and determining the serum CRP at the same time may be helpful in differentiating septic and inseptic infection.

Objective To explore the effect of advanced hierarchical training based on Benner theory on nurses' core competence and post competency. Methods A total of 499 nurses were selected to participat in the training from January 2016 to December 2017. They were divided into before-training group and after- training group, the training method was based on the advanced hierarchical training model of energy level under the guidance of Benner′ s theory.The nurse′ s core competence, post competency, and nursing satisfaction were compared. Results The ratings of nurses′ critical thinking and research, clinical nursing, ethics and legal practice, professional development and education consultation (34.21±4.56), (30.12±5.25), (27.12±5.24), (25.46±4.52), (26.24±4.21), (20.21±3.56), (23.12± 5.24) points in after-training group were significantly higher than in before-training group (28.36±4.12), (26.45±4.52), (26.72±4.52), (25.12±4.12), (24.50±3.25), (18.65±3.12), (20.24±4.65) points (t=7.308-21.264, P<0.05 or 0.01). The scores of nurses' professional knowledge, professional skills, professional ability, and overall quality (72.32 ± 9.21),(93.24 ± 12.35), (43.34 ± 4.12), (54.20 ± 4.23) points were significantly higher than before training (68.25±8.32), (86.42±10.21), (41.05±5.24), (52.12±5.25) points (t=6.892-9.507, P<0.05 or 0.01), and patient satisfaction 92.67％(12164/13126) was significantly higher than before training 88.68％ (11106/12524) (χ2=121.409, P<0.01). Conclusion The advanced level-stratified training model based on Benner theory is helpful to promote the development of nurses′ core competence and post competency, and improve patient satisfaction.