Objective To investigate the alexithymia, mental health condition and their relationship in female rheumatoid arthritis patients. Methods Fifty-four female patients with rheumatoid arthritis and 50 healthy women were enrolled and assessed with Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20) and the symptom checklist-90(SCL-90). Disease duration and DAS28 of the patients were also recorded and calculated. The data were statistical analyzed by t test between the two groups and other block groups. The association between TAS-20, SCL-90, duration and DAS28 was assessed using Spearman corre-lations. Results ① The TAS-20 total score and Tf1, Tf2, Tf3 factors score of female rheumatoid arthritis patients were significantly higher than those of the control group (57±9, 51±7, t=4.15, P<0.01); it was also the same with the total score and factors score of SCL-90 (beside the paranoid factor) between patients and control groups (165±50, 138±41, t=3.06, P<0.05). ② Correlation analysis showed significantly positive correlation between Tf1 factor and all factors of SCL-90, also between Tf3 factor and obsession-compulsion, interpersonal sensitivity, phobias and paranoid factors(P<0.05). ③ Only hostility factor was different between the higher TAS-20 total score group and the lower one. However, the obsession-compulsion, anxiety and phobias factors scores of the higher Tf1 score group were significantly higher than those of the lower one (P<0.05); The higher Tf3 score group was significantly different from the lower one in obsession-compulsion, interpersonal sensitivity, depression, hostility, paranoid and psychoticism factors (P<0.05). The Tf1 factor score of higher SCL-90 total score group was significant higher than that of the lower one (P<0.05). ④ There were significantly positive correlation between duration and depression and paranoid factors, also between
DAS28 and anxiety and paranoid factors (P <0.05). Conclusion There is obvious alexithymia and psychological problems in female rheumatoid arthritis patients; the Tf1 and Tf3 factors of TAS-20, duration and DAS28 are all major factors related to the psychological state.

Objective:To explore the application and feasibility of PDCA cycle mode during the initial review of medical ethics committee in the hospital, to further promote the sustainable capacity building of ethics committee.Methods:To improve the quality of initial review management in the hospital ethics committee, PDCA method was used in this study from four aspects that including planning, implementation, inspection and action.Results:Measures adopted including clarifying the scope of ethical review, strengthening the practicability and operability of the review system, standardizing the ethical review procedures, strengthening the substantive review, reinforcing the cooperation among departments, and strengthening the training of medical ethics. Along with the implementation of these measures, ethics committee members were empowered their capacity of conducting initial review, at the same time, investigators also had better understandings and be more serious of the initial review. Furthermore, a PDCA improvement plan was proposed, which including the establishment of independent consultant expert database, the initiative of ethical review data management system, adopting clinical decision analysis methods in ethical review, as well as the improvement of post-approval management and operating procedures.Conclusions:The ethical review management work is continuingly improved under the guidance of PDCA cycle theory. The method of PDCA cycle theory is an ideal model for the long-term development of ethical management.

ObjectiveTo evaluate the clinical effectiveness and safety of acupuncture with manipulation for lumbar disc herniation in remission period. MethodsOne hundred and four patients with lumbar disc herniation in remission were randomly divided into a treatment group and a control group， with 52 cases in each group. Treatment group applied acupuncture with manipulation of pointing， pulling， and shaking. Acupoints were selected as lumbar Jiaji （EX-B2， bilateral）， Ashi point， Shenshu （BL 23， bilateral）， Huantiao （GB 30， bilateral）， Weizhong （BL 40， opposite side of the affected area）， Chengshan （BL 57， opposite side of the affected area）. The control group applied lumbar traction plus acupoint ultrasonic pulse penetration therapy （acupoints selection same as the treatment group）； 20 minutes each time， 3 times a week， a total of 3 weeks for both groups. The primary outcome was the improvement rate of lumbar disc herniation symptoms and signs， which was calculated at 1 week of treatment， 3 weeks of treatment， 1 month follow-up， and 3 months follow-up， respectively； the secondary outcome were the Japanese Orthopaedic Association （JOA） scores， Visual Analogue Scale （VAS） scores， and Oswestry Disability Index （ODI） scores （including ODI total scores， sitting scores and standing scores）， which were evaluated before treatment， 1 week of treatment， 3 weeks of treatment， 1 month follow-up， and 3 months follow-up； clinical effectiveness was assessed at 3 months follow-up； and the occurrence of adverse events in the participants， as well as blood routine， urine routine， stool routine， and electrocardiograms before and after the treatment were recorded to evaluate safety. ResultsTwo patients from each group fell out， and 50 patients of each group were included in the outcome analysis ultimately. The scores of lumbar disc herniation symptoms and signs improved more in the treatment group than in the control group at 1 week of treatment， 3 weeks of treatment， 1 month follow-up and 3 months follow-up （P＜0.01）. The JOA scores of participants in both groups at 1 week of treatment， 3 weeks of treatment， 1 month follow-up and 3 months follow-up were higher than those before treatment in the same group， and the VAS scores， ODI total scores， ODI sitting scores and standing scores were significantly lower than those before treatment in the same group （P＜0.05）， and the JOA scores of patients in the treatment group were higher than those of the control group at all time points， and the VAS scores， ODI total scores， ODI sitting scores and standing score were lower than those of the control group （P＜0.05）. At the 3 months follow-up， the excellent rate of the treatment group was 70.00% （35/50） better than that of the control group， which was 50.00% （25/50） （P＜0.05）. There were no abnormalities in blood， urine， stool routines and electrocardiograms before and after treatment in both groups， and no adverse events occurred. ConclusionAcupuncture with manipulation of pointing， pulling， and shaking for treating patients with lumbar disc herniation in remission has a better safety on pain relief and improving quality of life， and the effectiveness is better than lumbar traction plus acupoint ultrasonic pulse penetration therapy.