OBJECTIVE:To systematically review the effect of stroke efficacy and bleeding risk of edoxaban versus warfarin in the prevention of patients with atrial fibrillation,and provide evidence-based reference for clinical treatment. METHODS:Re-trieved from Cochrane Library,Medline,EMBase,CJFD,Wangfang Database and VIP Database,randomized controlled trials (RCT)about the stroke efficacy and bleeding risk of edoxaban versus warfarin in patients with atrial fibrillation were collected. Me-ta-analysis was performed for the incidences of stoke and excessive hemorrhage by using Rev Man 5.3 software after data extract. RESULTS:Totally 13 RCTs were included,involving 24 950 patients. Results of Meta-analysis showed,compared with warfarin group,there were no significant differences in the incidences of stoke [RR=0.97,95%CI(0.88,1.08),P=0.60] and excessive hem-orrhage [RR=0.84,95%CI(0.59,1.19),P=0.33] in edoxaban group. But the subgroup analysis showed,when daily dose of edoxa-ban was more than 30 mg,the incidence of stroke in edoxaban group was significantly lower than warfarin group [RR=0.84,95%CI(0.72,0.97),P=0.02];when it was 30 mg,the incidence of excessive bleeding in edoxaban group was significantly lower than warfarin group [RR=0.46,95%CI(0.35,0.61),P<0.001],the difference was statistically significant. CONCLUSIONS:Compared with warfarin,higher doses(>30 mg/d)of edoxaban can more effectively prevent the occurrence of stroke and low doses(30 mg/d) can reduce the risk of excessive bleeding.

Objective:To investigate the continuing education training demands and its related factors in mental health practitioners in China.Methods:The sample of 1391 mental health practitioners was collected from 29 provinces by convenient sampling with the self-made questionnaire.Results:The practitioners had the highest demands for practice(4.2±1.0)and skill training(4.1±1.0).Their training demands could be summarized as three factors:supervision and evaluation,knowledge,practice and skill.The ones who had lower educational level,less work experience,or more knowledge training had more demands for these three kinds of training.For supervision and evaluation training,junior colleges had more demands than doctors [(14.9±3.9)vs.(13.1±3.9),P<0.05],females had more demands than males [(14.8±3.7)vs.(14.3±3.4),P<0.05],and the ones with social orientation had more demands than those with educational or clinical orientation [(15.2±3.6)vs.(14.4±3.6),(14.4±3.6);Ps<0.05].The ones who were part-time workers,trained less times,and skill-trained had more demands for skill training [e.g.part time workers:(8.4±1.6),full time workers:(8.1±1.8);P<0.05].Conclusion:The mental health practitioners have the highest demands for continuing training,especially practice and skill training.The related factors to their demands include gender,age,education level,occupation area and working time.

BACKGROUND: Since the diagnostic unit is established in "mental disorder due to Qigong", it has been lack of comparative analysis of experimental observation on whether Qigong exercise affects physiological state in central nerve system, on what the difference are between Qigong and hypnotic induction in the effects on central system.OBJECTIVE: To observe the changes in brain evoked potentials in "normal state", "Qigong meditation" and "hypnosis" so as to analyze the difference between Qigong release and hypnotic induction in cerebral physiological effects in normal adults.DESIGN: Brain evoked potential experiment was designed, in which, normal adults were employed.SETTING: Shanghai Mental Health Center.PARTICIPANTS: They were staffs, interns and volunteers in Shanghai Mental Health Center, of either gender, at any age and with any educational background, totally 52 people.METHODS:① American Nicolet Spirit evoked brain electrophysiological meter was used. The electrodes were attached according to 10/20 system on Cz, C3, C4, Pz and Fz of scalp. Verbal or fixation inductive hypnosis was applied. Hypnosis lasted 20 to 30 minutes, in which, the induction lasted 10to 15 minutes. The experimental observation were performed when the receptors were determined to be in hypnosis.② The Qigong meditation was co-performed by the Qigong masters from Shanghai Qigong Institute or Qigong folk masters. They released "external qi" to the receptors. The degree of "Qigong meditction" was based on folk standards. The observation was carried on when the receptors were identified to be in theQigong state.The entire process lasted 20 to 30 minutes.③ To observe successively the latency and amplitude of the event related potentials [contingent negative variation (CNV), P300 ] and sensory evoked potentials [visual evoked potentials (VEP), auditory evoked potentials (AEP), auditory brainstem reaction (ABR)] of receptors in "normal state", "Qigong meditation" and "hypnotic state". The observed values were performed multiple analysis of variance of single-factor quantitative linear model in 2 × 2 factorial design.MAIN OUTCOMES MEASURES:① Observation of event related potentials. ② Observation of sensory evoked potentials RESULTS: Due to limited result of hypnotic induction and incomplete record of brain-evoked potentials, 3 cases were lost. Terminally, 49 cases entered statistical analysis. ①Observation of event related potentials: under hypnotic state, the amplitude of P300 (target stimuli-P3) was decreased compared with normal state [(4.18±2.23), (6.07±3.23) μV, P ＜ 0.01]. The amplitude of AEP (P2) in hypnotic state and normal state was decreased compared with Qigong meditation [(2.01±1.28), (2.71±1.83), (2.73±1.34)μV, P＜0.05].The amplitude of CNV(M2) was decreased comparedwith normal state and Qigong meditation[(5.93±3.36),(7.83±4.59),(7.76±4.42) μ,V,P ＜ 0.05].②Observation of sensory evoked potentials: The amplitude of VEP (P2, P3) in hypnotic state was reduced compared with normal state and Qigong meditation [(3.47±2.69), (4.76±2.78), (4.30±2.64) μV; (1.18 ±1.08), (1.68±0.95),(2.01±1.48) μV, P ＜ 0.05].CONCLUSION: In hypnotic state, sensory evoked potentials presented low amplitude and such alternation did not appeared in Qigong meditation and normal state. It is explained that there are differences between hypnotic induction and Qigong release in the influence on cerebral physiological process. The extensively recognized hypothesis in Qigong field that "Qigong state" is "hypnosis" cannot be verified by above-mentioned experiment.

Objective To explore the preventive effects of Radix et Rhizoma Rhei Granule on the occurrence of complicated stress ulcer of stomach (CSUS) in rats after cerebral infarction (CI) and its mechanism. Methods Rat models wi t h CI were established by the occlusion of middle cerebral artery. Preventive tre at ment of CSUS in rats after CI with Radix et Rhizoma Rhei Granule was carried out . Results As compared with the control group (Group A),apoptosis index of gastric mucosal cells was decreased and prolifer ation index increased, 5_HT level and noradrenaline (NE) content in gastric muco sa and plasma were declined, gastric and cholic acid reduced and pH value incre a sed in gastric juice of the treatment group(Group B) (P

Objective To investigate the expressions of vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor-D (VEGF-D) and their relationship with lymph node metastasis in gastric cancer. Methods Eighty patients with gastric cancer had been admitted to our department from January 2005 to December 2005, including 48 with local lymph node metastasis and 32 without local lymph node metastasis. Ten specimens of normal gastric mucosa from patients with gastric ulcer were used as control. The expression of VEGF-C and VEGF-D in serum and tissues were detected. Results The senun levels of VEGF-C and VEGF-D in patients with gastric cancer were significantly higher than those in the control group (χ2= 8.39, P < 0.05). The positive rate of the VEGF-C expression in the sermn of patients with gastric cancer was influenced by the lymph node metastasis (χ2 = 7.01, P < 0.05). The positive rates of the expressions of VEGF-C and VEGF-D in the gastric cancer tissue were 53% (42/80) and 63% (50/80), which were significantly higher than those in the normal gastric mucosa (χ2 =6.44, 6.58, P <0.05). The positive rate of the VEGF-C expression in the tissue of patients with gastric cancer was influenced by the lymph node metastasis (χ2=11.25, P <0.05). Conclusions The expression of VEGF-C is closely related to lymph node metastasis of gastric cancer. The serum levels of VEGF-C can be used as biologic markers in detecting lymph node metastasis of gastric cancer preoperatively.

Objective To conduct a methodological evaluation on flowcytomotry fluorescence detection of serum CA242, and to evaluate its value in the diagnosis of pancreatic cancer.Methods The blood samples of 40 cases of pancreatic cancer, 49 cases of other tumors, 48 cases of benign digestive diseases and 159 healthy volunteers were collected.Fowcytometry fluorescence immunoassay was used to detect serum level of CA242, and it was compared with routine ELISA method to measure its sensitivity and specificity.Results The detection limit of CA242 by flowcytometry fluorescence immunoassay was 0.89 U/ml, the linear range was 1～ 500 U/ml after confirmation.The within-batch CV was 3.37％～ 5.30％, between batch CV was 7.43％ ～ 9.60％.When compared with routine ELISA, flowcytometry fluorescence immunoassay showed the equation of linear regression is Y =1.0398X-0.947, r =0.9687.Area under ROC curve was 0.811 ± 0.025 (95％ CI 0.763 ～0.859), with 18.625 U/ml as the best cutoff value, the specificity was 92.0％ and the sensitivity was 62.1％.Conclusions Flowcytometry fluorescence immunoassay for CA242 testing has the advantage of shorter detection time, miltiple sample and testing project detection, which is worth of clinical application.

This study was aimed to optimize the extraction process of resveratrol by central composite design (CCD) and response surface method (RSM), based on the result of single factor experiment. Resveratrol was extracted from Polygonum cuspidatum by water bath extraction of organic solvent. And content of resveratrol was taken as index in the investigation of solvent concentration effect, extraction time and solvent content on extraction process. The results showed that the optimum condition was 12.7 times amount of 72.0% ethanol and extract for 2 times under the temperature of 50℃, 1.1 h for each time; the average deviation between the maximum theoretical value and measured value was 0.83%. It was concluded that this extraction process was highly predictive, which provided experimental evidence for the industrial production of P. cuspidatum extraction.

Objective To analyze the learning curve of microendoscopic lumbar discectomy (MED) and summarize the operative experience. Methods From July 2010 to March 2012, the first 100 patients with single level lumbar disc herniation managed with MED were divided into chronological groups (A, B, C and D), 30 patients in group A, B, C and 10 patients in group D. The comparsons were conducted in terms of operative time , estimated blood loss , number of cases with transition from MED to open surgey or for reoperation , rate of complications and postoperative efficacy. Results The mean operative time and the mean estimated blood loss in each group was valuated respectively. In group A , the operative time and estimated blood loss were significantly decreased as compared with those in group B, C and D respectively (P < 0.05), but those in group B were not significantly different from those in group C and D (P > 0.05). There were 6 complications in group A, 1 complication in group B and C respectively and no complication in group D. The leg pain visual analogue scale and Oswestry disability index at the first month and the twelfth month postoperatively were all improved respectively as compared with those preoperatively (P < 0.01). Conclusion The learning curve of microendoscopic lumbar discectomy generally may reach the plateau when about 30 cases are operated on. The key procedure to pass over the learning curve includes puncture and location , flavectomy , anatomy mark identification, and precaution of damage in dural sac.

Purpose:To prove that electroacupuncture pudendal nerve stimulation(EPNS)can exactly excites the pudendal nerve.by simultaneous measurements of pelvic floor muscle (PFM) movements(perineal ultrasound),vaginal pressure and pelvic floor surface myoelectricity.Methods:Long needles(acupuncture needles)were deeply inserted into four sacral points and electrifled to stimulate the Pudendal nerves.When EPNS Was performed.perineal ultrasound B-mode images of PFM movements(contractions),M-mode PFM movement curves;vaginal pressure and pelvic floor surface electromyogram were recorded simultaneously by use of an urodynamic instrument with video suite(Medtronic Duet Encompass).Simultaneous records were also obmined under three conditions in the process of the nerve stimulation:1) pausing electric stimulation;2)reducing the intensity of electric stimulation(to about 2/7 of the original);3)drawing back the two lower needles to make the tips 1-2 cm away from the original position.Results:Thirty-five female patients with stress incontinence(aged 54.9±9.81 received EPNS and the simultaneous measurements.When EPNS was performed correctly,the patient felt rhythmic and cephalad PFM contractions with the urethra as the center.Simultaneous records showed the following:1) cranio-caudal PFM movements on the B.mode image;2)the M-mode curves indicating the PFM contractions (amplitude:about 1 mm,n=31,14 cases≥1 mm and 17 cases＜1 mm);3)A sawtooth curve of changes in vaginal pressure[amplitude:2.61±1.69(0.7-5.6)cmH2O,n=34];4)pelvic floor myoelectric waves[amplitude:23.9±25.3(5-96)μV,n=34].The amplitude of a PFM movement curve conformed basically to that of a vaginal pressure curve.If the electric current was stopped or its intensity was reduced to about 2/7 of the original or during the process of the nerve stimulation the two lower needles were gradually drawn back until the tips were 1-2 cm away from the original positions,then B-mode PFM movements,M-mode curves and sawtooth changes in vaginal pressure disappeared.Conclusion:Electroacupuncture pudendal nerve stimulation can exactly excites the pudendal nerve and effectively contract the pelvic floor muscles.