Spleen-yin theory was the innovation of doctors in Ming Dynasty for Piwei theory of Dongyuan based on the inheritance of nourishing yin theory of Danxi. But because of rise of stomach yin theory, spleen yin theory was ignored gradually. This article revealed the neutralizing therapeutic conception contained in this theory, which was hoped to be applyed into medical practice and to be deepened furtherly.

Objective To evaluate the safety of central lymph node dissection with total thyroidectomy for papillary thyroid carcinoma. Methods A meta-analysis on the data of suitable seven clinical researches was performed using the Mantel-Haenszel method and the risk difference was calculated.Results Seven studies with a total of 1524 patients were eligible for inclusion, 620 were with totalthyroidectomy plus central lymph node dissection and 904 with thyroidectomy alone. There was a significant increased risk of temporary hypocalcaemia ( P = 0. 03 ) and temporary vocal cord palsy ( P = 0. 01 ) when central lymph node dissection was performed in addition to a thyroidectomy. However, the risk of permanent hypocalcaemia( P = 0. 32 ) and permanent vocal cord palsy (P = 0. 75 ) has no statistical difference between the two groups. Conclusion Central neck dissection added to thyroidectomy does not increase rate of permanent morbidity in thyroid cancer patients.

Objective To clarify the genetic diversity of HIV-1 strains currently circulating in Shanghai and establish the molecular epidemiological database of HIV-1 infection.Methods The samples from 114 newly diagnosed HIV-l-infected individuals between June 2004 and June 2005 were investigated.HIV-1 pol gene(protease 1-99 aa and reverse transcriptase 1-252 aa) from plasma sam- ples were amplified by RT-PCR,sequenced and phylogenetieally analyzed.Protease inhibitors(PRIs) and reverse transcriptase inhibitors (RTIs) resistance-associated mutations in protease (PR) and re- verse transcriptase(RT) regions were analyzed.Results (1)Epidemiological survey showed the exist ence of different modes of transmission of HIV-1 including sexual contacts 51(44.74%),intravenous drug users 43 (37.72%),contaminated blood/blood products transfusion 3(2.63%) and unknown in- fection 17(14.91%);(2)Phylogenetic analysis revealed that 9 of the analyzed sequences were identi- fied as subtype B(7.89%),15 as subtype B'(13.16%),1 as subtype C(0.88%),1 as subtype G (0.88%),38 as CRF01 AE(33.33%),46 as CRF07 BC(40.35%) and4 asCRF08 BC(3.51%); (3)Analysis of drug-resistance associated mutation showed that 21 of 114 (18.42%) persons infected with drug-resistant HIV-1,among which major mutations in PR and RT regions accounted for 2.63 (3/114) and 17.54% (20/114),respectively.The frequencies of major mutation in PR region were M46I(66.67%),M46L(33.33%) and in RT region were M41L(7.69%),A62V (7.69%),T69S (7.69%),V75I/L(15.38%),K103R(25.00%),V118I(23.08%),V179D/E/T(33.33%),G190R (8.33%),L210K/M/X(38.46%),227L/I(16.67%),M230R(8.33%),P236R(8.33%).Conclusions The results revealed the current presence of multiple HIV-1 subtypes and recombinants strains infec- ting residents and migrants living in Shanghai.The broad diversity of HIV-1 has been introduced into Shanghai mainly through drug injection and heterosexual contacts.This study also revealed that HIV-1 strains infecting these newly diagnosed treatment-naive persons have acquired major mutations in both PR gene and RT gene of HIV-1.

Objective To evaluate the safety of performing thyroidectomy together with central lymph node dissection(CLND). Methods Meta analysis was performed on 7 selected clinical papers using MantelHaenszel method and relative risk was calculated. Results A total of 1524 patients were eligible to be included,among whom 904 cases underwent thyroidectomy alone and 620 cases underwent total thyroidectomy combined with CLND. The risk rate of temporary hypocalcemia and temporary vocal cord palsy for CLND was 24. 77% and 9. 12% respectively, which was higher than that in performing thyroidectomy alone. However, the risk of permanent hypocalcemia and permanent vocal cord palsy had no statistic difference between the two groups. Conclusion As there is no increased morbidity of CLND, it is prudently suggested to give a prophylactic CLND for patients with high risk of thyroid papillary carcinoma.

Objectives To provide prenatal diagnosis and genetic counseling for four athigh-risk pregnant women with a suspected family or personal history of fragile X syndrome (FXS) by genetic screening of fragile X mental retardation (FMR1) gene.Methods This study was conducted on four pregnant women (No.l to 4) who received outpatient treatment in Peking University First Hospital from August 2014 to June 2016.Genomic DNA was extracted from peripheral blood samples of the pregnant women and six of their family members,four of which were suspected or confirmed FXS and the other two were FMR1 gene carriers.Amplide X kits were used to detect CGG repeat size in FMR1 gene.Two amniocytes and one chorionic villi samples were collected from three pregnant women to extract DNAs for FMR1 gene and karyotyping analyses.Results There were patients diagnosed with FXS in all the families by detecting CGG repeat numbers in FMR1 gene.The pregnant woman No.1 was a permutation carrier;No.2 carried normal FMR1 alleles while her brother had a mutation with over 20 CGG repeats in FMRI gene at chromosome X.No.3 and 4 were full mutation carriers with over 200 CGG repeats in FMR1 gene.After genetic counseling,No.3 decided to terminate the pregnancy due to abnormal fetal karyotype (47,XY,+21) and full mutation of FMR1 alleles.No.1 and 4 continued to pregnancy as their fetuses were normal in FMR1 alleles and karyotype.No.2 continued to pregnancy as her fetus was free of FXS risk.Conclusions Prenatal diagnosis and genetic counseling should be conducted on women at highrisk for FXS to avoid birth defects.People with a family history of FXS should be tested for FMR1 gene carrier status.

Objective To perform a prenatal diagnosis for the second fetuses from 28 pedigrees with proband of mitochondrial disease due to mitochondrial DNA (mtDNA) mutation.Methods From April 2011 to November 2015,peripheral blood samples of 28 probands and their parents,urine samples of these probands and their mothers as well as amniotic fluid samples of the second fetuses from the 28 pedigrees were collected in Peking University First Hospital.DNA sequencing was used to identify mtDNA mutations.Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to verify mutation sites,calculate mutation loads,and further confirm the diagnosis after birth.Microsatellite maker analysis was also performed on five short tandem repeats located in nuclear genes to exclude maternal contamination.Statistical analysis was carried out using independent t-test.Results In the 15 pedigrees carrying A3243G mutation,13 mothers and nine fetuses carried A3243G mutation.Neither the other two mothers nor their fetuses were positive for A3243G mutation.Among the 12 pedigrees with T8993G mutation,there were eight mothers carrying T8993G mutation and all of their fetuses carried the same mutation;and the other four mothers and their fetuses were negative for T8993G mutation.T10191C mutation was only found in one proband and the second fetus of that pedigree,but not in the mother.None of the fathers had mtDNA mutation.Results of PCR-RFLP were consistent with those of DNA sequencing.Short tandem repeat analysis demonstrated that amniocyte samples were from fetuses without maternal contamination.No mtDNA mutations were found in the six newborns who were negative for mtDNA mutations in prenatal diagnosis.The mean mutation load in urine samples of the six mothers without A3243G mutation in amniocytes was significantly lower than that of the nine mothers with A3243G mutation [(10.1 ±4.8) ％ vs (28.2 ± 15.1) ％,t=2.290,P=0.043].Conclusions The lower the mtDNA mutation load in maternal urine samples,the less the possibility she bears a child with mtDNA mutation.However,prenatal diagnosis of mitochondrial disease is necessary.

Objective To compare the myocardial protective effects of isoflurane versus sevoflurane in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods Forty ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ ) of both sexes, aged 40-55 yr, weighing 55-94 kg, scheduled for elective OPCABG, were randomly divided into 2 groups ( n = 20 each): isoflurane group ( group Ⅰ) and sevoflurane group ( group S). Anesthesia was induced with midazolam, sufentanil and vecuronium. Patients were tracheal intubated and mechanically ventilated. Anesthesia was maintained with inhalation of isoflurane or sevoflurane and infusion of sufentanil and vecuronium. In group Ⅰ, the initial end-tidal concentration of isoflurane was 1.2%. In group S, the initial end-tidal concentration of sevoflurane was 1.7 %. BIS value was maintained at 40-50 by adjusting the end-tidal concentration of isoflurane or sevoflurane. The central venous blood samples were collected immediately before skin incision, at the end of surgery, 2 and 24 h after surgery for determination of plasma creatine kinase-MB (CK-MB) activity and cardiac troponin Ⅰ (cTnI) concentration. The adverse cardiovascular events were recorded. Results The incidences of ventricular premature beat, tachycardia, bradycardia, ventricular fibrillation and S-T segment elevation ( ＞0.1 mV) during surgery and the plasma CK-MB activity and cTnI concentration after surgery were significantly higher in group S than in group Ⅰ ( P ＜ 0.05). Conclusion Isoflurane has better myocardial protective effect than sevoflurane in patients undergoing OPCABG.

Aortic Aneurysm, Abdominal ; surgery ; Endovascular Procedures ; adverse effects ; Humans ; Intestinal Fistula ; diagnosis ; etiology ; Male ; Middle Aged

Objective To evaluate the effect of different degrees of pubic symphysis diastasis on the stress distribution of posterior pelvic ring. Methods Eight embalmed pelvis and articulated proximal 1/3 of the femurs were harvested for this study. The samples were positioned as both legs standing straight and loaded to 600 N on the on the CSS-44020 biomechanical machine. The strain gages were adhered to 38 sites distributed symmetrically on the two sides of sacroiliac joint, anterior sacrum and posterior ilium. The strain gages were connected to WS3811 digital strainometer to record strain changes of the intact pelvic ring and at 1,2, 2.5 cm of pubic symphysis diastasis. Results Elastic changes occurred in the cortical bone of the pelvis under 600 N load. The symmetrical sites had similar strain changes without significant difference in the intact pelvic ring and at 1,2, 2.5 cm of pubic symphysis diastasis ( P ＞0.05 ). The sites with more strain changes were distributed on the iliofemoral arch in the intact pelvis.The strain changes were increased significantly frona the posterolateral sites to the iliofemoral arch. But the strain changes on the iliofemoral arch were decreased significantly during pubic symphysis diastasis.Conclusion The conduction of vertical load runs along the sacrofemoral arch in the intact pelvic ring and redistributes posterolaterally during pubic symphysis diastasis.

Objective To explore the effects of surface modification of PLGA-[ASP-PEG] scaffold with typeⅠcollagen on the adhesion,proliferation and osteogenic differentiation of rabbit bone marrow stromal cells (BMSCs).Methods After PLGA-[ASP-PEG] materials were modified with typeⅠcollagen chemically,the collagen was coated onto the materials physically.The BMSCs obtained from rabbits were cultured on the modified PLGA-[ ASP-PEG] and on the unmodified PLGA-[ ASP-PEG] as control.The adhesion and proliferation behavior of the cells was analyzed and the expressions of osteogenie marker alkaline phosphatase,osteocalcin,osteopontin,typeⅠcollagen and core binding factor al were also detected.Results X-ray photoelectron spectrometry(XPS) confirmed that TypeⅠcollagen was grafted onto the surface of PLGA-[ASP-PEG] successfully and the collagen content on the materials modified chemically and physically was significantly increased.The abilities of adhesion and proliferation and the expressions of osteogenie makers of the BMSCs were significantly greater than those in the control group(P＜0.05).Conclusion Since Type collagen I can improve the biocompatibility of PLGA- [ASP-PEG] scaffold materials,it can be used as a new way to optimize scaffolds in tissue engineering.