The target value of intact parathyroid hormone (iPTH) in main international guidelines is not consistent completely.Furthermore,the evidence levels of clinical studies these guidelines based on are generally low and most of them are based on observational studies.Some studies even showed that there was no association between iPTH level and clinical outcomes.This review focuses on the following three points for reassessing iPTH target value: comparison of iPTH target value in main international guidelines,the difference of iPTH target value in large clinical studies and reasons for the difference.

Objective To clarify the cellular localization of triptolide and to explore its in-cell action sites.Methods 4-(Bro-momethyl)-7-methoxycoumarin was employed to label triptolide,then labelled triptolide was incubated with human hepatoma carci-noma cells.Subsequently,incubated cells were subjected to stain with fluorescent dye DiI or PI,which were specific to cytoplasmic membrane system and nucleus,respectively.Results Compared with the non-triptolide control,coumarin labelled triptolide shown a light blue fluorescence under UV excitation;Co-localization with DiI showed that triptolide exist in cytoplasm and(or)on cell mem-brane;Co-localization with PI showed that triptolide located in cell nucleus.Moreover,microscopic observation indicated that the fluorescence intensity in nucleus was denser than that in cytoplasm.Conclusion The presnt study demonstrate that triptolide main-ly act in nucleus,followed by acting in cytoplasm and(or)on cell membrane.

Death with dignity is now not legislation in our country .This paper mainly discussed about some barriers to the legalization of death with dignity in China , from the viewpoint of Chinese traditional ideas , the lack of death education , risk of abusing , the subject change of the informed consent right , doctor-patient communica-tion and trust lsot and so on .It is proposed that our country should perfect the medical security system , strengthen the education of death at the same time and help the citizen set up the view of science .Outside, still need to fur-ther deepen the reform of medical system in our country , the maintaining patient ’ s autonomy and right of choosing , protect the informed consent right of patients .Create the doctor-patient relationship of mutual trust .

Objective: To explore the association between plasma leptin (LEP) levels, soluble leptin receptor(SLR), free leptin index and breast cancer. Methods: 245 new female cases of primary breast cancer confirmed by histopathology examination were sequentially recruited into the study. A total of 245 age-matched healthy women were enrolled as controls during the same period. A standardized questionnaire was used to collect the demographic information of the subjects. Blood samples were collected and the levels of LEP and SLR in plasma were measured by enzyme linked immunosorbent assay. The differences of LEP, SLR and FLI expression between control and cases group, as well as different breast cancer subtypes and TNM stages were compared using t-test and ANOVA after stratification by menopause status. Multivariate logistic regression was used to explore the contributions of the three indexes to the risk of breast cancer. Results: Females in both cases and control group were (50.7 ± 9.4) years old. The level of SLR and FLI (P₅₀(P₂₅,P₇₅)) in premenopausal women were 18.4 (11.2, 28.7), 0.5 (0.4, 0.6) μg/L in case group and 27.7 (19.2, 43.4), 0.3 (0.3, 0.4) μg/L in control group (P<0.001). While the level of postmenopausal women in case group were 20.3 (12.8, 31.8), 0.5 (0.4, 0.6) μ g/L (P<0.001), and 30.1 (18.8, 40.5), 0.3 (0.3, 0.5) μg/L in control group (P<0.001), respectively. After adjustment for confounding factors and BMI, the relationship between FLI and breast cancer remained significant for both pre- and postmenopausal women while the association between SLR and breast cancer was significant only in premenopausal women. Compared with the lowest level of SLR, higer levels of SLR is associated with a reduced risk of breast cancer (premenopausal women, OR=0.10, 95% CI: 0.04-0.29, P_trend<0.001). Compared with the lowest level of FLI, FLI at higher levels is associated with an increased risk of breast cancer (premenopausal women, OR=7.14, 95% CI: 2.86-17.83, P_trend<0.001; postmenopausal women, OR=8.10, 95% CI: 2.85-22.98, P_trend<0.001). No significant association between LEP and breast cancer or association between the three indexes and breast cancer subtypes and TNM stages was found (P>0.05). Conclusion SLR may be a protective factor for breast cancer while FLI may increase the risk of breast cancer.

Objective To explore the postoperative anxiety and depression in patients with kidney transplantation and its influencing factors. Methods Totally 104 patients with kidney transplantation in nephrotransplantation center of our hospital from March 2015 to July 2015 were selected as the research object. Self-designed questionnaire, self-rating depression scale ( SDS) and self-rating anxiety scale ( SAS) were used to investigate patients, and causes of anxiety and depression were analyzed. Results The average score of anxiety in patients with kidney transplantation was (37.81±11.38) points, among which there were 15 cases of positive symptoms that accounting for 14. 4%; the average score of depression was ( 40. 12 ± 12. 09 ) points, among which there were 23 cases of positive symptoms that accounting for 22. 1%. Multiple linear regression analysis revealed that nationality and income had an impact on anxiety score (P<0.05).Conclusions Patients with kidney transplantation would have a certain degree of anxiety and depression symptoms after surgery. Nationality and income are independent influencing factors for anxiety. Targeted psychological interventions in patients with kidney transplantation, are good for the improvement of negative emotions.

OBJECTIVETo study the clinical effects of Achillon for the treatment of acute Achilles tendon rupture (AATR).

METHODSFrom April 2009 to April 2010, 19 patients with AATR who were treated with Achillon were retrospectively analyzed. There were 17 males and 2 females, with an average age of 40.2 years (30 to 58 years). There were 9 cases of sports injury, and 2 case of fall injury. The time from injury to surgery ranged from 0 to 8 days (2.2 days on average). The results of Thompson test and single heel rise test were positive in 19 cases. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score during follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 28 months (19.9 months on average). The average operation time was 41 minutes. There were no wound infections, recurrent rupture, or sural nerve complications. At the latest follow-up, 18 patients were totally satisfied with the surgical result, 1 patient feel generally due to mild pain when running. None of the patients were dissatisfied with the final results the latest follow-up. At the latest follow-up, the AOFAS score was 98.42 +/- 3.29 (89 to 100). All the patients regained normal range of motion and were able to resume their previous activities at six months after operation, with a high rate of satisfaction. Average decreased of mid-calf circumference was (0.82 +/- 0.85) cm (ranged from 0 to 3 cm).

CONCLUSIONTreatment with Achillon is safe, effective for AATR with low incidence of complications and early active rehabilitation can be carried out. It is a good method to treat AATR.

Achilles Tendon ; injuries ; surgery ; Acute Disease ; Adult ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; instrumentation ; Retrospective Studies ; Rupture ; Suture Techniques ; instrumentation ; Tendon Injuries ; surgery

Objective:To screen and evaluate sunscreen cosmetics for sensitive facial skin.Methods:From June to August in 2019, 40 subjects with positive lactic acid sting test were recruited from the staff of Chongqing Traditional Chinese Medicine Hospital, and subjected to human skin closed patch testing with 4 kinds of sunscreen cosmetics for sensitive skin (marked as products Ⅰ, Ⅱ, Ⅲ, Ⅳ respectively) separately. Then, the 40 subjects were equally divided into 2 groups to apply 2 sunscreen products with relatively higher safety (according to the above closed patch testing results) on the face respectively. Erythema, edema and desquamation were evaluated at baseline, 2 and 4 weeks after application of the 2 products, and non-invasive measurement methods were used to detect transepidermal water loss (TEWL) , stratum corneum hydration, skin melanin content and skin sebum content. In additon, the 2 products were applied on the back of the subjects separately, and an ultraviolet solar simulator was used to determine the sun protection factor (SPF, n = 12) and protection factor of UVA (PFA, n = 11) . Measurement data were compared using paired t test and one-way analysis of variance, and nonparametric data were compared using Wilcoxon signed rank test. Results:Patch testing showed that only 1 subject developed a grade 1 reaction to the sunscreen product Ⅲ, no subjects showed positive reactions to the product Ⅳ, and the safety of products Ⅲ and Ⅳ was higher than that of the other 2 products. Subjective safety evaluation revealed that the degree of erythema after 4-week application of products Ⅲ and Ⅳ was significantly lower than that before application (Wilcoxon signed rank test, Z = 4.73, 4.82 respectively, both P < 0.05) . Objective efficacy evaluation revealed that the TEWL, stratum corneum hydration and skin melanin content significantly differed among different time points (baseline, after 2- and 4-week application of products Ⅲ and Ⅳ, all P < 0.05); after 4-week application of products Ⅲ and Ⅳ, the TEWL (30.05 ± 1.47, 30.37 ± 1.28 respectively) and skin melanin content (112.58 ± 7.34, 103.47 ± 5.48 respectively) were significantly lower than those before application (all P < 0.05) , and the stratum corneum hydration (62.35 ± 2.67, 63.72 ± 2.54 respectively) was significantly higher than that before application (both P < 0.05) . At week 4, the skin melanin content was significantly lower in the product Ⅳ group (103.47 ± 5.48) than in the product Ⅲ group (112.58 ± 7.34, t = 8.45, P < 0.05) . The SPF and PFA values of the product Ⅳ (51.8 ± 2.9, 10.1 ± 1.2 respectively) were both significantly higher than those of the product Ⅲ (31.5 ± 2.6, 7.4 ± 0.7, t = 15.34, 24.66, respectively, both P < 0.05) . Conclusion:Comprehensive application of closed patch testing, long-term application test and sun protection index determination can be used to screen and evaluate the safety and efficacy of sunscreen cosmetics for sensitive facial skin.

Objective:To analyze clinical characteristics of cosmetics-related adverse reactions and main allergenic components of cosmetics, to provide guidance for cosmetics-related adverse reaction monitoring, and to provide an objective basis for risk assessment.Methods:A total of 512 patients with suspected cosmetic adverse reactions were collected from the outpatient clinic of Chongqing Traditional Chinese Medicine Hospital from March 2018 to October 2019, including 14 males and 498 females. A uniform cosmetic adverse reaction report card was filled in, and medical history of patients and related information about the used cosmetics were recorded; 103 patients (3 males and 100 females) were subjected to patch test with their own cosmetics or cosmetic ingredients, and 48- and 72-hour patch test results were combined for comprehensive determination and analysis.Results:Among the 512 cases of suspected cosmetic adverse reactions, contact dermatitis (495 cases, 96.7%) was the most common manifestation. Cosmetic adverse reactions mainly manifested as erythema (501 cases, 97.9%), papules (313, 61.1%), edema (249, 48.6%), and scaling (166, 32.4%) ; main symptoms included itching (480, 93.8%), burning sensation (359, 70.1%), and tense sensation (297, 58.0%). Patch test with cosmetic ingredients showed positive reactions in 71 of 103 cases, and thimerosal was the allergen mostly liable to cause adverse reactions (31 cases, 30.1%), followed by sodium dodecyl sulfate (29 cases, 28.2%), Peru balsam (17 cases, 16.5%), bronopol (12 cases, 11.7%) and triethanoamine (10 cases, 9.7%). The cosmetic allergens were divided into 14 categories, and the top 4 categories with high positive patch test rates were emulsifiers (54 cases, 45.8%), preservatives (47 cases, 39.8%), fragrances (17 cases, 14.4%) and surfactants (10 cases, 8.5%). Positive patch test reactions were observed in 2 males and 69 females, and there was no significant difference in the positive rate between males and females (2/3 vs. 69/100, χ2 = 0.01, P > 0.05) ; there was also no significant difference in the positive rate among the groups aged 18 - 29 years (34%), 30 - 49 years (34%) and 50 - 70 years (32.4%; χ2 = 0.693, P > 0.05) . Conclusions:Contact dermatitis is the most common adverse reaction to cosmetics. Among the diverse allergenic components of cosmetics, thimerosal is the allergen that is mostly liable to cause adverse reactions, followed by sodium dodecyl sulfate, Peru balsam, bronopol and triethanoamine.

Objective To evaluate the clinical efficacy and safety of do-cetaxel in the treatment of advanced gastric cancer .Methods Eighty-five patients with advanced gastric cancer were randomly divided into control group (n=42) and treatment group (n=43).Control group was given irinotecan hydrochloride 60 mg? m-2 , day 1 +60 mg? m-2 cisplatin, intravenous infusion, day 1.Treatment group was given 40 mg? m-2 docetaxel , intravenous infusion , day 1.Two groups were trea-ted for 4 courses with 7 d per course.The total effective rate , levels of carcinoembryonic antigen ( CEA ) and carbohydrate antigen 199 ( CA199 ) , incidence of adverse drug reactions were compared between two groups.Results After treatment, the total effective rate in treatment group was 93.02%(40/43), which was significantly higher than that in control group [69.05%(29/42), P <0.05] .After treatment, the serum levels of CEA were ( 37.61 ±5.87 ) , ( 59.73 ±6.97 )μg? L-1 and CA199 were ( 49.25 ±6.83 ) , ( 98.23 ±14.63 ) U? L-1 in the treatment and control group .And those indexes after treatment in treat-ment group were significantly lower than those in control group (P<0.05).The adverse drug reactions were based on gastrointestinal reactions and bone marrow suppression for two groups .Also, the inci-dence of adverse drug reactions was not statistically significant in the two groups ( 9.30% vs 16.67%, P >0.05 ) .Conclusion Docetaxel has a definitive clinical efficacy for the treatment of advanced gastric cancer , which was better than irinotecan hydrochloride combined with cisplatin , without increasing the incidence of adverse drug reactions .

Objective To observe the clinical efficacy and safety of thymosin α1 injection combined with entecavir capsules in the treatment of cirrhosis with decompensated liver function.Methods Eighty patients with hepatitis B virus (HBV) e antigen (HBeAg) positive patients with decompensated liver function were randomly divided into control group (n =40 cases) and treatment group (n =40 cases).Control group was received oral entecavir 0.5 mg qd.Treatment group was given subcutaneous injection of thymosin α1 1.6 mg biw,on the basis of control group.Two groups were treated for 24 weeks.The clinical efficacy,alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin,negative rates of HBV-DNA and HBeAg,adverse drug reactions were compared in two groups.Results After treatment,the total rates of treatment and control groups were 92.50％ (37/40 cases) and 75.00％ (30/40 cases) with significant difference (P ＜ 0.05).After treatment,the main indexes in treatment and control groups were compared,ALT were (51.39 ± 8.17),(64.12 ± 6.24) U·L-1;AST were (33.49 ± 5.14),(40.05 ± 5.28)U · L-1;total bilirubin were (17.59 ± 1.59),(16.32 ±1.32)mmol · L-1;negative rates of HBV-DNA were 77.50％,40.00％;negative rates of HBeAg were 70.00％,32.50％;conversion rates of HBeAg/anti-HBe were 35.00％,22.50％,there were statistically significant difference (P ＜ 0.05).Adverse drug reactions in treatment group were nausea,vomiting and dizziness,which in control group were nausea,vomiting,dizziness and allergies.The incidence of adverse drug reactions were 7.50％ and 17.50％ in treatment and control groups,with significant difference (P ＜0.05).Conclusion Thymosin α1 injection combined with entecavir capsules has a definitive clinical efficacy and safety for the treatment of HBeAg positive cirrhosis with decompensated liver function.