Objective To observe the clinical efficacy of deep needling the points around the ear plus scalp acupuncture in treating neurosensory tinnitus.Method Totally 210 patients with neurosensory tinnitus were randomized into a treatment group and a control group, 105 cases in each group. The treatment group was intervened by deep needling the points around the ear plus scalp acupuncture, while the control group was by conventional acupuncture. The clinical efficacies were compared between the two groups after 3 treatment courses.Result The total effective rate was 82.9% in the treatment group versus 63.8% in the control group, and the difference was statistically significant (P<0.05).Conclusion Deep needling the points around the ear plus scalp acupuncture is an effective method in treating neurosensory tinnitus.

Objective Fluctuation of glucose levels is more likely to cause oxidative stress which contributes to the development of insulin resistance through activating c-Jun N-terminal kinase (JNK).Such antio xidants as vitamin C or vitamin E do not appear very helpful.Radix Astragali (RA) is an herbal medicine with antioxidative ability.The study was to explore whether RA would lower the risk of insulin resistance in diabetic rats.Methods Diabetic rats received RA,insulin or both RA and insulin after diabetes were induced in male Wistar rats.Serum levels of interleukin 6 (IL-6) and tumor necrosis factor α (TNFα),advanced glycation endproducts(AGEs) levels in kidney,the expression of insulin receptor (IR),insulin receptor substrate 1 (IRS-1),p38 mitogen-activated protein kinase (MAPK),p-p38 MAPK,p-JNK,p-IRS-1 Ser307,and p-IRS-1 Tyr612 in skeletal muscles were determined.Results Compared to diabetic rats treated with insulin,the diabetic rats treated with both insulin and RA demonstrated significantly lower levels of IL-6,TNF-α and AGEs (P ＜ 0.05),significantly lower activation of p-p38 MAPK and JNK (P ＜0.05),significantly higher expressions of IRS-1 (P ＜0.05),p-IRS-1 Tyr612,and significantly lower expression of p-IRS-1 Ser307 (P ＜ 0.05).Conclusions RA can lower the risk of insulin resistance through fighting oxidative stress in diabetic rats.

Objective:To identify the HLA-A0201 restricted CTL epitopes derived from hepatitis B virus X protein predicted by computer program and general principles in vitro.Methods:HBx gene sequences of Hepatitis B virus genotypes B/C and serotypes adw/adr,with the highest frequencies in Chinese,were computed and analyzed by screening service offered by Internet combined with peptide supermotif,extended motif and quantitative motif prediction.Four most ideal nine-peptides(HBx1,HBx2,HBx3,and HBx4)were selected as candidate peptides.Using flow cytometry,the fluorescence index of both control and experimental groups were detected and the 4 nine-peptides were evaluated with T2 binding assay and DC50 assay.Results:The nine-peptides VLCLRPVGA(HBx1),CLFKDWEEL(HBx2),VLHKRTLGL(HBx3)and HLSLRGLPV(HBx4)were selected as candidate targets.Among the 4 candidate peptides,HBx2 showed higher HLA-A0201 affinity and HBx2,HBx4 showed better stability.Conclusion:Our study indicates that CLFKDWEEL might be a potential HLA-A0201 restricted CTL epitope from hepatitis B virus X protein;further study is needed for verification of its immunity in vivo.

OBJECTIVE:To prepare Carbinoxamine maleate sustained-release suspension,and evaluate its quality. METH-ODS:Using carbinoxamine maleate as raw material,drug-loaded resin was prepared by cation exchange resin;surface coating method was used to finally prepare sustained-release suspension,using Eudragit RS100 as sustained-release coating material to pre-pare sustained-release microparticles. HPLC was conducted to determine the content of carbinoxamine maleate,release degree of original preparations and self-made suspensions was compared,drug-loading capacity was calculated. RESULTS:The drug amount in preparing drug-loaded resin was 2%,reaction temperature was 25 ℃,and reaction time was 4 h;the drug-loading capacity in surface coating was 35%,amount of coating material was 10%,and reaction temperature was 40 ℃. The drug-loading capacities of sustained particles before and after coating were 35.23%,32.72%,respectively;the yield was 96.82%. The carbinoxamine ma-leate in prepared sustained-release suspension accounted for 98.76% of the labeled amount;release degree in 10 h reached about 80%,f2 was 65.73. CONCLUSIONS:Carbinoxamine maleate sustained-release suspension is prepared successfully,and its release is similar to the original preparation.

OBJECTIVE:To study the pharmacodynamic effects of volatile oil from Homalomena occulta on adjuvant-induced arthritis(AA)model rats and its mechanism. METHODS:60 rats were randomly divided into normal control group(0.5%polysor-bate 80),model control group (0.5% polysorbate 80),positive control group (Tripterygium glycosides tablets,10 mg/kg), high-dose,middle-dose and low-dose(0.08,0.04 and 0.02 ml/kg)groups of volatile oil from H. occulta. Except for normal control group,other groups were given complete Freund's adjuvant subcutaneously via right rear foot plantar to induce AA model,and giv-en relevant medicine intragastrically for 25 days,once a day,since modeling. The articular swelling degree,immune organ (thy-mus gland and spleen) index,pathological change,the contents of IL-1β and TNF-α in serum were detected. RESULTS:Com-pared with normal control group,the primary and secondary articular swelling degree and thymus gland index of rats and the serum contents of IL-1β and TNF-α increased in model control group,while spleen index decreased(P<0.05 or P<0.01);obvious tissue swelling,large amount of neutrophile granulocyte,leukomonocyte and macrophage infiltrating joint surrounding tissue,the prolifer-ation of synovial cells and obvious osteoarthritic lesion were observed in podarthrum. Compared with model control group,the pri-mary and secondary articular swelling degree and the serum content of IL-1β decreased in the volatile oil from H. occulta groups;thymus gland index increased in middle-dose and low-dose groups of the volatile oil from H. occulta;the content of TNF-α de-creased in high-dose group of the volatile oil from H. occulta(P<0.05 or P<0.01). The inflammatory cell infiltration of joint sur-rounding tissue relieved in treatment groups,synovial cells proliferation was not obvious and synovial cells morphology was im-proved. CONCLUSIONS:The volatile oil from H. occulta has the pharmacodynamic effects on AA in rat,and its mechanism might be related to the serum content reduction of IL-1β and TNF-α.

Objective To compare the predictive value of 5 scoring systems for hemorrhagic transformation risk after intravenous thrombolysis in patients with acute ischemic stroke (AIS) in different therapeutic windows.Methods A single-center and retrospective study was performed for 243 AIS patients who underwent intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) in different therapeutic windows in our department during January 2014 and December 2016.Five scoring systems,including HAT model (hemorrhage after thrombolysis),MSS model (multicenter stoker survey),GRASPS model (glucose at presentation,race,age,sex,systolic blood pressure at presentation,severity of stroke at presentation),SEDAN model (baseline blood sugar,early infarct signs,hyperdense cerebral artery sign on admission CT,age,NIHSS on admission),and SITS model (safe implementation of thrombolysis in strokemonitoring study) were used to evaluate the risks for hemorrhagic transformation.The relationships between the 5 scoring systems and incidence rate of hemorrhagic transformation were analyzed among the patients in different therapeutic windows.The predictive values of the 5 scoring systems were compared using the areas (AUC) under the receiver operating characteristic (ROC) curve.Results When the AIS patients were treated by intravenous thrombolysis within 3 h,the AUC of GRASPS and HAT models were 0.698 and 0.619,respectively,higher than those of the other 3 systems.When the therapeutic window was between 3 to 4.5 h,HAT model and SEDAN model had highest AUC (0.719,0.744) than the other 3 systems (P ＜0.05).When the windows were ＞4.5 ～6 h,the HAT model had the highest AUC (0.676).Conclusion The 5 scoring systems show better predictive value for hemorrhagic transformation after intravenous thrombolysis.For the therapeutic window within 4.5 h,HAT model presents best predictive value than the other 4 scoring systems.

ObjectiveTo explore the efficacy and safety of risperidone and haloperidol in treating Tic disorder.Methods78 patients with Tic disorder were randomly divided into the risperidone group and haloperidol group with 39 cases in each group and treated with risperidone and haloperidol respectively for 8 weeks. All patients of two groups were assessed with the Clinical Global Impression Scale (CGI) and Treatment Emergent Symptom Scale (TESS) before treatment and at the end of the 2nd, 4th and 8th week after treatment. Dosages of patients of two groups were recorded.ResultsAfter 8 weeks treatment, the average maximum dosage of risperidone was (1.4±0.34)mg, and that of haloperidol was (7.3±0.52)mg. The total effective rate of risperidone group was 82% and that of haloperidol group was 82.3 %. There was no significant difference between two groups ( P>0.05). The incidence of adverse reactions in risperidone group was 28.2%, and that in haloperidol group was 76.9%. There was a significant difference between two groups (P<0.01), especially at the end of 2nd week after treatment.ConclusionRisperidone and haloperidol both are effect on Tic disorder, but safety and compliableness of risperidone are higher.

Objective To explore the effect of sinomenine on the expression of tumor necrosis factor-α (TNF-α),cathepsin G (Cat-G) and cathepsin S (Cat-S) in rats with collagen induced arthritis (CIA).Methods The 60 SPF male Wistar rats were randomly divided into normal group,model group,high dose group,medium dose group,low dose group,and dexamethasone group (with 1 0 in each group).In the normal control group,the rats were given ordinary feed.For the other five groups,the rats were used to build a CIA model and give pharmacologic intervention in the following 20 days.After 20 days of inflammation,sinomenine would be divided into three different dose groups,with 120 mg/kg,90 mg/kg and 60 mg/kg,respectively,and each group was given a gavage daily.For the dexamethasone group,7.5 mg/kg dexamethasone was given for gavage once a day.In terms of the model group and normal group,the rats were perfused with the same volume of saline once daily.Then,taken the pictures of foot paw X-ray and foot paw pictures of rats in each group,measured the content of TNF-α,Cat-G,Cat-S in blood serum,observed the pathological changes in the synovial tissue of rats in each group by tissue section,measured the content of TNF-α,Cat-G,Cat-S in in spleen of rats by Immunohistochemical staining.Results The results of X-ray showed that there were obvious soft tissue swelling,joint deformity and osteolysis in the paws of the model group,and the above symptoms were alleviated in different degrees in each treatment group compared with the model group.Compared with the model group,the expression of TNF-α (376.48 ± 22.21 pg/ml,369.45 ± 82.68 pg/ml,425.17 ± 153.51 pg/ml vs.457.63 ± 152.67 pg/ml),Cat-G (1 398.05 ± 167.32 pg/ml,1 337.65 ± 209.34 pg/ml,1 412.78 ± 67.65 pg/ml vs.2 283.03 ± 185.21 pg/ml),and Cat-S (662.18 ± 169.66 pg/ml,406.80 ± 41.93 pg/ml,452.76 ± 50.49 pg/ml vs.838.11 ± 141.86 pg/ml) in blood serum of sinomenine high dose group,medium dose group and low dose group significantly decreased (P＜0.05).The expression of TNF-α (0.28 ± 0.05,0.21 ± 0.03,0.34 ± 0.04 vs.0.50 ± 0.04),Cat-G (0.28 ± 0.02,0.18 ± 0.06,0.27 ± 0.02 vs.0.37 ± 0.03),and Cat-S (0.22 ± 0.02,0.18 ± 0.03,0.27 ± 0.02 vs.0.35 ± 0.03) in spleen tissue significantly decreased (P＜0.05).The results of HE staining showed that the synovial tissue of normal rats was normal,the synovial tissue cells of model rats were damaged,the expression of inflammatory cells was significantly increased,and pannus hyperplasia was observed.Inflammatory cell infiltration and pannus hyperplasia were decreased in each group after administration.Conclusions Sinomenine has a sound and comprehensive intervention effect on rheumatoid arthritis,and the mechanism may be related to the inhibition of the expression ofTNF-α,Cat-G and Cat-S.

Objective To retrieve,analyse and integrate the best evidences in perioperative fluid management for elderly patients with hip fracture,therefore to provide references for patient care.Methods Following the 6S evidence model,databases and websites were searched to collect the evidences on perioperative fluid management of elderly patients with hip fracture.The searched databases including BMJ Best Practice,UpToDate,AAOS Clinical Practice Guidelines,ASBMR,ANZHFR,ESTES,NICE,SIGN,JBI,Cochrane Library,CINAHL,Embase,PubMed,Web of Science,CNKI,Wanfang Data,VIP database,CEBM Database,Medive,China Science and Technology Journal Database,SinoMed,and other websites about orthopaedics.The searched literatures included guidelines,clinical decision-making,best practices,expert consensus and systematic reviews.The time span for the published literatures was from the inception of the databases and websites to August 2022.Two researchers independently completed quality evaluations of the retrieved literatures,as well as extraction,assessment and integration of the abstracted evidences.Results A total of 15 articles were included,they were 2 guidelines,3 clinical decision-makings,1 best practice,7 expert consensus,and 2 systematic reviews.Thirty pieces of evidence were summarised from 7 aspects,covering multidisciplinary team collaboration,dynamic assessment and monitoring of fluid status,fluid resuscitation,fluid management before and after the surgery and health education.Conclusions This study summarised the best evidences in perioperative fluid management for elderly patients with hip fracture.The evidences provide an evidence-based solution which will enable the healthcare workers to fully combine the clinical scenarios,evaluate changes in fluid volume status dynamically,develope personalised fluid management strategies and improve patient outcomes.

Objective:To make bibliometric analysis of Debriefing related research papers, and to lay a foundation for further research.Methods:A bibliometric analysis was conducted on the distribution of years, nations, institutions, the situation of citations, and main research contents of Debriefing related researches.Results:Analysis of the distribution of the publication years of Debriefing related literature indicated that since the relevant literature of Debriefing had been reported in 1979, its publication volume has been increasing year by year, mainly published by the United States, the United Kingdom, Canada and other countries. In addition, most journals that publish more literature on Debriefing are related to medical education, and most of the highly cited studies focus on relevant research theories based on Debriefing. Debriefing may be mainly applied in clinical teaching, nursing students' simulation teaching and training and its clinical application, among which nursing, psychiatry, emergency, internal medicine, pediatrics, surgery, anesthesiology, and other departments are common.Conclusion:Through the bibliometric analysis of Debriefing related research papers, this paper has a preliminary understanding of the status quo and hotspots of this field, which lays a good foundation for the subsequent research.