Evidence-based medicine (EBM), which aims to get the best evidence from medical research, is a growing international movement in health care. Because of this new shift in medical practice, great attention should be paid to how to introduce EBM into Chinese Tuina, and this is a good opportunity for the development of Chinese Tuina. To adopt EBM will be beneficial to developing Chinese Tuina, improving clinical research, renewing education mode and getting more academic achievement. So it is necessary to establish a new experimental methodology combined with EBM in order to get great progress in Chinese Tuina.

Children with biliary atresia generally present nutritional deficiency, and often have growth failure and neurodevelopmental impairments.Increasing evidence shows that malnutrition is not only a risk factor for growth failure and neurodevelopmental impairments in children with biliary atresia, but also a risk factor for morbidity and mortality.Nutritional support is extremely important to improve the prognosis.This article reviews the relationship between malnutrition, growth failure and neurodevelopmental impairments in children with BA, and discusses the timing and methods of nutritional support.

ObjectiveTo compare the clinical results of small surgical incision of bilateral spinous process and traditional open surgical incision in posterior single level lumbar interbody fusion,and assess the application value of the small surgical incision of bilateral spinous process in posterior single level lumbar interbody fusion.MethodsFrom December 2006 to June 2008,70 patients with lower lumbar vertebral diseases underwent single segment posterior lumbar interbody fusion.Patients were randomly divided into small surgical incision of bilateral spinous process group(Hereinafter referred to as small incision group) of 36 cases and 34 cases of conventional open group.Small incision group included 20 males and 16 females with an average age of 52.0 years.Traditional open group included 16 males and 18 females with an average age of 53.2 years.Two groups of operative time,blood loss,postoperative drainage,X-ray projection operation frequency,hospital stay,complication rate,creatine phosphokinase (CPK) level,multifidus cross-sectional area,postoperative low back pain visual analogue scale(VAS),Oswestry disability index(ODI),interbody fusion rate were compared,respectively.ResultsAll of 70 cases were followed up for 12-24 months (average,16).There were no statistically differences in the operation time,the number of X-ray projection,complication rate,and fusion rate between the two groups (P＞0.05),but there were significant differences in blood loss,postoperative drainage,the first day and the third day of postoperative the level of CPK,postoperative multifidus muscle cross-sectional area,postoperative low back pain VAS,hospital stay,and postoperative ODI between the two groups(P＜0.05).ConclusionSmall surgical incision of bilateral spinous process and traditional open surgical posterior lumbar interbody fusion were satisfied with the efficacy,but small surgical incision of bilateral spinous process with less trauma,shorter hospital stay,and rapid postoperative recovery.

Objective To investigate the effect of exogenous orexinA on the pyramid neurons and interneurons in the prefrontal cortex prelimbic(PL)area.Methods The pyramid neurons and interneurons in PL area of Kunming mice were selected from prefrontal cortex slices by infrared visual patch clamp technique.The morphology and electrophysiological features of the pyramid neurons and interneurons were observed.The effect of exogenous orexinA at a concentration of 400 nmol/L on these cells was studied using the whole cell configuration.Results The pyramid neurons were large,pyramidal in cell body with clear apical dendrites extending vertically and several basal dendrites radiating.The interneurons were comparatively smaller and had several processes from cell body.In current clamp mode,all 54 pyramid neurons having been recorded showed frequency adaption,and the 15 recorded interneurons discharged rapidly and had no frequency adaption.While in vol-tage clamp mode,36 pyramid neurons were regarded as Ih(+)pyramid neurons for recorded hyperpolariztion-activated cation current,and the left 18 and 15 interneurons were Ih(-).Exogenous orexinA had a total reaction rate of 51.9% on 54 recorded pyramid neurons under current clamp,and a rate of 66.7% on 36 Ih(+)pyramid neurons and of 22.2% on the Ih(-)pyramid neurons under voltage clamp.All 15 recorded interneurons had no reaction to exogenous orexinA under either mode.Conclusion OrexinA plays excitatory effect on pyramid neurons in the prefrontal cortex PL area,and this effect is much more noticeable in pyramid neurons with Ih currents.

Executive impairment is one of the common sequelae of stroke, which seriously affects the quality of life of patients. Repeti-tive transcranial magnetic stimulation (rTMS), as a new type of electrophysiological technique, has been used in the clinical treatment of Post-Stroke Executive Impairment (PSEI). This paper summarized the survey of PSEI, the basic principle and mechanism of rTMS, clinical application of rTMS for PSEI and its safety. Clinical studies showed that high frequency stimulation, low frequency stimulation, and combi-nation with other therapeutic methods were effective in PSEI. However, there was no unified theory about the mechanism and the best treat-ment plan of rTMS for PSEI.

Objective To research the results of skin tests for cephalosporin in outpatient and emergency department of Suzhou Hospital of Traditional Chinese Medicine in Jiangsu.Methods Set 500 μg/mL of every kind of cephalosporin for the skin test.We observed the skin test results of the patients with treatment in outpatient and emergency department of Suzhou Hospital of Traditional Chinese Medicine in Jiangsu during June 2014 to December 2014.We collected the data of the positive skin test.Results There were 3 247 patients who accepted the skin test of cephalosporin during the half of the year,including 234 cases were positive.The positive rate was 7.21%.The ratio of patients who were sensitive to food or drug was 13.6%.The rate of contacting with alcohol in 24 hours before the skin test was 8.54%.Conclusion We should pay attention to the results of cephalosporin of skin test.We are looking forward to the relevant departments formulate a unified standard of the skin test.

Objective To investigate the CT perfusion imaging and the pathological features on the disturbance of regional cerebral microcirculation in a pre-infarction period, and to evaluate the relationship between the astrocytes and regional cerebral microcirculation. Methods Dynamic CT perfusion imaging of the models with regional cerebral hypoperfusion and astrocytic swelling in rats was performed to assess the presence or absence of the disturbance of regional cerebral microcirculation. Then, the histopathologic examination was made for both models, respectively. The ratios of side-to-side were measured at hypoperfusion areas in the models of regional cerebral ischemia. Results Regional hypoperfusion was revealed by regional cerebral blood flow (rCBF) and mean transit time (MTT) maps in the group of hypoperfusion for 6 hours. Regional cerebral blood volume (rCBV) and time-to-peak (TTP) maps were normal in that group. The ratios of rCBF, rCBV, MTT and TTP were 0 39-0 55, 0 92-1 00, 1 20-1 50 and 1 00-1 00 respectively. Astrocytic swelling pressing the capillary wall was obvious and subtle neuronal reversible degeneration was occasionally found. TTC stain was normal. In the tACPD group of astrocytic swelling, the abnormal hemodynamic regions on rCBF and MTT maps were found. The rCBV maps of 3 rats in the tACPD group showed the area of reduced rCBV. In 2 rats of tACPD group, the areas of delayed TTP were also found. The ratios of rCBF, rCBV, MTT and TTP were 0 25-0 44, 0 70-1 01, 1 20-2 00 and 1 02-1 45 respectively. TTC stain was negative. Electron microscope study revealed remarkable swelling of astrocytes, especially endfoot processes of astrocytes around capillaries. The abnormal hemodynamic region on rCBF and MTT maps matched with abnormal extent on histopathologic examination. The rCBV and TTP maps appeared normal. Conclusion The astrocytes can react in a way faster than the neurons in the pre-infarction period, viz. astrocytic swelling. The swelling of astrocytic foot, which pressed capillary vessel, induced the disturbance of regional cerebral microcirculation, and then aggravated hypoxic ischemic state in regional brain parenchyma. Perfusion CT and its parameters' analysis may play an increasing role to delineate the reversible hypoperfusion areas in pre-infarction period. Analyzing the relationship of rCBF and rCBV is very helpful to know the status of the capillary vessels in regional cerebral hypoperfusion area.

This study was purposed to investigate the immunophenotypic characteristics in multiple myeloma (MM) cells and their significance. Thirty three cases of MM and 12 cases of reactive plasmacytosis (as control group) were enrolled in the study. The expressions of surface antigens in MM cells were detected with flow cytometry by using direct immunofluorescent technique and gating method of CD38/SSC and were confirmed with morphologic observation of myeloma cells. The results indicated that the proportion of myeloma cells detected by morphologic examination was 6.0% - 76.0%. With CD38/SSC gating method, a cluster of CD38 bright positive cells could be detected in their scatter plot, the proportion ranged from 0.99% to 57.54%. Most phenotype of MM was 38(st+)CD138(+)CD19(-)CD56(+) (78.8%). While the expressions of CD20, CD33, CD117, HLA-DR were seen in some MM patients, the positive rates were 12.1%, 15.2%, 30.3%, 9.1%, respectively; the expression of other antigens was negative. cκ or cλ monoclonal restriction was detected in 27 cases (81.8%) of MM, both cκ and cλ in the remaining cases of MM was negative. It is concluded that detecting the immunophenotype of MM patients by flow cytometry with CD38/SSC gating method and basing on the heterogeneity of cell antigens can discriminate myeloma cells from normal plasma cells, which provides evidence for targeted therapy and prognosis evaluation.
Adult ; Aged ; Female ; Flow Cytometry ; methods ; Humans ; Immunophenotyping ; Male ; Middle Aged ; Multiple Myeloma ; immunology

Objective To evaluate whether an early change in 18F-fluorodeoxyglucose (18F-FDG) uptake can predict tumor response to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and prognosis in patients with non-small cell lung cancer (NSCLC). Methods From August 2009 to April 2015, 22 patients with NSCLC who were eligible to EGFR-TKI treatment were enrolled. PET-CT scan was performed before (baseline) and 1 month after EGFR-TKI administration. Up to 5 hottest single tumor lesions (no more than 2 per organ) were considered to be target lesions. Maximum standardized uptake values (SUVmax) were measured, and post-treatment percentage changes in SUVmax (ΔSUV%) were calculated. PET responses were classified using PET response criteria in solid tumors (PERCIST). Then conventional CT scan was performed every 2 months for follow-up. Kappa statistic was used to compare agreement between the RERCIST recommendations-based therapeutic response evaluation and those based on RECIST1.1 criteria. Fisher exact test was used to compare the probability of disease progression in the early metabolic response and non-response groups. Predictive accuracy of ΔSUV% with respect to response or non-progression at CT scan was evaluated by ROC analysis. Progression-free survival (PFS) was determined by Kaplan-Meier survival analysis, and between-group comparison was performed by log-rank test. Results After 1 month of EGFR-TKI treatment, 12 patients (55%) showed partial metabolic response (PMR), 6 (27%) had stable metabolic disease (SMD), and 4 (18%) had progressive metabolic disease (PMD). There was a moderate agreement(Kappa=0.506,P<0.05) between PET response at 1 month based on PERCIST recommendations and CT response at 3 months according to RECIST 1.1. Non-progression was significantly more frequent in patients with an early PMR (χ2=11.941, P=0.005). Progression had been confirmed later during therapy in all patients with PMD . By using ROC analysis, the area under the curve for prediction of response was 0.906 (95% CI, 0.766—1.000; P=0.002), corresponding to a sensitivity of 88.9% and specificity of 84.6% at a cut-off of 40.36% in ΔSUV%. Using a cut-off value of 25.84% in ΔSUV%, highΔSUV% group (ΔSUV% ≥ 25.84%) had significantly longer PFS than low ΔSUV% group (ΔSUV%<25.84%). Conclusion Early assessment of PET-CT at 1 month of EGFR-TKI treatment could be useful to predict tumor response and clinical outcome in patients with NSCLC.

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou,China The women were assigned to receive combination ART (cART) or mono/dual ART or no treatment.The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy,spontaneous abortion,stillbirth,preterm birth,small for gestational age (SGA)] and adverse early growth outcome (including infant death,HIV infection of mother-to-child transmission,and underweight,wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202 (35.1％) of all enrolled HIV-infected women,and 121 (31.3％) of all infants exhibited adverse effects on early growth at 4 weeks of age.The rates of adverse pregnancy outcomes,spontaneous abortion,ectopic pregnancy,stillbirth,infant death and perinatal HIV infection were higher among women not receiving ART,compared to those treated with cART or mono/dual ART (P ＜ 0.05).However,women treated with cART had a higher rate of SGA,compared to untreated women (P ＜ 0.05).No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART,as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival