The paper selects 4 famous foreign Evidence-based Medicine (EBM) databases-UpToDate,DynaMed,Medskills and CISMeF for analysis and comparison from 3 perspectives of the structures,retrieval methods and evidence grading standards,in order to provide reference for the construction and development of the EBM databases in China.

The semantic construction of EHR information model has experienced a developmental process from es-tablishing core data set and modeling to two-level modeling, which are usually used in combination in construction of information models at present. In general, the framework (reference model), necessary elements (core data set) and technical specifications for EHR information model were first established when its top architecture was de-signed, which was followed by the establishment of different medical concepts, subjects and special archetypes for different departments according to the framework standards.

Objective To compare the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of ropivacaine for epidural block and investigate the appropriate dose.Methods One hundred and twenty ASA Ⅰ patients of both sexes,aged 20-55 yr,weighing 50-75 kg,scheduled for knee arthroscopic operation,were randomly divided into 4 groups (n =30 each):no dexmedetomidine group (group D0),0.25 μg/kg dexmedetomidine group (group D0.25),0.50μg/kg dexmedetomidine group (group D0.50),and 1.00μg/kg dexmedetomidine group (group D1.00).In group D0,ropivacaine 20 ml was injected into epidural space.The ropivacaine-dexmedetomidine mixtures containing 0.25,0.50 and 1.00 μg/kg dexmedetomidine were injected into epidural space in groups D0.25,D1.00 and D0.50 respectively.The volume of mixtures was 20 nl in groups D0.25,D1.00 and D0.50.The initial concentration of ropivacaine was set at 0.40 ％,0.40 ％,0.28 ％ and 0.20 ％ in groups D0,D0.25,D0.50 and D1.00 respectively and then the EC50 was determined by up-and-down technique.The concentration of ropivacaine was increased/decreased by 0.02％ in the next patient.The analgesic effect was assessed using VAS score.VAS score =0 was considered as effective analgesia.The EC50 and 95％ confidence interval (CI) of ropivacaine were calculated using probit method.Adverse effects were recorded.Results The EC50 and 95 ％ CI of ropivacaine was 0.38％ (0.35-0.41)％,0.34％ (0.31-0.36)％,0.22％ (0.20-0.24)％ and 0.14％ (0.12-0.15) ％ in groups D0,D0.25,D0.50 and D1.00 respectively.The EC50 of ropivacaine was decreased gradually in groups D0,D0.25,D0.50 and D1.00 ( P ＜ 0.05).Compared with group D0,the incidonce of hypotension and bradycardia was significantly increased in group D1.00 ( P ＜ 0.05),while no significant change was found in the incidence of adverse effects in groups D0.25 and D0.50 (P ＞ 0.05).Conclusion The appropriate dose of dexmedetomidine for epidural analgesia is 0.50 μg/kg.

Objective To explore the clinical characteristics and prognostic factors of breast carcinosarcoma.Methods Clinical data of 37 breast carcinosarcoma patients treated at Tianjin Cancer Hospital from 1974 to 2014 was analyzed retrospectively.Kaplan-Meier unvariate analysis was used to calculate the survival rate and compare the survival rates.Multivariate factors for survival were analyzed by COX proportional hazards regression model.Results 37 cases of breast carcinosarcoma were all female.The median age was 55 years.Among them 31 cases complained for painless mass,six cases had breast mass with skin ulceration.21 cases were three-negative breast cancer.Ten cases had axillary lymph node metastasis,ten cases had distant metastasis.The 5-year survival rate was 62.3％.Unvariate analysis showed that axillary lymphnodes metastasis (P =0.045) and therapeutic schedule (P =0.016) significantly influenced the oulcome of the patients.COX multivariate analysis validated that the therapy modality was an independent prognostic factor for breast carcinosarcoma(P =0.041).Conclusions Breast carcinosarcoma is rare and has a poor prognosis.ER,PR and HER-2 expressions in most cases are negative.If there is axillary lymph node metastasis,the prognosis is poor.A reasonable and comprehensive treatment can improve the prognosis.

BACKGROUND: Diabetic retinopathy is the common complications of diabetes mellitus. Taurine is free aminoacid with the mostly abundant content in retina, and it is the necessary nutrition factor for regeneration and development of retina. Deficiency of taurine will cause structural and functional change of retina.OBJECTIVE: To probe into the effect of taurine on the expression of retinal glial fibrillary acidic protein (GFAP) mRNA DESIGN: A randomized and controlled observation SETTING: Third Military Medical University of Chinese PLA MATERIALS: This experiment was carried out at the Third Military Medical University of Chinese PLA from March 2003 to December 2003.Totally 54 closed group SD rats, with body mass of 250 g, were chosen.The successful diabetic rat model were randomly divided into 6 groups: diabetic group of 1 month, taurine-treated diabetic group of 1 month, diabetic group of 2 months, taurine-treated diabetic group of 2 months, diabetic group of 3 months, taurine-treated diabetic group of 3 months, with 9 rats in each group. Another 15 rats were chosen homeochronously as normal control group.METHODS: The animals were raised in separate cages. They were free to access to food and water, and fasted for 12 hours before experiment. Streptozotocin was used to induce diabetes mellitus .When Tes-Tape showed urine glucose reached more than (+++), and blood glucose concentration of venous blood from tail measured ＞16.7 mmol/L, models were established successfully. Expressions of GFAP mRNA and protein were measured with immunohistochemistry, RT-PCR, Western blotting and other technical methods. The effect of taurine on retinal neurons and glial cells in rats with diabetes mellitus was observed.MAIN OUTCOME MEASURES: Expressions of GFAP mRNA and protein RESULTS: ① Immunohistochemical analysis showed that: When rats suffered from diabetes mellitus for 1 month, taurine can inhibit the immunoreactivity of GFAP. With the elongation of intervention time of taurine, the immunoreactivity of GFAP is weakened. ②RT-PCR detection: Starting from the beginning of 2 months, the expression of GFAPmRNA in diabetic group began to increase; taurine obviously down-regulated the expression of GFAP mRNA. ③ In taurine-treated diabetic group of 3 months,the expression of GFAP was the strongest. When diabetic rats were treated by taurine for 2 months, the expression of GFAP was decreased.CONCLUSION: Taurine can down-regulate the expression of GFAP mR-NA and protein, indicating that it can protect retinal pathological change in rats with diabetes mellitus.

Objective To explore the effect of nucleos(t)ide analog (NA)antiviral treatment on the pathological differentiation of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC)and the prognostic factors of HCC.Methods Totally 127 patients with HBV-related HCC who were hospitalized and received partial hepatectomy in First Affiliated Hospital of Harbin Medical University from March 2007 to November 2013 were included in this study.Sixteen cases received antiviral treatment before operation and the remaining 111 cases had no history of NA treatment.The differences of histopathological grading were compared between the two groups.Twenty-nine patients received antiviral treatment for the first time after surgery,and the rest 82 patients did not.All these patients were followed up for survival and recurrence.Multivariate analysis was used to explore the prognostic factors for HCC.The categorical variables were analyzed byχ2 test or Fisher exact test.Survival rate was compared with Log-rank test. Univariate or multivariate Cox regression analysis was used to explore the related factors of survival. Results The proportions of well-,moderately- or poorly-differentiated HCC in patients with antiviral treatment before surgery were 18.75 %,68.75 % and 12.5 %,respectively.Whereas the proportions in those without treatment were 16.22%,66.67% and 17.11 %,respectively.There was no significant difference in histopathological grading of HCC between the two groups (χ2=0.224,P =0.885 ).The overall median survival time was 39 months.The 6-month,1-and 2-year survival rates were 91 .7%, 77.5 % and 59.3%,respectively.The 6-month,1- and 2-year survival rate of postoperative antiviral treatment were 96.3%,92.4% and 78.5 %,respectively,which were significantly higher than those of no antiviral treatment group (85 .9%,70.0% and 48.5 %,respectively;χ2= 6.967,P = 0.008 ). Univariate analysis showed that tumor number,size,portal vein transfer,AFP level,postoperative antiviral treatment,histopathological grading,TNM staging,BCLC staging,γ-GT and PTA were prognostic factors for postoperative HCC survival.Multivariate analysis showed that AFP level (HR=1 , 95 %CI :1 .0004—1 .002,P =0.004),postoperative antiviral treatment (HR =0.38,95 %CI :0.38—0.15 ,P =0.04)and BCLC stage (B vs A:HR=1 .55 ,95 %CI :0.76—3.18;C vs A:HR=3.63,95 %CI :1 .31 —10.09,P =0.04)were independent prognostic factors.Conclusions Preoperative antiviral treatment has no impact on the histopathological grading of HCC. BCLC stage, AFP level and postoperative antiviral treatment are independent prognostic factors for HBV-related HCC.

Objective To investigate the interfractional and intrafractional prostate motion during hypofractionated precise radiotherapy for prostate cancer. Methods From 2013 to 2016, twenty?eight patients who received 5 Gy radiotherapy in 9 fractions for prostate cancer were enrolled as subjects. Every patient had three gold fiducials implanted into the prostate by transrectal ultrasound guidance two weeks before computed tomography ( CT) simulation. All patients underwent CT scans in the supine position with full bladders and rectal balloons filled with 60 ml air. The Pinnacle planning system was used to design the treatment plans. Twenty?three patients were treated with a Synergy accelerator. Those patients underwent cone?beam CT ( CBCT) scans prior to treatment. The set?up error was recorded by bone alignment between CBCT images and planning CT images. The prostate displacement was then recorded by gold fiducial alignment. The interfraction prostate displacement was defined by the difference between the above two parameters. The other 5 patients were treated with a Novalis accelerator. Based on gold fiducial alignment,the real?time tracking of gold fiducials was carried out by the ExacTrac system to evaluate the intrafractional prostate displacement. Results A total of 207 measurements of interfractional prostate displacement were made in the 23 patients before treatment. The mean interfractional prostate displacements in the left?right (LR),superior?inferior (SI),and anterior?posterior (AP) directions were (0.05±0?10),(0.20±0?22),and (0.19±0?18) cm,respectively. The displacements larger than 0?3 cm in the above three directions were observed in 1,52,and 49 measurements,respectively,while the displacements larger than 0?5 cm in the three directions were observed in 1,29,and 16 measurements,respectively. A total of 225 measurements of gold fiducial displacement were made in the 5 patients during treatment. The mean intrafractional prostate displacements in LR,SI,and AP directions were (0.61±0?50),(0.68±0?69),and (0.70±0?67) mm, respectively. The displacements larger than 3 mm in the three directions were observed in 0, 1, and 1 measurement, respectively. Conclusions In hypofractionated precise radiotherapy for prostate cancer, the interfractional prostate displacement is significantly larger than the intrafractional prostate displacement. The interfractional prostate displacement must be corrected before radiotherapy. In order to avoid off?target irradiation due to postural changes in patients,the tracking of the intrafractional prostate displacement is still necessary although the displacement is relatively small. The rectal balloon can help immobilize the prostate.

Objective To study the effect of Numb gene overexpression on invasion and migration in human renal cell carcinoma cells and its related mechanism. Methods The Numb-ORF plasmid was transfected into renal cell carcinoma cells 786-O, set the negative control and blank control. The expression of Numb and matrix metalloproteinase-9 (MMP-9) was detected by real-time PCR and western blot. Then abilities of cells invasion and migration were measured respectively by transwell assay and scratch-wound-healing assay. Results Compared to negative control (2.51±0.27) and blank control (2.87±0.21), Numb expression in Numb-ORF group (36.13 ±8.33) was significantly higher (P= 0.00). Meanwhile, MMP-9 level in Numb-ORF group was decreased: Numb-ORF group was 2.36±0.29, negative control was 8.73±0.91, blank control was 8.99±0.78 (P=0.00). In scratch-wound-healing assay,the repair ratio of 12 h was as follow: Numb-ORF group was 0.53 ±0.06, negative control was 0.73 ±0.09, blank control was 0.75 ±0.08 (P= 0.02). In transwell assay, the number of invasion cells in Numb-ORF group was 31.40±5.96, less than negative control (126.93±13.61) and blank control (131.87 ±15.42) (P= 0.00). Conclusion Overexpression of Numb significantly decreases abilities of invasion and migration in 786-O cells, and the suppressive effect may be due to the down-regulation of MMP-9 expression in human renal cell carcinoma.

Objective To investigate the clinical use of array comparative genomic hybridization (aCGH) with fluorescence in situ hybridization (FISH) in preimplantion genetic diagnosis (PGD)for reciprocal and Robertsonian translocation carriers.Methods From Jan.2012 to Jun.2013,a total of 220 PGD cycles from 151 reciprocal translocation and 62 Robertsonian translocation carrier couples,including 33 cycles for reciprocal translocation carriers and 22 cycles for Robertsonian translocation carriers performed using array CGH,and 119 cycles for reciprocal translocation carriers and 46 cycles for Robertsonian translocation carriers performed using FISH were retrospectively studied.The rate of accurate diagnosis was compared between two methods.Results Normal and/or balance rates of the two translocated chromosomes detected by aCGH for both reciprocal and Robertsonian translocation carriers were 38.20％ (123/322) and 67.20％ (127/189),significantly higher than 15.39％ (195/1 267) and 30.75％ (202/657) by FISH (all P ＜0.05).Abnormal rates of the two translocated chromosomes detected by aCGH for both reciprocal and Robertsonian translocation carriers were 59.32％ (191/322) and 30.69％ (58/189),significantly lower than 83.03％ (1 052/1 267) and 67.43％ (443/657) by FISH (all P ＜ 0.05).And the rate of aneu ploidy in non-translocated chromosome from reciprocal translocation embryos was 20.19％ (65/322),which was significantly lower than 38.62％ (13/189) from Robertsonian translocation embryos (P ＜ 0.01).Conclusions Normal and/or balance rates of the two translocated chromosomes detected by array CGH were significantly higher than FISH.And the rate of aneuploidy in non-translocated chromosomes from reciprocal translocation embryos was significantly lower than that from Robertsonian translocation embryos.