OBJECTIVETo introduce the framework of evidence-based practice with a case of castration-resistant prostate cancer (CRPC) as an example.

METHODSA clinical question was formulated according the clinical scenario. A systematic search was conducted for the published literature in the databases of PubMed, EMBASE, Cochrane Library, Clinical Trial Registries, and Web of Knowledge up to Dec 2014. The identified literature was reviewed for quality appraisal before the evidence was applied to clinical practice.

RESULTSThe treatment was effective and the patient achieved disease remission.

CONCLUSIONEvidence-based practice should be integrated with clinical scenario, current evidence, and patients' willingness, and follow a systematic framework.

Evidence-Based Medicine ; Humans ; Male ; Orchiectomy ; Prostatic Neoplasms, Castration-Resistant ; therapy

Objective To study the prevalence of mental disorders among the Chinese youths aged 15-34 years,in rural areas and to identify risk factors related to suicide.Methods A consecutive sampling strategy was used for suicidal cases in 16 randomly selected counties in Hunan,Liaoning,and Shandong provinces.Between 2005 and 2008,a total of 392 suicide cases were recruited with 416 community controls at the same age range,selected from the same areas one family member together with one close friend of each suicidal case were interviewed,using the psychological autopsy (PA) method.The same method with structured instruments was performed on the two informants for each control in the same community.SCID was used for the diagnosis of mental disease.Results 48.0％ of the suicides were diagnosed as having at least one mental disorder episode,in comparison with only 3.8％ among the controls.It was found that mental disorder was the most important risk factor for the Chinese young suicide cases in the rural areas.Conclusion As seen in the Western countries,mental disorder had also been the number one correlate on suicidal cases in China,with the difference as other social and psychological factors might have played relatively more important roles in China.

Objective To analyze the initial treatment strategies, blood glucose control and reaching standard status of newly diagnosed type 2 diabetes mellitus (T2DM) in the middle-aged and elderly. Methods The 771 patients diagnosed with T2DM newly or within one year, aged 50-70 years, selected from Chinese Diabetes Complication Prevention Study (CDCPS) were enrolled in this study. The correlations of initial treatment strategies with blood glucose control (target value of glycated hemoglobin was less than 7.0%) and reaching standard status were analyzed retrospectively. Based on the same lifestyle intervention, the therapy was further divided into group A (without medication), group B (single oral hypoglycemic agent), group C (combined oral hypoglycemic agents), group D (treatment including insulin). Results Although receiving the different treatments, the 771 patients had a similar mean glycated hemoglobin level, from 7.2% to 7.7%, among the four kinds of intervention before entering the study. The increased intensity and complexity after therapy adjustment along with the increased glycated hemoglobin level was observed at baseline. The corresponding relationships between medication and HbA1c were as follow: without medication-6.1%, single oral hypoglycemic agent-7.2%, combined oral hypoglycemic agents-7.7%, treatment including insulin-9.2%. After 20 months of follow-up, the mean fasting glucose and glycated hemoglobin were 6.6 mmol/L and 6.2%, separately. According to the target glycated hemoglobin level of less than 7.0%, all four-kinds of therapies had high achievement rates, which were all above 80% except that was 63.2% in group D. Sulphonylurea and biguanide as initial single oral hypoglycemic agent therapy had the similar effectiveness on glucose control and target glycated hemoglobin achievement. Conclusions According to the levels of glucose and glycated hemoglobin, multiple individual therapies should be enacted at the beginning of treatment. The strategy mainly based on sulphanylurea and biguanide is proved to be persistently effective in newly-diagnosed middle-aged and elderly diabetic patients in China.

OBJECTIVETo evaluate the effects of Rbl on action potentials and force of contraction in guinea pig ventricular papillary muscles.

METHODThe ventricular papillary muscles of guinea pig were isolated regularly and immersed with Tyrode, s solution. The effects of Rbl (purified saponins of panaxnotoginseng) on the action potentials (AP), the slow action potentials and the force of contraction (FC) of the muscles were studied. The AP and FC were measured synchronously.

RESULTRbl shortened the duration of AP, including APD2O and APD90, and reduced the FC(n = 5, P < 0.01), but didn't affect the rest potential (RP), the amplitude of action potential (APA), overshot (OS) and maximal upstrok velocity (Vmax). Rbl also decreased the APA of slow action potential, but quinidine had no such effects.

CONCLUSIONRbl may be a channel blocker.

Action Potentials ; drug effects ; Animals ; Calcium Channel Blockers ; pharmacology ; Drugs, Chinese Herbal ; isolation & purification ; pharmacology ; Female ; Ginsenosides ; isolation & purification ; pharmacology ; Guinea Pigs ; Male ; Myocardial Contraction ; drug effects ; Panax ; chemistry ; Papillary Muscles ; physiology

The main pathogenesis of functional constipation in children is the disturbance of large intestine conduction function, so the treatment of lubricating bowel and purging stool, dispersing food and abducting stagnation, nourishing blood and enriching yin is used in clinic. According to the characteristics of the physiopathologic of children, based on the clinical practice, this article believed that the occurrence of this disease was closely related to the ascending the clear of the spleen, the descending turbidity of the stomach, the dispersion of the lung and the catharsis of the liver. The root of pathogenesis is disturbance in ascending and descending of the functional activities of qi, so it is effective to treat the disease with the theory of qi ascending and descending.

Objective To investigate the clinical significance of intraportal vein anticoagulation for the prevention of portal vein thrombosis after portaazygous devascularization and splenorenal shunt. Methods In this study 67 patients of portal hypertension undergoing surgery were randomly divided into two groups,receiving respectively intraportal vein heparin injection by 100 U?kg~(-1)?d~(-1)?7 d in group A (32 patients)and placebo in group B(35 patients).Portal vein thrombosis,the recurrent bleeding after operation and portal hypertensive gastropathy were compared between the two groups.Results The occurrence of portal vein thrombosis after operation in group A(0)was significantly lower than that in group B(20%,X~2=5.169,P

Objective To find out the relationship of ecological environment protection and the transmission of Lyme disease under economic development of western regions in China.Methods Both scene molecular and traditional epidemiological methods were used to assess the effects of environmental protection on the transmission of Lyme disease.Results Among areas as protected natural forests,semiprotected nursery forests and farmland,the vector tick species and reservoir rodents from protected natural forests area had the highest quantity of population and diversity index and followed by semi-protected nursery forests.Vector competence of reservoir hosts and value of natural foci from protected natural forests area were also remarkably higher than those areas of semi-protected nursery forests and farmland. Staff working in the areas who were bitten by ticks from protected natural forests areas had higher serological Dositive rate(66.7%)than those from semi-protected nursery forests areas(2.5%),and both showed remarkable difference(P=6.45,E-11＜0.01,df=1).The difference of genetic divergence among these subpoPulations from different habitats being surveyed showed that the biggest genetic divergence index (Fst)of 0.557 42 was between protected natural forests area and farmland area.The index between semiprotected nursery forests area and farmland area was also bigger than zero with statistical significance.The genetic divergence index of 0.108 02 between semi-protected nursery forests area and protected natural forests area was the lowest which showed that genetic divergence between the subpopulations of the two sampling areas was not obvious.The genetic distance among these subpopulations had similar change along with their habitats.Conclusion Under economic development of western regions in China,when programs as natural forests protections,recovery prairie and grassland from farmland were actively performed,vectors insects and reservoir hosts of Lyme disease might also be protected to some degree but the risk and value of natural foci on Lyme disease might increase.Data suggested that people entering these areas should be told to strengthen their awareness on individual protection against the disease.

OBJECTIVEThis study is to understand the difference of semen quality among the different areas and the related factors.

METHODSFive hundred and sixty-two people were under from seven provinces.

RESULTSResults showed that the quantity and density of semen, the rate of moving forward semen, livability, percent age of normal formed semen and the total number of semen were statistically different among the seven areas. The difference was ranged as 28.82%, with the highest 2.95 ml in Shanxi province and the lowest 2.29 ml in Henan province. Geometric mean of semen density was found the lowest 36.27 x 10(6)/ml in Guizhou province, next to it was 42.52 x 10(6)/ml in Shandong province and the highest was 74.77 x 10(6)/ml in Hebei province. The percent age with forward progression of semen was seen the lowest 44.40% in Henan province, followed by 51.88% in Hebei province and 52.88% in Zhejiang province and the highest were 76.50% in Shanghai, 75.24% in Shanxi province, with a range of 72.30%. The highest semen viability was 85.89% in Shanghai, while the lowest 72.35% in Henan, with a range of 18.71%. Normal sperm morphology was seen the lowest 68.45% in Hebei province, with the highest 88.06% in Guizhou province, and the range was 28.65%. The geometric mean of total sperm count was seen the highest 204.23 x 10(6)/ml in Hebei province and the lowest 77.69 x 10(6)/ml in Guizhou province. Results showed through analysis of variance that some indexes were different in some provinces.

CONCLUSIONThe results indicated that the semen quality was different in different regions in China and its influential factors may be region and geography environment.

Adult ; China ; Humans ; Male ; Residence Characteristics ; Semen ; cytology ; physiology ; Socioeconomic Factors ; Sperm Count ; Sperm Motility ; Spermatozoa ; physiology

OBJECTIVETo observe the effect of Modified Zuoguiwan (MZ) on the balance between helper T cell subsets 17 (Th17) and regulatory T cell subsets (Treg) in estrogen deficiency induced bone loss mice and to explore its mechanism.

METHODSTotally 50 BALB/c mice were divided into the sham-operation group, the ovariectomy model group, the low dose MZ group, the middle dose MZ group, and the high dose MZ group by random digit table, 10 in each group. Mice in the low, middle, and high dose MZ groups were respectively administered with MZ at the daily dose of 7.25, 14.50, and 29.00 g/kg by gastrogavage, 0.5 mL each time for 12 successive weeks. Meanwhile, mice in the sham-operation group and the ovariectomy model group were administered with equal volume by gastrogavage, 0.50 mL each time. The serum estradiol (E2) level was assessed by enzyme linked immunosorbent assay (ELISA). Bone mineral density (BMD) of thigh bone was measured with dual energy X ray absorptiometry. In addition, the population of Th17/Treg subsets in spleen mononuclear cells was analyzed by extracellular and intracellular staining method using flow cytometry. Moreover, the mRNA expression of IL-17A and TGF-β in the spleen mononuclear cells was detected by reverse transcription polymerase chain reaction (RT-PCR).

RESULTSCompared with the sham-operation group, both E2 and BMD significantly decreased, the percentage of Th17 subset and Th17/Treg ratio both increased, the percentage of Treg subset obviously decreased, the expression of IL-17A mRNA significantly increased, and the expression of TGF-β mRNA significantly decreased in the ovariectomy model group (all P < 0.05). Compared with the model group, BMD obviously increased, the percentage of Th17 subset and Th17/Treg ratio both decreased, the percentage of Treg subset obviously increased, the expression of IL-17A mRNA significantly decreased, and the expression of TGF-β mRNA significantly increased in the middle dose MZ group and the high dose MZ group (all P < 0. 05). Correlation analyses showed that BMD was positively related to both the serum E2 level and the percentage of Treg subset (P < 0.05), but negatively related to the percentage of Th17 subset (P < 0.05). In addition, the serum E2 level was positively related to the percentage of Treg subset, but obviously negatively related to that of Th17 subset (P < 0.05).

CONCLUSIONSThere was correlation between Th17/Treg imbalance and E2 deficient bone loss. MZ could decrease the proportion of Th17 subset, but elevate the proportion of Treg subset in E2 deficient bone loss mice. It could achieve therapeutic effect through adjusting the balance of Th17/Treg in E2 deficient bone loss mice.

Animals ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Estrogens ; deficiency ; metabolism ; Female ; Flow Cytometry ; Humans ; Interleukin-17 ; Mice ; Mice, Inbred BALB C ; Osteoporosis, Postmenopausal ; drug therapy ; RNA, Messenger ; Spleen ; T-Lymphocyte Subsets ; T-Lymphocytes, Helper-Inducer ; T-Lymphocytes, Regulatory ; Th17 Cells ; Transforming Growth Factor beta ; metabolism

OBJECTIVETo investigate the safety and efficacy of low-concentration inhaled nitric oxide (NO) in the treatment of hypoxic respiratory failure (HRF) among premature infants.

METHODSSixty premature infants (gestational age ≤ 34 weeks) with HRF were randomized into NO and control groups between 2012 and 2013, with 30 cases in each group. Both groups received nasal continuous positive airway pressure (nCPAP) or mechanical ventilation. NO inhalation was continued for at least 7 days or until weaning in the NO group. The general conditions, blood gas results, complications, and clinical outcomes of the two groups were analyzed.

RESULTSThe NO group showed significantly more improvement in blood gas results than the control group after 12 hours of treatment (P<0.05). After that, the change in oxygenation status over time showed no significant difference between the two groups (P>0.05). There were no significant differences in total time of assisted ventilation and duration of oxygen therapy between the two groups (P>0.05). The incidence of bronchopulmonary dysplasia (BPD), patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, and pneumothorax in infants showed no significant differences between the NO and control groups (P>0.05), but the incidence of IVH and mortality were significantly lower in the NO group than in the control group (7% vs 17%, P<0.05; 3% vs 13%, P<0.05).

CONCLUSIONSNO inhalation may improve oxygenation status and reduce the mortality in premature infants with HRF, but it cannot reduce the incidence of BPD and the total time of mechanical ventilation or nCPAP and duration of oxygen therapy. NO therapy may have a brain-protective effect for premature infants with HRF and does not increase clinical complications.

Administration, Inhalation ; Blood Gas Analysis ; Bronchopulmonary Dysplasia ; epidemiology ; Humans ; Hypoxia ; complications ; Incidence ; Infant, Newborn ; Infant, Premature ; Nitric Oxide ; administration & dosage ; Respiratory Insufficiency ; blood ; complications ; drug therapy