The medical historical data in the "Left Biography" show the formation and developments of TCM basic theory in the Spring and Autumn Period.The article exposes traditional culture is the foundation to develop and carry TCM from the relative items concerned in "Left Biography" on Yingyang Five Elements,causa morbi and mechanism,healthy-keeping,disease-prevention,treatment principle and methods.

Outsourcing hospital rear service is an inevitable result of the deepening of hospital reform and each hospital has its own ways of promoting the move. The authors give an account of the measures adopted in their hospital: ①detennining which part of the rear service was to be outsourced first; ②selecting the organizations for cooperation; ③clarifying the obligations of each party and drawing up working standards; ④amplifying necessary rules and regulations; and ⑤strengthening organization and management. Marked effects have been obtained as a result of about half a year's practice: ①optimization of the contingent of temporary workers which has rid the hospital of the worries behind; ②promotion of the change of concepts on the part of the staff which has led to an intensification of the sense of urgency and the awareness of competition; ③improvement of the quality of the rear service; and ④economy of funds.

Objective To investigate the relationship of the chemical coding enteric nervous system of the mice and expression for neurotransmittor of enteric primary afferent neurons for Nociceptors.Methods Immunocytochemical and morphometric techniques were used to quantify the distribution of IB4-containing neurons in mice enteric nervous system using three mice chiocing every vision 50 neurons undering confocal microscopy IB4 immunolabelling and colocalized with calretinin and lectin B4.Results IB4 being binded to primary afferent neurons of enteric pleuxes happend in small intestin and colon of mice,where it was selective for nociceptive neurons.IB4 revealed large round or oval(Dogiel type II)neurons,type I neurons with prominent laminar dendrites and small neurons of myenteric ganglia.The type II neurons were immunoreactive for calretinin,and some type I neurons were immunoreactive for nitric oxide synthase.Most neurons in the submucosal ganglia bound IB4,and some of these were vasoactive intestinal peptide immunoreactive.Conclusion The results indicate that IB4 labels specific subgroups of enteric neurons in the enteric nervous system of the mice.These include intrinsic primary afferent neurons,but other neurons,including secretomotor neurons,are labeled.The results suggest that IB4 is not a specific label for enteric nociceptive neurons.

Objective To investigate the effects of oral folic acid supplementation on the expressions of heart devel-opment-related proteins GATA4 and Nkx2 . 5 of offspring in the rat models of maternal hyperglycemia during preg-nancy. Methods Forty Sprague-Dawly( SD) rats in pregnancy were randomly divided into 5 groups:control group, models group, FA3rd group, FA7th group and FA15th group. Except for the control group, maternal hyperglycemi-a was induced by a single intraperitoneal injection of streptozotocin (38 mg/kg) in SD rats of four other groups on the first day of pregnancy. And group FA3rd, FA7th, FA15th were intragastriced with folic acid (0. 8 mg/kg per day) from day 3,7,and 15 of pregnancy respectively until the end of the pregnancy. The hearts of neonates were taken on the 21st day of pregnancy and the heart tissues with haematoxylin and eosin staining were observed. The expressions of GATA4 and Nkx2. 5 proteins were detected by immunohistochemistry and Western blot. Results The blood glucose level of pregant rats intervened by streptozotocin was significantly increased(P<0. 05),and in a part of their offspring,the cardiac injury was detected. GATA4 protein was expressed in atria,ventricles, interven-tricular septum and valvular tissues. Nkx2. 5 protein was expressed in atria, ventricles and interventricular septum, while it was not expressed obviously in valvular tissues. The expression levels of GATA4 and Nkx2. 5 were de-creased in the groups intervened by streptozotocin compared with the control group(P<0. 05). The expression lev-els of GATA4 and Nkx2. 5 in FA3rd group and FA7th group were higher than that of the models group(P<0. 05). Compared with FA7th group, the expression of GATA4 and Nkx2. 5 in FA3rd group increased greatly(P<0. 05). However, it showed no significant difference between the models group and FA15th group. Conclusion Maternal hyperglycemia during pregnancy may result in offspring’ s cardiac injury and decrease their expressions of heart de-velopment-related protein GATA4 and Nkx2. 5 at the same time. Folic acid supplementation may increase the ex-pressions of GATA4 and Nkx2. 5 protein and has a protective effect on offspring’s myocardial development of mater-nal hyperglycemia in pregnancy.

Objective To explore the associations of the genetic polymorphisms of cytochrome P450, family 2, subfamily D, polypeptide 6 (CYP2D6) and cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9) with early-onset severe pre-eclampsia and the efficacy of labetalol therapy. Methods Totally 105 gravidas diagnosed with early-onset severe pre-eclampsia (experimental group) and 103 healthy gravidas (control group) were recruited from Beijing Obstetrics and Gynecology Hospital between August 2013 and July 2016. Labetalol was given to control blood pressures in gravidas with early-onset severe pre-eclampsia. If labetalol administration alone did not exceed the mean dose (100 mg, one dose per eight hours) and effectively controlled the blood pressures, it would be considered to be valid (n=75), otherwise it would be viewed as an invalid treatment. Genotype and allele frequencies of CYP2C9 gene (rs1057910 and rs4918758) and CYP2D6 gene (rs1065852, rs28371725, rs35742686 and rs3892097) in the gravidas were analyzed by TaqMan probe polymerase chain reaction. Differences in the genotype and allele frequencies were compared between the experimental and control groups, and the valid and invalid labetalol treatment groups. Chi-square test, analysis of variance and LSD test were used as statistical methods. Results The gravidas in both experimental and control groups were AA genotype in CYP2C9 gene rs1057910, TT genotype in CYP2D6 gene rs35742686 and CC genotype in CYP2D6 gene rs3892097. Frequencies of CC and CT genotypes in CYP2D6 gene rs28371725 in the experimental group were higher than those in the control group [18.1% (19/105) vs 14.6% (15/103);56.2% (59/105) vs 42.7% (44/103); χ2=6.707], and higher C allele frequency in CYP2D6 gene rs28371725 was also observed in the experimental group [46.2% (97/210) vs 35.9% (74/206), χ2=4.529] (all P<0.05). No statistical differences in maternal age, diastolic pressure, body mass index before pregnancy, serum triglyceride, creatinine and neonatal birth weight were observed among women with CC, CT or TT genotype of CYP2D6 gene rs28371725 in the experimental group (all P>0.05). Compared with the gravidas with CT or TT genotype of CYP2D6 gene rs28371725, those with CC genotype had longer gestational age [(32.5±2.1) vs (29.5±1.8) and (29.8±2.2) weeks] and higher plasma albumin [(27.2±9.3) vs (20.3±10.4) and (22.5±7.4) g/L], but lower systolic pressure and 24 hours urine protein (LSD test, all P<0.05). The G allele frequency in CYP2D6 gene rs1065852 in invalid labetalol treatment group was higher than that in valid labetalol treatment group [93.3% (56/60) vs 76.0% (114/150), χ2=8.351, P=0.004]. Conclusions The polymorphism of CYP2D6 gene rs28371725 may be associated with early-onset severe pre-eclampsia, and the allele of G in CYP2D6 gene rs1065852 may be associated with the efficacy of labetalol in treatment of early-onset severe pre-eclampsia.

Objective To evaluate the methods and the factors of affecting imaging quality of 3D CE MRA of carotid arteries.Methods 3D CE MRA in 48 patients were performed using 1.5T super conductive MR scanner,cervical and lumbar combination phased array coils. All patients were examined using intravenous injection Gd-DTPA and breath-hold 3D FLASH sequence. Results Imaging quality was satisfied in 46/48 patients (96%). MIP and MPR could clearly showed normal anatomy. The site,size and stenosis degree of the lesion were also demonstrated. Compared to surgery,DSA and/or ultrasound results , in 23 patients, the sensitivity and specificity of 3D CE MRA were 100% and 100% respeectively for the lesion of carotid arteries. Conclusion High quality images of 3D CE MRA mainly depends on determining the best acquisition delay time,optimizing injection volume and rate of contrast material,using reasonable sequence parameters and skilled level of operators.

OBJECTIVE:To evaluate evidence foundation of phamracogenetics personalized medication,and to provide refer-ence for clinical application. METHODS:Using“phamracogenetics”“pharmacogenomics”and“gene polymorphism”as key words,related literatures and clinical guideline were retrieved from PubMed,CNKI,Wanfang database,and analyzed in respects of involved gene,site and drug types,etc. Evidences of package inserts of phamracogenetics biomarker were evaluated by using phamracogenetics practice and prevention evaluation guideline. RESULTS:8 276 papers,25 guidelines and 166 drug package in-serts are available for analysis. The phamracogenetics literatures mostly focus on the relationship between some one gene and differ-ent drugs. In guidelines,some one specific gene can guide clinical application of multiple drugs in different fields. In drug package inserts,general level of clinical evidence is not high;detectable biomarkers is inadequate in category,and detection rate is only 38.06% besides targeting preparation. CONCLUSIONS:Under the condition of low clinical evidence level the detection of pharma-cogenetics biomarker should be conducted carefully,and basic study should be further strengthened.

Objective To compare the diagnostic performance of multi-contrast atherosclerosis characterization (MATCH) and magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for the detection of IPH with histologic analysis as the reference standard.Methods Thirty individuals were collected in this study.They were diagnosed to have carotid stenosis＞50％ by ultrasound and scheduled for carotid endarterectomy from 2014 to 2015.3 T carotid MR examinations using MPRAGE,MATCH and 3D TOF were performed in these patients.Axial images covered all plaques and centered at the bifurcation of the carotid artery.All image data sets were processed on a semi-automatic software (MRI-Plaque View,VPDiagnostics,US) to analyze the component of IPH for vulnerable plaques.The consistency between MATCH and MPRAGE was analyzed by using Cohen Kappa analysis.Comparison of the two sequences to the pathological results was performed in a similar manner.The sensitivity and specificity of the two sequences were obtained.The SNR,CNR and contrast ratio(CR) of the two regions of interest were calculated and Wilcoxon rank sum test was used to compare the difference between the two methods.Results Among 30 patients,a total of 602 available sections and 95 correponding histology specimens were included in the analysis.When all 602 available sections were included in the analysis,MATCH yielded good agreement with MPRAGE(Kappa=0.773) on the detection of IPH.With pathological specimens as the gold standard,moderate to good agreement was shown for both MATCH and MPRAGE (Kappa=0.778,0.685).The sensitivity and specificity for the detection of IPH was 93.2％ (68/73) and 90.9％ (20/22) for MATCH.For MPRAGE,the sensitivity and specificity was 87.7％(64/73) and 90.9％(20/22) respectively.The difference between MATCH and MPRAGE was statistically significant for SNR,CNR and CR.That is to say,SNR and CNR of MPRAGE were higher than those of MATCH(P＜0.05),while CR of MATCH was higher than that of MPRAGE(P＜0.05).Conclusion Compared to the MPRAGE sequence,MATCH technique demonstrates similar diagnostic performance for the detection of IPH.

Objective To investigate the diagnostic performance of stress cardiac magnetic resonance(CMR) for evaluating low-risk patients with suspected acute coronary syndrome(ACS).Methods Twenty-two patients with low risk of suspected ACS were prospectively and consecutively enrolled in this study.Diagnostic performance of stress CMR was compared with single-photon emission computed tomography(SPECT) for diagnosis of myocardial ischemia with coronary angiography (CAG) as the reference method.Results On the patient-based level analysis,the diagnostic performance of CMR for detection of ACS was sensitivity 93% and specificity 75%.The corresponding value of SPECT was 79%,63%.The area under the ROC (AUC) of CMR was 0.897, which was slightly superior to that of SPECT at 0.723 (P=0.19).On the per-vessel assessment, the diagnostic value of CMR was sensitivity 89%,specificity 87%, while the corresponding value of SPECT was 68%,83%.The AUC of CMR was 0.923,which was significantly higher than that of SPECT at 0.774 (P<0.05).Furthermore, the AUC of CMR was significantly superior to that of SPECT with AUC being 0.900 and 0.553 in the left anterior descending (LAD) vessels (P=0.009 6).Conclusion Stress perfusion CMR has excellent diagnostic performance in low risk ACS patients.Compared with SPECT,stress perfusion CMR performed better in the low-risk ACS populations.

Objective To prospectively evaluate the feasibility and reliablity of low kilovoltage contrast-enhanced multi-slice CT(MSCT)to detect the myocardial viability in chronic myocardial infarcetion.with comparison to magnetic resonance(MR)myocardial perfusion and viability imaging.Methods Thirty-two patients with clinical diagnosed chronic myocardial infarction underwent the first pass and delayenhanced myocardial imaging with 64-slice MSCT and MR Left ventricle was divided into 16 segments.MSCT and MR images of all the patients were blindly analyzed.The size and extent of hypoenhanced regions in first pass phase and hyperenhanced regions in delayed phase were define.The Kappa test was used to assess the ability of identifying the viable myocardium between the two methods.Results In 32 patients with chronic myocardial infarction,MSCT showed hypoenhanced regions in 41 segments and normal in 471 segments during the first phase,while MRI revealed hypoenhanced regions in 47 segments and normal regions in 465 segments.The Kappa value was 0.650 and the concordance rate of the two techniques was 94.5%(484/512).MSCT showed 135 hyperenhanced regions which were non-transmural in 50 segments and transmural in 85 segments.And the other 377 normal segments showed no enhancement in the delayed phase.MRI revealed 120 hyperenhanced regions which were non-transmural in 56 segments and transmural in 64 segments.And the other 392 normal segments showed no enhancement in the delayed phase.The Kappa value of the two techniques was 0.609 and the concordance rate of the two techniques was 80.7% (413/512).Conclusion The study showed that low kilovolrage CE MSCT has a good concordance with MRI and has high feasibility and reliability in evaluating the myocardial viability in chronic myocardial infarction.The radiation dose is still the important aspect of MSCT application.