There has been much difference between effectiveness and harm in evidence evaluation. Many evidence ranking or grading systems have been developed'by researchers in the world. However, no evidence ranking or grading systems are based on safety research reality. Those existing evidence ranking or grading systems are prone to evaluating effectiveness evidence not proper for harm evidence. It is necessary to develop a new system for harm evidence. We put forward to establishing the body of evidence for harm for postmarketing traditional Chinese medicine as required by our daily research work. We do hope such an ideal could be helpful and indicative for evidence evaluation for harm.
Medicine, Chinese Traditional ; adverse effects ; Product Surveillance, Postmarketing

Objective To explore the value of the LigaSure vessel sealing in laparoscopic nephrectomy surgery. Methods Laparoscopic nephreetomies were performed in 41 cases from May 2004 to December 2006 by using LigaSure, including simple nephrectomies, radical nephrectomies and nephroureterectomies. The operative time, estimated blood loss, open conversion rate, duration of postoperative drainage, total amount of postoperative drainage, postoperative hospital day as well as complication rate were recorded and analyzed retrospectively. Results All procedures were finished successfully without conversion to open surgery. No severe vascular complication or other serious complications happened. The mean operative time was 146min (range, 35-240 min) ; mean blood loss was 163ml (range, 30-450 ml); mean time for postoperative drainage was 3d (range, 1-6 d) ; mean amount of postoperative drainage was 229ml (range, 45-435 ml). The postoperative hospital staying was 6-21 d, with the average of 10 days. Conclusions The LigaSure vessel sealing system produees a consistent, reliable, permanent seal of veins, arteries, and tissue bundles. It could decrease operative time and blood loss. This new energy-based vessel-ligation device appears to be effective in advanced laparoscopic procedures.

OBJECTIVE:To investigate the role of medication reconciliation in pharmaceutical care provided by clinical phar-macists. METHODS:Clinical pharmacists participated in pharmaceutical care for a elderly patient,and reconciled drugs as anti-in-fective drugs,cardiovascular drugs,electrolyte:stop taking unnecessary drugs:Xuebijing injection,Kang'erxin capsule,Shedan chuanbei soft capsule,Mosapride citrate tablet;adjust the dose of Dihydrochlorothiazide tabet and Potassium chloride tablet;stop taking Non first-line drug Reserpine tablet in order to decrease the risk of drug use;stop taking Furosemide tablet,Lactulose oral solution and using Suppositories glycerol timely according to the disease outcome. RESULTS&CONCLUSIONS:The medication reconciliation can avoid repeated drug use,optimize medication plan,reduce drug variety and cost and decrease the potential ADR risk of drug use so as to guarantee safe and effective drug use.

AIM:To investigate the changes of visual development produced by monocular atropinization in rats.
METHODS: Twenty normal SD rats were randomly divided into two groups: control group ( n = 10 ) and atropinization ( experimental) group ( n=10 ) . All the left eyes were selected as the experimental eyes, and the right eyes served as the normal eyes. The left eyes in atropinization group was produced by 1% atropine, 3 times a day and the right eyes in control group was treated with normal saline, 3 times a day. The flash visual evoked potentials ( F-VEP ) and retinoscopy refraction of the rats'both eyes were detected at five time points:0, 7, 14, 21, and 28d after atropinization, respectively. After 28d, six rats were randomly selected from both groups and each group had three rats. The expression of the c- fos mRNA was observed in both visual cortexes. Another six rats were chosen for the same test after 2d dark environment with 2h light later. The expression of c-fos mRNA was detected again.
RESULTS: After 14d anisometropia was observed in experimental group, the difference was 3. 9D ( P<
0.0 5 ) , F-VEP P1 wave of the rats left in experimental group was reached to 88. 9±1. 889ms at 21d, there was statistical difference compared with the right eye ( P<0.05). After 28d, c-fos mRNA expression in the left visual cortex of rats in the experimental group was higher than that of the right side, but there was no significant difference. But when underwent 2h light stimulation after in the darkroom 2d, the c-fos mRNA expression in in the left visual cortex of rats in the experimental group was 5 times higher than that of the right side, there was a statistically significant difference (P<0. 05).
CONCLUSION: In the critical period of visual development, monocular chronic atropine in rats can form anisometropia, may delay the transmission of the optic nerve, hinder the normal development of the visual cortex. Monocular atropinization in rats can be used as the model of anisometropia.

BACKGROUND:Due to the importance of pedicle adjacent structures, once the screw replacement appears a deviation, adjacent structures may be damaged, leading to extremely serious consequences. Although the security of screw placement in thoracic vertebral pedicle-rib complex is significantly greater than that of pedicle screws, the mechanics of the pedicle-rib complex at different cross-sectional areas of the screw are rarely reported.
OBJECTIVE:To observe mechanical property of different cross-sectional area screws in the middle and upper thoracic vertebral pedicle-rib complex.
METHODS:Five specimens of adult cadaveric thoracic spine (T 1-T 10 ) and adjacent rib segment (50-60 mm long) were used. The bone density of specimens was measured using difunctional bone density testing machine, and osteoporotic vertebral body was excluded. The position of the screws was detected with CT images. The maximal withdrawal force of the pedicle screw was measured with biomechanical force test machine.
RESULTS AND CONCLUSION:Thirty-eight specimens at normal bone density were implanted with 25 screws (5.5 mm), 25 screws (6.0 mm) and 26 screws (6.5 mm). Because the pedicle screws destroyed the pedicle-rib complex and perforated the vertebral body, we final y obtained the withdrawal force of 68 screws. The axial withdrawal force of pedicle screws at different diameters was (812.36±147.22) N, (868.64±160.48) N and (946.48±157.58) N, respectively. There were significant differences between the 5.5 mm screws and the 6.5 mm screws (P<0.05). Experimental findings indicate that, the pedicle screws (diameter>5.5 mm) are suitable in the middle and upper thoracic vertebral pedicle-rib complex due to strong internal fixation and clinical requirement.

Objective To evaluate the safety and efficacy of intra-arterial infusion neoadiuvant chemotherapy in local advanced bladder cancer. Methods Nineteen cases with T2-T4a bladder cancer were enrolled in this study.Intra-arterial infusion chemotherapy with Gemcitabine and Cisplatin (GC)were performed for 1 to 3 cycles before radical cystectomy.Postoperative values of hematological parameters,maximum diameter of tumors,TNM(tumor,node and metastasis)stages and pathological grades were compared with preoperative parameters of the same case. Results Compared to the values before GC chemotherapy,WBC count showed no significant change post-operative,(6.63±2.58)×109/L vs(5.12±2.91)×109/L(P=0.13);RBC(4.41+0.52)×1012/L vs(3.92±0.42)×1012/L(P=0.00)and platelet count(220.50±59.86)×109/L vs(157.05±56.72)×109/L(P=0.001)showed significant decrease;ALT did not show significant decrease(20.00±8.31 vs 26.88±17.04 U/L,P=0.08);Creatltme also showed no significant change(95.82±14.57 vs 88.04±17.76μmol/L,P=0.06);Maximum diameter of tumors decreased significantly(3.72±1.23 vs 2.80±1.29 cm,P=0.02).Compared with clinical TNM stages,pathological TNM stages demonstrated significant decrease in 9 cases;While cell differentiation did not show decrease. Conclusions Intra-arterial infusion with GC regimen can reduce tumor size,decrease TNM stages,while not causing significant adverse impact to radical cystectomy.Bladder-spare treatment is an option for chemotherapy-sensitive cases.

Objective To discuss the role of assistance of intraoperative uitrasonography in ret-roperitoneal laparoscopic nephron-sparing surgery for renal tumors. Methods The intraoperative laparoscopic ultrasonography was applied in retroperitoneal nephron-sparing surgery for 20 patients, of whom 11 were men and 9 were women. The average age was 53(range 33 to 73) years. There were 12 patients with renal cell carcinoma and the mean tumor size was 2.9(range 1.4 to 4.6)cm in diame-ter. All of them were staged as T1 N0 M0. Seven patients had angiomyolipoma and the mean tumor size was 4.5(range 1.8 to 8.0)cm in diameter and 1 patient had a 3.1 cm oncocytoma in diameter. The ul-trasonography was used to locate the tumor, observe the bloodstream and detect whether there were small satellite tumors. The surgical time, time of renal artery occlusion and operative effect were ob-served. Results Laparoscopic surgery was successful in all cases without conversion to open surger-y. Mean operative time was 115 (range 85 to 270) min, mean time of renal artery occlusion was 28 (range 22 to 50) min. During the mean followup of 16(range 4 to 30) months, no patients with renal cell carcinoma had local or port site recurrence or metastatic disease. Conclusion In retroperitoneal laparoscopic nephron-sparing surgery, the intraoperative uhrasonography is helpful to locate the tumor in the surgery, to estimate whether the renal artery is occluded completely and to excise the tumor pre-cisely.

Objective To measure the volume of hippoeampal formation(HPF) in healthy Chinese Han adults and provide database for researching on a variety of diseases associated with alteration of hippocampal structure. Methods This is a clinical multi-center study. One thousand Chinese healthy volunteers (age range = 18 to 70) recruited from 15 hospitals were divided into 5 groups, i. e. , Group A (age range = 18 to 30), B (age range =31 to40), C (age range =41 to 50), D (age range=51 to 60),and E (age range =61 to 70). Each group contained 100 males and 100 females. All of the volunteers were scanned by MR using T1 weighted three-dimensional magnetization prepared rapid acquisition gradient echo sequence. The margin of HPF were outlined manually for each side. Using multiple linear regression,relationships between hippocampal volume and sex, age, weight and height were analyzed respectively.Independent two sample t test was used to study the differences between male and female and between lcft and right. The differences of hippoeampal volume among age groups were analyzed by ANOVA. Results Hippocampal volume for left and right side were (4752 ± 659) and (5032 ± 660) mm3 respectively. The volume of HPF is significant correlated with gender and age, but without relevance to height and weight ( left and right r = 0. 283,0. 311, F = 30. 127,37. 050 ,P < 0. 01 ). The volumes of left and right hippocampus were (4897 ± 670), (5192 ± 667)mm3 respectively for men, and (4647 ± 624) and (4904 ± 630) mm3 for women. The right hippocampal volume was larger than the left ( t = 7. 030,6. 696, P < 0. 05 ). On both sides, men have larger hippocampus than that of women ( t = 6. 586,7. 326, P < 0. 01 ). The volumes of the left hippocampus among the five age groups in the male were (4981 ± 684), ( 5003 ± 609 ), (4976 ± 657 ),(4841 ± 631 ), (4631 ± 681 ) mm3 respectively, while the volumes of the right hippoeampus were (5340 ±647) ,(5276 ±582), (5264 ±620), (5133 ±661 ), (4894 ±699) mm3 respectively. Among age groups,the differences were statistically significant ( left and right F = 5. 737,7. 607, P < 0. 01 ). For male, there was significant difference of bilateral hippoeampus between the 18-30, 31-40, 41-50 years group and 61-70 years group ( P < 0. 05 ) and there was no significant difference among the other groups ( P > 0. 05 ).There was no significant difference of hippocampal among different groups in women (P > 0. 05 ).Conclusions With high-resolution MRI, the volume of the HPF was accurately measured, so as to provide the basic data for research of the hippocampus-related disease.

OBJECTIVETo study the efficacy and safety of Reinhartdt and sea cucumber capsule (RSC) combined with donepezil in treating Alzheimer's disease (AD), and its effect on thyroid function axis.

METHODSSixty-eight patients were randomly assigned to the RSC group, the Donepezil group and the combined treatment group, who were treated for 3 and 6 months with RSC, Donepezil and RSC combined with Donepezil, respectively. The curative effect was evaluated by scoring according to Mini-Mental State Examination (MMSE), ADAS-Cog and ADL chart, and the level of thyroid hormones, including TSH, FT3, FT4, TT3 and TT4, were measured with radioimmunoassay before treatment, 3 and 6 months after treatment respectively.

RESULTSAs compared with the baseline, MMSE score increased, ADAS-Cog score and ADL score decreased significantly in all the three groups after 3 months and 6 months of treatment (P < 0.05 and P < 0.01), but the improvement in the combined treatment group was more significant than that in the other two groups (P < 0.01). After 6 months of treatment, the levels of FT3 and FT4 in the combined treatment group were significantly changed (P < 0.01), but no significant change in all the thyroid hormones was found in the other two groups. No obvious adverse reaction occurred in all the three groups.

CONCLUSIONRSC combined with Donepezil in treating AD is effective and safe with no evident adverse reaction, better than single drug treatment, which may be through influencing the metabolism of thyroid hormones to improve the cognition function of AD patients.

Aged ; Aged, 80 and over ; Alzheimer Disease ; drug therapy ; Animals ; Capsules ; Drug Therapy, Combination ; Female ; Humans ; Indans ; therapeutic use ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Nootropic Agents ; therapeutic use ; Piperidines ; therapeutic use ; Radioimmunoassay ; Sea Cucumbers ; chemistry ; Thyroid Hormones ; blood

ATP Binding Cassette Transporter, Sub-Family B ; metabolism ; Apoptosis ; genetics ; Carcinoma, Non-Small-Cell Lung ; genetics ; metabolism ; pathology ; Genes, MDR ; Humans ; Lung Neoplasms ; genetics ; metabolism ; pathology ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; RNA, Messenger ; biosynthesis ; genetics ; Telomerase ; biosynthesis ; genetics ; Tumor Suppressor Protein p53 ; metabolism ; Vault Ribonucleoprotein Particles ; metabolism