Objective To explore the effect of interaction between alcohol dehydrogenase 1B-1/2 (ADH1B·1/2) polymorphism and obesity on premature coronary heart disease (p-CHD).Methods Hospital-based case-control study was conducted.The newly diagnosed CHD patients were recruited as the subjects.One hundred and ninety-seven CHD patients diagnosed before 60 years old for males and 65 years old for females were assigned to the p-CHD case group with other 205 late onset CHD patients as the control group.Body mass index≥28 kg/m2 was defined as the obesity.Polymerase chain reaction-reatriction fragment length polymorphism was used to detect the ADH1B·1/2 polymorphism.Multivariate logistic regression model was performed to adjust the potential confounding factors and odds ratio estimation.Synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (AP) were measured to assess the interaction as departure from additivity.Results There was a positive correlation between ADH1B ·1/2 polymorphism and obesity in patients with p-CAD.S was 2.07, RERI was 1.20, and AP was 36.1%.After adjusting sex, smoking index, alcohol drinking index, serum triglyceride, total cholesterol, diastolic blood pressure, systolic blood pressure and fasting plasma glucose by multiple logistic regression, there was also a positive correlation between ADH1B* 1/2 polymorphism and obesity.S was 2.24, RERI was 1.24, and AP was 38.3% after adjustment.Conclusions The interaction between ADH1B*1/2 polymorphism and obesity has a positive effect on the p-CAD in this studied population.

Public hospital's public property is mainly reflected in providing people with equitable access, quality and efficiency of basic medical services. However, due to lack of understanding in importance of the medical services positive and negative externalities, lead to the dilution of commonweal of public hospital. Meanwhile, externalities caused by transaction costs and unclear property rights in medical services activities further exacerbate welfare fade. The government should take effective measures to protect and encourage positive externalities, prevent and control the negative externali-ties, and, by way of reducing transaction costs, clear property rights to resolve external effects, as far as possible to pro-tect the public interest in public hospitals.

Following the development of clinical trials, the methodology of clinical trials has developed a great deal, including randomization method and blinding method, etc. The method of randomization includes simple randomization, stratification randomization, etc. Dynamic randomization is also considered as a method of randomization. Two dynamic randomization methods are introduced in this paper, including a method considering the balance of numbers in each group and a method considering prognostic factors. This paper also demonstrates the procedure of dynamic randomization of the above two methods by simulations and actual examples.

A nested case-control study was carried out to assess the effectiveness of Chinese medicines in the treatment of diabetic nephropathy, so as to explore the feasibility of using nested case-control study on effect assessment of Chinese medicine.

Objective To evaluate the effectiveness and safety of acupuncture in the management of post-stroke spasticity.Methods Six domestic and abroad databases were screened by computer.Randomized controlled trials (RCT)were included if acupuncture treatment was used as the sole intervention or as an adjunction to another conventional treatment on post-stroke spasticity. Two independent reviewers screened the articles,extracted data and assessed the risk of bias.The evaluation of the quality was performed using Cochrane Risk of Bias Tool and the data was analyzed by using RevMan 5.3.Mean difference (MD)and 95% confidence interval (CI)were used to describe quantitative data.Results A total 29 RCT were included,7 of them had high risk of bias and the rest of them had unclear risk of bias. Acupuncture was better than rehabilitation therapy in remission of spasticity (-0.40 [-0.68,-0.12]).The 4 or 8 weeks of treatment in studies of unmentioned spasmodic regions showed that acu-puncture with rehabilitation therapy was better than rehabilitation therapy (-0.31 [-0.50,-0.11],-0.41[-0.54,-0.28]).The studies of 4 weeks of treatment showed superior effect of acupuncture with conventional treatment compared with rehabilitation therapy with conventional treatment (-0.96 [-1.73,-0.19]),and acupuncture with rehabilitation therapy was superior to conventional treatment with rehabilitation therapy (-0.57[-0.80,-0.34]).After 6 months of treatment,acupuncture with nerve block therapy and rehabilitation therapy was better than nerve block therapy with rehabilitation therapy (-0.63[-1.12,-0.14]),and acupuncture with nerve block therapy was better than nerve block therapy (-0.70[-1.08,-0.32]).In improving the physical activity,acupuncture,acupunc-ture with rehabilitation therapy,acupuncture with conventional treatment and rehabilitation therapy 1 or 4 weeks of follow-up,and acupuncture with nerve block therapy was better than that of control group. Conclusion Acupuncture could remiss the spasticity after stroke and improve the ability of daily life and motor function of patient,but the conclusion of subgroups are not the same.The high quality RCT studies with clear spasmodic position and measurement at more time points are needed to confirm the effectiveness and safety of acupuncture in post-stroke patients with spasticity.

Objective:To evaluate the clinical effectiveness and safety of Jiuwei-Zhuhuang San plus amoxilcillin sodium and sulbactam sodium in the treatment of bacterial pneumonia in children. Methods:A total of 120 patients with bacterial pneumonia in children from 1 year to 14 years old were randomly divided into the study group ( n=90) and the control group ( n=30) with ratio 3 to 1, the random sequence created by SAS software. Both groups were treated with amoxilcillin sodium for basic treatment, the observation group was treated with Jiuwei-Zhuhuang San. Both groups were treated for 1 week and followed up for 1 week. The cough frequency, clinical effective rate, symptoms and signs score, Traditonal Chinese medicine (TCM) pattern scores and adverse event rate were observed. Results:Eighteen cases were dropped and eliminated in the observation group, and 4 cases were dropped and eliminated in the control group, so 72 of observation group and 26 of control group were analyzed. After treatment, the clinical effective rate of the observation group was 27.8% (20/72), and the control group was 0% (0/26), where the difference was significant ( χ2=7.445, P=0.006). The difference of TCM syndrome score before and after treatment in the observation group (-16.8 ± 8.2 vs. -11.0 ± 5.8, t=-3.858) was lower than that of the control group ( P<0.01). There was significant difference between the two groups ( Z=-2.347, P= 0.019) in the TCM syndrome. The cough frequency of the observation group was 41.7% (30/72), and the control group was 26.9% (7/26). There wasn’t any significant differences in the cough frequency between two groups ( P>0.05). There was no statistical difference in symptoms and signs score or adverse event rate between two groups ( P>0.05). Conclusion:On the basis of amoxicillin sodium and sulbactam sodium, combined use of Jiuwei-Zhuhuang San can improve the clinical effectiveness of children with bacterial pneumonia.

Objective:To understand the epidemiological characteristics of an outbreak of Chikungunya fever (CHIK) in Ruili city at Sino-Myanmar border area in Yunnan province, China, 2019.Methods:The data of CHIK cases in Ruili city were collected. Serum samples were collected from acute phase of the patients for the detection of the viral nucleic acid with real-time reverse transcription PCR assay.Results:A total of 121 CHIK cases (laboratory-confirmed cases) were reported in Ruili city in 2019, in which 98 were indigenous cases (80.99%) including 2 pregnant women and 3 neonatal cases (twin boys and 1 girl) were observed with vertical mother-to-child transmission), and 23 were imported cases (19.01%) from Myanmar. CHIK mainly occurred in Urban area (Mengmao town) and port area (Jiegao development zone) of Ruili city. The epidemic of CHIK lasted from September to November. The epidemic peak was in October (74.38%). The majority of patients were aged from 20—59 years (77.69%), in addition to 3 cases of mother-to-child transmission, the youngest was 3 months and the oldest 72 year-old. The male to female ratio was 1∶1.28 (53∶68). Occupational distribution of CHIK cases was mainly for the commercial service personnel (33.06%), home workers and unemployed persons (21.49%) and retiree (11.57%).Conclusions:During the outbreak of CHIK in Ruili in 2019, both indigenous and imported cases were detected. The imported CHIK cases from Myanmar were the main sources for local transmission of CHIK in Ruili city. This is the first time that a local epidemic of CHIK has occurred in Yunnan Province. It is necessary to strengthen control of the cross-border spread of CHIK in this area.

Cervical spondylosis is due to degenerative cervical disc and its stimulation or oppression of the adjacent nerves, spinal cord, spinal artery and other tissue caused by clinical symptoms. The cervical spine is an anatomical structure with activity, while the pillow has a certain plastic fixation effect on the cervical spine anatomy. Therefore, the pillow not only plays a health role in the cervical spine, but also plays an important role in restoring the normal physiological curvature of the cervical spine. Based on this, a multi-functional cervical vertebra treatment pillow is designed, which not only has the functions of traction, maintaining different positions of the cervical spine, correcting the cervical curvature and equipment exercises, but also has the functions of voice broadcast and network data terminal.

The syndrome/pattern of defensive qi deficiency is a common basic syndrome of traditional Chinese medicine in clinical practice. However,there is a lack of standardized and operable diagnostic specifications in practical applications. Based on the previous literature,this study proposed the idea of starting from the elements of the syndrome,qualitative diagnostic criteria for the syndrome/pattern of defensive qi deficiency oriented to the entire region of the disease were constructed based on the two dimensions of " deficient defensive qi failing to consolidate the exterior" and " qi deficiency" and constructing a set of quantitative evaluation criteria as the supporting content for the diagnostic items. The core members of the research group attempted to formulate the draft standard,then reached a consensus through the Delphi method expert questionnaire consultation and the Nominal group technique,and finally evaluated the reliability and validity of the standard through clinical verification to provide ideas for the standardization and normalization of research on syndromes.

OBJECTIVE：To systematically evaluate the effectiveness and safety of Shenfu qiangxin pills combined with chemical medicine conventional therapy in the treatment of chronic heart failure ，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，Google Scholar ，PubMed，the Cochrane Library and Embase database ，RCTs about Shengfu qiangxin pills combined with chemical medicine conventional therapy （trial group ） versus chemical medicine conventional treatment （control group ）were collected during the inception to May 12th，2020. After literature screening and data extraction ，the quality of the literatures was evaluated with risk bias assessment tool recommended by Cochrane 5.1.0 system evaluator manual. Meta-analysis and sensitivity analysis were performed by using Stata 14.0 software. RESULTS：A total of 7 RCTs were included ，involving 596 patients. Meta-analysis results showed that the total response rate of trial group was significantly higher than that of control group [OR ＝4.14，95％CI（2.15，7.97），P＜0.000 01]；the results of sub-group analysis according to the different criteria for determining the efficacy showed that the total response rates of trial group determined by Lee integral method and cardiac function grading method were sig nificantly higher than that of the control group （P＜0.05）. After treatment ，N-terminal pro-B-type natriuretic peptide （NT-proBNP） level of trial group was significantly lower than that of control group [OR ＝－1.33，95％CI（－1.55， qq.com －1.11），P＜0.000 01]. Results of sub-group analysis accor- ding to cardiac failure type showed that NT-proBNP level of patients with chronic heart failure in trial group was lower than control group （P＜0.001）. The level of left ventricular ejection fraction （LVEF）in trial group after treatment [WMD ＝5.76，95％CI （5.05，6.47），P＜0.000 01] was significantly higher than control group ；after treatment ，the level of B-type natriuretic peptide [SMD＝－1.61，95％CI（－2.58，－0.54），P＜0.000 01]，left ventricular end-diastolic diameter （LVEDD）level [WMD ＝ －6.06，95％CI（－6.84，－5.27），P＜0.000 01]，left ventricular end-systolic diameter level [WMD ＝－0.52，95％CI（－5.70，－4.33）， P＜0.000 01] were significantly lower than control group. There was no statistically significant difference in the incidence of ADR between 2 groups（P＞0.05）. Results of sensitivity analysis showed that when NT-proBNP ，LVEF level ，LVEDD level after treatment were used as indicators ，there was no significant difference in the analysis results after eliminating heterogeneity source ， compared with before elimination. CONCLUSIONS ：Shenfu qiangxin pills combined with chemical medicine conventional treatment has good efficacy and safety.