Threatened abortion is a common disease of obstetrics and gynecology and one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in TCM obstetrics and gynecology， Western medicine obstetrics and gynecology， and pharmacology to deeply discuss the advantages of TCM and integrated Chinese and Western medicine treatment as well as the medication plans for threatened abortion. After discussion， the experts concluded that chromosome， endocrine， and immune abnormalities were the key factors for the occurrence of threatened abortion， and the Qi and blood disorders in thoroughfare and conception vessels were the core pathogenesis. In the treatment of threatened abortion， TCM has advantages in preventing miscarriages， alleviating clinical symptoms and TCM syndromes， relieving anxiety， regulating reproductive endocrine and immune abnormalities， personalized and diversified treatment， enhancing efficiency and reducing toxicity， and preventing the disease before occurrence. The difficulty in diagnosis and treatment of threatened abortion with traditional Chinese and Western medicine lies in identifying the predictors of abortion caused by maternal factors and the treatment of thrombophilia. Recurrent abortion is the breakthrough point of treatment with integrated traditional Chinese and Western medicine. It is urgent to carry out high-quality evidence-based medicine research in the future to improve the modern diagnosis and treatment of threatened abortion with TCM.

Objective: To provide high-quality clinical evidence of the efficacy of Tibetan medicine Honghua Ruyi (HHRY) pills for endometriosis-associated dysmenorrhea. Methods: This study constitutes a multicenter, randomized, double-blind, placebo-controlled trial encompassing a three-menstrual cycle intervention followed by a three-menstrual cycle follow-up period. A total of 164 eligible females with endometriosis-associated dysmenorrhea were randomly divided into HHRY pills and placebo groups in a 1:1 ratio. The primary outcome included dysmenorrhea symptoms assessed using Visual Analog Scale (VAS) scores and quality of life, whereas the secondary outcome measures included the maximum VAS for non-menstrual pelvic pain, duration of pain episodes (in days), frequency and quantity of the consumption of ibuprofen sustained-release capsules (or other non-steroidal anti-inflammatory drugs), and days off work/study for staff/student due to dysmenorrhea, ovarian cyst, and/or pelvic nodule size. The safety was monitored throughout the treatment period. All the analyses were based on the intention-to-treat principle. For continuous outcomes, simple or multiple linear regressions were used to estimate the differences between the HHRY pills and placebo groups, with categorical data expressed as the number and percentage of occurrences. Differences were compared using the chi-square test or Fisher's exact test. The predefined analysis was adjusted for concomitant treatment, a variable considered to be associated with outcomes but unaffected by treatment allocation. Estimates of treatment effects were reported with 95% confidence intervals. Two-tailed P values ≤ .05 were considered statistically significant. Conclusion Positive results from this trial, upon completion would provide robust evidence for the efficacy and safety of HHRY pills in treating dysmenorrhea in patients with endometriosis.

Objective:To study the role of ultraviolet fluorescence detection technology in personal protective equipment education (PPE) and training.Methods:A study was designed to inspect the risk of self-contamination during PPE doffing between 77 healthcare workers. Used a fluorescent tracer slurry which put on the hands, chest, abdomen, knees to simulate the contaminations. Self-contamination of scrubs and skin was measured using ultraviolet light visualization respectively.Results:According to the uv-fluorescer simulating study, 43 (55.8%) of the medical staff had contamination after the removal of PPE, and the main sites of contamination included: left side of the abdomen 11 (11.70%), left side of the chest 9 (9.57%), left forearm 6 (6.38%), left foot instep 6 (6.38%), neck 6 (6.38%), right shoulder 5 (5.32%), etc. Among them, the frequency of simulated fluorescence pollution in the group with working years less than 6 years was less than that in the other groups, and the difference was statistically significant compared with the group of 11-15 years ( t value was -3.685, P value was 0.001 ). Conclusion:Ultraviolet fluorescence labeling detection technology can directly, quickly and effectively evaluate and feedback the key contaminated parts in the process of using PPE, which can provide detailed evidence for redesigning PPE and improve the PPE training process to reduce the contamination.

Objective To determine the expression of miRNA-148a-3p in CD4+ T lymphocytes in peripheral blood of patients with psoriasis vulgaris,and to explore its role in occurrence of psoriasis vulgaris.Methods Totally,20 patients with psoriasis vulgaris and 20 healthy controls were enrolled from Guangzhou Institute of Dermatology between July 2017 and April 2018.Peripheral venous blood samples were obtained from these subjects,and CD4+ T lymphocytes were isolated from these peripheral blood samples by magnetic cell sorting system.Real-time quantitative PCR (RT-PCR) was performed to determine the expression of miRNA-148a-3p in CD4+ T lymphocytes in the peripheral blood.Potential target genes of miRNA-148a were predicted by using bioinformatics software,and verified by using a dual-luciferase reporter system.Western blot analysis was conducted to determine the protein expression of Bcl-2 interacting mediator of cell death (Bim,the potential target gene of miRNA-148a-3p) in the CD4+ T lymphocytes of the subjects.Statistical analysis was carried out with SPSS 20 software by two sample-t test for comparing the means of normally distributed data,and by Pearson correlation analysis for analyzing the correlation of two variables.If the data were not normally distributed,Mann Whitney U test was used for comparing means between two groups,and Spearman correlation analysis for analyzing the correlation of two variables.Results The miRNA-148a-3p expression in the CD4+ T lymphocytesin the psoriasis vulgaris group (18 cases,5.61 ± 1.66) was significantly higher than that in the healthy control group (12 cases,1.00 ± 0.26;U =12,P ＜ 0.05),and was positively correlated with the psoriasis area severity index (PASI) score (r =0.93,P ＜ 0.001).Bim was predicted to be one of the potential target genes of miRNA-148a-3p by bioinformatics software,which was also verified by using a dual-luciferase reporter system.The protein expression of Bim in the CD4 + T lymphocytes was significantly lower in the psoriasis vulgaris group (11 cases,0.69 ± 0.07) than in the healthy control group (8 cases,0.93 ± 0.06;t =4.38,P ＜ 0.01),and the protein expression of Bim in the patients with psoriasis vulgaris was negatively correlated with PASI score (r =-0.774,P ＜ 0.01).Conclusion miRNA-148a-3p is overexpressed in CD4+ T cells in the peripheral blood of patients with psoriasis vulgaris,which may regulate the protein expression of Bim,leading to abnormal activation of CD4+ T cells,and then participate in the occurrence and development of psoriasis.

Objective To compare the prognostic factors and adverse effects of elderly patients with esophageal cancer between radiotherapy alone and concurrent chemoradiotherapy. Methods A total of 479 patients with esophageal squamous cell carcinoma aged 70 years or older were analyzed retrospectively at our institute, from January 2008 to December 2017. The patients were divided into radiotherapy alone group ( 359 cases ) and concurrent chemoradiotherapy group ( 120 cases ) . After Propensity Score Matching ( PSM) , data from matched patients with 102 cases in each group was analyzed. The overall survival (OS) rates, the prognostic factors and adverse effects were assessed. Results The 1, 3, 5-year of OS in radiotherapy alone group after PSM were 77. 4％, 40. 1％, 22. 7％, respectively, and median overall survival time (mOS) was 26. 9 months (95％ CI:18. 7 - 35. 2 months). The chemoradiotherapy group after PSM were 79. 5％, 47. 6％, 35. 7％ and 35. 6 months (95％ CI:23. 2-48.0 months), respectively, while there was no significant difference between the groups (P >0. 05). Subgroup analysis showed that the 1, 3, 5-year of OS and mOS of the patients aged 70 -75 years in radiotherapy alone group were 79. 4％, 41. 0％, 26. 2％ and 29. 2 months, respectively. The patients aged 70-75 years in chemoradiotherapy group were 86. 5％, 56. 1％, 47. 6％ and 48. 9 months, respectively. There was statistically significance between the groups after PSM(χ2 =4. 746, P<0. 05). The univariate prognostic analysis showed that the age, T stage, N stage, clinical stage, short-term efficacy and performance status were influencing factors for OS (χ2 =6. 714-42. 900, P<0. 05). The clinical stage and short-term efficacy were independent prognostic factors for OS (χ2 =5. 007 -9. 181, P<0. 05). In addition , the risk of non-tumor related death of the patients aged 75 years or older in the chemoradiotherapy group was higher than those in the radiotherapy alone group(χ2 =5. 630, P<0. 05). The prevalence of toxicities (≥grade 3) including bone marrow suppression, radiation esophagitis and radiation pneumonia in the chemoradiotherapy group were higher than that in the radiotherapy alone group (χ2 =4. 701 -28. 318, P<0. 05). Conclusions Concurrent chemoradiotherapy, compared with radiotherapy alone, may improve the prognosis of patients aged 70-75 years with esophageal squamous cell carcinoma.

Objective To develop Chinese version of the Manchester patient safety framework, and evaluate the feasibility of its clinical application. Methods The Manchester patient safety framework (MaPSaF) was transformed into Chinese version by translation and back-translation together with inquiries from experts. The trial study was done firstly among 136 nurses in five pilot wards and followed by five times of focus-oriented group interviews. A semi-structured, in-depth interview was then performed in 12 randomly selected participants and acquired data were analyzed by category analysis. Result Two themes were abstracted: Chinese version of MaPSaF showed a good practicability, effectiveness and operability and it was effective for deepened understanding of patient′s safety culture. Conclusion The Chinese version of MaPSaF can be used for safety culture evaluation during nursing process in China.

Objective To study the influence of sole massage on children’s analepsia from general anesthesia.Methods One hundred children in analepsia period were divided into the test group(50 cases)and the control group(50 cases).The routine nursing and monitoring during recovery stage were done in the control group.Based on the routine monitoring and nursing care as in the control group,the test group received sole massage for 10 minutes.The two groups were compared in terms of declining percentage of SpO2, rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores.Result The test group was significantly lower than the control one in all the indexes of the declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores(all P<0.05).Conclusions Sole massage during children’s analepsia from general anesthesia is effective not only in lessening their declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability, and recovery dysphoria mark,but also easing their dysphoria,anxiety and fear.It may create a good condition for children to live through analepsia period successfully and safely.

BACKGROUND: Serum levels of high-sensitivity C-reactive protein (hs-CRP) can be used to predict cardiovascular injury.OBJECTIVE: To investigate the serum levels of hs-CRP in a rabbit model of atherosclerosis following repeated long-termexposure to positive acceleration and to predict the risk of cardiovascular injury.METHODS: Twenty-four New Zealand purebred rabbits were randomly divided into a positive acceleration group and a controlgroup. Rabbits in the positive acceleration group were exposed to +4 g rotation for 20 seconds with an acceleration of 1 g/s. Therotation interval was 5 minutes and totally three rotations were daily performed for 3 days per week. 0.5 g rotation was addedevery week, and by week 4, +6 g rotation was added, and the exposure lasted for 40 seconds.RESULTS AND CONCLUSION: Exposure to positive acceleration yielded significant effects on serum level of hs-CRP in rabbitswith atherosclerosis compared with before exposure (P < 0.01), but exposure time did not produce effects on serum level ofhs-CRP (P > 0.05). The interaction between exposure to positive acceleration and exposure time also did not produce significanteffects on serum level of hs-CRP (P > 0.05). Hyperplastic foam cells in the aortic tunica intima and the superficial layer of mediaincreased with the prolongation of exposure to positive acceleration. Repeated long-term exposure to positive acceleration maylead to a long-term high serum level of hs-CRP in rabbits.

Objective To study the influence of sunscreens with different efficacy on delayed type hypersensitivity (DTH) and their immunoprotective effect in mice.Methods A cohort of mice were randomly divided into 5 groups with 10 mice in each group:group 1 as the positive control without irradiation,group 2 receiving solar-simulated radiation (SSR) only,group 3 receiving SSR and protected by sunscreen l with sun protection factor 15(SPF15)and persistent pigment darkening(PPD)12,group 4 receiving SSR and protected by sunscreen 2 with SPF 50 and PPD 28,and group 5 as the negative contml receiving SSR only.SSR was carried out on the back of mice with the UVA dose being 1.4 J/cm2 and UVB dose being 100 mJ/cm2 for 10 days.After a 5-day irradiation,the groups 1 to 4 were immunized by intraperitoneal injection with 100 μl(107 cells/ml) of Candida albicans suspension.On the 10th day both sides of the posterior foot pad were measured;then the foot pads were injected with additional 50 μl of the Candida albicans suspension.Twenty-four hours after the injection,the thickness of each foot pad was measured,and immunosuppression rate was calculated.Finally,the mice were sacrificed and skin samples were obtained from the back of these mice followed by the examination of CDla, CD80 and CD86 expression by Western blot.Resets The thickness of edema in foot pads was 0.41±0.38 mm,0.21±0.23 mm and 0.30 ± 0.25 mm in group 1,3 and 4,respectively,significantly higher than in group 5 and 2(0.04±0.03 mm,0.14±0.12 mm,respectively,all P<0.05),while no significant difference was observed between the group 3 and 4(P>0.05).Significant differences were observed in the immunosuppression rate between group 2,3 and 4(73.0%±11.3%,54.1%±6.4%,29.7%±7.5%,respectively,all P<0.01).Western blot revealed a significant increment in the expression of CDla protein in group 1 compared with group 2 as well as in the expression of CD86 protein in group 1 and group 3 compamd with group 2 and group 5(all P<0.05),but no statistical difference was observed between the other groups in the expression level of CDla,CD80 or CD86(P>0.05).Conclusions The exposure to sub-erythema dose of UV can induce DTH,and sunscreens have an immunoprotective effect in this process.Epidermal Langerhans cells are not essential for UV-induced immunosuppression.