Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective:To observe the clinical effect of electroacupuncture(EA)combined with exercise therapy on balance function in patients with knee osteoarthritis(KOA). Methods:Seventy patients with KOA were randomly divided into a treatment group and a control group,with 35 cases in each group.The treatment group was treated with EA combined with exercise therapy.EA was applied to Dubi(ST35),Neixiyan(EX-LE4),Xuehai(SP10),Liangqiu(ST34),Yanglingquan(GB34),and Zusanli(ST 36).Exercise therapy(muscle strength training and knee mobility training)was applied after EA.The control group only received the same exercise therapy as the treatment group.The two groups were treated with the same course of treatment,3 times a week for 4 consecutive weeks,12 times in total,and followed up for 1 month.The Pro-Kin254P balance test system was used to measure the balance function parameters at 4 time points,including before treatment,after 1 session of treatment,after 12 sessions of treatment,and at 1-month follow-up after treatment.The visual analog scale(VAS)and the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)scores were recorded. Results:The markedly effective rate and total effective rate in the treatment group were higher than those in the control group(P<0.01).The Romberg area,Romberg length,and VAS scores of the two groups decreased significantly after 1 session of treatment,12 sessions of treatment,and 1 month after treatment,and the differences between different time points in the same group were statistically significant(P<0.01).There were significant differences between the two groups at the same time point(P<0.05).The total WOMAC scores of the two groups after 1 session of treatment,12 sessions of treatment,and 1 month after treatment decreased significantly,and there were significant differences between different time points in the same group(P<0.05),but there was no significant difference between the two groups at the same time point(P>0.05). Conclusion:EA combined with exercise therapy or exercise therapy alone can enhance the balance function,relieve joint pain,and improve joint function in patients with KOA.EA combined with exercise therapy is superior to exercise therapy alone in improving balance function and pain,but the two treatment protocols have similar effects in improving joint function.

Objective:To construct a value evaluation framework for high-value medical consumables,providing a guidance for medical insurance access and hospital access management scenarios in China.Methods:It conducted literature review,qualitative in-terviews and quantitative surveys.A total of 12 experts were invited for qualitative interviews,while 100 experts from four fields of health technology assessment,medical insurance,hospital management,and clinical practice participated in the quantitative survey.Through those process,it generated the composition of the value framework and the scoring of each item.Differences in ratings be-tween different scenarios and experts were analyzed through chi-square tests.The recommendation level for each item was graded.Re-sults:A comprehensive value evaluation framework for high-value medical consumables was established,which included 6 core dimen-sions,comprised 16 items for secondary dimensions and 50 items for tertiary dimensions.It showed significant differences between the medical insurance access and hospital access scenarios,as well as among different fields of experts in the same scenario.furthermore,grading the items in two scenarios.The medical insurance access scenario had 8 highly recommended items,and the hospital access scenario had 24 highly recommended items.Conclusion:Value evaluation should encourage multi-dimensional assessments and inter-disciplinary participation,continually improving the management of high-value medical consumables in medical insurance and hospital access.

Objective:Cost accounting for its diagnosis items based on virtual standardized clinical chemistry laboratory.Methods:Relevant data of clinical chemistry laboratories from January to June 2019 were extracted from the laboratory information systems of 10 hospitals in Shanghai, and three health economic experts and the directors of their laboratory departments were interviewed in this regard.On such basis, a virtual standardized clinical chemistry laboratory was constructed. The project cost of the virtual laboratory was calculated from the aspects of supplies exhaust, labor and others. The routine clinical chemistry diagnosis items were clustered according to the principle of laboratory methods, and the cost differences of items in the same cluster were compared using paired t test. Results:The cost of rate method and dry chemical method in testing alanine aminotransferase was 5.12 and 11.63 respectively, and that of immune turbidimetry and immune scattering turbidimetry method in testing immunoglobulin G was 20.00 and 22.26 respectively. Cluster analysis was conducted on 214 routine clinical biochemical diagnostic items, of which 202 items were classified into 42 clusters. The average of clinical chemistry items accounted for 91.7%(4 493/4 900)of the total per day. Based on enzymology, the calculation costs of alanine aminotransferase(rate method), aspartate aminotransferase(rate method), cholesterol(enzyme method)and uric acid(enzyme method)was 5.12, 5.10, 5.24 and 5.14 respectively, presenting no statistical difference( P>0.05). Conclusions:Research on the cost accounting method of clinical chemistry laboratory diagnosis items constructed includes labor cost, reflects the technical labor value of medical staff. Cost accounting based on project clustering can provide references for medical service pricing and financial management of hospitals.

Objective:To investigate whether miRNA-296-5p can inhibit enterovirus 71 (EV71) virus replication in neural cells SK-N-SH by targeting the phosphatase and tensin homology deleted on chromosome 10 (PTEN)/phosphatidylinositol 3-kinase (PI3K)/serine/threonine kinases (AKT) signaling pathway.Methods:Serum samples were collected from patients with EV71 virus-infected hand-foot-mouth disease and normal physical examination, and the expressions of serum inflammatory factors procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) , interleukin-6 (IL-6), IL-1β, and IL-13 were detected by enzymelinked immunosorbent assay (ELISA). Human neuroblastoma SK-N-SH cells infected by EV71 virus in logarithmic growth phase were set up as control group, miRNA-296-5p mimic group and miRNA-296-5p inhibitor group. The transfection was carried out according to the Lipofectamine 2000tm cell transfection reagent. The expression of EV71-VP1 gene mRNA and protein and PTEN/PI3K/Akt signal pathway related molecules in three groups of cells was observed by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) and Western blot.Results:ELISA test results showed that the levels of serum inflammatory factors PCT, CRP, TNF-α, IL-1β, IL-6 and IL-13 in patients with EV71 virus-infected hand, foot and mouth disease were significantly higher than those in normal physical examination ( P<0.05). The results of qRT-PCR and Western blot showed that the mRNA and protein levels of mirna-296-5p and PTEN in SK-N-SH were significantly decreased after EV71 virus infection, while the mRNA and protein levels of EV71-VP1 and molecules related to PI3K/AKT signaling pathway were significantly increased ( P<0.05). The expression of PTEN was significantly increased in the miRNA-296-5p mimic group, and the expression of EV71-VP1 and the activation of the PI3K/AKT signaling pathway were inhibited, while the effect was reversed in the miRNA-296-5p inhibitor group ( P<0.05). Conclusions:MiRNA-296-5p inhibits the replication of EV71 virus in neural cells SK-N-SH by targeting the PTEN/PI3K/AKT signaling pathway, while reducing the cellular inflammatory response, targeting miRNA-296-5p and downstream PTEN/PI3K/AKT The signal pathway is expected to provide therapeutic targets and theoretical basis for the treatment of hand-foot-mouth disease caused by clinical EV71 virus.

Objective To compare the clinical efficacies of Qin’s scalp eight-needle acupuncture versus conventional scalp acupuncture in treating cancer pain. Method Sixty cancer pain patients with clinically or pathologically diagnosed malignant tumors were allocated, using a random number table, to a treatment (Qin’s scalp eight-needle acupuncture) group of 30 cases and a control (conventional scalp acupuncture) group of 30 cases. The treatment group received Qin’s scalp eight-needle acupuncture at selected points every other day and the control group, conventional scalp acupuncture every other day. One course of treatment consisted of 10 days. Result Cancer pain was relieved, analgesic dosage decreased, adverse reactions to analgesics reduced and quality of life raised significantly in the treatment group compared with the control group. Conclusion Qin’s scalp eight-needle acupuncture is effective in treating cancer pain.

Objective To evaluate the effects of isoflurane postconditioning on long-term cognitive function of neonatal rats with hypoxic-ischemic brain injury (HIBI).Methods Sixty 7-day-old Sprague-Dawley rats,weighing 12-16 g,were randomly divided into 4 groups (n =15 each) using a random number table:sham operation group (group Ⅰ),isoflurane postconditioning group (group Ⅱ),cerebral hypoxia-ischemia group (group Ⅲ),and isoflurane postconditioning after cerebral hypoxia-ischemia group (group Ⅳ).Brain ischemia was induced by permanent ligation of the left common carotid artery followed by inhalation of 8 ％ O2-92 ％ N2 for 2 h at 37 ℃ in Ⅲ and Ⅳ groups.In Ⅰ and Ⅱ groups,the left common carotid artery was only isolated but not ligated.The rats inhaled 1.5％ isoflurane in 30％ O2-70％ N2 for 30 min starting from 2 h of hypoxia in Ⅱ and Ⅳ groups.The rats were exposed to 30％ O2-70％ N2 for 30 min in Ⅰ and Ⅲ groups.Morris water maze test was carried out at 30-35 days after HIBI.The escape latency,swimming speed,swimming distance,the number of times the animals crossing the platform quadrant,the percentage of time spent in the platform quadrant and the percentage of swimming distance in the platform quadrant were recorded.The animals were sacrificed after Morris water maze test.The density of normal neurons in ventral posterior inferior thalamic nucleus and hippocampal CA3 region in left and right cerebral hemisphere was measured and the ratio of the density of normal neurons in the left to right cerebral hemisphere was calculated.Results Compared with group Ⅰ,the escape latency was significantly prolonged at 30-34 days after HIBI in group Ⅲ and at 31 and 34 days after HIBI in Ⅳ group,the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,percentage of swimming distance in the platform quadrant,and ratio of the density of normal neurons in the left to right cerebral hemisphere were decreased at day 35 after HIBI in group Ⅲ,no significant changes were found in the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,and percentage of swimming distance in the platform quadrant,and the ratio of the density of normal neurons in the left to right cerebral hemisphere was decreased at day 35 after HIBI in group Ⅳ,and no significant changes were found in the parameters mentioned above in group Ⅱ.Compared with group Ⅲ,the escape latency was significantly shortened at 31-34 days after HIBI,and the number of times the animals crossing the platform quadrant,percentage of time spent in the platform quadrant,percentage of swimming distance in the platform quadrant,and ratio of the density of normal neurons in the left to right cerebral hemisphere were increased at day 35 after HIBI in group Ⅳ.There was no significant difference in the swimming speed and swimming distance at day 35 after HIBI between groups.Conclusion Isoflurane postconditioning can improve long-term cognitive function of neonatal rats with HIBI.

Objective To evaluate the effects of isoflurane postconditioning on mitochondrial permeability transition pore (mPTP) in brain tissues of neonatal rats with hypoxic-ischemic brain injury.Methods One hundred and twenty 7-day-old Sprague-Dawley rats,weighing 12-16 g,were randomly divided into 4 groups (n =30 each) using a random number table:sham operation group (group S),isoflurane group (group I),hypoxicischemic brain injury group (group HIBI),and hypoxic-ischemic brain injury + isoflurane postconditioning group (group HI).To establish hypoxic-ischemic brain injury model in the neonatal rats,the left common carotid artery ligation was carried out,and then the rats were exposed to 8％ O2 + 92％ N2 at 37 ℃ for 2 h in HIBI and HI groups.The rats inhaled 1.5 ％ isoflurane for 30 min after the model was established in group HI.The rats only inhaled 1.5％ isoflurane for 30 min in group I.At 24 h after the model was established,10 rats taken out randomly in each group were sacrificed and brains were removed to detect mPTP opening.At 7 days after the model was established,the survival rate was recorded in the rest rats.The rats were then sacrificed and brains were removed and the right and left cerebral hemispheres were weighed separately,and the ratio between left/right cerebral hemispheres was calculated.The density of normal neurons in ventral posterior inferior thalamic nucleus and hippocampal CA3 region in the left and right cerebral hemispheres were measured and the ratios of the density of normal neurons in the left to right cerebral hemisphere were calculated.Results There was no significant difference in the survival rate between the four groups (P ＞ 0.05).Compared with group S,the ratios of the density of normal neurons in the left to right cerebral hemisphere,weight of left cerebral hemisphere,and ratio between left/right cerebral hemispheres were significantly decreased,and mPTP opening was increased in group HIBI (P ＜ 0.05),and no significant changes were found in the parameters mentioned above in group I (P ＞ 0.05).Compared with group HIBI,the ratios of the density of normal neurons in the left to right cerebral hemisphere,weight of left cerebral hemisphere,and ratio between left/right cerebral hemispheres were significantly increased,and mPTP opening was decreased in group HI (P ＜ 0.05).Conclusion The mechanism by which isoflurane postconditioning reduces hypoxic-ischemic brain injury may be related to inhibition of mPTP opening in brain tissues of neonatal rats.

Objective The purpose of this study was to investigate the chemical constituents of Pierre. Methods The chemical compositions were isolated by silica gel column chromatography, semi-preparative HPLC,Sephadex LH-20, and MPLC packed with MCI gel, and their structures were identified on the basis of chemical and spectroscopic evidence (NMR and MS) . Results Eight compounds were obtained and determined as fibraurin (1),makisterone A (2),cycloartenol (3),feruloylphenethylamine (4),trans- -feruloyltyramine(5),β-sitosterol(6),1-monopalmitin(7),1-sinapoyl-β-D-glucopyranoside(8). Conclusion Compounds 2-8 were isolated from this plant for the first time.

With the rapid development of general anesthesia technology and the occurrence of new types of inhalation and intravenous anesthetics,safety and comfort requirements of general anesthesia become increas-ingly higher. Therefore,emergence agitation and its adverse consequences gradually receive more and more atten-tion . Thus the etiology and prevention of emergence agitation is an important issue in pediatric anesthesia at pres-ent. In recent years, some achievement has been made in emergence agitation following general anesthesia in children. This article will summarize the related factors,possible mechanisms and prevention strategics of pediat-ric emergence agitation.