Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.

ObjectiveTo systematically evaluate the effects of threshold inspiratory muscle training (TIMT) on respiratory function, motor function and quality of life in patients with chronic obstructive pulmonary disease (COPD). MethodsRandomized controlled trials (RCT) about the effects of TIMT on dyspnea, quality of life, motor function and inspiratory muscle strength for COPD patients were retrieved from PubMed, EBSCO, Web of Science, Ovid, Cochrane Library, SinoMed, CNKI, VIP, since establishment to September, 2020. Two researchers independently screened literatures, extracted data and evaluated the methodological quality. A meta-analysis was performed using RevMan 5.3. ResultsA total of 30 RCTs involving 2 060 patients were included. TIMT could obviously improve the maximum inspiratory pressure (MD = 10.68, 95%CI 7.43 to 13.92, P < 0.001), optimize the results of 6-minute Walking Test (MD = 24.62, 95%CI 9.09 to 40.15, P = 0.002), the St George's Respiratory Questionnaire (MD = -3.08, 95%CI -5.84 to -0.33, P = 0.03), the modified Medical Research Council Dyspnea Scale (MD = -0.30, 95%CI -0.52 to -0.07, P = 0.01) and Borg score (MD = -0.84, 95%CI -1.24 to -0.44, P < 0.001). TIMT could also improve the forced expiratory volume in one second (MD = 0.11, 95%CI 0.04 to 0.19, P = 0.003) and the forced expiratory volume in one second in predicted (MD = 3.72, 95%CI 2.62 to 4.82, P < 0.001). There was no significant difference in the COPD Assessment Test (MD = -1.14, 95%CI -2.32 to 0.03, P = 0.06) or forced vital capacity (MD = 0.07, 95%CI -0.12 to 0.25, P = 0.49). ConclusionTIMT can improve the inspiratory muscle strength, alleviate the symptoms of dyspnea, and improve the lung function and the quality of life for COPD patients.

Objective:To retrieve, evaluate and integrate relevant evidence on the management of the developmentally supportive environment in the neonatal intensive care unit(NICU), and to provide clinical references.Methods:Evidence on NICU environmental management was retrieved from Guidelines International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guide Network, National Guideline Clearinghouse, Registered Nurses′ Association of Ontario, Yimaitong and other Websites, BMJ Best Practice, UpToDate, Cochrane Library, PubMed, Embase, Wanfang Database, CNKI and other database.The evidence included guidelines, evidence summaries, best clinical practice manuals, expert consensus and systematic reviews.The date limit was from the establishment of the databases to March 31, 2021.Results:Totally 16 articles were involved, including 4 guidelines, 9 systematic reviews, and 3 expert consensus.Finally, 20 pieces of best evidence on four aspects were su-mmarized: sound, light, touch, and smell.There were 11 A-level recommendations and 9 B-level recommendations.The evidence suggested that health care workers should reduce noise and protect premature infants from being exposed to bright light, noxious gases, and negative touch stimuli.Besides, benign auditory and olfactory stimuli, circadian light, and mother-infant skin-to-skin contact should be used to promote the development of premature infants.Conclusions:This study is a summary of the recommendations on NICU environmental management.It is well-designed and has achieved fruitful results, showing great significance for reducing environmental stress of premature infants in the NICU.However, the current recommended methods for providing benign stimulation require validation of more high-quality, well-designed research.It is recommended that medical staff should selectively apply the evidence to clinical practice according to the actual situation.

Objective:To investigate the influence of different characteristics of implant-supported fixed dental prostheses on the incidence of peri-implant disease.Methods:Prospective cohort was established for patients who received implant-supported fixed dental prostheses at the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University between June 2014 and September 2015. Several patient-related factors, implant prostheses factors, and oral hygiene maintenance factors were collected. The Log-rank test was used to compare the peri-implant disease rates of various factors, and the Cox proportional hazards model was used to conduct multivariate study on single factor significant factors to analyze the impact on the incidence of peri-implant disease.Results:A total of 214 subjects and 351 implants were included in the cohort, the follow-up period was (11.0±3.5) months. Finally, 43.0% (92/214) of patients and 37.3% (131/351) of implants developed peri-implant diseases. The incidence of peri-implant mucositis and peri-implantitis was 41.1% (88/214) and 4.2% (9/214) at the subject level,and 34.2% (120/351) and 3.1% (11/351) at the implant level. Among the factors associated with the implant prosthesis, single factor Log-rank analysis showed that prostheses retention methods, proximal contact of the prostheses, occlusion situation were statistical significance ( P<0.05). Multivariate analysis using Cox proportional hazards model showed that screw retention (hazard ratio=2.38, 95% CI: 1.42-3.99), proximal contact loss of the prostheses (hazard ratio=2.36, 95% CI: 1.31-4.27) were independent risk factors for peri-implant disease ( P<0.05). Conclusions:Factors such as prostheses retention mode and proximal contact characteristics have important influence on the health status of the implant.

OBJECTIVETo assess the association of vascular endothelial growth factor (VEGF) gene polymorphisms with susceptibility to Crohn's disease (CD) in a Chinese population.

METHODSFor 275 CD patients and 495 controls, the genotypes of VEGF gene rs699947 and rs3025039 loci were determined with a SNaPshot method.

RESULTSThe allelic and genotypic frequencies of the rs699947 and rs3025039 loci did not differ between the two groups (all P>0.05). By stratification analysis, allele A and genotype CA+AA of rs699947 were more frequent in patients with colonic CD compared with the controls (P=0.006, 95%CI:1.143-2.234; P=0.005, 95%CI:1.203-2.900, respectively). Compared with the controls, the allele A and genotype CA+AA of rs699947 were less frequent in patients with ileal lesions including ileal CD and ileocolonic CD (P=0.033, 95%CI:0.524-0.974;P=0.043, 95%CI:0.481-0.989, respectively). The frequency of TT homozygote of rs3025039 was lower in patients with non-stricturing and non-penetrating CD compared with the controls (P=0.036, 95%CI:0.016-0.870).

CONCLUSIONPolymorphisms of the VEGF gene rs699947 locus may contribute to an increased risk for colonic CD, but may play a protective role in patients with ileal lesion. Individuals carrying the TT genotype for VEGF rs3025039 locus may be less susceptible to non-stricturing and non-penetrating CD.

Objective To analyze the association of Crohn's disease(CD)with vitamin D receptor(VDR) gene polymorphisms. Methods After collecting 326 CD patients and 464 healthy controls,the four single nucleotide polymorphisms of VDR (FokI, BsmI, ApaI and TaqI) were examined by a SNaPshot technique. Results Compared with those in controls,the frequencies of mutant allele(A)and genotype(GA+AA)of BsmI were significantly decreased in CD patients(both P=0.001). The similar conclusions were also drawn for the mutant allele(C)and genotype(TC+CC)of TaqI(both P<0.05). In further stratified analysis,compared with those in controls,the mutant alleles and genotypes of BsmI and TaqI were significantly reduced in stenotic type CD patients (all P<0.0083). The analyses of linkage disequilibrium(LD)and haplotype showed that BsmI,ApaI and TaqI were in a strong LD,and the formed haplotype AAC was significantly lower in CD patients than that in controls (P <0.05). Conclusions VDR(BsmI and TaqI)polymorphisms are significantly related with the reduced susceptibility to CD,especially for patients with stenotic CD. Moreover,the haplotype AAC might engender a reduced risk of CD.

Aim To investigate the effect of intrathecal injection of PI3 K inhibitor LY294002 on pain behav-iour and expression of p-Akt in spinal dorsal horns in bone cancer pain( BCP) rats. Methods Forty female SD rats weighing 180~200 g were randomly divided in-to five groups ( n =8 each ):(Ⅰ) sham group;(Ⅱ) sham+LY294002 group;(Ⅲ) BCP group;(Ⅳ) BCP+DMSO group;( V) BCP+LY294002 group. BCP rat model was induced by inoculating Walker 256 mamma-ry gland carcinoma cells into the medullary cavity of the left tibia. Rats received i. t. injections of either PI3 K inhibitor LY294002 10μL ( 2. 5 g · L-1 ) or 5%DMSO 10 μL at the time of d 7~9 after the operation. Mechanical withdrawal threshold( MWT) test was per-formed before and after i. t. injections on d7(till 8h). The rats were sacrificed after inoculation and the L4~6 segments of the spinal cords were removed for immu-nohistochemistry to determinate the expression changes of spinal p-Akt. Results Compared with I group, the rats inⅢ,Ⅳ,Ⅴgroup showed obvious mechanical hy-peralgesia. The MWT of V group increased apparently from 2nd hour to 4th hour(P<0. 05),and reached the peak in 3rd hour(P<0. 01). Compared with I group, the expression of p-Akt in the spinal cord in Ⅲ,Ⅳgroup increased obviously ( P <0. 01 ) . Compared withⅢ,Ⅳ group,i. t. injections of LY294002 obviously cut down the expression of p-Akt in the spinal cord ( P <0. 05). Conclusion PI3K/Akt singaling pathway may take part in the development of bone cancer pain.

OBJECTIVE To analyze a neonate with multiple malformations and to correlate its genotype with phenotype. METHODS The karotypes of the child and her parents were subjected to G-banding chromosome analysis, and array comparative genomic hybridization (array-CGH) was used for fine mapping of the aberrant region. RESULTS The karyotype of the child was ascertained as 46,XX,del(18)(p11.2). Array CGH has identified a 9.8 Mb deletion at 18p11.32-p11.22. The patient has presented features such as holoprosencephaly, choanal atresia, heart defect, and craniofacial dysmorphisms. CONCLUSION The de novo 18p deletion probably underlies the main clinical manifestations of the child.
Abnormalities, Multiple ; genetics ; Chromosome Banding ; Chromosome Deletion ; Chromosomes, Human, Pair 18 ; Female ; Humans ; Infant, Newborn ; Phenotype

Objective To develop a rapid quantitative detecting assay for point-of-care testing ( POCT ) of N-terminal pro-brain natriuretic peptide ( NT-proBNP ) in serum by the fluorescence immunochromatographic technology.Methods Applying double-antibody sandwich assay to establish the quantitative NT-proBNP kit.The performance of quantitative NT-proBNP kit was evaluated by the sensitivity , specificity, accuracy, precision, stability and clinical effectiveness.It compared the research kit and conference kit by the parallel experience in the 1 056(605 males, 451 females)serum specimen collected from Guangdong Provincial People′s Hospital, Sun Yat-sen Memorial Hospital and Children′s Hospital of Zhengzhou between February 2013 to April 2014.Statistical significance of the results was assessed by correlation analysis , linear regression , receive operating characteristic ( ROC) curve analysis , negative and positive consistent.Results The report range of the NT-proBNP kit was 18-35 000 ng/L.The coefficient of variation ( CV) values for low , median and high concentration calibrators respectively were all less than 15%.Common interfering substances in human serum specimens such as bilirubin , triglyceride and cholesterol were found no significant affect on NT-proBNP antigen detection and the CV were no more than 15%.According to the results of detection for calibrators , the shelf time of the NT-proBNP diagnostic kit should be longer than 12 months.The NT-proBNP kit and reference kit had good correlation ( Y=1.048 9X developed reference +121.54, R2 =0.956 6, n=1 056) to detect the target protein through the parallel experiments and the deviation of the quantitative results of clinical serum samples showed no statistical significance (Z=0.88, P=0.379>0.05).The clinical assays of two different diagnostic kits showed good consistency based on the ROC curve evaluation which is compared by two cut-off values (300 and 450 ng/L).The areas under ROC curve were 0.981 and 0.978 respectively.Conclusions A novel NT-proBNP chromatographic quantitative immunofluorescence detection method was developed in this study .The performance evaluation data indicated that the kit is suitable for rapid detection of serum NT -proBNP.