BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

The basic principles of medical ethics included respect and autonomy,beneficial and nonmaleficence,informed consent and confidentiality,impartiality and mutual assistance.During medical journal editing,medical ethics principles should be strictly applied.Focused on two types of medical thesis,medical scientific research and clinical trials,this paper concluded the ethics issues related to experimental animals,cells and gene researches,all these should be noticed in manuscripts.Meanwhile,this paper analyzed the ethics principles about contrast set and the use of placebo that should be abided in clinical trial,and the respects of patients'privacy during clinical observation,etc.Some review key points were put forward from the perspective of editors.

Objective To investigate the effect of narrow-band UVB (NB-UVB ) on melanocytes proliferation,melanin production,tyrosinase activities and miRNA-2 5 expression so as to explore the relationship between NB-UVB and miRNA-25 and the possible mechanism of NB-UVB for treatment of vitiligo.Methods Melanocytes cultured in vitro were treated with 40 mJ/cm2 dose of NB-UVB for 72 h,the effects of NB-UVB on cell proliferation,tyrosinase activity and melanin content were investigated.After NB-UVB stimulation for 1 2 h,the effect of NB-UVB on miRNA-2 5 expression in melanocytes was detected. Melanocytes were transfected with miRNA-2 5 mimics,miRNA-2 5 inhibitor and miRNA-2 5 mutant,respectively,the changes of cell proliferation, tyrosinase activitiy and melanin content were observed.Cell viability was detected using MTT method.Tyrosinase activities were measured with levodopa as the substrate.NaOH assay was used for the detection of melanin content. Real-time quantitative polymerase chain reaction (qRT-PCR)was used to detect miRNA-25 expression.Results After NB-UVB of 40 mJ/cm2 dose was used for the cells cultured for 72 h,the viability of melanocytes,tyrosinase activities,and melanin content were significantly increased (P<0.05 ).After NB-UVB stimulation for 12 h, miRNA-2 5 expression was significantly lower than that in the control group (P<0 .0 5 ).After knockdown of miRNA-2 5 ,the cell proliferation of melanocytes,tyrosinase activities and melanin content were increased,whereas overexpression of miRNA-2 5 decreased the cell proliferation, tyrosinase activities and melanin production.Overexpression of miRNA-2 5 partially inhibited the effect of NB-UVB on the treatment of melanocytes. Conclusion NB-UVB may promote cell proliferation,increase tyrosinase activities and melanin formation through partially downregulating the expression of miRNA-2 5 in melanocytes.

Based on three aspects of academic research, academic morality and academic publication, this pa-per discussed the ethical quality that medical journal editors should possess. Medical knowledge and knowledge of medical ethics are the basic ethical qualities that a good medical editor should possess. Editor should strictly control the manuscript process, abide by the professional ethics, and contribute to the fast and correct spread of medical information.

In this paper, the authors analyzed the clinical features and the psychological characteristics of pa-tients with vitiligo: nervousness and inferiority, urgent treatment, high expectation , disappointed feelings of the failtreatment. Aimed at these psychological problems, the medical ethics requirements in the process of diagnosis and treatment were proposed:respect for the patient, protect of the patient′s privacy, patient communication and regular follow-up and health education.

Objective To investigate the status of palliative care knowledge and attitude of nurses in primary hospitals, and analyze the influencing factors, so as to provide bases and decisions for the further popularization of palliative care. Methods Totally 362 nurses from primary hospitals were selected as this research object, and their knowledge and attitude of palliative care were investigated by self-designed questionnaires. Results The standard score of palliative care of nurses from primary hospitals was ( 54. 28 ± 14. 06), 123 nurses were qualified (33.98%), and 26 nurses were good (7.18%);the standard score of caring attitude was (82.76±9.24). The influencing factors of palliative care knowledge and caring attitude included religion, department, working years and title(β′=0.308,0.263,0.121,0.104). Conclusions The attitude of nurses in primary hospitals is positive, but their related knowledge of palliative care is incomplete, especially the knowledge of spiritual care. Targeted training can improve the knowledge of palliative care of nurses, and popularizing it successfully.

Dermatology ; history ; History, 15th Century ; History, 16th Century ; History, 17th Century ; History, Medieval ; Humans ; Medicine, Chinese Traditional ; history

OBJECTIVETo investigate the expression of promyelocytic leukaemia (PML) protein of PML protein in Bowen's disease (BD), skin squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and explore the role of PML in the pathogenesis of these diseases.

METHODSPML protein in normal skin tissues and lesions of Bowen's disease, SCC and BCC were detected with immunohistochemistry.

RESULTSNormal skin tissues did not express PML protein. In BCC, PML showed rather low expressions in the skin lesions (8.69% in cell nuclei and 4.35% in cytoplasm). The lesions in BD and SCC (grade I and II) showed obvious overexpression of PML protein in the cell nuclei and cytoplasm, and its expression in the cell nuclei of these lesions was significantly higher than that in grade III-IV SCC.

CONCLUSIONPML protein may play an important role in the early stage of SCC, and its overexpression may contribute to the carcinogenesis and metastasis of SCC.

Adult ; Aged ; Bowen's Disease ; metabolism ; pathology ; Carcinoma, Basal Cell ; metabolism ; pathology ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Female ; Humans ; Male ; Middle Aged ; Nuclear Proteins ; metabolism ; Promyelocytic Leukemia Protein ; Skin Neoplasms ; metabolism ; pathology ; Transcription Factors ; metabolism ; Tumor Suppressor Proteins ; metabolism

OBJECTIVETo investigate the effects of topical treatment with adenovirus-mediated promyelocytic leukemia gene (PML) gene in a psoriasis-like mouse model.

METHODSThe effect of adenovirus-mediated PML gene on the granular layer of mouse tail scale epidermis and epithelial mitosis were observed on longitudinal histological sections prepared from the tail skin and vaginal epithelium of the mice.

RESULTSAdenovirus-mediated PML gene significantly inhibited mitosis of mouse vaginal epithelial cells and promoted the formation of granular layer in mouse tail scale epidermis.

CONCLUSIONThe therapeutic effect of PML gene in the psoriasis-like mouse model may be associated with increased granular cells and suppressed epidemic cell proliferation.

Adenoviridae ; genetics ; Administration, Topical ; Animals ; Cell Proliferation ; Disease Models, Animal ; Epithelial Cells ; cytology ; Female ; Genetic Vectors ; Male ; Mice ; Mice, Inbred Strains ; Mitosis ; Nuclear Proteins ; genetics ; Promyelocytic Leukemia Protein ; Psoriasis ; therapy ; Skin ; cytology ; Transcription Factors ; genetics ; Tumor Suppressor Proteins ; genetics ; Vagina ; cytology

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.