Perimenopausal syndrome （MPS）， a common endocrine system disease， is one of the diseases responding specifically to traditional Chinese medicine （TCM）. The China Association of Chinese Medicine organized experts in endocrinology， gynecology， and interdisciplinary fields of both Western and Chinese medicine to discuss the advantages and challenges of diagnosing and treating MPS with Western medicine， TCM， and integrative medicine. Experts at the conference believe that MPS is initiated by estrogen decline and rooted in deficiency， with the pathogenesis being imbalance between Yin and Yang in the kidney. The hormone replacement therapy in Western medicine for menopause can rapidly alleviate related symptoms by quickly restoring the estrogen level and timely detect and delay complications of menopause， whereas such a therapy has certain risks， necessitating close monitoring of adverse reactions. Moreover， the various contraindications and precautions limit the clinical application of the hormone replacement therapy. TCM has advantages in synergistically alleviating symptoms such as hot flashes， sweating， sleep disorders， and emotional abnormalities of MPS without causing obvious adverse reactions. However， its efficacy is slower than the hormone replacement therapy， and the TCM evidence for preventing and treating complications of menopause remains unclear. Three suggestions were proposed for the future development of both Western and TCM for ameliorating MPS. First， an integrated diagnosis and treatment system for MPS with both Western and Chinese medicine should be established. Second， high-quality evidence-based interventions for MPS should be developed with TCM alone or in combination with Western medicine. Third， efforts should be made to promote the new TCM drug development and the interdisciplinary cooperation for treating MPS.

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the efficacy of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects who were previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extended or switched TMF treatment for 48 weeks. Efficacy was evaluated based on virological, serological, biological parameters, and fibrosis staging. Statistical analysis was performed using the McNemar test, t-test, or Log-Rank test according to the data. Results:593 subjects from the initial TMF group and 287 subjects from the TDF group were included at week 144, with the proportions of HBV DNA<20 IU/ml at week 144 being 86.2% and 83.3%, respectively, and 78.1% and 73.8% in patients with baseline HBV DNA levels ≥8 log10 IU/ml. Resistance to tenofovir was not detected in both groups. For HBeAg loss and seroconversion rates, both groups showed a further increase from week 96 to 144 and the 3-year cumulative rates of HBeAg loss were about 35% in each group. However, HBsAg levels were less affected during 96 to 144 weeks. For patients switched from TDF to TMF, a substantial further increase in the alanine aminotransferase (ALT) normalization rate was observed (11.4%), along with improved FIB-4 scores.Conclusion:After 144 weeks of TMF treatment, CHB patients achieved high rates of virological, serological, and biochemical responses, as well as improved liver fibrosis outcomes. Also, switching to TMF resulted in significant benefits in ALT normalization rates (NCT03903796).

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the safety profile of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects that previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extending or switching TMF treatment for 48 weeks. Safety profiles of kidney, bone, metabolism, body weight, and others were evaluated.Results:666 subjects from the initial TMF group and 336 subjects from TDF group with at least one dose of assigned treatment were included at week 144. The overall safety profile was favorable in each group and generally similar between extended or switched TMF treatments from week 96 to 144. In subjects switching from TDF to TMF, the non-indexed estimated glomerular filtration rate (by non-indexed CKD-EPI formula) and creatinine clearance (by Cockcroft-Gault formula) were both increased, which were (2.31±8.33) ml/min and (4.24±13.94) ml/min, respectively. These changes were also higher than those in subjects with extending TMF treatment [(0.91±8.06) ml/min and (1.30±13.94) ml/min]. Meanwhile, switching to TMF also led to an increase of the bone mineral density (BMD) by 0.75% in hip and 1.41% in spine. On the other side, a slight change in TC/HDL ratio by 0.16 (IQR: 0.00, 0.43) and an increase in body mass index (BMI) by (0.54±0.98) kg/m 2 were oberved with patients switched to TMF, which were significantly higher than that in TMF group. Conclusion:CHB patients receiving 144 weeks of TMF treatment showed favorable safety profile. After switching to TMF, the bone and renal safety was significantly improved in TDF group, though experienceing change in metabolic parameters and weight gain (NCT03903796).

H 1-antihistamines are widely used in the treatment of various allergic diseases, but there are still many challenges in the safe and rational use of H 1-antihistamines in pediatrics, and there is a lack of guidance on the prescription review of H 1-antihistamines for children.In this paper, suggestions are put forward from the indications, dosage, route of administration, pathophysiological characteristics of children with individual difference and drug interactions, so as to provide reference for clinicians and pharmacists.

Objective The objective of this study was to explore the differences of serum metabolomics between small cell lung cancer(SCLC)patients and healthy volunteers,and to discover serum potential biomarkers for identification and small cell lung cancer staging. Methods Ultra-performance liquid chromatography time of flight mass spectrometry(UPLS-TOF/MS)was used to establish the serum metabolic profile of SCLC. Principal Component Analysis(PCA)and orthogonal hidden variables were analyzed by the EZinfo2. 0 software. Orthogonal Partial Least Squares Discriminant Analysis(OPLS-DA)was used to analyze the metabolic differ-ences between the case and normal control groups. Through cluster analysis using HMDB and METLIN database to search for the exact mass-to-charge ratio of the difference,preliminary identification of some substances with significant differences was carried out. Results Ten differential metabolites such as lysophosphatidylcholine between patients and control groups were screened and identi-fied by mass spectrometry and database search. There were 10 different metabolites such as glycocholic acid in the contour analysis of SCLC patients with different stages. Conclusion There is a significant difference in serum metabolism between SCLC patients and healthy controls. The discovery of differential metabolites provides experimental evidence for the identification of small cell lung cancer and potential markers of staging.

Objective: To explore the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection who received entecavir alone or in combination with anluohuaxianwan for 78 weeks. Methods: Patients with chronic HBV infection were randomly treated with entecavir alone or in combination with anluohuaxian for 78 weeks. Ishak fibrosis score was used for blind interpretation of liver biopsy specimens. The improvement in liver fibrosis condition before and after the treatment was compared. Student's t test and non-parametric test (Mann-Whitney U-Test and Kruskal-Wallis test) were used to analyze the measurement data. The categorical variables were analyzed by Chi-square test method and Spearman’s rank correlation coefficient was used to test bivariate associations. Results: Liver fibrosis improvement rate after 78 weeks of treatment was 36.53% (80/219) and the progression rate was 23.29% (51/219). The improvement of liver fibrosis was associated to the degree of baseline fibrosis and treatment methods (P < 0.05). The improvement rate of hepatic fibrosis in patients treated with anluohuaxianwan combined with entecavir at baseline F < 3 (54.74%, 52/95) was significantly higher than that in patients treated only with entecavir (33.33%, 16/48), P = 0.016 and the progression rate of hepatic fibrosis (13.68%, 13/95) was lower than that in patients treated alone (18.75%, 9/48), P = 0.466. In patients with baseline F < 3, the proportion of patients with improved and stable liver fibrosis in the combined treatment group (68.1%, 32/47) was higher than that in the treatment group alone (51.7%, 15/29). Conclusion Combined anluohuaxianwan and entecavir treatment can significantly improve the improvement rate of liver fibrosis in patients with chronic hepatitis B virus infection. Furthermore, it has the tendency to improve the stability rate and reduce the rate of progression of liver fibrosis.

Ultrasound-guided serratus anterior plane block is one of the ways to provide analgesia to post thoractomy.It appears to be more easily performed compared with other techniques and is applied to be a postoperative analgesia for chest surgery such as breast cancer,ribs fracture and lung cancer.The review studies the using of serratus anterior plane block in clinical pain management.

Objective To investigate the effect of ultrasound-guided serratus plane block (SAPB) on efficacy of postoperative analgesia in patients undergoing video- assisted thoracoscopic surgery. Methods Sixty patients scheduled for video- assisted thoracoscopic radical resection of lung cancer under general anesthesia from October 2017 to April 2018 were divided into 2 groups by random digits table method with 30 cases each: SAPB group and control group. After induction of anesthesia, ultrasound-guided homolateral SAPB was performed, and 0.5％ ropivacaine 20 ml was injected in SAPB group, while the equal volume of normal saline was used instead in control group. The patients received intravenous analgesia after operation in 2 groups. The scores of visual analogue score (VAS) and Bruggrmann comfort score (BCS) were evaluated at 1, 2, 4, 6, 12, 24 and 48 h after operation. The consumption of additional pain medication within 48 h after operation and remifentanil during operation were recorded. The adverse effects were also recorded. Results The VAS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly lower than those in control group: (2.70 ± 0.92) scores vs. (5.10 ± 2.04) scores, (2.80 ± 1.00) scores vs. (5.13 ± 1.78) scores, (3.07 ± 1.17) scores vs. (4.93 ± 1.53) scores, (3.13 ± 1.07) scores vs. (4.63 ± 1.47) scores and (2.87 ± 0.73) scores vs. (3.83 ± 1.29) scores, P <0.05; the BCS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly better than those in control group: (1.90 ± 0.66) scores vs. (0.93 ± 0.91) scores, (2.03 ± 0.41) scores vs. (0.90 ± 0.80) scores, (1.90 ± 0.40) scores vs. (1.07 ± 0.69) scores, (1.97 ± 0.32) vs. (1.20 ± 0.66) scores and (2.03 ± 0.18) scores vs. (1.73 ± 0.45) scores, and there were statistical differences (P<0.05). The dose of remifentanil consumption of additional pain medication within 48 h in SAPB group were significantly lower than those in control group: (0.23 ± 0.03) mg vs. (0.34 ± 0.03) mg and (26.67 ± 25.37) mg vs. (40.00 ± 24.21) mg, and there were statistical differences (P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P > 0.05). Conclusions The SAPB can reduce the early pain after video-assisted thoracoscopic radical resection of lung cancer, improve the comfort of patients, enhance the effect of postoperative analgesia and reduce the use of postoperative analgesic drugs.

Objective To observe the clinical effect of drug moxibustion in the treatment of chronic obstructive pulmonary disease (COPD).Methods A total of 90 patients with acute myocardial infarction in Taihe Hospital emergency department were randomly divided into the control group (n=30) and the treatment group (n=90).The patients in the control group were treated with routine western medicine, while treatment group was treated with drug moxibustion on the basis of the control group treatment. Both groups were treated for 6 weeks.The pulmonary function was assessed, and the clinical effect was evaluated.Results The total effective rate was 86.7% (52/60) in the treatment group and 70.0% (21/30) in the control group. The difference between the 2 groups was statistically significant (χ2=6.059,P=0.048). After treatment, the forced expiratory volume in 1 second (FEV1) (1.07 ± 0.3l L vs. 1.05 ± 0.41 L,t=15.272) in the treatment group were significantly higher than that in the control group (P<0.01).Conclusions The drug-separated moxibustion can improve the curative effect and improve the lung function of patients with stable COPD.

This paper summarized nursing experience of 23 patients with malignant tumor treated by 3D printing individualized template and 125I seed implantation.Nursing points included:preoperative assessment and preparation,reviewing the process of template conduction,assisting the physician to simulate the position of patients,making treatment plans,preparing templates before operation;resetting and maintaining position of patients,performing template alignment,seed implantation,monitoring vital signs and complications during operation;observation of complications,providing radiation protection and discharge guidance after operation.All 23 patients completed 125I seed implantation and no serious complication was observed.All patients recovered well and were discharged after treatment.