Clinical pathway is an important quality management tool for regulating medical behavior both at home and abroad, and an important means of controlling medical costs in the reform of medical insurance payment methods.The author reviewed the current development status of clinical pathways both at home and abroad, focusing on summarizing the development experience of foreign countries, and analyzing the shortcomings in the development of clinical pathways in China from the perspectives of formulation, implementation, and evaluation. It is proposed that China should establish and improve the regulatory and incentive mechanisms for clinical pathways, accelerate the construction of supporting medical security systems, explore new incentive transmission models, attach importance to the role of patient participation in the formulation and implementation of clinical pathways, and so on, in order to provide reference for promoting the efficient development of clinical pathways in China.

Objective:To anylyze the combination rule of prescriptions containing Cmnamomi Mmulus in the book of Treatise on Typhoid and Miscellaneous Diseases based on tree analysis algorith method. Methods:By collecting prescriptions contain Cmnamomi Mmulus in the book of Treatise on Typhoid and Miscellaneous Diseases, and applying the tree analysis algorithm method on the Ancient and Modern Medical Case Cloud Platform to co-occurrence calculate each layer of the prescriptions, we got the hierarchical tree structure diagram of Cmnamomi Mmulus prescriptions. Results:79 prescriptions containing 96 medicines were included, which appeared 529 times, with 7 different functions. The medicines that are frequently appeared include Cmnamomi Mmulus, Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle, Zingiberis Rhizoma Recens, Jujubae Fructus, etc. The main effects include relieving the exterior, warming the meridians, warming yang and promoting diuresis. The tree structure diagram of the prescription is divided into seven layers, including the largest items of Cmnamomi Mmulus, Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle,Zingiberis Rhizoma Recens, Jujubae Fructus, Paeoniae Radix Alba, Ephedrae Herba, Puerariae Lobatae Radix, and the collateral drugs of Poria, Atractylodis macrocephalae rhizoma, Alismatis Rhizoma, Zingiberis Rhizoma, etc. Conclusion:The formula tree analysis algorithm can connect the correlation between drugs in series, and show the relationship between a series of high-frequency co-occurrence drugs in the formula, which can be used for the learning of classics.

ObjectiveTo investigate the effect of the Yap1 gene and tanshinone ⅡA on the proliferation, migration, and invasion abilities of Huh-7 hepatoma cells. MethodsA total of 10 pairs of human hepatocellular carcinoma (HCC) samples and adjacent tissue samples were collected in Zhongnan Hospital of Wuhan University from June 1 to December 1, 2019. Quantitative real-time PCR and Western blotting were used to measure the expression of the Yap1 gene and phenotype-related molecules. MTT cell proliferation detection reagent was used to measure the inhibition rate of cell proliferation after the treatment with different concentrations of tanshinone ⅡA. Western blotting was used to measure the changes in the expression of apoptosis-and migration-related markers after different interventions. Flow cytometry and Transwell assay were used to measure apoptosis and cell migration and invasion abilities. The data of 375 cases of liver cancer and 50 cases of relatively normal liver tissue samples were downloaded from The Cancer Genome Atlas, including clinicopathological information. The t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsIn 8 of the 10 pairs of HCC samples and adjacent tissue samples, HCC samples had significantly higher expression of Yap1 than the adjacent tissue samples. Compared with the normal human liver epithelial cells L02, the Huh-7 and HCCL-M3 hepatoma cells had a significant increase in the expression of Yap1. The silencing efficiency of si-Yap1-3 transfection reached 87.004% at the protein level. MTT results showed that tanshinone ⅡA effectively inhibited the proliferation of Huh-7 cells, with a half inhibitory concentration of 8.683 μmol/L. After the cells were treated with si-Yap1-3 and tanshinone ⅡA, there was an increase in the expression of the downstream marker for proliferation and migration E-cadherin and a reduction in the expression of vimentin, and the results of Transwell assay showed that compared with the si-NC group, the tanshinone ⅡA+si-Yap1-3 group had significant reductions in the migration and invasion abilities of Huh-7 cells (migration: 43.19±2.88 vs 132.20±10.03, t=8.527, P=0.001; invasion: 53.95±4.20 vs 179.10±11.11, t=4.484, P=0.011). The group treated with si-Yap1-3 and tanshinone ⅡA had an increase in the expression of the apoptosis-related marker Bax and a reduction in the expression of Bcl-2, as well as a significantly higher early apoptosis rate than the si-NC group (2598% vs 9.21%, χ2=4.078, P＜0.05). ConclusionOncogene Yap1 silencing combined with tanshinone ⅡA can promote the apoptosis of Huh-7 hepatoma cells and inhibit their migration and invasion, which can provide certain guiding significance for clinical medication.

The incidence rate of primary liver cancer continues to increase around the world, with a younger age of onset and poorer prognosis. As the most classic regulator of cell polarity and density, mechanical signal transduction, cell proliferation, and organ development, the Hippo pathway can promote the development and progression of various cancers including primary liver cancer. YAP, a classic nuclear effector of the Hippo pathway, is significantly upregulated in primary liver cancer and promotes the development of drug resistance. This article aims to investigate the association of the dysregulation of the Hippo signaling pathway with the development and progression of primary liver cancer and analyzes the mechanism of action of the Hippo signaling pathway in the drug resistance of primary liver cancer as an early event of the development of primary liver cancer, which is of great significance for exploring new treatment strategies for primary liver cancer.

With the rapid development of science and technology, more creative methods have been applied to the inheritance mode of traditional Chinese medicine, such as studying the inheritance process of famous doctorsin an objective and rigorous way. The bottleneck of information transmission from famous doctors is to collect data, process data, apply algorithms, analyze and summarize data. The integration of artificial intelligence and big data deep learning algorithm knowledge mapping technology and other technical methods has brought technological innovation for the inheritance of famous doctors. With such development, the team of the research center of TCM grand health intelligence, Institute of Information on Chinese Medicine, China Academy of Chinese Medical Science, has carried out a series of professional application system research in the field of traditional Chinese medicine, centering on the planning and inheritance of famous doctors. We developed the ancient and modern medical case cloud platform, medical big data analysis platform, cloud medical APP, and famous doctor inheritance workstation. In such way, the problems were solved of low efficiency of medical case collection and the lack of objective data support and information barriers in the experience summary of famous doctors. The artificial intelligence techniques are to promote the inheritance of famous doctors' experience and improve the teaching ability and efficiency.

Objective To investigate whether the population pharmacokinetics (PPK)models can optimize the initial dosage of individualized Valproic acid (VPA)in children with epilepsy. Methods The epileptic children without taking VPA previously were recruited from October 2015 to May 2017 at the Department of Pediatrics,Peking University First Hospital,and they were divided into the PPK model group and the traditional empirical method group by randomized method. The initial VPA dosages for the PPK model group were calculated by PPK model,whereas those of the traditional empirical method group were dosed at 20-25 mg/(kg·d)regularly. The steady-state serum trough concentrations of VPA were extracted,and then the number and percentage of the patients whose serum trough concen-trations of VPA were 50-100 mg/L in the 2 groups were analyzed and compared with prospectively randomized me-thod. Results Totally 65 epileptic children were recruited and they were randomly divided into the traditional empirical method group (32 cases)and the PPK model group (33 cases). Twenty-seven children in the traditional empirical method group were observed,and 12 children had local epilepsy attack and 15 had generalized seizures;whereas among 29 cases in the PPK model group,there were 12 local attack of epilepsy and 17 had generalized seizures. VPA add-on therapy was administrated in 9 cases and 15 cases in the traditional empirical method group and the PPK model group, respectively. There were 5 cases,21 cases and 1 case with VPA serum concentrations of ＜50 mg/L,50-100 mg/L and＞100 mg/L in the traditional empirical group;while there were 9 cases,20 cases and 0 case in the PPK model group. The VPA serum concentrations of 21 cases (77. 8%,21/27 cases)in the traditional empirical method group and 20 ca-ses (69. 0%,20/29 cases)in the PPK model group were 50-100 mg/L,respectively,and the difference was not sta-tistically significant(P＞0. 05). Conclusion Although the study doesn't suggest that the established PPK model of VPA in Chinese epileptic children is superior to the traditional empirical method,the PPK model might be potentially valuable for optimized individualized dosage adjustment for those with serum trough concentrations not in the reasonable range by the traditional empirical method and with clinical seizure or brain firing activities.

Objective: To research the medication regularity of Chinese medicine on treating urinary tract infection based on the Ancient and Modern Consilia Cloud Platform to provide references for clinical treatment of urinary tract infection.Methods: The Ancient and Modern Consilia Cloud Platform was used to screen the consilia of Traditional Chinese Medicine for the treatment of urinary tract infection, the materials mainly come from books, journal articles, famous medical studios in the modern Chinese medicine case database. Screening, cleaning, standardizing consilia, and the standardized consilia database was set up. Statistical analysis, cluster analysis and complex networks were used to analysed the core prescription, the herb medicine frequency, the herb medicine four gas, the herb medicine five flavors, the herb medicine channel tropism and other regularity of Chinese medicine treatment of urinary tract infection, and displayed visually. Results: A total of 501 prescriptions were included, a total of 245 herb medicine were involved, and liquorice, poria, dianthus superbus and rehmannia were used more frequently. The tastes are cold, neutral, sweet taste, and bitter taste. Their channel tropisms mainly belong to lung and liver. The core prescriptions are based on Bazhengsan and Zhibaidihuangwan. Conclusion: Heat, dampness and diuretic herbs are used in the treatment of urinary tract infections in Chinese medicine, and nourishing yin and kidney, and relieving the stagnation of liver at the same time.Asthenic and sthenia syndrome, appearance and essence are also taken into account.

OBJECTIVETo investigate the effects of embryo cryopreservation and thawing on clinical outcomes of transplantable embryos after preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) in cleavage-stage.

METHODSThe clinical data of 302 cases (including 118 cases using frozen/thawing embryos and 184 cases using fresh embryos) undergoing PGD/PGS in Women's Hospital, Zhejiang University School of Medicine during January 2011 and December 2016 were retrospectively analyzed. The pregnancy rate, implantation rate, live birth rate and abortion rate of fresh and frozen-thawed embryo transfer (FET) cycles were compared. And the influencing factors for pregnancy outcome was analyzed by multivariate logistic regression.

RESULTSThe rate of normal or balanced translocation embryos in fresh cycle was higher than that in FET cycle (23.52% vs 16.67%,<0.05), and the average number of transplanted embryos was more than that in FET cycle (1.54±0.56 vs 1.33±0.51,<0.05). But there were no significant differences in pregnancy rate (36.42% vs 40.00%,>0.05), implantation rate (26.62% vs 32.91%,>0.05), abortion rate (19.44% vs 8.33%,>0.05) and live birth rate (25.96% vs 28.33%,>0.05) between fresh cycle and FET cycle. Multivariate logistic regression showed that, parent ages, embryo status (fresh or frozen), the mode of PGD/PGS and the findings of PGD/PGS had no impact on pregnancy outcome (all>0.05).

CONCLUSIONSCryopreservation do not have significant effects on the clinical outcomes of transplantable embryos after PGD/PGS in cleavage-stage.

OBJECTIVETo investigate the effect of low and high oxygen concentration on embryo development, pregnancy outcome and birth defects offertilization-embryo transfer (IVF-ET).

METHODSAccording to the oxygen concentration ofculture environment, the IVF-ET performed in the Women's Hospital, Zhejiang University School of Medicine during 2013 and 2015 were divided into low oxygen concentration group (=2036, 5% O) and high oxygen concentration group (=4617, 20% O). The rate of fertilization, good quality embryo, clinical pregnancy, ectopic pregnancy, abortion and birth defect were compared between two groups.

RESULTSThe good quality embryo rate was significantly higher in the low oxygen concentration group (<0.05). However, no significant differences were found between two groups in the rate of fertilization, clinical pregnancy, ectopic pregnancy, abortion and birth defect (all>0.05).

CONCLUSIONSLow oxygen environment may improve the potential of embryonic development, but its impact on pregnancy outcome and birth defect is not significant.

OBJECTIVETo investigate the relationship between serum/follicular fluid fetuin B levels and outcome offertilization (IVF).

METHODSInfertility women (28 with low fertilization rates, 44 with normal fertilization rates) receiving IVF in Women's Hospital of Zhejiang University School of Medicine during June and December 2016 were enrolled in the study. Serum/follicular fluid fetuin B levels were measured with ELISA method. Correlations of serum and follicular fetuin B level with fertilization outcome of IVF were analyzed with Pearson correlation coefficient and receiver operating characteristic (ROC) curve.

RESULTSA positive correlation between serum fetuin B and follicular fluid fetuin B levels was observed (=0.675,<0.01). Both serum and follicular fluid fetuin B levels in women with low fertilization rates of IVF were lower than those in women with normal fertilization rates[(6.09±1.31) μg/mL vs. (7.13±1.47) μg/mL,=3.050,<0.05; (5.13±0.96)μg/mL vs. (6.22±1.33) μg/mL,=3.755,<0.01]. ROC analysis showed that the area under curve (AUC) of serum fetuin B level in predicting fertilization rate was 0.832 (95%:0.729-0.934,<0.01), and 6.08 μg/mL could be used as cut-off value.

CONCLUSIONSSerum fetuin B level is correlated with follicular fluid fetuin B level, and it may be used for predicting the fertilization outcome of IVF.