British Journal of General Practice2015年2月目次选登

Pushing for victory:where next for 4-year GP training?争取成功:全科医生4年期培训路在何方?The CPRD and the RCGP:building on research success by enhancing benefits for patients and practices临床实践研究数据链和英国皇家全科医师学院:利用研究成果加强患者和医疗的福利Mental health care in hospitals and primary care:an unsustainable balance     

《美国家庭医生》(American Family Physician)三月份目次选登

Reducing the Risk of Adverse Drug Events in Older Adults降低老年患者中的药物不良事件风险Diabetic Ketoacidosis:Evaluation and Treatment糖尿病酮症酸中毒:评估和治疗Identification and     

Biochemical activity and gene analysis of inherited protein C and antithrombin deficiency in two Chinese pedigrees

Background We identified the gene mutations in two Chinese pedigree of type Ⅰ hereditary protein C deficiency and type Ⅰ hereditary antithrombin deficiency.Methods The plasma level of protein C activity (PC: A), protein C antigen ( PC: Ag) , protein S activity, antithrombin activity (AT: A) and antithrombin antigen (AT: Ag) of propositi and two family members were detected using ELISA and chromogenic assay, respectively. All exons and intron-exon boundaries of protein C gene and antithrombin gene were analyzed by direct sequencing of the corresponding amplified PCR products in DNA from the propositus.Results The plasma PC: A and PC: Ag of propositus 1 was 26% and 1.43 mg/dl, respectively. The PC: Ag and PC: A of his father were normal. The decreased PC: A level was seen in his mother and 4 of his maternal pedigree. PS: A and AT: A were all normal in pedigree 1 members. A C5498T heterozygous mutation in exon 3 of protein C gene, resulting in the substitution of Arg for Trp at the 15th amino acid, was identified in propositus 1 and 8 of his relatives. The plasma AT: A and AT: Ag of propositus 2 was 48.6% and 10.4 mg/dl, respectively. The reduced AT: A and AT: Ag levels were found in his father and 5 of paternal pedigree. PC: A, PC: Ag and PS: A were all in normal range. A heterozygous 13387-9G deletion in exon 6 of antithrombin gene was identified in propositus 2. This mutation introduced a frameshift and a premature stop at codon 426 and existed in 6 members of pedigree 2.Conclusion The C5498T heterozygous mutation in exon 3 of protein C gene, first reported in China,leads to type Ⅰ hereditary protein C deficiency. The 13387-9G deletion, a novel mutation, can cause antithrombin deficiency and thrombosis.     

Study on the Sequence in Formulating Standards for Acupuncture and Moxibustion

Objective: To study which items need the formulation of national standards and which standards should be first formulated. Methods: Apply the method of the questionnaire survey to collect data, and the statistical analysis adopt the frequency and weighted average method. Results: Propose the items of acupuncture and moxibustion which need the urgent formulation of standards and the sequence in the formulation of standard items. Conclusion: Provid important bases for the follow-up report of national standard items and avoid temporary formulation of standards without plan     

SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine

OBJECTIVE: The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine(TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients.METHODS: Sim TCM presents five major attributes for simulation: representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding, and test reproducibility. RESULTS: Simulations using data from patients diagnosed with hypertension and post-stroke sensorymotor impairments yielded no signifi cant differences between expected and simulated frequencies of patterns(P = 0.22 or higher). Time for convergence of simulations varied from 9.90 s(9.80, 10.27) to 28.31 s(26.33, 29.52). The ratio iteration prof ile necessary for convergence varied between 1:1 and 5:1.CONCLUSION: This model is directly connected to forthcoming models in a large project to design and implement the SuiteTCM: Pront TCM, SciTCM, DiagTCM, StudentTCM, ResearchTCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine. The software is freely available for download at: http://suitetcm.unisuam.edu.br.     

Correlation between tobacco and alcohol use and Traditional Chinese Medicine constitutions: an analysis based on a sample from general population of China

OBJECTIVE:To investigate the relationship between smoking and drinking and constitution types from Traditional Chinese Medicine(TCM)theory.METHODS:The Constitution in Chinese Medicine Questionnaire(CCMQ)was used.A sample of 8448subjects from nine provinces and municipalities was chosen from the database of the TCM constitution and health status survey.Constituent ratio and correspondence analysis were used to find the relationship between smoking and drinking and TCM constitution.RESULTS:There was an association between smokinganddrinkingandtheGentleness,phlegm-dampness,and dampness-heat type constitutions.People that did not smoke tobacco or drink alcohol tended to have Yang-deficiency,Yin-deficiency,Qi-depression,Qi-deficiency,special diathesis,orblood-stasis type constitutions.CONCLUSION:There was a significant correlation between tobacco and alcohol use and TCM constitutions.To improve patient health,more attention should be paid to tobacco and alcohol control.     

Recovery of nitrogen and phosphorous as struvite from swine waste biogas digester effluent

Objective To investigate the feasibility of nitrogen and phosphorus recovery from swine waste biogas digester effluent and the effects of pH and NH4 : Mg2 : PO43- molar ratio on its precipitation. Methods Precipitation experiments with swine waste biogas digester effluent were conducted at pH 7.5, 8.0, 8.5, and 9.0 together with NH4 : Mg2 : PO43- molar ratios 1: 0.2: 0.08, 1: 1: 1, and 1: 1.5: 1.5. Chemical and X-ray diffraction (XRD) analysis were done to determine the composition of the precipitate. Results The highest removal and recovery of NH4 and PO43- were achieved at pH 9.0 in each experiment. The elevation of pH to 9.0 alone could decrease the initial PO43- concentration from 42 mg L-1 to 4.7 mg L-1 and 89.2% PO43- recovery was achieved. The pH-molar ratio combination 9.0-1: 1.5: 1.5 effected 76.5% NH4 and 68.5% PO43- recovery. The molar ratio of 1: 1: 1 together with pH elevation to 9.0 was determined to be the optimum combination for both NH4 and PO43- removal as it recovered over 70% and 97% of the initial NH4 and PO43-, respectively. Conclusions Nitrogen and phosphorus can be recovered from biogas digester effluent as struvite.     

Fracture healing with osteopathy in traditional Mongolian medicine

OBJECTIVE: To explore the concept and norm of fracture healing with osteopathy in traditional Mongolian medicine (TMM). METHODS: Based on the correspondence between man and the universe (including psychosomatic integration) in fracture healing with osteopathy in TMM, we used modern physio-psychological and biomechanical principles and methods to probe the integrated, dynamic and functional characteristics of fracture healing. RESULTS: Based on the integration of limbs and the body, unification of the body and function and harmony of man and nature (including psychoso-matic integration), fracture healing with osteopathy in TMM comprises the concept of natural functional healing of fractures, and follows the norm of considering physiological healing and psychological function as well as limb healing and motor function. CONCLUSION: Fracture healing with osteopathy in TMM is characterized by a lack of trauma without future complications. This therapy makes the concept of fracture healing develop in the direction of humanity, behaviorism and integration.     

Analysis on the Epidemiological Characteristics of Escherichia coli O157:H7 Infection in Xuzhou, Jiangsu, China, 1999

Objective:To determine epidemiologic features of an Escherichia coli O157:H7 outbreak occurred in Xuzhou,Jiangsu Province,China in 1999,and assess the incidence of E. coli O157:H7 in diarrhea patients and host animals and its relationship with disease onset,and provide a scientific basis for establishing prevention and control strategies. Methods: Epidemiological,microbiological,and molecular methods were performed to identify risk factors and describe the ecology of E. coli O157:H7 in the environment. Resu...     

Influence of catgut implantation at acupoints on leptin and insulin resistance in simple obesity rats

OBJECTIVES:To investigate the influence of catgut implantation at acupoints on leptin resistance(LR) and insulin resistance(IR) in the simple obesity rat.METHODS:Rats were made obese with high-fat diets,after which surgical catgut was implanted at Zusanli(ST 36) and Neiting(ST 44) acupoints once a week for 4 weeks(implantation group).Rats from the implantation group were compared with normal rats and unoperated obese rats(control group).Gene expression of the leptin receptor(OB-R) was evaluated using RT-PCR and northern blot.Serum and hypothalamus leptin and insulin(INS) levels were determined by radioimmunoassay.Body weight,Lee’s index,body fat,serum and hypothalamus leptin and INS levels,and hypothalamic OB-R gene expression were determined before and after treatment.RESULTS:Body weights,Lee’s index,body fat,and serum leptin and INS levels were significantly higher in obese than in normal rats.Hypothalamic leptin and INS levels and OB-R gene expression were significantly lower in obese rats.Catgut implantation at acupoint promoted weight loss and decreased serum leptin and INS levels.Hypothalamic leptin and INS levels and OB-R gene expression increased significantly.CONCLUSIONS:Catgut implantation at acupoint adjusts central and peripheral leptin and promotes hypothalamic OB-R gene expression.This may be an important method for regulation of LR,IR and abnormal endocrinology and metabolism.     

Experimental study on anaphylaxis of Qingkailing injection and its components on Beagle dogs

OBJECTIVE:To study the anaphylaxis of Qingkailing injection(QI) and its components.METHODS:Experimental anaphylactoid and allergic reactions were used.Changes in the behaviors of Beagles and serum levels of histamine,immunoglobulin(Ig)E,IgG,IgM,eosinophil cationic protein(ECP),and interleukin(IL)-4,as well as blood pressure,after injecting QI and its components on the forelimb veins of Beagles were observed.RESULTS:According to comprehensive determination of abnormal behavior scores and changes in serum levels of histamine,IgE,IgG,IgM,ECP,and IL-4,as well as in blood pressure,radix isatidis and hyodeoxycholic acid caused anaphylactoid reactions,and honeysuckle,radix isatidis,hydrolysate,cholic acid and Gardenia jasminoides caused allergic reactions.The anaphylaxis of QI involved anaphylactoid and allergic reactions.CONCLUSION:QI and its components need to be refined further to improve the safety,efficacy,and quality of its use in clinical settings.     

Differences in effects of Zuojin Pills (左金丸) and its similar formulas on Wei cold model in rats

Objective:To explore the effects of Zuojin Pills(左金丸)and its similar formulas on the stomach cold syndrome in a Wei cold model in rats.Methods:The rat Wei cold model was established by intragastric administration of glacial NaOH,and the gastric mucosa injury indices,together with the levels of motilin and gastrin in the stomach,were determined.The preventive and curative effects of Zuojin Pills and its similar formulas on gastric mucosa injury were investigated.Results:Zuojin Pills and its similar formul...     

Effects of Different Scraping Techniques on Body Surface Blood Perfusion Volume and Local Skin Temperature of Healthy Subjects

Objective: To study the mechanism and effects of different scraping techniques on body surface blood perfusion volume and local skin temperature of healthy subjects and to provide a baseline for microcirculation and energy metabolism for the evaluation of the therapeutic effects of scraping. Methods: Changes of the local blood perfusion volume and skin temperature of healthy subjects before and after applying different scraping techniques were observed with a laser Doppler imager combined with an infrared thermographic device and the resulting data was analyzed with imaging and processing software for statistical analysis. Results: Local blood perfusion volume and skin temperature all increased after both reinforcing and reducing scraping techniques. The value of blood flow 60 and 90 min after the reducing technique was significantly higher than that after the reinforcing technique (P<0.01), while the skin temperature increased after both techniques but was not significantly different between the two (P>0.05). Conclusion: Scraping can significantly improve the local blood perfusion volume, increase skin temperature and promote local blood circulation and metabolism of tissues.     

Relationship between serum copper and protein thiols in hyperlipidemic patients

Objective:To measure serum copper and protein thiols along with lipid profile in hyperlipidemic patients and to establish the relationship between serum copper,protein thiols and lipid profile parameters.Methods: The study group consisted of 26 newly diagnosed hyperlipidemic patients not associated with any other systemic diseases and 26 age and sex matched healthy controls.Fasting lipid profile was done by enzymatic method using automated analyzer.Serum copper and protein thiols were measured spectrophotometrically.Results: Serum copper and protein-SH levels were significantly decreased in cases(P<0.01,P<0.01) compared to controls.Serum copper correlated positively with protein thiols(r=0.800,P<0.01) and negatively with LDL cholesterol(r=-0.351 P<0.05).Conclusion: Serum copper and protein thiols were decreased in hyperlipidemia and they correlated positively indicating protective role of copper in preventing homocysteinylation of protein and hence in preventing atherosclerosis.     

Expression of Vascular endothelial growth factor (VEGF) and VEGF-C in serum and tissue of Wilms tumor

Background  Angiogenesis and lymphogenesis which were promoted by vascular endothelial growth factor (VEGF) and VEGF-C are important in the growth and metastasis of solid tumors. The high level of VEGF and VEGF-C were distributed in numerous types of cancers, but their distribution and expression in Wilms tumor, the most common pediatric tumor of the kidney, was unclear.

Methods  To learn about the distribution, mass spectroscopy and immunohistochemistry were used to measure the level of VEGF and VEGF-C in serum and tissue of Wilms tumor.

Results  The expression level of VEGF in serum of Wilms tumor was the same as in pre-surgery and control, so it was the same case of VEGF-C. Both of these factors were chiefly located in Wilms tumor tissue, but not in borderline and normal. In addition, the higher clinical staging and histopathologic grading were important elements in high expression of VEGF and VEGF-C. Gender, age and the size of tumor have not certainly been implicated in expression level of VEGF and VEGF-C.

Conclusions  The lymph node metastasis and growth of tumors resulted from angiogenesis and lymphogenesis which were promoted by VEGF and VEGF-C in Wilms tumor. The autocrine and paracrine process of VEGF and VEGF-C were the principal contributor to specific tissues of Wilms tumor but not to the entire body.

     

Downregulation of metabotropic glutamate receptors mGluR5 and glutamate transporter EAAC1 in the myenteric plexus of the diabetic rat ileum

Objective: To study the morphologic abnormalities of the myenteric plexus in diabetic rats and to explore the mechanism of their effect on gastrointestinal motility. Methods: Forty rats were randomly divided into a diabetic group and a control group, Gastric emptying and small intestine transit rates were measured and histologic and molecular changes in glutamatergic nerves in the ileal myenteric plexus were observed, mGluR5 receptor and EAAC1 transporter changes in the diabetic rats were studied using fluorescence immunohistochemistry and RT-PCR. Results:Eighteen weeks after the establishment of the diabetic rats model, gastric emptying and small intestine transit rates were found to be significantly delayed in the diabetic group when compared with the control group. The density of glutamatergic ganglia and neurons in the ileal myenterie plexus were significantly decreased in the diabetic group when compared with control group(P < 0.05) and the mGluR5 receptors and EAAC1 transporters were downregulated in the diabetic rats(P < 0.05). Conclusion: Decreased glutamatergic enteric ganglia and neurons and decreased mGluR5 receptors and EAAC1 transporters in the intestinal myenteric plexus is one of the mechanisms of diabetic gastroenteropathy in rats.     

A bio-chemical study on liver disorders among Jaundice patients from Coastal Andhra Pradesh, India

Objective:To detect types of liver disorders through biochemical studies in coastal Andhra Pradesh,India.Methods:Serum level of bilirubin(total and direct),serum glutamate oxaloacetate transaminase(SGOT),serum glutamate pyruvate transaminase(SGPT)and alkaline phosphatase(ALP)were measured among the adult men and women from a South Indian district.Standard methodologies were adopted during selection of study participants and collection and analysis of blood samples.Results:It is observed that there is no difference in the levels of bilirubin(total and direct)and ALP in male and female patients.It is observed that there are significant differences in the levels of SGOT and SGPT.Males recorded higher levels than females.Conclusion:A considerable number of patients showed increased levels of total and direct bilirubin,SGOT,SGPY and ALP.The higher levels of SGOT and SGPT among males might be due to their alcoholic habits and among men in this community.The overall liver function abnormalities may be due to dietary habits,mal-absorption,nonalcoholic fatty liver,diabetes mellitus and contaminated drinking water.     

Inhibition of cellular proliferation and induction of apoptosis in human esophageal carcinoma cell lines by extracts of Dioscorea bulbifera L and Chinese Angelica

Objective: To investigate the antiproliferative and apoptogenic activities of polysaccharides extracted from Dioscorea bulbifera L (DBP) and Chinese Angelica (CAP) and a 3:2 mixture of these compounds (DCCP) on two esophageal carcinoma cell lines, EC9706 and Eca109. Methods: A MTT assay was used to detect the effects of DBP (10 μg/ml and 100 μg/ml), DCCP(17 μg/ml and 170 μg/ml) and CAP (10 μg/ml and 100 μg/ml) on the proliferation of EC9706 and Eca109 cells. DNA content analysis by flow cytometry was used to determine the cell cycle distribution, and Annexin V-FITC/PI stained fluorescence-activated cell sorter (FACS) was used to detect the apotosis rate of treated cells. Western blots were used to examine protein levels. Results: DBP and DCCP strongly inhibited the proliferation and viability of both the EC9706 and Eca109 cells. CAP enhanced the effects of DBP. DCCP primarily arrested the EC9706 and Eca109 cells at the G1 phase of the cell cycle. DCCP induced apoptosis in both esophageal carcinoma cell lines, and reduced the expression of pIκBα and Bcl-2 proteins. Conclusion: DCCP triggered apoptosis in esophageal carcinoma cells by inhibiting the NF-κB signaling pathway.     

Biological macro-idea and criterion of osteopathic fracture immobilization in China’s traditional mongolian medicine

OBJECTIVE:To investigate the biological macro-idea and criterion of osteopathic fracture immobilization in China’s traditional Mongolian medicine.METHODS:Based on biological naturalism regarding the relationship between man and universe(including psychosomatic integration) in osteopathic fracture immobilization in China’s traditional Mongolian medicine,we used modern physiopsychological and biomechanical principles and methods to investigate the biological macro-characteristics of humanization,behaviorism,and wholism in "dynamic" fixation of fractures.RESULTS:Osteopathic fracture immobilization in China’s traditional Mongolian medicine is based on the fixation criterion of macro-idea and method as well as on geometry,mechanics,motion,and stress and psychological stability in "non-sheltered fixation" of fractures contained in the life view of nature,regarding the relationship between man and universe(including psychosomatic integration) and on harmony between the limbs and the whole body,between body and function,and between man and nature.CONCLUSIONS:Osteopathic fracture immobilization in China’s traditional Mongolian medicine is fixation without trauma or shelter.The principle and method of whole,dynamic,and functional fixation of fractures is not only radical,but also represents a new direction for developing the principle and method of fracture immobilization.