Anorectal malignant melanomas: Retrospective experience with surgical management

AIM: To present the experience and outcomes of the surgical treatment for the patients with anorectal melanoma from the Cancer Hospital, Chinese Academy of Medical Sciences. METHODS: Medical records of the diagnosis, surgery, and follow-up of 56 patients with anorectal melanoma who underwent surgery between 1975 and 2008 were retrospectively reviewed. The factors predictive for the survival rate of these patients were identified using multivariate analysis. RESULTS: The 5-year survival rate of the 56 patients with anorectal melanoma was 20%, 36 patients underwent abdominoperineal resection (APR) and 20 patients underwent wide local excision (WLE). The rates of local recurrence of the APR and WLE groups were 16.13% (5/36) and 68.75% (13/20), (P = 0.001), and the median survival time was 22 mo and 21 mo, respectively (P = 0.481). Univariate survival analysis demonstrated that the number of tumor and the depth of invasion had significant effects on the survival (P < 0.05). Multivariate analysis showed that the number of tumor [P = 0.017, 95% confidence interval (CI) = 1.273-11.075] and the depth of invasion (P = 0.015, 95% CI = 1.249-7.591) were independent prognostic factors influencing the survival rate. CONCLUSION: Complete or R0 resection is the first choice of treatment for anorectal melanoma, prognosis is poor regardless of surgical approach, and early diagnosis is the key to improved survival rate for patients with anorectal melanoma.

Clinicopathologic characteristics and prognostic factors of 63 gastric cancer patients with metachronous ovarian metastasis

Objective： This study aims to explore the clinicopathologic characteristics and prognostic factors of gastric cancer patients with metachronous ovarian metastasis. Methods： Clinicopathologic data were collected from 63 post-operative gastric cancer patients with metachronous ovarian metastasis. The patients were admitted to the Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College between January 1999 and December 2011. A log-rank test was conducted for survival analysis. Possible prognostic factors that affect survival were examined by univariate analysis. A Cox regression model was used for multivariate analysis. Results： The incidence of ovarian metastasis was 3.4% with a mean age of 45 years. Up to 65.1% of the patients were pre- menopausal. The mean interval between ovarian metastasis and primary cancer was 16 months. Lowly differentiated carcinoma ranked first in the primary gastric cancers. The majority of lesions occurred in the serous membrane （87.3%）. The metastatic sites included Nz.3 lymph nodes （68.3%）, bilateral ovaries （85.7%）, and peritoneal membrane （73%）. Total resection of metastatic sites was performed （31.7%）. The overall median survival was 13.6 months, whereas the overall 1-, 2-, and 3-year survival rates were 52.5%, 22.0%, and 9.8%, respectively. The 5-year survival rate was zero. Univariate analysis showed that the patient prognosis was correlated with metastatic peritoneal seeding, vascular tumor embolus, range of lesion excision, and mode of comprehensive treatment with adjuvant chemotherapy （P〈0.05）. Multivariate analysis indicated that metastatic peritoneal seeding was an independent prognostic factor for gastric cancer patients with ovarian metastasis （P〈0.01）. Conclusion： Effective control of peritoneal seeding--induced metastasis is important for improving the prognosis of gastric cancer patients with ovarian metastasis.

A Decade of Scien tific and Tech no logical Inno vati on at Chin ese Academy of Medical Sciences&Peking Union Medical College:Retrospect and Prospect

Focusing on the reform initiatives of Chinese Academy of Medical Sciences(CAMS) & Peking Union Medical College(PUMC) in medical scientific and technological innovation from perspectives of deepening the reform and optimizing the ecosystem of science and technology innovation,this article summarizes the highlights of CAMS & PUMC’s efforts in safeguarding people’ s health and promoting the Healthy China 2030 strategy through scientific and technological innovation in the fields including basic research,disease prevention and treatment,and medical technology in the past ten years.These achievements embody the endeavors and responsibility of CAMS& PUMC in realizing self-reliance and self-improvement of Chinese medical science and technology and highlight its contributions to the development of medical science and technology of China.

Management of Adult Growth Hormone Deficiency at Peking Union Medical College Hospital:A Survey among Physicians

Objective To evaluate physicians' attitude and knowledge about the management of adult growth hormone deficiency(AGHD) at Peking Union Medical College Hospital and impact factors associated with better decision-making.Methods A 21-question anonymous survey was distributed and collected at Peking Union Medical College Hospital,a major teaching hospital in Chinese Academy of Medical Sciences.Data of physicians' educational background,clinical training,patient workload per year and continuing medical education in AGHD were collected.Factors associated with appropriate answers were further analyzed by multivariate regression models.Results One hundred and eighteen internal medicine residents,endocrine fellows,attending physicians and visiting physicians responded to the survey.Among them,44.9% thought that AGHD patients should accept recombinant human growth hormone replacement therapy.Moreover,56.8% selected insulin tolerance test and growth hormone-releasing hormone-arginine test for the diagnosis of AGHD.Logistic regression analysis of physician demographic data,educational background,and work experience found no consistent independent factors associated with better decision-making,other than continued medical education,that were associated with treatment choice.Conclusions The physicians' reported management of AGHD in this major academic healthcare center in Beijing was inconsistent with current evidence.High quality continued medical education is required to improve Chinese physician management of AGHD.

16 CASES OF SCALENUS SYNDROME TREATED BY MASSAGE AND ACUPOINT-INJECTION

Scalenus syndrome is a kind of thoracicoutlet syndrome. I treated 16 such cases withmassage in combination with acupointinjection from 1989-1996. The results weresatisfactory and introduced as follows.

Analysis of Prognosis and Prognostic Factors of Cervical Adenocarcinoma and Adenosqumous Carcinoma of the Cervix

OBJECTIVE To analyze clinical characteristics and treatment methods of the patients with adenocarcinoma of the uterine cervix （AUC） and adenosquamous carcinoma of the cervix （ASCC）. To compare the survival time of the patients in 2 groups and analyze the prognostic factors. METHODS Clinical data of both 123 patients with AUC and 32 patients with ASCC treated at the Cancer Hospital, Chinese Academy of Medical Science （CAMS） ＆ Peking Union Medical College （PUMC）, were retrospectively analyzed. RESULTS The median age of the AUC patients was 50 years, and that of the ASCC patients was 44, P = 0.019. Poorly-differentiated （grade 3） cases accounted for 59.5% of the total ASCC patients, while only 32.5% of the AUC patients were in grade 3, P = 0.002. In 123 AUC patients, relapse or failure of the treatment occurred in 63 of the patients （51.2%）, and the median relapse time was 6 months （0-59 months）. In 32 ASCC patients, relapse or failure of the treatment occurred in 8 of these patients （51.2%）, with a median relapse time of 4.5 months （0-52 months）. The overall 5-year survival rate of the AUC patients was 49.8%, which was significantly lower than that of the ASCC patients （74.1%）, P = 0.015. The 5-year survival rates of the ASCC patients in Stage Ⅰ-Ⅲ were higher than that of the AUC patients with the same stages. However, statistical significant difference could only be found among the patients in Stage II, P = 0.006. The 5-year survival rates of the ASCC patients with various differential grade were higher than those of the AUC patients with the same differential grade, but statistical significant difference could only be found among the patients in the two groups with moderately differentiation, P = 0.039. It was found by Cox regression analysis that only clinical stage （P 〈 0.001） and histological type （P = 0.046） were the independent prognostic factors. CONCLUSION Clinical stage and histological type were the independent prognostic factors of the AUC and ASCC patients. The prOgnosis of ASCC patients is better than that of the AUC patients.

EFFECTS OF ELECTRO ACUPUNCTURE AND TWIRLING REINFORCING-REDUCING MANIPULATIONS ON VOLUME OF MICROCIRCULATORY BLOOD FLOW IN CEREBRAL PIA MATER

Effects of electroacupuncture (EA) and routine acupuncture with twirling reinforcing and reducing manipulation of the needle (RA) both at Zusanli point (St 36) on volume of microcirculatory blood flow in the cerebral pia mater were observed by fenestration of the cranial bone and laser Doppler microcirculatory blood flow analyser. Results showed that both RA and EA could increase the volume of microcirculatory blood flow in the cerebral pia mater; and that the increase in the EA group was superior to that in RA group. This suggests that a moderate and effective stimulation is a key to the production of a regulative effect on the organism.

Discussion on the theory of paying equal attention to sinew and bone in China osteosynthesis

‘Paying equal attention to sinew and bone＇ is an important principle in China osteosynthesis （CO）. Traditional bone-setting manipulations not only pay high attention to fracture reduction, but also to sinew-regulating and soft tissues protection. The advantage of this principle has also been confirmed by modern medicine. To understand the principle better, it is essential to learn its historical origin, its important role in traumatology and its significant influence on modern orthopedics. In addition, we should inherit and further develop its theory, innovate and promote the development of CO constantly.

Liu Shih-Hao:Pioneer of translational medicine in China

Editorial comment Translational medicine is a new discipline which aims to eliminate the barrier between preclinical and clinical medicine. Here, Dr. Li discusses the application of translational medicine in the research, teaching and clinical work of Prof. Liu Shih-Hao, the founder of endocrinology in China, who was particularly renowned for his early work in calcium and phosphorus metabolism. This well-known success story can be traced back to an early appreciation of translational medicine by Prof. Liu Shih-Hao, and serves as an important and revelatory lesson for us all.

Assessing the Quality of the First Batch of Evidence-Based Clinical Practice Guidelines in Traditional Chinese Medicine

Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.

Multi-disciplinary Research in Traditional Chinese Medicine——An Exploration

This paper discusses the present state of Tra- ditional Chinese Medicine being divided into three leading lines of thought, namely, the Clinical line, the Integration of Western and Chinese Medicine line and the Development of Traditional Chinese Medicine line. It also describes the position of Tra- ditional Chinese Medicine being a medical science rich in philosophy and wisdom and a culture centred upon medical science and technology. It outlines the basic characteristic of Traditional Chinese Medicine being rooted in the ’ Holistic Theory’ and ’ Syndrome Differentiation and Treatment ’ and pointed out various flaws in methodology in Integra- tion of Western and Chinese Medicine research. It also stresses that in order to make fruitful progress in the development of Traditional Chinese Medicine, multi-discipline research in Traditional Chinese Medicine should be made on a thoroughly under- standing of the basic methodology of Traditional Chi- nese Medicine and follow its established principles.

Papers published from 1995 to 2012 by six Traditional Chinese Medicine universities in China: a bibliometric analysis based on science citation index

OBJECTIVE: The quality and quantity of published research papers are important in both scientific and technology fields. Although there are several bibliometric studies based on citation analysis, very few have focused on research related to Traditional Chinese Medicine in China. METHODS: The bibliometric method used in this study included the following focuses: publication outputs for each year, paper type, language of publication, distribution of internationally collaborative countries, sources of funding, authorization number, distribution of institutes regarding collaborative publications, research fields, distribution of out-puts in journals, citation data, and h-index. RESULTS: A total of 3809 papers published from 1995 to 2012 were extracted from the science citation index(SCI). The cumulative number of papers from all six universities is constantly increasing. The United States attained the dominant position regarding complementary and alternative medicine research. The Chinese Academy of Sciences was the greatest participator in collaborative efforts. Research field analysis showed that the research mainly focused on pharmacology pharmacy, chemistry, integrative complementary medicine, plant sciences, and biochemistry molecular biology. The Shanghai University of Chinese Medicine had the most citations. CONCLUSION: In recent years, in terms of SCI papers, the six Traditional Chinese Medicine universities studied here have made great advances in scientific research.

WFAS-CACMS-CAAM-ETCMA acupuncture experts forum was held

The WFAS-CACMS-CAAM-ETCMA acupuncture experts forum was held in China Academy of Chinese Medical Sciences on 7 September,2017.Gerd Ohmstede,Taina Alakulppi,Yves Giarmon,Guy Polak,Philip Rose-Neil,Judy James,Paddy McBride, David Miller from the European Traditional Chinese Medicine Association （ETCMA）, LIU Bao-yan, YANG Jin-sheng, YU Xiao-chun, LIU Wei-hong, HE Li- yun, ZHAO Hong, SONG Li, YANG Yu-yang, TAN Yuan-sheng, LIU Jiafrom The World Federation of Acupuncture-Moxibustion societies （WFAS）, China Academy of Chinese Medical Sciences （CACMS） and China Association ofAcupuncture-Moxibustion （CAAM） attended the meeting.

Profile of Xiyun Yan

Dr.Xiyun Yan obtained her B.S.degree in 1983,from the Henan Medical College,and then studied cell biology in Professor Shizhang Bei’s lab in the Institute of Biophysics,Chinese Academy of Sciences（CAS）until leaving for Germany in 1989.After receiving her medical doctor＇s degree from Heidelberg University in Germany,she joined the Memorial Sloan-Kettering Institute in New York as a postdoctoral research fellow.In 1997,