日本热衷医用蛋白质

蛋白质因其与诸多疾病有关而开始被医药产业界视为划时代新药开发的关键物质。人体内的蛋白质不仅能为肌肉、内脏等提供养分，同时也是形成各种疾病的主要原因，因此在研究基因与疾病关系的同时，开展蛋白质研究，开发与之相关的新药，对医治各种疾病将更有针对性。

Acupuncture treatment in gastrointestinal diseases: A systematic review

The purpose of this work was to assess the evidence for effectiveness of acupuncture （AC） treatment in gastrointestinal diseases. A systematic review of the Medline-cited literature for clinical trials was performed up to May 2006. Controlled trials assessing acupuncture point stimulation for patients with gastrointestinal diseases were considered for inclusion. The search identified 18 relevant trials meeting the inclusion criteria. Two irritable bowel syndrome （IBS） trials, 1 Crohn＇s disease and 1 colitis ulcerosa trial had a robust random controlled trial （RCT） design. In regard to other gastrointestinal disorders, study quality was poor. In all trials, quality of life （QoL） improved significantly independently from the kind of acupuncture, real or sham. Real AC was significantly superior to sham acupuncture with regard to disease activity scores in the Crohn and Colitis trials. Efficacy of acupuncture related to QoL in IBS may be explained by unspecific effects. This is the same for QoL in inflammatory bowel diseases （IBD）, whereas specific acupuncture effects may be found in clinical scores. Further trials for IBDs and in particular for all other gastrointestinal disorders would be necessary to evaluate the efficacy of acupuncture treatment. However, it must be discussed on what terms patients benefit when this harmless and obviously powerful therapy with regard to QoL is demystified by further placebo controlled trials.

Medical malpractice litigation related to gastrointestinal endoscopy in Japan:A two-decade review of civil court cases

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan. METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken. RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to eso- phagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%). CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

Cost of two different therapies for end-stage renal disease in northwest China

Currently,the growing number of end-stage renal disease patients in developing countries consumes a greater proportion of healthcare budget,and increasing attention is being focused on the cost-effectiveness of the procedure.We aimed to assess the cost-effectiveness of living-related renal transplantation (RTx) as compared with that for hemodialysis (HD) and identify medical factors associated with charges for RTx in northwestern China.This study was a retrospective analysis of 372 patients on regular HD and 122 living-related kidney transplant recipients on regular follow-up for at least 3 years in northwestern China.All data on charges included HD procedure,RTx procedure,the cost for donor operation,immunosuppression,and follow-up medicare.The average annual cost to all patients on HD and kidney recipients during the first 3 years after RTx was $14482/$31027,$13502/$11038,and $13382/$10243,respectively.The three variables were found to be significant in predicting increased costs for RTx:diltiazem administration,acute rejection and infection complications.We concluded that from the second year on,RTx in China was more effective and less costly than dialysis treatment,although recipients without diltiazem administration and with acute rejection or infection proved costlier during the first year after transplantation.

Prevalence of left ventricular dyssynchrony in patients with heart failure assessed by a novel programmer-cardioGRAF

Objectives Left ventricular systolic dyssynchrony is the most important determinant of response to cardiac resynchronization therapy （CRT）, playing a vital role to predict improvement of systolic function or LV reverse remodeling. CardioGRAF is a novel programmer based on the ECG gated single photon emission computed tomography （G-SPECT） imaging to detect LV systolic and diastolic dyssynchrony simultaneously. This study was to investigate the prevalence of systolic and diastolic left ventricular （LV） dyssynchrony in patients with heart failure. Methods We retrospectively studied 69 patients with heart disease, including 31 patients who had symptoms of heart failure （NYHA class Ⅱ-Ⅲ）, and 38 patients who had no symptoms of heart failure. （NYHA class Ⅰ）. G- SPECT data were analyzed by cardiaGRAF, and measurements included the time to end systole （TES）, the time to peak ejection （TPE）, the time to peak filling （TPF）, TES＋TPF and maximal difference （MD） of each parameters were obtained, using the 95th percentile of the control group as a cutoffof 150 ms for MD-TES, 139 ms for MD-TPE, 345 ms for MD-TPF and 315 ms for MD-TES＋TPF. Results The prevalence of LV systolic dyssynchrony was significantly higher in heart failure patients with reduced LV ejection fraction （LVEF）〈45% （72% for MD-TES; 64% for MD-TPE） compared with heart failure patients with preserved LVEF=45% （14% for both MD-TES and MD-TPE; P=0.002, P=0.005, respectively）; The prevalence of MD-TES〈150 ms was higher in NYHA class Ⅲ patients （64%） compared with NYHA class Ilpatients （27%, P=0.049）. However, the prevalence of the LV diastolic dyssynchrony were high but not difference between NYHA class III（47% for both MD-TPF and MD-TES＋TPF） and class Ⅲ（63% for MD-TPF; 69% for MD-TES＋TPF; P=NS） patients as well as between patients with preserved LVEF （43% for both MD-TPF and MD-TES＋TPF） and patients with reduced LVEF（64% for MD-TPF; 72% for MD-TES＋TPF; P=NS）. Conclusions The prevalence of LV systolic dyssynchrony was high in heart failure patients with reduced LVEF. Diastolic dyssynchrony was common in patients with heart failure. CardioGRAF maybe a useful method to detect LV dyssynchrony （J Gerlatr Cardio12009; 6：151-156）.

Measurement of Tip Trajectories in the Cardiac Reentry

Reentrant impulse in the myocardium is considered to be a major factor promoting electrophysiological abnormalities or even leading to ventricular tachycardias (VTs) and ventricular fibrillations (VFs). Tip trajectory of the reentrant wave can reflect stability of the electrical propagation and area of the reentrant movement, thereby being considered as one of the most concerned parameters in studying electrical activities during VT/VF. The purpose of the present study is to propose a practical method to find out tip trajectories using a computational approach. In this study Luo-Rudy 1991 mathematical model of the ventricular cell was used. The operator splitting method was utilized to integrate the partial differential equations in the two-dimensional tissue. And spiral waves were initiated by the cut wave front technique. Through experiments we found it was difficult to find out the tips by finding intersection of the two isovoltage lines as proposed in most papers. Therefore, we suggested that tip points were detected by seeking the shortest distance of the two adjacent isovoltage contour lines. The results showed that tip trajectories of these spiral waves found in our way were very near to the tips observed, implying validation of our method in measuring tip trajectories in cardiac reentry.

The progress of research in medical-image assessment system of melasma

Melasma, a kind of damaging disease, is commonly found in women during reproductive age. It causes great harm to patient＇s confidence and, has an effect on social contact as well. Melasma has been cured effectively by modern medicine and traditional Chinese medicine so far, in contrast, the treatment analysis system is far from flawless. Our research team is going to cooperate with Beijing University of Aeronautics and Astronautics and develop a computer-vision treatment analysis system for facial dermatosis based on present technology. It＇s supposed to provide clinical doctors with objective standards for melasma and other facial dermatosis.

Localization of Auricular Projection Area of the Liver and Its Use in the Monitoring of Viral Hepatitis

Background： Pathology of an internal organ causes significant rectification of electrical currents （diode phenomenon） in related skin areas once the resistance ＇breakthrough effect＇ has been induced in the skin. Objective： Localization of auricular projection area of the liver and evaluation of its usefulness in the monitoring of viral hepatitis. Design, Patients and Setting： Comparative study of the degree of electrical rectification measured at various spots in the auricular concha region, in 19 inpatients with hepatitis B and 15 clinically healthy volunteers, at the Department of Infectious Diseases, Provincial Teaching Hospital, Tychy, Poland. Intervention： Evaluation of electrical rectification at various spots on the auricular concha using a ＂rectification ratio＂ that quantifies the degree of rectification （normal range： 0-60%）. Main outcome measure： The location of the skin area where a statistically significant difference existed between the rectification ratios was observed in patients （82±12% at the time of the ＇peak period＇） versus controls （42±8%）. Results： A location was identified on the ear auricle where the electrical rectification phenomenon demonstrated a dependence on the presence of hepatitis. Conclusions： Liver projection area exists on the ear auricle which is located within the region of cymba conchae, next to anthelix and the cavity of concha. The existence of viral hepatitis causes this skin area to show a higher degree of electrical rectification once the skin resistance ＇breakthrough effect＇ has been induced. Evaluation of the rectification phenomenon of the liver proiection area provides a method of non-invasive monitoring of viral hepatitis.

Cardiac catheterisation in nonagenarians： Single center experience

Objective To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. Methods We retrospectively studied 32 patients ≥ 90 years （93.0 ± 1.2 years） who underwent cardiac catheterisation in a tertiary specialist hospital （0.2% of 14,892 procedures during three years）. The results were compared to a patient cohort younger than 90 years of age. Results Baseline characteristics revealed a higher prevalence of diabetes （P 〈 0.001）, chronic obstructive pulmonary disease （P 〈 0.04）, previous myocardial infarction （P 〈 0.02）, and complex coronary anatomy （SYNTAX score 33 vs. 19） in nonagenarians. Patients 〈 90 years of age showed more hyperlipidemia （P 〈 0.01） and previous percutaneous coronary interventions （P 〈 0.015）. Nonagenarians underwent coronary angiography more often for acute coronary syndrome （ACS） （P 〈 0.003）, were presented more often in cardiogenic shock （P 〈 0.003）, and were transferred faster to coronary angiography in cases ofACS （P 〈 0.0001）. The observed in-hospital mortality rate （13% study group vs. 1% control group; P 〈 0.003） in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction （TIMI） and global registry of acute cardiac events （GRACE） mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. Conclusion Despite the common scepticism that cardiac catheterisation exposes patients 〉 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.

Survey on skin aging status and related influential factors in Southeast China

Objective： To investigate cutaneous aging patterns of residents in Hangzhou, Zhejiang, China, and their contributing factors. Methods： Eight hundred and forty-eight Hangzhou residents received the survey between March 2004 and September 2004. Results： Facial wrinkling first occurred at 21 years of age and skin elasticity began to lose at 22 years of age. In middle-aged and old people, facial wrinkling and looseness escalated with the increase of ultraviolet （UV）-exposure time, indicating the accelerating effect of a higher accumulative dose of UV radiation on skin aging. Only Fitzpatrick types Ⅱ, Ⅲ and Ⅳ were found in the skin phototypes of residents in Hangzhou area, and Fitzpatrick type Ⅱ seemed to be much more subject to severe wrinkling, elasticity destruction and skin tumors than types Ⅲ and Ⅳ. The oily skin was more protected against wrinkling and facial looseness than dry skin. However, as to concomitant cutaneous diseases, no difference was found among different skin types. Conclusion： Age, solar-exposure time, Fitzpatrick type and skin type are the associated forces in promoting skin aging, and emotional factor seems to be another independent risk factor. The age of 49 years and 2 h/d of solar-exposure time seem to be the turning points responsible for dramatic changes of cutaneous appearance in the process of skin aging in Southeast China.

TCM Non-medicinal Therapy for Regulation and Treatment of Chronic Fatigue Syndrome

Chronic fatigue syndrome （CFS） is a severe issue to influence the psychosomatic health of the mankind. With the social development, because of the enhancement of the medical and hygienic levels and improvement of the life quality, people pay an increasing attention to the issue of CFS. How to solve CFS, currently due to limitation in the theory of Western medicine, there is no concrete therapeutic method, in addition to the suggestion to change bad life style, regulate the psychological status and pay attention to proper balance between fatigue and physical exercise. But, TCM non-medicinal therapies have unique advantage and remarkable therapeutic effect in the elimination of CFS. Now, current-used TCM non-medicinal therapies for sub-health are summarized in the following.

Effect of Jianpi therapy in treatment of chronic obstructive pulmonary disease:a systematic review

OBJECTIVE： To evaluate the efficacy of Jianpi thera- py in Traditional Chinese Medicine （TCM） for treat- ment of chronic obstructive pulmonary disease （COPD） in stable phase by performing a systematic review and meta-analysis. METHODS： The literatures concerning randomized controlled trials （RCTs） and quasi-RCTs comparing TCM treatment plus Western Medicine （WM） treat- ment with TCM alone, orTCM treatment vs no treatment, placebo for stable phase of COPD were searched in PubMed （1990-December 2010）, in Eng- lish and using Chinese National Knowledge Infra- structure （CNKI, 1990-December 2010）, Chinese Bio- medical Database （1990-December 2010）, Wang- fang Database （1990-December 2010）, and Weipu （VlP） Database in Chinese. The quality assessment and data extraction for RCTs were conducted by two reviewers independently. Jadad scale and allo-cation concealment were used to assess the quality of the included studies, and meta-analyses were conducted with the Collaboration＇s Revman 5.0 software. RESULTS： Seventeen RCTs or quasi-RCTs involving 1269 patients were included. The methodological quality was poor in all trials except one trial （Jadad score=4）. In the meta-analysis, TCM-WM treatment was significantly superior to WM treatment in cure rate [0R=3.82, 95%C/（2.45, 5.95）], and the effective rate between TCM treatment and placebo also had significant difference [0R=4.31, 95%C/（2.35, 7.91）]. Moreover, pulmonary function of the patients in TCM-WM group and TCM group was significantly improved [forced vital capacity （FVC）, P=O.01, quali- ty of life, P〈O.O01 ]. CONCLUSION： The experience in TCM-WM treat- ment of COPD in stable phase was encouraging. The current evidence shows that TCM-WM treat- ment might be more efficient in effective rate, qual- ity of life, and FVC than WM treatment alone. But for forced expiratory volume in one second （FEVl） and FEV1/FVC, no matter TCM-WM treatment com- pared with WM treatment alone or TCM treatment compared with placebo, there was no significant difference, with no obvious adverse reactions. Due to the low methodological quality of trials includ- ed, more RCTs of high quality in large scale are re- quired.

Effects of therapies for regulating and reinforcing lung and kidney on osteoporosis in rats with chronic obstructive pulmonary disease

OBJECTIVE:To evaluate the efficacy and long-term effects of the three therapies for regulating and reinforcing lung and kidney(reinforcing lung and invigorating spleen,reinforcing lung and replenishing kidney,and supplementing Qi and nourishing kidney) in Traditional Chinese Medicine(TCM) on osteoporosis in rats with chronic obstructive pulmonary disease.METHODS:Totally 120 rats were randomly divided into control,model,Bufeijianpi,Bufeiyishen,Yiqizishen,aminophyline groups.Repeated smoke inhalations and bacterial infections were used to duplicate the stable Chronic obstructive pulmonary disease rat model.Normal saline was given to the air control and model groups,while Bufeijianpi granule,Bufeiyishen granule,and Yiqizishen granule,and aminophylline were administrated to rats in the Bufeijianpi,Bufeiyishen,Yiqizishen,and aminophylline groups respectively from weeks 9 through 20.Another 12 weeks without medicines to observe the long-term effect.Rats were sacrificed at week 20 and week 32.Bone mass density(BMD),bone mineral content(BMC),morphology of the femoral head,lung function,and levels of serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-a were detected.RESULTS:At weeks 20 and 32,tidal volume,peak expiratory flow and expiratory flow at 50% tidal volume in the three TCM-treated groups were higher than those in the model group(P < 0.05).Femur weight,BMD,and BMC were significantly higher in the three TCM-treated groups and the aminophylline-treated group compared with the model group(P < 0.01),except for BMC in the Yiqizishen-treated group at week 20.CONCLUSION:Bufeijianpi,Bufeiyishen,and Yiqizishen granules show good effects in the prevention and treatment of osteoporosis,which can alleviate airflow limitations and inflammation,improve BMD and BMC of the femur,and have favorable long-term effects.

Therapeutic effect in patients with coronary heart disease based on information analysis from Traditional Chinese Medicine four diagnostic methods

OBJECTIVE:To study information gained by Traditional Chinese Medicine(TCM)four diagnostic methods and characteristics of syndrome development before and after treatment in patients with coronary heart disease,and to probe into assessment indexes of therapeutic effects with distinctive TCM features.METHODS:Information from the four diagnostic methods before and after treatment in 100 patients with coronary heart disease was collected using the TCM interrogation scale,a pulse condition instrument,a tongue-face diagnosis instrument,anda voice diagnosis information collection system.Changes in the four diagnostic method results from before and after treatment were analyzed with frequency analysis and t-test methods.RESULTS:Before treatment,deficiency syndrome complicated with hyperactivity of pathogenic factors was most common.After treatment,deficiency syndrome was most common.This change from complex syndromes to single syndromes indicates disease and syndrome alleviation.Frequencies of symptoms gained by interrogation after treatment for syndrome of deficiency of heart-Qi,syndrome of deficiency of heart-Yin,and turbid phlegm syndrome were all less severe than those before treatment.Parameters of face color,color on all sub-regions of tongue,color of tongue fur,septic and greasy fur,and lip color after treatment all had significant changes.After treatment,part of the voice diagnosis parameters in the deficiency of heart-Yin and turbid phlegm syndromes had significant changes,but no significant changes were found in the deficiency of heart-Qi syndrome.CONCLUSION:Use of the TCM four diagnostic methods can provide an effective basis forTCM syndrome diagnosis,observation of development of state of illness,and evaluation of clinical therapeutic effects.

Mortality and recurrence of vascular disease among stroke patients treated with combined TCM therapy

OBJECTIVE:To confirm the long-term outcomes of stroke patients and determine predicting factors for death,recurrence of vascular events and poor outcome(either recurrence or death) after the use of combined TCM therapy.METHODS:This was a retrospective hospital-based cohort study and was performed in the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine in Tianjin.All subjects with stroke consecutively admitted to an inpatient ward of the Acupuncture Department from January 1,2008,to December 31,2008 were retrospectively followed through one year.The main outcomes were either a recurrence of vascular events,,mortality or both.Risk factors were recorded from medical records.Multivariate regression models were used to analyze predictors.The following independent variables were used:age,gender,hypertension,ischemic heart disease,atrial fibrillation,diabetes mellitus,carotid arterial lesions and history of stroke.RESULTS:Four-hundred and five patients were included.The 1-year mortality rate was 11.11%.23.70% of the patients had a recurrent vascular event,and 30.86% suffered a poor outcome.Multiple logistic regression analysis found that previous stroke,and advanced age were predictors of death within one year,Recurrence of vascular events was associated with carotid arterial lesions,history of diabetes and previous stroke.Long-term poor outcome was predicted by advanced age,history of diabetes,and previous stroke.CONCLUSION:Age,previous stroke,carotid arterial lesions and diabetes history seem to have different impacts on the three outcomes within one year.Our findings provide important data for planning future hospital register studies of stroke patients in TCM hospitals.