Ethic analysis of the role of incentive system in the organ donation after citizen’s death / 器官移植

Organ transplantation has demonstrated its significant values by its excellent effectiveness in health reconstruction and life survival, where organ donation is a major component in promoting the development of organ transplantation in China. In recent years, an important progress has been made in organ transplantation in China with an annually increased organ donation rate. In spite of this, there is a serious fact confronted by us that the donated organ quantity is insufficient, which may be solved by further improvement of medical science and public health policy. According to the international experience, an incentive system may improve the organ donation rate effectively although the hidden ethic property of the incentive system itself may have an essentially conflict with the altruism contained in the organ donation. Therefore, in this article, the property of the incentive system, the interaction between organ donation and incentive system and the ethic justification of the system was reviewed, aiming to provide a reference for the further development of the organ donation and transplantation business in China.

Oocyte cryopreservation for non-medical reasons: Ethical and regulatory concerns in China.

Assisted reproductive technology is a complex medical intervention with many potential social sensitivities. Within this domain, oocyte cryopreservation has emerged as an important research area for preserving female fertility. Against the backdrop of the hotly debated first legal case in China of a single woman wishing to freeze her eggs, and the implementation of the 'three-child policy' in China, there is an urgent need to evaluate policies and address ethical considerations surrounding oocyte cryopreservation for non-medical reasons. This review examines current policies, explores China's practices and research, and examines the latest ethical challenges surrounding non-medical oocyte cryopreservation. It develops strategies and recommendations that will be relevant in China and other developing countries seeking to navigate this complex landscape.

Dynamic monitoring of scar changes by B-mode ultrasound / 中华医学美学美容杂志

Objective:To study the application of B-mode ultrasound in objective evaluation and dynamic monitoring of scar.Methods:The subjects were patients with scar in the outpatient and inpatient department of plastic surgery in the First Affiliated Hospital of Zhengzhou University from March 2018 to June 2020. According to the type of scar, they were divided into 3 groups: 21 patients in the normal scar group, 23 patients in the hypertrophic scar group, and 15 patients in the keloid group. All 59 patients were regularly scanned by B-mode ultrasound for scar images and the scar thickness was measured.Results:B-mode ultrasonic images of scars were analyzed in each group: The echo intensity of dermis of normal scar was uneven, hypertrophic scar and keloid dermis showed obvious hypoecho, and some cases of keloid presented a small amount of blood flow. There was no significant change in the ultrasonic images of scar in each group within 1 year. Changes in scar thickness were observed in each group. The normal scar thickness did not change significantly within 1 year. The thickness of hypertrophic scar showed a trend of first increasing and then stabilized within 1 year.Conclusions:B-mode ultrasound can assist to identify different scar types according to ultrasonic performance. B-mode ultrasound can be used to measure scar thickness objectively and accurately and monitor the dynamic changes of scars.

Circ_0002770, acting as a competitive endogenous RNA, promotes proliferation and invasion by targeting miR-331-3p in melanoma.

Melanoma is a kind of tumor that originates from melanocytes and is characterized by chemoresistance and distant metastasis. Although the complete pathogenesis of melanoma remains unclear, increasing evidence suggests that circular RNAs (circRNAs) may be involved. In the present study, we identified a circular RNA, circ_0002770, which is produced from the well-known oncogene MDM2, and was sharply increased in melanoma and correlated with a poor prognosis. Knockdown of circ_0002770 suppressed melanoma cell invasion, migration and proliferation. Mechanistically, circ_0002770 acted as a sponge of miR-331-3p and could indirectly regulate DUSP5 and TGFBR1. Inhibition of miR-331-3p reversed the inhibitory effect of si-circ_0002770 on melanoma cell proliferation and invasion. In vivo evidence further confirmed that silencing circ_0002770 inhibited melanoma tumor formation. In conclusion, circ_0002770 facilitated melanoma cell proliferation, invasion and migration by sponging miR-331-3p and modulating DUSP5 and TGFBR1.

Botulinum toxin type A injections in the facial plastic surgery incision: a meta-analysis / 中华医学美学美容杂志

Objective:To systematically evaluate the influence of botulinum toxin type A (BTXA) injections in the facial plastic surgery incision.Methods:A systematic literature search for studies which were published on PubMed, EMbase, Cochrane Central, CNKI and VIP, was performed from January 1998 to Octomber 2019. " Facial wound" , " Keloid" , " Scar" , " Cicatrix hypertrophy" , " Botulinum toxin" , " Boutulin" , " Botox" were set as the key words. We included trails related to the influence of botulinum toxin type A (BTXA) injections in the facial plastic surgery incision. The data were extracted and Rev Man 5.3 was used for meta-analysis.Results:Participants included seven randomized controlled trial of 450 patients. The Vancouver scar scale score of BTXA group was higher than those in the control group ( Z=23.92, P<0.01). The visual analogue scale score of BTXA group was higher than that of the control group ( Z=8.60, P<0.01). The scar width of BTXA group was less than that in the control group ( Z=10.84, P<0.01). Patients＇ satisfactory rate of BTXA group was higher than that of the control group ( Z=2.83, P<0.01). Conclusions:The injection treatment of BTXA for facial hyperplastic scar has certain curative effect, without obvious side effects, but the authenticity and stability of therapeutic effect have to be verified by more high quality research.

Keloidal cutaneous fibrohistiocytic tumor: a clinical analysis / 中华医学美学美容杂志

Objective:To investigate the clinical and pathological features and immunophenotyping of keloidal cutaneous fibrous histiocytoma (FH) and dermatofibrosarcoma protuberans (DFSP) to provide evidence for clinical diagnosis and treatment.Methods:The clinical data were colleceted from March 2015 to March 2019 and retrospectively analyzed, including 12 cases of FH, 5 males and 7 females, aged 14-76 years, with average age (37.67±17.71) years and 9 cases of DFSP, 5 males and 4 females, aged 19-64 years, with average age (42.56±13.82) years. The clinical manifestations, histopathological features and immunophenotyping of FH and DFSP were compared.Results:The clinical manifestations of all cases were keloid-like lesions. All patients underwent surgical treatment. 12 cases of FH were diagnosed in the postoperation routine pathological examination and immunohistochemical staining, CD68 was positive in 10 cases, 9 cases of SMA were positive and all of S-100 were negative. 9 cases of DFSP were diagnosed and 2 cases were fibrosarcomatous DFSP among them. For the 7 cases of DFSP, CD34 were all positive, 5 cases of CD68 were negative, 6 cases of SMA were negative. For 2 cases of fibrosarcomatous DFSP, CD34, CD68 and SMA were all negative. During the follow-up period from 6 months to 4 years, there was no recurrence of FH cases, and 3 cases of DFSP recurred, 2 cases were fibrosarcomatous DFSP among them, and 1 case of fibrosarcomatous DFSP presented distant metastasis.Conclusions:The clinical manifestations and pathological features of some FH and DFSP are similar to keloids in a certain extent, and there is a little difficulty for clinical differential diagnosis. Early diagnosis and standardized treatment are crucial for prognosis.

Association between ADAM33 gene polymorphism and keloid in Chinese Han population in Henan / 中华医学美学美容杂志

Objective:To investigate the association between the polymorphism in a disintegrin and metalloprotease 33 (ADAM 33) gene and keloid in the Chinese Han population from Henan Province. It may provide a new theoretical basis for the prevention and treatment of keloids at the genetic level.Methods:There were 84 patients with keloid and 78 patients with hypertrophic scar in this group.We selected 3 SNPs in ADAM33 gene and detected the sample genotypes by Mass ARRAY system to compare genotype and allele frequency differences at each locus.Results:There were no significant differences in gender and age of two groups ( P>0.05). The genotypes of 3918394 (L1) and rs574174 (ST+ 7) locus in the two groups of ADAM33 gene were consistent with the Hardy-Weinberg genetic equilibrium law ( P>0.05), while the genotypes of rs597980 (ST+ 5) locus in the two groups of ADAM33 gene were not consistent with the Hardy-Weinberg genetic equilibrium law. There was a significant difference of genotypes or alleles in L1 locus between keloid and hypertrophic scar groups ( P<0.05). No significant differences were detected of genotypes or alleles in ST+ 7 locus between two groups ( P>0.05). In addition, there was a significantly difference of GG genotype and G allele between keloid and hypertrophic scar groups ( χ2=6.387、6.117, all P<0.05). There was no significantly difference of all genotypes and alleles in ST+ 7 locus between two groups ( P>0.05). There was weak linkage disequilibrium between ST+ 7 and L1 locus in ADAM33 gene. Haplotype analysis showed that haplotype Hap2 (CA) in keloid group was much lower than hypertrophic scar group ( χ2=6.752, P<0.05). Conclusions:The polymorphism of the L1 locus in the ADAM33 gene may have significant associations with keloid in the Chinese Han population from Henan Province, while the ST+ 7 locus may have no significant associations with that. The GG genotype and G allele of L1 locus is a risk factor for keloids and increases the risk of keloids. The susceptible and protective haplotypes of keloid may exist in Chinese Han population from Henan Province.

Training can promote the recovery of gastrointestinal function after radical cystectomy for elderly bladder cancer patients / 中华物理医学与康复杂志

Objective:To explore the effect of comprehensive gastrointestinal training on the recovery of gastrointestinal function after radical cystectomy (Bricker′s operation).Methods:Seventy-one elderly bladder cancer patients who had undergone Bricker′s operation were randomly divided into a control group of 34 and an observation group of 37. Both groups were given routine treatment, while the observation group was additionally provided with comprehensive gastrointestinal training immediately after the operation. Plasma gastrin was measured before the operation and on the 1st and 3rd day afterward. The return of peristaltic sounds, the exhausting and defecation time, the incidence of intestinal obstruction and the average hospital stay were recorded. On the 7th, 14th, 21st and 28th day after the operation, both groups′ gastrointestinal functioning was scored by using Gastrointestinal Symptom Rating Scale (GSRS).Results:The levels of plasma gastrin in the observation group were significantly higher than before the surgery and significantly higher than those in the control group on the 1st and 3rd day after the surgery, though there had been no significant difference between the two groups before the operation. Compared with the control group, peristaltic sounds returned significantly earlier in the observation group (after 1.22±0.15d), and the group′s exhaust time (1.88±0.22d) and first defecation time (2.95±0.19d) were also better. The incidence of intestinal obstruction (23.53%) was significantly lower in the observation group as well. The observation group recorded lower average GSRS values than the control group throughout the observation and follow-up periods, and their average hospital stay was significantly shorter.Conclusion:Comprehensive gastrointestinal training can effectively promote recovery after radical bladder cystectomy.

Discussion on Security Technology Ethics / 中国医学伦理学

After "9·11" incident,the profound changes and rapid development in the fields of society,poli-tics and economy have made the response to terrorism and crime prevention become a focus,and the security tech-nology has received great attention.This paper discussed the ethical principles of evaluating the action in the field of security technology,balanced the relationship between security and freedom,analyzed the conditions that the re-striction of individual freedom can be defended in ethics,and finally proposed the suggestions on standardizing se-curity technology,including clarify supervision responsibility and establish or improve judicial supervision;take nec-essary,effective and proportionate monitoring measures;the joint application of ethical and legal evaluation criteria to build or rebuild trust.

Discussion on Privacy Protection in the Application of Biometric Identification Technology / 中国医学伦理学

First of all,this paper summarized the new features of privacy in the context of biometrics identifica-tion,namely the permanence of biometric information,the concealment of biometric information infringement,and the disclosure to medical information. Secondly,this paper analyzed the challenges faced by privacy protection from three aspects of database security,function creep and informatization of the body. Finally,from the perspective of ethics,this paper put forward some management suggestions for the privacy protection problems brought by the ap-plications of biometric identification technology.

Guideline Formulation of the Off-label Use of Drugs Based on Evidences / 中国药房

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

Precision Medicine: Ethical and Regulatory Challenges / 中国医学伦理学

This article describes the definition of precision medicine and the American and Chinese precision medicine initiatives.It then discussed ethical and regulatory challenges raised by precision medicine.These challenges include cost-effectiveness ratio evaluation for precision medicine initiatives,risk-benefit ratio in precision medicine,valid informed consent for research participants,independent ethical review of precise prevention and treatment protocols,protection of individual privacy data,mass data sharing and equitable access of research results.

Physicians' attitude toward the withdrawal of life-sustaining treatment: A comparison between Korea, Japan, and China.

End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians' perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status.

Privacy Protection in the Context of E-health / 中国医学伦理学

E-health was referred as the use of internet and ICT ( information and communication technology) for health in this paper, which mainly encompassed electronic health record, online health information and tele-health. The paper summarized the new characteristics of privacy of e-health, and presented current privacy issues raised by these applications. The major privacy concerns were unauthorized access to and secondary use of privacy data. The paper put forward some governance suggestions of privacy protection.

Clinical efficacy of expanding flap for large hyperplastic scar on scalp / 中华医学美学美容杂志

Objective To observe the efficacy and safety of implantation of tissue expanders for large hyperplastic scar on scalp.Methods Between June 2011 and April 2013,a total of 23 patients with large hyperplastic scar received treatment with 31 tissue expanders.The scar size varied from 5.5 cm × 4.0 cm to 17.5 cm ×9.5 cm.The capacity was 50-400 ml for expanders,with the shape of kidney or ellipse.After tissue expansion for 6 to 8 weeks,the expander was removed and hyperplastic scars were resected,followed by the repair of defect with expanded flaps.Further more,the patients received postoperative superficial isotope irradiation after the surgery.Follow-up varied from 6 to 12 months.Results Thirty expanders,except l expander pocket that was removed ahead of time due to infection,were implanted successfully during the whole course of treatment.The main complication was expander exposure in 4 patients,which showed no significant influence on secondary surgery.Twenty patients reported relief of symptoms and achieved satisfactory outcomes,while 3 patients showed great suture tension and experienced delayed stitch removal,followed by the recurrence of hyperplastic scar after the operation.Conclusions The implantation of tissue expanders under the scalp skin is an ideal treatment option for large hyperplastic scar on scalp.Regional suture tension is a direct contributor to the recurrence of hyperplastic scar formation after surgical excision.

Construction and identification of an RNA interference lentivirus vector targeting the Ras homology C gene of melanoma cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Melanoma has the highest mortality among all superficial malignant tumors. The poor prognosis is due to its high metastasis rate and the lack of therapeutic targets. As a molecular switch that controls tumor metastasis, Ras homology C (RhoC) has been correlated with tumor progression, especially tumor invasion and metastasis. However, little research has been done about the effects of RNA interference (RNAi) targeting RhoC on the invasion and metastasis of melanoma. In this study, we constructed an RNAi lentivirus vector targeting the RhoC gene of melanoma cells and identified its silencing effects on the RhoC gene.</p><p><b>METHODS</b>Based on the RhoC gene encoding information, three pGPU6/GFP/Neo-short hairpin (shRNA) plasmids were constructed. After detecting their silencing effects on the RhoC gene of A375 cells, the most effective pGPU6/GFP/Neo-shRNA plasmid was packed with lentivirus to construct the recombinant pLenti6.3-EGFP-453 targeting RhoC. The lentivirus vector was used to infect A375 cells, and then the expression of RhoC mRNA and protein were determined with real-time PCR and Western blotting.</p><p><b>RESULTS</b>The plasmids pGPU6/GFP/Neo-shRNA 336, pGPU6/GFP/Neo-shRNA 453, and pGPU6/GFP/Neo-shRNA 680 were constructed. After they were transfected into A375 cells, the expressions of RhoC mRNA and protein were 1.47 ± 0.26, 1.13 ± 0.16, 1.39 ± 0.11 and 70.98 ± 9.21, 50.67 ± 6.06, 65.77 ± 4.06, respectively. pGPU6/GFP/Neo-shRNA 453 was the most effective sequence, and was used to successfully construct the pLenti6.3-EGFP-453 lentiviral vector targeting RhoC. pLenti6.3-EGFP-453 was used to infect A375 cells. The expression of RhoC mRNA and protein were 1.05 ± 0.05 and 62.04 ± 15.86 in the lentivirus group, 4.21 ± 0.24 and 220.86 ± 24.07 in the negative lentivirus control group, and 4.63 ± 0.32 and 257.39 ± 12.30 in the normal control group respectively with the difference between the lentivirus group and the control groups being statistically significant (P < 0.05).</p><p><b>CONCLUSION</b>The successfully constructed pLenti6.3-EGFP-453 vector targeting the RhoC can effectively infect human melanoma A375 cells in vitro, and significantly inhibit the RhoC mRNA and protein expression.</p>

A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan.

PURPOSE: The debate about the end-of-life care decision is becoming a serious ethical and legal concern in the Far-Eastern countries of Korea, China and Japan. However, the issues regarding end-of-life care will reflect the cultural background, current medical practices and socioeconomic conditions of the countries, which are different from Western countries and between each other. Understanding the genuine thoughts of patients who are critically ill is the first step in confronting the issues, and a comparative descriptive study of these perspectives was conducted by collaboration between researchers in all three countries. METHODS: Surveys using self-reporting paper questionnaire forms were conducted from December 2008 to April 2009 in Korea (six hospitals in two regions), China (five hospitals in four regions) and Japan (nine hospitals in one region). The subjects were patients who were critically ill who had been diagnosed as having cancer. A total of 235 participants (Korea, 91; China, 62; Japan, 52) were eventually recruited and statistically analysed. RESULTS: Most respondents had sometimes or often thought of their own death, mostly fear of 'separation from loved ones'. They wanted to hear the news regarding their own condition directly and frankly from the physician. A quarter of them preferred making end-of-life care decisions by themselves, while many respondents favoured a 'joint decision' with their family members. The most favoured proxy decision maker was the spouse, followed by the children. Most admitted the necessity of 'advance directives' and agreed with artificial ventilation withdrawal in irreversible conditions. The most common reason was 'artificial prolongation of life is unnecessary'. Most respondents agreed with the concept of active euthanasia; however, significant differences were sometimes observed in the responses according to variables such as patient's country of origin, age, gender and education level. CONCLUSION: Patients in Far-Eastern countries gave various responses regarding end-of-life care decisions. Although familial input is still influential, most patients think of themselves as the major decision maker and accept the necessity of advance directives with Westernization of the society. Artificial ventilation withdrawal and even active euthanasia may be acceptable to them.

Pathogenesis of keloids and its related factors of recurrence: a clinical analysis of 476 cases / 中华医学美学美容杂志

Objective To study what affect the incidence and recurrence of keloids. Methods A total of 476 cases were treated with surgery plus adjunctive radiation therapy, intraleisional injection of triamcinolone acetonaide acetate, or surgery plus postoperative topical medicine. The family history and other clinical data were analyzed, including patients' age, sex, the duration of keloids, initiating factors, location, size, treatment method, and recurrence of the keloids. Results Keloids occurred in both male and female with the rate of 1. 83 ∶ 1. 00, with a predominance in woman aged from 22 to 45 years old. Trauma and pierce were the most significant initiating factors. The recurrence was affected by patients family history, treatment methods and the location of keloids, and less affected by keloids size, patients' age and sex. Conclusions Both surgery following adjunctive radiation therapy and intraleisional Kenalog injection are useful methods, which are prior to surgery plus postoperative topical medicine. The keloids incidence has a preponderance in some patients with family history. Therefore,genetic research is important to identify the pathogenetic factors in the keloids.

Measurement of microvessel density (MVD)and its relationship with expression of survivin mRNA in pathologic scar / 中华医学美学美容杂志

Objective To study the mierovessel density (MVD) marked by CD105 and expression of survivin gene in pathologic scar, and to investigate the function of oncogenes in tumorigenic process and abnormal scarring. Methods In situ hybridization and immunohistoehemical methods (SP technique) were used to detect survivin mRNA, CD105-MVD in 40 pathologic scar cases, 20 normotrophic scar cases, and 20 normal skin cases, respectively. The relationship between the expression of survivin mRNA and CD105-MVD in 40 pathologic scar cases were analyzed. Results Compared with normotrophic scar and normal skin cases, the expression of survivin mRNA, CD105-MVD were significant difference in pathologic scar cases (P<0.05). In pathologic scar tissue, the expression of survivin had significant correlation with MVD marked by CD105 (P<0.05). Conclusion survivin is up-regulated in pathologic scar, which may contribute to the vascular formation.

Privacy and confidentiality of patients / 基础医学与临床

Information disclosed in the context of a professional relationship must be held confidential.It is an important ethical principle,and also physicians' conventional obligations that respect for the privacy of patient and ensure the confidentiality of the information.This article discussed the situation of unjustifiable disclosure and justifiable infringement of privacy and confidentialility as well.