Bing Zhang is the Chief of Clinical Chinese Pharmacy in Beijing University of Chinese Medicine and Chief of Center for Chinese Pharmacovigilance and Rational Use of Chinese Medicine. She has researched on the prevention and treatment of metabolic diseases. She had published more than 300 papers as first or correspondence author.

Hyperuricemia is characterized by high levels of serum uric acid which is related with impairments of urate excretion closely. It is commonly accepted that the kidney is an important organ which is responsible for two-thirds of urate excretion. At the same time, the gut is also an essential excretive pathway for hyperuricemia which take charge of the remaining third urate excretion. Thus, the drug which could promote renal-pathway and extra-renal/intestinal-pathway of urate excretion may be valued for urate-lowering treatment. Chicory is a traditional Chinese medicine. Functions of it are diuresis and detumescence and it is also could be applied to treat spleen insufficiency. Our previous studies found chicory was excellent in uric acidlowering. Currently, we observed whether the uricosuric effect of chicory is benefited by renal and/or intestinal pathways. We chose two kinds of animal model in present research, quails and rats. Quail, an ideal animal for hyperuricemia due to its similar metabolism pathway with human, was fed with 15% yeast. Rats were administrated with 10% fructose-drinking. All of model animals in our studies showed the sustained high level of serum urate level during experimental days. Meanwhile, results showed that chicory extract decreased the serum urate levels of these two kinds of animal models significantly, and increased urate levels of in excreta of hyperuricemia quails obviously, as well as promoted the urate excretion in the urine and feces of hyperuricemia rats. As of now, it is thought that chicory may be a promising anti-hyperuricemia agent both from renal pathway and intestinal pathway of urate excretion. Next, we will further explore the possible mechanism of the uricosuric effect of chicory underlying the urate transporter responsible for renal pathway and intestinal pathway separately.

Genki Murakami has his expertise in public health and management engineering especially safety management in hospital. He practices the hospital's safety management method using the resilient engineering, which is safety management method based on ergonomics. He has completed his graduation in Management Engineering and Public Health.

There is an increasing focus on the prevention of Deep Vein Thrombosis (DVT) in medical care from the perspective of healthcare safety. However, when implementing preventive measures, physicians will first conduct an overall evaluation of each patient’s condition and may choose to administer measures that deviate from these guidelines to ensure optimal treatment. The aim of this study was to ascertain and conduct a descriptive analysis of resilience in the implementation of DVT preventive measures in a tertiary care teaching hospital in Japan. The study sample comprised patients who had been newly admitted to the subject hospital between October 2016 and September 2017 and had undergone DVT risk assessments during hospitalization. Data were collected on the results for each risk assessment item and the final assessed risk, as well as on the preventive measures implemented for each patient. Among the patients who had undergone DVT risk assessments at the subject hospital, there were 5,311 patients who had undergone surgery, 549 patients who were prescribed bed rest for 48 hours or more and 7,045 patients who did not require any bed rest. Regardless of surgical status, there were 5,059 patients with moderate DVT risk; among these, 1,008 patients were administered preventive measures that were less stringent (i.e., early ambulation and active mobilization only) than those prescribed in the guidelines. There is a trade-off between preventing DVT and mitigating the risk of hemorrhage and physicians must implement the most appropriate DVT prevention strategy based on each patient’s condition. The adoption of resilience measures that allow deviations from conventional rules can be effective for non-standard cases. However, such deviations must be supported by each physician’s specialized expertise and experience and should not be implemented lightly.

Huei-Ching Hsu has obtained her Bachelor’s degree of Traditional Chinese Medicine from China Medical University and started her MA degree program in Kaohsiung Medical University, both in Taiwan. She is an Attending Physician of Traditional Chinese Medicine, participated in education program for Licensed Medical Staff in Taiwan and recently completed her certificated program from Harvard Medical School Global Education, ICRT 2018 (Introduction to Clinical Research Training Program).

Evidence-based medicine exists, while digitalized computer technology and Cochrane database prevalent nowadays. The process of “kaozheng” (practicing evidential research) also exist when inconclusive narratives in ancient Chinese medicine books. For example, Shi-Zhen Li (A.D.1518-1593) the author of 27-year work, scientific Chinese medicine book, Compendium of Materia Medica, was suspicious of the Chinese five elements theory and popular trends, made efforts to investigate the truth, point out the incorrect viewpoints of the prescription of mercury medicine at that time. Qing-Ren Wang put emphasis on inspection of dog-torn children who had died in a plague epidemic in A.D.1798. His textbook of anatomy was based on cadaveric dissection, with opposition to only imagine human anatomy by way of the ancient Chinese yin-yang cosmic system, made steps forward in reversing past misconceptions based on Chinese mysticism. Moreover, when Western anatomy was introduced to Eastern Asia, opposition to mysticism concepts in Chinese medicine, is not equal to abandon of usage of its vocabulary, which the vocabulary is more familiar to Chinese users than Latin origin ones. In the future, with clear research topics, sound study design, appropriate measurement (such as multimedia database for TCM tongue diagnosis or Bi-sensing pulse diagnosis instrument). National Health Insurance database in Taiwan could be explored to identify the efficacy and sideeffects of TCM. But we should keep in mind; these studies must be made by way of hypothesis-driven process after reviewing associated literature, not made according to template forms. Besides, after combining botanic resources, more EBM appraisal about TCM was looked forward to and expected.

Yu Wang has her expertise in evaluation and passion in improving metabolic disorders by traditional Chinese medicine. Her studies focus on the excretion pathway of hyperuricemia and assess the pharmacodynamics of Cichorium intybus L., a dietetic herb frequently used in Chinese medicine and nutrition in lowering serum uric acid levels.

Hyperuricemia is a chronic metabolic disease which caused by excessive production or impediment excretion of uric acid. The kidney plays an important role in uric acid excretion which contains the handling process of reabsorption and secretion. A series of renal uric acid transporters is responsible for the two processes, mainly including reabsorption transporters URAT1 and Glut9 as well as secretion transporters OAT1 and OAT3. Excessive intake of fructose may result in elevated serum uric acid levels. Cichorium intybus L., commonly known as Chicory, has been used as an edible vegetable and a traditional remedy which function as diuresis, detumescence and cholagogue. Our previous studies found chicory had an effect on treating hyperuricemia which correlate with decreased production and increased intestinal excretion. Currently, we evaluated the mechanism of its uricosuric effect via renal pathway. Hyperuricemia rats induced by 10% fructose solution were treated with chicory at three doses and benzbromarone, respectively. Chicory decreased the serum levels of uric acid and creatinine and promoted the clearance rates of creatinine and uric acid, as well as improved renal pathological changes in hyperuricemia rats. Further examination illustrated that chicory inhibited the mRNA and protein expressions of URAT1 and GLUT9 markedly in a dose-dependent manner whereas showed no influence in the mRNA and protein expressions of OAT1 and OAT3. Taken together, chicory might be a promising anti-hyperuricemia agent to promote uric acid excretion in the kidney via inhibiting renal reabsorption which may relate with down-regulation of mRNA and protein expression levels of URAT1 and Glut9.