Looking back at the past and seeking for greater development: in commemoration of the 120th anniversary of the Chinese Medical Journal

Abstract

As we, the members of the present editorial board and all the editors of Chinese Medical Journal (CMJ), celebrate the 120th anniversary of the journal, the first and the most important thing that we should do is to pay our tribute to the founders of the journal and many others who worked for the journal as editors and members of the past editorial boards, the authors and readers of the journal and all the individuals and organizations that supported the journal for its existence and development during the past 120 years. We also extend our cordial appreciation to the authorities of the Chinese Medical Association (CMA), past and present, for their efforts to support, protect and assist the CMJ as one of the most important “windows” for exchanging knowledge and techniques of medicine both internationally and domestically. As medical science and technology have been developing at almost every moment during the recent decades, clinicians and medical researchers naturally pay their attention to the latest advances reflected in literature. However, reading articles written by some of the older generations of physicians who directly or indirectly served patients in China many years ago may be of certain value even to the current medicine and medical care practice. Patient education Patient education was one of the foci of the work of Western physicians who worked in China about a hundred years ago. A brief note describes the importance of producing pamphlets for telling patients what they ought to do and “more especially what they ought not to do” for the purposes of taking care of themselves and preventing spread of contagious diseases to others.1 Publication of the pamphlets was well organized, the texts were written in English and after revisions translated into Chinese. Figure shows an example of such leaflets. The text is concise, clear and easy to understand. Similar pamphlets are applied today in many hospitals in China. However, the availability is limited, the spectra of contents are too narrow. Therefore, we may need to publish many more pamphlets for patients and the public to improve today's patient education and public health education, which is indeed still an important part of our medical care.Fig.: Content of a leaflet for patient education. From CMMJ 1907; 21: 23.Laboratory reports The past issues of the CMJ published 100 years ago often had laboratory reports from major hospitals in China. The report from the pathological laboratory of St. Luke's Hospital in Shanghai, as many others, provided important reference information for understanding prevalent pathogens in that particular area and the situation.2 Nowadays, although highly specialized surveillance systems are available for infectious diseases like influenza, S ARS, etc in many areas of developing countries, they may not be a regular laboratory report system or mechanism. It is impractical or unnecessary to have all laboratory reports published in a journal like the CMJ or others, but simple listing of important results of laboratory tests, especially those for contagious etiological agents, if posted timely on the websites or distributed in printed forms among hospitals, may be of certain value to clinicians and other professionals in the management and control of some severe infectious diseases. Efforts for publishing textbooks in Chinese The China Medical Missionary Association (CMMA) and its publication committee made tremendous efforts to publish the Chinese versions of a standard series of textbooks in different fields of medicine for the convenience of Chinese physicians. To make the medical terms uniform among the publications, it was considered necessary for the association and committee to invite a doctor from Scotland who was also a master of Chinese language as well to work as a secretary and translator for the committee. The committee successfully raised sufficient amount of fund to support his work in Shanghai. As can be read in an editorial under the title “A Great Gift to China” that Chinese translation of eleven standard textbooks soon became available with the committee's “united work, united interest and united responsibility”.3 It is interesting to note that during the recent couple of decades, there has been a trend to publish English edition of medical journals in China and certain journals of medicine and related disciplines have even been publishing their English edition for quite a few years, for example, Chinese Journal of Traumatology, Chinese Journal of Cancer Research, Journal of Microbiology and Immunology, Acta Pharmacologica Sinica, Cell Research, Asian Journal of Andrology, etc. Such a trend undoubtedly reflects the increasing demands for international exchanges in the related fields of medicine. A few of these journals published in English have already been indexed by Index Medicus, Medline and even by Science Citation Index (SCI). Medical education In addition to medical care and research, medical education was another major issue to which the Journal and the Association paid much attention. A special column entitled Medical Education in China described 18 medical and nursing schools in China.4 Most of the medical schools or colleges were very small, with even less than 10 students enrolled per year. The whole course of study was 4 to 6 years. However, of special interest is that the curriculum of medical schools or colleges, e.g., Hong Kong College of Medicine, included lectures in medical jurisprudence, public health and mental health. The number of lectures for these fields of teaching was as many as 50, 50 and 13, respectively. It has been emphasized during the recent years that basic knowledge of public health and mental health is extremely important for clinicians who are not specialized in these fields. Therefore, many of the medical universities and colleges in China have included public health into their teaching programs, in fewer medical universities and colleges mental health has become part of the general teaching program, but very few of them teach medical jurisprudence. As a result, most physicians who graduated during the recent decades almost have no knowledge of medical jurisprudence or law which is closely associated with medical services. As patients’ awareness of their rights and self-protection increases, hospitals and clinicians face more challenges from entanglement and lawsuit. Lack of knowledge of law often leads hospitals and clinicians to unfavorable situation. Therefore, having medical jurisprudence included into the teaching programs in every medical university or college is extremely important and urgent. Twenty years have passed since the staff of the CMJ celebrated its centennial in March 1987 by publishing a special issue. We are proud that during the past 20 years the journal mirrored to some extent the fast development of clinical medicine and medical research in various specialties and subspecialties in China. We wish that the following description of recent developments in a few areas of studies based on publications in the journal would partially reflect the present status of medicine and medical research in China. Cardiovascular diseases have been one of the CMJ's most frequently reported fields during the recent years. Original articles and review articles reflect many progresses in different fields of cardiovascular diseases, including prevention and control, pathogenesis, diagnosis and treatment. Increasing numbers of large- scale, multicenter, randomized, controlled clinical studies for pharmacotherapies of cardiovascular diseases and others have been conducted in China during the recent years either independently or as part of multinational collaborative clinical trials. Percutaneous coronary intervention (PCI) has been one of the fastest growing fields. Numerous national as well as international conferences in this field were held. Application of interventional techniques is being gradually standardized in addition to stipulation and implementation of relevant regulations, and formal training programs have been carried out. A national registry for PCI and other interventional treatments has been set up and in active use. Recent developments in this field include studies on prevention and treatment of restenosis after PCI, e.g., comparisons of different drug-eluting stents with respect to long-term efficacy, trials of different techniques, for instance, use of magnetic stent, excimer laser angioplasty, etc. Interestingly, in a prospective, multi-center, randomized, double-blind, placebo-controlled trial involving more than 300 patients revealed that an oral preparation of traditional Chinese medicine could significantly reduce the rate of restenosis 6 months after the patients received PCI.5 The CMJ also reported comparative studies on different therapeutic approaches to the same cardiovascular diseases, for instance, comparison of primary stenting with thrombolysis plus stenting for treatment of acute myocardial infarction, off-pump and on-pump CABG surgeries, and so on. Restenosis after PCI may hopefully be prevented or treated with gene approach combined with coronary stenting as suggested by an article.6 Another rapidly developing field in clinical medicine is application of minimally invasive surgeries (MIS) and endoscopic surgeries, including hand assisted endoscopic surgeries and stenting. Such techniques have been successfully applied in neurosurgery, hepatobiliary surgery, thorathic surgery, urology and gynecology etc. Laparoscopic cholecystectomy has probably been one of the most frequently applied endoscopic surgeries since a decade ago in China. Only the articles published between April 1994 and November 1995 in other Chinese journals reported as many as over 39 000 cases.7 Analyses of data showed that the operation was associated with low morbidity and mortality, but bile duct injury was a major problem. In many hospitals the technique is applied as one of the standard or routine procedures for cholecystectomy. However, large-scale multicenter randomized controlled clinical studies are still required to further evaluate, elaborate and improve endoscopic and minimally invasive surgeries. The number of reports on gene and molecular biology in the CMJ has increased significantly during the recent couple of decades. Such studies included various disease-susceptible or disease relevant gene mutations or identification, relationship between genotypes and phenotypes, experimental studies on vector (e.g., adenovirus and retrovirus etc)-mediated gene transfer, application of gene chip technology, etc. Many of them are relevant to malignant diseases, cardiovascular diseases, inherited diseases, infectious diseases and other disorders. Although most of the studies were in vitro or animal studies, a few of such studies have shown encouraging prospects of direct or indirect clinical application in early diagnosis and possibly treatment of certain conditions. For example, a therapeutic gene system showed potent inhibitory effects on hepatocellular carcinoma cells both in vitro and in vivo in a nude mice model.8 Another example is that a retroviral vector mediated parathyroid hormone gene could cure hypoparathyroidism in a mouse model.9 A new type of vector for gene transfer named “gene-viral vector” was reported to have anti-tumor gene inserted into the genome of a replicative virus specific for tumor cells. This vector virus could specifically replicate in tumor cells and express the anti-tumor gene at an amount of hundreds to thousands times higher than the amount expressed by conventional adenovirus vector for gene therapy. Therefore, this gene-viral vector overcomes the disadvantages of conventional gene therapy, such as low transfer rate, low gene expression, lack of target tropism and low anti-tumor activity. Stem cell transplantation has also been an active research field in China during the recent decade. A randomized controlled study reported from Beijing showed that intracoronary injection of cultured autologous bone marrow mesenchymal stem cells in 34 patients with acute myocardial infarction treated with PCI resulted in significantly better cardiac function, myocardial perfusion and other parameters 3 months after the treatment as compared to pre-transplantation and control patients.10 A similar randomized controlled study conducted in Shanghai also showed that emergency transplantation of autologous bone marrow stem cells could improve global and regional contractility and attenuate post-infarction left ventricular remodeling. In another two studies, unrelated umbilical cord blood stem cell transplantation for treatment of high risk leukemia patients and combined transplantation of G-CSF primed allogenic bone marrow cells and peripheral blood stem cells for treatment of severe aplastic anemia patients achieved successful engraftments and significant relief of the diseases for a considerable length of time.11,12 The aplastic anemia patients had a median survival time of 789 days without transfusions after the transplantation. An earlier report showed that after autologous peripheral blood stem cell transplantation, the 5-year survival rates of patients with non-Hodgkin's lymphoma and acute myelogenous leukemia were 83.3% and 74.8%, respectively.12 Very recently the CMJ published Guidelines for Diagnosis and Treatment of HIV/AIDS in China (2005) and a few years ago published Guidelines to Rational Use of Antibiotics in Acute Upper Respiratory Tract Infections in Chinese Children (2001). The purpose of doing so is to show our international readers the recommended principles and procedures in management of the relevant diseases in the particular environment in China and more importantly to invite invaluable critiques, comments and suggestions. We shall attempt to publish more Chinese guidelines or recommendations in the future.The most recent editorial board meeting of the CMJ was held in September 2006. Professor ZHONG Nan-shan, President of the Chinese Medical Association (CMA), Academician of the Chinese Academy of Engineering and also a member of the editorial board of the CMJ, spoke at the meeting. He emphasized that the journal should reflect the latest achievements in clinical medicine and medical research in China, and that the CMA would provide strong support to the development of the journal by all means. The present editorial board has 100 members, 40 correspondent members, 10 advisors, and 8 associate editors-in-chief. The members of the board who attended the meeting discussed the measures taken to improve the journal, and provided a number of important suggestions and comments. The recent developments of the journal itself include the following. The impact factor (IF) and total citations (TC) of the CMJ had some steady increase (IF from 0.107 of 2000 to 0.561 of 2005 and TC from 752 of 2000 to 1736 of 2000), though to a small extent, during the past few years, and the number of manuscripts submitted to the journal exceeded 2000 per year. The source of manuscripts has been significantly expanded, and during the recent few years CMJ has received manuscripts from more than 20 countries. We have made the journal from a monthly to a semimonthly one ever since the beginning of 2005. The proportion of accepted manuscripts that were published within 180 days increased from 10.0% of 2000 to 59.4% of the first half of 2006. The editorial office organized more theme issues with the help of the members of the editorial board by active recruitment of manuscripts through different ways during the past few years. The CMJ has had its own independent website since 1999 and in 2003 we renewed the web pages. Now the website has more functions, including increased searching capability and especially links with such databases as PubMed, BioMed central, etc. However, as the members of the board pointed out during the meeting that we need to do much more work to improve the journal, including substantial increase in IF, TC, publication of high quality articles, and internationalization of the journal and so on, we shall make every effort to attract more manuscripts from other countries. It is expected to see the CMJ in the rank of the internationally influential medical journals with the support from the Chinese Medical Association and with our efforts.